Medical News Today
- Society Of Cardiovascular Computed Tomography Announces R... The Society of Cardiovascular Computed Tomography (SCCT), the leading international professional society dedicated to research, education and clinical excellence in cardiovascular computed tomography (CT), has named Dr. Raman Dusaj and Dr. Thomas Smith the recipients of the fourth annual Young Investigator Award. The Young Investigator Award was announced at SCCT's 2010 Annual Scientific Meeting in Las Vegas...
- HHS Announces Availability Of $51 Million In Resources Fo... The Department of Health and Human Services (HHS) announced two key steps in the process of partnering with states and other stakeholders to begin establishing health insurance Exchanges. HHS announced the availability of up to $1 million in grants per state to help states begin work to establish Exchanges and published a request for comment calling for public input as HHS develops standards for the Exchanges...
- Swimmers Make A Splash For A Good Cause More than 200 swimmers took to the shores of Lake Michigan for the annual Swim Across America (SAA) fundraiser earlier this month. The event raised money for cancer research, prevention and treatment at Loyola University Health System's Cardinal Bernardin Cancer Center (CBCC). "Participants challenged themselves in the water and on dry land, as they raised funds for a worthy cause," said Swim Across America Event Director Sue Hopkinson. "This event brought the total funds raised for Loyola through Swim Across America events to approximately 1 million dollars...
- Snowe Becomes Fourth GOP Sen. To Announce Support For Kagan Sen. Olympia Snowe (Maine) on Wednesday became the fourth Republican senator to announce her support for Elena Kagan's nomination to the Supreme Court, the New York Times' "The Caucus" reports. Snowe said Kagan met the standard she uses for evaluating judicial nominations by displaying "strong intellect, respect for the rule of law and [an] understanding of the important but limited role of the Supreme Court that I believe is required of any justice" (Becker, "The Caucus," New York Times, 7/28)...
- GOP Sens. Request Assurances From HHS That High-Risk Pool... In a letter sent on Wednesday, 13 Republican senators asked HHS Secretary Kathleen Sebelius for assurances that the new high-risk insurance pools will not provide coverage for abortion services, CQ HealthBeat reports. The insurance pools set up under the federal health reform law (PL 111-148) aim to provide coverage to individuals with pre-existing conditions. The issue of abortion coverage in the program emerged earlier this month after reports that some states' proposals to run the pools could allow abortions to be covered...
- Group Opposing Alaska Parental Notification Initiative Re... The group Alaskans Against Government Mandates -- which opposes a ballot initiative that would require parental notification for state minors seeking abortions -- has reported collecting five times the money disclosed by Alaskans for Parental Rights, which supports the initiative, the AP/Anchorage Daily News reports. The proposed initiative would provide only limited exceptions to the parental notification rule, such as cases in which a girl has been abused by a parent. It also would make it a felony for physicians to "knowingly violate" the rule, according to ballot language...
- GP Groups Call For Proposed Practice Nurse Funding Models... United General Practice Australia (UGPA) - the coalition of the peak groups representing Australia 's general practitioners - commends the Government on its investment and focus on general practice nurses, but is calling on the Government to ensure that the Budget proposal does not disadvantage practices that already employ nurses, and to consult with GP representatives over implementation. UGPA members welcomed the Federal Government's 2010-11 Budget initiative to improve access for patients to general practice nurses across Australia through the provision of an additional $390...
- Thirty Million Women To Benefit From Health Reform Law, I... Thirty million women will benefit from the new health reform law over the next decade, either through new or strengthened insurance coverage, according to a new report from The Commonwealth Fund. In the first analysis of its kind, the authors report that the law will stabilize and reverse the growing exposure to health costs that women now experience by subsidizing health insurance for up to 15 million currently uninsured women, and strengthening existing coverage for 14...
- Insurers Change Kids Coverage Stance After HHS Clarifies ... Health insurers have started to back down "on their decision to pull out of the child-only coverage market after the Obama administration addressed their concerns about the potential damage to their bottom lines," The Hill reports. "The Department of Health and Human Services (HHS) on Tuesday clarified regulations mandating that insurance plans agree to cover sick children. HHS made it clear that plans are free to set up specific enrollment periods for their insurance plans if allowed under state laws. ...
- CVS-Aetna Deal Boosts The Drug Store Chain Forbes: CVS Caremark, the drug retailer and pharmacy benefit management firm, announced a new agreement with Aetna to help constrain drug costs. "The deal encompasses approximately $9.5 billion in annual drug spending relating to approximately 9.7 million lives. CVS expects significant long-term financial benefits from this strategic relationship" (7/28). The Street: The 12-year deal helped mask a weak performance in second quarter earnings for CVS. "CVS Caremark ... missed second-quarter expectations, lowering its outlook. But a massive deal with health insurer Aetna...
Newswise: MedNews
- Broadening Partnerships to Spur Medical Advances for War ... The USU-HJF Military Medicine Symposium will gather prominent civilian and military researchers and clinicians from across the United States to discuss and identify current research and opportunities to collaborate and share information that could speed treatments to those in need.
- Cedars-Sinai Medical Center Named One of the Country's To... Cedars-Sinai Medical Center has been selected as one of the top work environments for technology specialists in the United States by Computerworld, a leading national publication devoted to information technology.
- Students with Humanities Background Equally Successful in... Researchers from Mount Sinai School of Medicine have found that students enrolled in the Humanities and Medicine (HuMed) program are as successful in medical school as students who fulfill the traditional pre-med requirements. HuMed students are accepted in their sophomore year of college and complete their studies in the humanities or social sciences before matriculating at Mount Sinai School of Medicine.
- UCSD Researcher Leads Schizophrenia Genetics Consortium The six-site Consortium on the Genetics of Schizophrenia (COGS), led by the director of the Schizophrenia Program at the University of California, San Diego School of Medicine, has received a $10 million renewal grant from the National Institute of Mental Health (NIMH), one of the National Institutes of Health.
- AACN Certification Corporation Board of Directors Announc... Kathryn Roberts, Children's Hospital of Philadelphia; and Linda Harrington, Baylor Health Care System, Dallas; join 2010-11 national board of AACN Certification Corporation, which provides comprehensive credentialing for establishing and maintaining standards of excellence in acute and critical care nursing.
- AACN Announces 2010-11 Board of Directors Kristine Peterson, a cardiac clinical nurse specialist in Wisconsin, is the 2010-11 AACN president. Volunteers and leaders in their communities, she and the other board members bring together their varying expertise and leadership from across the country to benefit AACN members and those who care for acutely and critically ill patients and their families.
- Kidney Injury Prevention May be Possible: Watch for the W... Reduced kidney function and protein in the urine place a person at risk for kidney injury, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The results suggest that improved recognition of these warning signs could help reduce preventable forms of acute kidney injury (AKI).
- Just Drop It: The One-Size-Fits-All Approach to Blood Sug... Aggressive blood sugar control does not improve survival in diabetic patients with kidney failure, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results suggest that physicians should individualize blood sugar targets for these patients and not rely on recommendations based on studies in the general population.
- Scientists for the First Time Identify Cell-of-Origin for... UCLA scientists have identified for the first time a cell-of-origin for human prostate cancer, a discovery that could result in better predictive and diagnostics tools and the development of new and more effective targeted treatments for the disease.
- Annual Price Tag for Treating Back Problems Now Totals $3... Treating back problems, one of the most bothersome medical problems, cost Americans more than $30 billion in 2007- up from $16 billion in 1997 (in 2007 dollars).
ScienceDaily: Health & Medicine News
- Calcium supplements linked to increased risk of heart att... Calcium supplements, commonly taken by older people for osteoporosis, are associated with an increased risk of a heart attack, a new study finds.
- Resting brain activity associated with spontaneous fibrom... A recent study provides the first direct evidence of linkage between elevated intrinsic (resting-state) brain connectivity and spontaneous pain intensity in patients with fibromyalgia. This research shows an interaction of multiple brain networks, offering greater understanding of how pain arises.
- Most youth hockey injuries caused by accidents, not check... Hockey fans likely would assume that body-checking -- intentionally slamming an opponent against the boards -- causes the most injuries in youth ice hockey. But they would be wrong.
- Cell-of-origin for human prostate cancer identified for f... Scientists have identified for the first time a cell-of-origin for human prostate cancer, a discovery that could result in better predictive and diagnostics tools and the development of new and more effective targeted treatments for the disease.
- Fluorescent biosensor to aid in drug development Scientists have developed a new fluorescent biosensor that could aid in the development of an important class of drugs that target a crucial class of proteins called G protein-coupled receptors (GPCRs). GPCRs are popular drug targets because of the pivotal role they play in cells' communication circuits responsible for regulating functions critical to health, including circuits involved in heart and lung function, mood, cognition and memory, digestion and the inflammatory response.
- Vascular-targeted photodynamic therapy for localized pros... NYU Langone Medical Center has begun a clinical trial offering vascular-targeted photodynamic therapy to patients with localized prostate cancer. This novel, minimally invasive procedure uses a light-activated drug to deliver light energy waves by way of laser fibers in order to destroy prostate cancer cells.
- Psychologists develop two potent new predictors of suicid... Two powerful new tests developed by psychologists show great promise in predicting patients' risk of attempting suicide. The work may help clinicians overcome their reliance on self-reporting by at-risk individuals, information that often proves misleading when suicidal patients wish to hide their intentions.
- Key enzyme in DNA repair pathway identified Researchers have discovered an enzyme crucial to a type of DNA repair that also causes resistance to a class of cancer drugs most commonly used against ovarian cancer.
- Kidney injury prevention may be possible: Watch for the w... Reduced kidney function and protein in the urine place a person at risk for kidney injury, according to a new study. The results suggest that improved recognition of these warning signs could help reduce preventable forms of acute kidney injury.
- Researchers study benefits of white button mushrooms Scientists have conducted an animal-model and cell-culture study showing that white button mushrooms enhanced the activity of critical cells in the body's immune system.
Yahoo! News: Health News
- Chicken producers debate 'natural' label (AP) AP - A disagreement among poultry producers about whether chicken injected with salt, water and other ingredients can be promoted as "natural" has prompted federal officials to consider changing labeling guidelines.
- Hands-only CPR, pushy dispatchers are lifesavers (AP) AP - More bystanders are willing to attempt CPR if an emergency dispatcher gives them firm and direct instructions — especially if they can just press on the chest and skip the mouth-to-mouth, according to new research.
- DC pushes female condoms to fight HIV epidemic (AP) AP - Charlene Cotton will talk to anyone about sex. Several days a week she stands behind a table decorated with a bowl of flavored condoms and safer sex pamphlets, calling to women passing on the street, "Come check out my table. Don't be scared."
- NYC looks to stop spreading bedbug infestations (AP) AP - One of every 15 New Yorkers battled bedbugs last year, officials said Wednesday as they announced a plan to fight the spreading infestation, including a public-awareness campaign and a top entomologist to head the effort.
- New program rebuilding faces of soldiers, veterans (... AP - Master Sgt. Todd Nelson lost his right eye and ear in a flash when a car bomb in Afghanistan exploded, sending fire up his arm and over his head.
- Tests aim to settle if fresher blood works better (AP) AP - Facing surgery? You could receive blood that's been stored for a week, or three weeks, or nearly six — and there's growing concern that people who get the older blood might not fare as well.
- Knee, Hip Replacements May Aid Weight Loss: Study (H... HealthDay - THURSDAY, July 29 (HealthDay News) -- Weight loss has been noted among patients who've had a knee or hip replacement, a new study says.
- New Study Finds HPV Vaccine Protects Against Genital Wart... HealthDay - TUESDAY, July 20 (HealthDay News) -- A new study finds that the human papillomavirus (HPV) vaccine protects not only against the sexually transmitted virus that causes cervical cancer, but also helps prevent genital warts and low-grade cervical growths.
- Clinical Trials Update: July 29, 2010 (HealthDay) HealthDay - (HealthDay News) -- Here are the latest clinical trials, courtesy of ClinicalConnection.com:
- Health Tip: Dealing With Separation Anxiety (HealthD... HealthDay - (HealthDay News) -- It's common for young children to have a tough time when mom or dad leaves them with someone else.
BBC World Health News
- Calcium pills 'raise' heart risk Calcium supplements taken by many older people could be increasing their risk of a heart attack, research shows.
- Pregnant women rights questioned The right of women to choose whether they have home births is being questioned by a leading medical journal.
- Drug prescribed after web search A father persuades the NHS to give his sick daughter a "miracle" drug he found on the internet.
- Addiction drugs 'aid weight loss' A combination pill of two drugs used to treat addiction may help people lose weight, say US researchers.
- Child heart op ban 'should stay' Children's heart surgery should remain suspended at Oxford's John Radcliffe Hospital where four babies died, a report says.
- Public health fear in NHS revamp The overhaul of the NHS may harm the public health drive, a health think tank is warning.
- Say fat not obese, says minister GPs and other health professionals should tell people they are fat rather than obese, England's public health minister says.
- Hip hope from stem cell technique Doctors may soon be able to patch up damaged bones and joints anywhere in the body with a simple shot in the arm.
- Alcohol can 'lessen' arthritis Drinking alcohol can reduce the severity of rheumatoid arthritis symptoms, a study has found
- Warning for obese mothers-to-be Obesity levels among pregnant women have reached epidemic levels, putting the health of their babies at risk, experts say.
MedPageToday Headlines
- Steroid Shots Soothe Some Sciatica (CME/CE) (MedPage Today) -- Injection of steroids into the affected spinal nerve appears to ease lumbar radicular pain better than other types of injections, but still in only a proportion of patients, according to a randomized trial.
- Fever Often Missing in Mild Pandemic Flu (CME/CE) (MedPage Today) -- Physicians using standard diagnostic criteria -- which include fever -- may miss mild cases of the pandemic flu, researchers reported.
- Risk of MI May Go Up With Calcium Supplements (CME/CE, wi... (MedPage Today) -- Calcium supplementation appears to increase the risk of myocardial infarction, a meta-analysis showed.
- TZD Use Linked to Fracture Risk in Women 50 and Older (CM... (MedPage Today) -- Patients with type 2 diabetes may face an increased fracture risk when treated with thiazolidinedione (TZD) drugs, data from a large observational study suggest.
- Renal Troubles Spell Acute Injury Risk (CME/CE) (MedPage Today) -- Reduced kidney function and protein leaking into the urine may be warning signs for acute kidney injury, researchers warned.
- Estradiol Spray May Pose Risk for Kids and Pets (MedPage Today) -- Menopausal women who use a spray form of topical estradiol (Evamist) to control hot flushes should avoid touching children and pets with treated areas of the skin, the FDA warned.
- Pandemic Strain Dominated Most Recent Flu Season (CME/CE) (MedPage Today) -- Pandemic H1NI influenza was almost the only type of flu virus circulating in the U.S. during the 2009-2010 flu season -- and it disproportionately affected younger age groups, according to the CDC.
- Less Pain, More Gain in OA With Regular Exercise (CME/CE) (MedPage Today) -- Patients with knee or hip osteoarthritis (OA) who stick to a recommended exercise program and increase their overall physical activity have less pain and more improvement in physical functioning, according to a Dutch observational study.
- FDA Finds Pneumonia Risk with Daptomycin (MedPage Today) -- The FDA said that the intravenous antibiotic daptomycin (Cubicin) may be linked to an increased risk of eosinophilic pneumonia -- a rare but serious potential side effect -- and requested that a new drug label warning be added.
- Number of Uninsured Varies Greatly by State Massachusetts (MedPage Today) -- a state with a universal health insurance program -- has the nation's lowest rate of uninsured residents under age 65, at 7.8%, according to data released by the Census Bureau.
Reuters: Health News
- Rabbits grow their own joint replacements in study WASHINGTON (Reuters) - Rabbits implanted with artificial bones re-grew their own joints, complete with cartilage, researchers reported on Thursday.
- Damp house linked to kids' risk of nasal allergies NEW YORK (Reuters Health) - Children who live in damp, water-damaged homes may be more likely than other kids to develop nasal allergies, a new study suggests.
- Pregnancy-related diabetes likely to recur: study NEW YORK (Reuters Health) - Pregnant women with a history of pregnancy-related diabetes, also called gestational diabetes, have a good chance of developing the condition again, suggests a large new study.
- Calcium supplements may raise risk of heart attack HONG KONG (Reuters) - Calcium supplements, which many people consume hoping to ward off osteoporosis, may increase the risk of heart attack by as much as 30 percent, researchers reported Friday.
- Protein in urine can forecast kidney disease WASHINGTON (Reuters) - Doctors may be able to watch for kidney injury and protect patients by looking for protein in urine, researchers reported on Thursday.
- EMS systems catch cardiac arrests, and a lot more NEW YORK (Reuters Health) - San Francisco sends out seven ambulances in response to people thought to be in cardiac or respiratory arrest for every one person that is actually in cardiac arrest, according to a new study of the city's Emergency Medical Dispatch system.
- New York to spend big to kill bloodsucking guests NEW YORK (Reuters) - In the city that never sleeps there is one increasingly busy nocturnal resident who New York wants to evict -- the bedbug.
- Obese patients lose weight on new Orexigen drug WASHINGTON (Reuters) - Overweight volunteers who took Orexigen's experimental drug Contrave, designed to reduce cravings, lost about 13 pounds (6 kg) over a year, U.S. researchers reported on Thursday.
- Meth use in pregnancy endangers mom and baby NEW YORK (Reuters Health) - New research shows that babies born to methamphetamine-using moms face much higher risks of serious complications, compared to babies not exposed in the womb to this illegal street drug.
- New TB test must reach more people: expert HONG KONG (Reuters) - A new diagnostic tool that reduces to two hours the time needed to detect drug-resistant tuberculosis must be made available to populations vulnerable to the disease, a World Health Organization expert said.
Medscape Headlines
- A 23-Year-Old Man With Pain and Decreased Vision A 23-year-old man presents with acute pain and decreased vision shortly after a fight. What is your diagnosis? Medscape Ophthalmology
- Postoperative Infections, HIV Deaths, and Copy-Years Vire... John Bartlett selects and reviews the top infectious disease and HIV articles. Medscape HIV/AIDS
- When a Child Comes to the Emergency Department Altered... A 21-month-old boy presents to the ED with a change in mental status. What's the diagnosis? Medscape Emergency Medicine
- A Scorecard for Testing the Quality of a Donor Pancreas The use of a pancreas donor risk score is found to be useful for assessing the risk of allograft failure. Medscape Transplantation
- Accuracy of Advanced Versus Strictly Conventional 12-Lead... Do resting 12-lead A-ECG tests detect coronary artery disease and left ventricular hypertrophy with higher sensitivity and specificity than strictly conventional ECG? BMC Family Practice
- Focused Practice in Hospital Medicine Answers to all your questions surrounding ABIM’s new pathway to Maintenance of Certification. The Hospitalist
- Protein Intake and Incident Frailty in the Women's Health... The risk of frailty in older women, an increasingly important public health problem, may be lowered by simply increasing protein intake. Journal of the American Geriatrics Society
- First-line Latanoprost Therapy in Ocular Hypertension or ... How effective is latanoprost in the treatment of both glaucoma and ocular hypertension? BMC Ophthalmology
- Two Multistate Outbreaks of Shiga Toxin-Producing Escheri... How can e-coli outbreaks be prevented? This study looks at widespread illness resulting from tainted beef. Morbidity & Mortality Weekly Report
- Healthy Nursing Academic Work Environments What factors most influence healthy work environments for nursing faculty, and what strategies can be employed to improve nursing academia? OJIN: The Online Journal of Issues in Nursing
AP Health News
- Chicken producers debate 'natural' label By JULIANA BARBASSA 2010-07-30T08:48:04Z SAN FRANCISCO (AP) -- A disagreement among poultry producers about whether chicken injected with salt, water and other ingredients can be promoted as "natural" has prompted federal officials to consider changing labeling guidelines....
- Hands-only CPR, pushy dispatchers are lifesavers By MIKE STOBBE 2010-07-29T11:25:08Z ATLANTA (AP) -- More bystanders are willing to attempt CPR if an emergency dispatcher gives them firm and direct instructions - especially if they can just press on the chest and skip the mouth-to-mouth, according to new research....
- DC pushes female condoms to fight HIV epidemic By JESSICA GRESKO 2010-07-29T07:21:06Z WASHINGTON (AP) -- Charlene Cotton will talk to anyone about sex. Several days a week she stands behind a table decorated with a bowl of flavored condoms and safer sex pamphlets, calling to women passing on the street, "Come check out my table. Don't be scared."...
- NYC looks to stop spreading bedbug infestations By SARA KUGLER FRAZIER 2010-07-29T01:53:10Z NEW YORK (AP) -- One of every 15 New Yorkers battled bedbugs last year, officials said Wednesday as they announced a plan to fight the spreading infestation, including a public-awareness campaign and a top entomologist to head the effort....
- New program rebuilding faces of soldiers, veterans By MICHELLE ROBERTS 2010-07-27T10:44:27Z SAN ANTONIO (AP) -- Master Sgt. Todd Nelson lost his right eye and ear in a flash when a car bomb in Afghanistan exploded, sending fire up his arm and over his head....
- Tests aim to settle if fresher blood works better By LAURAN NEERGAARD 2010-07-27T07:03:15Z WASHINGTON (AP) -- Facing surgery? You could receive blood that's been stored for a week, or three weeks, or nearly six - and there's growing concern that people who get the older blood might not fare as well....
- Japanese women extend life expectancy to new high By MARI YAMAGUCHI 2010-07-26T17:22:45Z TOKYO (AP) -- Japanese women are expected to live almost 86 1/2 years, topping the world longevity ratings for the 25th straight year, the government reported Monday....
- Full face transplant Spaniard displays new look By DANIEL WOOLLS 2010-07-26T19:32:15Z MADRID (AP) -- A Spanish man who underwent the world's first full face transplant appeared before TV cameras Monday for the first time since his surgery, thanking his doctors and the family of the donor....
- Medical device problems hurt 70,000+ kids annually By LINDSEY TANNER 2010-07-26T10:42:05Z CHICAGO (AP) -- More than 70,000 children and teens go to the emergency room each year for injuries and complications from medical devices, and contact lenses are the leading culprit, the first detailed national estimate suggests....
- In midst of river cleanup, supporters are divided By BOB SALSBERG 2010-07-25T19:39:30Z LENOX, Mass. (AP) -- Once a dumping ground for chemicals, a stretch of the Housatonic River that winds near this Berkshires hamlet is being scoured in a lengthy, expensive cleanup. Now, dredging other parts of the riverbed is under consideration, but the fishers, bird watchers and swimmers who would benefit are wondering how much effort is too much....
NYTimes Health News
- Patient Money: For Most, Implants Beat Dentures, but at a... Prosthetic teeth attached to the jaw with titanium screws are preferred for replacing lost teeth, but they’re expensive, and insurance coverage is usually minimal.
- Getting Into Med School Without Hard Sciences A program admits students if they study humanities instead of the traditional pre-medical school curriculum.
- Added to the Recall List: Millions of Frozen Mice Salmonella outbreaks that sickened more than 400 in the U.S. and Britain have been traced to mice sold as food for exotic pets.
- Are Migraines Linked to a Heart Defect? Dr. David Dodick of the Mayo Clinic explores the link between migraines and a hole in the heart.
- Monitoring Elderly Parents New technologies can help adult children keep track of their aging parents.
- Recipes for Health: Baked Large Limas With Spinach and Feta This Greek-inspired dish makes a hearty meal rich in nutritious spinach.
- The Bay Citizen: In Mission, Aging Hospital Is Seen as a ... St. Luke’s Hospital in the Mission district is essentially on life-support, with its future largely dependent on the fate of an expansion plan by its owner, California Pacific Medical Center.
- French Mother Indicted in Smothering of Infants A nursing assistant was charged with what prosecutors called modern France’s worst case of infanticide.
- Books of The Times: Stefanie Syman’s Yoga History, ‘T... Stefanie Syman’s book examines how yoga, the centuries-old spiritual discipline, became a fitness routine for American athletes, C.E.O.’s, movie stars and soccer moms.
- Sanofi Said to Plan a Bid of $70 for Genzyme A deal would bolster Sanofi’s drug pipeline and significantly increase its presence in biopharmaceuticals.
USAToday Health News
- Many men with low-risk prostate cancer treated aggressively Too many men with low-risk prostate cancers, those whose level of prostate-specific antigen (PSA) is normal or below normal, still receive aggressive ...
- Russians may be more negative but less depressed than Ame... Despite what many social observers have described as a generally dark and brooding take on life, a new report suggests that Russians are actually ...
- Summer falls, bike crashes, drownings top risks to kids Falls, bicycle crashes, burns, motorized vehicle accidents and near-drownings are the leading causes of hospitalization for American children ...
- Without mouth-to-mouth, hands-only CPR saves lives More bystanders are willing to attempt CPR if an emergency dispatcher gives them firm and direct instructions especially if they can just press ...
- Relationship insecurity may undermine health People who feel insecure in their relationships may be at increased risk for cardiovascular disease and other health problems, according to a ...
- Study: The longer you sit, the shorter your life Women who spent six hours a day sitting had a 37% increased risk of dying versus those who spent less than three hours a day on their bottoms. ...
- New blood: Hospitals test if it's safer for transfusions Facing surgery? You could receive blood that's been stored for a week, or three weeks, or nearly six and there's growing concern that people ...
- Medical devices hurt 70,000 kids a year; contact lenses w... More than 70,000 children and teens go to the emergency room each year for injuries and complications from medical devices, and contact lenses ...
- Italy reports human case of mad cow disease A woman in northern Italy has been reported as being infected with mad cow disease and has been hospitalized in serious condition.
- Treating HIV also prevents its spread, study finds Provocative new research shows that treating people with the AIDS virus can provide a powerful bonus: It cuts the risk that they will infect ...
msnbc.com:
- Daydreams really can take you far away Just how distracting daydreams can be depends on where exactly your wandering mind takes you, a new study suggests.
- Video: Tanning addiction a growing problem Dermatologists warn of the dangers of addiction to tanning beds, reflector blankets and roasting in the sun. WNBC's Tom Llamas reports. (NBC News Channel)
- 4 vets positive for hepatitis after St. Louis clinic visit Four veterans treated at the St. Louis VA Medical Center's dental clinic have tested positive for hepatitis, but further testing is needed to determine if inadequately sterilized dental equipment is to blame.
- Prostate cancer 'cell of origin' identified For researchers, a key to studying any cancer is finding its "cell of origin." Now scientists at the University of California at Los Angeles say they've found just that -- a specific type of cell that gives rise to prostate cancer.
- Can a vasectomy kill a guy's sex drive? Can a vasectomy dim a guy's enjoyment of sex? Also, how does a young woman in a rural area without any resources find a safe way to come out and enter the "lesbian scene"?
- Protein in urine can forecast kidney disease Doctors may be able to watch for kidney injury and protect patients by looking for protein in urine, researchers reported on Thursday.
- No surprise: Meth is bad for pregnant ladies The Body Odd: Hey! Did you guys know that meth is not good for pregnant women or their babies? We know. We'll give you a minute.
- Obese patients shown to lose weight on Orexigen Overweight volunteers who took Orexigen's experimental drug Contrave, designed to reduce cravings, lost about 13 pounds (6 kg) over a year, U.S. researchers reported on Thursday.
- Study: Gestational diabetes likely to recur Pregnant women with a history of pregnancy-related diabetes, also called gestational diabetes, have a good chance of developing the condition again, suggests a large new study.
- Secondhand smoke may be hurting kids' grades Children and teenagers exposed to secondhand smoke at home may get poorer grades than their peers from smoke-free homes, a study of Hong Kong students suggests.
MSN Health News
- More Women to Get Health Insurance Under Affordable Care Act
- Many Leaders Actually Want to Help Others: Study
- Genetic Tests Marketed to Consumers Can Be Dangerously Mi...
- Calcium Supplements Linked to Boost in Heart Attack Risk
- Menopause Treatment Could Harm Kids, Pets, FDA Warns
- Doctors, Patients Rarely on Same Page
- Experts Support FDA Panel's Backing of New Blood Thinner
- Breast Cancer's DNA Yields More Secrets
- Story-Telling More Difficult for Brain-Injured Children: ...
- Clinical Trials Update: July 29, 2010
CBS Health News
- Crystal Renn: Stunning Model Beats Anorexia She Starved Herself to 90 Pounds, but Found Success with Real Curves
- House Rejects Bill to Aid Sick 9/11 Responders Bill Would Have Provided Up To $7.4 Billion in Aid; Vote Largely along Party Lines
- Video: Calcium, Heart Attack Link A new study in the British Medical Journal shows calcium supplements are linked to an increased risk of heart attack. As Dr. Jon Lapook reports, researchers say doctors should rethink recommending calcium.
- Calcium Supplements Linked to Heart Attacks Study Shows Patients Taking Pills to Boost Calcium Levels Face 31 Percent Increase in Heart Attacks
- Most Disgusting Stadium Food Are Stadiums Serving Up Tainted Fare
- Video: Hairdresser Horror Stories Susan Koeppen reports on the dangers of hair salons using unlicensed stylists.
- 9/11 Health Bill Spurs Partisan Finger-Pointing GOP Rep. Blames Dems for Likely Failure of Bill to Aid 9/11 Responders But GOP Leadership Advises Members to Reject Bill
- Video: Older Brains Work Better Erica Hill spoke with Dr. Jennifer Ashton about new research that suggests that brain function is sharper among middle-aged people than that of younger people.
- "Hands Only" CPR Enough to Save a Life New Studies Reveal That More People Would Attempt CPR If Given Better Instructions, No Mouth-to-Mouth
- Video: Capitol Hill's Most Beautiful It's that time of year again, Congressional newspaper "The Hill" has released 2010's Most Beautiful People on Capitol Hill list. Features Editor Kris Kitto spoke with Bill Plante to find out who made the cut.
BBC UK Health News
- Calcium pills 'raise' heart risk Calcium supplements taken by many older people could be increasing their risk of a heart attack, research shows.
- Pregnant women rights questioned The right of women to choose whether they have home births is being questioned by a leading medical journal.
- Drug prescribed after web search A father persuades the NHS to give his sick daughter a "miracle" drug he found on the internet.
- Addiction drugs 'aid weight loss' A combination pill of two drugs used to treat addiction may help people lose weight, say US researchers.
- Child heart op ban 'should stay' Children's heart surgery should remain suspended at Oxford's John Radcliffe Hospital where four babies died, a report says.
- Public health fear in NHS revamp The overhaul of the NHS may harm the public health drive, a health think tank is warning.
- Say fat not obese, says minister GPs and other health professionals should tell people they are fat rather than obese, England's public health minister says.
- Hip hope from stem cell technique Doctors may soon be able to patch up damaged bones and joints anywhere in the body with a simple shot in the arm.
- Alcohol can 'lessen' arthritis Drinking alcohol can reduce the severity of rheumatoid arthritis symptoms, a study has found
- Warning for obese mothers-to-be Obesity levels among pregnant women have reached epidemic levels, putting the health of their babies at risk, experts say.
Massachusetts Medical Society: New England Journal of Medicine: Table of Contents
- The New NEJM.org New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
- Health Reform, Primary Care, and Graduate Medical Education New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
- Patient-Specific Induced Pluripotent Stem-Cell Models for... New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
- Truth and Consequences — Insurance-Premium Rate Regulat... New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
- Walking the Tightrope of Health Insurance Reform between ... New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
- Revisiting the Rosiglitazone Story — Lessons Learned New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
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NEJM This Week - Audio Summaries
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of July 29, 2010. Featured are articles on sipuleucel-T immunotherapy for castration-resistant prostate cancer, CPR with chest compression alone or with rescue breathing, compression-only CPR or standard CPR in out-of-hospital cardiac arrest, a school-based intervention for diabetes risk reduction, and understanding severe dengue; a review article on acupuncture for chronic low back pain; a case report of a man with perinephric fluid collections and renal failure; and Perspective articles on buying health care, the individual mandate, and the U.S. Constitution; on the SGR for physician payment; and on geographic variation in Medicare drug spending.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of July 22, 2010. Featured are articles on sensor-augmented insulin-pump therapy in type 1 diabetes, prediction of lung cancer, treatment for acute ACL tears, molecular architecture of the Goodpasture autoantigen in anti-GBM nephritis, and efficacy of gene therapy for X-linked severe combined immunodeficiency; a review article on functional hypothalamic amenorrhea; a case report of a woman with dementia and a seizure; and Perspective articles on the path to personalized medicine, on the ACA's new weapons against health care fraud, and on cancer clinical trials approaching a state of crisis.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of July 15, 2010. Featured are articles on rituximab versus cyclophosphamide for ANCA-associated vasculitis, retinopathy progression in type 2 diabetes, lorcaserin for weight management, early versus standard antiretroviral therapy for HIV-infected adults in Haiti, and metabolic disorders and fat transport; a review article on acute pulmonary embolism; a case report of a request for oocyte retrieval from a woman with anoxic brain injury; and Perspective articles on tobacco control, on the Havasupai Indian tribe case, and on a medical student's perspective on primary care.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of July 8, 2010. Featured are articles on adverse events with testosterone administration, late-onset hypogonadism in middle-aged and elderly men, zotarolimus-eluting vs. everolimus-eluting stents, restoring vision after corneal damage, and new recommendations on duty hours from the ACGME task force; review articles on mitral regurgitation due to degenerative mitral-valve disease and on genomewide association studies and assessment of the risk of disease; a case report of a woman with oligomenorrhea and infertility; and Perspective articles on implementing health care reform and Medicare, on the Independent Payment Advisory Board, and on identifying and eliminating the roadblocks to comparative-effectiveness research.
