- FDA Panel Votes To Restrict Acetaminophen An advisory committee to the US Food and Drug Administration (FDA) voted on Tuesday to recommend new restrictions on the popular pain relief drug acetaminophen (known in many other countries as paracetamol), which is found in many US top selling over the counter medications such as Tylenol, aspirin-free Anacin, Excedrin, and also in prescription drugs such as Vicodin and Percocet.
- Minimise Risks Of Phone Consultations, Warns Summons, Sco... GP phone consultations carry definite risks, warns an article in the current edition of Medical and Dental Defence Union of Scotland (MDDUS) magazine Summons today (Thursday, 2 July). Latest data suggests that between a tenth and a fifth of all daytime contacts between patients and GP surgeries are by phone, says the article, by GP and GP trainer Dr Malcolm Thomas.
- New UK Drive To End Malaria Deaths An additional 30 million bed nets, the development of life-saving new treatments and new funding to increase access to anti-malarial drugs are announced today in a package of measures by International Development Secretary, Douglas Alexander, as the UK continues its fight to rid the world of malaria.
- HCL Welcomes Government Proposals For More Flexible NHS, UK HCL plc, the UK's largest health and social care recruitment agency, said the Government's proposals to reform the NHS by devolving power to frontline professionals and patients will mean a greater need for flexible staffing and more collaboration between the public and private sectors.
- How Do I Know If I Need Knee Replacement Surgery? Most knee replacement patients are between the ages of 60 and 80 years old. In some cases, younger patients with traumatic knee injuries may also require a total knee replacement. However the most common diagnosis is osteoarthritis. If you are prevented from carrying out your everyday activities due to pain or discomfort in the knee, then you may have arthritis of some kind.
- Occupational Therapist Suspended For Lack Of Competence Occupational therapist, Ms Hannah McIlhinney has been suspended from the HPC Register for lack of competence whilst working for the Greater Glasgow & Clyde NHS trust.
- Governor Rell: State Of Connecticut To Receive $3.75 Mill... Governor M. Jodi Rell announced that the State of Connecticut is receiving $3.75 million federal grant to expand access to health care in Hartford for low-income women nearing childbirth to ensure their newborns get a healthy start. "Our children are our most precious resource and the health of a child is intrinsic to the health of the mother," stated Governor Rell.
- Connecticut Health Department Urges Food Safety When Gril... Summer is the season for sizzling - steaks, chicken, ribs, veggie kabobs and much more. The Connecticut Department of Public Health reminds everyone that food safety is essential when grilling outdoors and offers tips to ensure that family barbecues and backyard picnics remain fun, healthy outings.
- Illinois Department Of Public Health Director Offers Tips... Illinois Department of Public Health Director Dr. Damon T. Arnold wants to remind you of some steps you can take to ensure a safe and healthy Fourth of July. Food Safety Picnics and cookouts top the list of summer activities. But remember, special precautions need to be taken when preparing and serving food during warm weather to avoid foodborne illnesses like salmonellosis.
- Provectus Pharmaceuticals Completes Patient Accrual In In... Provectus Pharmaceuticals, Inc. (OTC BB: PVCT), a development-stage oncology and dermatology biopharmaceutical company, has completed patient accrual for its Phase 2 study of PH-10 for atopic dermatitis. PH-10 is the Company's topical drug for the treatment of dermatologic diseases, including atopic dermatitis, a chronic skin condition that includes some forms of eczema.
- Childhood Arthritis: Common but Preventable Consequence o... When left untreated, children infected with Lyme disease can experience many severe complications as a result including arthritis, problems with the heart or central nervous system. Early detection is the key to preventing the lasting complications seen frequently at Hospital for Special Surgery.
- Existing Parkinson's Disease Drug May Fight Drug-Resistan... Existing drugs used in the treatment of Parkinson's disease could be repositioned for use in the treatment of extreme drug-resistant tuberculosis, which kills about 2 million people each year, according to a study led by researchers at the University of California, San Diego. The rise of these strains of TB throughout the world, including industrialized countries, poses a great threat to human health.
- Healthcare 411 Podcast Tip Sheet for July 1, 2009 In this week's Healthcare 411 podcast from AHRQ, stories about asthma care; integrated electronic medical records; and patient safety advisory councils.
- Tick, Tick, Tick...Lyme Season has Begun, Physician Warns The persistent cool and damp weather in the Northeast this spring put many outdoor activities on hold. With the weather finally improving, many people will head outdoors, and when they do, they are likely to ticks lurking, ready to latch onto the next warm-blooded body that comes by. "And that could spell serious health trouble," warns Dr. Chad Richmond, a UMDNJ family physician.
- Sports Injuries Cause 1 in 5 Emergency Department Visits ... Sports-related injuries such as bruises, scrapes and broken bones accounted for 22 percent of hospital emergency department visits for children ages 5 to 17.
- Academy Sends Congress a Solution to Fix Broken Physician... The American Academy of Neurology Professional Association has sent a letter to Congress offering a solution to fix the way physicians are reimbursed under Medicare for treating patients with severe or disabling chronic conditions, such as dementia, Parkinson's disease, ALS, epilepsy and stroke. Several other physician and patient groups have signed onto the letter.
- Prostate Cancer Patients Disease Free After Five Years Li... Prostate cancer patients who receive brachytherapy and remain free of
disease for five years or greater are unlikely to have a recurrence at 10 years, according to a study in the July 1 issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO).
- From Little Leaguer to All-Star: Staying Off the DL As the All-Star game approaches, Saint Louis University director of sports medicine, Scott Kaar, M.D. offers advice to ballplayers of every age to stay healthy.
- Center Receives Grant Renewal for Hypertension and Vascul... The Hypertension and Vascular Research Center at Wake Forest University School of Medicine has received renewal of a multi-million dollar grant from the National Heart, Lung and Blood Institute of the National Institutes of Health to continue the development of new approaches to treat hypertension and vascular disease. The program is in its 16th year of existence at the School of Medicine.
- Brain Malformations Significantly Associated with Preterm... New research out of Wake Forest University School of Medicine provides for the first time a solid scientific answer for the long-standing question of whether there is an association between preterm birth and brain malformations.
- Acid-reducing Medicines May Lead To Dependency Treatment with proton pump inhibitors for eight weeks induces acid-related symptoms like heartburn, acid regurgitation and dyspepsia once treatment is withdrawn in healthy individuals. Data suggests proton pump inhibitors can induce acid-related symptoms in healthy adults.
- CPAP Treatment Linked To Lower Mortality In Stroke Patien... Stroke patients with obstructive sleep apnea who undergo treatment with continuous positive airway pressure following their stroke may substantially reduce their risk of death.
- Brain Functions That Can Prevent Relapse Improve After A ... Researchers report that it takes at least a year for former methamphetamine users to regain impulse control. The results tell recovering substance abusers, their families and drug-treatment specialists that it can take an extended period of time for the brain functions critical to recovery to improve.
- Virus-gene Therapy Combination Against Melanoma Under Tes... Researchers are injecting a modified herpes virus into melanoma tumors, hoping to kill the cancer cells while also bolstering the body's immune defenses against the disease.
- What Should A Teenage Girl Do If She Finds A Lump In Her ... If a lump is found in the breast of an adolescent girl, she often will undergo an excisional biopsy. However, breast cancer is rare in adolescents, and the vast majority of teenage breast lumps are benign. A recent study suggests that a breast ultrasound might eliminate the need for biopsy in many cases.
- Possibility Of Vaccine For Ear Infections Otitis media, more commonly known as an ear infection, is the most frequently diagnosed illness in children less than 15 years of age in the United States and is the primary cause for emergency room visits. More than 80 percent of children will experience at least one ear infection before their third birthday. A new study could introduce a pain-free vaccination strategy that works against ear infections.
- 'Stealth' Herpes Simplex Inflammation Impacts Corneal Tra... The herpes simplex virus (HSV) can infect the eye and sometimes causes so much damage that the person's cornea must be replaced with a transplant. (The cornea is the clear covering of the front of the eye that helps focus light for vision.) Doctors knew transplants were more likely to fail in people with HSV than in patients with other disorders, such as keratoconus, an abnormal steepening of the cornea.
- Will IVF Work For A Particular Patient? The Answer May Be... For the first time, researchers have been able to identify genetic predictors of the potential success or failure of IVF treatment in blood. New research helps explain why IVF works for some patients but not for others.
- Many Genetic Contributions To Schizophrenia, Bipolar Diso... Scientists have discovered that many common genetic variants contribute to a person's risk of schizophrenia, providing the first molecular evidence that this form of genetic variation is involved in schizophrenia. The researchers also found that many of these DNA variations also are involved in bipolar disorder but not in several nonpsychiatric diseases.
- Environmental Cues Control Reproductive Timing And Longevity When humans and animals delay reproduction because food or other resources are scarce, they may live longer to increase the impact of reproduction, according to a new study.
- Study: New flu inefficient in attacking people
(AP)
AP - With swine flu continuing to spread around the world, researchers say they have found the reason it is so far more a series of local blazes than a wide-raging wildfire. The new virus, H1N1, has a protein on its surface that is not very efficient at binding with receptors in people's respiratory tracts, researchers at the Harvard-MIT Division of Health Sciences and Technology report in Friday's edition of the journal Science.
- Advocates are back with real health care stories
(AP)
AP - When carpenter Greg Douglas crashed his pickup truck, his toolbox hit him and smashed his ribs and collarbone. After a month in the hospital, the medical bills hit him even harder, totaling $165,000.
- Federal probe finds problems with chelation study
(AP)
AP - A federal investigation has found that heart attack survivors enrolled in a study of a controversial alternative medicine treatment were not told enough about potential dangers from the drug being tested, including death.
- World health officials tackle swine flu challenges
(... AP - Swine flu is running wild in the Southern Hemisphere and is spreading rapidly through Europe, with Britain projected to reach 100,000 daily cases by the end of August. The virus is even showing signs of rebounding in Mexico.
- Fawcett's death spotlights a rare cancer
(AP)
AP - In a perverse twist of medical fate, Farrah Fawcett has become the poster girl for anal cancer, a rare disease often linked to a sexually transmitted virus.
- Jackson's hospital is known for 'raising the dead'
(... AP - When Michael Jackson went into cardiac arrest, rescuers took him to a place known for bringing the dead back to life. A world-renowned surgeon at the UCLA Medical Center has pioneered a way to revive people that most doctors would have long written off, including a woman whose heart had stopped for 2 1/2 hours.
- Kids With Type 1 Diabetes Often Overweight
(HealthDay)
HealthDay - THURSDAY, July 2 (HealthDay News) -- Children with type 1
diabetes are more likely to be overweight than those without the disease,
increasing their risk of serious health complications, researchers
say.
- Women's Sexual Health Issues Hit Home
(HealthDay)
HealthDay - THURSDAY, June 25 (HealthDay News) -- A new survey finds that 70
percent of American women have experienced a sexual health issue, and 22
percent felt very or extremely concerned about it.
- Health Tip: Controlling Asthma
(HealthDay)
HealthDay - (HealthDay News) -- Medication used to control asthma may be
used every day, without the fear of becoming addicted, the American
Academy of Family Physicians says.
- C-Section Stress Could Alter Baby's Immune Cells
(He... HealthDay - THURSDAY, July 2 (HealthDay News) -- Babies delivered by cesarean
section experience changes to the DNA of white blood cells, which might
explain why they're at increased risk for immunological diseases such as
diabetes and asthma later in life, Swedish researchers say.
- Rebound Acid Reflux with PPIs May Induce Dependence (CME/CE) SAN FRANCISCO (MedPage Today) -- Proton-pump inhibitors may cause or aggravate the very acid-reflux symptoms they are used to treat, according to a randomized trial.
- Tab for Senate Healthcare Reform Bill Drops to $611 Billion WASHINGTON (MedPage Today) -- With a cost of about $611 billion over 10 years, the Senate Health, Education, Labor and Pension (HELP) Committee's healthcare reform bill comes in significantly lower than the expected trillion-plus price tag.
- ASMBS: Gastric Banding Less Effective than Other Procedur... DALLAS (MedPage Today) -- Patients who underwent laparoscopic adjustable gastric banding achieved less weight loss and less improvement in comorbid conditions than those who had gastric bypass or sleeve gastrectomy.
- FDA Approves Heart Drug After New Trials WASHINGTON (MedPage Today) -- The FDA has approved the antiarrhythmic dronedarone (Multaq) for treatment of atrial fibrillation and atrial flutter, the drug's developer announced today.
- Clinical Pathways Improve Joint Replacement Outcomes (CME... RIDGEWOOD, N.J. (MedPage Today) -- Organizational strategies known as clinical pathways can significantly improve the quality of care, shorten hospital stays, and reduce the cost of hip and knee joint replacements, a meta-analysis found.
- ASMBS: Modest Data Suggest Bariatric Surgery Durability (... DALLAS (MedPage Today) -- Obese patients can achieve long-term weight loss with bariatric surgery, although follow-up remains problematic, according to studies reported here.
- CMS Announces New Payment Rules that Benefit Primary Care... WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services (CMS) has announced proposed changes that will increase Medicare payments for primary care physicians by an estimated 6% to 8%.
- ASMBS: Obesity Surgery Resolves Diabetes but for How Long... DALLAS (MedPage Today) -- Weight-loss surgery allowed a majority of obese type 2 diabetes patients to stop or reduce medical therapy, but questions persisted about the durability of the effects, according to three studies reported here.
- America Still Losing Battle of the Bulge CLEVELAND (MedPage Today) -- As the economy slumped, waistlines surged, according to the latest national obesity report card, which found that adult obesity rates increased in 23 states over the past year.
- Target Antigen Identified for Common Kidney Disease (CME/CE) CLEVELAND (MedPage Today) -- A newly identified target antigen -- M-type phospholipase A2 receptor or PLA2R -- may hold the key to both diagnosis and treatment of idiopathic membranous nephropathy, according to a multinational team of researchers.
- WHO chief identifies "warning signs" of severe flu GENEVA (Reuters) - H1N1 influenza is causing mild symptoms that go away without medication in most patients, but care-givers should be alert for warning signs of severe cases, the head of the World Health Organization said on Thursday.
- Washington to give antiviral drugs to WHO WASHINGTON (Reuters) - The U.S. government said on Thursday it will give 420,000 treatment courses of Tamiflu to the Pan-American Health Organization to help fight the new H1N1 influenza virus in Latin America and the Caribbean.
- Parkinson's drugs show promise in resistant TB CHICAGO (Reuters) - Drugs used to treat Parkinson's disease show promise as a new way to stem the rise of drug-resistant forms of tuberculosis, U.S. researchers said on Thursday.
- Birth weight appears associated with leukemia NEW YORK (Reuters Health) - There may be an association between high birth weight and an increased risk of overall leukemia and acute lymphoblastic leukemia (ALL). The increased risk of acute myeloid leukemia (AML) appears to be associated with the high and low extremes of birth weight.
- Obama seeks to build support for health reform ANNANDALE, Virginia (Reuters) - President Barack Obama on Wednesday sought to build support to overhaul the U.S. healthcare system as a key Republican questioned whether bipartisan support among lawmakers is possible.
- Internet used to help young smokers quit NEW YORK (Reuters Health) - The University of Illinois at Chicago (UIC) is leading a $2.9 million National Cancer Institute project to increase demand for evidence-based, Internet-based smoking cessation treatment for young adults aged 18 to 24 years.
- New flu may not spread like regular flu WASHINGTON (Reuters) - The new H1N1 influenza strain may be just a little less catching than seasonal flu, but seems a little better able to cause stomach upsets, researchers reported on Thursday.
- U.S. orders suicide warnings on two anti-smoking drugs WASHINGTON (Reuters) - U.S. health officials on Wednesday ordered Pfizer Inc and GlaxoSmithKline PLC to add strong "black box" warnings on their anti-smoking drugs to highlight the risk of serious mental health problems, including suicidal thoughts.
- Father's depression may affect infant's colic NEW YORK (Reuters Health) - Excessive crying in infants, otherwise known as colic, has been linked to symptoms of depression in the mother. Now a study conducted in the Netherlands links infant colic to depression in the father as well.
- "Boomeritis" hits aging athletes NEW YORK (Reuters Health) - Fifty may be the new thirty, but baby boomers' bodies haven't heard the news.
- Study: New flu inefficient in attacking people WASHINGTON (AP) -- With swine flu continuing to spread around the world, researchers say they have found the reason it is - so far - more a series of local blazes than a wide-raging wildfire. The new virus, H1N1, has a protein on its surface that is not very efficient at binding with receptors in people's respiratory tracts, researchers at the Harvard-MIT Division of Health Sciences and Technology report in Friday's edition of the journal Science....
- Advocates are back with real health care stories CHICAGO (AP) -- When carpenter Greg Douglas crashed his pickup truck, his toolbox hit him and smashed his ribs and collarbone. After a month in the hospital, the medical bills hit him even harder, totaling $165,000....
- Federal probe finds problems with chelation study A federal investigation has found that heart attack survivors enrolled in a study of a controversial alternative medicine treatment were not told enough about potential dangers from the drug being tested, including death....
- World health officials tackle swine flu challenges CANCUN, Mexico (AP) -- Swine flu is running wild in the Southern Hemisphere and is spreading rapidly through Europe, with Britain projected to reach 100,000 daily cases by the end of August. The virus is even showing signs of rebounding in Mexico....
- Fawcett's death spotlights a rare cancer ATLANTA (AP) -- In a perverse twist of medical fate, Farrah Fawcett has become the poster girl for anal cancer, a rare disease often linked to a sexually transmitted virus....
- Jackson's hospital is known for 'raising the dead' When Michael Jackson went into cardiac arrest, rescuers took him to a place known for bringing the dead back to life. A world-renowned surgeon at the UCLA Medical Center has pioneered a way to revive people that most doctors would have long written off, including a woman whose heart had stopped for 2 1/2 hours....
- Obesity rates rising, Mississippi's still fattest WASHINGTON (AP) -- Mississippi's still king of cellulite, but an ominous tide is rolling toward the Medicare doctors in neighboring Alabama: obese baby boomers....
- Few survive cardiac arrest, even with hospital CPR You don't have to be Michael Jackson to have this problem: The odds of surviving cardiac arrest after getting CPR in a hospital are slim and have not improved in more than a decade, a big Medicare study concludes....
- CDC: Private health care coverage at 50-year-low ATLANTA (AP) -- The percentage of Americans with private health insurance has hit its lowest mark in 50 years, according to two new government reports....
- WHO working on formulas to model swine flu spread GENEVA (AP) -- The World Health Organization said Wednesday it is working to mathematically model the spread of swine flu in an attempt to better understand how the outbreak developed from a handful of cases to a global epidemic in less than two months....
- Fawcett's legacy beyond the biz: Spotlighting rare cancer In a perverse twist of medical fate, Farrah Fawcett has become the poster girl for anal cancer, a rare disease often linked to ...
- Study: Few survive cardiac arrest, even with hospital CPR The odds of surviving cardiac arrest after getting CPR in a hospital are slim and have not improved in more than a decade, a ...
- 'Incredibly unethical': Federal probe finds problems in c... A federal investigation has found that heart attack survivors enrolled in a study of a controversial alternative medicine treatment ...
- J&J takes on Alzheimer's disease with $1B stake in Elan Johnson & Johnson, making a big jump into the risky but potentially lucrative field of Alzheimer's disease, is taking a major ...
- Obama takes health care pitch to Virginia At an emotional forum in Virginia, President Obama hugged a cancer patient Wednesday and vowed to bring greater efficiency and ...
- Jackson's hospital known for 'raising the dead' When Michael Jackson went into cardiac arrest, rescuers took him to a place known for bringing the dead back to life. A world-renowned ...
- 12 hospitalized in possible E. coli beef outbreak Federal health officials say at least 12 people have been hospitalized in connection with a possible E.coli outbreak in beef ...
- CDC: Private health care coverage at 50-year low The percentage of Americans with private health insurance has hit its lowest mark in 50 years, according to two new government ...
- FDA: Stop-smoking drugs Chantix, Zyban must carry suicide... The smoking cessation drugs Chantix and Zyban must now carry a boxed warning the strongest type possible about the risk of ...
- Study: More sex may help damaged sperm For men with fertility problems, some doctors are prescribing a very conventional way to have a baby: more sex. In a study of ...
- Patient safety 'still threatened' Changes recommended after a fatal drug slip-up eight years ago have not been implemented, MPs say in a review of patient safety.
- Brain tumours 'forgotten cancer' More funding needs to be ploughed into research into the "forgotten cancer" of brain tumours, campaigners say.
- Solo life ups gene dementia risk People who have a gene flaw and live alone in middle-age are at highest risk of developing dementia, a study suggests.
- Swine flu 'cannot be contained' The rising numbers of swine flu cases mean trying to contain the virus is no longer an option, ministers say.
- Gene clues to schizophrenia risk Scientists identify thousands of tiny genetic variations which raise the risk of schizophrenia.
- Youngsters 'drinking dangerously' One in four young drinkers consume dangerous quantities of alcohol every week, but the number is falling, a poll shows.
- Sound waves offer prostate hope An experimental therapy using sound waves may offer people with early stage prostate cancer an alternative treatment.
- Four pints 'increase health risk' Men who drink four pints of beer a week could be increasing the risk of needing hospital treatment during their lifetime, a study says.
- Call for VAT cut on sports goods VAT rates should be reduced on sports equipment, such as tennis rackets, and gym membership to encourage people to become more active, experts say.
- Best way to get pregnant: have sex every day Having sex every day improves sperm quality and could boost the chances of getting pregnant, research finds.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of July 2, 2009. Featured are articles on phospholipase A2 receptor in idiopathic membranous nephropathy, an epidemiologic study of in-hospital CPR in the elderly, preoperative staging of lung cancer with combined PET-CT, the effects of enalapril and losartan in type 1 diabetes, the effect of Medicare Part D on drug and medical spending, and cardiomyocyte renewal; a review article on rhabdomyolysis and acute kidney injury; a Clinical Problem-Solving article describing a fragile balance; and Perspective articles on the role of medical liability reform in federal health care reform, on a win-win approach to financing health care reform, on the individual mandate and universal coverage, and on Vermont's new law on marketing prescribed products.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of June 25, 2009. Featured are articles on routine early angioplasty after fibrinolysis for acute myocardial infarction, mutation in ovarian granulosa-cell tumors, treating childhood acute lymphoblastic leukemia without cranial irradiation, and isolated familial hypogonadotropic hypogonadism and a GNRH1 mutation; review articles on alpha1-antitrypsin deficiency and on alcoholic hepatitis; a case report of a woman with a blistering cutaneous eruption; and Perspective articles on a lifeline for primary care, on easing the shortage in adult primary care, on the Centers for Medicare and Medicaid Services' landmark decision on CT colonography, and on for-profit hospice care and the Medicare benefit.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of June 18, 2009. Featured are articles on the emergence of a novel swine-origin influenza A (H1N1) virus in humans, triple-reassortant swine influenza A (H1) in humans in the United States, 2005-2009, evaluation of universal antenatal screening for group B streptococcus, immunodeficiency associated with FCN3 mutation and ficolin-3 deficiency, and a new target for tumor therapy; a review article on autologous hematopoietic stem-cell transplantation for multiple myeloma; a case report of a woman with carcinoma of the gastroesophageal junction; and Perspective articles on Congressional action on health care reform, on the signature features of influenza pandemics and their implications for policy, on rescuing the safety net, and on left atrial appendage occlusion.
- NEJM This Week: Supplement to the New England Journal of ... This summary covers the issue of June 11, 2009. Featured are articles on treatment for type 2 diabetes and coronary artery disease, duration of androgen suppression in the treatment of prostate cancer, safety of metaclopramide use in the first trimester of pregnancy, Zika virus outbreak on Yap Island, and primary biliary cirrhosis associated with HLA, IL12A, and IL12RB2 variants; a review article on prenatal screening for aneuploidy; a Clinical Problem-Solving article entitled Kiss of Death; and Perspective articles on the FDA as a public health agency, on how physicians can help achieve health care reform, on vaccine injury claims going to court, and on protecting the public's health through childhood immunization.
- Tattoo Allergy
A 40-year-old man presented with intractable pruritus within portions of a tattoo imprinted with red ink on the left leg (Panel A). The intense localized itching had begun approximately 4 months after placement of the . . .
- Lipomatosis of the Tongue
An 88-year-old man presented with diffuse, painless swelling of the lateral borders of his tongue (Panel A). The swelling had been slowly increasing during the previous 20 years. Yellowish tumors with a smooth, shiny . . .
- Perforated Umbilical Hernia
A 68-year-old man with alcoholic cirrhosis, portal hypertension, ascites, and an umbilical hernia presented to the emergency department after an episode of coughing that was followed by a rush of fluid and fat from the . . .
- Graves' Hyperthyroidism
A 42-year-old woman presented with palpitations, anxiety, tremor, and weight loss. She had received a diagnosis of Graves' disease 15 years previously but had discontinued therapy more than 5 years previously. Over the ensuing years . . .