JAMA current issue
- A 29-Year-Old Woman With Flulike Symptoms [Clinical Cross...
- This Week in JAMA [This Week in JAMA]
- Risk of Acute Myocardial Infarction, Stroke, Heart Failur... Context Studies have suggested that the use of rosiglitazone may be associated with an increased risk of serious cardiovascular events compared with other treatments for type 2 diabetes. Objective To determine if the risk of serious cardiovascular harm is increased by rosiglitazone compared with pioglitazone, the other thiazolidinedione marketed in the United States. Design, Setting, and Patients Nationwide, observational, retrospective, inception cohort of 227 571 Medicare beneficiaries aged 65 years or older (mean age, 74.4 years) who initiated treatment with rosiglitazone or pioglitazone through a Medicare Part D prescription drug plan from July 2006-June 2009 and who underwent follow-up for up to 3 years after thiazolidinedione initiation. Main Outcome Measures Individual end points of acute myocardial infarction (AMI), stroke, heart failure, and all-cause mortality (death), and composite end point of AMI, stroke, heart failure, or death, assessed using incidence rates by thiazolidinedione, attributable risk, number needed to harm, Kaplan-Meier plots of time to event, and Cox proportional hazard ratios for time to event, adjusted for potential confounding factors, with pioglitazone as reference. Results A total of 8667 end points were observed during the study period. The adjusted hazard ratio for rosiglitazone compared with pioglitazone was 1.06 (95% confidence interval [CI], 0.96-1.18) for AMI; 1.27 (95% CI, 1.12-1.45) for stroke; 1.25 (95% CI, 1.16-1.34) for heart failure; 1.14 (95% CI, 1.05-1.24) for death; and 1.18 (95% CI, 1.12-1.23) for the composite of AMI, stroke, heart failure, or death. The attributable risk for this composite end point was 1.68 (95% CI, 1.27-2.08) excess events per 100 person-years of treatment with rosiglitazone compared with pioglitazone. The corresponding number needed to harm was 60 (95% CI, 48-79) treated for 1 year. Conclusion Compared with prescription of pioglitazone, prescription of rosiglitazone was associated with an increased risk of stroke, heart failure, and all-cause mortality and an increased risk of the composite of AMI, stroke, heart failure, or all-cause mortality in patients 65 years or older.
- Respiratory Morbidity in Late Preterm Births [Original Co... Context Late preterm births (340/7-366/7 weeks) account for an increasing proportion of prematurity-associated short-term morbidities, particularly respiratory, that require specialized care and prolonged neonatal hospital stays. Objective To assess short-term respiratory morbidity in late preterm births compared with term births in a contemporary cohort of deliveries in the United States. Design, Setting, and Participants Retrospective collection of electronic data from 12 institutions (19 hospitals) across the United States on 233 844 deliveries between 2002 and 2008. Charts were abstracted for all neonates with respiratory compromise admitted to a neonatal intensive care unit (NICU), and late preterm births were compared with term births in regard to resuscitation, respiratory support, and respiratory diagnoses. A multivariate logistic regression analysis compared infants at each gestational week, controlling for factors that influence respiratory outcomes. Main Outcome Measures Respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, respiratory failure, and standard and oscillatory ventilator support. Results Of 19 334 late preterm births, 7055 (36.5%) were admitted to a NICU and 2032 had respiratory compromise. Of 165 993 term infants, 11 980 (7.2%) were admitted to a NICU, 1874 with respiratory morbidity. The incidence of respiratory distress syndrome was 10.5% (390/3700) for infants born at 34 weeks' gestation vs 0.3% (140/41 764) at 38 weeks. Similarly, incidence of transient tachypnea of the newborn was 6.4%(n = 236) for those born at 34 weeks vs 0.4% (n = 155) at 38 weeks, pneumonia was 1.5% (n = 55) vs 0.1% (n = 62), and respiratory failure was 1.6% (n = 61) vs 0.2% (n = 63). Standard and oscillatory ventilator support had similar patterns. Odds of respiratory distress syndrome decreased with each advancing week of gestation until 38 weeks compared with 39 to 40 weeks (adjusted odds ratio [OR] at 34 weeks, 40.1; 95% confidence interval [CI], 32.0-50.3 and at 38 weeks, 1.1; 95% CI, 0.9-1.4). At 37 weeks, odds of respiratory distress syndrome were greater than at 39 to 40 weeks (adjusted OR, 3.1; 95% CI, 2.5-3.7), but the odds at 38 weeks did not differ from 39 to 40 weeks. Similar patterns were noted for transient tachypnea of the newborn (adjusted OR at 34 weeks, 14.7; 95% CI, 11.7-18.4 and at 38 weeks, 1.0; 95% CI, 0.8-1.2), pneumonia (adjusted OR at 34 weeks, 7.6; 95% CI, 5.2-11.2 and at 38 weeks, 0.9; 95% CI, 0.6-1.2), and respiratory failure (adjusted OR at 34 weeks, 10.5; 95% CI, 6.9-16.1 and at 38 weeks, 1.4; 95% CI, 1.0-1.9). Conclusion In a contemporary cohort, late preterm birth, compared with term delivery, was associated with increased risk of respiratory distress syndrome and other respiratory morbidity.
- Incidence of Breast Cancer and Its Subtypes in Relation t... Context There is limited evidence on how the risk of breast cancer and its subtypes depend on low-penetrance susceptibility loci, individually or in combination. Objective To analyze breast cancer risk, overall and by tumor subtype, in relation to 14 individual single-nucleotide polymorphisms (SNPs) previously linked to the disease, and in relation to a polygenic risk score. Design, Setting, and Participants Study of 10 306 women with breast cancer (mean age at diagnosis, 58 years) and 10 393 women without breast cancer who in 2005-2008 provided blood samples for genotyping in a large prospective study of UK women; and meta-analysis of these results and of other published results. Main Outcome Measures Estimated per-allele odds ratio (OR) for individual SNPs, and cumulative incidence of breast cancer to age 70 years in relation to a polygenic risk score based on the 4, 7, or 10 SNPs most strongly associated with risk. Results Odds ratios for breast cancer were greatest for FGFR2-rs2981582 and TNRC9-rs3803662 and, for these 2 SNPs, were significantly greater for estrogen receptor (ER)–positive than for ER-negative disease, both in our data and in meta-analyses of all published data (pooled per-allele ORs [95% confidence intervals] for ER-positive vs ER-negative disease: 1.30 [1.26-1.33] vs 1.05 [1.01-1.10] for FGFR2; interaction P < .001; and 1.24 [1.21-1.28] vs 1.12 [1.07-1.17] for TNRC9; interaction P < .001). The next strongest association was for 2q-rs13387042, for which the per-allele OR was significantly greater for bilateral than unilateral disease (1.39 [1.21-1.60] vs 1.15 [1.11-1.20]; interaction P = .008) and for lobular than ductal tumors (1.35 [1.23-1.49] vs 1.10 [1.05-1.15]; interaction P < .001). The estimated cumulative incidence (95% confidence interval) of breast cancer to age 70 years among women in the top and bottom fifths of a polygenic risk score based on 7 SNPs was 8.8% (8.3%-9.4%) and 4.4% (4.2%-4.8%), respectively. For ER-positive disease the corresponding risks were 7.4% (6.9%-8.0%) and 3.4% (3.1%-3.8%), respectively; while for ER-negative disease they were 1.4% (1.2%-1.6%) and 1.0% (0.8%-1.2%). The findings did not differ materially according to the number of SNPs included in the polygenic risk model. Conclusions The polygenic risk score was substantially more predictive of ER-positive than of ER-negative breast cancer, particularly for absolute risk.
- Hospital Complication Rates With Bariatric Surgery in Mic... Context Despite the growing popularity of bariatric surgery, there remain concerns about perioperative safety and variation in outcomes across hospitals. Objective To assess complication rates of different bariatric procedures and variability in rates of serious complications across hospitals and according to procedure volume and center of excellence (COE) status. Design, Setting, and Patients Involving 25 hospitals and 62 surgeons statewide, the Michigan Bariatric Surgery Collaborative (MBSC) administers an externally audited, prospective clinical registry. We evaluated short-term morbidity in 15 275 Michigan patients undergoing 1 of 3 common bariatric procedures between 2006 and 2009. We used multilevel regression models to assess variation in risk-adjusted complication rates across hospitals and the effects of procedure volume and COE designation (by the American College of Surgeons or American Society for Metabolic and Bariatric Surgery) status. Main Outcome Measure Complications occurring within 30 days of surgery. Results Overall, 7.3% of patients experienced perioperative complications, most of which were wound problems and other minor complications. Serious complications were most common after gastric bypass (3.6%; 95% confidence interval [CI], 3.2%-4.0%), followed by sleeve gastrectomy (2.2%; 95% CI, 1.2%-3.2%), and laparoscopic adjustable gastric band (0.9%; 95% CI, 0.6%-1.1%) procedures (P < .001). Mortality occurred in 0.04% (95% CI, 0.001%-0.13%) of laparoscopic adjustable gastric band, 0 sleeve gastrectomy, and 0.14% (95% CI, 0.08%-0.25%) of the gastric bypass patients. After adjustment for patient characteristics and procedure mix, rates of serious complications varied from 1.6% (95% CI, 1.3-2.0) to 3.5% (95% CI, 2.4-5.0) (risk difference, 1.9; 95% CI, 0.08-3.7) across hospitals. Average annual procedure volume was inversely associated with rates of serious complications at both the hospital level (<150 cases, 4.1%; 95% CI, 3.0%-5.1%; 150-299 cases, 2.7%; 95% CI, 2.2-3.2; and ≥300 cases, 2.3%; 95% CI, 2.0%-2.6%; P = .003) and surgeon level (<100 cases, 3.8%; 95% CI, 3.2%-4.5%; 100-249 cases, 2.4%; 95% CI, 2.1%-2.8%;≥250 cases, 1.9%; 95% CI, 1.4%-2.3%; P = .001). Adjusted rates of serious complications were similar in COE and non-COE hospitals (COE, 2.7%; 95% CI, 2.5%-3.1%; non-COE, 2.0%; 95% CI, 1.5%-2.4%; P = .41). Conclusions The frequency of serious complications among patients undergoing bariatric surgery in Michigan was relatively low. Rates of serious complications are inversely associated with hospital and surgeon procedure volume, but unrelated to COE accreditation by professional organizations.
- Delirium in Elderly Patients and the Risk of Postdischarg... Context Delirium is a common and serious complication in elderly patients. Evidence suggests that delirium is associated with long-term poor outcome but delirium often occurs in individuals with more severe underlying disease. Objective To assess the association between delirium in elderly patients and long-term poor outcome, defined as mortality, institutionalization, or dementia, while controlling for important confounders. Data Sources A systematic search of studies published between January 1981 and April 2010 was conducted using the databases of MEDLINE, EMBASE, PsycINFO, and CINAHL. Study Selection Observational studies of elderly patients with delirium as a study variable and data on mortality, institutionalization, or dementia after a minimum follow-up of 3 months, and published in the English or Dutch language. Titles, abstracts, and articles were reviewed independently by 2 of the authors. Of 2939 references in the original search, 51 relevant articles were identified. Data Extraction Information on study design, characteristics of the study population, and outcome were extracted. Quality of studies was assessed based on elements of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies. Data Synthesis The primary analyses included only high-quality studies with statistical control for age, sex, comorbid illness or illness severity, and baseline dementia. Pooled-effect estimates were calculated with random-effects models. The primary analysis with adjusted hazard ratios (HRs) showed that delirium is associated with an increased risk of death compared with controls after an average follow-up of 22.7 months (7 studies; 271/714 patients [38.0%] with delirium, 616/2243 controls [27.5%]; HR, 1.95 [95% confidence interval {CI}, 1.51-2.52]; I2, 44.0%). Moreover, patients who had experienced delirium were also at increased risk of institutionalization (7 studies; average follow-up, 14.6 months; 176/527 patients [33.4%] with delirium and 219/2052 controls [10.7%]; odds ratio [OR], 2.41 [95% CI, 1.77-3.29]; I2, 0%) and dementia (2 studies; average follow-up, 4.1 years; 35/56 patients [62.5%] with delirium and 15/185 controls [8.1%]; OR, 12.52 [95% CI, 1.86-84.21]; I2, 52.4%). The sensitivity, trim-and-fill, and secondary analyses with unadjusted high-quality risk estimates stratified according to the study characteristics confirmed the robustness of these results. Conclusion This meta-analysis provides evidence that delirium in elderly patients is associated with poor outcome independent of important confounders, such as age, sex, comorbid illness or illness severity, and baseline dementia.
- Treatment of Primary Sjogren Syndrome: A Systematic Revie... Context A variety of topical and systemic drugs are available to treat primary Sjögren syndrome, although no evidence-based therapeutic guidelines are currently available. Objective To summarize evidence on primary Sjögren syndrome drug therapy from randomized controlled trials. Data Sources We searched MEDLINE and EMBASE for articles on drug therapy for primary Sjögren syndrome published between January 1, 1986, and April 30, 2010. Study Selection Controlled trials of topical and systemic drugs including adult patients with primary Sjögren syndrome were selected as the primary information source. Results The search strategy yielded 37 trials. A placebo-controlled trial found significant improvement in the Schirmer and corneal staining scores, blurred vision, and artificial tear use in patients treated with topical ocular 0.05% cyclosporine. Three placebo-controlled trials found that pilocarpine was associated with improvements in dry mouth (61%-70% vs 24%-31% in the placebo group) and dry eye (42%-53% vs 26%). Two placebo-controlled trials found that cevimeline was associated with improvement in dry mouth (66%-76% vs 35%-37% in the placebo group) and dry eye (39%-72% vs 24%-30%). Small trials (<20 patients) found no significant improvement in sicca outcomes for oral prednisone or hydroxychloroquine and limited benefits for immunosuppressive agents (azathioprine and cyclosporine). A large trial found limited benefits for oral interferon alfa-2a. Two placebo-controlled trials of infliximab and etanercept did not achieve the primary outcome (a composite visual analog scale measuring joint pain, fatigue, and dryness); neither did 2 small trials (<30 patients) testing rituximab, although significant results were observed in some secondary outcomes and improvement compared with baseline. Conclusions In primary Sjögren syndrome, evidence from controlled trials suggests benefits for pilocarpine and cevimeline for sicca features and topical cyclosporine for moderate or severe dry eye. Anti–tumor necrosis factor agents have not shown clinical efficacy, and larger controlled trials are needed to establish the efficacy of rituximab.
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The Lancet
- [Editorial] Home birth—proceed with caution The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
- [Editorial] The science and practice of HIV prevention Prevention as a strategy to defeat HIV finally came of age at the International AIDS Conference in Vienna last week. The call for “an all-out, unprecedented effort towards HIV prevention” was made by Peter Piot and colleagues in The Lancet 2 years ago. At the beginning of the Vienna meeting, Julio Montaner's study of highly active antiretroviral treatment on HIV transmission in British Columbia, Canada, further showed that treatment and prevention are indivisible. As HIV intervention strategies, they are intimately connected.
- [Editorial] Delays in UK stroke prevention Patients in the UK are waiting too long for vascular surgery after symptoms of stroke or transient ischaemic attack (TIA), according to an audit from the Vascular Society and the Royal College of Physicians. In some patients with carotid stenosis, carotid endarterectomy after TIA substantially reduces risk of further stroke. The protective effect is greatest immediately after symptoms occur, but an audit of 7000 procedures done between Jan 1, 2008, and Sept 30, 2009, has shown that patients in the UK are waiting a median 28 days for surgery. National Institute for Health and Clinical Excellence guidelines recommend no longer than a 14-day delay between symptoms and operation, and the 2007 National Stroke Strategy set a target of 48 h, to be achieved by 2017. The recent data show that only 3% of patients had the operation within 48 h, and about a third met the 14-day guideline.
- [Comment] Dissociating HDL cholesterol from cardiovascula... Cardiovascular disease is the leading cause of death worldwide. Reducing concentrations of LDL cholesterol with statin therapy has resulted in reductions of 23% in cardiovascular risk for every 1·03 mmol/L (40 mg/dL) decrease in LDL cholesterol. However, despite a reduction in LDL cholesterol with high-dose statins to 1·6 mmol/L in patients with stable coronary heart disease, and to 2·0 mmol/L in those with acute coronary syndrome, the risk of cardiovascular disease remains substantial at 8·7% after 4·9 years of follow-up, and 22·4% after 24 months' follow-up, respectively. Low concentrations of HDL cholesterol might contribute to this residual cardiovascular risk.
- [Comment] Untreated HIV: harmful even at high CD4 cell co... HIV-infected individuals with low CD4 cell counts and advanced immune suppression have a high mortality rate. But what is the effect of untreated HIV infection in individuals at an earlier stage of disease who have CD4 cell counts that put them at a lower risk for AIDS-related complications? In The Lancet today, Rebecca Lodwick and colleagues examine whether people with higher CD4 counts, who have not received antiretroviral therapy, have higher mortality than the general population. These investigators combined data from 23 cohorts and collaborations (18 European and five North American), and focus on 40 830 adults with at least one CD4 cell count greater than 350 cells per μL, and up to 1 year of follow-up. They compared death rates adjusted for age, sex, and country in the HIV-infected sample with that in the general population with standardised mortality ratios, stratified by risk groups. They also estimated the difference in risk of death at high CD4 count strata compared with a stratum of 350–499 cells per μL.
- [Comment] NO for preterm infants at risk of bronchopulmon... Although the initial clinical application of inhaled nitric oxide was for its vasodilatory role in pulmonary hypertension in term infants, nitric oxide showed positive effects in animal models of lung immaturity and lung injury: a reduction in lung inflammation, reduction in neutrophil infiltration into the lung, protection against oxidant lung injury, reversal of the effects of inhibition of vascular endothelial growth factor, and stimulation of angiogenesis and alveolarisation. On the basis of these findings, several studies were done to test the hypothesis that inhaled nitric oxide might preserve angiogenesis and alveolarisation, and therefore reduce lung injury and bronchopulmonary dysplasia.
- [Comment] Vienna Declaration: a call for evidence-based d... There remain crucial areas in public health in which the gap between evidence and public policy persists, and there are few more striking than in the global response to illicit drugs. In the USA, for example, annual federal budgets for drug-law enforcement have exceeded US$15 billion since the 1990s, and, at a global level, untold billions more have been spent on drug-law enforcement. Over the past several decades, considerable effort has also gone towards evaluating the “war on drugs” approach.
- [Comment] HIV and women who use drugs: double neglect, do... HIV infections continue to rise in drug-involved women, especially injecting drug users in Asia and eastern Europe, and in crack-cocaine users in the USA and other countries. Women who use drugs are doubly at risk for HIV infection via unprotected sex and unsafe injections. These women have exceptional needs that have not been addressed in current global HIV-prevention strategies. Drug-treatment and HIV-prevention programmes are usually designed and run by men, and therefore might not be sensitive to the unique needs of women. Drug treatment, harm reduction, and HIV programmes for women are near universally underfunded despite evidence of efficacy. The challenges facing drug-involved women mandate a call to action for this often hidden and neglected population.
- [Comment] The double-helix derailed: the story of the BRC... The March 29, 2010, landmark decision of US federal-court judge Robert W Sweet to invalidate many of Myriad Genetics' patent claims on BRCA1 and BRCA2 has exposed a controversy that has been brewing in cancer genetics for over a decade. Namely, two genes for hereditary breast and ovarian cancer syndrome (BRCA1, BRCA2) discovered via an international collaboration of researchers—many using government funding—were patented by Myriad Genetics in the mid-1990s. Granting a patent on a gene was not novel but the scope of the patents, how Myriad has enforced these patents, and the subsequent impact of their monopoly on clinical care and research is unprecedented.
- [Comment] Offline: The following day, no one died President Obama has become a hate figure for some AIDS activists. Médecins Sans Frontières, among others, claim that Obama is personally “denying and delaying AIDS treatment, ignoring evidence on how to defeat the pandemic”. These critics accuse Obama of breaking promises. One activist at the International AIDS Society's conference in Vienna last week said that he had “lied”. Meanwhile, some of Obama's political foes level an opposite attack. They argue that he has been too kind to factions on the political left (including AIDS activists), which (his critics claim) have held him hostage to causes that hurt his centrist credentials. In Vienna, Bill Clinton begged activists to reflect on their opposition to Obama. He argued that it was neither fair nor accurate to say that Obama was callously walking away from AIDS. The question for AIDS activists might be this: will you help people living under the threat of AIDS by accusing the most liberal US President in a generation of lying and being indifferent to the fight against AIDS? Activists are poised for tactical victory, but strategic failure. If their highly personalised criticisms contribute to Obama losing mid-term Congressional elections in November, they will have scored one of the biggest own goals in over 25 years of AIDS activism.
Listen to The Lancet
- Listen to The Lancet: 31 July Discussion of HDL cholesterol as an indicator of cardiovascular risk after lipid-lowering therapy to reduce LDL cholesterol.
- Listen to The Lancet: 24 July Issue highlights, and Pam Das summarises the HIV series.
- Listen to The Lancet: 17 July Discussion of the trial concerning home-based telemonitoring and self-management of hypertension.
- Listen to The Lancet: 10 July July 10 issue highlights, and news about infectious diseases research.
- Listen to The Lancet: 3 July Richard Horton discusses a special online update of The Lancet Series on health in the Occupied Palestinian Territory.
- Listen to The Lancet: 26 June Professor Cliff Bailey discusses the potential role of dapagliflozin for the treatment of type 2 diabetes.
- Listen to The Lancet: 19 June How the gout drug allopurinol could be a new anti-anginal therapy.
- Listen to The Lancet: 12 June Erika Niesner interviews Filip Cools about HFOV for preterm infants.
- Listen to The Lancet: 5 June Listen to Richard Horton discuss the women deliver themed issue in The Lancet Podcast.
- Listen to The Lancet: 29 May Richard Lane discusses the treatment of heroin addiction with John Strang.
Archives of Internal Medicine current issue
- National Institute of Mental Health Multisite Eban HIV/ST... Background Human immunodeficiency virus (HIV) has disproportionately affected African Americans. Couple-level interventions may be a promising intervention strategy.Methods To determine if a behavioral intervention can reduce HIV/sexually transmitted disease (STD) risk behaviors among African American HIV serodiscordant couples, a cluster randomized controlled trial (Eban) was conducted in Atlanta, Georgia; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania; with African American HIV serodiscordant heterosexual couples who were eligible if both partners were at least 18 years old and reported unprotected intercourse in the previous 90 days and awareness of each other's serostatus. One thousand seventy participants were enrolled (mean age, 43 years; 40% of male participants were HIV positive). Couples were randomized to 1 of 2 interventions: couple-focused Eban HIV/STD risk-reduction intervention or attention-matched individual-focused health promotion comparison. The primary outcomes were the proportion of condom-protected intercourse acts and cumulative incidence of STDs (chlamydia, gonorrhea, or trichomonas). Data were collected preintervention and postintervention, and at 6- and 12-month follow-ups.Results Data were analyzed for 535 randomized couples: 260 in the intervention group and 275 in the comparison group; 81.9% were retained at the 12-month follow-up. Generalized estimating equation analyses revealed that the proportion of condom-protected intercourse acts was larger among couples in the intervention group (0.77) than in the comparison group (0.47; risk ratio, 1.24; 95% confidence interval [CI], 1.09 to 1.41; P = .006) when adjusted for the baseline criterion measure. The adjusted percentage of couples using condoms consistently was higher in the intervention group (63%) than in the comparison group (48%; risk ratio, 1.45; 95% CI, 1.24 to 1.70; P < .001). The adjusted mean number of (log)unprotected intercourse acts was lower in the intervention group than in the comparison group (mean difference, –1.52; 95% CI, –2.07 to –0.98; P < .001). The cumulative STD incidence over the 12-month follow-up did not differ between couples in the intervention and comparison groups. The overall HIV seroconversion at the 12-month follow-up was 5 (2 in the intervention group, 3 in the comparison group) of 535 individuals, which translates to 935 per 100 000 population.Conclusion To our knowledge, this is the first randomized controlled intervention trial to report significant reductions in HIV/STD risk behaviors among African American HIV serodiscordant couples.Trial Registration clinicaltrials.gov Identifier: NCT00644163
- Rosiglitazone Revisited: An Updated Meta-analysis of Risk... Context Controversy regarding the effects of rosiglitazone therapy on myocardial infarction (MI) and cardiovascular (CV) mortality persists 3 years after a meta-analysis initially raised concerns about the use of this drug.Objective To systematically review the effects of rosiglitazone therapy on MI and mortality (CV and all-cause).Data Sources We searched MEDLINE, the Web site of the Food and Drug Administration, and the GlaxoSmithKline clinical trials registry for trials published through February 2010.Study Selection The study included all randomized controlled trials of rosiglitazone at least 24 weeks in duration that reported CV adverse events.Data Extraction Odds ratios (ORs) for MI and mortality were estimated using a fixed-effects meta-analysis of 56 trials, which included 35 531 patients: 19 509 who received rosiglitazone and 16 022 who received control therapy.Results Rosiglitazone therapy significantly increased the risk of MI (OR, 1.28; 95% confidence interval [CI], 1.02-1.63; P = .04) but not CV mortality (OR, 1.03; 95% CI, 0.78-1.36; P = .86). Exclusion of the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes) trial yielded similar results but with more elevated estimates of the OR for MI (OR, 1.39; 95% CI, 1.02-1.89; P = .04) and CV mortality (OR, 1.46; 95% CI, 0.92-2.33; P = .11). An alternative analysis pooling trials according to allocation ratios allowed inclusion of studies with no events, yielding similar results for MI (OR, 1.28; 95% CI, 1.01-1.62; P = .04) and CV mortality (OR 0.99; 95% CI, 0.75-1.32; P = .96).Conclusions Eleven years after the introduction of rosiglitazone, the totality of randomized clinical trials continue to demonstrate increased risk for MI although not for CV or all-cause mortality. The current findings suggest an unfavorable benefit to risk ratio for rosiglitazone.Published online June 28, 2010 (doi:10.1001/archinternmed.2010.207).
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- In This Issue of Archives of Internal Medicine [In This I...
- Measuring Outcomes of Coronary Artery Bypass Surgery: Wha...
- Rosiglitazone Revisited: An Updated Meta-analysis of Risk... Context Controversy regarding the effects of rosiglitazone therapy on myocardial infarction (MI) and cardiovascular (CV) mortality persists 3 years after a meta-analysis initially raised concerns about the use of this drug. Objective To systematically review the effects of rosiglitazone therapy on MI and mortality (CV and all-cause). Data Sources We searched MEDLINE, the Web site of the Food and Drug Administration, and the GlaxoSmithKline clinical trials registry for trials published through February 2010. Study Selection The study included all randomized controlled trials of rosiglitazone at least 24 weeks in duration that reported CV adverse events. Data Extraction Odds ratios (ORs) for MI and mortality were estimated using a fixed-effects meta-analysis of 56 trials, which included 35 531 patients: 19 509 who received rosiglitazone and 16 022 who received control therapy. Results Rosiglitazone therapy significantly increased the risk of MI (OR, 1.28; 95% confidence interval [CI], 1.02-1.63; P = .04) but not CV mortality (OR, 1.03; 95% CI, 0.78-1.36; P = .86). Exclusion of the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes) trial yielded similar results but with more elevated estimates of the OR for MI (OR, 1.39; 95% CI, 1.02-1.89; P = .04) and CV mortality (OR, 1.46; 95% CI, 0.92-2.33; P = .11). An alternative analysis pooling trials according to allocation ratios allowed inclusion of studies with no events, yielding similar results for MI (OR, 1.28; 95% CI, 1.01-1.62; P = .04) and CV mortality (OR 0.99; 95% CI, 0.75-1.32; P = .96). Conclusions Eleven years after the introduction of rosiglitazone, the totality of randomized clinical trials continue to demonstrate increased risk for MI although not for CV or all-cause mortality. The current findings suggest an unfavorable benefit to risk ratio for rosiglitazone.
- Case Volume, Quality of Care, and Care Efficiency in Coro... Background How case volume and quality of care relate to hospital costs or length of stay (LOS) are important questions as we seek to improve the value of health care. Methods We conducted an observational study of patients 18 years or older who underwent coronary artery bypass grafting surgery in a network of US hospitals. Case volumes were estimated using our data set. Quality was assessed by whether recommended medications and services were not received in ideal patients, as well as the overall number of measures missed. We used multivariable hierarchical models to estimate the effects of case volume and quality on hospital cost and LOS. Results The majority of hospitals (51%) and physicians (78%) were lowest-volume providers, and only 18% of patients received all quality of care measures. Median LOS was 7 days (interquartile range [IQR], 6-11 days), and median costs were $25 140 (IQR, $19 677-$33 121). In analyses adjusted for patient and site characteristics, lowest-volume hospitals had 19.8% higher costs (95% CI, 3.9%-38.0% higher); adjusting for care quality did not eliminate differences in costs. Low surgeon volume was also associated with higher costs, though less strongly (3.1% higher costs [95% CI, 0.6%-5.6% higher]). Individual quality measures had inconsistent associations with costs or LOS, but patients who had no quality measures missed had much shorter LOS and lower costs than those who missed even one. Conclusion Avoiding lowest-volume hospitals and maximizing quality are separate approaches to improving health care efficiency through reducing costs of coronary bypass surgery.
- Racial Differences in Admissions to High-Quality Hospital... Background Research increasingly shows that blacks with coronary heart disease (CHD) are treated at lower-quality hospitals. Little is known about racial differences in admission to high-quality hospitals. Methods We identified all black and white Medicare patients with acute myocardial infarction and coronary artery bypass grafting (CABG) admitted during 2002 through 2005 to hospitals located in markets with top-ranked cardiac hospitals, as ascertained from the US News and World Report "America’s Best Hospitals" annual rankings. The relationship between race and admission to top-ranked hospitals was estimated using multinomial conditional logit models to account for distance from patient residence to all available hospitals. Results In unadjusted analyses, blacks with AMI or undergoing CABG, compared with whites, were more likely to be admitted to top-ranked hospitals (18.3% vs 10.5% and 34.4% vs 22.7% [P < .001]) but also more likely to bypass top-ranked hospitals (25.8% vs 14.7% and 37.5% vs 26.3% [P < .001]). In models accounting for distance, blacks with acute myocardial infarction were more likely (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.16 [P < .001]), whereas blacks undergoing CABG were equally likely (OR, 1.05; 95% CI, 0.97-1.13; P = .27) to be admitted to top-ranked hospitals compared with whites. However, within socially disadvantaged zip codes, blacks undergoing CABG were less likely to receive care at top-ranked hospitals (OR, 0.75; 95% CI, 0.64-0.86 [P < .001]) compared with whites and more likely to bypass top-ranked hospitals located closer to their residence (OR, 1.16; 95% CI, 1.02-1.30 [P = .03]). Conclusion Black Medicare patients with acute myocardial infarction or undergoing CABG were equally or more likely to be admitted to top-ranked hospitals, except for socially disadvantaged black patients undergoing CABG.
- Receipt of High-Quality Coronary Heart Disease Care in th...
- Geographic Variation in Carotid Revascularization Among M... Background Little is known about patterns in the use of carotid revascularization since a 2004 Medicare national coverage decision supporting carotid artery stenting. We examined geographic variation in and predictors of carotid endarterectomy and carotid stenting. Methods Analysis of claims from the Centers for Medicare & Medicaid Services from January 1, 2003, through December 31, 2006. Patients were 65 years or older and had undergone carotid endarterectomy or carotid stenting. The main outcome measures were annual age-adjusted rates of carotid endarterectomy and carotid stenting, factors associated with the use of carotid revascularization, and mortality rate at 30 days and 1 year. Results The rate of endarterectomy decreased from 3.2 per 1000 person-years in 2003 to 2.6 per 1000 person-years in 2006. After adjustment for demographic and clinical characteristics, there was significant geographic variation in the odds of carotid revascularization, with the East North Central region having the greatest odds of endarterectomy (odds ratio, 1.60; 95% confidence interval, 1.55-1.65) and stenting (1.61; 1.46-1.78) compared with New England. Prior endarterectomy (odds ratio, 3.06; 95% confidence interval, 2.65-3.53) and coronary artery disease (2.12; 2.03-2.21) were strong predictors of carotid stenting. In 2005, mortality was 1.2% at 30 days and 6.8% at 1 year for endarterectomy and 2.3% at 30 days and 10.3% at 1 year for stenting. Conclusions Significant geographic variation exists for carotid endarterectomy and carotid stenting. Prior endarterectomy and coronary disease were associated with greater odds of carotid stenting.
Annals of Internal Medicine current issue
- Contextual Errors and Failures in Individualizing Patient... This article has been corrected. For original version, click "Original Version (PDF)" in column 2. Background: A contextual error occurs when a physician overlooks elements of a patient's environment or behavior that are essential to planning appropriate care. In contrast to biomedical errors, which are not patient-specific, contextual errors represent a failure to individualize care. Objective: To explore the frequency and circumstances under which physicians probe contextual and biomedical red flags and avoid treatment error by incorporating what they learn from these probes. Design: An incomplete randomized block design in which unannounced, standardized patients visited 111 internal medicine attending physicians between April 2007 and April 2009 and presented variants of 4 scenarios. In all scenarios, patients presented both a contextual and a biomedical red flag. Responses to probing about flags varied in whether they revealed an underlying complicating biomedical or contextual factor (or both) that would lead to errors in management if overlooked. Setting: 14 practices, including 2 academic clinics, 2 community-based primary care networks with multiple sites, a core safety net provider, and 3 U.S. Department of Veterans Affairs facilities. Measurements: Primary outcomes were the proportion of visits in which physicians probed for contextual and biomedical factors in response to hints or red flags and the proportion of visits that resulted in error-free treatment plans. Results: Physicians probed fewer contextual red flags (51%) than biomedical red flags (63%). Probing for contextual or biomedical information in response to red flags was usually necessary but not sufficient for an error-free plan of care. Physicians provided error-free care in 73% of the uncomplicated encounters, 38% of the biomedically complicated encounters, 22% of the contextually complicated encounters, and 9% of the combined biomedically and contextually complicated encounters. Limitations: Only 4 case scenarios were used. The study assessed physicians' propensity to make errors when every encounter provided an opportunity to do so and did not measure actual error rates that occur in primary care settings because of inattention to context. Conclusion: Inattention to contextual information, such as a patient's transportation needs, economic situation, or caretaker responsibilities, can lead to contextual error, which is not currently measured in assessments of physician performance. Primary Funding Source: U.S. Department of Veterans Affairs Health Services Research and Development Service.
- Effect of an End-of-Life Planning Intervention on the Com... Background: Few interventions have focused on improving end-of-life care for underserved populations, such as homeless persons. Objective: To determine whether homeless persons will complete a counseling session on advance care planning and fill out a legal advance directive designed to assess care preferences and preserve the dignity of marginalized persons. Design: Prospective, single-blind, randomized trial comparing self-guided completion of an advance directive with professionally assisted advance care planning. (ClinicalTrials.gov registration number: NCT00546884) Setting: 8 sites serving homeless persons in Minneapolis, Minnesota. Participants: 262 homeless persons recruited between November 2007 and August 2008. Intervention: Minimal, self-guided intervention consisting of advance directive forms and written educational information versus a one-on-one advance planning intervention consisting of counseling and completing an advance directive with a social worker. Measurements: Rate of advance directive completion, assessed by inspection of completed documents. Results: The overall completion rate for advance directives was 26.7% (95% CI, 21.5% to 32.5%), with a higher rate in the counselor-guided group (37.9%) than in the self-guided group (12.8%) (CI of adjusted difference, 15.3 to 34.3 percentage points). This difference persisted across all sites and most subgroups. The advance directive's 4 clinical scenarios found a preference for surrogate decision making in 29% to 34% of written responses. Limitations: Sampling was limited to a more stable subset of the homeless population in Minneapolis and may have been subject to selection bias. Modest compensation to complete the preintervention survey could have influenced participants to complete advance directives. Conclusion: Both a simple and complex intervention successfully engaged a diverse sample of homeless persons in advance care planning. One-on-one assistance significantly increased the completion rate. Homeless persons can respond to an intervention to plan for end-of-life care and can express specific preferences for care or a surrogate decision maker, but additional studies are needed to assess the effect of these directives on subsequent care. Primary Funding Source: National Institute for Nursing Research and National Center on Minority Health and Health Disparities.
- Brief Communication: Case Reports of Ribavirin Treatment ... Background: There is currently no accepted treatment of chronic hepatitis E virus (HEV) infection. Objective: To report 2 patients in whom ribavirin therapy seemed to alter the natural history of chronic HEV infection. Design: Case reports. Setting: Hepatology unit of a tertiary care center in France. Patients: A kidney and pancreas transplant recipient and a patient with idiopathic CD4+ T lymphocytopenia, both with biopsy-proven chronic HEV infection. Intervention: Patients received oral ribavirin, 12 mg/kg of body weight daily for 12 weeks. Measurements: Liver function tests, detection of HEV RNA (viremia and stool shedding) by reverse transcriptase polymerase chain reaction, and anti-HEV IgM and IgG antibodies. Results: Both patients had normalized liver function test results after 2 weeks of treatment and cleared HEV after 4 weeks of treatment. Hepatitis E virus RNA remained undetectable in the serum and stools throughout follow-up (3 months and 2 months for the first and second patient, respectively). Side effects were considered mild. Limitation: Given the relatively short follow-up, the achievement of HEV eradication could not be claimed. Conclusion: Ribavirin is a potentially effective treatment of HEV infection and should be evaluated in patients with chronic HEV infection. Primary Funding Source: None.
- Plagiarism in Residency Application Essays Background: Anecdotal reports suggest that some residency application essays contain plagiarized content. Objective: To determine the prevalence of plagiarism in a large cohort of residency application essays. Design: Retrospective cohort study. Setting: 4975 application essays submitted to residency programs at a single large academic medical center between 1 September 2005 and 22 March 2007. Measurements: Specialized software was used to compare residency application essays with a database of Internet pages, published works, and previously submitted essays and the percentage of the submission matching another source was calculated. A match of more than 10% to an existing work was defined as evidence of plagiarism. Results: Evidence of plagiarism was found in 5.2% (95% CI, 4.6% to 5.9%) of essays. The essays of non–U.S. citizens were more likely to demonstrate evidence of plagiarism. Other characteristics associated with the prevalence of plagiarism included medical school location outside the United States and Canada; previous residency or fellowship; lack of research experience, volunteer experience, or publications; a low United States Medical Licensing Examination Step 1 score; and nonmembership in the Alpha Omega Alpha Honor Medical Society. Limitations: The software database is probably incomplete, the 10%-match threshold for defining plagiarism has not been statistically validated, and the study was confined to applicants to 1 institution. Evidence of matching content in an essay cannot be used to infer the applicant's intent and is not sensitive to variations in the cultural context of copying in some societies. Conclusion: Evidence of plagiarism in residency application essays is more common in international applicants but was found in those by applicants to all specialty programs, from all medical school types, and even among applicants with significant academic honors. Primary Funding Source: No external funding.
- Narrative Review: The Systemic Capillary Leak Syndrome The systemic capillary leak syndrome (SCLS) is a rare disease of reversible plasma extravasation and vascular collapse accompanied by hemoconcentration and hypoalbuminemia. Its cause is unknown, although it is believed to be a manifestation of transient endothelial dysfunction due to endothelial contraction, apoptosis, injury, or a combination of these. Fewer than 150 cases of SCLS have been reported, but the condition is probably underrecognized because of its nonspecific symptoms and signs and high mortality rate. Patients experience shock and massive edema, often after a nonspecific prodrome of weakness, fatigue, and myalgias, and are at risk for ischemia-induced organ failure, rhabdomyolysis and muscle compartment syndromes, and venous thromboembolism. Shock and edema reverse almost as quickly as they begin, at which time patients are at risk for death from flash pulmonary edema during rapid fluid remobilization. Diagnosis is made clinically and by exclusion of other diseases that cause similar symptoms and signs, most notably sepsis, anaphylaxis, and angioedema. Acute episodes are treated with vasopressor therapy and judicious fluid replacement, possibly with colloid solutions for their osmotic effects, to prevent the sequelae of underperfusion. Between episodes, patients may be treated with theophylline and terbutaline, which clinical experience suggests may reduce the severity and frequency of acute episodes. Prognosis is uncertain, but patients who survive an initial severe SCLS episode are estimated to have a 10-year survival rate greater than 70%. Much remains to be learned about SCLS, and clinicians should consider the diagnosis in patients with unexplained edema, increased hematocrit, and hypotension.
- Open Notes: Doctors and Patients Signing On Few patients read their doctors' notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients' interest in reading their doctors' notes may increase. Inviting patients to review these notes could improve understanding of their health, foster productive communication, stimulate shared decision making, and ultimately lead to better outcomes. Yet, easy access to doctors' notes could have negative consequences, such as confusing or worrying patients and complicating rather than improving patient–doctor communication. To gain evidence about the feasibility, benefits, and harms of providing patients ready access to electronic doctors' notes, a team of physicians and nurses have embarked on a demonstration and evaluation of a project called OpenNotes. The authors describe the intervention and share what they learned from conversations with doctors and patients during the planning stages. The team anticipates that "open notes" will spread and suggests that over time, if drafted collaboratively and signed by both doctors and patients, they might evolve to become contracts for care.
- Screening for Osteoporosis: An Update for the U.S. Preven... Background: This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening. Purpose: To determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and the efficacy and harms of medications to reduce primary fractures. Data Sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2009), MEDLINE (January 2001 to December 2009), reference lists, and Web of Science. Study Selection: Randomized, controlled trials of screening or medications with fracture outcomes published in English; performance studies of validated risk-assessment instruments; and systematic reviews and population-based studies of bone measurement tests or medication harms. Data Extraction: Data on patient populations, study design, analysis, follow-up, and results were abstracted, and study quality was rated by using established criteria. Data Synthesis: Risk-assessment instruments are modest predictors of low bone density (area under the curve, 0.13 to 0.87; 14 instruments) and fractures (area under the curve, 0.48 to 0.89; 11 instruments); simple and complex instruments perform similarly. Dual-energy x-ray absorptiometry predicts fractures similarly for men and women; calcaneal quantitative ultrasonography also predicts fractures, but correlation with dual-energy x-ray absorptiometry is low. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce primary vertebral fractures. Trials are lacking for men. Bisphosphonates are not consistently associated with serious adverse events; raloxifene and estrogen increase thromboembolic events; and estrogen causes additional adverse events. Limitation: Trials of screening with fracture outcomes, screening intervals, and medications to reduce primary fractures, particularly those enrolling men, are lacking. Conclusion: Although methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals. Primary Funding Source: Agency for Healthcare Research and Quality.
- Contextual Errors In this issue, Weiner and colleagues evaluate the frequency and circumstances of "contextual errors"—when a physician overlooks elements of a patient's environment or behavior that are essential to planning appropriate care. This editorial discusses the article's findings, suggests implications for medical education, and shares the editorialist's own memorable contextual errors.
- Plagiarism on Personal Statements: A Disturbing Symptom o... In this issue, Segal and colleagues report evidence of plagiarism in more than 5% of the personal statements of applicants to 5 residency programs. This editorial argues that plagiarism is a symptom of a broader problem with integrity and suggests that we modify selection procedures to focus attention on new approaches that evaluate an applicant's potential through standardized firsthand observations.
- An Exchange It seemed like an ordinary infectious diseases consultation. I was asked to see a 48-year-old homeless man with a soft tissue infection. He was the sort of patient whose very name would produce groans among nurses and physicians. He was a bedraggled man who panhandled at the local freeway on-ramp and a familiar figure on the wards with many complications of his injection drug use.
Annals of Internal Medicine Podcast
- Progress notes Opening progress notes to patients; interview with Jan Walker, RN, MBA, and Thomas Delbanco, MD, of Harvard Medical School; plus a summary of all articles in the issue.
- Israel in Haiti The Israeli field hospital experience in Haiti; interview with Ofer Merin, MD, Commander in Chief of the Israel Defense Forces Reserve Field Hospital, Deputy Director General of Shaarei Tzedek Hospital, Lecturer at Hebrew University in Jerusalem; plus a summary of all articles in the issue.
- HbA1c HbA1c as a diagnostic test and measure of diabetes control; interview with William H. Herman, MD, MPH, of the University of Michigan, and Robert M. Cohen, MD, of the University of Cincinnati; plus a summary of all articles in the issue.
- Opioids II Managing opioid misuse with treatment agreements and urine drug testing; interview with Barbara Turner, MD, MSED, of the University of Pennsylvania; plus a summary of all the articles in the issue.
- [PDF] Sample treatment agreement Sample treatment agreement for prescription opioids from Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain available at http://health.utah.gov/prescription/guidelines.html
- Primary care II Preventing osteoporosis in men with prostate cancer; excerpts from a conference on Reinventing Primary Care; plus a summary of all the issue's articles.
- ESAs Erythropoiesis-stimulating agents in patients with anemia of chronic kidney disease; interview with Daniel Weiner, MD, MS, of Tufts Medical School. Plus a summary of all the issue's articles.
- Breast cancer II The history of the mammography screening controversy and the experience of breast cancer in America; interview with Robert Aronowitz, MD, of the University of Pennsylvania. Plus a summary of all the issue's articles.
- Health reform The Patient Protection and Affordable Care Act of 2010; interview with Robert Doherty of the American College of Physicians; plus a summary of all the articles in the issue.
- Concierge medicine Concierge Medicine, by Michael Stillman, M.D.; Through a Glass Darkly by Tumi Johnson, M.D.; plus a summary of all the articles in the issue.
Journal of Hospital Medicine
- Prevalence and management of hypertension in the inpatien... Hypertension (HTN) is a major cardiovascular risk factor yet control rates remain suboptimal. Thus, improving recognition, treatment, and control of HTN by focusing on novel populations such as hospitalized patients is warranted. Current consensus guidelines do not address inpatient HTN, and little is known about HTN prevalence or patterns of care in this setting.We conducted a systematic review of English-language studies published in 1976 or later that reported on HTN prevalence and care patterns among adult inpatients. We included MEDLINE-indexed randomized-controlled trials, meta-analyses, and observational studies that: (1) reported estimates of the prevalence of HTN in the inpatient setting, and (2) used HTN diagnosis or treatment as a primary focus. We excluded randomized, controlled trials that recorded measures of inpatient blood pressure but whose focus was not HTN.We identified 9 studies meeting inclusion criteria, and in those studies, HTN was highly prevalent among inpatients, ranging from 50.5% to 72%. Intensification of antihypertensive treatment was inconsistent, and 37% to 77% of hypertensive patients remained hypertensive at the time of discharge. Most patients with inpatient HTN continued to have elevated blood pressures at outpatient follow-up.Inpatient HTN is prevalent and a large percentage of those with this condition remain hypertensive at the time of discharge and at follow-up. The potential exists for improved recognition and treatment of newly diagnosed and known, but uncontrolled, HTN observed in the inpatient setting. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
- ACEi/ARB for systolic heart failure: Closing the quality ... National guidelines recommend angiotensin converting enzyme inhibitor (ACEi) or angiotensinogen receptor blocker (ARB) therapy for patients with left ventricular systolic dysfunction (LVSD), including those with symptomatic heart failure (HF). However, guideline adherence has not been optimal. The goal of this quality improvement project is to devise and implement a sustainable care-delivery model in a 920-bed academic hospital center that would improve ACEi/ARB adherence before hospital discharge.The Model of intervention is: (1) a computer-based daily screening program; (2) inpatient pharmacist e-flag message; and (3) alerts for inpatient care teams. Its operating algorithm: If eligible adult HF/LVSD inpatients are not on ACEi or ARB nor documentation of contraindications, a flag alert is generated; deficiency is confirmed by a pharmacist and conveyed to the patient-care teams; if alert is acted on and care brought into adherence, the screening program would not re-flag the same patients the succeeding day; if not, the patients would be re-flagged daily until reaching adherence. We compared ACEi/ARB adherence before, during, and after the intervention.Baseline performance (percentage of eligible HF/LVSD patients receiving ACEi/ARB) was 87.5%. After implementation of the Model the ACEi/ARB adherence rate at the time of hospital discharge rose to 96.7% (P < 0.002) and was sustained for 21 months without needing additional personnel.A carefully designed, computer-based care-delivery model is highly efficient and sustainable for enhancing ACEi/ARB adherence. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
- An unusual cause of chest pain: Mycobacterium avium compl... The HIV-associated immune reconstitution inflammatory syndrome usually manifests as new infections or worsening of pre-existing infections during the first few months of initiating anti-retroviral therapy. It is commonly associated with local or systemic inflammation, presumably due to rapid reconstitution of host immune system. Here we describe a unique case of the immune reconstitution inflammatory syndrome presenting as acute pericarditis and pericardial effusion caused by mycobacterium avium complex. We also demonstrate that judicious use of steroids, along with pathogen specific antimicrobial therapy, can prevent local complications of the inflammatory response. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
- Intramural Hematoma of the esophagus (IHE) presenting as ... No abstract.
- The performance of US hospitals as reflected in risk-stan... Pneumonia is a leading cause of hospitalization and death in the elderly, and remains the subject of both local and national quality improvement efforts.To describe patterns of hospital and regional performance in the outcomes of elderly patients with pneumonia.Cross-sectional study using hospital and outpatient Medicare claims between 2006 and 2009.A total of 4,813 nonfederal acute care hospitals in the United States and its organized territories.Hospitalized fee-for-service Medicare beneficiaries age 65 years and older who received a principal diagnosis of pneumonia.None.Hospital and regional level risk-standardized 30-day mortality and readmission rates.Of the 1,118,583 patients included in the mortality analysis 129,444 (11.6%) died within 30 days of hospital admission. The median (Q1, Q3) hospital 30-day risk-standardized mortality rate for patients with pneumonia was 11.1% (10.0%, 12.3%), and despite controlling for differences in case mix, ranged from 6.7% to 20.9%. Among the 1,161,817 patients included in the readmission analysis 212,638 (18.3%) were readmitted within 30 days of hospital discharge. The median (Q1, Q3) 30-day risk-standardized readmission rate was 18.2% (17.2%, 19.2%) and ranged from 13.6% to 26.7%. Risk-standardized mortality rates varied across hospital referral regions from a high of 14.9% to a low of 8.7%. Risk-standardized readmission rates varied across hospital referral regions from a high of 22.2% to a low of 15%.Risk-standardized 30-day mortality and, to a lesser extent, readmission rates for patients with pneumonia vary substantially across hospitals and regions and may present opportunities for quality improvement, especially at low performing institutions and areas. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
- Effects of provider characteristics on care coordination ... Care coordination is critical in settings characterized by high levels of uncertainty, time constraints, and interdependent work processes. The effects of provider characteristics on coordination in comanaged teams has never been examined.To characterize individual providers based on their contribution to team coordination.Hospitalists, nonphysician providers, hepatologists, and fellows on a comanaged liver service of an academic hospital.Between April 2008 and October 2008, participants were surveyed at baseline and repeatedly at the completion of physician rotations to assess their preferred and actual comanagement structures. In addition, they repeatedly rated their comanagers' contributions to overall coordination using an instrument that assessed relational coordination (RC). Providers were categorized into tertiles of RC. Their management preferences and the frequency of a "composite bad outcome" (intensive care unit [ICU] transfer or inpatient death) in each tertile were evaluated.All (100%) Baseline Surveys and 177/224 (79%) Repeated Surveys were completed by 32 providers. RC was shown to be a stable attribute of providers and not of adverse patient outcomes. Higher coordinators were characterized by their "ownership of patients" (higher 86% vs. lowest 20%, P < 0.01). High compared to low coordinator hepatologists demonstrated leadership through a broader delegation of tasks as well as self-assignment of responsibilities. A trend toward more frequent "composite bad outcomes" was seen for low tertile physicians: hospitalists (low 8.6% vs. high 1.1%, P < 0.01), hepatologists (low 5.2% vs. high 2.0%, P = 0.22), fellows (low 5.8% vs. high 1.8%, P = 0.08).Individual provider's teamwork-related disposition affects perceived coordination on comanaged team and may influence patient outcomes. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
- A multiple choice answer? No abstract.
- A descriptive case series of patients with end-stage live... It is unknown whether venous thromboembolism prophylaxis (VTEP) should be utilized in hospitalized patients with end-stage liver disease (ESLD), particularly in those admitted with variceal bleeding.We sought to describe a cohort of patients who received pharmacologic VTEP, specifically identifying the occurrence of rebleeding.Descriptive case series.All adult patients with ESLD admitted to an urban county teaching hospital over three years with variceal bleeding who received pharmacologic VTEP during hospitalization.A total of 22 patients with ESLD and variceal bleeding received pharmacologic VTEP. Only 1 patient rebled after initiation of VTEP; 2 patients were diagnosed with lower extremity deep venous thrombosis while on VTEP including the 1 patient who rebled.VTEP was associated with an unexpectedly low incidence of recurrent bleeding in patients with ESLD and variceal bleeding. Further study may be warranted. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
- A Small kindness No abstract.
- Improving teamwork: Impact of structured interdisciplinar... Effective collaboration and teamwork is essential in providing safe and effective care. Research reveals deficiencies in teamwork on medical units involving hospitalists.The aim of this study was to assess the impact of an intervention, Structured Inter-Disciplinary Rounds (SIDR), on nurses' ratings of collaboration and teamwork.The study was a controlled trial involving an intervention and control hospitalist unit. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. We asked nurses to rate the quality of communication and collaboration with hospitalists using a 5-point ordinal scale. We also assessed teamwork and safety climate using a validated instrument. Multivariable regression analyses were used to assess the impact on length of stay (LOS) and cost using both a concurrent and historic control.A total of 49 of 58 (84%) nurses completed surveys. A larger percentage of nurses rated the quality of communication and collaboration with hospitalists as high or very high on the intervention unit compared to the control unit (80% vs. 54%; P = 0.05). Nurses also rated the teamwork and safety climate significantly higher on the intervention unit (P = 0.008 and P = 0.03 for teamwork and safety climate, respectively). Multivariable analyses demonstrated no difference in the adjusted LOS and an inconsistent effect on cost.SIDR had a positive effect on nurses' ratings of collaboration and teamwork on a hospitalist unit, yet no impact on LOS and cost. Further study is required to assess the impact of SIDR on patient safety measures. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
Evidence-Based Medicine current issue
- Combined estrogen plus progestin may reduce coronary hear...
- Intermittent preventive treatment of infants with mefloqu...
- Pregabalin similar to lorazepam for alcohol withdrawal sy...
- Rosuvastatin is similarly effective for primary preventio...
- Daily self-monitoring unlikely to be cost-effective in ad...
- Insufficient evidence to recommend routine adjunctive che...
- Nicotine patch plus lozenge gives greatest increases in a...
- Combination therapy with long-acting {beta}-agonists plus...
- Quadrivalent HPV vaccine administered to women who became...
- No evidence that vaccinating health care workers prevents...
Cleveland Clinic Journal of Medicine current issue
- Escaping the heat in the EMR pool The electronic medical record (EMR) is a tool, and it performs at the skill level of the person using it.
- The electronic medical record: Diving into a shallow pool? We should reassess the possible unintended consequences of the rush to adopt electronic medical records.
- The electronic medical record: Learning to swim Skepticism and vigilance are warranted, but so is optimism.
- The eyes: A window into the past The patient, 33 years old and living in Southern California, has "spots" on the retina. What is the most likely diagnosis?
- Pyogenic liver abscess Klebsiella pneumoniae has emerged as the most common organism seen in pyogenic liver abscess.
- Coenzyme Q10: A therapy for hypertension and statin-induc... These supplements appear to be safe, but larger trials are needed to determine if they are truly effective.
- Menstrual manipulation: Options for suppressing the cycle If they wish, women can have more control over when and if they menstruate, even though myths and misperceptions abound among clinicians.
- Pharmacoresistant epilepsy: From pathogenesis to current ... Almost one-third of people with epilepsy continue to have seizures despite appropriate treatment. We recommend early referral to an epilepsy center.
- Bariatric surgery for type 2 diabetes: Weighing the impac... Bariatric surgery results in remission of diabetes in most patients. Why should this be?
QJM - current issue
- Editors choice: Risk assessment and thromboprophylaxis
- Bioelectromagnetics, complex behaviour and psychotherapeu... The brain is a complex non-linear dynamical system that is associated with a wide repertoire of behaviours. There is an ongoing debate as to whether low-intensity radio frequency (RF) bioelectromagnetic interactions induce a biological response. If they do, it is reasonable to expect that the interaction is non-linear. Contradictory reports are found in the literature and attempts to reproduce the subtle effects have often proved difficult. Researchers have already speculated that low-intensity RF radiation may offer therapeutic potential and millimetre-wave therapy is established in the countries of the former Soviet Union. A recent study using transgenic mice that exhibit Alzheimer’s-like cognitive impairment shows that microwave radiation may possibly have therapeutic application. By using a highly dynamic stimulus and feedback it may be possible to augment the small effects that have been reported using static parameters. If a firm connection between low-intensity RF radiation and biological effects is established then the possibility arises for its psychotherapeutic application. Low intensity millimetre-wave and peripheral nervous system interactions also merit further investigation. Controlled RF exposure could be associated with quite novel characteristics and dynamics when compared to those associated with pharmacotherapy.
- Lactose malabsorption and intolerance: a systematic revie... Background: When lactose malabsorption gives rise to symptoms, the result is called ‘lactose intolerance’. Although lactose intolerance is often bothersome for patients, once recognized it may be managed by simple dietary adjustments. However, diagnosing lactose intolerance is not straightforward, especially in primary care. Aim: To summarize available evidence on the diagnostic performance of gastrointestinal symptoms and self-reported milk (lactose) intolerance in primary care, and the relationship between lactose malabsorption and intolerance. Data sources: PubMed, EMBASE and reference screening. Study selection: Studies were selected if the design was a primary diagnostic study; the patients were adults consulting because of non-acute abdominal symptoms; the diagnostic test included gastrointestinal symptoms and/or self-reported milk intolerance. A total of 26 primary diagnostic studies were included in the review. Data extraction: Quality assessment and data extraction were performed by two reviewers independently. They adhered to the most recent guidelines for conducting a diagnostic review as described in the Cochrane Diagnostic Reviewers’ Handbook. Results: The diagnostic performance of diarrhea, abdominal pain, bloating, flatulence and self-reported milk intolerance was highly variable. A non-Caucasian ethnic origin was associated with the presence of lactose malabsorption. Both lactose malabsorbers and lactose absorbers reported symptoms during the lactose hydrogen breath test. Conclusions: Our review shows that high-quality studies on the diagnosis of lactose malabsorption and intolerance in primary care are urgently needed. An important prerequisite would be to clearly define the concept of lactose intolerance, as well as how it should be assessed.
- Diuretic, opiate and nitrate use in severe acidotic acute... Background: Drug treatments for acute cardiogenic pulmonary oedema (ACPO) have not been rigorously evaluated and recent observational data suggests some agents are related to poorer outcome. Aim: We aimed to examine the effect of treatment with diuretics, nitrates and opiates on 7-day mortality, acidosis and respiratory distress in UK Emergency Department (ED) patients with severe acidotic pulmonary oedema. Design: Analysis of data from the 3CPO trial; a multicentre randomized controlled trial. Methods: Data were analysed from patients recruited with severe acidotic pulmonary oedema to the 3CPO trial in 26 UK EDs between 2003 and 2007. The effects of these treatments on 7-day mortality, improvement in acidosis (pH change between baseline and 1 h) and improvement in respiratory distress (patient measured breathlessness using a Visual Analogue Score between baseline and 1 h) were tested using univariate logistic regression analysis, and a regression model used to adjust for confounding baseline differences. Results: Nitrates were given to 947/1048 (90.4%) patients, diuretics to 934/1049 (89.0%) patients and opiates to 541/1052 patients (51.4%). Adjusted analysis showed that opiate treatment was associated with less improvement in acidosis [difference in improvement in pH –0.022, 95% confidence interval (CI) –0.014 to –0.030, P < 0.001], but no difference in mortality or improvement in respiratory distress. We found no evidence that nitrate or diuretic use were associated with any difference in mortality, improvement in acidosis or respiratory distress. Conclusions: Opiate use is associated with less improvement in acidosis during initial treatment and may attenuate effective treatment of severe acidotic ACPO.
- The hazards of diagnosis Background: Making a diagnosis is perceived as a climax of clinical effort. Little consideration is being given to potential down sides after the diagnosis is achieved. Methods: The authors' personal experience, extensive discussions with peers and a search of the literature. Results: Several common and significant pitfalls after making a diagnosis were identified. They include 'locking' and disregard of further data pointing to possible diagnostic error; pursuing a diagnosis when further information has little practical significance; a severe impact of the news on the patient; a 'stigma' effect; loss of the patient's individual narrative; stopping the diagnosis short of the full pathogenesis or of its finer characterization; disregarding additional medical issues; losing interest in the patients once the diagnostic problem is solved; and assuming full control of future decisions at the expense of the patient's autonomy. Conclusions: Physicians need to be cognizant of the impact and significant potential for harm associated with closure of diagnosis and its delivery to their patient. Humility, double-checking and sensitivity to the patient's predicament may improve quality and communication and prevent ‘the hazards of diagnosis’.
- Orthostatic symptoms predict functional capacity in chron... Objectives: To establish the relationship between the functional impairment experienced by Chronic fatigue syndrome (CFS) patients and the symptoms frequently experienced by those with CFS; specifically cognitive impairment, fatigue and orthostatic symptoms. Design: Cross sectional questionnaire survey. Setting: Specialist CFS Clinical Service. Subjects: Ninety-nine Fukuda diagnosed CFS and 64-matched controls. Main outcome measures: Symptom and functional assessment tools completed and returned by post included; PROMIS HAQ (Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire), CFQ (Cognitive Failures Questionnaire), FIS (Fatigue Impact Scale) and OGS (Orthostatic Grading Scale) assessment tools. Results: CFS patients experience greater functional impairment than controls [mean (95% CI) PROMIS HAQ scores CFS 36 (31–42) vs. controls 6 (2–10); P < 0.0001], especially in the functional domains of activities and reach. Poorer functional ability impairment is significantly associated with greater cognitive impairment (P = 0.0002, r = 0.4), fatigue (P < 0.0001, r = 0.5) and orthostatic symptoms (P < 0.0001, r = 0.6). However, only orthostatic symptoms (OGS) independently associated with functional impairment (β = 0.4, P = 0.01). Conclusions: Treatment of orthostatic symptoms in CFS has the potential to improve functional capacity and so improve quality of life.
- The use of an exclusion-based risk-assessment model for v... Background: Venous thromboembolism is a common condition in hospitalized medical patients. Numerous studies have demonstrated that low molecular weight heparin significantly reduces this risk but, despite this, the use of thromboprophylaxis remains poor. Aim: To evaluate the use of an exclusion based risk-assessment model (RAM) for venous thrombosis in improving the uptake of appropriate thromboprophylaxis in hospitalized medical patients. Design: A survey with a subsequent audit cycle of three separate audits over 36 months. Methods: 497 hospitalized patients with acute medical conditions on general medical wards were audited at a secondary care centre in London, UK. The survey and subsequent audits were performed by reviewing the notes and medication charts of medical patients, prior to the launch of the RAM and at 12, 28 and 36 months following its introduction. Results: Prior to launching the RAM, 49% of hospitalized medical patients received appropriate thromboprophylaxis. This did not change 12 months after the RAM was introduced but increased significantly to 71% following formal education of the health care professionals involved in thromboprophylaxis prescription. This improvement was maintained as demonstrated by a subsequent audit 8 months later (75.9%). Conclusions: The introduction of a simple exclusion-based RAM for venous thrombosis in medical patients significantly improved delivery of thromboprophylaxis. The successful uptake of the RAM appears to have been dependent on direct education of those health carers involved in its use. A similar exclusion-based model used nationally could have a significant impact on the burden of VTE currently experienced in the UK.
- Apoplexy in a corticotrophin-secreting pituitary macroade...
- A potential role for keratinocyte growth factor and clari...
- Subclavian cycle syndrome
The American Journal of Medicine
- Learning to Write: A Personal Reflection Many of you have asked me how someone's career can evolve to marry medicine and editing and writing. The story actually begins with learning to read. My father's sister, a frequent visitor in our home, was a first grade teacher who began teaching me to read when I was 3 years old. As a journalism major and later as a career journalist, my mother was chief proofreader and critic of any school writing project. But all that changed when I was 14 years old, and my mother, tiring of typing our school essays, enrolled my brother and me in a summer secretarial school typing class where I learned to touch type without looking at my fingers on the keyboard. At the time I had no idea how important this skill would become. In later years, I often jokingly told my mother that the “best thing she ever did for me was to enroll me in the secretarial typing class.” Although typing is not writing, this skill started to pay off in high school when I wrote for the school newspaper and literary magazine, and found that typing efficiency could lead to better writing and more effective self-editing. My mother continued to encourage me to write both literary and academic essays, and I found great satisfaction in doing so.