- Infection 57 Years after Plombage
An 86-year-old man was hospitalized for repeated episodes of septic shock due to methicillin-resistant Staphylococcus aureus (MRSA) pneumonia; he ultimately died of pseudomonal sepsis and pneumonia. In 1948, the patient had pulmonary tuberculosis and . . .
- Tongue Necrosis in a Patient with Essential Thrombocytosis
A 69-year-old woman with complete atrioventricular block was admitted for implantation of a pacemaker. Her medical history included multiple sclerosis with tetraparesis. She had been taking acenocoumarol for the previous 10 years for the treatment . . .
- Patulous Eustachian Tube and Eustachian-Tube Dysfunction
A 36-year-old woman presented with a 4-year history of intermittent bilateral aural fullness, subjective hearing loss, and popping and crackling tinnitus with autophony of the left ear. Aural symptoms were sometimes relieved by positional changes, . . .
- White Tongue
A 55-year-old male nonsmoker with multiple myeloma refractory to chemotherapy was admitted to the hospital for autologous stem-cell transplantation. Palifermin was to be administered before and after the transplantation. On completion of the 3-day infusion . . .
- Fecaliths in Crohn's Disease
A 74-year-old man presented with a 5-day history of diffuse abdominal pain, constipation, nausea, and vomiting. His abdomen was tympanitic without peritoneal signs. Radiography of the abdomen revealed a dilated small intestine that was consistent . . .
- Chvostek's Sign and Carpopedal Spasm
A 35-year-old man presented with a 2-day history of cramps and paresthesias in the arms, predominantly involving the fingers. This presentation was preceded by a bout of viral gastroenteritis 1 week earlier. The patient reported . . .
- THIS WEEK IN JAMA: This Week in JAMA
- ORIGINAL CONTRIBUTION: Genetic Loci Associated With C-Rea...
Context Plasma levels of C-reactive protein (CRP) are independently associated with risk of coronary heart disease, but whether CRP is causally associated with coronary heart disease or merely a marker of underlying atherosclerosis is uncertain.
Objective To investigate association of genetic loci with CRP levels and risk of coronary heart disease.
Design, Setting, and Participants We first carried out a genome-wide association (n = 17 967) and replication study (n = 13 615) to identify genetic loci associated with plasma CRP concentrations. Data collection took place between 1989 and 2008 and genotyping between 2003 and 2008. We carried out a mendelian randomization study of the most closely associated single-nucleotide polymorphism (SNP) in the CRP locus and published data on other CRP variants involving a total of 28 112 cases and 100 823 controls, to investigate the association of CRP variants with coronary heart disease. We compared our finding with that predicted from meta-analysis of observational studies of CRP levels and risk of coronary heart disease. For the other loci associated with CRP levels, we selected the most closely associated SNP for testing against coronary heart disease among 14 365 cases and 32 069 controls.
Main Outcome Measure Risk of coronary heart disease.
Results Polymorphisms in 5 genetic loci were strongly associated with CRP levels (% difference per minor allele): SNP rs6700896 in LEPR (–14.8%; 95% confidence interval [CI], –17.6% to –12.0%; P = 6.2 x 10–22), rs4537545 in IL6R (–11.5%; 95% CI, –14.4% to –8.5%; P = 1.3 x 10–12), rs7553007 in the CRP locus (–20.7%; 95% CI, –23.4% to –17.9%; P = 1.3 x 10–38), rs1183910 in HNF1A (–13.8%; 95% CI, –16.6% to –10.9%; P = 1.9 x 10–18), and rs4420638 in APOE-CI-CII (–21.8%; 95% CI, –25.3% to –18.1%; P = 8.1 x 10–26). Association of SNP rs7553007 in the CRP locus with coronary heart disease gave an odds ratio (OR) of 0.98 (95% CI, 0.94 to 1.01) per 20% lower CRP level. Our mendelian randomization study of variants in the CRP locus showed no association with coronary heart disease: OR, 1.00; 95% CI, 0.97 to 1.02; per 20% lower CRP level, compared with OR, 0.94; 95% CI, 0.94 to 0.95; predicted from meta-analysis of the observational studies of CRP levels and coronary heart disease (z score, –3.45; P < .001). SNPs rs6700896 in LEPR (OR, 1.06; 95% CI, 1.02 to 1.09; per minor allele), rs4537545 in IL6R (OR, 0.94; 95% CI, 0.91 to 0.97), and rs4420638 in the APOE-CI-CII cluster (OR, 1.16; 95% CI, 1.12 to 1.21) were all associated with risk of coronary heart disease.
Conclusion The lack of concordance between the effect on coronary heart disease risk of CRP genotypes and CRP levels argues against a causal association of CRP with coronary heart disease.
- ORIGINAL CONTRIBUTION: Novel and Conventional Biomarkers ...
Context Prior studies have demonstrated conflicting results regarding how much information novel biomarkers add to cardiovascular risk assessment.
Objective To evaluate the utility of contemporary biomarkers for predicting cardiovascular risk when added to conventional risk factors.
Design, Setting, and Participants Cohort study of 5067 participants (mean age, 58 years; 60% women) without cardiovascular disease from Malmö, Sweden, who attended a baseline examination between 1991 and 1994. Participants underwent measurement of C-reactive protein (CRP), cystatin C, lipoprotein-associated phospholipase 2, midregional proadrenomedullin (MR-proADM), midregional proatrial natriuretic peptide, and N-terminal pro-B-type natriuretic peptide (N-BNP) and underwent follow-up until 2006 using the Swedish national hospital discharge and cause-of-death registers and the Stroke in Malmö register for first cardiovascular events (myocardial infarction, stroke, coronary death).
Main Outcome Measures Incident cardiovascular and coronary events.
Results During median follow-up of 12.8 years, there were 418 cardiovascular and 230 coronary events. Models with conventional risk factors had C statistics of 0.758 (95% confidence interval [CI], 0.734 to 0.781) and 0.760 (0.730 to 0.789) for cardiovascular and coronary events, respectively. Biomarkers retained in backward-elimination models were CRP and N-BNP for cardiovascular events and MR-proADM and N-BNP for coronary events, which increased the C statistic by 0.007 (P = .04) and 0.009 (P = .08), respectively. The proportion of participants reclassified was modest (8% for cardiovascular risk, 5% for coronary risk). Net reclassification improvement was nonsignificant for cardiovascular events (0.0%; 95% CI, –4.3% to 4.3%) and coronary events (4.7%; 95% CI, –0.76% to 10.1%). Greater improvements were observed in analyses restricted to intermediate-risk individuals (cardiovascular events: 7.4%; 95% CI, 0.7% to 14.1%; P = .03; coronary events: 14.6%; 95% CI, 5.0% to 24.2%; P = .003). However, correct reclassification was almost entirely confined to down-classification of individuals without events rather than up-classification of those with events.
Conclusions Selected biomarkers may be used to predict future cardiovascular events, but the gains over conventional risk factors are minimal. Risk classification improved in intermediate-risk individuals, mainly through the identification of those unlikely to develop events.
- ORIGINAL CONTRIBUTION: Prevalence, Complications, and Hos...
Context No national data exist to examine use of bone-morphogenetic proteins (BMPs) in spinal fusion surgery.
Objective To determine the patterns of use and rates of complications and financial charges associated with BMP use in spinal fusion nationally.
Design, Setting, and Patients Retrospective cohort study of 328 468 patients undergoing spinal fusion procedures from 2002-2006 identified from the Nationwide Inpatient Sample database, a 20% sample of US community hospitals.
Main Outcome Measures The rates of use of BMP among patients undergoing spinal fusion procedures are examined along with complications, length of stay, and hospital charges associated with use of this fusion adjunct.
Results The nationwide usage of BMP has increased from 0.69% of all fusions in 2002 to 24.89% of all fusions in 2006. Use of BMP varied by patient sex, race, and primary payer with increased use seen in women (56.26% with BMP vs 53.35% without BMP; odds ratio [OR], 1.12; 95% confidence interval, [CI], 1.09-1.16) and Medicare patients (29.62% with BMP vs 27.16% without BMP; OR, 1.43; 95% CI, 1.31-1.56) and decreased use in nonwhite patients (8.69% with BMP vs 10.23% without BMP; OR, 0.80; 95% CI, 0.75-0.85). When comparing immediate postoperative, in-hospital rates of complications for the year 2006 among patients undergoing spinal fusion by BMP use status, no differences were seen for lumbar, thoracic, or posterior cervical procedures. On univariate analysis and after multivariable adjustment, the use of BMP in anterior cervical fusion procedures was associated with a higher rate of complication occurrence (7.09% with BMP vs 4.68% without BMP; adjusted OR, 1.43; 95% CI, 1.12-1.70) with the primary increases seen in wound-related complications (1.22% with BMP vs 0.65% without BMP; adjusted OR, 1.67; 95% CI, 1.10- 2.53) and dysphagia or hoarseness (4.35% with BMP vs 2.45% without BMP; adjusted OR, 1.63; 95% CI, 1.30-2.05). Bone-morphogenetic protein use was associated with greater inpatient hospital charges across all categories of fusion. Increases between 11% and 41% of total hospital charges were reported, with the greatest percentage increase seen for anterior cervical fusion.
Conclusion Bone-morphogenetic protein was used in approximately 25% of all spinal fusions nationally in 2006, with use associated with more frequent complications for anterior cervical fusions and with greater hospital charges for all categories of fusions.
- SPECIAL COMMUNICATION: The Obligation to Participate in B...
The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived.
- CLINICAL CROSSROADS: A 70-Year-Old Woman With Shingles: R...
Herpes zoster is a common late complication of varicella-zoster virus exposure and can be further complicated by postherpetic neuralgia. Ms A is a 70-year-old woman with shingles and Ramsay-Hunt syndrome who presented to the emergency department with a few days of earache followed by pain in the back of her head. Using her case as a springboard, the diagnosis, natural history, and treatment of herpes zoster and postherpetic neuralgia in immunocompetent older adults are reviewed, in addition to the effectiveness of the herpes zoster vaccine.
- CLINICAL CROSSROADS UPDATE: Update: A 59-Year-Old Man Con...
- COMMENTARY: Ethical Collection, Storage, and Use of Publi...
- COMMENTARY: Building Bridges Between Medical Care and Pub...
- COMMENTARY: The Case for Public Ownership of Patient Data
- [RESEARCH] Public perceptions, anxiety, and behaviour cha...
Objective To assess whether perceptions of the swine flu outbreak predicted changes in behaviour among members of the public in England, Scotland, and Wales.
Design Cross sectional telephone survey using random digit dialling.
Setting Interviews by telephone between 8 and 12 May.
Participants 997 adults aged 18 or more who had heard of swine flu and spoke English.
Main outcome measures Recommended change in behaviour (increases in handwashing and surface cleaning or plans made with a "flu friend") and avoidance behaviours (engaged in one or more of six behaviours such as avoiding large crowds or public transport).
Results 37.8% of participants (n=377) reported performing any recommended behaviour change "over the past four days . . . because of swine flu." 4.9% (n=49) had carried out any avoidance behaviour. Controlling for personal details and anxiety, recommended changes were associated with perceptions that swine flu is severe, that the risk of catching it is high risk, that the outbreak will continue for a long time, that the authorities can be trusted, that good information has been provided, that people can control their risk of catching swine flu, and that specific behaviours are effective in reducing the risk. Being uncertain about the outbreak and believing that the outbreak had been exaggerated were associated with a lower likelihood of change. The strongest predictor of behaviour change was ethnicity, with participants from ethnic minority groups being more likely to make recommended changes (odds ratio 3.2, 95% confidence interval 2.0 to 5.3) and carry out avoidance behaviours (4.1, 2.0 to 8.4).
Conclusions The results support efforts to inform the public about specific actions that can reduce the risks from swine flu and to communicate about the government’s plans and resources. Tackling the perception that the outbreak has been "over-hyped" may be difficult but worthwhile. Additional research is required into differing reactions to the outbreak among ethnic groups.
- [NEWS] European Commission urges countries to introduce b...
- [NEWS] NHS could learn from John Lewis about motivating s...
- [EDITORIALS] Dementia and marital status at midlife and l...
- [RESEARCH] Association between mid-life marital status an...
Objectives To evaluate whether mid-life marital status is related to cognitive function in later life.
Design Prospective population based study with an average follow-up of 21 years.
Setting Kuopio and Joensuu regions in eastern Finland.
Participants Participants were derived from random, population based samples previously investigated in 1972, 1977, 1982, or 1987; 1449 individuals (73%), aged 65-79, underwent re-examination in 1998.
Main outcome measures Alzheimer’s disease and mild cognitive impairment.
Results People cohabiting with a partner in mid-life (mean age 50.4) were less likely than all other categories (single, separated, or widowed) to show cognitive impairment later in life at ages 65-79. Those widowed or divorced in mid-life and still so at follow-up had three times the risk compared with married or cohabiting people. Those widowed both at mid-life and later life had an odds ratio of 7.67 (1.6 to 40.0) for Alzheimer’s disease compared with married or cohabiting people. The highest increased risk for Alzheimer’s disease was in carriers of the apolipoprotein E e4 allele who lost their partner before mid-life and were still widowed or divorced at follow-up. The progressive entering of several adjustment variables from mid-life did not alter these associations.
Conclusions Living in a relationship with a partner might imply cognitive and social challenges that have a protective effect against cognitive impairment later in life, consistent with the brain reserve hypothesis. The specific increased risk for widowed and divorced people compared with single people indicates that other factors are needed to explain parts of the results. A sociogenetic disease model might explain the dramatic increase in risk of Alzheimer’s disease for widowed apolipoprotein E e4 carriers.
- [EDITORIALS] Distribution of insecticide treated nets in ...
- [PRACTICE] Addison's disease
- [PRACTICE] Addison's disease
- [RESEARCH] Household ownership and use of insecticide tre...
Objectives To evaluate the impact of the Tanzania National Voucher Scheme on the coverage and equitable distribution of insecticide treated nets, used to prevent malaria, to pregnant women and their infants.
Design Plausibility study using three nationally representative cross sectional household and health facility surveys, timed to take place early, mid-way, and at the end of the roll out of the national programme.
Setting The Tanzania National Voucher Scheme was implemented in antenatal services, and phased in on a district by district basis from October 2004 covering all of mainland Tanzania in May 2006.
Participants 6115, 6260, and 6198 households (in 2005, 2006, and 2007, respectively) in a representative sample of 21 districts (out of a total of 113).
Interventions A voucher worth $2.45 (£1.47, 1.74) to be used as part payment for the purchase of a net from a local shop was given to every pregnant woman attending antenatal services.
Main outcome measures Insecticide treated net coverage was measured as household ownership of at least one net and use of a net the night before the survey. Socioeconomic distribution of nets was examined using an asset based index.
Results Steady increases in net coverage indicators were observed over the three year study period. Between 2005 and 2007, household ownership of at least one net (untreated or insecticide treated) increased from 44% (2686/6115) to 65% (4006/6198; P<0.001), and ownership of at least one insecticide treated net doubled from 18% (1062/5961) to 36% (2229/6198) in the same period (P<0.001). Among infants under 1 year of age, use of any net increased from 33% (388/1180) to 56% (707/1272; P<0.001) and use of an insecticide treated net increased from 16% (188/1180) to 34% (436/1272; P<0.001). After adjusting for potential confounders, household ownership was positively associated with time since programme launch, although this association did not reach statistical significance (P=0.09). Each extra year of programme operation was associated with a 9 percentage point increase in household insecticide treated net ownership (95% confidence interval –1.6 to 20). In 2005, only 7% (78/1115) of nets in households with a child under 1 year of age had been purchased with a voucher; this value increased to 50% (608/1211) in 2007 (P<0.001). In 2007, infants under 1 year in the least poor quintile were more than three times more likely to have used an insecticide treated net than infants in the poorest quintile (54% v 16%; P<0.001).
Conclusions The Tanzania National Voucher Scheme was associated with impressive increases in the coverage of insecticide treated nets over a two year period. Gaps in coverage remain, however, especially in the poorest groups. A voucher system that facilitates routine delivery of insecticide treated nets is a feasible option to "keep up" coverage.
- [ANALYSIS] Measuring patients' experiences and outcomes
- [Editorial] Alcohol and harm reduction in Russia The Series on alcohol and global health, published in The Lancet today, draws attention to one of the most pressing public health problems in the world. Alcohol promotes inequities and accounts for substantial harm to individuals, families, and communities, most of which could be prevented or reduced. The three Series papers address the burden of alcohol, strategies for harm reduction, and future actions. By way of an example, an Article analyses the influence of alcohol on cause-specific mortality in Russia.
- [Editorial] Cash transfers for children—investing into ... Accumulating evidence from large-scale programmes is starting to show positive effects of cash transfer programmes on many levels. A new report by Save the Children, Lasting Benefits, highlights the importance of regular cash transfers, such as child benefits or pensions, as one crucial intervention to get Millennium Development Goal 4—reduction of mortality in children younger than 5 years by two-thirds—back on track.
- [Editorial] Moving forward with maternal health and human... 500 000 women die each year as a result of pregnancy or childbirth. Efforts are being made to reduce these deaths by three quarters by 2015—Millennium Development Goal 5. But many countries are not making substantial progress towards this target. Can the human-rights community help?
- [Comment] Alcohol: a global health priority Most of the world's population abstains from alcohol. This is good news for both the public health community, which seeks to reduce the harm caused by alcohol, and for industry, which seeks to expand its markets. A Series of three reports in The Lancet today provides strong evidence for greater public health efforts to reduce the harmful effects of alcohol. The Series updates the health and economic burdens caused by alcohol, summarises the effectiveness and cost-effectiveness of interventions to reduce the harm caused by alcohol, and ends with a call to action.
- [Comment] Action needed to tackle a global drink problem Postwar Britain smugly thought that alcohol misuse was someone else's problem. Despite earlier rumblings of concern in the health community, the wake-up call came in 2001 when the Chief Medical Officer reported that deaths from cirrhosis in the UK, predominantly caused by alcohol, were rising and set to overtake the European Union mean. In some age groups, the increase was nearly ten-fold over one generation of 30 years. While our continental neighbours had succeeded in cutting back over this period, per-person consumption had almost doubled in the UK, fuelled by falling prices and increasing availability. But 8 years after the nation's problem with alcohol was accepted, where are the policies to tackle it? In the UK they are largely absent, but some signs suggest a change; and the Series in The Lancet today is timely for the UK and other countries, both rich and poor.
- [Comment] A case study in how harmful alcohol consumption... In their analysis of the role of alcohol in Russian mortality in The Lancet today, David Zaridze and colleagues provide a case study in how harmful to health widespread heavy drinking in a population can be. As dramatic as the results are, they are not an indicator of the total harm to the society, since they exclude many social problems from drinking and harm to people other than the drinker. The lesson has broader applicability than in eastern Europe and northern Asia alone, because many other societies—both industrialised and indigenous—have had periods with drinking patterns similar to those in Russia in the 1990s. Even in modern societies with well-developed health-care systems, pervasive heavy drinking can result in a public health crisis.
- [Comment] Impending type 2 diabetes Can we detect any prodrome to type 2 diabetes, and does it matter? These questions are far from new, but well-controlled longitudinal studies to address the problem are few. The Whitehall study is a notable exception. Donald Reid and Geoffrey Rose collected data from British civil servants with the aim of examining the epidemiology of risk. They reported in the 1970s both on myocardial ischaemia and on glucose tolerance, showing markedly better survival in the higher echelons of the service. This success was followed by a more systematic data collection—Whitehall II, which has nine phases, where phases 3, 5, and 7 have measures of fasting glucose and insulin. In The Lancet today, Adam Tabák and co-workers report on these data, examining the question of prodromes to type 2 diabetes—a process made possible by having biochemical data available from people who subsequently developed diabetes, contrasted with data from those who did not develop the disease.
- [Comment] Primary immunodeficiency diseases: the J Project Primary immunodeficiency diseases have long been neglected as medical conditions, but are now recognised as a worldwide health problem. The rapid progress of research in this field has widened the gap between cutting-edge medical care and the lack of appropriate diagnosis and treatment of these conditions in most countries, especially in those with poor socioeconomic conditions.
- [Comment] Strengthening health systems to promote security We are living through a paradoxical mix of uncertainty and opportunity. The current economic crisis is placing additional strains on a world that is already overburdened by its inability to meet the basic needs of billions of its inhabitants. Yet we also have before us the unique opportunity represented by strong interest in health systems. The political visibility of this topic has recently grown to unprecedented levels, as discussed by Michael Reich and Keizio Takemi in an overview of follow-up activities on global health to the most recent G8 Summit. We must seize this opportunity by articulating concrete proposals.
- [Comment] Judicialisation of the right to health in Brazil Across Brazil, patients are turning to courts to access prescribed drugs. Brazil is one of at least 115 countries that recognise a constitutional right to health. An important part of this right is access to pharmaceutical drugs. Although Brazil has the developing world's most advanced HIV/AIDS programme, many of its citizens still go to local pharmacies only to find that essential medicines are out of stock. Brazil is also one of the fastest growing pharmaceutical markets in the world. Doctors increasingly prescribe and patients demand new drugs, some of questionable benefit. Faced with high cost or no availability, many individuals are suing the government to obtain drugs. Although lawsuits secure access for thousands of people, this judicialisation of the right to health generates enormous administrative and fiscal burdens and has the potential to widen inequalities in health-care delivery.
- ABOUT THIS JOURNAL: About This Journal
- IN THIS ISSUE OF ARCHIVES OF INTERNAL MEDICINE: In This I...
- COMMENTARY: The Silent Dimension: Expressing Humanism in ...
- EDITORIAL: Treating Anemia With Erythropoiesis-Stimulatin...
- EDITORIAL: Cost-effectiveness Analysis of an Established,...
- REVIEW ARTICLE: The Impact of Selecting a High Hemoglobin...
Background Treatment of anemia in chronic kidney disease (CKD) with erythropoietin-stimulating agents (ESAs) is commonplace. The optimal hemoglobin treatment target has not been established. A clearer understanding of the health-related quality of life (HQOL) impact of hemoglobin target levels is needed. We systematically reviewed the randomized controlled trial (RCT) data on HQOL for patients treated with low to intermediate (9.0-12.0 g/dL) and high hemoglobin target levels (>12.0 g/dL) and performed a meta-analysis of all available 36-item short-form (SF-36) RCT data.
Methods We conducted a search to identify all RCTs of ESA therapy in patients with anemia associated with CKD (1966–December 2006). Inclusion criteria were (1) 30 or more participants, (2) anemic adults with CKD, (3) epoetin (alfa and beta) or darbepoetin used, (4) a control arm, and (5) reported HQOL using a validated measure. All available SF-36 data underwent meta-analysis using the weighted mean difference.
Results Of 231 full texts screened, 11 eligible studies were identified. The SF-36 was used in 9 trials. Reporting of these data was generally incomplete. Data from each domain of the SF-36 were summarized. Statistically significant changes were noted in the physical function (weighted mean difference [WMD], 2.9; 95% confidence interval [CI], 1.3 to 4.5), general health (WMD, 2.7; 95% CI, 1.3 to 4.2), social function (WMD, 1.3; 95% CI, –0.8 to 3.4), and mental health (WMD, 0.4; 95% CI, 0.1 to 0.8) domains. None of the changes would be considered clinically significant.
Conclusions Our study suggests that targeting hemoglobin levels in excess of 12.0 g/dL leads to small and not clinically meaningful improvements in HQOL. This, in addition to significant safety concerns, suggests that targeting treatment to hemoglobin levels that are in the range of 9.0 to 12.0 g/dL is preferred.
- ORIGINAL INVESTIGATION: Cost-effectiveness of Total Knee ...
Background Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States.
Methods We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters' influences on cost-effectiveness.
Results Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37 100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18 300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28 100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA.
Conclusions Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers.
- INVITED COMMENTARY: Cost-effectiveness of Total Knee Arth...
- ORIGINAL INVESTIGATION: Frequency of Failure to Inform Pa...
Background Failing to inform a patient of an abnormal outpatient test result can be a serious error, but little is known about the frequency of such errors or the processes for managing results that may reduce errors.
Methods We conducted a retrospective medical record review of 5434 randomly selected patients aged 50 to 69 years in 19 community-based and 4 academic medical center primary care practices. Primary care practice physicians were surveyed about their processes for managing test results, and individual physicians were notified of apparent failures to inform and asked whether they had informed the patient. Blinded reviewers calculated a "process score" ranging from 0 to 5 for each practice using survey responses.
Results The rate of apparent failures to inform or to document informing the patient was 7.1% (135 failures divided by 1889 abnormal results), with a range of 0% to 26.2%. The mean process score was 3.8 (range, 0.9-5.0). In mixed-effects logistic regression, higher process scores were associated with lower failure rates (odds ratio, 0.68; P < .001). Use of a "partial electronic medical record" (paper-based progress notes and electronic test results or vice versa) was associated with higher failure rates compared with not having an electronic medical record (odds ratio, 1.92; P = .03) or with having an electronic medical record that included both progress notes and test results (odds ratio, 2.37; P = .007).
Conclusions Failures to inform patients or to document informing patients of abnormal outpatient test results are common; use of simple processes for managing results is associated with lower failure rates.