- The Future of Malpractice Reform There are few topics in health care that incite as much fervor as the American malpractice system. Almost every interested party—patients, physicians, and policymakers—has expressed an opinion on malpractice reform. Physicians, particularly through professional organizations, have long argued that the American malpractice system leads to a multitude of problems, such as an aversion to disclose medical errors, defensive medicine (the overuse of clinical services because of malpractice fears), and limitations on access to care, particularly care that is perceived as high risk.
- Pain/Depression Dyad: A Key to a Better Understanding and... Abstract: Functional somatic syndromes include some of the most common and frustrating illnesses seen by primary care physicians and medical specialists. An extensive literature search of the 2 best characterized functional somatic syndromes, fibromyalgia and irritable bowel syndrome, reveals the overlap of these 2 disorders and their close relationship to depression. New pathophysiologic studies have shown that there are similar central nervous system changes in fibromyalgia, irritable bowel syndrome, and depression. These clinical and biologic similarities are consistent with the observations that the effective management of fibromyalgia and irritable bowel syndrome is comparable to that of depression.
- Assessing the Presence and Severity of Depression in Subj... Abstract: Our understanding of how depression alters the origin and course of coronary heart disease is derived from subjective methodologies. Many psychiatric instruments were not tested for reliability and validity in subjects with comorbid medical illness, particularly coronary heart disease. They largely use scales of categoric or ordinal variables. Instruments used to assess coronary heart disease are considerably more objective and often use interval variables. By searching the websites of Circulation and the Journal of the American College of Cardiology, we entered the word “depression” on August 28, 2009. We ignored articles using “depression” in the context of cardiovascular concepts such as “ST-segment depression.” By searching articles dating back to 1995, we selected publications that studied the prognostic association of depression and coronary heart disease. There were 5 relevant publications: 3 from Circulation and 2 from the Journal of the American College of Cardiology. The methods used to assess coronary heart disease (specifically, myocardial infarction) are largely homogenous across the studies, but the methods used to assess depression are heterogeneous. Parameters used to diagnose myocardial infarction and determine its severity are precise, objective, and reliable, whereas those used to assess depression and its severity exhibit less precision and lack comparable objectivity and reliability. This mismatch may compromise our understanding of the link between coronary heart disease and depression in depressed patients with comorbid coronary heart disease. We propose using precise instruments to identify and quantitate coronary heart disease as outcome variables to assess psychiatric interventions and to better define depression in depressed patients with comorbid coronary heart disease. This should lead to a better understanding of the link between depression and comorbid coronary heart disease.
- Celiac Disease Diagnosis: Simple Rules Are Better Than Co... Abstract: Celiac disease is the only treatable autoimmune disease, provided that a correct diagnosis is achieved and a strict, lifelong gluten-free diet is implemented. The current diagnostic algorithm for celiac disease includes initial screening serological tests, followed by a confirmatory small intestinal biopsy showing the autoimmune insult typical of celiac disease. The biopsy, considered the diagnostic gold standard, has been recently questioned as a reliable and conclusive test for every case. Indeed, the wide variability of celiac disease-related findings suggests that it is difficult to conceptualize the diagnostic process into rigid algorithms that do not always cover the clinical complexity of this disease. Instead we find clinically useful the shifting to a quantitative approach that can be defined as the “4 out of 5” rule: the diagnosis of celiac disease is confirmed if at least 4 of the following 5 criteria are satisfied: typical symptoms of celiac disease; positivity of serum celiac disease immunoglobulin, A class autoantibodies at high titer; human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes; celiac enteropathy at the small bowel biopsy; and response to the gluten-free diet.
- Sweet's Syndrome A 31-year-old woman with no significant medical history was admitted to the hospital with a 5-day history of development of slightly painful, pustular lesions on her face and neck, chest, upper back, axillae, and suprapubic area. The patient had been seen in an urgent care center and diagnosed with “strep throat” approximately 2 weeks before admission and had received a course of oral amoxicillin. Five days before admission, she was reevaluated at the urgent care center because of low-grade fever and pustular lesions on the right side of her face and neck. Oral trimethoprim/sulfamethoxazole was administered, but her skin lesions continued to progress as described, and she presented for admission.
- Malignant Mimicry Although syphilis has been known historically as “the Great Mimicker,” some other diseases also merit this appellation, presenting with a plethora of symptoms and signs commonly ascribed to other ailments. We recently had the opportunity to care for a patient whose pathologic condition masqueraded as an alternative condition.
- A Diagnosis in Vein Frequently, patients describe symptoms that seem to have limited relevance to their presentation but ultimately prove to be the critical clue to the diagnosis. This case illustrates the importance of listening carefully to our patients. Dismissal of seemingly insignificant symptoms can lead to vain diagnostic efforts.
- Captain Ignose to the Rescue Some patients require powerful incentive before they seek a physician's help. After years of avoiding medical attention, a 68-year-old man presented from home with shortness of breath that was so severe, he was unable to leave the house to purchase cigarettes. He had become progressively more homebound during the previous year due to gradually deteriorating respiratory status. In the weeks before presentation, his chronic dyspnea had become far worse, preventing him from performing routine activities. During the same period, he also had developed a severe physical and emotional malaise. He took no medications, lived alone, and had smoked 2 packs of cigarettes a day for more than 40 years.
- A Toxic Combination This case reminds the physician to be cautious when administering QT-prolonging medications to patients with underlying heart disease. A 73-year-old man with a known history of chronic obstructive pulmonary disease presented to the emergency department with severe dyspnea and altered mental status. He was promptly intubated by the emergency department physicians, placed on mechanical ventilation, and given intravenous levofloxacin and corticosteroids. He was transferred to the medical intensive care unit for management. An electrocardiogram (ECG) taken at admission showed signs of left ventricular hypertrophy and a QTc interval (QT interval corrected for heart rate) of 450 msec.
European Journal of Internal Medicine
- Editorial Board
- Contents
- Current methods to diagnose the unresponsive and complica... Abstract: Coeliac disease is a common disorder. Due to the protean manifestations of the disease and the often mild but indolent course, the diagnosis is often missed. The method to diagnose this in principle reversible disease after the introduction of a gluten-free diet has attracted the attention of several scientific disciplines to find the simplest and most patient-friendly test. This has resulted in a noticeable impact on the clinical practice next to a general increased awareness of its existence, its pathogenesis, its course and recent evidence of increased mortality.Amendments made in the diagnostic criteria of coeliac disease over the last half century have simplified the diagnosis. However, the aspect most relevant to the specialist in internal medicine is related to its grave consequences when the disease fails to respond to a gluten-free diet. These refractory cases may culminate in severe complications with sombre endings and malignancy. Fortunately, current technology can offer the specialist in internal medicine more facilities to diagnose the cause of the complicated cases in order to attempt to intervene in the course of disease and hopefully save these patients.We review the available tools that now exist and their indications that can be practiced in a modern clinical setting for the diagnosis of the complicated forms of this disease.
- Mechanism of hemostasis defects and management of bleedin... Abstract: The main cause of the hemostasis defects and related bleeding complications in patients with acute coronary syndromes (ACS) are the intake of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as coronary angiography and percutaneous coronary intervention (PCI). Antithrombotic drugs that impair several phases of hemostasis (platelet function, coagulation, and fibrinolysis) are causing bleeding particularly in elderly patients, in those underweight and with comorbidities such as renal insufficiency, diabetes, hypertension and malignancy. Identification of patients at high risk of bleeding is the most important preventive strategy, because the choice and dosages of drugs may to some extent be tailored to the degree of risk. Transfusions of blood products, which may become necessary in patients with major bleeding, should be used with caution, because they are associated with adverse cardiovascular events. To reduce the need of transfusion, the hemostatic drugs that decrease blood loss and transfusion requirements in cardiac surgery (antifibrinolytic amino acids, desmopressin, and recombinant factor VIIa) might be considered. However, the efficacy of these drugs in the control of bleeding complications is not unequivocally established in ACS and there is concern for an increased risk of thrombosis. In conclusion, evidence-based recommendations for the management of bleeding in patients with ACS are currently lacking, so that prevention through accurate assessment of the individual risk is the most valid strategy.
- A closer look at paroxysmal nocturnal hemoglobinuria Abstract: Knowledge of the molecular mechanisms leading to the paroxysmal nocturnal hemoglobinuria (PNH) phenotypes has substantially increased in the past two decades. The associated intravascular hemolysis, hypercoagulablilty, and bone marrow failure result in a wide range of clinical sequlae. Although treatment has usually been symptomatic through several modalities and rarely curative through hematopoietic cell transplantation, recent development of the novel targeted therapeutic agent eculizumab has offered new promises for this highly morbid and fatal disease. This review summarizes current knowledge of the pathophysiology, diagnostic modalities, clinical implications, and treatment approaches of patients with PNH.
- Body height and sex-related differences in incidence of v... Abstract: Background: Sex-related differences in incidence rate of venous thromboembolism (VTE) have been reported. It is unclear whether these differences reflect sex-related differences in the incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) or both and to which extent the differences are mediated by known risk factors for VTE.Objective: To compare the incidence of DVT and PE between middle-aged men and women.Methods: We computed sex-specific incidences of VTE, DVT and PE and estimated the crude and adjusted incidence rate ratios (IRR) of VTE, DVT and PE using Cox regression for men versus women participating in the prospective study Diet, Cancer and Health. We controlled for body mass index, body height, leisure-time physical activity and smoking dose.Results: We verified 641 VTE events during a median follow-up time of 10years. The overall incidence of VTE was 1.15 [95%CI: 1.07–1.25] per thousand person years; it was higher for men than women (crude IRR: 1.55 [95%CI: 1.32–1.82]). The adjusted IRR for DVT was 1.06 [95%CI: 0.75–1.50] and for PE 0.60 [95%CI: 0.41–1.18] for men versus women. The higher rate among men appeared to be mediated mainly by body height.Conclusions: In this middle-aged population, men experienced a higher incidence of VTE due to a higher incidence of DVT. The higher incidence among men appeared to be mediated by body height. Adjusted for body height, male sex was not associated with an excess risk of either VTE or DVT but the risk of PE was notably lower compared with women.
- No early signs of atherosclerotic alterations in carriers... Abstract: Background: Congenital thrombophilia is a risk factor for venous thromboembolism (VTE). Whether it is associated with increased risk of arterial disease is today a matter of debate. We aimed to look for early signs of atherosclerotic alterations in carriers of inherited thrombophilic alterations (ITA).Methods: Between January 2006 and September 2008 ultrasonography assessment of the carotid arteries with measurement of intima-media thickness (IMT), and determination of the ankle/brachial pressure index (ABI), was performed in: a) 161 carriers of ITA (deficiency of antithrombin, protein C or S, factor V Leiden or prothrombin G20210A mutations), 84 of whom with previous VTE, and b) 180 subjects without ITA, matched for age, sex and previous VTE. All subjects were 1mm) were detected in 6 subjects with and 1 without thrombophilia (p=0.055). The prevalence of IMT values>90th percentile was not different in subjects with/without thrombophilia (15.2% vs 11.6%, p=0.416). At multivariate analysis only age was significantly associated with increased odds ratios for IMT values>90th percentile. No subjects had abnormal (<0.9) ABI values.Conclusions: The present study, the first to investigate the presence of atherosclerotic markers in relatively young subjects with inherited thrombophilia, did not find a particular prevalence of signs of early atherosclerotic markers in these subjects.
- Delay and misdiagnosis in sub-massive and non-massive acu... Abstract: Background: There is limited information about the extent and clinical importance of the delay in the diagnosis of acute pulmonary embolism.Patients and methods: Between 1998 and 2009, all consecutive patients diagnosed of acute pulmonary embolism from a registry of a single department were evaluated. We recorded the start or shift in symptoms as the beginning of pulmonary embolism and the mistaken diagnosis for which the patients had been treated. We evaluated the factors associated with the delay and misdiagnosis and their relation with mortality.Results: Overall 375 patients were evaluated. Median age was 75years, interquartile range (IQR) 15, and female 186 (49%). Median delay was 6 (IQR 12) days. Median Wells score was 4.5 (IQR 3).Delay in diagnosis was longer than 6days in 50% (95% CI 44–55) of patients, longer than 14days in 25% (95% CI 21–30) and longer than 21days in 10% (95% CI 7–13). Misdiagnosis occurred in 50% (95% CI 44–55) of patients. Higher age, more days of delay and the absence of syncope or sudden onset dyspnea were factors associated with misdiagnosis.Follow-up was carried out in 331 patients during a median of 31 (IQR 45) months. 36% (95% CI 33–43) of patients died [median 8 (IQR 29) months]. Higher age, misdiagnosis and a history of cancer were factors associated with mortality. Days of delay were not associated with mortality.Conclusions: Delay and misdiagnosis of pulmonary embolism is frequent. Elderly patients and the absence of syncope or sudden onset dyspnea favour the misdiagnosis. Delay in diagnosis does not participate in mortality.
- Safety of withholding anticoagulant therapy in patients w... Abstract: Background: To assess the safety of withholding anticoagulant therapy in patients with clinically suspected pulmonary embolism with a negative multislice computed tomography pulmonary angiography (MCTPA).Methods: Three hundred and eighty six patients who were consecutively assessed in the emergency room of our institution for suspected pulmonary embolism were eligible for our study. Patients with either a low or an intermediate clinical probability of pulmonary embolism according to the Wells score and a negative MCTPA for pulmonary embolism were enrolled. Patients with anticoagulant therapy for other medical conditions were excluded from this study. We assessed the percentage of patients in whom venous thromboembolic events or death related to this condition within three months after the negative CT.Results: Two hundred and forty two patients were included in our series [mean age±standard deviation (SD) (63.1±18.1)]. Only one patient (0.41% [95% confidence interval −0.4%–1.22%]) showed a non-fatal pulmonary embolism during the three-month follow-up period after an initial negative CT scan (negative predictive value, 99.58%). Eleven patients died during the follow-up period due to conditions unrelated to venous thromboembolic disease (pneumonia [n=5], lung cancer [n=2], wasting syndrome [n=1], acute myocardial infarction [n=1], leiomyosarcoma [n=1], and severe pulmonary hypertension [n=1]).Conclusions: Withholding anticoagulant therapy in patients with suspected venous thromboembolic disease with a negative result on MCTPA seems to be safe in our clinical setting.
- Single nucleotide polymorphisms in inflammation-related g... Abstract: Background: Various genetic risk factors are known to increase the risk of venous thromboembolism (VTE). Increasing evidence suggests a “cross-talk” between the coagulation and inflammatory cascade. Therefore, polymorphisms in genes involved in inflammation may influence susceptibility towards VTE. The aim of the study was to investigate the role of single nucleotide polymorphisms (SNPs) in inflammation genes for susceptibility towards VTE.Methods: The study group consisted of 108 (47 men and 61 women) Dutch patients with documented VTE and 325 healthy controls from the same geographical area (117 men and 208 women). Odds ratios (OR) and 95% confidence intervals (95% CI) for VTE separately and if indicated by gender were calculated to assess whether genotype and allele frequency were associated with thrombosis.Results: Heterozygosity for SNP −899C/T of the interleukin 1-alpha gene (IL1A −899C/T) was under-represented in VTE patients compared to the control group (OR=0.51, 95% CI 0.32–0.82). The IL6 −174 CC genotype was more frequent in male patients with VTE compared to male controls (OR=4.06, 95% CI 1.43–11.5). Female patients carried significantly more IL13 (intron3) TT genotype (OR=5.60, 95% CI 1.94–18.5) compared to female controls. The allelic frequency of IL4 −589 T allele was significantly increased in female patients (OR=1.72, 95% CI 1.05–2.81) in contrast to men where no differences were observed.Conclusion: Four SNPs in inflammatory-related genes of IL1A, IL4, IL6, and IL13 may be associated with VTE. These results need to be confirmed in independent groups with larger number of patients.
Canadian Medical Association Journal current issue
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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--'Don't know much biology ... ' Study painting, drama or the "soft" social sciences and you'll probably be a pretty good doctor anyway. Mt. Sinai School of Medicine has been doing it for years and compared students in a special liberal arts admissions program to its traditional pre-med students. For years, Mt. Sinai has admitted students from Amherst, Brandeis, Princeton, Wesleyan, and Williams colleges based on a written application with personal essays, verbal and math SAT scores, high school and college transcripts, letters of recommendation, and personal interviews. No MCAT is required.Students need to take one year of biology and one year of chemistry and maintain (swallow hard) a B average. They later get an abbreviated course in organic chemistry and medical physics. Researchers compared 85 students in this program to their traditionally-trained peers and reported results in Academic Medicine. The liberal arts students struggled more early on with the sciences, their gross anatomy coursework and the Step 1 exam. But by the end, they equaled their peers and were highly successful in university hospitals, and in psychiatry and pediatrics, often taking more prizes and awards at graduation. Authors wrote, "Although students in this program have more academic difficulties in the preclinical years, they excel in the clinical/community setting and have greatly enriched the medical school environment. This program demonstrates that success in medical school does not depend on a traditional premed science curriculum."Singer Sam Cooke would have been a great doctor. Just listen to all the pre-med subjects he knows nothing about.In case you missed it ... The Senate introduced a bi-partisan bill to reduce hospital readmissions by including lawyers on the health delivery team. The legislation would fund a pilot demonstration of providing legal help for patients in public health settings. Domestic violence, housing and Medicaid benefits were cited as three examples of how legal advice could prevent the same issues from cropping up over and over. (The Hill)
- New Pap smear guidelines: right care or rationed care? This post by Davis Liu, MD, appeared at Better Health.The American College of Obstetricians and Gynecologists (ACOG) recently reiterated their position that Pap smears should be performed on healthy women starting at age 21. This is different from the past which recommended screening for cervical cancer at either three years after the time a woman became sexually active or age 21, whichever occurred first.How will the public respond to this change?Over the past year there have been plenty of announcements from the medical profession regarding to the appropriateness of PSA screening for prostate cancer and the timing of mammogram screening for breast cancer. Understandably, some people may view these changes in recommendations as the rationing of American healthcare.They should instead, however, welcome these advancements. Doctors are becoming even better at understanding which screening tests work and which ones don't.Doctors have discovered that for cervical cancer, which is detected by Pap smears, a significant risk factor in infection from the human papilloma virus (HPV). HPV is the most common sexually-transmitted disease and aside from causing cervical cancer is also the cause of genital warts. Women under age 21 who are healthy and do not have a compromised immune system from HIV or organ transplant rarely develop cervical cancer from HPV infection.Unlike the past, when women needed annual Pap smears, advances in screening with new liquid-based Pap smears as well as screening for HPV allows women to be checked for cervical cancer every other year. Women age 30 and older who have had three normal pap smears in a row can have Pap smears every two to three years with a Pap smear or every three years with a Pap test and HPV DNA screening.If all doctors recommended these interventions, this would reduce the number of Pap smears needed by 50%. The newest cervical cancer screening method would be far better as it identified which women were at risk with better precision and information than the past. By doing fewer unnecessary Pap smears, doctors are now free to address other problems as well as begin to take on the millions of Americans who will have health insurance due to reform.The question is will they do it? Will women accept the new changes in screening intervals?Research shows it takes about 17 years before results of studies and guidelines become commonly practiced in the community. One study showed primary care doctors were not particularly good at screening for colon cancer though new guidelines have been around for a decade.It's easy to blame doctors for being slow to change. It's easy to blame patients for being slow to change. Many of my patients still demand an annual pap smear even though HPV DNA testing is something my colleagues and I have practiced for years.The fact is that change is hard unless of course you are new to something. As my five year old daughter proudly told me recently there are exactly EIGHT planets, not nine, in the solar system.For the next generation of women, they will not need Pap smears until age 21. They can be safely screened every other year. There is a chance that none of them will ever develop cervical cancer as, since 2006, HPV vaccines exist for individuals age 9 to 26 that immunize them from the subtypes of HPV that cause cancer.These women won't get upset. They won't get worried. They know this is the right care. This is not rationed care. That is, of course, until the next revision in the guidelines and recommendations.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.
- Crackdowns on painkillers may deny some legitimate uses This post by ACP Member Kevin Pho, MD, originally appeared on MedPage Today's KevinMD.com.Patients requiring controlled substances to manage their pain have always been controversial to treat. Every time the subject is broached on KevinMD.com, the comments inevitably becomes a contentious discussion of "drug seeking behavior" versus treating legitimate pain.It's a problem that doctors nationwide grapple with every day, and is addressed in a recent essay from the New York Times.Michael Kahn is a Boston psychiatrist who recently asked residents how they would approach a patient who had asked for Xanax, a benzodiazepine often used to treat anxiety.In the end, Dr. Kahn notes that, "The prevailing attitude was one of 'They'll have to pry that pill from my cold dead hands.' It made me wonder whether these budding psychiatrists might be working too hard to avoid being hoodwinked."He then compares screening patients for drug seeking behavior with tests from other medical fields: "Surgeons are fooled when they open an acutely painful abdomen only to find a normal appendix: in the days before CT scans, it was said that if that didn't happen once in a while, you weren't operating often enough. When in doubt, it was safer (and wiser) to operate than to risk a rupture and peritonitis, even if the diagnosis was 'wrong.' Here was an error that wasn't an error, but rather a predictable side effect of balancing known risks with imperfect information."Applying that to pain management, he suggests accepting a degree of false positives instead of missing patients with true pain: "I'd rather be taken for a sucker once in a while than know that my suspicion had denied someone legitimate help."That's certainly the ideal, but the federal government isn't helping matters much. Recent high-profile crackdowns of more liberally prescribing physicians have scared doctors into a bunker-like mentality. Until there is better clarity from both law enforcement and pain specialists as to what constitutes appropriate pain management prescribing, it's likely that patients in true pain will continue to suffer.This post originally appeared on MedPage Today's KevinMD.com, social media's leading physician voice. Voted best medical blog in 2008, and with over 33,000 subscribers and 23,000 Twitter followers, KevinMD.com is the web's definitive site for influential health commentary.
- QD: News Every Day--'Unusual' health utilization drop unc... Americans are using less health care than they used too. A weak economy, high unemployment and more high-deductable plans may all be to blame for an unusual pattern of lower utilization, as measured by insurers, labs, hospitals and physician billing services. Weak demand could accomplish one health reform goal of bending the cost curve. Or, it could bend the curve like a diving board, only to see costs bounce upward later. (Wall Street Journal)Health care reform is encouraging Texas physicians to leave private practice for hospital-owned arrangements. The new law lets Medicare reward accountable care organizations in which doctors and facilities collaborate to improve care and reduce hospitalizations. And, the financial pressure on private physicians is tremendous right now. But while hospitals are gobbling up independent practices, not every doctor is lining up to affiliate. They worry about how much of the rewards they'll see, and they don’t want to be told how to practice medicine. (Los Angeles Times, ACP Internist)Don't try this at homeTeetotalers have four times the risk of rheumatoid arthritis as people who drink more than 10 days a month, reports a study. Authors divided more than 1,000 adults into four categories, based on how frequently (but not how much) they drank. Arthritis was progressively less severe as frequency increased, with noticeable differences between abstainers and people who drink one to five times a month. More frequent drinking also lessened the severity of inflammation in joints, as measured by X-rays. Rheumatologist Guy Fiocco, FACP, said while it's known that alcohol suppresses the immune system, drinking is still not an advisable arthritis remedy. People who drink excessively have more cytokines, which lead to inflammation. (MSN)
- QD: News Every Day--a friend indeed A study published in the July PLoS Medicine is getting a lot of press today for its conclusion that strong social networks are related to increased life span. The meta-analysis of 148 studies involving 308,849 people found that those with stronger relationships were 50% more likely to survive over 7.5 years of follow-up. What's more, the researchers reported that a lack of strong social ties is as bad, healthwise, as drinking or smoking and worse than not exercising or being obese. But although the association between strong social ties and improved longevity seems robust, other factors could be at play, and applying the findings in clinical practice could be difficult. And sorry, Facebook fanatics: Online "friendships" aren't thought to count as much as in-person ones do. (PLoS Medicine, New York Times, TIME, The Atlantic)
- QD: News Every Day--Telemedicine advances ease patient ad... Monitoring vital signs remotely saves time and money for everyone: patients, physicians, facilities and insurers. Heart failure is a particular target because its increasingly common, its easily triggered (by as little as too much salt on food, for example) it costs so much to manage in the hospital and it's so easily avoided. Remote monitoring equipment made even easier with wireless connections can take vital signs, and even ask standard questions every morning. The equipment puts patients in contact with nurses once they detect warning signs. That human touch is key. Case managers can screen out false alarms (avoiding alert fatigue) and can direct patients to the physician when needed. ACP Internist covered remote monitoring technology in its March issue. (Wall Street Journal, ACP Internist)Ironically, the hospitals themselves are having trouble making the most of the technology they install, reports the American Hospital Association. The group changed its top 100 "Most Wired" hospital list to reflect new standards in infrastructure, administration, clinical quality and safety, and continuity of care in the ambulatory and physician community. 30% of hospitals on last year's list didn't make it back this year, and the list had to be pared down to 99 because that's all that met the criteria. One area of concern is electronic medical record use in affiliated (not owned) practices. 43% of practices affiliated with a "Most Wired" hospital use one, while 69% of owned practices do.
- A letter to patients with chronic illness Author's Note: The following post, which recently appeared in my blog, has had a larger response from readers than any other I have written. The depth of emotion felt by people with chronic disease making comments that this stirred was remarkable. This is clearly an issue we physicians mishandle often. Chronic disease patients are the mainstay of internal medicine, but many of us don't quite understand what it's like to face this every day. I encourage you to go over and read the comments.Dear Patients:You have it very hard, much harder than most people understand. Having sat for 16 years listening to the stories, seeing the tiredness in your eyes, hearing you try to describe the indescribable, I have come to understand that I too can't understand what your lives are like. How do you answer the question, "how do you feel?" when you've forgotten what "normal" feels like? How do you deal with all of the people who think you are exaggerating your pain, your emotions, your fatigue? How do you decide when to believe them or when to trust your own body? How do you cope with living a life that won't let you forget about your frailty, your limits, your mortality?I can't imagine.But I do bring something to the table that you may not know. I do have information that you can't really understand because of your unique perspective, your battered world. There is something that you need to understand that, while it won't undo your pain, make your fatigue go away, or lift your emotions, it will help you. It's information without which you bring yourself more pain than you need suffer; it's a truth that is a key to getting the help you need much easier than you have in the past. It may not seem important, but trust me, it is.You scare doctors.No, I am not talking about the fear of disease, pain, or death. I am not talking about doctors being afraid of the limits of their knowledge. I am talking about your understanding of a fact that everyone else seems to miss, a fact that many doctors hide from: We are normal, fallible people who happen to doctor for a job. We are not special. In fact, many of us are very insecure, wanting to feel the affirmation of people who get better, hearing the praise of those we help. We want to cure disease, to save lives, to be the helping hand, the right person in the right place at the right time.But chronic unsolvable disease stands square in our way. You don't get better, and it makes many of us frustrated, and it makes some of us mad at you. We don't want to face things we can't fix because it shows our limits. We want the miraculous, and you deny us that chance.And since this is the perspective you have when you see doctors, your view of them is quite different. You see us getting frustrated. You see us when we feel like giving up. When we take care of you, we have to leave behind the illusion of control, of power over disease. We get angry, feel insecure, and want to move on to a patient who we can fix, save, or impress. You are the rock that proves how easily the ship can be sunk. So your view of doctors is quite different.Then there is the fact that you also possess something that is usually our domain: knowledge. You know more about your disease than many of us do-- most of us do. Your MS, rheumatoid arthritis, end-stage kidney disease, Cushing's disease, bipolar disorder, chronic pain disorder, brittle diabetes, or disabling psychiatric disorder--your defining pain--is something most of us don't regularly encounter. It's something most of us try to avoid. So you possess deep understanding of something that many doctors don't possess. Even doctors who specialize in your disorder don't share the kind of knowledge you can only get through living with a disease. It's like a parent's knowledge of their child versus that of a pediatrician. They may have breadth of knowledge, but you have depth of knowledge that no doctor can possess.So when you approach a doctor, especially one you've never met before, you come with a knowledge of your disease that they don't have, and a knowledge of the doctor's limitations that few other patients have. You see why you scare doctors? It's not your fault that you do, but ignoring this fact will limit the help you can only get from them. I know this because, just like you know your disease better than any doctor, I know what being a doctor feels like more than any patient could ever understand. You encounter doctors intermittently (more than you wish, perhaps); I live as a doctor continuously.So let me be so bold as to give you advice on dealing with doctors. There are some things you can do to make things easier, and others that can sabotage any hope of a good relationship:--Don't come on too strong. Yes, you have to advocate for yourself, but remember that doctors are used to being in control. All of the other patients come into the room with immediate respect, but your understanding has torn down the doctor-god illusion. That's a good thing in the long-run, but few doctors want to be greeted with that reality from the start. Your goal with any doctor is to build a partnership of trust that goes both ways, and coming on too strong at the start can hurt your chances of ever having that.--Show respect. I say this one carefully, because there are certainly some doctors who don't treat patients with respect, especially ones like you with chronic disease. These doctors should be avoided. But most of us are not like that; we really want to help people and try to treat them well. But we have worked very hard to earn our position; it was not bestowed by fiat or family tree. Just as you want to be listened to, so do we.--Keep your eggs in only a few baskets. Find a good primary care doctor and a couple of specialists you trust. Don't expect a new doctor to figure things out quickly. It takes me years of repeated visits to really understand many of my chronic disease patients. The best care happens when a doctor understands the patient and the when the patient understands the doctor. This can only happen over time. Heck, I struggle even seeing the chronically sick patients for other doctors in my practice. There is something very powerful in having understanding built over time.--Use the ER only when absolutely needed. Emergency room physicians will always struggle with you. Just expect that. Their job is to decide if you need to be hospitalized, if you need emergency treatment, or if you can go home. They might not fix your pain, and certainly won't try to fully understand you. That's not their job. They went into their specialty to fix problems quickly and move on, not manage chronic disease. The same goes for any doctor you see for a short time: they will try to get done with you as quickly as possible.--Don't avoid doctors. One of the most frustrating things for me is when a complicated patient comes in after a long absence with a huge list of problems they want me to address. I can't work that way, and I don't think many doctors can. Each visit should address only a few problems at a time, otherwise things get confused and more mistakes are made. It's OK to keep a list of your own problems so things don't get left out. I actually like getting those lists, as long as people don't expect me to handle all of the problems. It helps me to prioritize with them.--Don't put up with the jerks. Unless you have no choice (in the ER, for example), you should keep looking until you find the right doctor(s) for you. Some docs are not cut out for chronic disease, while some of us like the long-term relationship. Don't feel you have to put up with docs who don't listen or minimize your problems. At the minimum, you should be able to find a doctor who doesn't totally suck.--Forgive us. Sometimes I forget about important things in my patients' lives. Sometimes I don't know you've had surgery or that your sister comes to see me as well. Sometimes I avoid people because I don't want to admit my limitations. Be patient with me. I usually know when I've messed up, and if you know me well I don't mind being reminded. Well, maybe I mind it a little.You know better than anyone that we docs are just people--with all the stupidity, inconsistency, and fallibility that goes with that--who happen to doctor for a living. I hope this helps, and I really hope you get the help you need. It does suck that you have your problem; I just hope this perhaps decreases that suckishness a little bit.Sincerely,Dr. RobRob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
- QD: News Every Day--Patient-centered pilots need a PR mak... While the patient-centered medical home may be a good idea, it needs a better name. It sounds like a hospice, reports surgeon and columnist Pauline Chen, MD. She outlines the initial experiences of practices making the transition to the new practice model.One problem uncovered by pilot projects is that doctors in transition to the practice model have to spend inordinate amounts of time of things other than patients. And while the patients want and welcome the changes, they face a learning curve too, as they move from seeing just the doctor to working with a team of providers for their care. Physicians suggested using resources from a collaborative group set up to help offices make the transition, the Patient-Centered Primary Care Collaborative. (New York Times)GenomicsIn a follow-up to last week's post, the maker of one direct-to-consumer genetics test has fired back at the Government Accountability Office's critical report of industry practices and results. While the GAO said the saliva-based gene tests are unreliable, test-maker 23andMe tossed a gob of its own at the agency, claiming it failed to analyze scientific information on its scientific merits, lumped credible companies in with all the rest and also failed to provide a copy of the report to companies before its release. (They may be spitting in the wind on that last point. The GAO works for Congress, not private industry.) 23andMe also pointed out that the GAO report hinged on the wide differences in results offered by each test, even though each one was conducted on the same test subject. Here, they talk about some of the difficulties of interpreting evidence-based medicine:"Instead of constructively adding to these efforts, GAO has instead implied that because results differ between companies, they are simply wrong. Their report fails to provide all relevant information, and perpetuates the misunderstandings of genetics in particular and science in general that 23andMe has since the very beginning been dedicated to changing."It should be noted that the problem of different risk predictions from different sources is not unique to the direct-to-consumer genetic testing industry. Take for example, these two tools (here and here) available to the public to calculate risk for cardiovascular disease. Both are clinically valid, yet they give different answers. It should be noted that development of both of these two tools was at least partially funded by the federal government."
- QD: News Every Day--OTC gene tests are usually wrong Rarely does a government report make for thrilling reading, but the subhead of this one was eye-catching: Direct to Consumer Genetic Tests: Misleading Test Results are Further Complicated by Deceptive Marketing and Other Questionable Practices. The title could have added "And they're expensive, too." The FDA has already been working on regulating genetic tests as medical devices, varying from their hands-off policy for lab tests. ACP Internist's genomics columnist, Greg Feero, MD, PhD, outlined how doctors can prepare for patients who use these tests and present results for interpretation. (Government Accountability Office, Reuters, ACP Internist)Normally, one would sit down to digest a report of this scope, but as it turns out, that's not advisable either. Women and men who are sedentary for six hours during their leisure time are 40% and 20% more likely to die sooner than those who spend less than three hours sedentary. Exercise, diet and obesity weren't factors, reported an American Cancer Society study of more than 123,000 people for 13 years. (CNN)
- QD: News Every Day--Patients don't mind long waits if kep... Patients don't mind waiting in the ER as long as they're kept apprised of the time, an industry survey revealed. This is a good thing, since ER waits have risen nationally to an average of four hours and seven minutes this year. Press Ganey Associates, Inc., has conducted the survey annually and says that ER wait times are four more minutes than last year, or a half hour more than the first survey in 2002. The company collected data on 1.5 million patients treated at 1,893 hospitals in 2009.Despite longer wait times, patient satisfaction with U.S. hospital emergency departments stayed about the same in 2009. Communication was the key, as patients who waited more than four hours, but received "good" or "very good" information about delays were just as satisfied as patients who spent less than one hour in the emergency department.Industry interactionAs a follow-up to yesterday's post on Harvard cracking down on physician-industry ties for its 11,000 faculty members, NPR points out that the rules have loopholes, albeit small ones. Faculty can still partner for speeches, research and consulting, but the intent is measured now. They can still accept meals and travel stipends, but they have to be integral to the work involved. Gifts are still forbidden, but CME courses can be industry-sponsored, just not single-sponsored. (ACP Internist, NPR)
AAFP News Now
- Financial, Technical Support Are Keys to Health IT Adopti... The American Recovery and Reinvestment Act of 2009, or ARRA, will spur the adoption and use of health information technology, or health IT, among small physician practices by giving them much-needed financial and technical support to implement health IT systems. Without this kind of assistance, many small physician practices will find it difficult, if not impossible, to adopt health IT and electronic health records, or EHRs. That was one of the main messages delivered by AAFP President-elect Roland Goertz, M.D., M.B.A., of Waco, Texas, and other witnesses who testified July 27 before the House Energy and Commerce Committee's Subcommittee on Health.
- 2010 Tar Wars Winner Trumps Brother's Achievement Jared Gorthy wasn't the first member of his family to be selected a state winner in the Colorado AFP's annual Tar Wars poster contest. That honor went to his brother Derek, who won the state contest and finished seventh at the Tar Wars National Conference in 2007. Jared, however, fared even better than his older brother and was named the winner of the AAFP initiative's 2010 national poster contest July 26 during the national conference in Washington, D.C.
- Provisions in Health Care Reform Law Lay Out Role of Prim... Recent passage of the Patient Protection and Affordable Care Act was only a starting point in reforming the health care system in the United States. As guidelines and regulations are developed, many health policy experts note that actual implementation of the law will not work without the ability to bend the health care cost curve. And that cannot be accomplished without a greater emphasis on prevention and primary care, making these two components essential to the ultimate success of health care reform.
- Health Care Reform Law Will Increase Demand for Preventiv... The recently enacted health care reform legislation, which calls for eliminating financial barriers for many preventive services, likely will create a greater demand for these services and give physicians a better opportunity to provide preventive care, according to analysts interviewed by AAFP News Now. The Patient Protection and Affordable Care Act will require new health plans (i.e., plans that are established on or after Sept. 23, 2010) to cover and eliminate copays, deductibles and coinsurance amounts for preventive services rated "A" or "B" by the U.S. Preventive Services Task Force.
- FDA Warns Docs, Consumers About Unapproved IUDs The FDA is warning physicians and consumers about risks associated with the use of unapproved intrauterine devices, or IUDs, and intrauterine systems, or IUSs. The agency said in a July 22 letter to physicians that the items in question include unapproved versions of various FDA-approved products.
- News Briefs: Week of July 26-30 This roundup includes the following news briefs: Study Examines Students' Intentions to Serve the Underserved; PCPCC Releases Guides on Payment Reform, Medication Management; AHRQ Launches Website on Medical Home; AHRQ Releases 2009 'State Snapshot' Report with New Features; HHS Extends Comment Period for Proposed Rulemaking on Financial Conflicts; State Supreme Court Rules in Favor of Physicians, Health Care Professionals; NIH Appoints Guttmacher Director of NICHD; Varmus Sworn in as New NCI Director; and HHS Seeks Suggestions for National CER Database.
- Operating Costs, Medicare Pay, EHRs Top 2010 'Challenges'... Keeping a U.S. medical practice afloat in 2010 is still a struggle, according to new survey data collected by the Medical Group Management Association, or MGMA. However, the specific day-to-day challenges of running a practice have shifted somewhat when compared with similar MGMA surveys conduced in 2008 and 2009. MGMA collected responses from 1,798 medical group practices across the country for this year's survey, dubbed "Medical Practice Today 2010: What Members Have to Say."
- Expanded Tax Relief on State Loan Repayment, Forgiveness ... Physicians who have received student loan forgiveness as an incentive to practice in medically underserved areas of their states may be eligible for some relief from federal income taxes on those loan amounts. Under Section 10908 of the new Patient Protection and Affordable Care Act, an existing tax exclusion has been expanded to include health professionals in 16 states who are enrolled in these types of state loan repayment or loan forgiveness programs.
- Pair of Studies Link Vitamin D, Cognitive Ability in Seniors Two recent studies indicate that vitamin D intake can have a significant effect on the cognitive abilities of the elderly. Unfortunately, more than half of older Americans have insufficient levels of vitamin D, according to David Llewellyn, Ph.D., a researcher at the University of Exeter Peninsula Medical School, United Kingdom. Llewellyn presented data on this topic from the Third National Health and Nutrition Examination Survey, or NHANES III, during the Alzheimer's Association International Conference on Alzheimer's Disease 2010, July 10-15 in Honolulu.
- Robert Graham Center to Study 'Social Mission' of Teachin... The Josiah Macy Jr. Foundation has awarded a two-year, $409,410 grant to the AAFP's Robert Graham Center and George Washington University, or GWU, both in Washington, to study how well teaching hospitals and teaching health centers are meeting the health care needs of the public. According to Robert Phillips, M.D., M.S.P.H., director of the Robert Graham Center, the upcoming study will examine two aspects of the medical workforce.
Journal of Internal Medicine
- Angiogenesis and biomarkers of cardiovascular risk in adu... Abstract. Siervo M, Ruggiero D, Sorice R, Nutile T, Aversano M, Stephan BCM, Ciullo M. (Address: Human Nutrition and Physiology, Department of Neuroscience, University "Federico II", Faculty of Medicine, Napoli; Institute of Genetics and Biophysics "A. Buzzati-Traverso", CNR, Napoli, Italy; and Institute of Public Health, University of Cambridge, UK). Angiogenesis and biomarkers of cardiovascular risk in adults with metabolic syndrome. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02255.x.Objectives. Metabolic syndrome (MetSyn) is associated with an increased risk of atherosclerosis and fatal cardiovascular events. Angiogenesis is thought to contribute to this risk as it might be involved in the progression of atherosclerotic plaques. We investigated the levels of circulating biomarkers of angiogenesis and cardiovascular risk in adults with MetSyn and assessed their association with established metabolic risk factors.Design. The Genetic Park project is a highly inclusive cross-sectional survey (about 80% of residents) conducted in three isolated populations in Southern Italy. A total of 1000 men and women (age range: 18[ndash]98 years) were included in the analysis. Anthropometric and blood pressure measurements were recorded. Metabolic and cardiovascular biomarkers included glucose, triglycerides, total cholesterol, HDL, vascular endothelial growth factor, placental growth factor (PlGF), soluble fms-like tyrosine kinase-1, high-sensitivity C-reactive protein, high-sensitivity troponin T (hs-TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP).Result. Subjects with MetSyn had higher levels of PlGF and NT-proBNP after adjustment for age, smoking and body mass index. Circulating levels of PlGF, hs-TnT and NT-proBNP were directly related to the number of criteria of MetSyn, and this association interacted with gender. There was a strong correlation between ageing and cardiovascular risk.Conclusions. The increase in circulating levels of biomarkers of angiogenesis and cardiac function in subjects with MetSyn mirrors the pathophysiological changes occurring in the cardiovascular system. Over time, these changes might accelerate the formation and progression of atherosclerotic plaques and contribute significantly to cardiovascular morbidity and mortality risk.
- New features of troponin testing in different clinical se... Abstract. Omland T. (Institute of Clinical Medicine, University of Oslo, Oslo and Division of Medicine, Akershus University Hospital, Lørenskog, Norway) New features of troponin testing in different clinical settings (Review). J Intern Med 2010. doi: 10.1111/j.1365-2796.2010.02253.x. Cardiac troponin levels are routinely measured for diagnosing acute myocardial infarction. Cardiac troponin measurements also provide information concerning prognosis and the effect of early intervention in patients with acute coronary syndromes. The recent development of highly sensitive cardiac troponin assays permits detection of very low circulating levels. Use of sensitive troponin assays improves overall diagnostic accuracy in patients with suspected acute coronary syndromes, and these assays provide strong prognostic information in stable coronary artery disease and chronic heart failure. However, increased sensitivity comes with a cost of decreased specificity, and serial testing, as well as clinical context and judgment, is likely to become increasingly important in the interpretation of troponin assay results.
- Contemporary management of pulmonary embolism: the answer... Abstract. Bounameaux H (Division of Angiology and Hemostasis, Department of Internal Medicine, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland). Contemporary management of pulmonary embolism: the answers to ten questions (Review). J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02254.x. Pulmonary embolism (PE) cannot be diagnosed solely on a clinical basis, because of the lack of sensitivity and specificity of clinical signs and symptoms. Pulmonary angiography is invasive and resource demanding. Because the prevalence of PE is relatively low (20% or less) amongst individuals who are clinically suspected of having the disease, submitting all of them to imaging (multi-detector CT angiography or ventilation/perfusion lung scintigraphy) would not be cost-effective. Therefore, diagnostic algorithms have been developed that include clinical probability assessment and D-dimer measurement to select the patients who require noninvasive imaging. Once the diagnosis is suspected or confirmed, therapy must be started to avoid potentially fatal recurrence. Treatment starts for an initial 3-month period with a 5-day course of parenteral unfractionated or low-molecular-weight heparin or fondaparinux overlapping with and followed by oral vitamin K antagonists monitored to maintain an international normalized ratio of 2[ndash]3. This initial period of 3 months may then be followed by a long-term secondary prevention period in patients who experience an idiopathic thromboembolic event and are at low risk of bleeding. New oral anticoagulants that do require patient monitoring and might exhibit a more favourable benefit[ndash]risk balance are currently under extensive clinical testing and might change the situation in the near future. A critical appraisal of the contemporary management of suspected PE is given in this overview with the discussion of 10 practical questions.
- Circulating soluble urokinase plasminogen activator recep... Abstract. Eugen-Olsen J, Andersen O, Linneberg A, Ladelund S, Hansen TW, Langkilde A, Petersen J, Pielak T, Møller LN, Jeppesen J, Lyngbæk S, Fenger M, Olsen MH, Hildebrandt PR, Borch-Johnsen K, Jørgensen T, Haugaard SB (Copenhagen University, Hvidovre Hospital, Hvidovre; Copenhagen University Hospital, Glostrup; Copenhagen University Hospital, Copenhagen; Copenhagen University Hospital, Glostrup; Copenhagen University, Hvidovre Hospital, Hvidovre; Steno Diabetes Center, Gentofte; University of Aarhus, Aarhus; University of Copenhagen, Copenhagen; Copenhagen University, Hvidovre Hospital, Hvidovre, Denmark). Circulating soluble urokinase plasminogen activator receptor predicts cancer, cardiovascular disease, diabetes and mortality in the general population. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02252.x.Background. Low-grade inflammation is thought to contribute to the development of cardiovascular disease (CVD), type-2 diabetes mellitus (T2D), cancer and mortality. Biomarkers of inflammation may aid in risk prediction and enable early intervention and prevention of disease.Objective. The aim of this study was to investigate whether plasma levels of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) are predictive of disease and mortality in the general population.Design. This was an observational prospective cohort study. Cohort participants were included from June 1993 to December 1994 and followed until the end of 2006.Setting. General adult Caucasian population.Participants. The MONICA10 study, a population-based cohort recruited from Copenhagen, Denmark, included 2602 individuals aged 41, 51, 61 or 71 years.Measurements. Blood samples were analysed for suPAR levels using a commercially available enzyme-linked immunosorbent assay. Risk of cancer (n = 308), CVD (n = 301), T2D (n = 59) and mortality (n = 411) was assessed with a multivariate proportional hazards model using Cox regression.Results. Elevated baseline suPAR level was associated with an increased risk of cancer, CVD, T2D and mortality during follow-up. suPAR was more strongly associated with cancer, CVD and mortality in men than in women, and in younger compared with older individuals. suPAR remained significantly associated with the risk of negative outcome after adjustment for a number of relevant risk factors including C-reactive protein levels.Limitation. Further validation in ethnic populations other than Caucasians is needed.Conclusion. The stable plasma protein suPAR may be a promising biomarker because of its independent association with incident cancer, CVD, T2D and mortality in the general population.
- A prospective randomized, controlled trial of intravenous... Abstract. Khalafallah A, Dennis A, Bates J, Bates G, Robertson IK, Smith L, Ball MJ, Seaton D, Brain T, Rasko JEJ Launceston General Hospital (LGH), Australia; University of Tasmania, Australia; and Centenary Institute, University of Sydney, NSW, Australia) A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02251.x.Background. Iron deficiency anaemia is the most common deficiency disorder in the world, affecting more than one billion people, with pregnant women at particular risk.Objectives and design. We conducted a single site, prospective, nonblinded randomized-controlled trial to compare the efficacy, safety, tolerability and compliance of standard oral daily iron versus intravenous ironSubjects. We prospectively screened 2654 pregnant women between March 2007 and January 2009 with a full blood count and iron studies, of which 461 (18%) had moderate IDA. Two hundred women matched for haemoglobin concentration and serum ferritin level were recruited.Interventions. Patients were randomized to daily oral ferrous sulphate 250 mg (elemental iron 80 mg) with or without a single intravenous iron polymaltose infusion.Results. Prior to delivery, the intravenous plus oral iron arm was superior to the oral iron only arm as measured by the increase in haemoglobin level (mean of 19.5 g/L vs. 12 g/L; P < 0.001); the increase in mean serum ferritin level (222 [mu]g/L vs. 18 ug/L; P < 0.001); and the percentage of mothers with ferritin levels below 30 [mu]g/L (4.5% vs. 79%; P < 0.001). A single dose of intravenous iron polymaltose was well tolerated without significant side effects.Conclusions. Our data indicate that intravenous iron polymaltose is safe and leads to improved efficacy and iron stores compared to oral iron alone in pregnancy-related IDA.
- Gallstone disease in Swedish twins: risk is associated wi... Abstract. Katsika D, Magnusson P, Krawczyk M, Grünhage F, Lichtenstein P, Einarsson C, Lammert F, Marschall H-U (Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; and Saarland University Hospital, Homburg, Germany). Gallstone disease in Swedish twins: risk is associated with ABCG8 D19H genotype. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02249.x.Objective. Recently, variants of the hepatocanalicular cholesterol hemitransporters ABCG5/8 were linked to gallstone disease; ABCG8 D19H in Caucasians and ABCG5 Q604E in Chinese. We investigated these polymorphisms in Swedish twins by merging the Swedish Twin Registry with the Hospital Discharge and Causes of Death Registries for gallstone disease-related diagnoses.Design. All monozygotic (MZ) twins with gallstone disease alive in the Stockholm area were invited to participate. Gallstone disease was defined by entry in all above mentioned registries, questionnaire or abdominal ultrasound.Subjects. ABCG5 Q604E and ABCG8 D19H genotyping was performed in 24 unique MZ and eight dizygotic (DZ) twins from concordant pairs. Screening of the TwinGene database for gallstone disease resulted in an additional 20 concordant MZ and 54 twins from concordant DZ pairs. We included 109 concordantly stone-free MZ and 126 stone-free independent DZ twins as controls.Results. Amongst the 341 twins, 20.8% carried at least one D19H allele as compared to 9.4% of stone-free controls. The association analysis showed that D19H positivity significantly increased the risk of gallstone disease [odds ratio (OR), 2.54; 95% confidence interval (CI), 1.33[ndash]4.82; P = 0.004]. We also found a trend for a positive association between gallstone disease and the Q604E variant (OR, 1.47; 95% CI, 1.00[ndash]2.16; P = 0.052).Conclusion. Twins carrying a heterozygous or homozygous ABCG8 D19H genotype have a significantly increased risk of gallstone disease. Our study confirms the ABCG8 D19H genotype as a major risk factor for gallstone disease.
- Rheumatoid arthritis and birth outcomes: a Danish and Swe... Abstract. Nørgaard M, Larsson H, Pedersen L, Granath F, Askling J, Kieler H, Ekbom A, Sørensen HT, Stephansson O (Aarhus University Hospital, Denmark, Karolinska Institutet; Karolinska University Hospital, Solna; and Karolinska Institutet, Solna; Stockholm, Sweden). Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02239.x.Objectives. To examine the prevalence of preterm birth, infants with low Apgar score, small for gestational age (SGA) birth, stillbirth and congenital abnormalities in women with rheumatoid arthritis (RA) compared with women without RA.Design. Prevalence study.Setting. Combined Sweden and Denmark nationwide from 1994 to 2006.Subjects. We included 871 579 women with a first-time singleton birth identified through population-based healthcare databases.Main outcome measures. We compared the prevalence of preterm birth, low Apgar score (<7 at 5 min), SGA birth, stillbirth and congenital abnormalities amongst women with RA compared with women without RA using prevalence odds ratio (OR) with 95% confidence interval (95% CI), whilst controlling for maternal age, smoking, parental cohabitation and year. We stratified analyses by period of birth (1994[ndash]1997, 1998[ndash]2001 and 2002[ndash]2006).Results. Amongst 1199 women with RA, 7.8% gave birth between 32 and 36 gestational weeks (adjusted OR, 1.44; 95% CI, 1.14[ndash]1.82), 1.4% gave birth before gestational week 32 (adjusted OR, 1.55; 95% CI, 0.97[ndash]2.47), 1.6% had an infant with a low Apgar score (OR, 0.99; 95% CI, 0.95[ndash]1.65), 5.9% had an SGA birth (adjusted OR, 1.56; 95% CI, 1.2[ndash]2.01), 0.9% experienced stillbirth (adjusted OR, 2.07; 95% CI, 0.98[ndash]4.35) and 4.3% gave birth to an infant with congenital abnormalities (adjusted OR,1.32; 95% CI, 0.98[ndash]1.79). The OR for congenital abnormalities decreased from 2.57 (95% CI, 1.59[ndash]4.16) in 1994[ndash]1997 to 1.00 (95% CI, 0.64[ndash]1.56) in 2002[ndash]2006.Conclusions. Women with RA had a high prevalence of most adverse birth outcomes. This could be due to inflammatory activity, medical treatment or other factors not controlled for.
- Erythropoietic protoporphyria in Sweden: demographic, cli... Abstract. Wahlin S, Floderus Y, Stål P, Harper P (Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden). Erythropoietic protoporphyria in Sweden: demographic, clinical, biochemical and genetic characteristics. J Intern Med 2010; 00: 00[ndash]00.Objective. To investigate the demographic, clinical, biochemical and genotypic features of patients with erythropoietic protoporphyria (EPP) in a Swedish cohort.Design. Cross-sectional questionnaire, biochemical and genetic study.Setting. Sweden.Subjects. Fifty-one Swedish individuals known in 2008 to have EPP confirmed by molecular diagnosis. There were no exclusion criteria; all patients were included in the demographic and genetic study. A total of 92% participants completed the questionnaire study and 82% the biochemical study.Results. The prevalence of EPP was 1 : 180 000. Nine novel ferrochelatase gene mutations were found. The most commonly reported age at onset of symptoms was the first year of life and the mean age at diagnosis was 22 years. Painful photosensitivity was the main symptom. Exogenous factors other than sunlight were frequently reported to cause cutaneous symptoms. One in five patients reported a positive effect of beta-carotene therapy. A marked impact of EPP on quality of life was reported. Women had a significantly lower mean erythrocyte protoporphyrin concentration than men. Of all participants, 84% had insufficient vitamin D concentrations, 44% had below normal serum ferritin or transferrin saturation levels and red cell abnormalities were common.Conclusions. The notably delayed diagnosis suggests the need for an increased awareness of EPP. Disturbed erythropoiesis, biochemical signs of iron deficiency and low vitamin D levels are frequent findings in this disease. New and better treatments are needed as current treatment options for symptom amelioration are limited. Vitamin D supplementation should be considered.
- Pain inhibition and postexertional malaise in myalgic enc... Abstract. Van Oosterwijck J, Nijs J, Meeus M, Lefever I, Huybrechts L, Lambrecht L, Paul L (Vrije Universiteit Brussel, Brussels; Artesis University College Antwerp, Antwerp; University Hospital Brussels, Brussels; Private Practice For Internal Medicine, Ghent/Aalst; CVS Contactgroep, Bruges; Belgium; and University of Glasgow, Glasgow, UK). Pain inhibition and postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome. J Intern Med 2010; doi:10.1111/j.1365-2796.2010.02228.x.Objectives. To examine the efficacy of the pain inhibitory systems in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) during two different types of exercise and to examine whether the (mal)functioning of pain inhibitory systems is associated with symptom increases following exercise.Design. A controlled experimental study.Setting and subjects. Twenty-two women with ME/CFS and 22 healthy sedentary controls were studied at the Department of Human Physiology, Vrije Universiteit Brussel.Interventions. All subjects performed a submaximal exercise test and a self-paced, physiologically limited exercise test on a cycle ergometer. The exercise tests were undertaken with continuous cardiorespiratory monitoring. Before and after the exercise bouts, subjects filled out questionnaires to assess health status, and underwent pressure pain threshold measurements. Throughout the study, subjects' activity levels were assessed using accelerometry.Results. In patients with ME/CFS, pain thresholds decreased following both types of exercise, whereas they increased in healthy subjects. This was accompanied by a worsening of the ME/CFS symptom complex post-exercise. Decreased pressure thresholds during submaximal exercise were associated with postexertional fatigue in the ME/CFS group (r = 0.454; P = 0.034).Conclusions. These observations indicate the presence of abnormal central pain processing during exercise in patients with ME/CFS and demonstrate that both submaximal exercise and self-paced, physiologically limited exercise trigger postexertional malaise in these patients. Further study is required to identify specific modes and intensity of exercise that can be performed in people with ME/CFS without exacerbating symptoms.
- Haemochromatosis genotype and iron overload: association ... Ellervik C, Tybjærg-Hansen A, Appleyard M, Ibsen H, Nordestgaard BG (Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Herlev; Næstved Hospital, University of Copenhagen, Naestved; Copenhagen University Hospital, University of Copenhagen, Copenhagen East; Bispebjerg Hospital, Copenhagen University Hospital, University of Copenhagen, Bispebjerg; and Holbaek Hospital, Holbaek; Denmark). Haemochromatosis genotype and iron overload: association with hypertension and left ventricular hypertrophy. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02217.x.Objective. We hypothesized that there is an association between haemochromatosis genotype C282Y/C282Y and/or iron overload and risk of hypertension and/or left ventricular hypertrophy (LVH).Methods. We analysed data from a cross-sectional study of the general population including 8992 individuals from the Copenhagen City Heart Study (CCHS), a follow-up study of 36 480 individuals from the Copenhagen General Population Study (CGPS), and a case-only study of 3815 Scandinavians from the Losartan Intervention For End-point Reduction in Hypertension Genetic Substudy (LIFEGEN) with LVH and hypertension.Results. In the CCHS, individuals with C282Y/C282Y versus wild type/wild type had an odds ratio for antihypertensive medication use of 4.8 (1.8[ndash]13; P = 0.003). In the CGPS, the corresponding hazard ratio was 1.7 (1.0[ndash]2.3; P = 0.003). Also, hazard ratios for antihypertensive medication use in the CGPS were 1.6 (1.0[ndash]2.6; P = 0.05) for transferrin saturation [ge]80% vs. <50%, and 2.3 (1.3[ndash]4.2; P = 0.005) for C282Y/C282Y + transferrin saturation [ge]80% vs. wild type/wild type + transferrin saturation <50%. These results were most pronounced in men above 55 years of age. We did not find any association between C282Y/C282Y or iron overload and LVH or hypertension (measured as blood pressure at a single occasion or continuous blood pressure), or LVH with hypertension in the CCHS or with severity of LVH in LIFEGEN.Conclusions. We found that haemochromatosis genotype C282Y/C282Y and extremely elevated transferrin saturation either separately or combined were associated with increased risk of antihypertensive medication use. Therefore, testing for haemochromatosis genotype C282Y/C282Y and extreme transferrin saturation could be considered in patients with essential hypertension.