- ORIGINAL INVESTIGATION: Cutaneous Malignancies Among HIV-...
Background As the life expectancy of persons infected with human immunodeficiency virus (HIV) increases, cancers have become an important cause of morbidity and mortality. Although cutaneous cancers are the most common malignant neoplasms in the general population, little data exist among HIV-positive persons, especially regarding the impact of HIV-specific factors.
Methods We evaluated the incidence rates and factors associated with the development of cutaneous malignancies among HIV-infected persons by examining data that were prospectively collected from a large HIV study that included 4490 participants (1986-2006). Poisson regression and Cox proportional hazards models were performed.
Results Six percent of HIV-infected persons (n = 254) developed a cutaneous malignancy during 33 760 person-years of follow-up (mean, 7.5 years). Since the advent of highly active antiretroviral therapy (HAART), the incidence rates of cutaneous non–AIDS-defining cancers (NADCs), in particular basal cell carcinoma, have exceeded the rates of cutaneous AIDS-defining cancers such as Kaposi sarcoma. Factors associated with the development of cutaneous NADCs in the multivariate models included increasing age (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.7-2.6) and race. Compared with the white/non-Hispanic race, African Americans (HR, 0.03; 95% CI, 0.01-0.14) and other races (HR, 0.14; 95% CI, 0.03-0.57) had a lower risk of cutaneous NADCs. There were no significant associations between cutaneous NADCs and time-updated CD4 lymphocyte counts, HIV RNA levels, or receipt of HAART.
Conclusions At present, the most common cutaneous malignancies among HIV-infected persons are NADCs. Cutaneous NADCs do not appear to be significantly associated with immune function or HAART but rather are related to traditional factors such as aging and skin color.
- UTI Catheter-associated urinary tract infection; interview with Jennifer Meddings, MD, of the University of Michigan; "Fault" by Gordon Rubenfeld, MD, of the University of Toronto; plus a summary of all the articles in the issue.
- Beta-blockers Beta-blockers and heart failure mortality; interview with Finlay McAlister, MD, of the University of Alberta; plus a summary of all the articles in the issue.
- Primary care ACEIs and ARBs in chronic kidney disease; The Demise of Primary Care by David Norenberg, MD; plus a summary of all the articles in the issue.
- Prostate cancer Risk prediction in prostate cancer; interview with Edward P. Gelmann, MD, of Columbia University; plus a summary of all the articles in this issue.
- Diabetes Intensive glycemic control for type 2 diabetes; interview with Victor Montori, MD, of the Mayo Clinic, Rochester; plus a summary of all the articles in the issue.
- Smoking New approaches to smoking cessation; interview with Nancy Rigotti, MD, of Harvard Medical School; plus a summary of all the articles in the issue.
- Aspirin Aspirin for primary prevention of heart disease; interview with Michael Lauer, MD, of the NIH's National Heart, Lung, and Blood Institute; plus a summary of all the articles in the issue.
- Aspirin for the Prevention of Cardiovascular Disease - Cl... Aspirin for the Prevention of Cardiovascular Disease - Clinical Summary of U.S. Preventive Services Task Force Recommendation
- Health Care Cost Control The Obama administration's options for health care cost control; interview with Jonathan Oberlander, PhD, of the University of North Carolina in Chapel Hill; plus a summary of all the articles in this issue.
- Mindless eating Coordinating care: it takes a village (of physicians); the Joy of Cooking too much; interview with Brian Wansink, PhD, of Cornell University; plus a summary of all the articles in this issue.
- Public reporting of hospital quality: Recommendations to ... Public reporting of hospital performance holds tremendous promise for improving the care provided by hospitals. To date, however, consumers have failed to embrace public reporting, despite considerable efforts to promote it. We review a number of reasons that public reporting has failed to live up to expectations, and we make 10 recommendations to improve the value of public reporting for both patients and hospitals. We also review 3 leading performance reporting programs to evaluate how well they adhere to these recommendations. Journal of Hospital Medicine 2009. © 2009 Society of Hospital Medicine.
- Acute vertebral fracture Vertebral fractures resulting from osteoporosis are a significant cause of morbidity and mortality in the aging population and are commonly seen in the hospital setting. Appropriately assessing and treating these conditions continues to be a challenge. This article is an evidenced based clinical update on the evaluation and management options of acute vertebral fractures, ranging from conservative treatment to surgical intervention. Hospitalists can play an influential role in the management of osteoporosis. Journal of Hospital Medicine 2009. © 2009 Society of Hospital Medicine.
- Transitions of Care Consensus Policy Statement: American ... The American College of Physicians, Society of Hospital Medicine, and Society of General Internal Medicine convened a multi-stakeholder consensus conference in July 2007 to address the quality gaps in the transitions between inpatient and outpatient settings and to develop consensus standards for these transitions. Over 30 organizations sent representatives to the Transitions of Care Consensus Conference. Participating organizations included medical specialty societies from internal medicine as well as family medicine and pediatrics, governmental agencies such as the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services, performance measure developers such as the National Committee for Quality Assurance and the American Medical Association Physician Consortium on Performance Improvement, nurse associations such as the Visiting Nurse Associations of America and Home Care and Hospice, pharmacist groups, and patient groups such as the Institute for Family-Centered Care. The Transitions of Care Consensus Conference made recommendations for standards concerning the transitions between inpatient and outpatient settings for future implementation. The American College of Physicians, Society of Hospital Medicine, Society of General Internal Medicine, American Geriatric Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine all endorsed this document. Journal of Hospital Medicine 2009. © 2009 Society of Hospital Medicine.
- Patient readmissions, emergency visits, and adverse event... One of the causes of postdischarge adverse events is poor discharge communication between hospital-based physicians, patients, and outpatient physicians. The value of hospital discharge software to improve communication and clinically relevant outcomes is unknown.To measure effects of a discharge software application of computerized physician order entry (CPOE).Cluster randomized controlled trial.Tertiary care, teaching hospital in central Illinois.A total of 631 inpatients discharged to home with high risk for readmission.Seventy internal medicine hospital physicians were randomly assigned (allocation concealed) to discharge software versus usual care, handwritten discharge.Blinded assessment of patient readmission, emergency department visit, and postdischarge adverse event.A total of 590 (94%) patients provided 6-month follow-up data. Generalized estimating equations gave intervention variable coefficients with 95% confidence interval (CI). When comparing patients assigned to discharge software versus usual care, there was no difference in hospital readmission within 6 months (37.0% versus 37.8%; coefficient -0.005 [95% CI, -0.074 to 0.065]; P = 0.894), emergency department visit within 6 months (35.4% versus 40.6%; coefficient -0.052 [95% CI, -0.115 to 0.011]; P = 0.108), or adverse event within 1 month (7.3% versus 7.3%; coefficient 0.003 [95% CI; -0.037 to 0.043]; P = 0.884).Discharge software with CPOE did not affect readmissions, emergency department visits, or adverse events after discharge. Future studies should assess other endpoints such as patient perceptions or physician perceptions to see if discharge software has value. Journal of Hospital Medicine 2009. © 2009 Society of Hospital Medicine.
- The blade, the flea, and the colon
Ischemic colitis often gives the internist and surgeon a chance to commiserate on the power of informed watchful waiting.
- Radiologic workup of a palpable breast mass (MARCH 2009)
- IN REPLY:
- Q: What is the role of probiotics in the treatment of acu...
Overall, the evidence does not support using probiotics to treat Clostridium difficile-associated diarrhea. More studies are needed to determine if they are helpful and, if so, which ones and at what dosages.
- Back pain made simple: An approach based on principles an...
Low back pain is a common and costly medical condition with only a weak correlation between symptoms and pathologic changes. The authors offer a simple, evidence-based approach.
- Black esophagus
A 60-year-old man with gastrointestinal bleeding due to alcoholic cirrhosis has necrosis of the distal esophagus.
- Clinical approach to colonic ischemia
Ischemic colitis is one of the diagnoses that should be considered when patients present with abdominal pain, diarrhea, and intestinal bleeding.
- Painful eye with a facial rash
Six days ago, the patient had an intense headache; 4 days ago, painful herpetiform lesions appeared on his face. What is the diagnosis?
- A 48-year-old man with uncontrolled diabetes
His type 2 diabetes has been well controlled for 6 years. Now, his blood sugar levels have been rising for the past week, and he has large amounts of glucose and ketones in the urine. What has happened?
- Alternative modes of mechanical ventilation: A review for...
Newer ventilators can be set to modes other than the pressure-control and volume-control modes of older machines. We review how they work and contrast their theoretical benefits and actual evidence of benefit.
- Elements: In this month's issue
- Tools used in the diagnosis and staging of lung cancer: w...
- Presentations and outcomes of neurosarcoidosis: a study o...
Objective: To report on the clinical presentations, laboratory abnormalities, treatment and outcomes in 54 patients with neurosarcoidosis (NS).
Background: Sarcoidosis is an inflammatory granulomatous disease affecting multiple organ systems. Neurosarcoidosis (CNS involvement) is seen in approximately 25% of patients with systemic sarcoidosis, although it is subclinical in most of these cases. Because of its rarity, exposure of neurologists to the clinical spectrum of NS is limited to case reports or short case series.
Patients and Methods: A database of 3900 patients treated at the Vanderbilt Multiple Sclerosis Clinic between 1995 and 2008 was searched for ‘neurosarcoidosis’, ‘neurosarcoid’, ‘sarcoidosis’ and ‘sarcoid’. Of the 162 patient records that were retrieved, 54 patients were found to meet the criteria for definite, probable or possible neurosarcoidosis and were reviewed, including their clinical presentation, Cerebrospinal fluid (CSF) findings, Magnetic resonance imaging (MRIs), biopsy results, treatment, and where available, outcomes 4 months to 20 years after onset of the presenting illness.
Results: Clinical presentations and imaging findings in NS were varied. Cranial nerve abnormalities were the most common clinical presentation and involvement of the optic nerve in particular was associated with a poor prognosis for visual recovery. Isolated involvement of lower cranial nerves had a more favorable outcome. T2 hyperintense parenchymal lesions were the most common imaging finding followed by meningeal enhancement. Long-term treatment consisted of prednisone and/or other immunomodulators (azathioprine, methotrexate or mycophenolate mofetil).
Conclusions: Unlike systemic sarcoidosis, there is difficulty in making tissue diagnosis when involvement of CNS is suspected. MRI and CSF studies are sensitive in the detection of CNS inflammation but lack specificity, making the ascertainment of neurosarcoidosis a clinical challenge. In addition the low prevalence of the disease makes clinical trials difficult and therapeutic decisions are likely to be made from careful reporting from case studies.
- The intravenous adenosine test: a new test for the identi...
Background: Intravenous adenosine has recently been used in the diagnosis of unexplained syncope, but there is no consensus as to the meaning of a ‘positive’ test. The objective is to determine the sensitivity and specificity of intravenous adenosine testing in the diagnosis of bradycardia-pacing indications [sinus node dysfunction(SND), atrio-ventricular block (AVB) and cardio-inhibitory carotid sinus syndrome (CSS)].
Design: Pilot cohort study.
Methods: Patients—(i) Bradycardia-pacing group: Consecutive patients referred for pacing for SND, AVB and CSS; (ii) Consecutive head-up tilt (HUT)-positive VVS patients. Controls—(i) Simple controls (S-Con: normal examination/ECG) and (ii) Electrophysiology controls (EP-Con: consecutive subjects referred for accessory pathway ablation). Pacing referrals and EP-Con had electrophysiology studies to confirm referral diagnosis and exclude others. All subjects had bolus injection of 20 mg intravenous adenosine during continuous ECG and blood pressure monitoring (positive test: >=6 s asystole, >=10 s high-degree AVB post-injection). Sensitivity, specificity, safety and tolerability of the test were measured.
Results: Of 264 potential participants (4 SND, 8 AVB, 7 CSS, 10 VVS, 10 EP-Con and 11 S-Con) 50 were studied. All (100%) of the bradycardia-pacing group were adenosine test-positive, as were 6 (60%) VVS. None (0%) and 3 (27%) of the EP- and S-Con groups were positive. Adenosine testing was 100% sensitive and 86% specific for bradycardia-pacing indications, and 100% specific using the diagnostically ‘clean’ EP-Con results. There were no significant adverse or side effects.
Conclusions: Adenosine testing reliably identified patients with definitive bradycardia-pacing indications in whom alternative diagnoses were excluded. Further work is needed to evaluate the role of this test in the diagnosis of unexplained syncope.
- Circulating plasma cortisol concentrations are not associ...
Background: Although the prevalence of cardiovascular disease is declining, the obesity epidemic with associated metabolic syndrome may reverse this trend. Hypothalamic–pituitary–adrenal (HPA) axis activation may underlie the metabolic syndrome, but whether circulating cortisol levels predict vascular disease is less clear. A recent study reported a positive correlation between cortisol levels measured prior to coronary angiography and disease severity, but others have not demonstrated such a relationship. This may be due to different sampling conditions, reflecting basal cortisol levels, vs. responsiveness of HPA axis activity, which may have diverse influences on the pathogenesis of atherosclerosis.
Aims: To determine whether basal circulating cortisol levels predict coronary artery (CAD) or peripheral vascular disease.
Methods: Basal plasma cortisol levels were measured in 278 subjects with suspected CAD, who had undergone elective coronary angiography and in 76 cases and 85 controls with and without peripheral vascular disease, respectively.
Results: After adjustment for potential confounding factors, circulating cortisol levels tended to be lower in those with confirmed coronary vessel disease at angiography (P = 0.10), and in those requiring intervention following angiography (P = 0.07). Lower cortisol levels also predicted those with more symptoms of angina (P = 0.01). Cortisol levels were no different in those with or without peripheral vascular disease.
Conclusion: A single measurement of circulating cortisol is a poor predictor of vascular disease. More detailed characterization of the HPA axis is necessary to determine the role of circulating endogenous glucocorticoids and their responsiveness to stress in atherosclerosis.
- Incidence and mortality of falls amongst older people in ...
Background: Despite the role of primary care in the falls care pathway, there are almost no data on the extent of falls seen in general practices.
Aim: To quantify the incidence and mortality of falls amongst older people in primary care in the UK.
Methods: Cohort study of people aged >=60 years and registered in a UK practice contributing data to The Health Improvement Network primary care database (THIN) throughout 2003–06. Analysis of crude incidence and estimation of incidence rate ratios using negative binomial regression, and survival using Cox regression. Sensitivity analysis of criteria for distinguishing discrete fall events from follow-up appointments.
Results: Amongst people aged >=60 years the overall crude incidence rate of recorded falls was 3.58/100 person-years (95% CI 3.56–3.61). The rate of recurrent falls was 0.67/100 person-years (95% CI 0.66–0.68). The incidence rate of recorded falls and recurrent falls was higher in older age groups, in women and least advantaged social groups. Incidence of recorded falls was constant through the time period 2003–06. Mortality for recurrent fallers was about twice that of general population controls.
Conclusions: These data suggest that more than 475 000 fall events in older people are recorded in general practice each year in the UK, and are associated with increased mortality and relative deprivation. The underlying incidence rate has remained stable in recent years.
- Delays and adverse clinical outcomes associated with unre...
Background: A recent UK audit showed that a significant proportion of patients who received pacemakers had pacing indications previously overlooked, leading to significant delays to pacemaker implantation.
Aim: To investigate the reasons for, and morbidity associated with, overlooked pacing indications.
Design: Prospective observational study in a UK regional pacing centre and its referring district hospitals.
Methods: Hospital records from referring and implanting centres were reviewed for 95 consecutive patients undergoing first pacemaker implant to determine symptoms, investigations and hospitalisations occurring after documentation of a pacing indication.
Results: Thirty-three of ninety-five patients (35%) had a pacing indication overlooked, which was Class I in 14 patients and Class IIa in 19. Reasons for not making a pacing referral in these patients included: failure to recognize the indication in 14, making adjustments to potentially culprit medication in 15 and requesting additional ‘confirmatory’ tests in 4. Twenty-six patients (79%) with missed indications experienced adverse events after documentation of an indication, and before receiving a pacemaker: 23 had ongoing symptoms (including one cardiac arrest), three received temporary pacing wires and 18 were hospitalized with symptoms related to cardiac rhythm. Twenty-seven patients (82%) had a total of 38 additional specialist investigations after documentation of a pacing indication.
Conclusions: Documentation of an indication for pacing failed to trigger referral for permanent pacing in 35% of patients. This failure led to significant delays, morbidity and use of health service resource, which may have been avoided if timely recognition of the pacing indication had prompted referral. Failure to recognize pacing indications and reassessing symptoms and repeating investigation after changes to medication, often required for the management of associated tachyarrhythmias or other medical conditions, contribute to these delays, perhaps unnecessarily.
- An uncommon cause of small bowel obstruction: isolated pr...
- Intestinal perforation in a patient with continuous ambul...
- Epilepsy genetics: clinical beginnings and social consequ...
The approach to epilepsy care has transformed in the last 30 years, with more and better anti-epileptic medications, improved cerebral imaging and increased surgical options. Alongside this, developments in neuroscience and molecular genetics have furthered the understanding of epileptogenesis. Future developments in pharmacogenomics hold the promise of antiepileptic drugs matched to specific genotypes. Despite this rapid progress, one-third of epilepsy patients remain refractory to medication, with their seizures impacting upon day-to-day activity, social well-being, independence, economic output and quality of life. International genome collaborations, such as HapMap and the Welcome Trust Case–Control Consortium single nucleotide polymorphism (SNP) mapping project have identified common genetic variations in diseases of major public health importance. Such genetic signposts should help to identify at-risk populations with a view to producing more effective pharmaceutical treatments. Neurological disorders, despite comprising one-fifth of UK acute medical hospital admissions, are surprisingly under-represented in these projects. Epilepsy is the commonest serious neurological disorder worldwide. Although physically, psychologically, socially and financially disabling, it rarely receives deserved attention from physicians, scientists and governmental bodies. As outlined in this article, research into epilepsy genetics presents unique challenges. These help to explain why the identification of its complex genetic traits has lagged well behind other disciplines, particularly the efforts made in neuropsychiatric disorders. Clinical beginnings must underpin any genetic understanding in epilepsy. Success in identifying genetic traits in other disorders does not make the automatic case for genome-wide screening in epilepsy, but such is a desired goal. The essential clinical approach of accurately phenotyping, diagnosing and interpreting the dynamic nature of epilepsy remains fundamental to harvesting its potential translational outcomes.
- It's Time to Bail Out Seniors Trapped in the Medicare Don... Medicare D, which became effective in January of 2006, was a major step forward in providing prescription drug coverage to one segment of our population: those age 65 and older. As of 2009, 90% of all seniors (Medicare beneficiaries) had signed up for Medicare D, which is voluntary, or had other insurance coverage for prescription drugs.
- “Hey, Doc, Is It OK for Me to Drink Coffee?” Many of my patients with coronary artery disease, diabetes, or hypertension have been warned at various times in their lives to avoid caffeinated coffee because they had been informed that drinking caffeinated coffee could result in increased blood pressure, worsening of diabetic control, and might even trigger a myocardial infarction. Some of my patients also worry that drinking caffeinated coffee might cause cancer. This editorial will briefly cite the now-voluminous evidence that caffeinated coffee in moderate doses (1-3 cups per day in some studies and more in other investigations) is not associated with clinically relevant increases in blood pressure, serum cholesterol levels, myocardial infarction, or various malignancies.
- Osteoporosis in Inflammatory Bowel Disease Abstract: Osteoporosis commonly afflicts patients with inflammatory bowel disease, and many factors link the 2 states together. A literature review was conducted about the pathophysiology of osteoporosis in relation to inflammatory bowel disease. Screening guidelines for osteoporosis in general as well as those directed at patients with inflammatory bowel disease are reviewed, as are currently available treatment options. The purpose of this article is to increase physician awareness about osteopenia and osteoporosis occurring in patients with inflammatory bowel disease and to provide basic, clinically relevant information about the pathophysiology and guidelines to help them treat these patients in a cost-effective manner.
- Inflammation, Coagulation, and the Pathway to Frailty Abstract: There are inevitable physiologic changes associated with advancing age, yet for some people these changes are exaggerated, and as a result a phenotype emerges recognized as “frailty.” Why some people become frail and others do not remains incompletely understood. Although chronic illnesses are common among frail elderly persons, some will develop all of the phenotypic features without a diagnosed underlying disease. It has been recognized that certain proinflammatory cytokines and coagulation factors are elevated to a greater extent in those who are frail than in age-matched nonfrail individuals. In this review, we provide an overview of current research in the biology of frailty with particular emphasis on the role of inflammatory pathways and disordered coagulation in its pathogenesis.
- Pharmacological Management of Psychosis in Elderly Patien... Abstract: Parkinsonism is a characteristic feature of Parkinson's disease and dementia with Lewy bodies and is commonly seen in Alzheimer's disease. Psychosis commonly appears during the course of these illnesses. Treatment of parkinsonism with antiparkinsonian medications constitutes an additional risk factor for the appearance or worsening of psychosis. Conversely, treatment of psychosis with antipsychotic drugs in patients with parkinsonism might worsen the underlying movement disorder, especially in the elderly. In this article, we review parkinsonian conditions in the elderly and offer guidelines to assess and manage comorbid psychosis. We focus on the pharmacologic management of psychosis with atypical antipsychotic medications and briefly review the role of acetylcholinesterase inhibitors.
- Erythema Multiforme Syndrome Erythema multiforme is a clinical diagnosis of skin manifestation characterized by eruption of annular, maculo-papular lesions with dark raised, erythematous, or vesiculo-bullous center surrounded by a pale zone.
- Hole in One Making a correct diagnosis, like hitting a hole in one, takes experience and an understanding of the best approach. In this case, a patient presenting with a cavitary lung lesion, the right approach is critical to making a timely diagnosis.
- Transplant Troubles Ten years after a successful liver transplant, a patient developed troubling symptoms. A 66-year-old woman presented to the emergency department complaining of left-sided weakness and sensory changes. These started 7 months earlier with numbness of the left hand that progressed to the left side of her face and her left leg. Two months prior to admission, she developed weakness in the left side of her face and her left arm and leg. On review of systems, she noted fatigue, difficulty completing activities of daily living, and a 20-lb weight loss. She had no confusion, seizures, or visual deficits.
- Bugs and Blood Cells When lymphoma is suspected in a patient already diagnosed with several other chronic, life-threatening diseases, the ultimate diagnosis brings good news in the form of a potentially very treatable condition.
- An Unusual Case of Syncope Some metabolic derangements can lead to impaired cardiac rhythm and conduction. As shown in the following case, correcting these derangements can result in the rapid resolution of electrocardiographic abnormalities.
- Editorial Board
- Contents
- Some thoughts on professionalism In the current online issue of the Journal, we present a series of, in our opinion, outstanding articles by van Mook WKNA and colleagues on professionalism in medicine . They present a state of the art review of the development of the concept and its current definition and in this capacity the series can be used as an introduction to the topic for physicians, students and other interested parties. In addition, they present an ambitious agenda for the teaching of professionalism to students and residents and review the current knowledge on assessment of professionalism.
- Transient elastography for liver fibrosis diagnosis Abstract: Liver biopsy is considered the “golden standard” for assessment of hepatic fibrosis. However, the procedure has limitations because of inconvenience and rare but serious complications as bleeding. Furthermore, sampling errors are frequent, and interobserver variability often poses problems.Recently, a modified ultrasound scanner (transient elastography) has been developed to assess fibrosis. The device measures liver elasticity, which correlates well with the degree of fibrosis. Studies have shown that transient elastography is more accurate in diagnosing cirrhosis than minor to moderate fibrosis. Most of the studies have been conducted on patients with chronic hepatitis but a few studies have also covered fibrosis and cirrhosis due to other etiologies, and they also demonstrate the high sensitivity and specificity. Transient elastography for assessment of fibrosis may turn out to be a valuable diagnostic procedure and follow-up of patients with chronic liver diseases.
- Serious infections due to methicillin-resistant Staphyloc... Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized major cause of nosocomial infection worldwide. During the past decade, however, the epidemiology of staphylococcal infections has partially changed, with an increase in the number of patients who acquire infections in the community. The changing epidemiology is a cause for concern among physicians, leading to an increase in the number of patients with infections due to MRSA diagnosed at hospital admission and in the emergency department. The aims of this article are to review the current state of knowledge regarding MRSA infections, to identify those factors which may help physicians to recognize the patients at high risk, and to manage these infections appropriately.
- Vascular disease in rheumatoid arthritis: From subclinica... Abstract: Rheumatoid arthritis (RA) is one of the most prevalent and complex inflammatory diseases affecting primarily the joints, but also associating several extra-articular features. The vascular disease in RA encompasses a large spectrum of lesions, from rheumatoid vasculitis to atherosclerotic lesions. During the last years the importance of the vascular disease related to atherosclerosis in terms of cardiovascular morbidity and global mortality became evident in RA. The inflammatory hypothesis of atherosclerosis in RA implies that mediators originating from the inflamed synovial tissue or from the liver may have systemic vascular consequences, leading to endothelial dysfunction and structural abnormalities of the vessels. Hence, the global management of patients with RA must include the improvement of cardiovascular risk in parallel with the management of joint disease.