Journal of General Internal Medicine
- Higher Physician Density is Associated with Lower Inciden... Abstract INTRODUCTION Colorectal cancer (CRC) is the third most common cancer in the United States and a leading cause of cancer related mortality. Routine screening decreases incidence and mortality; however rates of screening remain low. Physician recommendation is a key determinant of screening rates; thus, physician availability may also influence CRC incidence and mortality. METHODS Data on CRC incidence and stage at diagnosis was obtained for each county in Pennsylvania from the Pennsylvania cancer registry. Physician density (per 100,000 population) was calculated for each county using physician counts from the American Medical Association. Pearson correlation coefficients and linear regression models were used to examine the association between physician density and CRC incidence and outcomes. RESULTS Primary care physician density (Pearson’s correlation coefficient: -0.25, p = 0.05) and gastroenterologist density (correlation coefficient -0.25, p = 0.04) inversely correlated with county-level incidence of late-stage CRC. However, this association was seen only in non-metropolitan counties or those with low population density. On linear regression, non-metropolitan counties which had a high density of gastroenterologists had an incidence of late-stage CRC that was lower by 4/100,000 (reduction of 14%). Low population density counties had lower incidence of late-stage CRC by 5/100,000 (reduction of 17%) when they had at least 3.3 gastroenterologists/100,000 population compared to counties with a lower gastroenterologist-per-population ratio. Gastroenterologist density did not correlate with reduced late-stage CRC incidence prior to institution of Medicare coverage for colonoscopy for routine CRC screening. CONCLUSION Higher gastroenterologist or PCP density is associated with 14-17% lower incidence of late-stage CRC in non-metropolitan counties or those with low population density. Efforts at increasing physician supply should target these underserved areas. Content Type Journal ArticleCategory Original ResearchDOI 10.1007/s11606-010-1457-zAuthors Ashwin N. Ananthakrishnan, Medical College of Wisconsin Division of Gastroenterology and Hepatology 9200 W. Wisconsin Avenue Milwaukee WI 53226 USARaymond G. Hoffmann, Medical College of Wisconsin Department of Pediatrics Milwaukee WI 53226 USAKia Saeian, Medical College of Wisconsin Division of Gastroenterology and Hepatology 9200 W. Wisconsin Avenue Milwaukee WI 53226 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- How Well Do Doctors Know their Patients? Factors Affectin... Abstract BACKGROUND An important feature of patient-centered care is physician understanding of their patients’ health beliefs and values. OBJECTIVE Determine physicians’ awareness of patients’ health beliefs as well as communication, relationship, and demographic factors associated with better physician understanding of patients’ illness perspectives. DESIGN Cross-sectional, observational study. RESEARCH PARTICIPANTS A convenience sample of 207 patients and 29 primary care physicians from 10 outpatient clinics. APPROACH AND MEASURES After their consultation, patients and physicians independently completed the CONNECT instrument, a measure that assesses beliefs about the degree to which the patient’s condition has a biological cause, is the patient’s fault, is one the patient can control, has meaning for the patient, can be treated with natural remedies, and patient preferences for a partnership with the physician. Physicians completed the measure again on how they thought the patient responded. Active patient participation (frequency of questions, concerns, acts of assertiveness) was coded from audio-recordings of the consultations. Physicians’ answers for how they thought the patient responded to the health belief measure were compared to their patients’ actual responses. Degree of physician understanding of patients’ health beliefs was computed as the absolute difference between patients’ health beliefs and physicians’ perception of patients’ health beliefs. KEY RESULTS Physicians’ perceptions of their patients’ health beliefs differed significantly (P < 0.001) from patients’ actual beliefs. Physicians also thought patients’ beliefs were more aligned with their own. Physicians had a better understanding of the degree to which patients believed their health conditions had personal meaning (p = 0.001), would benefit from natural remedies (p = 0.049), were conditions the patient could control (p = 0.001), and wanted a partnership with the doctor (p = 0.014) when patients more often asked questions, expressed concerns, and stated their opinions. Physicians were poorer judges of patients’ beliefs when patients were African-American (desire for partnership) (p = 0.013), Hispanic (meaning) (p = 0.075), or of a different race (sense of control) (p = 0.024). CONCLUSIONS Physicians were not good judges of patient’s health beliefs, but had a substantially better understanding when patients more actively participated in the consultation. Strategies for increasing physicians’ awareness of patients’ health beliefs include preconsultation assessment of patients’ beliefs, implementing culturally appropriate patient activation programs, and greater use of partnership-building to encourage active patient participation. Content Type Journal ArticleCategory Original ResearchDOI 10.1007/s11606-010-1453-3Authors Richard L. Street, Texas A&M University Department of Communication College Station TX 77843-4234 USAPaul Haidet, The Pennsylvania State University College of Medicine The Office of Medical Education and the Department of Medicine Hershey PA USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Barriers to Follow-Up of an Abnormal Pap Smear in Latina ... Abstract BACKGROUND Lower rates of follow-up after an abnormal Pap smear in racial and ethnic minorities may contribute to the higher incidence and mortality rates of cervical cancer seen in these groups. OBJECTIVE To identify patient-perceived barriers to follow-up after an abnormal Pap smear result among Latina women. DESIGN, PARTICIPANTS AND APPROACH Qualitative, semi-structured, one-on-one interviews were conducted with patients from an academic hospital-affiliated urban community health center. Three groups of women were interviewed: new colposcopy clinic patients, patients who had previous colposcopies and patients enrolled in the health center's patient navigator program. Open-ended questions explored their knowledge, beliefs and experiences with colposcopy. Content analysis of transcripts was performed using established qualitative techinques. RESULTS Of 40 Latina women recruited, 75% spoke only Spanish. The average age was 31.5 (range 18–55). Personal and system barriers identified were categorized into four themes: (1) anxiety/fear of procedure and diagnosis; (2) scheduling/availability of appointments interfering with work and/or child care; (3) inadequate communication about appointments, including lack of explanation regarding diagnosis, procedure and results; and (4) pain. New patients more commonly reported problems with scheduling and communication. Follow-up patients were more concerned about pain, and navigated women most often reported fear of results but had fewer concerns about inadequate communication. CONCLUSION Anxiety/fear was the most common personal barrier, while difficulty scheduling appointments and inadequate communication were the major systems barriers identified in these Latina women. Interventions to lower these barriers to colposcopy among Latina women may increase adherence to follow-up of abnormal Pap smears. Content Type Journal ArticleCategory Original ResearchDOI 10.1007/s11606-010-1450-6Authors Sanja Percac-Lima, Massachusetts General Hospital Chelsea HealthCare Center 151 Everett Avenue Chelsea MA 02150 USALeslie S. Aldrich, Massachusetts General Hospital Center for Community Health Improvement Boston MA USAGloria B. Gamba, Massachusetts General Hospital Chelsea HealthCare Center 151 Everett Avenue Chelsea MA 02150 USAAdriana M. Bearse, Massachusetts General Hospital Center for Community Health Improvement Boston MA USASteven J. Atlas, Massachusetts General Hospital, and Harvard Medical School General Medicine Division, Department of Medicine Boston MA USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Proximal Tumors Are Associated with Greater Mortality in ... ABSTRACT BACKGROUND Colon cancer is the third leading cause of death from cancer in the United States. Recent studies report on increasing proportions of proximal cancers. The etiology behind this epidemiological trend is unclear, and its implication on survival outcomes is unknown. Further analysis of the impact of anatomic site of disease among a large multiethnic population will help facilitate research and education to improve colon cancer screening and treatment. OBJECTIVE To investigate the association between proximal tumor location and survival in patients with colon cancer. DESIGN AND PARTICIPANTS A large retrospective cohort study in the US utilizing the Surveillance, Epidemiology, and End Results (SEER) cancer registry analyzed survival outcomes of patients with colon cancer. Multivariable logistic regression analyses investigated sex-specific, race/ethnicity-specific, and anatomic site-specific disparities in survival. MAIN MEASURES Five-year survival outcomes from colon cancer. RESULTS Our study demonstrated significant disparities in survival by sex, race/ethnicity, and anatomic site. Across all time periods and among most cohorts, patients with proximal cancers had significantly worse survival outcomes. When compared to distal cancers, patients with proximal cancers were 13% less likely to survive 5 years (OR 0.87; 95% CI, 0.82–0.91). When compared to non-Hispanic whites, blacks were 30% less likely to survive 5 years (OR 0.70; 95% CI, 0.68–0.73). Stage-specific multivariable regression analysis of localized cancers demonstrated similar findings. CONCLUSIONS Significant race-specific, sex-specific, and anatomic site-specific disparities in colon cancer survival exist. Proximal cancers are associated with worse survival odds. These disparities may reflect differences in the genotype and phenotype of colon cancer among these groups. A modified risk assessment tool that incorporates these variations may be more effective in the early detection and treatment of colon cancer. Content Type Journal ArticleCategory Original ResearchDOI 10.1007/s11606-010-1460-4Authors Robert Wong, California Pacific Medical Center Department of Medicine 2351 Clay Street, Suite 380 San Francisco CA 94115 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- From the Editors' Desk: Renewing the Call for Innovations... From the Editors' Desk: Renewing the Call for Innovations in Medical Education Content Type Journal ArticleDOI 10.1007/s11606-010-1439-1Authors David A. Cook, Mayo Clinic Division of General Internal Medicine Baldwin 4-A, 200 First Street SW Rochester MN 55905 USADarcy A. Reed, Mayo Clinic College of Medicine Office of Education Research Rochester MN USADiane B. Wayne, Northwestern University Feinberg School of Medicine Department of Medicine Chicago IL USAColin P. West, Mayo Clinic Division of General Internal Medicine Baldwin 4-A, 200 First Street SW Rochester MN 55905 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- The Empirical Basis for Determinations of Medical Futility Abstract BACKGROUND Decisions to limit treatment in critically ill patients often rely on publications that make claims of futility based on outcome data. Our objective was to systematically review the criteria for futility and the strength of empirical evidence across clinical studies that purport to support or refute claims of futility. METHODS The MEDLINE database was searched for relevant articles published between1980 and 2008. Selected studies reported original outcome data in critically ill or cardiac arrest patients and claimed that these data can support or refute decisions to limit treatment in comparable patients. Two authors independently abstracted data on patient characteristics, intervention, outcomes, cost, and design. RESULTS Forty seven studies supporting a claim of futility and 45 refuting it were reviewed. Median point estimate for adverse outcome in studies supporting claims of futility was 100% (range 75% to 100%); median lower 95% confidence limit was 91% (range 48% to 99%). Explicit thresholds for futility were missing in 88% of articles. The original criteria for quantitative futility were fulfilled by only 28% of data, and almost exclusively in studies of cardiopulmonary resuscitation (CPR) for cardiac arrest. Substantial statistical overlap was observed between data brought in support of futility claims and data brought to refute them. CONCLUSIONS Most studies that purport to guide determinations of futility are based on insufficient data to provide statistical confidence for clinical decision-making. They usually lack explicit a priori thresholds for determination of futility. Many studies draw disparate conclusions based on statistically similar data. In most circumstances these problems preclude confident determinations of futility. Content Type Journal ArticleCategory ReviewsDOI 10.1007/s11606-010-1445-3Authors Ezra Gabbay, Tufts Medical Center Division of Nephrology 800 Washington St. Boston MA 02111 USAJose Calvo-Broce, Tufts Medical Center Division of Nephrology 800 Washington St. Boston MA 02111 USAKlemens B. Meyer, Tufts Medical Center Division of Nephrology 800 Washington St. Boston MA 02111 USAThomas A. Trikalinos, Tufts University School of Medicine Clinical and Translational Research Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Sackler School of Graduate Biomedical Sciences Boston MA USAJoshua Cohen, Tufts University School of Medicine Clinical and Translational Research Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Sackler School of Graduate Biomedical Sciences Boston MA USADavid M. Kent, Tufts University School of Medicine Clinical and Translational Research Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Sackler School of Graduate Biomedical Sciences Boston MA USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Quality of US Primary Care Delivered by Resident and Staf... ABSTRACT Background Few population-based data are available on the quality of outpatient care provided by resident physicians in the US. Objective To assess the quality of outpatient care delivered by resident and staff physicians. Design Cross-sectional analysis. We used chi-square tests to compare resident and staff physician performance on 19 quality indicators. Using multivariable logistic regression, we controlled for sex, age, race/ethnicity, insurance, and metropolitan status. Participants 33,900 hospital-based outpatient visits from the 1997-2004 National Hospital Ambulatory Medical Care Survey (NHAMCS). Measurements Resident and staff physician performance on 19 quality indicators. Results Resident physicians were more likely to care for younger, non-white, female, urban, and Medicaid-insured patients. In both adjusted and unadjusted analyses, residents outperformed staff on four of 19 measures including angiotensin converting enzyme inhibitor use for congestive heart failure (57.0% vs. 27.6%; p = <0.001), diuretic use for hypertension (57.8% vs. 44.0%; p = <0.001), statin use for hyperlipidemia (56.3% vs. 40.4%; p = 0.001), and routine blood pressure screening (85.3% vs. 79.6%; p = 0.02). Residents and staff performed at similar levels for counseling (range 15.7 to 32.0%). Residents and staff performed similarly well on measures capturing inappropriate prescribing or overuse of diagnostic testing (range 48.6 to 100%). Residents and staff performed similarly on measures of appropriate prescribing (range from 30.9% to 69.2%). Conclusions Primary care provided by resident physicians is of similar or higher quality than that provided by staff physicians. Significant opportunity remains to improve quality of outpatient care provided by all physicians. Residency training programs should devote attention to improving outpatient quality of care delivered by residents. Content Type Journal ArticleCategory Original ResearchDOI 10.1007/s11606-010-1456-0Authors Leah Zallman, Department of Medicine, Cambridge Health Alliance and Harvard Medical School Cambridge MA USAJun Ma, Palo Alto Medical Foundation Research Institute Palo Alto CA USALan Xiao, Palo Alto Medical Foundation Research Institute Palo Alto CA USAKaren E. Lasser, Boston Medical Center Section of General Internal Medicine 801 Massachusetts Avenue, Crosstown #2091 Boston MA 02118 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Online Professionalism and the Mirror of Social Media Abstract The rise of social media—content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs—has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they “tread” through the World Wide Web, they leave behind a “footprint” that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for “online professionalism.” Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see. Content Type Journal ArticleCategory PerspectivesDOI 10.1007/s11606-010-1447-1Authors S. Ryan Greysen, Yale University School of Medicine Robert Wood Johnson Clinical Scholar 333 Cedar Street, SHM IE-61 New Haven CT 06510 USATerry Kind, Children’s National Medical Center Department of Medical Education Washington DC USAKatherine C. Chretien, Medical Service, Washington DC VA Medical Center Washington DC USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- N-of-1 Trials: A New Future? N-of-1 Trials: A New Future? Content Type Journal ArticleCategory EditorialsDOI 10.1007/s11606-010-1440-8Authors Eric B. Larson, Group Health Research Institute 1730 Minor Avenue, Ste 1600 Seattle WA 98006 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- What Can General Medical Providers Do for Hospitalized Pa... What Can General Medical Providers Do for Hospitalized Patients with Alcohol Dependence After Discharge? Content Type Journal ArticleCategory EditorialsDOI 10.1007/s11606-010-1441-7Authors Katharine A. Bradley, Veterans Affairs (VA) Puget Sound Health Care System Health Services Research & Development (HSR&D) 1100 Olive Way, Suite 1400 Seattle WA 98101 USAEmily C. Williams, Veterans Affairs (VA) Puget Sound Health Care System Health Services Research & Development (HSR&D) 1100 Olive Way, Suite 1400 Seattle WA 98101 USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
Latest articles from Medical Marketing and Media
- GSK restructures bonuses for sales reps Beginning in 2011, GlaxoSmithKline will reward its sales reps for the relationships they forge with doctors, instead of the amount of drugs they sell.
- Novartis exploits J&J recall pains with Triaminic giveaway Novartis is capitalizing on rival J&J's woes with a giveaway of its new Triaminic OTC children's acetaminophen.
- Advisory panel rebuffs FDA risk-mgmt. plan for pain meds A combined advisory committee voted 25-10 against a risk-management plan put forward by the FDA to curb abuse of long-acting pain drugs.
- FDA expands online consumer communications The FDA has hired a broadband TV producer to head its online communications as the agency seeks to beef up its online content and launch a drug safety blog.
- Primary care docs prefer rep-delivered samples, says study Despite busier schedules and less time for a detail, most primary care physicians prefer to receive samples directly from a sales rep, in person, according to a DTW Marketing Research study.
- New pain meds pose tricky PR test, as FDA gaffe shows Reformulations of prescription pain drugs designed to reduce abuse potential are arriving on the scene, and the FDA is grappling with the best way to encourage manufacturers to communicate risks vs. benefits and ensure safety.
- DDMAC regulatory letters could double in 2010 New Year's Eve is five months away, but FDA letter-writers have already been prolific in 2010 on themes of risk omission, inflated efficacy claims, and unfair balance presentation as seen in promotional materials targeting physicians and consumers.
- Is your career on track? Please take a moment to complete the 24th annual MM&M Career & Salary Survey and help us provide you and the rest of the industry with the most meaningful picture of salaries, aspirations, motivation, job satisfaction and HR trends in the healthcare market. All respondents will be entered into a prize draw to win a $250 Amex card. You will not be identified and your answers will remain strictly confidential. The results will appear in the September issue of MM&M. Click through to complete the survey.
- Merck launches asthma awareness site for Spanish-speakers Merck teamed up with the Asthma and Allergy Foundation of America (AAFA), and former Miss Universe Dayanara Torres, for an asthma education website targeting Spanish-speakers.
- Luvox CR patient brochure gets warning for missing risk info The FDA demanded that Jazz Pharmaceuticals halt dissemination of a patient brochure for Luvox CR and run corrective messages to counter inflated benefit claims and omission of risk information.
WHO news
- Breastfeeding key to saving children’s lives 30 July 2010 -- Malnutrition is responsible for one-third of the 8.8 million deaths annually among children under five. Breastfeeding is a key to improve infant and young child nutrition. The "Ten Steps to Successful Breastfeeding" ensure right start for every infant and the necessary support for mothers to breastfeed.
- WHO and the International Olympic Committee sign agreemen... 21 July 2010 -- In addition to promoting healthy lifestyle choices the agreement aims to support physical activity, sports for all, Tobacco Free Olympic Games, and the prevention of childhood obesity.
- WHO announces new approaches to HIV prevention and treatm... 20 July 2010 -- WHO has made new recommendations with the objective of reducing and eventually eliminating new HIV infections in children. To reduce the number of infants that are infected with HIV each year, WHO recommends that all women with HIV receive antiretroviral drugs to protect against transmission during pregnancy, delivery or breastfeeding.
- More than five million people receiving HIV treatment 19 July 2010 -- WHO estimates that 1.2 million more people received HIV treatment in 2009 than in 2008. In addition HIV-related mortality can be reduced by 20% in the next five years if guidelines for early treatment are put into action.
- International experts limit melamine levels in food 6 July 2010 -- The maximum amount of melamine allowed in powdered infant formula is 1 mg/kg according to new rulings from the UN's food standards body, Codex Alimentarius Commission. The Commission also issued new guidance for hygienic measures for safer fresh salads and seafood.
- WHO launches Global Network of Age-friendly Cities 29 June 2010 -- A WHO network helps cities design urban settings that enables older people to remain active and continue to be healthy participants in society.
- New WHO guidance to improve use of medicines for children 18 June 2010 -- Accurate dosing of medicines for children is crucial, especially between the ages of 0 to12 months. Dosing errors in children this young can have devastating results. The newly released WHO Model Formulary for Children can help alleviate this problem with information on using over 240 essential medicines for children aged under 12.
- Global polio eradication initiative launches 2010-2012 st... 17 June 2010 -- Strategic plan for stopping polio worldwide builds upon lessons learnt in Nigeria. However at this important juncture the plan faces a 50% funding shortfall. Simply managing cash flow will not be enough; renewed donor commitment is required to go the final inch and eradicate polio.
- World Blood Donor Day: new blood for the world 14 June 2010 -- Young people under the age of 25 contribute an estimated 38% of all voluntary blood donations. World Blood Donor Day held on 14 June has the slogan, "New blood for the world," to raise awareness of the important role young people play in maintaining supplies of safe blood.
- WHO Director-General’s letter to BMJ editors 08 June, 2010 -- Dr Margaret Chan, Director-General of the WHO sent the following letter to the editors of the BMJ, formerly British Medical Journal, in response to their article on conflicts of interest at the WHO.
All MayoClinic.com Topics
- Deep brain stimulation: An experimental depression treatment Deep brain stimulation — Overview covers definition, risks, results of this experimental depression treatment.
- Headaches: Which type do you have? Migraine headache, tension headache, cluster headache — how each type affects you.
- Primary progressive aphasia: Dealing with lost language s... Primary progressive aphasia — Comprehensive overview covers symptoms, treatment of this speech-related dementia.
- Technology can extend life, but at what cost? No one lives forever, so why do so many people keep trying?
- What your scale won't tell you Normal weight obesity — normal BMI but too much body fat — can be a health risk.
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- Tips for diffusing anger in those with dementia As a caregiver, provide a sense of control to your loved one with dementia.
- Vitamin B-12 injections for weight loss: Do they work? Vitamin B-12 injections — A weight-loss shot sounds appealing, but does it work?
- Bilirubin test: An important liver function indicator Bilirubin test — Overview covers definition, results of this test for liver disease.
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WebMD Health
- Kids Getting in Bed with Parents? Get Children to Sleep i... WebMD answers common concerns about children who co-sleep with their parents at night and how to help them break the habit and sleep in their own beds.
- Combo Weight Loss Pill Fights Cravings and Appetite An experimental obesity drug reduces body weight by 5% or more after one year when combined with healthy diet and regular exercise.
- Study: Calcium May Increase Heart Attack Risk A new research analysis suggests a link between calcium supplements and heart attacks.
- More Evidence Links Fractures to Diabetes Drugs The popular diabetes drugs Actos and Avandia boost the risk of fracture in older women, according to findings from a new study that echo those of earlier research.
- Swine Flu Pandemic Hit Children the Hardest The H1N1 flu strain that sparked the first influenza pandemic in four decades has caused the majority of flu cases so far in the 2009-2010 season, the CDC says.
- Bedbugs Biting All Over U.S. The largest survey examining bedbug infestations ever conducted suggests that the creepy, blood-sucking creatures are being found and fought all over the United States.
- Unusual Ways to Quit Smoking WebMD discusses ways you can kick the smoking habit for good.
- Teach Your Kids Cold- & Flu-Fighting Habits Can a preschooler really learn ways to protect herself from cold and flu viruses? Here’s what the experts had to say.
- Potty Training the Clean Way Make potty training easier -- and keep germs at bay -- with these quick toilet training tips for your tot.
- When Kids Are Sick: How to Prevent Germs from Spreading Want to prevent viruses from spreading in your home? These quick tips from the pros may help.
CNN.com - Health
- Meet the critters inside your mattress The mattress can be a jungle of dust mites and bedbugs, milling around among dried remnants of blood, saliva, sweat and basically all the other bodily fluids.
- Lou Gehrig's victim: Kill me for my organs A Georgia man suffering from Lou Gehrig's Disease says he wants to die by having his organs harvested rather than wait for his degenerative nerve ailment to kill him.
- Hoarding called a public health issue In extreme cases, hoarders' obsession has led to fires, attracted vermin, endangered their families, that experts describe it as a growing public health problem.
- Calcium supplements may boost heart attack risk The millions of people who take calcium supplements to strengthen aging bones and ward off osteoporosis may be putting themselves at increased risk of a heart attack, a new study has found.
- Clone farm goal: Disease-resistant animals Cloning has been a controversial issue since German embryologist Hans Spemann first made a pair of adorable, genetically identical salamander twins out of a single egg, way back in nineteen-dickety-two.
- Alcohol may fight rheumatoid arthritis Drinking alcohol may ease the pain of -- and lower the risk of developing -- rheumatoid arthritis, a potentially crippling autoimmune disorder, a new study finds.
- Cell phones save lives in Rwanda The Rwandan government is giving out hundreds of cell phones in an attempt to save pregnant women and babies.
- Hands-only CPR equally effective As compression-only CPR has grown in use, the question has remained whether it's as effective as the traditional form that includes mouth-to-mouth resuscitation. Two new studies say yes. FULL STORY | WATCH: CPR in 2 minutes
- Dispersant concerns remain Little is known about the effects of the chemicals added to the Gulf of Mexico to break up oil flowing from the Deepwater Horizon's ruptured well.
- Government has your baby's DNA When Annie Brown's daughter, Isabel, was a month old, her pediatrician asked Brown and her husband to sit down because he had some bad news to tell them: Isabel carried a gene that put her at risk for cystic fibrosis.
MedlinePlus Health News
- Heat Alert Source: HealthDay - Related MedlinePlus Pages: Children's Health, Exercise for Children, Heat Illness
- Calcium Supplements Linked to Boost in Heart Attack Risk People should get needed mineral through their diet, researchers say Source: HealthDay Related MedlinePlus Pages: Calcium, Heart Attack
- Protein in Urine Can Forecast Kidney Disease Doctors may be able to watch for kidney injury and protect patients by looking for protein in urine, researchers reported on Thursday.Source: Reuters Health Related MedlinePlus Pages: Kidney Diseases, Laboratory Tests, Urine and Urination
- Doctors, Patients Rarely on Same Page Physicians often mistaken about patients' beliefs, feelings about their illness Source: HealthDay Related MedlinePlus Page: Talking With Your Doctor
- Meth Use in Pregnancy Endangers Mom and Baby New research shows that babies born to methamphetamine-using moms face much higher risks of serious complications, compared to babies not exposed in the womb to this illegal street drug.Source: Reuters Health Related MedlinePlus Pages: Methamphetamine, Pregnancy and Substance Abuse
- FDA Approves Drug for Chronic Drooling in Children Source: Food and Drug Administration Related MedlinePlus Pages: Developmental Disabilities, Neurologic Diseases, Neuromuscular Disorders
- FDA Advisory: Avoid Unintentional Exposure of Children an... Source: Food and Drug Administration Related MedlinePlus Page: Menopause
- NIH-Funded Researchers Make Progress Toward Regenerating ... Source: National Institute of Biomedical Imaging and Bioengineering - Related MedlinePlus Pages: Hip Replacement, Joint Disorders, Knee Replacement, Osteoarthritis
- Breast Cancer's DNA Yields More Secrets Another study shows that not all tumors are alike, pointing to better treatments Source: HealthDay Related MedlinePlus Pages: Breast Cancer, Genetic Testing
- Story-Telling More Difficult for Brain-Injured Children Parents can help by spending more time developing narratives, researchers suggest Source: HealthDay Related MedlinePlus Pages: Child Development, Stroke
WSJ.com: Health Blog
- Merck Ready to Play Let’s Make an (Emerging Markets) Deal Merck isn't ruling out making outright purchases of emerging-market companies, but competition is fierce.
- Mt. Sinai Program Lets Some Pre-Meds Swap Orgo for Shakes... Students in the Humanities and Medicine Program get spots in med school as long as they meet certain requirements -- but don't take the usual pre-med pre-requisites.
- A.M. Vitals: Merck Profit Falls 52% On Merger, Restructur... Also: high-risk pool regs are out; vote held up by motion to repeal provision of health-care overhaul; Republicans want HHS to edit HealthCare.gov.
- Got a Limited Screening Budget? Then Colonoscopy’s Not ... The study relies on computer simulations to gauge cost-effectiveness.
- Senator Slams FDA Advisory Committee’s Avastin Decision Sen. Vitter has also called on HHS to remove the new U.S. Preventive Services Task Force breast cancer screening recs from the agency's website.
- Med Students: We Want More Sex Ed! More than 53% of respondents said they didn't get sufficient training in med school to address patients' sexual concerns.
- Wellness Programs Won’t Necessarily Improve Health Or L... Programs limited to health assessments and "let's get fit!" web-based efforts are most likely to fail.
- A.M. Vitals: Sanofi Likely to Formally Offer to Buy Genzyme Also: new painkiller policy proposed in Washington State; the insured seem to be using less health care; Dendreon publishes results in the NEJM.
- Aetna’s CEO Discusses Health Overhaul, CVS Caremark Deal Obama isn't anti-business, Aetna CEO Ron Williams said, but his administration may lack an understanding of what it takes to run a business.
- Why Novartis’s Triaminic Giveaway Reminds Us of the Tou... Some parents say it's hard to find generic alternatives.
National Institutes of Health (NIH) News Releases
- NIH Director Announces Appointment of Robert Kaplan as As... National Institutes of Health Director Francis S. Collins, M.D., Ph.D., announced today the appointment of Robert M. Kaplan, Ph.D., as Director, Office of Behavioral and Social Sciences Research (OBSSR) and NIH Associate Director for Behavioral and Social Sciences Research. Dr. Kaplan is expected to join the NIH in early 2011.
- NIH-Funded Researchers Make Progress Toward Regenerating ... A team of NIH-funded researchers has successfully regenerated rabbit joints using a cutting edge process to form the joint inside the body, or in vivo. Regenerative in vivo procedures are performed by stimulating previously irreparable organs or tissues to heal themselves. In this study, bioscaffolds, or three-dimensional structures made of biocompatible and biodegradable materials in the shape of the tissue, were infused with a protein to promote growth of the rabbit joint.
- New Compound Improves Obesity-Related Health Complication... An experimental compound appears to improve metabolic abnormalities associated with obesity, according to a preliminary study led by researchers at the National Institutes of Health. A report of the study, which was conducted with obese mice, appears online today in the Journal of Clinical Investigation.
- NIH Director Announces Appointment of Alan Guttmacher as ... National Institutes of Health Director Francis S. Collins M.D., Ph.D., announced today the appointment of Alan E. Guttmacher, M.D., as director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of the 27 institutes and centers that comprise the National Institutes of Health. The appointment follows an extensive national search.
- Scientists Identify Brain Circuits Related to the Initiat... In humans, throwing a ball, typing on a keyboard, or engaging in most other physical activities involves the coordination of numerous discrete movements that are organized as action sequences. Scientists at the National Institutes of Health and the Gulbenkian Institute in Portugal have identified brain activity in mice that can signal the initiation and termination of newly learned action sequences. The findings appear online today in the current issue of Nature.
- Hyperthermia: Too Hot for Your Health Hot summer weather can pose special health risks to older adults. The National Institute on Aging (NIA), part of the National Institutes of Health, has some advice for helping older people avoid heat-related illnesses, known as hyperthermia.
- NIH-Funded Study Finds Early HAART during TB Treatment Bo... A clinical trial in Cambodia has found it possible to prolong the survival of untreated HIV-infected adults with very weak immune systems and newly diagnosed tuberculosis (TB) by starting anti-HIV therapy two weeks after beginning TB treatment, rather than waiting eight weeks, as has been standard. This finding by scientists co-funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the French National Agency for Research on AIDS and Viral Hepatitis, brings physicians closer to optimizing the treatment of severely immunosuppressed individuals with HIV-TB co-infection. The findings were presented today at the XVIII International AIDS Conference in Vienna by principal investigators Francois-Xavier Blanc, M.D., Anne E. Goldfeld, M.D., and Sok Thim, M.D.
- NIHSeniorHealth Site Offers Tips on Creating a Family Hea... At your next family reunion or gathering, consider discussing a different type of family tree--the family health history. Find out how to collect, organize and use information about your family's health at Creating a Family Health History, the newest topic on the NIHSeniorHealth website. NIHSeniorHealth is a health and wellness website designed especially for older adults from the National Institute on Aging (NIA) and the National Library of Medicine (NLM), both part of the National Institutes of Health.
- Statement of Anthony S. Fauci, M.D. Director, National In... Today we congratulate the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and the people of South Africa on the positive findings from the CAPRISA 004 microbicide study, which marks a significant milestone both for the microbicide research field and HIV prevention as a whole.
- NIDA NewsScan #67 To coincide with the 2010 International AIDS Conference in Vienna, NIDA has written a special issue of NewsScan on HIV/AIDS which features recent articles on the connection between drug abuse and HIV/AIDS and prevention and treatment strategies, authored by researchers supported by NIDA and other leading research organizations.
Health Collection From AOL News
- Study Asserts a Dark Side to Calcium Supplements Calcium supplements increase one's risk of heart attack by more than 30 percent, according to an analysis of 11 studies published this week in the British Medical Journal.
- Army Finds 'Alarming' Rise in Suicides, Risky Behavior (July 29) -- Increasing rates of drug abuse among soldiers and deteriorating leadership oversight are among the problems contributing to an alarming rise in suicides and other mental-health-related problems, according to a new Army report.
- Study: Med Students Need More Sex (And More Sex Ed) Med school students aren't adequately versed in sex -- in the bedroom and the classroom. And according to a new survey, that's taking a toll on their ability to comfortably discuss sex with patients.
- Why Have Portion Sizes Depicted in Jesus' Last Supper Pai... A new, controversial study says food portion sizes have expanded over time in depictions of Jesus' Last Supper.
- Army Preps Massive Study to Target Record High Troop Suic... A collaborative study between the Army and the National Institutes of Mental Health, aimed at preventing troop suicides, will kick off this summer. Stars and Stripes reports that researchers anticipate surveying 400,000 troops.
- Congress Cuts Sentencing Disparity Between Crack Cocaine ... Congress took a big step today toward ending what many libertarian and anti-drug war activists say was an unjust disparity in the mandatory sentencing for crack and powdered cocaine. But how do the two substances compare? Surge Desk takes a look at the data...
- Study Says Friends Extend Lives. Do Virtual Ones, Too? (July 28) -- Looking to live longer? You may be better off going out for a few drinks with friends than staying at home alone. According to a new analysis of 148 studies from around the world, loneliness can be even more harmful to your health than smoking or obesity. The data show that people with high levels of social interaction were 50 percent more likely to be alive by the time of the study follow-up.
- Spain's Catalonia Bans Bullfighting in Vote (July 28) -- Lawmakers in the Catalonia region of Spain voted after an emotional debate today to ban bullfighting, a decision that some hope will signal the end of the controversial spectacle throughout the country.
- A Decade of Tummy Tucks: 5 Superlative Stats From the Ame... The most fascinating findings from the American Society of Plastic Surgeons annual report.
- How to Survive a Cranial Impalement: Jessiah Jackson Edition Jessiah Jackson, 17 months, is recovering well, 10 days after being impaled by a metal hook to the head. But Jessiah, and others who've undergone accidental skull stabbings, are lucky to be alive. In their honor, a guide to surviving cranial impalements.
WashingtonPost Health News
- Including time for rest in a workout routine can help fi... If you're like me, you may be looking at some upcoming vacation and thinking: I wonder how many extra workouts I can squeeze into all that free time? Health - Fitness - Shopping - Personal Training - Physical exercise
- Featured Advertiser
- Baby is breast-fed by wrong woman at Virginia Hospital C... The day after her first child was born in January at Virginia Hospital Center in Arlington County, Suzanne Libby discovered that he was missing from the hospital nursery. Searching frantically, she found Spencer in his hospital bassinet -- in another woman's room. Standing next to him was a hospi... Breastfeeding - Health - Medicine - United States - Breast
- Lack of funding threatens the future of HIV drug therapy... Ten years ago, many experts thought you couldn't bring antiretroviral therapy to people with AIDS in poor countries. The drugs cost too much, there weren't enough doctors, the patients wouldn't take the medicines correctly, and the risk of creating a resistant virus was too high. HIV - AIDS - Health - Conditions and Diseases - Immune Disorders
- CPR studies find no benefit to mouth-to-mouth over chest... For anyone trying to save a victim of cardiac arrest, the questions used to be: How many breaths do I give? How many chest compressions? And do I really want to do this in the first place? Health - Cardiopulmonary resuscitation - Public Health and Safety - First Aid - American Heart Association
- Disputed chemical bisphenol-A found in paper receipts As lawmakers and health experts wrestle over whether a controversial chemical, bisphenol-A, should be banned from food and beverage containers, a new analysis by an environmental group suggests Americans are being exposed to BPA through another, surprising route: paper receipts. Business - Pulp and Paper - Materials - Bisphenol A - Paper
- Medical examiners use differing criteria to tally heat-r... It's nature's stealth killer. It's not always the medical examiner's prime suspect. And the deadly toll it exacts often becomes clear only well after it has left the scene. Coroner - Health - Conditions and Diseases - Wounds and Injuries - Heat Related
- D.C. developer David von Storch is pumped to take fitnes... Navy suits and crisp oxfords occupy every seat except his. With the jacket fringed in fur, the red high-top Nikes with electric blue laces, the polo shirt whose slim-fit sleeves permit the right amount of biceps bulge, David von Storch is a very Logan Circle presence in this very Georgetown meeti... Fitness - Health - United States - Gym - Services
- Health-care overhaul: Long-term-care benefits are a long... Among the most important questions involving the health-care overhaul are how seniors will be affected. Here are two of the biggest pocketbook issues. Health care - Insurance - Health - Business - Financial Services
- Medical Mysteries: Sudden hearing loss in one ear was no... As he picked up the phone to make the call, Wayne Curtis worried that his doctor might think he was a hypochondriac. Hearing impairment - Hearing - Health - Disability - Business
American Medical News
- AMA launches seminar series on health care payment models The educational events are part of the Association's work to help physicians understand the impact of health system reform.
- Cholesterol screening recommended for all children Screening only children with a family history of premature cardiovascular disease could miss about a third of youths with high LDL cholesterol, a study says.
- E-mail could be good for your patients' health Online communication between doctors and patients can improve results, a study says. But observers say more research is needed to determine exactly how.
- Hospitals boost response rates for timely angioplasties As hospitals reduce their "door-to-balloon" times, heart attack mortality rates are falling.
- Health reform tasks could overwhelm agencies, former fede... HHS, CMS and other departments must issue more than 40 health reform regulations, some of which will be complex and controversial.
- Med school tuition proposal: Take percentage of paycheck Students would commit to paying part of their future income rather than pay as they attend school.
- WellCare to pursue legal action against former executives The Florida-based Medicare and Medicaid contractor is now a plaintiff alongside shareholders seeking damages for alleged fraud.
- Medicare anti-fraud effort leads to record arrests More than 90 people, including physicians, are charged with fraudulent activity involving more than $251 million in false claims to Medicare.
- Pertussis epidemic in California linked to vaccination gaps Some doctors in the state say parents not vaccinating children, and physicians limiting the immunizations they administer because of payment issues, contributed to the outbreak.
- Job growth at physician offices, hospitals expected this ... The outlook is that health system reform combined with some temporary increased stability in Medicare pay may lead to expansion.
FOXNews.com
- Study: Mobile Phones Have More Bacteria Than Toilet Handles You may want to peel your mobile phone away from your face, considering it may be dirtier than a toilet handle
- Wedding De-Stressing Tips for the Former First Daughter If you thought planning your own wedding was stressful, try being the former First Daughter.
- Rare Disease Carried By Mosquitoes Kills Infant Gulf coast health officials are urging residents to use mosquito repellant after two people died of Eastern equine encephalitis this month.
- Another Infant Dies of Whooping Cough in California San Diego County health officials say a month-old baby boy has died of whooping cough. The death reported Thursday marks at least the seventh infant to die of whooping cough this year in California.
- 1 Dead, 3 Sickened at Pa. Water Treatment Plant A sewage plant employee became faint and died Thursday while working in a 30-foot hole, and three other people who tried to rescue him were overcome by an unknown gas and had to be hospitalized, officials said.
- Fox on Sex: Foods to Get You in the Mood Having fun with food and sex isn't limited to whipped cream--keep your sex life juicy and ripe with these foods
- Calcium Supplements May Raise Risk of Heart Attack Calcium supplements, which many people consume hoping to ward off osteoporosis, may increase the risk of heart attack by as much as 30 percent, researchers reported Friday.
- Bedridden Man Eaten Alive By Maggots A paralyzed man was eaten alive by maggots in his bed while his partner slept beside him.