- Managing patients with amyotrophic lateral sclerosis Abstract: Amyotrophic lateral sclerosis (ALS) is the most common rapidly progressive adult-onset neurodegenerative disorder. There have been great advances in the management of patients with ALS over the past decade. It starts with the giving of the diagnosis and continues to the terminal phase of the disease. This review will examine the impact of medical and non-medical interventions on improving survival and quality of life in these patients, emphasizing the importance of a multidisciplinary approach.
- Sudden death after emotional stress: A case history and l... Abstract: An 84-year old women in no apparent distress suddenly died, unexpectedly, an hour after being notified of having a malignancy. Behavioural scientists have long speculated about the relationship between emotional stress and sudden death. We reviewed the presently available evidence regarding the neurophysiologic mechanisms of sudden death after emotional stress.
- Predictors of mortality in medically treated patients wit... Abstract: Objective: We investigated the prognostic value of various parameters on the mortality of patients with nonrheumatic chronic heart failure and left ventricular (LV) systolic dysfunction.Methods: This study included 132 consecutive patients with congestive heart failure and reduced LV systolic function without rheumatic valve disease. The primary outcome was mortality. Mean follow-up was 38±6 months.Results: During the follow-up period there were 47 deaths (35.6%). The age (64.1±13.5 vs. 58.7±11.8 years, P=0.019), left bundle branch block (44.7% vs. 18.8%, P=0.002), urea concentration (11.4±5.3 vs. 8.9±4.6 mmol/L, P=0.006), LV end-diastolic and end-systolic dimensions (6.7±0.8 vs. 6.4±0.8 cm, P=0.025 and 5.5±0.8 vs. 4.9±0.8 cm, P<0.001, respectively), grade 3–4 mitral regurgitation (40.4 vs. 22.4%, P<0.001), fractional shortening (16.7±5.3% vs. 19.8±5.7%, P=0.002) and LV ejection fraction (32.9±8.5% vs. 38.7±11.3%, P=0.003) were different between non-survivors and survivors. Multivariate analysis identified severity of mitral regurgitation (OR=1.99, 95% CI 1.18–3.34; P=0.009), age (OR=1.07, 95% CI 1.02–1.12; P=0.01) and LV end-systolic dimension (OR=1.09, 95% CI 1.02–1.16; P=0.014) as independent correlates of mortality.Conclusions: In medically treated patients with nonrheumatic chronic heart failure and left ventricular systolic dysfunction, severity of mitral regurgitation, age and enlarged LV end-systolic dimension were independently associated with increased risk of death.
- High blood pressure response to stress ergometry could pr... Abstract: Background: Previous studies have shown that exaggerated blood pressure (BP) during exercise is a valid risk predictor for future hypertension in most men and women, yet the use of ergometry as a means of early detection of incipient hypertension still requires confirmation.Objectives: To assess the clinical utility of exercise BP measurement for the evaluation of risk for developing new-onset hypertension.Methods: Thirty individuals with normal BP were enrolled in this study and were subsequently divided into two groups: 13 persons with in-exercise hypertension were compared with 17 matched persons who were normotensive during ergometry. Their blood pressure was monitored during follow-up of two years.Results: More individuals in the exercise-hypertensive group developed hypertension after one or two years than those normotensive during the exercise (respectively, one year: 3 vs.0, p=0.03, two years: 10 vs. 1, p<0.0001). Both the systolic and diastolic BPs significantly differed between the two groups. Eighty four percent of those with exaggerated BP (≥210 mm Hg) during the treadmill exercise developed hypertension after 2 years. The sensitivity and specificity of in-exercise hypertension for predicting its 2 year occurrence were, respectively, 91% and 84%.Conclusion: Even in the absence of hypertension, its development during stress ergometry could be considered a predictive marker for the future development of hypertension, and can be a potential tool for identifying normotensive individuals at high risk. These individuals should be followed up and their BP controlled for a long time.
- Dermatology lessons learned, warts and all A crowded and popular scientific session at Internal Medicine 2009 outlines the essentials of psoriasis, eczema, acne, rosacea and warts.
- Treat addicted patients for the long-term Diagnosing addictions are often based on one question. An expert offers advice to make that one question count, and to move from diagnosis to treatment.
- Spotting thyroid nodules entails history - of patient and... An art masterpiece inspired goiters as a fashion trend in Baroque-era Europe, and in the modern age kicks off a discussion on diagnosing nodules that can be palpated in only 7% of women and 2% of men. An experts counsels how to detect them.
- Correcting myths about pneumococcus, flu, zoster vaccines Vaccines have an undeserved bad reputation, so a Master of the College promotes their use and discusses common errors in administration..
- Predicting risk is next challenge in tackling breast cancer Declining mortality from breast cancer creates a new problem. How will internists decide which patients will benefit from the new treatment and prevention strategies? Also, get an advance look what will influence the next 10 years of treatment.
- Addressing drug interactions when their likelihood is 'yes' Once a patient is taking 10 or more drugs, they face drug interactions. Douglas S. Paauw, MACP, addresses the most common problems, including the details of grapefruit juice and statins, thyroid-replacement therapy, proton pump inhibitors and warfarin.
- Leadership Day launches push for primary care Whether they were catching a Congressman in the hallway or pleading their personal stories to legislators, participants in ACP's annual Leadership Day were united in the message to their state representatives: save primary care. More than 400 ACP members gathered in Washington, D.C., on May 20 to lobby their senators and congressional representatives on behalf of internal medicine.
- Hunting for causes, cures and small game D. Lynn Loriaux, MACP, talks about how he transitioned from forestry to husbandry to internal medicine, hiw skills at the trumpet, and searching for cures to endocrine diseases at the Institutes of Health.
- Recalls target cold products, digoxin, defribrillators, d... A summary of approvals, recalls, warnings and alerts.
- Hysterectomy, ovary removal tied to mortality; IOM calls ... The latest news and clinical studies affecting internal medicine, from the files of ACP InternistWeekly.
- CRP? Fuggedaboutit. Big news from JAMA today: High C-reactive protein (CRP) levels don't appear to cause heart disease. Cardiologists have debated for years about whether patients should have their CRP levels routinely screened as a risk factor for CV disease, and whether CRP should be targeted therapeutically. The authors of the JAMA genetics study say nope:"In summary, our mendelian randomization study of more than 28,000 cases and 100,000 controls found no association of variants in the CRP locus and CHD, arguing against a causal role for CRP in atherosclerosis. Moreover, this study suggests that development of therapeutic strategies targeting specific reductions in plasma levels of CRP are unlikely to be fruitful," the researchers write in their article.I'm sure this study won't be the final word on the subject, but it's a strong argument toward trending back to the basics: Using BP levels, obesity, smoking, cholesterol and family history as risk factors for CHD. Plus ca change...
- Medical news of the obvious We've noticed a slowdown in studies that qualify for our Weekly e-newsletter in the last few weeks, and it seems the sluggish study season now applies to obvious news as well.Yes, for the first time in the history of Medical News of the Obvious, we didn't find anything last week that wasn't actually sort of reasonable. But, hey, we'd love it if we were wrong about this, so feel free to toss some studies our way if you feel we've missed something eye-rollingly obvious.
- If they don't give you the flu... It's good news for people who like to cuddle wild animals. The CDC's Advisory Committee on Immunization Practices has determined that four, rather than five, rabies shots are enough to protect an exposed human, according to an AP report.Apparently (bet you didn't know this either) there's been a nationwide shortage of rabies vaccine, so the experts are hoping that reducing the number of shots will help to alleviate that problem. On the other hand, Novartis, which charges $100 to $200 per shot, expressed concern about the recommendation and hasn't announced any plans to change their labeling info from 5 shots to 4.Maybe you can offer that extra shot to your friendly neighborhood bat. They seem to be having a rough year.
- One more thing to learn As part of ACP Internist's standard profile feature, we ask physicians "What's one thing you wish you had learned in medical school?" Their answers are usually something about communicating with patients or accepting people's inability to change.But an article on Slate.com makes the argument that what's missing from medical education is health policy. The authors report on how some schools are trying change the system, so that students actually know what a "third-party payer" is by the time they graduate.The article may exaggerate students' ignorance a little. I've certainly seen a lot of med students/policy activists at ACP's Leadership Day. But spreading the knowledge more widely sounds like a good thing. Only one problem: what classes will these health policy lessons replace? Maybe, to be more useful, we should rephrase our profile question. What do you wish you hadn't learned in med school?
- The doughnut hole will need a new name Yesterday, pharmaceutical companies agreed to shrink the Medicare doughnut hole by offering a 50% discount on meds purchased while a patient in the hole. The full price of the medicines will continue to count toward getting back out the other side. Given this development, the gap in coverage is going to need a new name to convey its smaller size--maybe the icing in the eclair or the Oreo filling?More seriously, the most interesting thing about this change is how it benefits everyone involved. The advantages to patients are obvious. But the seemingly altruistic move by big pharma will probably benefit their bottom line, too, according to an analyst interviewed by the New York Times."'Because of the discounts,' he said, 'Medicare beneficiaries are likely to continue filling prescriptions in the doughnut hole, whereas in the past many stopped taking their medications because the drugs were unaffordable to them.'"It makes you wonder why they didn't do it sooner. Was this strategy reserved until it would have the biggest possible PR impact as a contribution to health reform?And if the talk of doughnuts and Oreos has made you desperately crave some junk food, my apologies. The NYT also has an interesting article about this psychological torment.
- Medical news of the obvious It's best not to get holes in one's surgical gloves in the middle of a procedure, as this leads to a higher risk of infection for the patient, the Archives of Surgery reports in a study about the effect of ripped gloves. "Pathogens can still be transmitted through contact with skin or blood," quoth the press release. Which is, perhaps, why the surgeons put on the gloves in the first place? Teens often stop drinking milk after they leave home. A study (Eating Among Teens, or EAT) in the July/August issue of the Journal of Nutrition Education and Behavior notes that the transition from high school to young adulthood often triggers a dramatic drop in calcium intake--a problem, since bones are still developing until roughly age 30. The authors don't address whether the drop is linked to leaving the family meal table (typically with limited, healthy choices) for the cafeteria smorgasboard or solo apartment (abundant or limited choices, but rarely healthy). They suggest fixing the problem by using peer pressure, so it becomes cooler to swig a carton of milk than a bottle of beer ("c'mon, have another one, it won't hurt you--really!")People who live close to fast-food restaurants and convenience stores tend to eat fattening food. Researchers at the University of Alberta studied associations between the "retail food environmental index" and levels of obesity, boldly concluding that people are more likely to eat healthy food if they actually have easy access to it (i.e., by living close to supermarkets that sell more than burgers, fries and super-size sodas). Writing in BioMed Central's BMC Public Health, researchers make the astute observation: "Your local food environment can affect your weight." Contributors: Jessica Berthold, Janet Colwell
- ADHD drug study swerves way off course Recently, parents of children with ADHD were subjected to some alarming headlines warning of a possible association between the use of stimulant medications for the disorder and sudden cardiac death.The study, published in the American Journal of Psychiatry, seemed to carry some weight and even prompted a communication from the FDA (who provided funding, along with the National Institute of Mental Health), but pay close attention to the study's many limitations. Consider the unusual design of the study: researchers compared two groups of healthy children using stimulant medications. Half died suddenly in car accidents while the other half died suddenly from other causes. Because fewer kids in the car accident group died than in the other causes group (10 vs. 2), while taking the drugs, researchers surmised that there may be an association betwen the drugs and sudden death in healthy children. Huh?And how did the researchers determine whether the deceased children were taking stimulants at time of death? They simply asked the grief-stricken parents, often years after the fact -- that's one of the "limitations" mentioned by the FDA. Another is the very real possibility that a child's death from unexplained causes prompted an autopsy investigating medication use. According tothe FDA, "the low frequency of stimulant use in both groups, as well as possible differences in the type of post-mortem inquiry, could have a profound biasing effect on the results." No kidding.It's bewildering as to how this study even got funded. With so many problems with the methodology and possibilities for biases, the only effect of publicizing the results appears to be stirring up needless panic in the many parents whose children are being treated for ADHD.
- Did you miss it? Rationing already happened. Maybe you've heard that Obama is planning some kind of health care reform. In fact, reading the health news this week you might think that all scientific research and disease spread (where did you go, swine flu?) had been halted while the country debates health insurance.Comparisons to Canada and their "rationed" health care system are a popular conservative talking point. But a column in today's New York Times makes the point that health care in the U.S. is already rationed--against other resources, between the insured and uninsured, and perhaps most significantly to our audience, in the allocation of physicians' time. When a patient can't get an appointment, or the doc doesn't have time for one more question--that's rationing.Might be a useful rebuttal in those cocktail party debates over health care that you're likely to run into this summer. And if that doesn't work, maybe it's time to change the subject. Have you heard about the pandemic?
- Grand Rounds at ACP Internist Welcome to Grand Rounds at ACP Internist, a newspaper serving internal medicine. We're paying tribute to the daily newspaper. Read on for the latest headlines, opinions, features and even the funnies.Click on "More" to read the full post.Headline NewsRx for health care: good medicineBy See First BlogEvan Falchuk joins the chorus of comments that have arisen about Atul Gawande, MD's, influential New Yorker article on the U.S. health care system. Unfortunately, most readers are missing the most important point, "that we need to put good medicine back at the center of health care."For health care reform, keep it simpleBy Colorado Health Insurance InsiderSen. Ted Kennedy's health care reform bill includes good ideas but attempts to do too much.OpinionsFor best care, doctors must keep the whole patient in mindBy Not My Second OpinionA family medicine doctor provides clarity for a confused patient whose dizziness led her to see several specialists--and get several diagnoses. To prevent such situations and fix our broken healthcare system, doctors need to start treating the whole patient.Even evidence-based medicine has its exceptionsBy The Jobbing DoctorOf course, doctors should practice evidence-based medicine. But they should know when it's time to break the rules, as well, a 30-year veteran writes.Predicting the shape of health care reformBy ACP AdvocatePotential consensus legislation could include higher Medicare payments for primary care physicians but might be "too little, too late."When it comes to diabetes, misinformation aboundsBy Six Until MeKerri Sparling writes about some of the most common diabetes misconceptions and stereotypes she's encountered in the 22 years since her diagnosis.Letter to the editorDuncan Cross responds to a Wall Street Journal editorial that holds patients responsible for health care costs by suggesting the members of its editorial board either have perfect health or a virulent strain of contagious rectocephaly.MedicineInsight into asthmaBy Allergy NotesAllergy Notes highlights some intriguing research on how Leukotriene B(4)-BLT1 axis may contribute to airway remodeling in asthma.Some evidence isn't ready for practiceBy Laika's MedliblogThere is a lot of talk in medical circles about bridging the gap between evidence and practice, but even the gold standard randomized controlled trial doesn't always give useful answers.FinanceFactor patients into the health care cost equationBy Marianas EyeDavid Khorram discusses the ways in which patients' behavior can drive up health care costs.Slow and steady might win the health care reform raceBy HealthBlawgHealth care reformers may be biting off more than they can chew. The Massachusetts approach of addressing one thing at a time--access, cost and quality--might be worth considering at the national level.InternationalDon't blame CanadaBy Canadian MedicineSome commentators have pointed to Canada's health care problems as an excuse to avoid further federal involvement in the U.S. health care system. But this argument is no more than fearmongering, Canadian Medicine writes.Health and LifestyleIf changing a habit is hard, try 1/2 insteadBy How to Cope With PainSometimes tackling a habit is too hard. Make incremental changes instead for healthier choices about diet, exercise or smoking cessation.Women's HealthGynecology rules, but birth process is more boredom than miracleBy Vagus SurgicalisA New York Times piece on maternal mortality prompts an Australian medical student to reflect on his recent OB/GYN rotation.Lessons learned from a bittersweet birthBy Beyond the Short CoatA medical student recounts his very first delivery--of a baby destined to die from severe holoprosencephaly--and his subsequent interaction with the patient's family.Addicted to ultrasoundsBy Reality RoundsA NICU nurse wittily recalls her obsession with weekly ultrasounds while pregnant--until a wise medical director puts her in her place.SportsArthroscopy results no better than pretend surgeryBy The Fitness FixerKnee surgery is done, recommended, repeated and taught, but the evidence base shows it is more often not needed. A study shows that having arthroscopy is no more effective than having fake surgery.Your mattress, your health, your choiceBy The Back Pain BlogPubMed archives shed light on sleep studies that examine whether quality mattresses help back pain.Hip replacement technique may benefit 'young actives'By InsureBlogHenry Stern talks to orthopedic surgeon Robert Roman about the pros and cons of the Birmingham approach.TechnologyTricky diagnosis? Consult Dr. GoogleBy Clinical Cases and ImagesEver wonder how you can use Google Squared to create an automatic differential diagnosis list? Find out on the latest post.Cloud computing for automated patient remindersBy Medicine and TechnologySystems can gather medical information and alert clinicians and patients if a problem is detected. These types of automated reminders are not difficult to generate with the right algorithms that are driven by evidence-based practice guidelines. Will electronic health records lead to improved patient outcomes?WeekenderCatch more than a sunburn at these beachesBy Medicine for the OutdoorsCalifornia and Illinois beaches have particularly high levels of bacteria and swimmers may want to check online water quality reports before diving in.Add footwear to the list of essential protectionBy Teen Health 411It's a good idea to keep your shoes on this summer in the locker room or at the pool, where viruses and fungi often lurk.FamilyNot a DIY project: curing depressed teensBy Doc GurleyPaying for professional help, in the form of cognitive-behavorial therapy, is worth the money for the parents of depressed teens, according to new research.From caregiver to 'care-taker'By In Sickness and In HealthWhen a serious illness strikes, the role of caretaker often falls to the patient's significant other. But what happens when the caregiving partner gets sick?Curing bad behavior in the hospital familyBy FlorencedotcomIn an effort to improve patient safety, the Joint Commission is targeting disruptive behavior, yet another area where health care can take a cue from the aviation industry.Your careerSaying no to new businessBy Novel PatientIt takes some hunting to find an internist who wants a new patient with multiple complex chronic illnesses, according to this first-person investigation.Be honest about your experience (or lack)By Suture for a LivingWhen a patient asks how many procedures a physician has performed--or even if they don't ask--telling the truth is the right thing to do.EntertainmentNurse Jackie DisappointsBy Digital DoorwayOur "TV critic," Keith Carlson, RN, offers his reaction to the premier of Nurse Jackie, a new Showtime "dramedy" that showcases a drug-diverting, fib-telling, take-no-prisoners nurse who does little to advance the image of nurses in the public eye.Jenny McCarthy feuds with scienceBy Dr. ValDr. Val suggests a boycott of Oprah and provides evidence-based rebuttals to Jenny McCarthy's anti-vaccination propaganda.The Funny PagesCartoon Caption ContestEach month, ACP Internist lets readers create their own cartoon captions and vote for the winner. Submit all entries by June 18. Pen the winning caption and win a $50 gift certificate good toward any American College of Physicians product, program or service. (We have a gift shop and non-clinical books for the lay reader.)Medical News of the ObviousEvery Monday, ACP Internist skewers studies that shouldn't have needed to be done. Read more every Monday at Medical News of the Obvious."Bob at the Carnival"Bob the Male Nurse Action Figure goes to the carnival, a part of the continuing photographic adventures of Bob the Nurse.The Final PageWe hope you enjoyed our newspaper. Now that you're finished, don't forget to recycle.
- More than skin deep: Psoriasis has hidden dangers As we note in this month's cover story about dermatology for the internist, psoriasis is common, affecting about 2% of the general population. It's been known that patients with the condition are more vulnerable to heart attack, and thus their lipid and BP levels should be monitored. But a new study in the Archives of Dermatology suggests even this level of vigilance may not be enough.Researchers at the University of Miami analyzed the records of 3,236 patients with psoriasis and 2,500 individuals without it, and found that even after age, sex, smoking status and history of hypertension, diabetes and dyslipidemia were controlled for, patients with psoriasis still were significantly more likely to have atherosclerosis, as well as ischemic heart disease, cerebral vascular disease, or PAD. As such, psoriasis carries an independent risk of higher mortality--19.9% vs. 9.9%.So what's an internist to do with his or her psoriatic patients? Vigilantly screen them for CV risk factors, and consider prescriptive aspirin, the authors said, until more research can be done.
- Primary Care Has Critical Impact on Health Care Outcomes Legislation that underscores the critical role of primary care by providing support for the patient-centered medical home, aligning incentives to embrace value over volume, and ensuring the adequacy of the primary care workforce is vital to health care reform. That was the message delivered by AAFP President Ted Epperly, M.D., of Boise, Idaho, during his testimony before the House Ways and Means Committee on June 24 and a House Energy and Commerce health care subcommittee on June 25.
- AAFP President-elect Urges Support for Public Plan Option... More than 250 health care professionals called on Congress to pass a comprehensive health care reform bill that includes a public plan option during a town hall meeting here on June 26. The meeting was convened by Health Care for America Now, or HCAN.
- FDA Panel Recommends Acetaminophen Restrictions An FDA advisory panel has recommended that the agency remove prescription drugs that combine acetaminophen and powerful painkillers -- such as Percocet, which is formulated with oxycodone, and Vicodin, which is formulated with hydrocodone -- from the market because of the risk of liver injury associated with misuse of the products. The panel also voted to lower dosage recommendations for over-the-counter, or OTC, acetaminophen products.
- Family Medicine Leaders Urge ACGME to Resist Call for Mor... The AAFP, along with the other academic family medicine organizations, have asked the Accreditation Council for Graduate Medical Education, or ACGME, to resist putting additional restrictions on residents' duty hours because such restrictions may harm family medicine training programs and the quality of patient care.
- News Briefs: Clinical Practice Updates This roundup includes the following brief clinical practice updates: AHRQ Offering Fact Sheets on Cardiovascular Diseases; Escherichia coli Outbreak Linked to Cookie Dough; CDC Study Focuses on Falls; FDA Seeking Input on Tobacco Regulation; Chantix, Zyban to Add Boxed Warnings.
- CDC Reinstates Hib Booster Dose for 12- to 15-month-olds After more than a year and a half of deferrals, the booster dose of Haemophilus influenzae type b, or Hib, vaccine should again be considered a routine part of the childhood immunization schedule. The CDC -- in consultation with its Advisory Committee on Immunization Practices, or ACIP, the AAFP and the American Academy of Pediatrics -- is recommending that physicians immediately reinstate the Hib booster dose for children ages 12-15 months who have completed the three-dose primary series.
- CDC's Advisory Committee Gives Thumbs-up to New Antiviral... Members of the CDC's Advisory Committee on Immunization Practices, or ACIP, approved new antiviral treatment recommendations during the committee's June 24-26 meeting in Atlanta. The recommendations originally were released as interim guidance last year in the wake of oseltamivir resistance among circulating seasonal influenza A (H1N1) viruses.
- Treatment of Depression in Adults Should Consider Childre... Physicians and other health professionals who treat adults with depression also should consider the effects of the illness on their patients' children, according to a new report from the National Research Council and the Institute of Medicine.
- AMA Rejects Call for More Research on Vaccine Link to Aut... There's no need for more research into a possible link between vaccines and autism. But there is a continuing need for support of ongoing research into the true etiology of autism and its treatment. And physicians should continue to take a lead role in extolling the benefits of vaccines to health policymakers and the public.
- 2009 AMA House Adopts Proposals to Help Clinicians Identi... By adopting recommendations in an AMA Board of Trustees report considered during the 2009 annual meeting of the AMA House of Delegates, delegates threw their support behind the concepts -- if not the precise modalities -- embodied in a resolution introduced by the AAFP and the American Academy of Pediatrics, or AAP, last year that dealt with finding ways to capture information about patients' tobacco use from patients and urge them to quit.
- Recurrent Escherichia coli Bloodstream Infections: Epidem...
Page: 77DOI: 10.1097/MD.0b013e31819dd0cfAuthors: Sanz-Garcia, Marta MD, PhD; Fernandez-Cruz, Ana MD, PhD; Rodriguez-Creixems, Marta MD, PhD; Cercenado, Emilia Pharm D; Marin, Mercedes Pharm D, PhD; Munoz, Patricia MD, PhD; Bouza, Emilio MD, PhD
- Hirschsprung Disease and Congenital Anomalies of the Kidn...
Page: 83DOI: 10.1097/MD.0b013e31819cf5daAuthors: Prato, Alessio Pini MD *; Musso, Marco MD *; Ceccherini, Isabella MD; Mattioli, Girolamo MD; Giunta, Camilla MD; Ghiggeri, Gian Marco MD; Jasonni, Vincenzo MD
- Factors Associated With Underlying Malignancy in a Retros...
Page: 91DOI: 10.1097/MD.0b013e31819da352Authors: Fardet, Laurence MD, PhD; Dupuy, Alain MD, PhD; Gain, Murielle MD; Kettaneh, Adrien MD, PhD; Cherin, Patrick MD, PhD; Bachelez, Herve MD, PhD; Dubertret, Louis MD; Lebbe, Celeste MD, PhD; Morel, Patrice MD; Rybojad, Michel MD
- Renal Sarcoidosis: Clinical, Laboratory, and Histologic P...