- Are Some Soaps Damaging Sex Organs? A nonprofit environmental group has sued the U.S. Food and Drug Administration, claiming the agency failed to regulate toxic chemicals found in "antimicrobial" soap and other personal care products.
- Boy Released From Hospital After Metal Rod Impales Skull A 17-month-old boy, who was impaled in the skull by a metal rod, has been released from the hospital less than two weeks after the object was lodged 2 inches into his brain.
CBC | Health News
- Calcium pills may raise heart attack risk The value of taking calcium supplements to ward off osteoporosis has been called into question by a report that suggests the practice could lead to an increased risk of heart attacks.
- Slash salt intake, Canadians advised Canadians should consume half the sodium they're now taking in from foods and drinks as part of a multi-pronged approach to cutting salt intake, according to new federal guidelines.
- Coroner orders review of drowning deaths Ontario's acting chief coroner has ordered a review of all drowning deaths in the province since May following the death of a 2½-year-old-boy in a backyard swimming pool in the Ottawa region.
- N.L. medical labs lack expertise: report A review of Newfoundland and Labrador's largest medical labs has found dysfunctional relationships among staff and a lack of expertise in complex areas of medical testing.
- Ontario tackles ER wait times with $45M more The Ontario government is expanding its effort to reduce emergency-room wait times across the province.
- Stem cells grow replacement joints in rabbits Rabbits were able to regrow a leg joint using their own stem cells, say scientists exploring the cells' potential to replace artificial joints in human patients.
- BPA found in cash register and ATM receipts The controversial chemical bisphenol A has been found in 40 per cent of receipts collected by the U.S. organization Environmental Working Group.
- Alberta ponders paying for new MS treatment Alberta Health Minister Gene Zwozdesky is putting together a committee to look at whether to pay for studies of a controversial experimental treatment for people with multiple sclerosis.
- Hands-only CPR saves lives: studies More bystanders are willing to attempt CPR if an emergency dispatcher gives them firm and direct instructions, especially if they can just press on the chest and skip the mouth-to-mouth, according to new research.
- B.C. ends sex tests as researcher charged The B.C. government has cancelled a program that tested the sexual responses of young sex offenders by attaching sensors to their genitals, after it learned one of the researchers has been charged with a sexual offence.
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
- Caterers dish up more cases of food poisoning New figures from the federal Centers for Disease Control and Prevention show that illnesses from reported outbreaks of food poisoning linked to catering outpace those from restaurants or home cooking.
- Women's hormone cream can screw up your kids, pets The hug of a middle-aged woman might affect nearby kids and pets in alarming ways -- and it has nothing to do with menopause mood swings.
- No help for unemployed buying COBRA coverage? Dose of reality: A provision in federal law called COBRA allows certain people who lose their jobs to keep their employer-provided health insurance coverage, if they pay for it.
- Daydreams really can take you far away Just how distracting daydreams can be depends on where exactly your wandering mind takes you, a new study suggests.
- Video: Tanning addiction a growing problem Dermatologists warn of the dangers of addiction to tanning beds, reflector blankets and roasting in the sun. WNBC's Tom Llamas reports. (NBC News Channel)
- 4 vets positive for hepatitis after St. Louis clinic visit Four veterans treated at the St. Louis VA Medical Center's dental clinic have tested positive for hepatitis, but further testing is needed to determine if inadequately sterilized dental equipment is to blame.
- Army's suicide rate tied to rise in risky behaviors An Army report on the record number of soldier suicides says the trend is part of a rise in risky behavior, including drunk driving and drug abuse.
- 9 natural cures you can trust Cocoa for high blood pressure? Massage for depression? That's right. Doctors say these and other alternative remedies really work to help heal our everyday ailments.
- Lisps come and lisps go — like Sally Draper's Besides notable absences including guys like Sal, Ken and Paul, Sunday’s season premiere of “Mad Men” was missing one more beloved character: Sally Draper’s lisp.
- Protein in urine can forecast kidney disease Doctors may be able to watch for kidney injury and protect patients by looking for protein in urine, researchers reported on Thursday.
WSJ.com: Health
- Merck's Profit Falls 52% Pharmaceutical giant Merck said its earnings dropped 52%, weighed down by acquisition and other charges and weaker sales of key drugs.
- Health Bill's New Tax Rules Under Fire Democrats may water down or repeal new tax-reporting rules that are supposed to raise $16 billion for health-care legislation, facing a chorus of criticism about the rules.
- Americans Cut Back on Doctor Visits Insured Americans are using fewer medical services, raising questions about whether patients are consuming less care as they pick up more of the cost.
- In Many CPRs, Skip Mouth-to-Mouth Two new studies bolster a shift in thinking about how to revive many cardiac-arrest patients: Don't do mouth-to-mouth resuscitation.
- Sanofi Nearer to Genzyme Bid Sanofi is likely to make a formal bid to Genzyme's board in an effort to win enough support for a deal that could eventually be valued at about $20 billion.
- Sanofi Net Jumps 61% Sanofi-Aventis reported a 61% rise in net profit and will conduct "another re-evaluation" of the structure of its U.S. sales force in light of looming generic competition to the company's blockbuster drug Lovenox.
- Key Drugs Boost AstraZeneca AstraZeneca posted a 23% rise in profit, helped by a strong performance in emerging markets and sales of key drugs like cholesterol product Crestor.
- AstraZeneca Anticlotting Drug Wins Support An FDA panel backed an anticlotting drug being developed by AstraZeneca despite concerns about its effectiveness.
- Nvidia Warns of Sales Shortfall Nvidia lowered its second-quarter revenue estimates, amid weak consumer spending that weighed on sales of its flagship graphics processing chips.
- Eli Lilly Loses Appeal in Gemzar Patent Case A federal appeals court ruled Wednesday that an Eli Lilly Co. patent for anti-cancer drug Gemzar is invalid, a decision that may clear the way for generic competition to the drug late this year.
PLoS Medicine: New Articles
- PLoS Medicine Issue Image | Vol. 7(7) July 2010 HIV in Maternal and Child Heath: Concurrent crises demand cooperation. In our Editorial this month the PLoS Medicine editors argue that the time has come to integrate prevention and treatment of HIV into maternal and child health care programs. A recent analysis of maternal deaths worldwide cited in the Editorial revealed that without the HIV epidemic there would have been an estimated 61,400 fewer maternal deaths in 2008. Although tackling HIV is a priority within the Millennium Development Goals (MDGs), it is not specifically included in the MDGs for reducing child mortality and improving maternal health. A more integrated approach is needed, say the editors, recognizing maternal and child health and HIV as concurrent crises. The Editorial concludes that "the time has come to stop tackling infectious diseases, specifically HIV, in isolation from other health goals, and instead to examine the opportunities for integrating and scaling up delivery of HIV prevention and treatment services within the context of maternal and child health care."Image Credit: Narith5 at flickr.com
- Three Adult Cases of Listeria monocytogenes Meningitis in... Rogier van Doorn and colleagues from Ho Chi Minh city, Vietnam present a Learning Forum involving three unusual cases of patients with listerial meningitis.
- HIV in Maternal and Child Heath: Concurrent Crises Demand... The PLoS Medicine editors argue that the time has come to integrate prevention and treatment of HIV into maternal and child health care programs.
- Association of Early Repolarization Pattern on ECG with R... In a population-based cohort study of middle-aged people in Central Europe, Stefan Kääb and colleagues find an association between electrocardiographic early repolarization pattern and mortality risk.
- Integrative Genomic Analyses Identify BRF2 as a Novel Lin... William Lockwood and colleagues show that the focal amplification of a gene, BRF2, on Chromosome 8p12 plays a key role in squamous cell carcinoma of the lung.
- Social Relationships and Mortality Risk: A Meta-analytic ... In a meta-analysis, Julianne Holt-Lunstad and colleagues find that individuals' social relationships have as much influence on mortality risk as other well-established risk factors for mortality, such as smoking.
- HIV Testing for Children in Resource-Limited Settings: Wh... Scott Kellerman and Shaffiq Essajee argue that the time has come to increase access to HIV testing for children, especially in sub-Saharan Africa.
- Improving Prevention of Mother-to-Child Transmission of H... Younsook Lim and colleagues describe the Rwanda Learning Collaborative on Child Health, which aimed to improve and extend the impact of prevention of mother-to-child transmission of HIV/AIDS.
- A Model for the Roll-Out of Comprehensive Adult Male Circ... Bertrand Auvert and colleagues describe the large-scale roll-out of adult male circumcision through a program in South Africa.
- Left to Their Own Devices: Breakdowns in United States Me... Using examples from recent FDA regulatory proceedings, Jonas Hines and colleagues critique the medical device premarket review and identify eight weaknesses in the process that should be remedied.
Forbes.com: Health News
- The Cancer-Causing Sex Virus HPV--known for causing cervical cancer--is emerging as the leading cause of throat cancer in men. Should they get the vaccine too?
- False-Alarm Medical Tests Some tests pointing to serious conditions are wrong far more often than they are right. Which ones are most likely to cause needless anxiety?
- Why Your Kids Need Recess They might be better off putting down their books and heading outside.
- Ten Foods You Should Be Eating Improving your health can be as simple as eating these items.
- Getting Fitbit A new gadget helps track the healthy details of your life.
- Eight Ways Health Reform Affects You Today Health reform rolls into place over four years, but some changes will take effect very soon.
- America's Fittest Cities Washington, D.C. tops an annual ranking of which cities are in the best shape.
- Wacky Food Health Claims Snacks tout all sorts of ways they will make you healthier. Too bad many of the claims aren't true.
- Where Americans Suffer Allergies Most High pollen counts, fewer allergy specialists and over-medicating put these metro areas at the top of the list.
- America's Most Polluted Cities The metro areas with the nation's poorest air quality.
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
- The Value of YouTube Videos for Cancer Patients - Mayo Cl... Ruben Mesa, M.D., describes his experience using YouTube videos to provide in-depth information about blood cancers. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Evaluation of driving risk in dementia - practice paramet... For patients with dementia, the following characteristics are useful for identifyingpatients at increased risk for unsafe driving:- Clinical Dementia Rating scale (Level A)- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)- history of crashes or traffic citations (Level C)- reduced driving mileage or self-reported situational avoidance (Level C)- Mini-Mental State Examination scores of 24 or less (Level C)- aggressive or impulsive personality characteristics (Level C)Evaluation of driving risk in dementia (click to enlarge the image).The following characteristics are not useful for identifying patients at increased risk for unsafe driving: - patient’s self-rating of safe driving ability (Level A)- lack of situational avoidance (Level C)References:Practice Parameter update: Evaluation and management of driving risk in dementia. Neurology 2010;74:1316–1324 (PDF) Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Wound Closure Adhesive Strips Walgreens Wound Closure Adhesive Strips: adhesive strips used to secure, close and support small cuts and wounds. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Video: Awake Endotracheal Intubation Video: Awake Endotracheal Intubation for "Fun and Knowledge" by an anesthesiologist from the Massachusetts General Hospital (MGH). Not sure about the "fun" part...References:Awake Endotracheal Intubation for Fun and Knowledge. Medgadget, 2010. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Takotsubo cardiomyopathy (broken-heart syndrome) in diffe... Takotsubo cardiomyopathy (also called stress induced cardiomyopathy, apical ballooning, or broken heart syndrome) was first described in Japan 20 years ago. It is typically precipitated by acute emotional stress, hence the names “stress cardiomyopathy” or “broken-heart syndrome.”Takotsubo cardiomyopathy is characterised by acute, reversible left ventricular dysfunction in a distribution,which does not correlate with the coronary artery blood supply. The left ventricular dysfunction occurs without obstructive coronary artery disease (CAD) and usually resolves spontaneously over a period of weeks.The characteristic appearances on contrast angiography include:- ballooned apical segment- hypercontractile basal portion of the left ventricleThe appearances are reminiscent of the design of the traditional fishing pot used in Japan to trap octopus, hence the descriptive term "tako-tsubo" cardiomyopathy (octopus trap, tako tsubo). Such a trap, no more than simple ceramic jar, take advantage of the octopus’ preference for small, enclosed spaces and the security they seem to promise. They are simply left on the seabed and gathered later after octopi have had time to occupy them.Although Takotsubo cardiomyopathy was initially considered rare, it could possibly be responsible for 1-2% of admissions for acute coronary syndrome in industrialised countries.References:Takotsubo cardiomyopathy. Banning et al. 340: c1272, BMJ.Takotsubo Cardiomyopathy, or Broken-Heart Syndrome. SS Virani et al, Tex Heart Inst J. 2007; 34(1): 76–79.Morikami museum.Image source: Octopus trap, tako tsubo, Morikami museum. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Increasing Diet Polyunsaturated Fat in Place of Saturated... Reduced saturated fat (SFA) consumption is recommended to decrease coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.The overall pooled risk reduction was 19% (RR = 0.81), corresponding to 10% reduced CHD risk (RR = 0.90) for each 5% energy of increased PUFA.These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.References:Mozaffarian D, Micha R, Wallace S (2010). Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med 7(3): e1000252. doi:10.1371/journal.pmed.1000252Image source: Varieties of meat, Wikipedia, public domain. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Start metformin early when diabetes type II is first diag... Initiating metformin soon after diabetes diagnosis and while A1C is low might preserve β-cell function, prolong the effectiveness of metformin, reduce lifetime glycemic burden, and prevent diabetes complications.These findings support the current treatment algorithm for hyperglycemia management that recommends metformin initiation when diabetes is first diagnosed.Video: How the Body Works - The Pancreas.References:Secondary Failure of Metformin Monotherapy in Clinical Practice. Diabetes Care March 2010 vol. 33 no. 3 501-506. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Mipomersen - antisense technology to lower LDL cholesterol Homozygous familial hypercholesterolaemia is a rare genetic disorder in which both LDL-receptor alleles are defective, resulting in very high concentrations of LDL cholesterol in plasma and premature coronary artery disease. This study investigated the use of an antisense inhibitor of apolipoprotein B synthesis, mipomersen, to lower LDL cholesterol.Patients aged 12 years and older who were already receiving the maximum tolerated dose of a lipid-lowering drug, were randomly assigned to mipomersen 200 mg subcutaneously every week or placebo for 26 weeks.34 patients were assigned to mipomersen and 17 to placebo. Mean concentrations of LDL cholesterol at baseline were 11·4 mmol/L in the mipomersen group and 10·4 mmol/L in the placebo group. The mean percentage change in LDL cholesterol concentration was significantly greater with mipomersen (−24·7%) than with placebo (−3·3%).The most common adverse events were injection-site reactions in 76% of patients in mipomersen group vs 24% in placebo group. 12% of patients in the mipomersen group had increases in alanine aminotransferase of three times or more the upper limit of normal.Inhibition of apolipoprotein B synthesis by mipomersen represents a novel, effective therapy to reduce LDL cholesterol concentrations in patients with homozygous familial hypercholesterolaemia who are already receiving lipid-lowering drugs, including high-dose statins.References:Mipomersen, an apolipoprotein B synthesis inhibitor, for lowering of LDL cholesterol concentrations in patients with homozygous familial hypercholesterolaemia: a randomised, double-blind, placebo-controlled trial. The Lancet, Volume 375, Issue 9719, Pages 998 - 1006, 20 March 2010.Researchers make synthetic HDL cholesterol with a core of goldLipoprotein structure (chylomicron) (left). Image source: Wikipedia, GNU Free Documentation License. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Contact lenses change color when blood glucose increases ... In the future, diabetics may be able to wear contact lenses that continuously alert them to variations in their glucose levels by changing colors - potentially replacing the need to routinely draw blood throughout the day.The non-invasive technology, developed by Chemical and Biochemical Engineering professor Jin Zhang at The University of Western Ontario, uses extremely small nanoparticles embedded into the hydrogel lenses. These engineered nanoparticles react with glucose molecules found in tears, causing a chemical reaction that changes their color.References:Nanocomposites could change diabetes treatment. The University of Western Ontario, 2010.Image source: OpenClipArt.org. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
- Preventing diabetes, biological passport for athletes and... Low-dose combination therapy with rosiglitazone and metformin was highly effective in prevention of type 2 diabetes in patients with impaired glucose tolerance, with little effect on the clinically relevant adverse events of these two drugs.Preventing type 2 diabetes with low-dose combinations: Lifestyle interventions aimed at reducing bodyweight, and use of metformin, thiazolidinediones, acarbose, and orlistat, reduce the risk of diabetes by 25—60% over 3—6 yearsThe biological passport and doping in athletics: A biological passport monitors an athlete's blood and body chemistry values over time to assess whether there has been a deviation from an established baseline, thus indirectly detecting illegal manipulation.A long look at obesity: Even with their primitive understanding of nutrition, our neolithic forebears somehow made the “right choices”, thriving on a wholesome diet of nuts, seeds, and fruits with the occasional piece of meat. And what is more, their rare intake of animal protein could only have been obtained through vigorous exercise, which they would, of course, indulge in every day. Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
Medgadget
- Samsung Releases New Televisions for Hospital Use Samsung is releasing a new line of LCD TVs specifically designed for hospital use. The LCD 458 models are available in 26" and 32" and feature TeleHealth Services' interactive technology that brings entertainment, educational, and informational content to the bedside. One of the main features of the new LCD TVs is the integration of TeleHealth Services’ proprietary TIGR patient education system, which makes an entire library of educational videos available on-demand in hospital rooms. Educational programs can be accessed at any time, day or night directly from the patient’s bedside using a hospital’s telephone system. In addition, both models offer USB autosensing side inputs and an interchangeable pillow speaker interface. The USB autosensing side inputs enable patients to easily access content, such as music, movies, videos, games and more by allowing patients to connect external entertainment devices to the television via a USB port. Hospitals benefit from the interchangeable pillow speaker interface that enables inter-compatibility between multiple pillow speaker brands and pin sets. The Samsung line of healthcare LCD TVs, featuring technology from TeleHealth Services, offers a number of key features that improve operational efficiency. The new line of healthcare LCD TVs is UL-listed for hospital use and meets the more stringent requirements for use in hospital environments. To assist in the ease of installation, the Samsung healthcare LCD TVs also feature USB cloning technology, making it easy for administrators to quickly customize and deploy the sets across the facility. Press release: Samsung and TeleHealth Services Partner to Introduce LCD TVs Designed Exclusively for Hospitals......
- CervoCheck to Detect Preterm Uterine Contractions A team of biomedical engineering masters students at Johns Hopkins have developed a device that they hope will be able to spot oncoming pre-term labor in pregnant women earlier than by using an external tocodynamometer. The CervoCheck device is meant to be inserted into the vaginal canal/cervical opening where it then can measure electrical signals characteristic of contractions. Prototypes of the device are currently being tested in animals. We sympathize with those who have to insert them into pigs(?). After much research and brainstorming, the students built a prototype ring made of medical grade biocompatible silicone elastomer. The ring is designed to be compressed and inserted into the vaginal canal at a physician’s office or hospital. Embedded within the ring are sensors designed to pick up electrical signals associated with uterine contractions. The prototype has not yet been used on human patients, but the students say their early animal test results are promising and that improvement of the system is continuing. Working with the Johns Hopkins Technology Transfer office, the students and Aina-Mumuney have obtained a provisional patent covering their invention and established CervoCheck, LLC. Link: Students Design Early Labor Detector to Help Prevent Premature Births......
- Hologic 3D Mammography System to be Reviewed by FDA Hologic of Bedford, MA has announced that the FDA's Radiological Devices Panel will be reviewing the company's Selenia Dimensions 3-D digital mammography tomosynthesis system. The device takes many low energy X-ray shots from different angles and reconstructs a 3D image of the breast. Hologic's Selenia Dimensions technology is already available in most of the rest of the world, but FDA's regulatory bureaucracy will only meet to discuss the system in September. Some details about breast tomosynthesis from a Hologic white paper: The breast is compressed in a standard way. While holding the breast stationary, the x-ray tube is rotated over a limited angular range. A series of low dose exposures are made every degree or so, creating a series of digital images. Typically, the tube is rotated through 10-20 degrees and 10-20 exposures are made every 1° or so during a total scan of 5 seconds or less. The individual images are projections through the breast at different angles and these are what are reconstructed into slices. Normally the breast would be placed in the MLO or the CC view, although the tomosynthesis system should support the ability to acquire images in any desired orientation. One consideration in the design of tomosynthesis systems is the motion of the x-ray source during acquisition. The x-ray tube can move in a continuous or step-and-shoot motion. With continuous motion x-ray exposures must be short enough to avoid image blurring due to focal spot motion. If step-and-shoot motion is employed, the gantry must come to a complete stop at each angular location before turning on the x-rays, otherwise vibration will blur the image. The most important criteria is that the total scan time be as short as possible, to reduce the possibility of patient motion which will degrade the visibility of small microcalcifications and small spiculations. Press release: Hologic Announces Panel Date for its Selenia Dimensions (3-D) Digital Mammography Tomosynthesis System... White paper: Fundamentals of Breast Tomosynthesis... (.PDF)...
- Glucose Monitor Could Go From on the Belt to In the Belly Researchers led by Bioengineering Professor David Gough at UCSD have reported, in a paper in Science Translational Medicine, that they implanted a wireless telemetry CGM in two pigs (222 and 520 days, respectively) and the device was successfully reporting glucose levels to an external receiver. Following human testing and FDA approval, devices such as these could replace similar systems that are external to the body with a needle-attachment that pierces the skin to take measures. Combined with potential transdermal or intranasal insulin administration, this technology could lead to less sticking and poking of diabetics. From the abstract: The sensor detects glucose via an enzyme electrode that is based on differential electrochemical oxygen detection, which reduces the sensitivity of the sensor to encapsulation by the body, variations in local microvascular perfusion, limited availability of tissue oxygen, and inactivation of the enzymes. After an initial 2-week stabilization period, the implanted sensors maintained stability of calibration for extended periods. The lag between blood and tissue glucose concentrations was 11.8 ± 5.7 and 6.5 ± 13.3 minutes (mean ± standard deviation), respectively, for rising and falling blood glucose challenges. The lag resulted mainly from glucose mass transfer in the tissues, rather than the intrinsic response of the sensor, and showed no systematic change over implant test periods. These results represent a milestone in the translation of the sensor system to human applications. Full abstract in STM: Function of an Implanted Tissue Glucose Sensor for More than 1 Year in Animals Press release: Implanted glucose sensor works for more than 1 year......
- New Trial Will Test Efficacy of Spinal Cord Stimulation i... Medtronic announced today the start of its Defeat-HF study, in which the company will attempt to treat heart failure through the use of spinal cord stimulation (SCS). Trial subjects will be implanted with Medtronic's PrimeADVANCED neurostimulation device, which is currently being used for pain management. The treatment's efficacy will be evaluated based on heart size, muscle wall thickness, fatigue, shortness of breath, and quality of life improvements. An explanation from Medtronic's press release: Heart failure stimulates the sympathetic nervous system further progressing the disease. The Defeat-HF study will evaluate whether SCS can restore the natural balance between the sympathetic and parasympathetic nervous systems to improve blood flow, reduce inflammation and restore the heart’s dimensions and function. The study will be conducted under an Investigational Device Exemption (IDE) in the United States. The prospective, randomized, feasibility trial is expected to enroll NYHA Class III systolic heart failure patients at up to 15 centers worldwide. All patients are implanted with a Medtronic PrimeADVANCED™ neurostimulator and followed for 12 months. In this trial, the device delivers stimulation for 12 hours a day. Press release: Medtronic Launches Novel Clinical Trial Evaluating Spinal Cord Stimulation Therapy for Heart Failure... Product page: PrimeAdvanced Neurostimulator... Flashback: RestoreADVANCED™, PrimeADVANCED™ Neurostimulators...
- AfriDoctor Smartphone App for Remote Diagnosis AfriDoctor is a new app for Nokia smartphones that hopes to bring a bit of medical expertise to people and places where it is not readily available. The basic premise is that people who are experiencing an externally visible condition, like a rash or pink eyes, would take a photo of it using the app. The image is then forwarded to a panel of doctors from Health24, a South African health portal, and they reply within 48 hours with their "diagnosis". Somehow this app won Nokia's Africa Calling All Innovators contest, though there doesn't seem anything particularly novel about sending pics. Considering that live streaming video teleconferencing is insufficient to examine the great majority of patients, using camera phone photos will surely not be practical for much. Product page: Afridoctor ... Buy at Nokia's OVI store......
- mHealth 2010 Conference Invite Medgadget is proud to be a media partner for the mHealth 2010 Conference. You are invited to experience the event for yourself in Dubai, UAE on 13th-15th September 2010. mHealth 2010 Conference is bringing together leading players from across the entire mobile healthcare ecosystem. It will feature 35+ top executive presentations and global case studies. The conference will facilitate the global development of mobile healthcare and explore ways in which universal healthcare can be delivered with the aid of mobile technology. Download mHealth 2010 brochure here.... With over 200 attendees, global case studies, key decision makers, innovative formats and built-in networking time, this is a conference that you cannot afford to miss! For further information please visit the mHealth 2010 website......
- Metabolically Engineered Bacteria Produce Spider Silk Pro... Are you ready for new types of sutures or new hernia patches? We might have them coming. Spider silk is incredibly strong, but farming spiders is a delirious idea, so researchers have been looking at ways of generating this material in other ways. Scientists at Korea Advanced Institute of Science and Technology (KAIST), Seoul National University and Tufts University have managed to transplant spider silk protein producing genes into E. coli. By growing the new bacteria into significant quantities, they were able to harvest the silk protein produced and manufacture it into a strong fiber. For the successful expression of high molecular weight spider silk protein, Professor Lee [Sang Yup Lee, KAIST]and his colleagues pieced together the silk gene from chemically synthesized oligonucleotides, and then inserted it into the expression host (in this case, an industrially safe bacterium Escherichia coli which is normally found in our gut). Initially, the bacterium refused to the challenging task of producing high molecular weight spider silk protein due to the unique characteristics of the protein, such as extremely large size, repetitive nature of the protein structure, and biased abundance of a particular amino acid glycine. “To make E. coli synthesize this ultra high molecular weight (as big as 285 kilodalton) spider silk protein having highly repetitive amino acid sequence, we helped E. coli overcome the difficulties by systems metabolic engineering,” says Sang Yup Lee, Distinguished Professor of KAIST, who led this project. His team boosted the pool of glycyl-tRNA, the major building block of spider silk protein synthesis. “We could obtain appreciable expression of the 285 kilodalton spider silk protein, which is the largest recombinant silk protein ever produced in E. coli. That was really incredible.” says Dr. Xia. But this was only step one. The KAIST team performed high-cell-density cultures for mass production of the recombinant spider silk protein. Then, the team developed a simple, easy to scale-up purification process for the recombinant spider silk protein. The purified spider silk protein could be spun into beautiful silk fiber. To study the mechanical properties of the artificial spider silk, the researchers determined tenacity, elongation, and Young’s modulus, the three critical mechanical parameters that represent a fiber’s strength, extensibility, and stiffness. Importantly, the artificial fiber displayed the tenacity, elongation, and Young’s modulus of 508 MPa, 15%, and 21 GPa, respectively, which are comparable to those of the native spider silk. Statement by Korea Advanced...
- Cardiac Science Unveils Quinton 9500 Series Stress Test S... Cardiac Science of Bothell, Washington just released a new cardiac stress test system that's designed to save space in the clinic, and comes optionally as either a wall mounted unit or free-wheeling on a cart. Modalities: Stress Test -- Treadmill Stress Test -- Bicycle Stress Test -- Pharmacological Resting 12-lead ECG with Interp Features: Revolutionary designs optimize space and allow stress testing in a greater variety of settings. Both the Quinton 9500 (a unique wall-mounted cabinet) and the Quinton 9550 (a mobile cart with ample storage space) feature small footprints and fully integrated components. Wireless data acquisition delivers safety, comfort, and confidence to patients and staff. A modern user interface facilitates fast and efficient workflow and reduces training needs. The one-button navigation and optional touch screen make the Quinton 9500 Series intuitive to learn and use. Advanced connectivity assures easy and convenient management of patient records. Physicians can read, analyze, and confirm patient tests from anywhere with a secure internet connection. While no EMR is required to view data with CareCenter MD, records can be easily transferred to an EMR if desired. Press release: Cardiac Science Introduces Two New Cardiac Stress Systems... Product page: Quinton 9500 Series......
- Toaster Defibrillator Concept Would be Bad to Have in an ... ... but fun to have at home. This clever/funny Toast/e/r (including the name) is by designer Shay Carmon. Note the QRS complex grill. Concept Page: Toast/e/r... (via Gizmodo)...
The Health Care Blog
- Use Emotion to Drive Adoption—Not Rejection—of Health IT By LYGEIA RICCIARDI Last week I heard uber marketer Seth Godin speak about the power of fear. Fear is one of the strongest human emotions, based in the core of our brain--the “lizard brain” that evolved prior to our higher...
- Interview with Patrick Soon-Shiong By Ida Strom Seljeseth In this brief interview at the Health 2.0 Goes to Washington conference June 10, 2010 Executive Chairman of Araxis Health, Patrick Soon-Shiong, talks about the Health Transformation Institute.
- The Reform Dartboard: Predicting Healthcare Costs By ROGER COLLIER One thing about a democracy, everyone is entitled to publish their predictions about the future, and on the costs (or savings) of the Patient Protection and Affordable Care Act over the 2010-2019 decade, there are enough to...
- Reactor Panel: Health 2.0 Goes to Washington By Matthew Holt In final panel at Health 2.0 Goes to Washington the reactor panel, Will Yu (ONC), Esther Dyson (EDventure) and Chris Schroeder(Healthcentral) discussed health issues, and innovation in the healthcare system with Matthew Holt.
- Interview with Esther Dyson By Matthew Holt SUBTEXT:After being a panelist at the Health 2.0 Goes to Washington Conference, Esther Dyson, Chairman of EDventure Holdings, gave a backstage interview. She talked about the three markets that influence Health 2.0; the market for healthcare, bad...
- Government as an Engine for Innovation By LISA SUENNEN I’ve been thinking a great deal about the newly formed Center for Medicare and Medicaid Innovation. (CMI). This entity was established as a result of the Affordable Care Act (the new healthcare reform legislation) and its purpose...
- THCB Corporate Sponsors Include:
- Can CMS Be a Venture Capitalist? By PAUL LEVY Lisa Suennen, a venture capitalist, writes this post about the provision in the national health care reform act that created the Center for Medicare and Medicaid Innovation (CMI). This agency has $10 billion to “research, develop, test...
- Panel Discussion: Can Health 2.0 Improve EHR Adoption? By Matthew Holt SUBTEXT: On stage at Health 2.0 Goes to Washington, June 07, 2010, this panel discussed the Electronic Health Record (EHR) and ways to improve its adoption and the relationship between physicians and patients. The moderator was Joshua...
- THCB Corporate Sponsors Include:
KevinMD.com
- Diabetes is responsible for many heart disease deaths by Kristina Fiore More than one in 10 heart disease deaths may be attributable to diabetes, researchers say. In a meta-analysis of more than 100 studies, diabetes was associated with a twofold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of [...]
- Non-clinical physician job starting salaries by Joseph Kim, MD, MPH What are entry-level non-clinical physician job salaries? Let me clarify what I mean by “entry-level” here: I’m referring to non-clinical jobs that physicians may find if they leave clinical medicine to pursue a non-clinical job in a company (such as a medical communications company, a health IT company, pharmaceutical, biotechnology, or a [...]
- How industry money continues to influence orthopedics by Ford Vox, MD Three years ago, the Department of Justice took stock of the orthopedic medical device industry–represented by the five big makers of orthopedic implants–and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in [...]
- What to do if your doctor quits and leaves medicine by Jan Gurley, MD The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area. And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a [...]
- Let consumers decide if they want the patient centered me... by Jaan Sidorov, MD Is the Patient Centered Medical Home (PCMH) the panacea for all that ails health care? Have we exhausted all the allegories related to the term “home?” The answer to both questions apparently is no, thanks to this American Journal of Managed Care article by Timothy Hoff titled The Shaky Foundation of the Patient [...]
- Kombucha tea can be dangerous to your health by Michele R. Berman, MD Celebrities are powerful role models and are important to consumers concerned with their health because of the perception that famous people have access to the best health practices and medical care. The public looks to celebrities for hope and inspiration as they struggle with their own health issues and fight disease. [...]
- Homocysteine lowering does not reduce heart attack risk by Crystal Phend Homocysteine-lowering supplements do not help prevent further cardiovascular events in heart attack survivors, a large randomized trial affirmed. The trial, which followed more than 12,000 heart attack survivors over nearly seven years, found that folic acid plus vitamin B12 effectively reduced homocysteine levels, but did not reduce major vascular events overall nor any other [...]
- Why patients are wary of the primary care medical home by Kevin Pho, MD Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions. On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary [...]