Page: 98DOI: 10.1097/MD.0b013e31819de50fAuthors: Mahevas, Matthieu MD; Lescure, Francois Xavier MD; Boffa, Jean-Jacques MD, PhD; Delastour, Victoire MD; Belenfant, Xavier MD; Chapelon, Catherine MD; Cordonnier, Carole MD; Makdassi, Raifat MD; Piette, Jean-Charles MD; Naccache, Jean-Marc MD; Cadranel, Jacques MD, PhD; Duhaut, Pierre MD, PhD; Choukroun, Gabriel MD, PhD; Ducroix, Jean Pierre MD; Valeyre, Dominique MD
- Diminished Quality of Life and Physical Function in Commu...
Page: 107DOI: 10.1097/MD.0b013e31819d89d5Authors: Thein, Mya MD; Ershler, William B. MD; Artz, Andrew S. MD; Tecson, Josephine MD; Robinson, Bruce E. MD; Rothstein, Gerald MD; Liede, Alexander PhD; Gylys-Colwell, Ina MS; Lu, Z. John PhD; Robbins, Sean MS
- Community-Acquired Bacterial Meningitis in Elderly Patien...
Page: 115DOI: 10.1097/MD.0b013e31819d50efAuthors: Cabellos, Carmen MD, PhD; Verdaguer, Ricard MD; Olmo, Montse MD; Fernandez-Sabe, Nuria MD, PhD; Cisnal, Maria MD; Ariza, Javier MD, PhD; Gudiol, Francesc MD, PhD; Viladrich, Pedro F. MD, PhD
- Microbiology and Outcome of Iliopsoas Abscess in 124 Pati...
Page: 120DOI: 10.1097/MD.0b013e31819d2748Authors: Lopez, Vicente Navarro MD; Ramos, Jose M. MD; Meseguer, Victoria MD; Perez Arellano, Jose Luis MD; Serrano, Regino MD; Ordonez, Miguel Angel Garcia MD; Peralta, Galo MD; Boix, Vicente MD; Pardo, Javier MD; Conde, Alicia MD; Salgado, Fernando MD; Gutierrez, Felix MD *; for the GTI-SEMI Group
- Serum amyloid A is independently associated with metaboli... Abstract. Jylhävä J, Haarala A, Eklund C, Pertovaara M, Kähönen M, Hutri-Kähönen N, Levula M, Lehtimäki T, Huupponen R, Jula A, Juonala M, Viikari J, Raitakari O, Hurme M (University of Tampere and Tampere University Hospital, Tampere; and University of Turku, Health Care District of Southwest Finland and National Public Health Institute, Turku; Finland). Serum amyloid A is independently associated with metabolic risk factors but not with early atherosclerosis: the Cardiovascular Risk in Young Finns Study. J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02120.xBackground. Serum amyloid A (SAA) is a sensitive marker of inflammation and its elevation has been implicated in obesity and in cardiovascular disease, yet data on its regulation in young adults or on its role in early atherosclerosis is scarce. We investigated which factors explain the variation in SAA and analysed whether SAA could be associated with preclinical atherosclerosis.Methods. Serum amyloid A levels were measured in participants of the Cardiovascular Risk in Young Finns Study (n = 2280, n = 1254 women, n = 1026 men). Correlates and determinants of SAA were analysed and the effect of SAA on subclinical atherosclerosis, measured as intima-media thickness (IMT) and carotid artery compliance, was evaluated with risk-factor adjusted models.Results. Serum amyloid A correlated directly and independently of BMI with C-reactive protein (CRP), waist circumference and leptin in both sexes, with total cholesterol, LDL cholesterol and ApolipoproteinA1 (ApoA1) in women and with triglycerides, insulin levels and insulin resistance in men. Use of combined oral contraceptives and intrauterine device was also associated with SAA levels. Determinants for SAA included CRP, leptin and ApoA1 in women, and CRP, leptin and HDL cholesterol in men. SAA levels correlated with carotid compliance in both sexes and with IMT in men, yet SAA had no independent effect on IMT or carotid compliance in multivariable analysis.Conclusions. Serum amyloid A was associated with several metabolic risk factors but was not an independent predictor of IMT or carotid artery compliance. Further longitudinal studies will show whether SAA holds a prognostic value as a risk marker, analogously to CRP.
- NOD2/CARD15 genotype and common gastrointestinal diseases... Abstract. Yazdanyar S, Nordestgaard BG (Herlev Hospital, Herlev; Copenhagen University Hospital, University of Copenhagen, Copenhagen; Denmark). NOD2/CARD15 genotype and common gastrointestinal diseases in 43 600 individuals. J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02137.x.Objectives. NOD2/CARD15 is involved in the innate immune response and three polymorphisms in this gene (Arg702Trp rs2066844, Gly908Arg rs2066845 and Leu1007fsinsC rs5743293) have been associated with risk of the rare Crohn's disease. We tested the hypothesis that polymorphisms in NOD2/CARD15 associate with risk of nine common gastrointestinal diseases.Design and setting. We genotyped 43 596 white individuals from the Danish general population followed for 31 years, during which time 782 developed oesophagitis and reflux, 1395 ulcus ventriculi and duodeni, 1384 gastritis and dyspepsia, 1407 appendicitis, 646 irritable bowel syndrome, 1301 infectious diseases of the gastrointestinal tract, 681 anal fissure, fistula and abscess, 826 gastrointestinal cancer and 161 developed cancer in liver and pancreas.Results. Some 89% were non-carriers, 11% heterozygotes, 0.15% homozygotes and 0.23% compound heterozygotes. Cumulative incidences differed by genotype for appendicitis (log-rank P = 0.02), anal fissure, fistula and abscess (P = 0.003) and gastrointestinal cancer (P = 0.004), but not for any of the other endpoints. Compared with non-carriers, age and sex adjusted hazard ratios were 2.7 (95%CI 1.4[ndash]5.5) for appendicitis amongst compound heterozygotes, 3.2 (1.3[ndash]7.8) for anal fissure, fistula and abscess amongst compound heterozygotes, and 3.8 (1.6[ndash]9.2) for gastrointestinal cancer amongst homozygotes, whilst other genotypes did not have increased risk. The increased risk of gastrointestinal cancer amongst homozygotes appeared to be similar amongst both men and women and amongst those below or above 60 years, and likely included both upper gastrointestinal cancer and colorectal cancer.Conclusions. NOD2/CARD15 polymorphisms are not major risk factors for common gastrointestinal diseases; however, we cannot completely exclude association with appendicitis, anal fissure, fistula and abscess, and gastrointestinal cancer.
- Comparison of midregional pro-atrial natriuretic peptide ... Abstract. Potocki M, Breidthardt T, Reichlin T, Hartwiger S, Morgenthaler NG, Bergmann A, Noveanu M, Freidank H, Taegtmeyer AB, Wetzel K, Boldanova T, Stelzig C, Bingisser R, Christ M, Mueller C (University Hospital, Basel, Switzerland, B.R.A.H.M.S. AG, Hennigsdorf/Berlin, Germany; Klinikum Nuernberg, Internal Medicine, Nuernberg; and Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany). Comparison of midregional pro-atrial natriuretic peptide with N-terminal pro-B-type natriuretic peptide in the diagnosis of heart failure. J Intern Med 2009;Objectives. The concentration of atrial natriuretic peptide (ANP) in the circulation is approximately 10- to 50- fold higher than B-type natriuretic peptide (BNP). We sought to compare the accuracy of midregional pro-atrial natriuretic peptide (MRproANP) measured with a novel sandwich immunoassay with N-terminal pro-B-type natriuretic peptide (NTproBNP) in the diagnosis of heart failure.Design. The diagnosis of heart failure was adjudicated by two independent cardiologists using all available clinical data (including BNP levels) in 287 consecutive patients presenting with dyspnoea to the emergency department (ED). MRproANP and NTproBNP levels were determined at presentation in a blinded fashion.Results. Heart failure was the adjudicated final diagnosis in 154 patients (54%). Median MRproANP was significantly higher in patients with heart failure as compared to patients with other causes of dyspnoea (400 vs. 92 pmol L[minus]1, P < 0.001). The diagnostic accuracy of MRproANP was very high with an area under the receiver operating characteristic curve of 0.92 and was comparable with that of NTproBNP (0.92, P = 0.791). Moreover, MRproANP provided incremental diagnostic information to BNP and NTproBNP in patients presenting with BNP levels in the grey zone between 100 and 500 pg mL[minus]1.Conclusion. Midregional pro-atrial natriuretic peptide is as accurate in the diagnosis of heart failure as NTproBNP. MRproANP seems to provide incremental information on top of BNP or NT-proBNP in some subgroups and should be further investigated in other studies.
- 25-hydroxyvitamin D accumulation during summer in elderly... Abstract. Burgaz A, Åkesson A, Michaëlsson K, Wolk A (Karolinska Institute, Stockholm; and University Hospital, Uppsala; Sweden). 25-hydroxyvitamin D accumulation during summer in elderly women at latitude 60ºN. J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02125.xObjectives. During half of the year, cutaneous synthesis of 25-hydroxyvitamin D (25(OH)D) is not detectable at northern latitudes, leaving the population dependent on other sources for optimal vitamin D status. During April to September, 25(OH)D status may be improved by solar exposure. In this study, we measured seasonal differences in serum 25(OH)D concentrations and identified the major predictors of summer 25(OH)D concentrations.Design. We assessd serum 25(OH)D concentrations during both winter and summer amongst 100 women, aged 61[ndash]83 years, randomly sampled from the Swedish Mammography Cohort. Participants completed two detailed questionnaires covering diet, use of dietary supplements and sun-related behaviour, the first in January through March and a second time in August through September.Results. The mean seasonal increase in serum 25(OH)D concentrations was 38% from mean 72 ± 23 nmol L[minus]1 during winter to 99 ± 29 nmol L[minus]1 in summer. High summer 25(OH)D concentrations were associated with higher winter concentrations, preference of staying in sun instead of shade, having a nonsensitive skin type and normal body mass index. Based on multiple linear regression modelling, preferring sun, having nonsensitive skin type and normal weight as compared with preferring shade, having sensitive skin type and being obese, was associated with a 64 nmol L[minus]1 higher 25(OH)D concentrations during summer.Conclusions. Women with high winter 25(OH)D serum concentrations, with preference of staying in the sun instead of shade during summer, a skin type allowing for longer sun exposure and a normal weight had the highest summer 25(OH)D concentrations.
- Perceived stress as a risk factor for changes in health b... Abstract. Rod NH, Grønbæk M, Schnohr P, Prescott E, Kristensen TS (University of Copenhagen; University of Southern Denmark; Bispebjerg University Hospital; and Task-Consult, Copenhagen, Denmark). Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile:a longitudinal study. J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02124.xObjective. The aim of this study was to evaluate the long-term effects of stress on changes in health behaviour and cardiac risk profile in men and women.Design. A prospective cohort study.Setting. The Copenhagen City Heart Study, Denmark.Subjects. The analyses were based on 7066 women and men from the second (1981[ndash]1983) and third (1991[ndash]1993) wave of the Copenhagen City Heart Study. All participants were asked questions on stress and health behaviour and they had their weight, height, blood pressure and level of blood lipids measured by trained personnel.Main outcome measures. Changes in health behaviour (smoking, physical activity, alcohol consumption, overweight) and cardiac risk profile (cholesterol, HDL cholesterol, blood pressure, diabetes).Results. Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking (OR = 0.58; 95% CI: 0.41[ndash]0.83), more likely to become physically inactive (1.90; 1.41[ndash]2.55), less likely to stop drinking above the sensible drinking limits (0.43; 0.24[ndash]0.79), and stressed women were more likely to become overweight (1.55; 1.12[ndash]2.15) during follow-up. Men and women with high stress were more likely to use antihypertensive medication (1.94; 1.63[ndash]2.30), and stressed men were more than two times as likely to develop diabetes during follow-up (2.36; 1.22[ndash]4.59).Conclusion. This longitudinal study supports a causal relation between stress and cardiovascular diseases mediated through unfavourable changes in health behaviour and cardiac risk profile.
- Role of two nutritional hepatic markers (insulin-like gro... Abstract. Delaby C, To-Figueras J, Deybach JC, Casamitjana R, Puy H, Herrero C (Université Denis Diderot, Paris cedex; Hôpital Louis Mourier, Colombes Cedex; France; and University of Barcelona, Spain). Role of two nutritional hepatic markers (insulin-like growth factor 1 and transthyretin) in the clinical assessment and follow-up of acute intermittent porphyria patients. J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02118.xObjective. Acute intermittent porphyria (AIP) is caused by a deficiency of hydroxymethylbilane synthase. Clinical manifestations are abdominal pain and neurovisceral symptoms, accompanied by overproduction of heme-precursors in the liver, which frequently remains long-lasting in AIP patients. We tested the hypothesis that this condition may be associated with alterations of hepatic proteins known to be either increased or decreased in serum according to diverse pathological conditions including malnutrition, inflammation or liver disease.Design. Serum proteins were analyzed in 26 biochemically active AIP patients that were classified according to the EPI (European Porphyria Initiative) guidelines as follows: (i) patients who presented a single acute attack having remained so far free of clinical symptoms; (ii) patients who present recurrent attacks or chronic symptoms associated with exacerbations of AIP.Results. Most of the serum proteins were within normal limits, however insulin-like growth factor 1 (IGF-1) was decreased in 53.8% of AIP patients (z-score = [minus]2.86 ± 0.37) and transthyretin (prealbumin) was found significantly decreased in 38.5% of them. The IGF-1 z-score was lower in group B versus group A patients ([minus]2.66 vs. [minus]1.43; P = 0.024). The coincident decrease of both IGF-1 and transthyretin was associated with worsening of the clinical condition.Conclusions. This first study in humans suggests that the clinical expression AIP is associated with a state of under-nutrition and/or with hepatic inflammation due to the sustained accumulation of heme-precursors. We propose the use of both IGF-1 and transthyretin as biomarkers of disease morbidity/severity for the clinical follow-up of AIP patients.
- Telomere length and progression of diabetic nephropathy i... Abstract. Abstract. Fyhrquist F, Tiitu A, Saijonmaa O, Forsblom C, Groop P-H, on behalf of the FinnDiane Study Group (Minerva Institute for Medical Research; Helsinki University Central Hospital; and Folkhälsan Institute of Genetics; Helsinki, Finland). Telomere length and progression of diabetic nephropathy in patients with type 1 diabetes. J Intern Med 2009;doi: 10.1111/j.1365-2796.2009.02139.x.Objectives. To determine whether short telomere length of blood leucocytes from patients with type 1 diabetes is associated with or predictive of progression of diabetic nephropathy.Design and methods. Two consecutive DNA samples were obtained from 132 patients from the nationwide Finnish Diabetic Nephropathy Study with type 1 diabetes. Control DNA samples were taken from 44 healthy blood donors. Telomere length was measured by Southern blot. Patients were divided into three groups according to their urinary albumin excretion rate (AER): 48 patients with normoalbuminuria (AER < 20 [mu]g min[minus]1); seven patients with microalbuminuria (AER [ge] 20 [mu]g min[minus]1 <200 [mu]g min[minus]1) and 77 patients with macroalbuminuria (AER [ge] 200 [mu]g min[minus]1). Progression was defined as a change in albuminuria to a higher level.Results. Progression occurred in 21 patients. Progressors had shorter mean telomere length (8.1 ± 0.7 kb, mean ± SD; P = 0.017) and higher percentage of short telomeres (32.0 ± 8%, P = 0.002) than nonprogressors (8.5 ± 0.7 kb and 27 ± 7.2%, respectively). Thus, both shorter telomeres (HR = 0.190, 95%CI 0.065[ndash]0.558, P = 0.0025) and higher proportion of short telomeres (HR = 1.115, 1.039[ndash]1.195, P =0.0023) were independent predictors of diabetic nephropathy. Telomere length was not associated with the degree of albuminuria and was not different in patients with type 1 diabetes compared with healthy controls.Conclusions. Short telomeres are independent predictors of progression of diabetic nephropathy in patients with type 1 diabetes.
- Uric acid and risk of myocardial infarction, stroke and c... Abstract. Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G (Oslo University Hospital, Ulleval, Oslo; and Norwegian University of Life Sciences, Aas; Norway, Karolinska Institute, Stockholm; AstraZeneca R&D, Södertälje; Karolinska Institute, and CALAB Research, Stockholm; Karolinska institute, Stockholm; and AstraZeneca Sverige, Södertälje, Sweden). Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417 734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02133.x.Objectives. Few studies have simultaneously analysed the influence of elevated serum uric acid (UA) on acute myocardial infarction (AMI), ischaemic and haemorrhagic stroke (IS, HS) and congestive heart failure (CHF) in large healthy populations. We, here, examine UA as a risk factor for AMI, stroke and CHF by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study.Design. Prospective study (11.8 years, range 7[ndash]17) of fatal and nonfatal acute myocardial infarction, stroke and CHF through linkage with Swedish hospital discharge and mortality registers.Settings. Measurements of uric acid in 417 734 men and women from health check-ups in Stockholm area.Results. There was a gradual increase in risk of AMI, stroke and CHF by increasing UA levels. Women had a stronger relationship between UA and both AMI and IS than men. Predictions of AMI were at least as powerful in the elderly as in the young, but not so for IS. Associations were markedly attenuated when adjusted for total cholesterol, triglycerides, hospital hypertension and diabetes status. The association between UA and HS was U-shaped in both genders. CHF was more strongly related to UA than AMI and stroke and less affected by the adjustment factors.Conclusions. Already moderate levels of UA appear to be associated with an increased incidence of AMI, stroke and CHF in middle-aged subjects without prior cardiovascular disease. These associations seem to increase gradually from lower to higher levels of UA. UA may be an important complementary indicator of cardiovascular risk in the general population.
- Fitness and abdominal obesity are independently associate... Abstract. Ekblom-Bak E, Hellenius M-L, Ekblom Ö, Engström L-M, Ekblom B (Karolinska Institute; The Swedish School of Sport and Health Sciences; and Institute of Education; Stockholm, Sweden). Fitness and abdominal obesity are independently associated with cardiovascular risk. J Intern Med 2009;Objectives. To examine the relationship between cardiovascular fitness (VO2max) and abdominal obesity (waist circumference) and individual cardiovascular disease (CVD) risk factors, as well as a clustered risk factor profile, and to study the impact of gender, age and smoking on these relationships.Design. Cross-sectional.Setting. Astrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden.Subjects. Men (n = 781) and women (n = 890) from two random population-based samples of Swedish women and men aged 20 to 65 years.Main outcomes. Odds ratios.Results. Each unit of higher fitness was associated with a decrease in all individual risk factors ranging from 2% to 4% independent of waist circumference, each unit of higher waist circumference was associated with an increased risk ranging from 2% to 5% independent of fitness. For clustering of three or more of the risk factors, each unit of fitness was associated with a 5% decrease in risk and each unit of waist circumference with a 5% increase in risk. The clustered risk was higher in unfit participants who were older or smoked daily, regardless of waist circumference. Obese participants were at higher risk if they were men or older, regardless of fitness level. However, neither a higher fitness level nor lean status reduced the risk associated with smoking.Conclusions. Higher fitness and lower waist circumference are each independently associated to a similar extent with a lower CVD risk. Simultaneous evaluation of both fitness and abdominal obesity status in clinical practice is important.
- ANTI-HSP60 and ANTI-HSP70 antibody levels and micro/ macr... Abstract. Gruden G, Bruno G, Chaturvedi N, Burt D, Pinach S, Schalkwijk C, Stehouwer CD, Witte DR, Fuller JH, Cavallo-Perin P, EURODIAB Prospective Complications Study Group (From the Department of Internal Medicine, University of Turin, Italy, National Heart & Lung Institute, Imperial College, London, UK, Department of Internal Medicine, University Hospital Maastricht, the Netherlands. Department of Epidemiology and Public-Health, Royal Free and University College London, Medical School, UK). ANTI-HSP60 and ANTI-HSP70 antibody levels and micro/macrovascular complications in type 1 diabetes: the EURODIAB Study. J Intern Med 2009; Objectives. The heat shock proteins 60 and 70 (HSP60, HSP70) play an important role in cytoprotection. Under stress conditions they are released into the circulation and elicit an immune response. Anti-HSP60 and anti-HSP70 antibody levels have been associated with cardiovascular disease. Type 1 diabetes is associated with a greatly increased risk of micro- and macrovascular complications. Therefore, we investigated whether anti-HSP60 and anti-HSP70 antibody levels were associated with micro- and macrovascular complications in type 1 diabetic patients.Design. A cross-sectional nested case-control study from the EURODIAB Study of 531 type 1 diabetic patients was performed.Subjects. Cases (n = 363) were defined as those with one or more complications of diabetes; control subjects (n = 168) were all those with no evidence of any complication. We measured anti-HSP60 and anti-HSP70 antibody levels and investigated their cross-sectional associations with diabetic complications.Results. Anti-HSP70 antibody levels were significantly greater in control than in case subjects, whereas anti-HSP60 antibody levels were similar in the two groups. In logistic regression analysis, anti-HSP70 levels in the upper quartiles were associated with a 47% reduced odds ratio of micro/macrovascular complications, independently of conventional risk factors, markers of inflammation and endothelial dysfunction [odds ratio(OR) = 0.53, 95% confidence intervals(CI): 0.28[ndash]1.02].Conclusions. In this large cohort of type 1 diabetic subjects, we found an independent and inverse association between serum anti-HSP70 antibody levels and diabetic micro/macrovascular complications. This suggests that anti-HSP70 antibody levels may be a novel marker of protection from chronic diabetic complications.
- LETTER TO THE EDITOR LETTER TO THE EDITOR
Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s11606-009-1035-4Authors
Karina M. Berg, Montefiore Medical Center 111 East 210th Street Bronx NY 10467 USAJulia H. Arnsten, Albert Einstein College of Medicine and Montefiore Medical Center Bronx NY USAGalit Sacajiu, Albert Einstein College of Medicine and Montefiore Medical Center Bronx NY USAAlison Karasz, Albert Einstein College of Medicine and Montefiore Medical Center Bronx NY USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Spirituality and Religion in Patients with HIV/AIDS Spirituality and Religion in Patients with HIV/AIDS
Content Type Journal ArticleCategory ErratumDOI 10.1007/s11606-009-1052-3Authors
Sian Cotton, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USAChristina M. Puchalski, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USASusan N. Sherman, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USAJoseph M. Mrus, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USAAmy H. Peterson, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USAJudith Feinberg, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USAKenneth I. Pargament, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USAAmy C. Justice, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USAAnthony C. Leonard, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USAJoel Tsevat, University of Cincinnati Medical Center Department of Family medicine and the Institute for the Study of Health P.O. Box 670840 Cincinnati OH 45267–0840 USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Treatment of Obesity in Primary Care Practice in the Unit... ABSTRACT
OBJECTIVES This review examines the results of randomized controlled trials in which behavioral weight loss interventions, used alone
or with pharmacotherapy, were provided in primary care settings.
DATA SOURCES Literature search of MEDLINE, PubMed, Cochrane Systematic Reviews, CINAHL, and EMBASE (1950-present). Inclusion criteria for
studies were: (1) randomized trial, (2) obesity intervention in US adults, and (3) conducted in primary care or explicitly
intended to model a primary care setting.
REVIEW METHODS Both authors reviewed each study to extract treatment modality, provider, setting, weight change, and attrition. The CONSORT
criteria were used to assess study quality. Due to the small number and heterogeneity of studies, results were summarized
but not pooled quantitatively.
RESULTS Ten trials met the inclusion criteria. Studies were classified as: (1) PCP counseling alone, (2) PCP counseling + pharmacotherapy,
and (3) “collaborative” obesity care (treatment delivered by a non-physician provider). Weight losses in the active treatment
arms of these categories of studies ranged from 0.1 to 2.3 kg, 1.7 to 7.5 kg, and 0.4 to 7.7 kg, respectively. Most studies
provided low- or moderate-intensity counseling, as defined by the US Preventive Services Task Force.
CONCLUSIONS Current evidence does not support the use of low- to moderate-intensity physician counseling for obesity, by itself, to achieve
clinically meaningful weight loss. PCP counseling plus pharmacotherapy, or intensive counseling (from a dietitian or nurse)
plus meal replacements may help patients achieve this goal. Further research is needed on different models of managing obesity
in primary care practice.
Content Type Journal ArticleCategory ReviewDOI 10.1007/s11606-009-1042-5Authors
Adam Gilden Tsai, University of Colorado Denver Division of General Internal Medicine, Department of Medicine Denver CO USAThomas A. Wadden, University of Pennsylvania Center for Weight and Eating Disorders, Department of Psychiatry Philadelphia PA USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Measuring Residents’ Perceived Preparedness and Skillfu... Abstract
BACKGROUND As patient populations become increasingly diverse, we need to be able to measure residents’ preparedness and skillfulness
to provide cross-cultural care.