- How essential is industry funding for university CME? by Daniel Carlat, MD As originally reported in a New York Times article recently, with more coverage in MedPage Today, the University of Michigan School of Medicine has decided to end all industry support of CME as of January 1, 2011. According to the dean of the medical school, “the decision was based on a review of [...]
- How the Massachusetts gift ban hurts primary care doctors by Kate Atkinson, MD Six years ago, I organized a group of female healthcare practitioners for a women’s medical journal club. A multidisciplinary team of doctors and NPs from primary care and sub-specialties regularly attended monthly dinners. Invited speakers presented on a variety of topics and over the course of a meeting we exchanged [...]
Canadian Medicine
- Between a rock and a hard place? Commission a report, then ignore itWith only 94 general practice posts, Prince Edward Island is small, but it's a microcosm of the health budget squeezes being felt around the world. Something needs to be done to arrest the spiralling expenditure ... but what? Time to call in global management consulting firm Hay Group to produce a $200,000 report.Hay Group, not surprisingly, focussed their attention on one of the province's biggest expenses: doctors. How could the government reduce the amount it spends on doctors? To an accountant, the answer is simple and obvious - have fewer doctors.That's precisely what the Hay Group is recommending as its report nears completion, and the area in which it finds the most room for cuts is family practice. In fact, Hay suggests cutting the number of GPs on P.E.I. from 94 to as few as 65.Doing this would naturally require somebody else to shoulder the GPs' burden, and that's what the report recommends, suggesting new roles for nurses, nurse practitioners, and so on.The province's College of Family Physicians argues it's already adopting these new models. But, says president Dr. Andrew Wohlgemut: "We're not for substituting or getting rid of family physicians and replacing them with other people."On that issue, it seems, he has friends in high places. On the day the report's recommendations were made public, P.E.I.'s Health Ministry issued a press release trumpeting the hiring of seven new physicians, three of them GPs.Provincial Health Minister Carolyn Bertram said she won't comment fully on the report until the final draft is submitted to the cabinet in about six weeks, but it seems she's already decided how to address its main recommendation: "We are not cutting doctors' positions," she told the CBC.Some political realities can still trump even the budget squeeze. Get Canadian Medicine news by email or in an RSS reader
- Future looks bleak for Avandia as safety trial put on hold Last week saw an FDA panel rule that there is reason to believe the troubled diabetes drug Avandia (rosiglitazone) does indeed increase cardiovascular risks compared to its direct competitor Actos (pioglitazone).Now, the FDA appears to be moving to shut down the Canadian-led trial that represented the last chance for maker GlaxoSmithKline to prove its drug is safe. The agency put a "partial clinical hold" on new recruitment for the TIDE trial while it updates the lead investigators - Drs Salim Yusef and Hertzel Gerstein of McMaster University - on the results of last week's panel meeting.While the FDA safety panel stopped short of voting to remove Avandia from the market, the agency can still take action without a vote, and most observers suspect the end is near for Avandia, which has already seen sales collapse in the wake of data suggesting it increases cardiovascular events.In fact, the same safety concerns were inhibiting recruitment to the TIDE trial. GSK, which agreed in 2007 to fund a head-to-head comparison with pioglitazone, said last week that only 1,100 of an intended 16,000 study participants have volunteered to date. Get Canadian Medicine news by email or in an RSS reader
- Little sympathy for lung cancer patients A critical perspectiveCanadians tend to judge people stricken by lung cancer to a greater extent than do people of many other countries, according to a recent study conducted by Ipsos MORI for the Global Lung Coalition. Although this form of cancer is as painful and frightening as any other, consisting of symptoms that can include coughing (with and without blood), shortness of breath, chest and/or abdominal pain, weight loss, dysphagia, etc., because lung cancer is commonly believed to be brought on by the patients themselves, there tends to be less sympathy towards sufferers.Survey results found 1 in 5 of us admit to this attitude – generally 22% of our population – with men making up 27% and women 19%. Though the Canadian view has much company among the other 15 countries surveyed, we’re far more critical than those with greater empathy such as Argentina – the most caring country, coming in at only 10%. Countries shown to have the lowest rates of smoking tended to be the least sympathetic to lung cancer patients, despite the fact that 15% of these individuals never smoked and acquired the disease through exposure to radon, asbestos, air pollution or second-hand smoke – often from co-workers or people with whom they live. Regardless of the cause, lung cancer currently kills four times as many people as does breast cancer – roughly 20,000.Heather McQuaid, an oncology social worker maintains that lung cancer patients feel stigmatized. The superficial attitude that gives way to this stigma may very well be the reason why $25 million was invested in breast cancer research in 2007, compared with a paltry $8 million towards lung cancer, directly “impacting on the support these cancer victims receive, particularly from the healthcare system,” according to CEO and President of the Canadian Lung Association, Heather Borquez. Can’t we do better? Get Canadian Medicine news by email or in an RSS reader
- 5 risks to a woman's health Most physicians believe that too many Canadians eat too much and exercise too little. There are other health risks faced by women in particular. US gynecologist Jennifer Young put together a list of five female risks that can be avoided . It's been one of the most popular items on the Ivanhoe News Wire for the last couple of weeks.Dr Young's Top Five1) 50% of women with abnormal pap smears don't follow up.2) Many avoid birth control pills believing they increase the risk of cancer. Dr Young suggests they actually reduce the risk of ovarian cancer by half. She asserts that studies done in the 1980s that linked breast cancer with the pills turned out to be wrong.3) Quitting antidepressants cold turkey. Young advises lowering the dosage by ¼ a week for four weeks to mitigate the effects of sudden withdrawal.4) Drinking too much. Women are smaller, have less body water and lower amounts of an enzyme that breaks down alcohol. She asserts that women who get drunk just once a month increase their risk of heart attack by one third.5) Not taking folic acid regularly until they become pregnant. She recommends taking the vitamin for six months before pregnancy begins. Get Canadian Medicine news by email or in an RSS reader
- Mother of all studies claims half a million Britons The world's biggest health study will shortly wind up recruiting, having today passed the 500,000 subject mark – persuading one in fifty Britons aged 40-69 to let researchers follow their health for the next 30 years.The £66 million UK Biobank, backed by all the major institutions of British medical research, will "generate new knowledge about relationships between health, disease, genes and environment for many years to come", according to Sir Mark Walport, Director of the Wellcome Trust.The study aims to be as deep as it is wide, with patients followed in considerable detail. Each has provided samples of blood, urine and saliva, and answered questionnaires on diet, exercise, family and personal history. Each has undergone a battery of tests including lung function, arterial stiffness, bone mineral density, grip strength, brain function, intraocular pressure, sight and hearing.Much of the analysis won't be happening for at least a decade. But after that, organizers expect a steady stream of revelations in everything from cancer to heart disease to diabetes and arthritis. Needless to say, with their similar genetic heritage, many Canadians can expect Biobank will generate findings relevant to their lives. The study's ethical code dictates sharing anonymized data with all credible foreign researchers.A key function of Biobank is to act as a gene database. As the NHS's reporting system picks up subjects' health woes, their samples will be analyzed to look for genetic correlations. But participants have been told they won't be getting any genetic analysis back. In fact, they don't stand to gain personally in any way. One striking feature of the study is that even if it detects evidence of illness in participants, whether through blood or urine samples, or because they have genes that turn out to be high-risk, Biobank won't inform the affected patients or their physicians.One reason for this, the organizers say, is to stop insurance companies from penalising study volunteers. Insurance contracts often legally require purchasers to disclose test results they know, but not those they don't.But a major ultimate goal of the Biobank is to find the links between DNA and diseases, and disseminate that knowledge as widely as possible. One suspects that at some point, the insurance companies are going to get involved in that process.This morning, as they celebrated the recruiting of the half-millionth Biobank recruit, the great and the good of British medical research were effusive in their praise of these “local heroes” who will give so much of their time over the next 30 years for no obvious personal benefit. But hang on a minute – if they're all altruistic heroes, then how can they be a representative sample of the British population? Get Canadian Medicine news by email or in an RSS reader
- Canada -- we're number six! Canada's health system was ranked last out of six public systems in an international survey that found only the United States delivering worse care to its patients. The private Commonwealth Fund, a group which advocates broader access to healthcare in the U.S., surveyed both patients and physicians on their experiences in seven countries.The results are compiled in the 2010 edition of their ongoing report Mirror, mirror on the wall: How the performance of the US health care system compares internationally. The highly-regarded Dutch system came in first place, closely followed by Britain and Australia. Germany and New Zealand lagged behind, with Canada bringing up the rearguard of public health systems. The US, predictably, limped in a distant last.The US scored badly not just on access, efficiency and equity, but even on quality of care, a category in which it came sixth, with only Canada doing worse.Canada's great weaknesses will come as no surprise to anyone who lives here: primary care, primary care and primary care. The report reflects the growing belief among Canadians that if you haven't got a GP now, you may never get one.A corollary of this is overreliance on emergency services and lack of adequate preventive care. Wait times are an issue for patients, who also complain of lack of out-of-hours care. And Canada gets very poor marks for our patchwork adoption of electronic medical records.Canada was actually the biggest per capita spender of the "socialised medicine" countries, at US$3,895 a head. New Zealand occupied the bargain basement at a paltry $2,454. Needless to say, the USA truly was Number One on this metric, blowing away all opposition with its awesome $7,290 per capita health spending.The Canadian Medical Association's president, Dr Anne Doig, told CanWest News that she accepted the findings, which matched those of other organisations. “These [Commonwealth Fund] reports are held to be reasonably accurate and methodologically sound,” she said.Dr Doig agreed that primary care needs work and that electronic records should be adopted faster, but contended the problems go deeper than that. Canada needs a patient-centred system of care, she said. “One could argue the system serves itself rather than the patient.”Canadians did well on the metric of "Long, Healthy, Productive Lives", coming second behind Australia. But Dr Doig said: “Arguably, that is deteriorating. And if things don’t change, we might find we don’t do as well in another 20 years. We are essentially enjoying the benefits of reforms that happened in the ‘60s and ‘70s.” Transforming the health system is the CMA's biggest single project these days, she noted.Of course, the countries that get the most bang for their patient-centred buck, like Holland and France, also spend less on doctors' salaries than Canada does. We'll let you know when the CMA starts pushing for that reform. Get Canadian Medicine news by email or in an RSS reader
- End in sight for Avandia? Health Canada waits to see which way FDA will jumpThe diabetes drug rosiglitazone (Avandia) may shortly become the latest high-profile pill to meet an early demise after serious side effects emerged in real-world use.The U.S. Food and Drug Administration will be meeting next week to consider the fate of the insulin sensitizer, whose cardiac safety has been called into question. Elevated risk of heart attack and other cardiac events has been documented by several studies.An FDA advisory committee has already reviewed the evidence once in 2007. They concluded that rosiglitazone caused more ischemic events than placebo, but not more than metformin or a sulfonylurea.The latest research, however, seems likely to drive a stake into rosiglitazone's heart [JAMA, June 2010;304(4)]. For one thing, this retrospective review of 227,000 elderly American patients compared rosiglitazone directly against the other drug in the thiazolidinedione class, pioglitazone (Actos), and found increased risk of stroke, heart failure, and all-cause mortality.Worse for maker GlaxoSmithKline, the study was led by David Graham, the FDA's associate director of drug safety. Reporting a "number needed to harm" of 60 patients, Dr Graham recommends that rosiglitazone be taken off the market.Dr David Juurlink of Toronto's Sunnybrook Health Sciences Centre, lead author of the largest Canadian study on the drug's safety (BMJ 2009;339:b2942), echoes Dr Graham's call in a letter in the same issue of JAMA.In the past, beleaguered drugs have sometimes survived these FDA reviews after panel members with extensive ties to manufacturers voted to keep them on the market. But today's FDA is a chastened agency, stung by conflict of interest scandals. They need to show their regulatory teeth, especially in the current U.S. political environment where lax regulators are the villain of the moment.Nobody at the FDA will feel like going to bat for rosiglitazone anyway, since the agency was criticized earlier this year in a report by the Senate Finance Committee for letting trials continue even as the extra heart attacks piled up among rosiglitazone patients – the FDA itself has estimated that the drug played a role in 83,000 heart attacks from 1999 to 2007. The Senate also accused the drug's maker of knowing the dangers early but sitting on the information, an accusation that GlaxoSmithKline vehemently denies.Canadian regulators, meanwhile, say "the benefits are still considered to outweigh the risks" when the drug is used according to Canadian monographs, and within additional limits set by warnings issued in 2007. They will “monitor” the FDA meeting and will continue to review evidence submitted to them by the manufacturer.Dr Juurlink argues that Canada should remove rosiglitazone from the market now, since doing it right after the FDA would be bad “optics”. Health Canada issued a statement on rosiglitazone today, proudly pointing out that their post-market recommendations on the drug's use are actually somewhat tighter than those of the American agency.But Health Canada's warnings about rosiglitazone were issued in November 2007, right after the FDA reviewed the issue and decided to give it their notorious “black box”.It's inevitable that, being a government ministry and therefore insufferably pompous, Health Canada will deny to their last breath that they follow the FDA. But if the FDA pulls rosiglitazone, can anyone envisage Health Canada keeping the drug on the market? Now that would be bad optics. Get Canadian Medicine news by email or in an RSS reader
- Does steel netting around bridges prevent suicide? Maple Leaf Garden’s sex abuse victim Martin Kruze was but one of many to choose the Bloor Street Viaduct to end his lifeWhen someone is determined to end his or her life, choosing to jump off a bridge is a pretty good bet. The impact of falling over 30 metres at about 120-129 kilometres an hour is akin to being hit by a speeding car.To prevent the temptation by those overcome with despair and hopelessness, a barrier was constructed around Toronto’s Bloor Street Viaduct in 2003 – at a cost of 5½ million dollars. Known as the second most popular “suicide bridge” in the world (San Francisco’s Golden Gate ranks number one), some of the 400 people who’ve taken their lives there had travelled from afar to this particular bridge, since its construction in 1918.City planners were anxious to know whether such a deterrent – dubbed the Luminous Veil – would work.The verdict: “It works…,” says chief psychiatrist Anthony Levitt of Sunnybrook Health Sciences Centre, “…at the Bloor Street Viaduct.” Indeed, suicide rates there dropped from an average of 9.3 to zero per year. Depressed individuals – mostly men in their mid-30s -- however, chose alternative bridges to end their lives since the Luminous Veil was constructed, making the annual rate of bridge jumping suicides almost unchanged. Dr. Levitt and resident doctor Mark Sinyor, part of the study team at Sunnybrook and the U of T (BMJ 2010;341:c2884) noted that since the barrier was erected bridge jumpers rose from 8.7 to 14.2 each year at other bridges. The researchers conclude that building physical barriers is only a part of the solution. “You need programs that improve access to psychiatrists and other mental health workers,” says Dr. Sinyor.It seems abundantly clear that if millions of dollars are available to fight suicide, perhaps they could be better spent for mental health support, leaving artists like Bruce Cockburn to invent an alternate line for “You could have gone off the Bloor Street Viaduct” in his humorous song, “Anything Could Happen.” Get Canadian Medicine news by email or in an RSS reader
- Cartoon baddies Concern grows on the use of cartoon characters that entice children to eat badlyUsing a generational icon, say, recruiting Shrek to get kids to eat, is not new. The gimmick has worked for years. Doctors and parents have applauded the tactic when, for example, stamped images of Sesame’s Street’s Elmo endorsed packages of broccoli. Controversy arises when licensed characters promote victuals arguably considered to be junk food – those low in nutrients, like gummy bears and graham crackers.A recent study conducted by the Rudd Center for Food Policy and Obesity at Yale University and published in the June 21 issue of Pediatrics (doi:10.1542/peds.2009-3433) confirmed the rationale of many North American retailers – that to spend $1.6 billion annually on wooing children is well worth it – at least when it comes to dollars + cents. Nutritionally, it’s another matter. When pre-school and Grade 1 kids were asked to choose foods showing Shrek, Dora the Explorer and Scooby Doo on the packaging compared to unadorned choices, not surprisingly, most opted for the boxes with the cartoon characters, despite the identical content.This trend had certain groups up in arms. Corporate Accountability International, an advocacy group out of Boston, has begun the “Retire Ronald” campaign. Rather than symbolizing Ronald McDonald House of Charities, the 50-year-old clown these days appears to promote poor nutrition and food choices, according to the organization. “Ronald McDonald is a pied piper drawing youngsters all over the world to food that’s high in fat, sodium and calories,” says retired physician and volunteer Alfred David Klinger.Happy Meals – food geared to the under 12-year-old set – are also under the gun. Historically, McDonald’s has used toys and games to attract their youngest clientele. The Center for Science in the Public Interest is planning to wage a lawsuit against McDonald’s for selling toys. “McDonald’s marketing has the effect of conscripting children into an unpaid drone army of word-of-mouth marketers, causing them to nag their parents to bring them to McDonald’s,” says organization member Stephen Garner.In 2006, their first lawsuit against mega-chain Kellogg for promoting poor quality nutrition to children resulted in products with higher nutritional value.Even Disney, who partnered with McDonald’s from 1997-2006, allowing the food chain to use their cinematic characters in their toy line, eventually had second thoughts and ended that tie, in order to endorse healthier choices.So, where are Mom and Dad in all this? Everyone agrees that they should be doing more to guide their children towards healthier eating habits. But in many cases, they themselves are eating as badly, if not worse – with no need for encouragement from SpongeBob SquarePants, Buzz Lightyear, Diego, or that irritating little red racecar Lightning McQueen. We can make junk food less enticing, but kids won't eat healthier food unless it's served at home. Such a reminder by physicians will be much appreciated down the road, by the kids as adults, and our healthcare system. Get Canadian Medicine news by email or in an RSS reader
- Stroke causes ranked My mother suffered from transient ischemic storke (TIA). She was able to cover it up from her family and her GP for years. She lived alone and we only discovered her affliction after we hired a person to come in once a day to do the housekeeping and prepare her lunch. One day the helper called, frantic, to say that my mother was slumped over unconscious at the breakfast table. She came a round within a few minutes but clearly something was very wrong. I rushed over and mother confessed that she’d been having such episodes “for a few years.” Three weeks later she suffered a major stoke and went into a coma a couple of days later. She died in hospital two months after that. Stoke continues to be a major killer of Canadians and it is on the rise. Together with heart disease, stroke accounts for on third of all deaths in Canada yet it receives scant public attention attention compared to other diseases such as breast and prostate cancer. Any responsible physician who suspects a patient is sucepible to stroke owes it to the patient to warn of the signs what actions should be taken. A new study sheds yet more light on the causes of stroke. Hypertention continues to be the number one cause of ischaemic and intracerebral haemorrhagic stroke according to a Canadian study published in The Lancet last Friday, June 18, 2010. Of greater interest, the three year study, of 3000 patients and 3000 controls in 22 countries listed the chief causes which accounted for 90% of strokes. The participants were taken from middle and lower income groups. Contributing factors in order of their importance were: hypertension waist-to-hip ratio diet risk score diabetes mellitus alcohol intake for more than 30 drinks per month or binge drinking; psychosocial stress depression cardiac causes Collectively, these risk factors accounted for 88·1% of stokes. When an alternate definition of hypertension was used (history of hypertension or blood pressure >160/90 mm Hg), for all stroke the percentage rose to 90.3%. The risk factors were all significant for ischaemic stroke. Hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were significant risk factors for intracerebral haemorrhagic stroke. The conclusion, in keeping with current medical practice, suggested targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke. The study, involved 22 clinicans and was funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Pfizer Cardiovascular Award, Merck, AstraZeneca, and Boehringer Ingelheim. Get Canadian Medicine news by email or in an RSS reader
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- French Mother Indicted in Smothering of Infants A nursing assistant was charged with what prosecutors called modern France’s worst case of infanticide. Read more... | Original Medical News | Votes so far: 1 / 0
- Added to the Recall List: Millions of Frozen Mice Salmonella outbreaks that sickened more than 400 in the U.S. and Britain have been traced to mice sold as food for exotic pets. Read more... | Original Medical News | Votes so far: 1 / 0
- Getting Into Med School Without Hard Sciences A program admits students if they study humanities instead of the traditional pre-medical school curriculum. Read more... | Original Medical News | Votes so far: 1 / 0
- Recipes for Health: Baked Large Limas With Spinach and Feta This Greek-inspired dish makes a hearty meal rich in nutritious spinach. Read more... | Original Medical News | Votes so far: 1 / 0
- FDA Approves Glycopyrrolate Oral Solution for Chronic Sev... The FDA has approved glycopyrrolate oral solution for the treatment of patients aged 3 to 16 years with chronic severe drooling associated with neurologic conditions, such as cerebral palsy. Medscape Medical News Read more... | Original Medical News | Votes so far: 1 / 0
- African Ancestry Linked to Triple-Negative Breast Cancer The FDA has approved glycopyrrolate oral solution for the treatment of patients aged 3 to 16 years with chronic severe drooling associated with neurologic conditions, such as cerebral palsy. Medscape Medical News Read more... | Original Medical News | Votes so far: 1 / 0
- Health Bill's New Tax Rules Under Fire Democrats may water down or repeal new tax-reporting rules that are supposed to raise $16 billion for health-care legislation, facing a chorus of criticism about the rules. Read more... | Original Medical News | Votes so far: 1 / 0
GruntDoc
- A Letter from Afghanistan Forwarded by a friend of his, and I have the authors’ express permission to run it. Hey Gang, Another amazing and emotional day yesterday. I try to write about things that impress me professionally, emotionally, and spiritually. Yesterday I was again impressed. At 5:00 a.m., the Giant Voice (the base PA system) announced two incoming [...] Related posts:Wounded Soldiers Have Increased Odds of Survival – WSJ.com A nice WSJ article on how forward treatment of combat... Bumped: Project Valour-IT Today through November 11th Victory! Team Marine got to the Goal first! (But keep... The Laurinburg Exchange – Shooting at Scotland Memorial Hospital Scotland Memorial Hospital was locked down Monday morning after a... Related posts brought to you by Yet Another Related Posts Plugin.
- How to Answer a Nurses’ Questions: Funniest thing you... Via A Cartoon Guide to Becoming a Doctor comes this bit of Genius: How to Answer Nurses’ Questions: An Algorithm for New Interns. Go, read, laugh. You’ll enjoy it. Via DocRob Related posts:A Cartoon Guide to Becoming a Doctor: The med student gunner: profile A Cartoon Guide to Becoming a Doctor: The med student... Care [...] Related posts:A Cartoon Guide to Becoming a Doctor: The med student gunner: profile A Cartoon Guide to Becoming a Doctor: The med student... Care does not include sex – Dutch nurses’ union – Yahoo! News AMSTERDAM (Reuters) – A union representing Dutch nurses will launch... Specialist nurses paid higher salaries than family doctors – Mar. 11, 2010 NEW YORK (CNNMoney.com) — Despite the growing shortage of family... Related posts brought to you by Yet Another Related Posts Plugin.
- Dang. Still not perfect. All Emergency Docs fear the “hey, remember that patient…” conversation with a colleague. It’s hardly ever ego-stroking news. I had one of those tonight. “Hey, remember the patient…” and, yes I did. Yes, I missed something. The patient wasn’t harmed, and my excellent colleague took care of the problem, just wanted me to know. That [...] Related posts:Reviewing the Great ER Caper: Just to be sure. Kevin, MD linked to this, and I really must comment.... Related posts brought to you by Yet Another Related Posts Plugin.
- Doctor Charles is having a Poetry Contest And it’s not just any old contest, there’s $500 up for grabs. Here’s Doctor Charles’ contest page. I’m disqualified, as the only poetry I even remotely like is the bawdy limerick. Non-medical. Best of luck to you poets! Related posts:$100 Christmas Caption Contest $100 Christmas Caption Contest Happy’s got both a caption contest,... My Medical [...] Related posts:$100 Christmas Caption Contest $100 Christmas Caption Contest Happy’s got both a caption contest,... My Medical Museum Contest: Meet The Winner! We’re happy to announce that Adam Simone, who took us... Dr. Wes: US Health Care Reform Photoshop Contest Dr. Wes: US Health Care Reform Photoshop Contest In the... Related posts brought to you by Yet Another Related Posts Plugin.
- Yikes! Last minute bailout via @AndyLevy on Twitter… FWIW, an F-18 costs (according to the Internet tubes) between 28-58 Million dollars. video via Ace No related posts. Related posts brought to you by Yet Another Related Posts Plugin. No related posts. Related posts brought to you by Yet Another Related Posts Plugin.
- ER Waits meet truth in advertizing ER Fail – FAIL Blog: Epic Fail Funny Pictures and Funny Videos of Owned, Pwned and Fail Moments. Hahahaha…. Related posts:London Olympics 2012: Meet Wenlock and Mandeville, drips off the old block | UK news | The Guardian London Olympics 2012: Meet Wenlock and Mandeville, drips off the... Jane Hamsher: Fact Sheet: The Truth About [...] Related posts:London Olympics 2012: Meet Wenlock and Mandeville, drips off the old block | UK news | The Guardian London Olympics 2012: Meet Wenlock and Mandeville, drips off the... Jane Hamsher: Fact Sheet: The Truth About the Health Care Bill Congress may be too far down the road with this... Words fail « Dr. Ottematic Words fail « Dr. Ottematic This past week, I got... Related posts brought to you by Yet Another Related Posts Plugin.
- M.D.O.D.: Must Be a Brit M.D.O.D.: Must Be a Brit. Hahah. Funny video! Orthopedist vs. Anesthesiologists… No related posts. Related posts brought to you by Yet Another Related Posts Plugin. No related posts. Related posts brought to you by Yet Another Related Posts Plugin.
- OSHA Faults Hospital for Workplace Violence Violations ... DANBURY, Conn. — The Occupational Safety and Health Administration (OSHA) has cited Danbury Hospital for failing to provide its employees with sufficient protection against workplace violence. The hospital has been fined $6,300. The announcement comes on the heels of the March 2010 attack, when nurse Andy Hull was shot three times by 86-year-old Stanley Lupienski, [...] Related posts:amednews: Astrodocs: For these physicians, space is their workplace :: March 15, 2010 … American Medical News Astrodocs: For these physicians, space is their workplace Since 1973,... The Laurinburg Exchange – Shooting at Scotland Memorial Hospital Scotland Memorial Hospital was locked down Monday morning after a... Man suspected of trying to run down officer in Stockyards arrested | Crime and Safety | … I’m more interested in the sub-plot of this cops and... Related posts brought to you by Yet Another Related Posts Plugin.
- One of the ER Doc curses I was reminded of one of our particular curses the other day, reminded in the way we often are, when somebody reacts to what we do. Sometimes embarrassingly. Yesterday, I was taking a history, and this was of a patient with a long, complex one. That much I knew from a quick perusal of the [...] Related posts:The most embarrasing thing I’ve done in a while Recently, in the ED, I was seeing a patient who... I’ve made it here From the Triage nurses: I’ve made it. More and more... Question the Meds In my practice I try to apply some common sense,... Related posts brought to you by Yet Another Related Posts Plugin.
- Movin’ Meat: Here we go again Movin’ Meat: Here we go again. Shadowfax’s group is hiring. I skimmed it, but it looks like there’s some treadmill choreography they’re teaching new grads now… Things change. Related posts:Meat stylus for the iPhone Meat stylus for the iPhone. Another use for SlimJims…. I... Related posts brought to you by Yet Another Related Posts Plugin. Related posts:Meat stylus for the iPhone Meat stylus for the iPhone. Another use for SlimJims…. I... Related posts brought to you by Yet Another Related Posts Plugin.
Youtube Medical
- Dr. Vincent Valentine Author: UTMBGalveston Keywords: Added: July 30, 2010
- Dr. Michael Koerner Author: UTMBGalveston Keywords: Added: July 30, 2010
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- LivingFuelTV: Natural Medicine - Must Know Info Author: LivingFuelTV Keywords: Added: July 28, 2010
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- Spartan Sagas: Terrie Taylor, Of mosquito bites, healing,... Author: MichiganStateU Keywords: Added: July 26, 2010
- Roger Williams Medical Center FAQ Author: RWMCCHIEF Keywords: Added: July 25, 2010
- RWMC Board Review.mpg Author: RWMCCHIEF Keywords: Added: July 25, 2010
- The Knitters Author: SSMPeople Keywords: Added: July 23, 2010
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Flickr Medical
- Servicio Cántabro de Salud del15xaviii_xavo posted a photo: Foto pròpia. Ambulància Fiat Ducato, davant del centre de salut de San Vicente de la Barquera. Ambulancia Fiat Ducato, delante del centro de salud de San Vicente de la Barquera.
- Servicio Cántabro de Salud del15xaviii_xavo posted a photo: Foto pròpia. Ambulància Fiat Ducato, davant del centre de salut de San Vicente de la Barquera. Ambulancia Fiat Ducato, delante del centro de salud de San Vicente de la Barquera.
- Servicio Cántabro de Salud del15xaviii_xavo posted a photo: Foto pròpia. Cotxe del SUAP (Servei d'Urgències Atenció Primària) Honda Civic Hybrid, davant del centre de salut de San Vicente de la Barquera. Coche del SUAP (Servicio de Urgencias Atención Primaria) Honda Civic Hybrid, delante del centro de salud de San Vicente de la Barquera.
- Servicio Cántabro de Salud del15xaviii_xavo posted a photo: Foto pròpia. Ambulància Fiat Ducato, davant del centre de salut de San Vicente de la Barquera. Ambulancia Fiat Ducato, delante del centro de salud de San Vicente de la Barquera.
- Corpsman teaches Palauan girl how to floss during Pacific... Official U.S. Navy Gallery posted a photo: KOROR, Republic of Palau (July 28, 2010) Hospital Corpsman 1st Class Agnes Banias, assigned to the U.S 7th Fleet command ship USS Blue Ridge (LCC 19), teaches a child how to floss at a Pacific Partnership 2010 free dental clinic. Blue Ridge is in the Republic of Palau conducting Pacific Partnership 2010, the fifth in a series of annual U.S. Pacific Fleet endeavors to strengthen regional relationships with host and partner nations. (U.S. Navy photo by Mass Communication Specialist 3rd Class Fidel C. Hart/Released) 100728-N-0864H-092
- Aceh_relief 060724-N-3714J-006 USAID Indonesia posted a photo: 060724-N-3714J-006 BANDA ACEH, Indonesia (July 24, 2006) ñ A patientís father (left) embraces Navy Shipís Servicesman 2nd Class Christian Puentes, of San Diego, Cailf., a member of the Medical Treatment Facility aboard the U.S. Naval hospital ship USNS Mercy (T-AH 19), after his son returns for a check up aboard the ship a year after the December 2004 Tsunami devastated the city. Mercy will be off the coast to provide humanitarian and civic assistance to the people of this small island. The ship is in the third month of its five-month humanitarian assistance deployment where thousands of people from South and Southeast Asia have received medical treatment. Mercyís diverse crew consists of a multi-national, organizational medical team, Seabees from Naval Mobile Construction Battalion 40, Helicopter Sea Combat Squadron Two Five and the U.S. Navy Showband. Mercy is currently off the coast to provide humanitarian assistance here. U.S. Navy photo by Mass Communication Specialist 2nd Class Erika N. Jones (RELEASED)
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Delicious Medical
- Medical News: Renal Troubles Spell Acute Injury Risk - in... New research shows that minor renal problems may indicatae increased risk for renal injury which could be fatal.
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- Virtua: Careers in Healthcare in New Jersey Searching for healthcare jobs? Virtua is a comprehensive healthcare system located in South New Jersey. Browse listings for jobs in healthcare and Virtua's various hospitals.
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- Dartfish Video Technology - Therapy Services HPC Dartfish is the most advanced video technology available on the market. This video analysis software provides the essential tools / functionality to analyze technical performance during and after therapy or training. Dartfish also allows for the patient / athlete to use instant video feedback in order to alter inappropriate motion. Dartfish video is considered an essential component to the motion assessments performed at the HPC
WordPress Medical
- Polycystic Kidney Disease I’ve made some progress since this post: Starting on Kidneys. At this point I am working on sc
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- Day 60: July 30th Do you know your plugs? The really clever thing about E.T. my POC, is that he can basically run off
- ShaveDallas.org July 31st 7pm to 11pm at The Bomb Factor... I went to the organizational meeting for ShaveDallas.org. I meant individuals dedicated to the fight
- Purchase online soma with no prescription at OnlineSomas.org Soma is a drug to treat muscles pains and discomfort due to strain and sprain. It works by blocking
- Pari has a Problem! ….Now is not a good time for anything medical to go wrong!…. So you can imagine how frea
- Dr. Giancarlo Rastelli Recently, I’ve been trying to find out more about the man who developed the Rastelli procedure
- Reprise - English proofreading. Reprise is a noun and also a verb. Unlike most verbs ending in -ise, reprise cannot be spelled with
- Quiz #6 Grades, Medical Terminology, Thursday Class Below are the grades for Thursday’s quiz: 05309 10 00182 10 01077 10 01650 10 00566 9 01102 9
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