OBJECTIVE To develop a measure that assesses residents’ perceived readiness and abilities to provide cross-cultural care.
DESIGN Survey items were developed based on an extensive literature review, interviews with experts, and seven focus groups and ten
individual interviews, as part of a larger national mailed survey effort of graduating residents in seven specialties. Reliability
and weighted principal components analyses were performed with items that assessed perceived preparedness and skillfulness
to provide cross-cultural care. Construct validity was assessed.
PARTICIPANTS A total of 2,047 of 3,435 eligible residents participated (response rate = 60%).
MEASUREMENTS AND MAIN RESULTS The final scale consisted of 18 items and 3 components (general cross-cultural preparedness, general cross-cultural skillfulness,
and cross-cultural language preparedness and skillfulness), and yielded a Cronbach’s alpha = 0.92. Construct validity was
supported; the scale total was inversely correlated with a measure of helplessness when providing care to patients of a different
culture (p < 0.001).
CONCLUSIONS We developed a three-component cross-cultural preparedness and skillfulness scale that was internally consistent and demonstrated
construct validity. This measure can be used to evaluate residents’ perceived effectiveness of cross-cultural medical training
programs and could be used in future work to validate residents’ self assessments with objective assessments.
Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s11606-009-1046-1Authors
Elyse R. Park, Massachusetts General Hospital Institute for Health Policy Boston MA USAMaria B. J. Chun, University of Hawaii John A. Burns School of Medicine Department of Surgery Honolulu HI USAJoseph R. Betancourt, Massachusetts General Hospital Institute for Health Policy Boston MA USAAlexander R. Green, Massachusetts General Hospital Institute for Health Policy Boston MA USAJoel S. Weissman, Massachusetts General Hospital Institute for Health Policy Boston MA USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Population-Based Fracture Risk Assessment and Osteoporosi... ABSTRACT
BACKGROUND Undertreatment of osteoporosis has been recognized as a common problem in selected patient subgroups. However, primary prevention
has been hampered by limited risk assessment tools that can be applied to large populations.
OBJECTIVES Using clinical risk factors with a new tool from the World Health Organization (FRAX) and recommendations from the National
Osteoporosis Foundation (NOF), we evaluated fracture risk and osteoporosis treatment in a US cohort.
PARTICIPANTS African Americans and Caucasians recruited from 2003–7 across the US as part of a longitudinal study.
DESIGN Cross-sectional.
MEASURES The number of persons receiving prescription osteoporosis medications was assessed by race, sex, and fracture risk. Multivariable
logistic regression evaluated the association between receipt of osteoporosis medications and fracture risk after controlling
for potential confounders.
RESULTS Among 24,783 participants, estimated fracture risk was highest for Caucasian women. After multivariable adjustment for fracture-related
risk factors, the likelihood of receipt of osteoporosis medications among African Americans was lower than among Caucasians
[odds ratio (OR) = 0.44, 95% confidence interval (CI) 0.37, 0.53] and for men compared to women (OR = 0.08, 95% CI 0.06–0.10).
Even for the highest risk group, Caucasian women with 10-year hip fracture risk ≥3% (n = 3,025, 39.7%), only 26% were receiving
treatment.
CONCLUSIONS A substantial gap exists between 2008 NOF treatment guidelines based on fracture risk and the receipt of prescription osteoporosis
medications. This gap was particularly notable for African Americans and men. FRAX is likely to be useful to assess risk at
a population level and identify high-risk persons in need of additional evaluation.
Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-009-1031-8Authors
Jeffrey R. Curtis, University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology Birmingham USALeslie A. McClure, University of Alabama at Birmingham Department of Biostatistics Birmingham USAElizabeth Delzell, University of Alabama at Birmingham Department of Epidemiology Birmingham USAVirginia J. Howard, University of Alabama at Birmingham Department of Epidemiology Birmingham USAEric Orwoll, Oregon Health Sciences University Department of Medicine Portland OR USAKenneth G. Saag, University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology Birmingham USAMonika Safford, University of Alabama at Birmingham Division of Preventive Medicine Birmingham USAGeorge Howard, University of Alabama at Birmingham Department of Biostatistics Birmingham USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Internal Medicine Resident Self-report of Factors Associa... ABSTRACT
BACKGROUND Little is known about factors contributing to the career decisions of internal medicine residents.
OBJECTIVE To evaluate factors self-reported by internal medicine residents nationally as important to their career decisions.
DESIGN Cross-sectional survey conducted in October of 2005, 2006, and 2007 as part of the national Internal Medicine In-Training
Examination (IM-ITE).
PARTICIPANTS Postgraduate year 3 internal medicine residents taking the IM-ITE.
MEASUREMENTS Residents rated the importance of nine factors in their career decisions on 5-point Likert scales. Univariate statistics characterized
the distribution of responses. Associations between variables were evaluated using Cochran-Mantel-Haenszel statistics for
ordinal data. Multivariate analyses were conducted using logistic regression.
RESULTS Of 17,044 eligible residents taking the IM-ITE, 14,890 (87.4%) completed the career decision survey questions. Overall, time
with family was the factor most commonly reported as of high or very high importance to career decisions (69.6%). Women were
more likely to assign greatest importance to family time (OR 1.22, 95% confidence interval 1.12–1.31, p < 0.001) and long-term
patient relationships (OR 1.34, 95% confidence interval 1.23–1.46, p < 0.001). Across debt levels, financial considerations
were of greatest importance more often for residents owing >$150,000 (OR 1.33, 95% confidence interval 1.09–1.62, p < 0.001).
Across specialties, mentor specialty was rated lowest in importance by residents pursuing hospitalist and general internal
medicine careers.
CONCLUSIONS Greater attention to factors reported by residents as important to their career decisions may assist efforts to optimize the
distribution of physicians across disciplines. In addition to lifestyle and practice considerations, these factors may include
mentor specialty. As this factor is less commonly reported as important by residents planning careers in generalist fields,
attention to effective mentoring may be an important element of efforts to increase interest in these areas.
Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-009-1039-0Authors
Colin P. West, Mayo Clinic Division of General Internal Medicine Rochester MN 55905 USAMonica M. Drefahl, Mayo Clinic Division of General Internal Medicine Rochester MN 55905 USACarol Popkave, American College of Physicians Research Center Philadelphia PA 19106 USAJoseph C. Kolars, Mayo Clinic Division of Gastroenterology and Hepatology Rochester MN 55905 USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Comparison of Medicine Resident Diabetes Care Between Vet... ABSTRACT
BACKGROUND Although others have reported national disparities in the quality of diabetes care between the Veterans Affairs (VA) and private
health care delivery systems, it is not known whether these differences persist among internal medicine resident providers
in academic settings.
OBJECTIVE We compared the quality of diabetes primary care delivered by resident physicians in either a private academic health care
system (AHS) or its affiliated VA health care system.
DESIGN Cross-sectional observational study
PARTICIPANTS We included patients who: had a diagnosis of diabetes, had >2 primary care visits with the same resident provider during 2005,
and were not separately managed by an attending physician or endocrinologist. A total of 640 patients met our criteria and
were included in the analysis.
MEASUREMENTS AND RESULTS Compared to the VA, patients in the AHS were more likely to be younger, female, have fewer medications, and be treated with
insulin, but had less comorbidity. Patients in the VA were more likely to be referred for an annual eye exam (94% vs. 78%),
receive lipid screening (88% vs. 74%), receive proteinuria screening (63% vs. 34%), and receive a complete foot exam (85%
vs. 32%) in analyses adjusted for patient demographics and comorbidities (p-value <0.001 for all comparisons). In adjusted
analyses, there were no significant differences in HbA1c, blood pressure, or LDL cholesterol control.
CONCLUSIONS In spite of similar resident providers and practice models, there were substantial differences in the diabetes quality of
care delivered in the VA and AHS. Understanding how these factors influence subsequent practice patterns is an important area
for study.
Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-009-1048-zAuthors
Benjamin J. Powers, Durham VAMC Center for Health Services Research in Primary Care Durham NC USASteven C. Grambow, Durham VAMC Center for Health Services Research in Primary Care Durham NC USAMatthew J. Crowley, Duke University Department of Medicine, Division of General Internal Medicine Durham NC USADavid E. Edelman, Durham VAMC Center for Health Services Research in Primary Care Durham NC USAEugene Z. Oddone, Durham VAMC Center for Health Services Research in Primary Care Durham NC USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- REFLECTION REFLECTION
Content Type Journal ArticleCategory ReflectionDOI 10.1007/s11606-009-0934-8Authors
Matthew S. Sisson, 39 Wayne Road Newton MA 021459 USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Impact of a Pre-Clinical Clinical Skills Curriculum on St... ABSTRACT
BACKGROUND Research on the outcomes of pre-clinical curricula for clinical skills development is needed to assess their influence on
medical student performance in clerkships.
OBJECTIVE To better understand the impact of a clinical-skills curriculum in the pre-clinical setting on student performance.
DESIGN We conducted a non-randomized, retrospective, pre-post review of student performance evaluations from 3rd-year clerkships,
before and after implementation of a clinical-skills curriculum, the Colleges (2001–2007).
MAIN RESULTS Comparisons of clerkship performance data revealed statistically significant differences favoring the post-Colleges group
in the Internal Medicine clerkship for 9 of 12 clinical-skills domains, including Technical Communication Skills (p < 0.023,
effect size 0.16), Procedural Skills (p < 0.031, effect size 0.17), Communication Skills (p < 0.003, effect size 0.21), Patient
Relationships (p < 0.003, effect size 0.21), Professional Relationships (p < 0.021, effect size 0.17), Educational Attitudes
(p < 0.001, effect size 0.24), Initiative and Interest (p < 0.032, effect size 0.15), Attendance and Participation (p < 0.007,
effect size 0.19), and Dependability (p < 0.008, effect size 0.19). Statistically significant differences were identified
favoring the post-Colleges group in technical communication skills for three of six basic clerkships (Internal Medicine, Surgery,
and Pediatrics).
CONCLUSIONS Implementation of a pre-clinical fundamental skills curriculum appears to be associated with improved clerkship performance
in the 3rd year of medical school, particularly in the Internal Medicine clerkship. Similar curricula, focused on teaching
clinical skills in small groups at the bedside with personalized mentoring from faculty members, may improve student performance.
Continued efforts are needed to understand how to best prepare students for clinical clerkships and how to evaluate outcomes
of similar pre-clinical skills programs.
Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-009-1032-7Authors
Molly Blackley Jackson, University of Washington Department of Medicine 1959 N.E. Pacific St. Campus Box 356429 Seattle WA 98195 USAMisbah Keen, University of Washington Department of Family Medicine Seattle WA USAMarjorie D. Wenrich, University of Washington Department of Medical History and Biomedical Informatics Seattle WA USADoug C. Schaad, University of Washington Department of Medical Education and Biomedical Informatics Seattle WA USALynne Robins, University of Washington Department of Medical Education and Biomedical Informatics Seattle WA USAErika A. Goldstein, University of Washington Department of Medicine 1959 N.E. Pacific St. Campus Box 356429 Seattle WA 98195 USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Testing for CYP2C9 Before Anticoagulant Therapy Testing for CYP2C9 Before Anticoagulant Therapy
Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s11606-009-1040-7Authors
Mark H. Eckman, University of Cincinnati Medical Center P.O. Box 670535 Cincinnati OH 45267-0535 USASteven M. Greenberg, Massachusetts General Hospital Research Group, Department of Neurology Boston MA USAJonathan Rosand, Massachusetts General Hospital Center for Human Genetic Research Boston MA USA
Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734
- Declining ad rates close two CMPMedica titles CMPMedica ceased to publish two of its titles - Infections in Medicine and AIDS Reader - due to a continuing decline in print advertising sales.
- Roche coaches docs, RNs on diabetes care Roche added a new component to its $14 million diabetes education campaign, which pairs healthcare practitioners with Roche staff to improve dialogue between diabetics and their caregivers, and facilitate the integration of Accu-Check products into the lives of patients.
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- PhRMA pledges $80 billion in discounts towards health ref... PhRMA has committed to finding $80 billion in savings on drugs sold in the US over ten years, including selling drugs at half-price to seniors in the Medicare Part D "donut hole" coverage gap.
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- Greater equity in health should be a progress indicator 15 June 2009 -- Greater equity in the health status of populations, within and between countries, should be regarded as a key measure of how we are making progress, said WHO Director-eneral Dr Margaret Chan today, speaking at the UN Headquarters in New York.
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- Schizophrenia and Bipolar Disorder Share Genetic Roots Source: National Institute of Mental Health
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Related MedlinePlus Topics: Drug Safety, Quitting Smoking
- Growth Hormone May Build Muscle in Older Men Finding shows promise for treating age-related loss of strength, researchers say Source: HealthDay
Related MedlinePlus Topics: Hormones, Men's Health, Seniors' Health
- Maternal Diet Affects Infant's Long-Term Bone Health Women who maintain a healthy, well-balanced diet during pregnancy have children with bigger and stronger bones than women with poorer quality diets, according to the results of a study presented Tuesday at the National Osteoporosis Society Conference in Manchester, UK. Source: Reuters Health
Related MedlinePlus Topics: Nutrition, Pregnancy
- Schizophrenia and Bipolar Disorder Share Genetic Roots A trio of genome-wide studies -- collectively the largest to date -- have pinpointed a vast array of genetic variation that cumulatively may account for at least one third of the genetic risk for schizophrenia. One of the studies traced schizophrenia and bipolar disorder, in part, to the same chromosomal neighborhoods.
- Imaging Technique Allows Researchers to Monitor Protein C... A new imaging technique can monitor, in living mice, the HER2 protein found in above-normal amounts in many cases of breast cancer as well as some ovarian, prostate and lung cancers. This new approach, once validated in mice and pending further experiments, could provide a real-time noninvasive method for identifying tumors in humans who express HER2 and who would be candidates for targeted therapy directed against this protein. It may also provide real-time information that will help clinicians optimize treatment for individual patients. The study, published in the July 2009 issue of The Journal of Nuclear Medicine, was conducted by researchers at the National Cancer Institute (NCI) and the National Institute of Biomedical Imaging and Bioengineering, both parts of the National Institutes of Health.
- Dynasty: Influenza Virus in 1918 and Today The influenza virus that wreaked worldwide havoc in 1918-1919 founded a viral dynasty that persists to this day, according to scientists from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. In an article published online on June 29 by the New England Journal of Medicine, authors Anthony S. Fauci, M.D., Jeffery K. Taubenberger, M.D., Ph.D., and David M. Morens, M.D., argue that we have lived in an influenza pandemic era since 1918, and they describe how the novel 2009 H1N1 virus now circling the globe is yet another manifestation of this enduring viral family.
- Gene Expression Findings a Step Toward Better Classificat... Scientists have discovered gene expression differences that could
lead to better ways to classify, predict outcome, and treat juvenile
idiopathic arthritis (JIA). Eventually such findings could enable
doctors to target more aggressive treatment to children at risk
of more severe arthritis, while those likely to have milder disease
could be spared the stronger treatments that carry a greater risk
of side effects. The researchers were supported by the National
Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS),
a part of the National Institutes of Health.
- Second Gene Linked to Familial Testicular Cancer Specific variations or mutations in a particular can gene raise a man's risk of familial, or inherited, testicular germ-cell cancer, the most common form of this disease, according to new research by scientists at the National Institutes of Health. This is only the second gene to be identified that affects the risk of familial testicular cancer, and the first gene in a key biochemical pathway. The study appeared online June 23, 2009, in Cancer Research.
- New Biomarker Method Could Increase the Number of Diagnos... A team of researchers has demonstrated that a new method for detecting
and quantifying protein biomarkers in body fluids may ultimately
make it possible to screen multiple biomarkers in hundreds of patient
samples, thus ensuring that only the strongest biomarker candidates
will advance down the development pipeline. The researchers have
developed a method with the potential to increase accuracy in detecting
real cancer biomarkers that is highly reproducible across laboratories
and a variety of instruments so that cancer can be caught in its
earliest stages.
- Gregory G. Germino, M.D., Named Deputy Director of NIH's ... Gregory G. Germino, M.D., a world-renowned expert in inherited kidney disease, has been appointed as deputy director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, NIDDK Director Griffin P. Rodgers, M.D., has announced.
- Researchers Identify a Novel Mechanism that Could be Targ... Researchers have discovered a key to the function of a specific protein that
helps control the levels of other critical proteins within cells,
including a protein that suppresses the spread of cancer. The new
information about the mechanism of action of the protein, called
gp78, may enable researchers to explore new types of therapies
to prevent the spread of cancer. The study, by researchers at the
National Cancer Institute (NCI), part of the National Institutes
of Health, was published in the June 26, 2009, issue of Molecular
Cell.
- Migraines with Aura in Middle Age Associated with Late-Li... Women who suffer from migraine headaches in middle age accompanied by neurological aura (visual disturbances, dizziness or numbness that can precede migraines) are more likely to have damage to brain tissue in the cerebellum later in life, according to a study by researchers at the National Institute on Aging (NIA) of the National Institutes of Health, the Uniformed Services University of the Health Sciences and the Icelandic Heart Association in Reykjavik. Researchers noted that many people have these types of "silent" brain lesions, but their effect on physical and cognitive function in older people is not well studied.
- United States and the Republic of Chile Partner to Battle... A new alliance between the United States National Cancer Institute (NCI), part of the National Institutes of Health, and the Ministry of Health of the Republic of Chile, aims to accelerate progress against cancer in Hispanic populations in the United States and Latin America.
- Can Blood Test Predict Success of IVF? <
- Antismoking Proposal Gets Graphic Blackened lung tissue. Amputated finger tips. Tracheotomy scars. Sound appetizing?
- Mississippi Remains Most Obese State Mississippi holds on to its ranking as the nation's fattest state, with 32.5 percent of its population classified as obese, according to new health statistics. But it faces stiff competition from Alabama, whose obesity rate jumps to 31.2 percent because of a surge in heavy baby boomers. Adult obesity rates rose in 23 states and declined in none, the report says.
- Vaccine Shot Could Stop Type 1 Diabetes The doctor had barely pulled away the needle when a blister appeared on Tracey Berg-Fulton's abdomen: An experimental shot was revving up the 24-year-old's immune system -- part of a bold quest to create a vaccine-like therapy for diabetes.
- Panel Urges Smaller Doses of Painkillers Government experts say the maximum dose listed for Tylenol and dozens of other painkillers should be reduced to help curb deadly overdoses.
- More Sex May Mean Better Sperm For men with fertility problems, some doctors are prescribing a very conventional way to have a baby: more sex.
- Prescriptions Halted After Hacker Strikes RICHMOND, Va. (June 29) -- A state official says there are reports that some doctors are reluctant to prescribe powerful painkillers after an April hacker attack on a massive state-run drug database.
- Archdiocese to Probe Claim of Miracle A panel appointed by the Archdiocese of Baltimore is about to take on a rare investigation -- whether prayers to a 19th-century priest cured an Annapolis, Md., woman of terminal cancer, The Baltimore Sun reported.
- Beef Recall Grows Amid Reports of Illness CHICAGO (Reuters) - A Colorado meat company is expanding a recall of beef due to possible contamination by E.coli O157:H7 bacteria after an investigation found 18 illnesses may be linked to the meat, the company and the U.S. Agriculture Department said on Sunday.
- Woman Goes Three Years Without Food A British woman has gone three years without eating a bite of solid food.
- Obama Holds Health-Care Forum in Virginia President Obama offered a wonkish defense of his embattled health-care reform effort during an hour-long town hall meeting in Northern Virginia yesterday that featured seven questions, including one sent via Twitter and several from a handpicked audience of supporters.
- Arlington Man's Death Is Second Tied to Swine Flu in Va. An Arlington County area man whose health was already compromised has died after coming down with swine flu, becoming Virginia's second fatality related to the virus, state health officials said.
- To Curb Rising Costs, Hospitals Try to Reduce Repeat Adm... Doctors call them frequent fliers. They are the patients who leave the hospital, only to boomerang back days or weeks later. They have become a front-burner challenge not only for hospitals and doctors but also for those trying to rein in rising costs. Typically elderly and suffering from the chr...
- Acetaminophen Worries The Food and Drug Administration is pondering what to do about the wildly popular painkiller in Tylenol, Excedrin, Vicodin, Percocet and many other commonly used drugs to treat aches and pains and alleviate fevers. That's after an FDA panel called for sweeping changes yesterday at the conclusion of...
- Wal-Mart Endorses Employer Health Insurance Mandate After years of strenuous opposition, Wal-Mart, the nation's largest private employer, announced yesterday that it supports a controversial proposal requiring businesses to contribute to the cost of employee health insurance.
- Dog 'Guilt' Probably Just Reaction to Owners' Cues, Stud... Many dog owners have had this experience: Arriving home, they discover their pooch looking sheepish, with its head down, ears pulled back, tail tucked between the legs, maybe slinking behind the sofa. Puzzled, they soon discover the reason: a favorite pair of shoes chewed to pieces, or perhaps the...
- Featured Advertiser
- Odenton Couple Has Brand-New Quadruplets Doctors at Howard University Hospital successfully delivered quadruplets yesterday and said Folashade Omoyele and her three sons and daughter were doing well.
- Newborns' Blood Samples Are Used for Research Without Pa... Matthew Brzica and his wife hardly noticed when the hospital took a few drops of blood from each of their four newborn children for routine genetic testing. But then they discovered that the state had kept the dried blood samples ever since -- and was making them available to scientists for medic...
- Critics Cite Serious Side Effects of Benzodiazepine Anti... Stan Starr, a 54-year-old financial consultant, sat in the back of the room filled with blue chairs, quietly tapping his Converse sneakers on the carpet. The 12 steps to recovery, enshrined by Alcoholics Anonymous, were printed in large black letters on a wall. But Starr was there because of a di...
- Parents Get $200G After Son, 3, Dies From Botched Op The parents of a 3-year-old boy who died after an Oregon doctor operated on him have agreed to settle a wrongful death lawsuit for $200,000.
- Swine Flu May Not Spread Like Regular Flu The new H1N1 influenza strain may be just a little less catching than seasonal flu, but seems a little better able to cause stomach upsets, researchers reported on Thursday.
- How Could Diprivan End Up in the Hands of Michael Jackson? First it was rumors of Demerol mixed with a cocktail of prescription drugs that may have led to the death of Michael Jackson and now six days after his untimely demise another powerful drug has been linked to the singer's death Diprivan.
- Surgeon Gets Miracle Rep, Revived Patient 'Dead' 2 Hrs A world-renowned surgeon at the UCLA Medical Center has pioneered a way to revive people that most doctors would have long written off, including a woman whose heart had stopped for 2 1/2 hours.
- Diabetic-Friendly Dinners Calling all diabetics: It's time to feast on baby chicken, burgers and steak frites - without collapsing into an insulin-induced coma.
- 400,000 Cribs Recalled Due to Suffocation Risk The U.S. Consumer Product Safety Commission said Thursday that Simplicity Inc. is recalling about 400,000 cribs that put babies at risk of death by suffocation.
- Man Uses Nail Clippers to Circumcise Himself A British man was taken to the hospital for emergency treatment after attempting to circumcize himself with nail clippers, the Telegraph reported Tuesday.
- At Least 12 Hospitalized in Connection With Beef E. Coli Federal health officials say at least 12 people have been hospitalized in connection with a possible E.coli outbreak in beef and two of them suffered kidney failure.
- Woman Gives Birth to Almost 14-Pound Baby Girl A woman living in the Australian outback has given birth to a hearty 13.8-pound newborn named Chelsea Rose Mackay.
- 3 in Florida Bitten by Poisonous Snakes in 1 Week A 34-year-old man was the third victim of a poisonous snake bite reported in one-week period.
- Antipsychotic drug use spiralling in kids, research says Medical research out of the University of British Columbia suggests the number of children taking medications known as atypical antipsychotics has increased tenfold over the past decade, CBC News has learned.
- Swine flu cases worldwide surpass 77,000 The number of swine flu cases worldwide has reached more than 77,000, including 332 deaths, says the World Health Organization.
- Doctors take N.B. government to court over fee freeze The New Brunswick Medical Society has taken its fight against the provincial government's two-year fee freeze to the next level by launching its promised court action.
- Canadian HIV vaccine ready for human tests An HIV/AIDS vaccine developed in Canada has passed safety tests in animals and the researchers are awaiting approval to begin human trials in the U.S.
- More women aged 50-69 getting mammograms: StatsCan More Canadian women aged 50-69 than ever were getting mammograms by 2008, according to a new study released Tuesday by Statistics Canada.
- 3 more hospitalized in N.S. with swine flu Three more people in Nova Scotia have been hospitalized with swine flu.
- Alberta Health faces $1.1B budget shortfall Alberta's health-care system is wrestling with a $1.1 billion deficit and officials are promising changes to bring down spending.
- Lower income Canadians less likely to get colorectal test... An estimated 40 per cent of Canadians over the age of 50 reported having up-to-date colorectal cancer testing, according to a new report released on Tuesday by Statistics Canada.
- Deadly pneumonia in swine-flu outbreak hit young hard More than two-thirds of people with severe pneumonia in the first days of Mexico's swine flu outbreak were between the ages of five and 59, researchers reported Wednesday.
- Dad's depression could be linked to baby's colic Colicky infants who cry excessively may be more common in children of depressed men, Dutch researchers said Monday.
- Teens who move a lot have twice suicide risk Kids aged 11 to 17 were twice as likely to attempt suicide if their families moved three or more times compared to those who had never moved, a new study says.
- Nestlé refused FDA information, reports show Inspection reports from a Nestle USA cookie dough factory show the company refused several times to provide Food and Drug Administration inspectors with complaint logs, pest-control records and other information.
- Details, schmetails: Think big on health care As the debate over health care reform heats up, critics say overhauling U.S. health care can’t work because reform is “all in the details.” But in this case, success is not in the details.
- Jackson’s health woes took center stage Plastic surgery, mysterious hospitalizations and reports of pill popping have long plagued the “King of Pop.”
- Missouri boy, 3, leaves hospital after 2 years After spending almost his entire life in the hospital, 3-year-old Kyle McCarty was finally able to leave the hospital, after a recent successful kidney transplant.
- Is a 'public plan' the fix for health insurance? Two words — public plan — now dominate the debate over how to overhaul the nation’s health insurance system. Would you and your family be better off if there were such a government-sponsored rival to private insurers?
- Alcohol blamed for half of ’90s Russian deaths Drinking may have caused more than half of deaths among Russians aged 15 to 54 in the turbulent era following the Soviet collapse.
- Puzzling disparities found in childbirth injuries Women covered by Medicaid were less likely to be injured in childbirth than those with private insurance. Their babies, however, were more likely to experience complications.
- Cloning? Polygamy? Affair is worse, say most More of us believe an extramarital affair is morally wrong than any other item on a list of 16 ethically iffy acts, including human cloning, a new poll finds. What does this say about us?
- U.S. swine flu cases may have hit 1 million Health officials estimate that as many as 1 million Americans now have the new swine flu, although only 28,000 cases in the U.S. have been reported to the Centers for Disease Control and Prevention.
- PLoS Medicine Issue Image | Vol. 6(6) Ju... Clean water should be recognized as a human right.
At the March 2009 United Nations meetings coinciding with the World Water Forum, a declaration that would recognize water as a basic human right was defeated. In this month's Editorial, the PLoS Medicine Editors argue that access to clean water should be declared a basic human right for three reasons. First, access to clean water can substantially reduce the global burden of disease caused by water-borne infections. Second, the privatization of water—as witnessed in Bolivia, Ghana, and other countries—has not effectively served the poor, who suffer the most from lack of access to clean water. Third, the prospect of global water scarcity—exacerbated by climate change, industrial pollution, and population growth—means that no country is immune to a water crisis.Image Credit: Rudhach at flickr.com
- Seasonal Hunger: A Neglected Problem with Proven Solutions
- Clean Water Should Be Recognized as a Human Right
- Can We “Hedge” against the Development of Antiviral R... David K. Shay and Benjamin Ridenhour discuss a modeling study predicting that stockpiling a secondary antiviral for use early in a flu pandemic can forestall resistance to the primary stockpiled drug.
- Pralidoxime in Acute Organophosphorus Insecticide Poisoni... In a randomized controlled trial of individuals who had taken organophosphorus insecticides, Michael Eddleston and colleagues find that there is no evidence that the addition of the antidote pralidoxime offers benefit over atropine and supportive care.
- What Is the Optimal Therapy for Patients with H5N1 Influe... Nicholas White discusses optimal dosing of oseltamivir, Robert Webster and Elena Govorkova discuss combination antiviral therapy, and Timothy Uyeki discusses clinical care of patients with H5N1.
- An Economic Evaluation of Venous Thromboembolism Prophyla... Using decision analysis, Henry Stelfox and colleagues estimate the cost-effectiveness of three venous thromboembolism prophylaxis strategies in patients with severe traumatic injuries who were also at risk for bleeding complications.
- Are Markers of Inflammation More Strongly Associated with... In a secondary analysis of a randomized trial comparing pravastatin versus placebo for the prevention of coronary and cerebral events in an elderly at-risk population, Naveed Sattar and colleagues find that inflammatory markers may be more strongly associated with risk of fatal vascular events than nonfatal vascular events.
- Will the Public's Health Fall Victim to the Home Foreclos... Gary Bennett and colleagues discuss the ways in which the dramatic rise in home foreclosures, particularly in the US, may have health consequences.
- What Are the Prospects for Controlling Hepatitis C?
- 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...
- Social Media Thoughts From my Twitter account:Scientists use Gmail - more and more of the email correspondence addresses in PubMed abstracts are @gmail.com. It makes sense, if one moves to a different university, the old .edu email does not work anymore.PeRSSonalized Medicine vs Clinical Reader http://is.gd/1kk4e - In my experience, Google Reader is more powerful, simpler & gets the job done.Mayo Clinic gets its own AllTop aggregation page http://mayo-clinic.alltop.com - First hospital to be "honored" this way?"In case of fire, resist every urge to tweet about it, and leave building in calm orderly fashion." via @aaronwatkins http://bit.ly/tpJCrBing Search Engine by Microsoft Keeps Its Foot On The Gas, Adds Tweets To Results http://bit.ly/ozV88 - Google is losing market share to Bing and hasn’t yet figured out how to respond. http://bit.ly/W93IPEtherPad - web-based word processor that allows people to work together in really real-time http://etherpad.comVideos from “Celebrating case reports, the stories in healthcare” http://bit.ly/16ns1wImage source: OpenClipArt.org, public domain.
- Health News of the Day Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.Dr. Matthew Mintz: "Lantus Causes Cancer! Why Doesn't Anyone Seem Care?" - Insulin like growth factor (IGF-1) stimulates tumor growth. Lantus has a greater affinity for IGF-1 than human insulin. Levemir that has very little affinity for IGF-1 receptor (less than even human insulin) and is as effective as Lantus http://bit.ly/wv8d5Evidence does not support using probiotics to treat Clostridium difficile-associated diarrhea, CCJM: http://bit.ly/kscTyStatins Reduce Heart Attacks and Strokes in Patients With Normal Cholesterol http://bit.ly/gAAd4Better USMLE 2 score associated with students caring for more patients/day http://is.gd/1k0gw & http://is.gd/1k0hb - Students, not residents.20 Most Beautiful Hospitals in the U.S. Rankings for 2009 http://bit.ly/1ancNSFDA advisers vote to take Vicodin, Percocet off market http://bit.ly/BeDwGDermatology Online Journal is a free open access journal supported by UC-Davis, Creative Commons license http://bit.ly/kzA3rDr. Wes on the issue of placing pacers in 100-year olds http://bit.ly/11V2fImage source: OpenClipArt.org, public domain.
- Video: Twitter Search in Plain English The CommonCraft team has a new video explaining how to use Twitter as a search tool.
- Health News of the Day Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.Recurrent mouth ulcers (aphthous stomatitis) may suggest celiac disease http://is.gd/1jvwIClinical Image: 17 broken needles in the neck of a heroin addict http://bit.ly/2ArqglGreat set of videos about Cleveland Clinic Lerner College of Medicine http://is.gd/1iItVThe doctor will text you now: is there a role for the mobile telephone in health care? BMJ http://is.gd/1je4DPubMed Tips for Residents (and their Instructors) http://is.gd/1jdXIELITEDR - the license plate of a prominent concierge doctor in LA http://twitpic.com/8vw6c"Michael Jackson’s personal doctor, Conrad Murray, was a cardiologist who was not board certified in cardiology" http://is.gd/1jwmbImage source: OpenClipArt.org, public domain.
- Heat In Parked Car Turns Deadly In 5-10 Minutes From KETV.com:"On an 80-degree day this month, a Children's Hospital and Medical Center expert placed a gauge inside a car to show how fast the environment becomes deadly.The gauge read 91.4 degrees when first placed inside the parked car. With the windows up, the Greenhouse Effect kicked up the heat at a critical rate. Not even five minutes later, the temperature was climbing past 99 degrees.At 10 minutes in the car, the temperature was up to 106.2 degrees -- hot enough to kill a person."References:Heat In Parked Car Turns Deadly In Minutes. KETV.com.Image source: OpenClipArt.org, public domain.
- Health News of the Day Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.Patients Visit With Their Physicians Online as More Insurers Begin Paying for Digital Diagnoses. Bad idea: "How to be a digital doctor and diagnose conjunctivitis via email" http://bit.ly/KcUmBNew pneumonia score - SCAP (developed in Spain) outperforms other scores in predicting severity http://bit.ly/18eQyn36 Hippocratic Aphorisms of Nephrologic Interest - the authors of the article are 3 Greek doctors http://bit.ly/OSn3WIn the U.S., every horse receives Lasix (furosemide) diuretic on the day of the race http://bit.ly/HAla5Image source: OpenClipArt.org, public domain.
- Social Media Thoughts From my Twitter account:"If you want to be a thought leader, blog don’t Twitter" http://bit.ly/Juy5t“Thought leaders should avoid spending a lot of time in Twitter or FriendFeed because that time will be mostly wasted” http://bit.ly/Juy5tTwitter/micro-streams backlash has began: "Blogging Is Still the Foundation In A World of Streams" http://bit.ly/CtB8ZI review my Twitter updates at the end of every day and anything of lasting value gets transferred to my blog in a summary post.Image source: OpenClipArt.org, public domain.
- Health News of the Day Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.White-Coat Hypertension Not Benign: Doubles Risk for Sustained High Blood Pressure http://bit.ly/RPdh5Why the Copy and Paste Function of EMR Can be Hazardous http://bit.ly/se2pT -- EMRs degrade the quality of clinical documentation? Dr. RW has "yet to encounter an EMR generated note that effectively tells a patient’s story." http://bit.ly/2IyM0 - Not my experience.Rhinotillexomania: Nose picking frequency greater than 20/d in 7.6%, 17% considered they had serious nose-picking problem http://is.gd/1iy2I"People feel that placebo painkiller costing $2.50 provides better relief than if they’re told the pill costs 10 cents" http://bit.ly/qJmrMGoogle Search Trends Suicide Watch: http://bit.ly/dWawUTips on Implementing a Modern Hospital Website http://bit.ly/yIxovTwittering Your Heart Rate: sound like a good idea but your relatives might become a bit upset when Twitter crashes http://bit.ly/X77UvImage source: OpenClipArt.org, public domain.
- Selection of My Twitter Favorites, Edition 70 Twitter is a microblogging service where people answer the question "What are you doing?" via 140-character messages from their cellphone, laptop or desktop. You can select the messages (called "tweets") that you find interesting, useful, amusing, or disagreeable. Here is the 70th edition of My Twitter Favorites.HowardKurtz Just got a webcam at work to share my many media thoughts on video. Downside: having to comb my hair. 10:21 AM Jun 18th from web JRBtrip Gr8 quote - Murdoch summed up success in the digital age: "Big will not beat small any more - it will be the fast beating the slow." 5:49 AM Jun 18th from TweetDeck davewiner A smiley basically says "I'm a nice person, my mother loves me, please don't hit me." :-) 12:18 PM Jun 17th from web davewiner Liberal use of smileys helps avoid misunderstandings. :-) 12:18 PM Jun 17th from web kidney_boy @dwmoskowitz why did docs lose curiosity? Three letters: IRB. The bureaucratic overhead to curiosity breaks the back of busy clinicians. 10:36 AM Jun 17th from Tweetie in reply to dwmoskowitz schroncd I don't care for hiking. The longest hike I ever made was trying to find the car in a WalMart parking lot 8:47 AM Jun 17th from web gruntdoc Our EMR is very dedicated: Even when it crashes: (it says “Cannot Quit”). http://tinyurl.com/nxp5to9:12 PM Jun 16th from twitterfeed zappos Twittering is like hugging. Just because it's hard to measure the return on investment doesn't mean there isn't value there. 3:22 PM Jun 16th from txt davewiner Twitter forces the whole web through a 140-character window. 7:12 AM Jun 16th from webdrscottgberg residency orientation is officially scaring me. 4:59 PM Jun 15th from web timoreilly Jeff Immelt: "My job at GE is to look 20 years ahead....And every time I go to China, I get a headache." #wiredlive 4:05 PM Jun 15th from Seesmic Desktop The inclusion of a Twitter update (tweet) in Selection of My Twitter Favorites does not represent endorsement or agreement of any kind.If you are included in this post but you would like to have your tweet removed for any reason, please email me and will comply with your request the same day.Micro-blogging on Twitter is easy, fun and can be useful and educational if you follow/subscribe to interesting people. You can read more here: A Doctor's Opinion: Why I Started Microblogging on Twitter and visit my account at Twitter/AllergyNotes.
- Average Andorran lives 85 years, longer than anywhere els... Embedded video from CNN VideoReferences:Why Andorrans live longer than everyone else. CNN.
- Where Are Medicare Stories at BarackObama.com? We rarely delve into politics. But if we must, Independence Day is probably a good occasion. So over coffee and a brioche, we were reading Health Care Stories for America @ BarackObama.com. There we noticed an interesting pattern: scolding of health insurance companies is on at full steam, but no one wants to talk about the elephant in the room: Medicare. And that's where the real health care dollars are being sucked in, like into a giant black hole. Don't believe our independent Medgadget team of doctors? Ask practically any other physician, and he or she will tell you about real horrors. How about stories where hundreds of thousands of dollars are spend on each patient that has practically hit the wall? How about pacemakers and AICDs on 90 year olds with Alzheimer's, Parkinson's or stroke? How about interventional radiology procedures, where a terminal elderly patient becomes a cushion pad for physicians? How about CAT scans, MRIs, leg bypasses, peripheral catheters, exploratory laparotomies, and thousands of lab tests that are done every day, that often prolong more suffering than life? We understand that there are many problems in healthcare when it comes to younger patients. We know that people lose jobs, have prior conditions, and as a result they end up losing their insurance coverage. We also understand there are abuses in the health insurance industry. But the real bulk of the societal problems is not with the people under 60, but with older patients. In other words, with Medicare. And when families, who don't have to co-pay for any medical services, are being asked to estimate the risk/benefits ratios of going ahead with a treatment, the hope itself forces them to go "all in." And that is how the tax payer's money are being spent nowadays. For all the talk over at the Health Care Stories for America, there is indeed little substance but lots of fear. And that is from the administration that has promised us hope. And, finally, the real question. Why does the President and his team use the wrong symbol of Caduceus for his health care proposal? As we noted before, the Staff of Asclepius should be a single serpent encircling a staff, and no wings and no snake families, please. We hope you have a nice Independence Day!...
- Smoother GORE VIABAHN Endoprosthesis Gets Approved in US W. L. Gore & Associates just received FDA's OK to market an updated version of the firm's GORE VIABAHN® Endoprosthesis indicated for "improving blood flow in patients with symptomatic peripheral arterial disease in superficial femoral artery lesions with reference diameters ranging from 4.0 - 7.5 mm [and] in iliac artery lesions with reference vessel diameters from 4.0 – 12 mm" The modification is a result of the precision laser trimming technology which enables the removal of excess material at the device margin, resulting in a contoured edge. The device is the only stent-graft approved by the FDA for the treatment of patients suffering from Peripheral Arterial Disease (PAD) in superficial femoral artery (SFA) lesions and iliac artery lesions. In the US alone, as many as 12 million people suffer from PAD. The GORE VIABAHN Endoprosthesis is constructed with a durable, reinforced, biocompatible, expanded polytetrafluoroethylene (ePTFE) liner attached to an external nitinol stent structure. The outstanding flexibility of the GORE VIABAHN Endoprothesis enables it to traverse tortuous areas of the SFA and to conform to the complex anatomy of the artery. The device was initially approved by the FDA in 2005 for treating PAD in the SFA. Later in 2007, Gore made modifications to the device which includes reducing the profile and adding a Heparin Bioactive Surface. Product page: GORE VIABAHN® Endoprosthesis Press release: Gore Receives FDA Approval for Modification of GORE VIABAHN® Endoprosthesis Flashbacks Gore VIABAHN® Endroprosthesis Stent: Now Approved......
- WellAWARE Passive At Home Sensors Help Monitor Independen... Elderly folks tend to prefer to live in their own homes as the years pass, but the potential for accidents to happen leads many to seek nursing homes or to live with family. Dana Blankenhorn at ZDNet Healthcare is reporting on technology from WellAWARE Systems (Charlottesville, Virginia) that monitors people in their homes with sensors in beds, bath tubs, and generally throughout the living space. Dana Blankenhorn reports: At this writing, 60 facilities have the WellAWARE system, company officials told ZDNet. WellAWARE is offering a system of sensors that track a patient’s movement throughout their residence, comparing their activities to a baseline of normality, and alert caregivers to changes. Noce explained how this worked recently with an 81 year old client aging-in-place in Hastings, NE: "There was an alert that the woman had not slept for 26 hours. The woman was evasive, but we were able to be proactive, and the nurse was able to visit, knowing she hadn’t slept. The woman finally admitted she’d been hallucinating. The nurse asked about medication, the woman said she had some, and the nurse found that one of the side effects of one medicine was hallucination. She was able to fix the situation in a day. The patient didn’t have to do anything. The care giver was then able to provide an interaction that got correction. More at ZDNet Healthcare... Link: WellAWARE Systems......
- New Imaging Technology Monitors HER2 Protein Researchers from the National Cancer Institute have devised a new method to watch for the presence of the HER2 protein, a commonly expressed marker of breast cancer. As you can imagine, the implications for this technology could be immense, from doing research on pathophysiology of breast CA to developing protocols for treatment. From the statement issued by the National Cancer Institute: ... the research team used an imaging compound that consists of a radioactive atom (fluorine-18) attached to an Affibody molecule, a small protein that binds strongly and specifically to HER2. Affibody molecules, developed by Affibody AB, Bromma, Sweden, are much smaller than antibodies and can reach the surface of tumors more easily. The radioactive atom allows the distribution of the Affibody molecules in the body to be analyzed by positron emission tomography (PET) imaging. The research team first used the radiolabeled Affibody molecule to visualize tumors that expressed HER2 in mice. The mice were injected under the skin with human breast cancer cells that varied in their levels of HER2 expression, from no expression to very high expression. After three to five weeks, when tumors had formed, the mice were injected with the Affibody molecule and PET images were recorded. The levels of HER2 expression as determined by PET were consistent with the levels measured in surgically removed samples of the same tumors using established laboratory techniques. To determine whether their method could be used to monitor possible changes in HER2 expression in response to treatment, the team next injected the Affibody molecule into mice with tumors that expressed very high or high levels of HER2 and then treated them with the drug 17-DMAG, which is known to decrease HER2 expression. PET scans were performed before and after 17-DMAG treatment. The researchers found that HER2 levels were reduced by 71 percent in mice with tumors that expressed very high levels of HER2 and by 33 percent in mice with tumors that expressed high levels of HER2 in comparison with mice that did not receive 17-DMAG. The researchers confirmed these reductions by using established laboratory techniques to determine the concentrations of HER2 in the tumors after they were removed from the mice. Press release: Imaging Technique Allows Researchers to Monitor Protein Changes in Mouse Tumors Article abstract in The Journal of Nuclear Medicine: Changes in HER2 Expression in Breast Cancer Xenografts After Therapy Can Be Quantified Using PET and 18F-Labeled...
- Computer Simulations Extend Abilities of Shape Memory Alloys As medical devices become smaller and more complex because of the ever increasing demand for greater precision in clinical and research applications, the need for smart materials is also on the rise. Many metal alloys are able to "remember" a specific shape they were in before transformation, the best example being self expanding coronary stents. Although memory retaining alloys are already being used in many fields of medicine, researchers from Fraunhofer-Gesellschaft are using computers to extend the application of these materials. With the help of these simulations, the scientists have developed various objects, including a minuscule forceps for endoscopy. Normally, such micro forceps can only be created with joints. How can a component be produced that has such small dimensions, is elastic, can be thoroughly sterilized and has no joints? The computer supplies the answer: with the help of numerical simulation models, the researchers could calculate in advance the most important characteristics of the component, such as its strength and clamping force, and efficiently develop and manufacture the elastic component. "Normally, many tests with various prototypes would need to be conducted," Dr. Helm explains. "By using simulations, we can avoid producing most of these prototypes. This saves costs because the raw materials for the shape memory alloys are very expensive and are sometimes difficult to work with." In addition, the researchers can estimate through simulations how durable the modern materials are. Full story: Design tool for materials with a memory...
- Device Captures Endothelial Progenitor Cells; May Help De... Researchers from Northeastern University and Harvard Medical School have developed a miniature microfluidic device that is capable of capturing endothelial progenitor cells (EPCs) from the bloodstream, in a sample of only 200 microliters of blood. Because endothelial progenitor cells move towards injuries within blood vessels, detecting their presence can lead to a diagnostic system for various vascular diseases. From the abstract: The surface of a variable-shear-stress microfluidic device was conjugated with 6 different antibodies [anti-CD34, -CD31, -vascular endothelial growth factor receptor-2 (VEGFR-2), -CD146, -CD45, and -von Willebrand factor (vWF)] designed to match the surface antigens on ovine peripheral blood-derived EPCs. Microfluidic analysis showed a shear-stress-dependent decrease in EPC adhesion on attached surface antigens. EPCs exhibited increased adhesion to antibodies against CD34, VEGFR-2, CD31, and CD146 compared to CD45, consistent with their endothelial cell-specific surface profile, when exposed to a minimum shear stress of 1.47 dyn/cm(2). Bone-marrow-derived mesenchymal stem cells and artery-derived endothelial and smooth muscle cells were used to demonstrate the specificity of the EPC microfluidic device. Coated hematopoietic specific-surface (CD45) and granular vWF antibodies, as well as uncoated bare glass and substrate (1% BSA), were utilized as controls. Microfluidic devices have been developed as an EPC capture platform using immobilized antibodies targeted as EPC surface antigens. Abstract in FASEB Journal: Development of microfluidics as endothelial progenitor cell capture technology for cardiovascular tissue engineering and diagnostic medicine (hat tip: Gizmag)...
- Mysteries of Salamander Regeneration Revealed A collaborative group of German and American researchers has identified the important biochemical processes involved in the regeneration of limbs of salamanders. Nearly unique in their great ability to replace lost appendages, salamanders were thought to possess pluripotent stem cells with greater abilities to differentiate than those of mammals. Turns out that in salamanders cells located at the location where the damage has occurred keep a memory of what was in the vicinity, providing guidance for regrowth of future cells. The finding opens the possibility that scientists will be able to replicate this phenomenon in humans, leading to treatments for spinal cord injury, loss of arms and legs, and other serious injury. From the study abstract: During limb regeneration adult tissue is converted into a zone of undifferentiated progenitors called the blastema that reforms the diverse tissues of the limb. Previous experiments have led to wide acceptance that limb tissues dedifferentiate to form pluripotent cells. Here we have reexamined this question using an integrated GFP transgene to track the major limb tissues during limb regeneration in the salamander Ambystoma mexicanum (the axolotl). Surprisingly, we find that each tissue produces progenitor cells with restricted potential. Therefore, the blastema is a heterogeneous collection of restricted progenitor cells. On the basis of these findings, we further demonstrate that positional identity is a cell-type-specific property of blastema cells, in which cartilage-derived blastema cells harbour positional identity but Schwann-derived cells do not. Our results show that the complex phenomenon of limb regeneration can be achieved without complete dedifferentiation to a pluripotent state, a conclusion with important implications for regenerative medicine. Full story: Scientists: Salamanders, regenerative wonders, heal like mammals, people.... Abstract in Nature: Cells keep a memory of their tissue origin during axolotl limb regeneration Images: Top: Axolotl salamander by cataclico; Side: Green nerve cells cluster around a growing nerve in this cross-section of a regenerating limb. D.Knapp/E.Tanaka....
- Nephros' Dual Stage Ultrafilter System Guarantees Clean F... Nephros, Inc., out of River Edge, New Jersey, received FDA approval for the firm's Dual Stage Ultrafilter system. The device is designed to provide redundant filtration for purifying of dialysate fluid and bicarbonate solution. From the product page: The Nephros DSU has a 0.005 micron filter pore size designed to remove a broad spectrum of bacteria, viral agents and biological toxins. These toxins include salmonella, hepatitis, HIV, Ebola viruses, legionella, fungi and e-coli. The DSU removes these harmful substances more effectively than other microwater filters currently on the market. The Nephros DSU's unique design and materials ensure high flow rates and long life. The true redundant design provides the highest confidence in filter integrity and performance. The Nephros DSU is a truly cost effective, simple and compact means to reliably produce on-site ultrapure water where you need it, when you need it. Product page: Dual Stage Ultrafilter... Nephros DSU brochure... Press release: Nephros Receives 510k Approval for Dual Stage Ultrafilters......
- DIY Circumcision Makes Writing This Post Difficult An English gentleman, possibly skeptical of the offerings provided by the National Health Service (NHS), decided to perform his own circumcision at home. Apparently not aided by anything other than some ethanol, the patient/physician brought a pair of nail clippers to the surgical theatre/kitchen sink. Inevitably something went terribly wrong and medics had to be brought out. The Telegraph quotes one from the rescue team: "This is something we would advise men never to attempt," a medic said, "The results can be quite horrific and long-lasting and have quite an affect on a man's sexual performance. "Using a pair of nail clippers must have caused excruciating pain, even if he had had a few drinks beforehand." More from The Telegraph... Image: mokolabs...
- If Paris Hilton Had a Gas Mask Yanko Design blog is featuring the work of Elijah Stillson who offers a new design idea for a respirator. Although, when wearing this thing, one would be the most attractive person in a crowd of evacuees, let's hope the device can seal around the face to stay tight with this design. Link: Respirator Mask Design by Elijah Stillson (hat tip: Gizmodo)...
- Commentology Futurist Jeff Goldsmith's analysis of issues that could cause problems for any health reform effort that eventually emerges from the foodfight in Washington this summer provoked a wide range of reader replies. ("No Country For Old Men") Goldsmith wrote in...
- Is Wal-Mart Leading the Charge on Health Reform? By RAHUL PARIKH Last Wednesday's headline in the Wall Street Journal may have surprised you. It read: "Wal-Mart Backs Drive to Make Companies Pay for Health Coverage." The article discussed Wal-Mart's open support for an employer mandate requiring all but...
- Biggest and best month ever on THCB By Matthew Holt By the time most of you read this, I’ll be heading to England to tell those Limeys how to do healthcare right the American way….or something like that, and then off to China. I’ll be back in...
- Careful What You Wish For By THE INCIDENTAL ECONOMIST On the left are those who would like health reform to include a strong public plan, one that could negotiate large provider discounts, driving down the cost of medical care. On the right are those who...
- Implementing a Modern Hospital Website By JOHN HALAMKA Over the past two years, I've witnessed a transition in modern website design from plain text and static information to multimedia centric and interactive. I've written about the new BIDMC website we implemented to meet patient expectations...
- The Myth of Prevention and EHR’s? By SCOTT SHREEVE I was just referred this article which I found to be thoughtfully crafted. Abraham Verghese is a Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University. I found the article interesting,...
- Rantology: Cannon on Freedom or Power? By Matthew Holt Ah-ha. Michael Cannon has now replied to me and it basically comes down in his mind to me being a crypto-fascist Stalinist wanting to break the will of the American people mediated through its representatives, the health...
- No Country for Old Men By JEFF GOLDSMITH As we enter summer, the health reform process is moving into its Newtonian phase: irresistible forces meeting immovable objects. In both health cost and access, the trend is not our friend. There is ample evidence not only...
- THCB UPDATE If you haven't had a chance to sign up for THCB UPDATE yet, you really should. You'll get a helpful reminder email from us when important posts go up on the site. In the two and a half six months...
- Unions May Get a Pass on Health Care Benefits Tax By ROBERT LAWSZEWSKI There is a major bipartisan effort going on in the Senate Finance Committee to reform the health care system. Reportedly, one of the elements of that effort may be a tax on "gold plated" health insurance benefits...
- Should Steve Jobs talk more openly about his pancreatic c... As you have read here and elsewhere, Apple’s Steve Jobs recently underwent a liver transplant for a rare form of pancreatic cancer.
He, however, is not talking publicly about his case, and Apple is tightly controlling the information surrounding Mr. Jobs’ health.
Certainly, he is entitled to his medical privacy, but there are some who believe he [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Is Chantix safe, and why Zyban, or bupropion, also receiv... Popular smoking cessation drugs Chantix and Zyban received black box warnings from the FDA, the strongest of its kind.
Chantix, in particular, is quite effective in helping patients to quit smoking, but has been dogged by instances of increased suicidality, especially in those already having a psychiatric diagnosis.
As this report in MedPage Today states, “Reports [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Did propofol, or Diprivan, kill Michael Jackson? As predicted, the details surrounding the singer’s death continue to get more bizarre.
Recent reports have stated that the powerful anesthetic Diprivan, generically known as propofol, was found in the singer’s house. Apparently, according to a nurse, Jackson “was begging for the powerful sedative to help him get over insomnia.”
There are zero circumstances where [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Why removing the tax breaks for non-profit hospitals coul... It’s because of the unintended consequences, of course.
In their regular column in Slate, physicians Zachary Meisel and Jesse Pines talk about the recent attention that non-profit hospitals are garnering. The problem is this. Many are acting like for-profits, and in some cases, have been caught mistreating the uninsured and those who are on [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- America’s failed attempt at a single-payer system, the ... Contrary to what you may have been led to believe, the United States has already tried its hand at a pseudo-single-payer system. The VA is one example. Another, albeit less highly publicized, is the Indian Health Service. (via WhiteCoat)
Based on an agreement in 1787, the government is responsible to provide free health care [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Vicodin and Percocet banned and taken off the market, or ... The FDA has declared war on acetaminophen, with Vicodin and Percocet being collateral damage. You can bet Dr. Gregory House is sweatin’ pretty hard over this news.
In the last few days, acetaminophen, otherwise known as the brand name Tylenol, has been squarely in the FDA advisory panel’s crosshairs. In general, it’s a very [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Reader take: Moral hazard, and whether patients should co... The following is a reader take by an anonymous medical student.
One of the ideas that comes up in the search for explanations of high healthcare costs is the so-called “Moral Hazard”—the idea that insured patients are more likely to agree to unnecessary procedures because they don’t pay for them directly. Not everyone thinks it [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Why would a doctor stop seeing patients? It’s no secret that training a doctor takes a tremendous amount of time and money, both from the physician and the government, who subsidizes a substantial amount of the cost of training.
So, in the midst of a physician shortage, internist Toni Brayer wonders about doctors who simply decide to stop seeing patients.
After talking to a [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Why did Michael Jackson have a heart attack, and CPR by D... Michael Jackson suffered a cardiac arrest. And still, that’s really all we know for sure.
Medical websites continue to speculate on the possible causes. Over at theheart.org, doctors who were interviewed continue to speculate on Jackson’s narcotic use, including Demerol, which I wrote about a few days ago. Indeed, a spokesperson for [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Can the American Medical Association still be an influent... The repercussions after Obama’s speech to the AMA’s delegates continue to be felt.
Not least of which are the murmurings of the other professional physician groups, who say that the AMA does not represent a majority of physicians. In this piece from pediatrician Rahul Parikh, he notes that about 30 percent of physicians are AMA [...]Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.
- Recent severe cases of H1N1 flu worry health officials In a teleconference with reporters this afternoon, federal health officials provided an update on the current state of the Canadian government's response to the H1N1 flu pandemic.Health Minister Leona Aglukkaq -- who has kept a fairly low profile in her time at the helm of Health Canada throughout the H1N1 response as well as the radioisotope shortage crisis -- was in attendance but said little besides mentioning that she'd be traveling to Mexico soon alongside foreign governments' delegates to discuss at a World Health Organization meeting how to deal with the expected resurgence of the H1N1 virus this fall.Dr David Butler-Jones, the government's Chief Public Health Officer (above right), said that although the vast majority of the 7,775 cases detected in Canada so far (see the map below for a breakdown by province or visit the Public Health Agency's surveillance website) have been mild and have resulted in full recoveries, the anticipated "second wave" of infections this fall has been preceded already by the mysterious appearance in recent weeks of a small number of "severe" infections.According to Dr Butler-Jones, the reason or reasons for the emergence of this new set of "severe" cases in Canada has not been determined, though epidemiologists with Health Canada and the Public Health Agency of Canada have been dispatched to study the matter. Possible explanations, he explained, could include: genetic variations that result in either too little or too great an immune response in infected patients, a mutation in the H1N1 virus (which would augur potentially very serious consequences in the general population over the months to come, it would seem), or some combination of factors. He warned that we should expect to see more cases in Canada over the coming months, including more severe cases, and more deaths.At the top of the news lately have been accusations that the federal government's response to the rapid spread of the H1N1 flu virus in aboriginal communities, particularly in Manitoba, has been insufficient. Health Canada's regional director of First Nations and Inuit Health, Valerie Gideon, endeavored to convince reporters that was not the case. The shipments of hand sanitizer, which had been delayed because of concerns that the alcohol-based gels might be abused by First Nations patients, have now been delivered, she said, and nursing stations are open on the reserves 24 hours per day and are stocked with necessary medical supplies.One interesting item to note about Monday's news conference was the tone that Dr Butler-Jones employed when discussing recommended precautionary measures for pregnant women and people with preexisting health conditions, both of which groups of patients may be at higher risk of experiencing dangerous complications if they are infected with the H1N1 flu. Whereas US Vice-President Joe Biden was mocked not long ago for warning people to avoid crowded places like buses and trains for fear of catching the virus, Dr Butler-Jones said very seriously that pregnant women in Canada should consider staying out of crowds. He refused, however, to cite specific crowded places pregnant women should avoid; he demurred when asked by one reporter if he meant women should avoid shopping malls and public transportation, only mentioning for certain (and this is where things took a brief turn for the surreal) that pregnant women should avoid mosh pits.Photo: Public Health Agency of Canada Get Canadian Medicine news by email or in an RSS reader
- David Caplan aims for better, cheapter healthcare It's been said that the Canadian model of healthcare insurance promises three things: high-quality care, for everyone, quickly. Reality falls short of the promise, of course. As the saying goes: pick two.But David Caplan (left), the man selected to follow the controversial George Smitherman as health minister of Ontario a year ago this month, intends to make good on that promise. Universal coverage is a given, of course, but as for quality and efficiency -- well, let's just say that Canada is no Andorra. Maintaining a high level of quality has in some cases meant reduced access and longer wait times, and it's likewise assumed that providing all patients with family physicians (and the enviable same-day access patients in some other countries get) would compromise doctors' ability to give patients sufficient attention and deliver appropriate care.Complicating matters is the fact that the rate at which governments' health spending has been increasing has outstripped growth in GDP for years, and seems likely to do so for years to come.Mr Caplan's ambitious goal as health minister is to turn that move beyond the quality/wait-times binary and to save money in the process.He explained his thinking to me in a long interview for the June issue of Parkhurst Exchange magazine:"What I want to do is raise the quality of the healthcare experience, of healthcare service, because all of the literature I've read says that when you increase quality you increase efficiency and you increase sustainability and cost-effectiveness. That's the real way. The mistake I think governments have made in the past is they've tried to contain costs first and what you've seen is a degradation of quality. If you raise quality, and that's the goal, almost by definition it will logically follow that cost-effectiveness will result."Read the full Q&A on the Parkhurst Exchange website, for more on health policy as well as a discussion of following in his mother's footsteps as health minister of Ontario, the decline and future of solo practice, Mr Caplan's struggles with his weight and smoking addiction, and more. Get Canadian Medicine news by email or in an RSS reader
- What's in the news: Jun. 26 -- Manitoba First Nations dec... Manitoba First Nations declare H1N1 flu emergencyChiefs of Manitoba First Nations have declared a state of emergency as the H1N1 flu pandemic ravages their already-troubled communities.The chiefs lay the blame for the virus's quick spread on the federal and provincial governments, whom they say failed to act early enough."No one is taking responsibility," David Harper, of the Garden Hill First Nation, told the Winnipeg Sun. "We've crossed the line. We've had enough." [Winnipeg Sun]One point of contention is that deliveries of hand sanitizer were delayed because of concerns that the alcohol-based gels would be abused by First Nations patients trying to get drunk. A government official confirmed the reason for the delays. "The discussion was with the best interests of our clients in mind," Anne-Marie Robinson, the assistant deputy minister of the First Nations and Inuit Health Branch of the federal health ministry. "We have had some rare experiences in our communities where we have had theft of hand sanitizers. … We do have communities where we have large proportions of people who suffer from addiction. … We have had a number of people come forward, and some evidence, where this could potentially put people at risk."The delivery took two and half weeks to arrive, while the flu was making its way through the towns. [Globe and Mail]First Nations have higher infant mortality, TB ratesCanadian First Nations peoples have higher infant mortality and tuberculosis infection rates than the rest of the Canadian population, a new UNICEF Canada study showed. [Canwest News Service]More news from across Canada- Quebec appeared poised to abandon its public-private partnership plans for the construction of the forthcoming Montreal mega-hospitals. [La Presse]- Newfoundland MDs demanded higher pay in their next agreement with the provincial government. [CBC News]- A Canadian HIV expert prepared to begin an innovative new study that might lead to treatments that could not only suppress the virus's ability to reproduce but actually eliminate it from the body completely. [Canwest News Service]- Knee and hip joint surgeries, though they are expensive, actually save the public healthcare system money in the long run. (No pun intended.) [Globe and Mail]- The burden of chronic diseases presents a challenge particularly for women, who are now living longer than ever before. So says a new study from St Michael's Hospital and the Institute for Clinical Evaluative Sciences, in Toronto. [St Michael's Hospital news release]- The Coalition of Family Physicians of Ontario, a doctors' group that tends to oppose the Ontario Medical Association and the provincial government in part because they inhibit doctors' freedom to practise as they wish, pointed to a recent essay by health law experts Lonny Rosen and Elyse Sunshine that concluded "concern remains that doctors will find themselves embroiled in more conflicts and other proceedings as a result of the College's enhanced investigative powers and the increased information disclosure required by the new amendments." [COFP notice to physicians] The laws were passed as part of a major health regulatory reform package known as Bill 141, back in April. [Canadian Medicine]- Some MDs are concerned about a recent British Columbia law that permits naturopaths to do allergy testing. The Canadian Society of Allergy and Clinical Immunology, the British Columbia Medical Association and other groups have expressed their worries to the health minister. [Allergic Living]- The Supreme Court gave its okay to governments' practice of forcing Jehovah's Witness minors to receive blood transfusions if deemed medically necessary. However, the court's decision made clear that judges should use their discretion to determine whether the minor is capable of making a responsible decision before enforcing a transfusion. [CBC News]- A drug called aprepitant was found to reduce chemo-induced nausea and vomiting. The new evidence was presented at the Multinational Association of Supportive Care in Cancer, in Rome, yesterday. It has not yet been published in a peer-reviewed journal. [Merck Frosst news release]- Alcohol is linked to one in 25 deaths worldwide, reported researchers from Toronto's Centre for Addictions and Mental Health. [The Lancet abstract] [BBC News] [CAMH news release]- A Saskatchewan doctor was fined for refusing to report to the hospital when he was on call and for attempting to treat himself at the hospital. [Regina Leader-Post]- A Winnipeg Children's Hospital doctor was charged with child sex abuse. [Winnipeg Sun] [Winnipeg Free Press]- The government of Canada passed regulations banning the sale of plastic baby bottles containing the chemical bisphenol A (BPA). "Our Government is acting to protect its most vulnerable citizens-newborns and infants," Health Minister Leona Aglukkaq said in a release. "Canada is the first country to move ahead with regulations to prohibit polycarbonate baby bottles that contain bisphenol A. We want parents to feel confident that they can safely bottle-feed their newborns and infants." [Health Canada news release] Why has no other country acted yet? Because there's no firm evidence that bisphenol A is actually dangerous, wrote Terence Corcoran. [National Post]- You may soon be seeing fewer vaccine ads. (The fact you see any at all in Canada is because vaccines are not covered under the ban on direct-to-consumer drug advertising.) In response to complaints, Health Canada is demanding drug companies insert more safety information into their advertising material. [National Post]- Health Canada, in issuing a health advisory warning consumers of the dangers of reusable cloth shopping bags and the bacteria and mould they could potentially collect, has effectively backed the plastics industry. [Health Canada advisory] Who underwrote the "study" that alerted the public to the health risks that could theoretically arise from the contaminated cloth bags? Why, it was the plastics industry! [CBC News]- Dr PC Adams, published in the Canadian Journal of Gastroenterology an essay titled "The impact of cirrhosis on the history of jazz." [Canadian Journal of Gastroenterology abstract (free full-length PDF available)]- Canadian blogger and new family practice resident Dr Ottematic contemplated joining the Canadian Forces for the great salary and the medical training, but decided (for the time being at least) not to enlist. [Dr Ottematic]- Kevin Megeney, the Nova Scotia soldier killed inside a NATO base in Afghanistan in 2007, was shot by a fellow soldier while they played a game of "quick draw," alleged crown prosecutors. [Canadian Press] After he was shot, Mr Megeney was treated by a civilian physician on contract with the military named Kevin Patterson, from BC. Dr Patterson went on to publish a graphic account of the episode in an excellent article he wrote for the American political magazine Mother Jones. Dr Patterson later conceded that published Mr Megeney's name was unethical and agreed to donate his earnings from the article to charity and pay a fine to the BC College of Physicians and Surgeons. [Canadian Medicine]- This week's Health Wonk Review includes a whole section devoted to Canada. In it are articles by blogger The Ismological ["STOP LYING: Canadian Health Care DOESN'T Suck"] and by Canadian Medicine. [Healthcare Economist] Get Canadian Medicine news by email or in an RSS reader
- New health ministers in New Brunswick, Nova Scotia NB replaces health minister in midst of crisisAfter a calamitous and bruising weeks-long battle with the province's physicians, New Brunswick Health Minister Mike Murphy has been removed from the health ministry and sent to run the justice department.Mary Schryer (left) has been named the new health minister. [CBC News]Of course, that's hardly a demotion or a sign that Premier Shawn Graham is going to reverse the decision that precipitated the fight with the doctors -- the government's recent recession-influenced decision not to honour the agreement on raises it came to with the doctors' union last year -- and it appears so far that Mr Murphy's departure is unlikely to change the situation. But the appointment of a new health minister is at the very least a sign that Mr Graham and perhaps even Mr Murphy as well recognized that Mr Murphy's relationship with the medical community was irrecoverably damaged."Michael Murphy's departure from the Department of Health is welcome," commented the Telegraph-Journal. "A lawyer by profession and debater by temperament, he was never suited for a portfolio that must be above partisan politics. It's not surprising that his most prominent reforms have drawn threats of legal challenge." As for Mr Schryer, the newspaper remarked, "She'll have her hands full trying to re-open negotiations with physicians, address the doctor shortage, and bring order to a health system so overloaded that patients are being housed in shower stalls." [Saint John Telegraph-Journal]Ms Schryer was a financial planner and a director on the board of the Atlantic Health Sciences Corporation before entering politics.But while Mr Murphy's exit from the health portfolio might be seen as a positive development in what must inevitably be some variety of reconciliation between doctors and the government, there's no guarantee that as justice minister he will be, as the Daily Gleaner put it, be "in less of a position to trample all over people the way he did with the doctors' wage freeze fiasco." [Fredericton Daily Gleaner] The reason for that is because there is a strong possibility that he could end up directly involved with the doctors once again, since the New Brunswick Medical Society has now threatened to take the government to court over its decision to break the deal it had promised to the society last year.Perhaps it will not come to that, however. Mr Graham appears to have gradually come to realize the folly of angering nearly the entire medical profession in one fell swoop and he has made some initial overtures to the medical society, saying he would like to reopen negotiations. [Moncton Times & Transcript] So far, the NBMS has refused to return to the table. [Fredericton Daily Gleaner]But Bill 93, the legislation essentially authorizing the government to ignore the commitment it made last year, has indeed been passed by parliament but it has not been proclaimed yet, leaving open some potential room for Mr Graham and Ms Schryer to maneuver.Nova Scotia also gets new health ministerNew NDP premier Darrell Dexter named Maureen MacDonald the province's health minister. [Government of Nova Scotia] Ms MacDonald was a social work professor at Dalhousie before entering politics. [Canadian Press] She also worked as a community health educator, a legal aid worker, and a journalist. [Maureen MacDonald]Just before Ms MacDonald's name was announced, the Chronicle Herald's Ralph Surette penned a column with his advice for the new minister. He advised her, "you don’t have to overhaul the general policy direction... Indeed, the only policy challenge you have is to reverse your party’s crazy promise to keep all rural ERs open all the time. In order to keep that vow, you’d have to strip the primary care system of doctors, pay doctors more than they make in their offices to staff ERs overnight, when in fact there’s very little business and the ambulances take real emergencies elsewhere. This is not just bad policy, it’s nuts. You’d be paying doctors a fortune for basically doing nothing." [Halifax Chronicle Herald]Former health minister Karen Casey, meanwhile, took over as interim PC leader as defeated premier Rodney MacDonald stepped down. [CBC News]Ontario opts not to replace health ministerIn a move that surprised some in Ontario, Premier Dalton McGuinty shuffled his cabinet slightly but chose not to appoint a new health minister to replace the embattled David Caplan, who has been under fire from opposition members for several weeks in relation to the untendered contracts handed out by the eHealth Ontario agency.BC health minister still getting acclimatedBC Health Minister Kevin Falcon, who has only been on the job for about two weeks since being switched over from the ministry of transportation, offered a rather confused analysis of public-private balance before calling a Vancouver Sun reporter back to explain himself. [Vancouver Sun] Our guess: don't read too much into this exchange. We figure Mr Falcon was just trying to keep up with an experienced reporter and let his mouth get ahead of his brain. It's doubtful he was forming new policy on the fly.In a new article, Canadian Healthcare Technology wondered if new Mr Falcon will opt for the same kind of de-regionalization, or at least a limited variant thereof, that Alberta and New Brunswick have experimented with in recent years. [Canadian Healthcare Technology] Get Canadian Medicine news by email or in an RSS reader
- New Brunswick breaks deal with doctors The New Brunswick government followed through on Health Minister Mike Murphy's (left) threats and, last Thursday, passed Bill 93, effectively eliminating the wage increases the province's physicians had been promised in negotiations last year. [Bill 93, New Brunswick Legislative Assembly (PDF)]The New Brunswick Medical Society's reaction was -- not surprisingly -- one of disappointment but not surprise. Society president Dr Ludget Blier (right) issued a statement condemning the government and making clear that physicians don't intend to take this provocation lightly. In other words: you'll be hearing from their lawyers, Mr Murphy. Dr Blier's statement is so strongly worded that it's worth reading in full:If there was any remaining doubt about the level of respect that the Shawn Graham government has for New Brunswick doctors, it was wiped out on June 18, 2009 with the third reading of Bill 93. This historic piece of legislation will render a duly negotiated and ratified agreement to be "null and void", and will attempt to block any efforts to challenge that decree.The president of the New Brunswick Medical Society, Dr. Ludger Blier, says that it is difficult to find words that are strong enough to express how he and his fellow physicians feel about how they have been treated over the past eighteen months or more. "Used and abused are words that come to mind", says Dr. Blier. "We spent many days, weeks and months across the negotiating table from government representatives before finally signing off, page by page, on the terms for new agreements. We placed those terms in front of our membership for a vote, with a recommendation that they accept them. Our membership respected the results of the negotiations process. Government did not."Dr. Blier underlined once again that the decision to single out physicians and walk away from signed agreements was enough to seriously damage the relationship between physicians and the Graham government. The way that the Government chose to do that has reinforced the conclusion reached by the doctors, that the only remaining avenue for efforts to salvage the agreements is through the courts."We met with the Premier on March 11th at which time he told us that we had choices about how to participate in the government's restraint policy and that the 'negotiating process would be respected' if that was our choice. The Premier subsequently said that we misunderstood and were never given a choice." Dr. Blier points to a document that was given to the Premier on March 19th and letters that were sent to government on April 6th and April 23rd, as evidence of the Society's contention that there was a choice."The Premier has invited physicians to return to the negotiating table but only if we agree in advance that the government's policy of two years of "0" would be up front", says Dr. Blier. "Is that a true negotiation, or an attempt to bring some legitimacy to unacceptable behaviour?"Dr. Blier says that the Medical Society will continue to pursue what legal options are open to physicians to protect the duly negotiated agreements.For more on the ongoing battle between the government of New Brunswick and the province's doctors, read Canadian Medicine's previous coverage of doctors' threats to strike and campaign against the Liberals and our coverage of the recession-induced origins of the government's decision to rescind its offer of raises to the doctors. Get Canadian Medicine news by email or in an RSS reader
- What's in the news: Jun. 19 -- Spotty progress on wai... "Spotty progress" in latest Wait Time Alliance report cardThe 2009 report card by the Wait Time Alliance, its fourth annual one, shows small improvements on some measures in some provinces, but the authors of the report, entitled Unfinished Business, insist that is not enough. [Unfinished Business (PDF)]Unfortunately, the report card's accuracy is inherently limited by the lack of reliable data collected and disseminated by the provinces. That in itself is one of Canada's major hurdles in the struggle to reduce wait times, according to the report's authors. "People can go online and track the progress of a package they shipped from one end of the country to another, yet in many parts of Canada patients still cannot find out how long they can expect to wait for critical medical treatments and procedures," Dr Lorne Bellan, a co-chair of the Wait Time Alliance, said in a release. "We need to do a better job of tracking and reporting on the full wait that patients experience to access necessary medical care." [Wait Time Alliance news release]Dr Robert Ouellet, the president of the Canadian Medical Association (which is a member of the Wait Time Alliance), commented Thursday, "Right now, patients receive excellent care, but too often it is in spite of the system, rather than because of it." [Canwest News Service]The WTA is a research and advocacy group formed by associations of medical specialists from a number of fields of medicine.Presumably coinci
