Family Practice News back issues from December 2007:
Metrics chart plan for medical home.(Practice Trends)
Dec 01, 2007; ... [ILLUSTRATION OMITTED] WASHINGTON -- Medical home advocates hope a new set of metrics will help primary care physicians move closer to implementing this model of care. The metrics assess how patient centered an office-based practice is and how well the practice's ...
Simple algorithm boosts high blood pressure control: goal reached in 65% vs. 53% patients.(News)
Dec 01, 2007; ... ORLANDO -- A simple hypertension-treatment algorithm was more effective than was guideline-led practice for controlling blood pressure in a controlled study involving 45 family practices in southern Ontario. The cornerstone of the algorithm was initial, low-dose treatment with a ...
Gastroprotection gap spells disaster for arthritis patients.(News)
Dec 01, 2007; ... BOSTON -- Following years of decline, the rate of stomach complications in arthritis patients taking nonsteroidal anti-inflammatory drugs appears to be on the rise as a result of a widening gap between NSAID prescriptions and therapies that provide gastrointestinal protection, according to ...
Who pays for personal health care?(VITAL SIGNS)(Table)(Survey)(Brief article)
Dec 01, 2007 ... <Pre> Who Pays for Personal Health Care? Private health insurance 36% Medicare 20% Medicaid 17% Out of pocket 15% Other public * 8% ...
Preventive care gains useful how-to guidelines.(News)(Guidelines for Health Supervision of Infants, Children, and Adolescents)
Dec 01, 2007; ... The guidelines for well-child visits and anticipatory guidance just got simpler. For the first time, one set of guidelines will replace three separate documents from three different organizations, with the release of the third edition of "Bright Futures: Guidelines for Health ...
ESA labels show risks for cancer, kidney patients: specific recommendations for dosing adjustments and hemoglobin monitoring are established.(News)
Dec 01, 2007; ... The Food and Drug Administration approved major changes to the labels of erythropoiesis-stimulating agents, addressing serious risks that have been associated with these drugs in patients with cancer or chronic renal failure. The FDA announced last month that it okayed revisions ...
Merck offers $4.85 billion payout; FDA reform underway.(News)
Dec 01, 2007; ... Merck & Co. has announced that it will pay $4.85 billion into a fund to settle claims that its cyclooxygenase-2 inhibitor rofecoxib (Vioxx) was responsible for causing myocardial infarction and stroke in patients who took the drug for pain. The Vioxx saga spurred a sea change in ...
Obstetric care shortage worsens in Oregon.(News)(Survey)
Dec 01, 2007; ... VANCOUVER, B.C. -- Nearly a quarter of all trained obstetric providers stopped delivering babies in Oregon between 2002 and 2006, despite the introduction of malpractice premium subsidies midway through that period, Dr. Ariel K. Smits reported at the annual meeting of the North American ...
Myocardial infarction warning added to Avandia's black box.(News)
Dec 01, 2007; ... A warning about the potential increased risk for myocardial infarction associated with rosiglitazone has been added to the existing black box warning for the antidiabetic agent, reflecting the results of the widely publicized meta-analysis of 42 studies that found a signal for such a risk ....
SCHIP's fate unclear as Congress, Bush tussle: earlier, SCHIP reauthorization seemed like a foregone conclusion. Now states are slated to cut enrollment.(News)
Dec 01, 2007; ... With the end of the year drawing near--and Congress past due to adjourn--the fate of the reauthorization of the State Children's Health Insurance Plan was unclear. SCHIP received one reprieve when Congress approved a continuing resolution to keep the government operating through ...
Guidelines, tool kit help with universal autism screening.(News)
Dec 01, 2007; ... SAN FRANCISCO -- New clinical guidelines advocate surveillance for signs of autism at each well-child visit before 18 months of age and screening for autism at the 18- and 24-month checkups. "I know what you're thinking--'Aah! Another thing to do in an 11-minute well-child ...
Bridging the gastroprotection gap.(Guest Editorial)(Editorial)
Dec 01, 2007; ... The proportion of patients taking nonsteroidal anti-inflammatory agents without gastroprotection is a problem not just in California, but on a national scale. In my practice, where I have a lot of con tact with geriatric patients, I've seen a lot more gastric irritation as a ...
All roads meet in public health system.(Guest Editorial)
Dec 01, 2007; ... Access to first-rate public health services is essential for overall health quality and outcomes, and also for individuals and society to be productive. The Mexican sociologist Dr. Julio Frenk wrote: "Health is a crossroad. It is where biological and social factors, the ...
Correction.(Opinion)(Correction notice)
Dec 01, 2007 ... In "Specialists Reject CT for Lung Cancer Screening" (Nov. 1, 2007, p. 41), we incorrectly reported that Dr. James L. Mulshine participates in the International Early Lung Cancer Action Program. Also, the ...
MDCT scores in trial, but critics still wary.(Cardiovascular Medicine)(multidetector computed tomography)
Dec 01, 2007; ... ORLANDO -- CT angiography remains controversial after a report on the diagnostic accuracy of multidetector CT measured in 316 patients. Noninvasive multidetector CT (MDCT) angiography had a 91% positive predictive value and an 83% negative predictive value, compared with ...
Venous thromboembolism.(Clinical Guidelines For Family Physicians)
Dec 01, 2007; ... Venous thromboembolic disease includes pulmonary embolus and deep vein thrombosis. The annual incidence of the disease in the United States is 600,000 cases. These new recommendations review the diagnosis and treatment of pulmonary embolus and deep vein thrombosis. Diagnosis ...
Childhood trauma raises risk of adult CHD and depression.(Cardiovascular Medicine)
Dec 01, 2007; ... VIENNA -- Childhood trauma was an independent predictor of coronary heart disease and major depression later in life in a study with 360 men. "Childhood trauma can have important consequences, but it is a risk factor that physicians don't usually think about," Dr. Viola ...
CVD affects about 6 million U.S. Diabetics.(Cardiovascular Medicine)
Dec 01, 2007; ... Cardiovascular disease affected approximately 6 million diabetic adults aged 35 years and older in the United States in 2005, according to the Centers for Disease Control and Prevention. Reseachers at the CDC analyzed data from the National Health Interview Survey on the ...
No clear benefit from rosuvastatin for heart failure patients.(Cardiovascular Medicine)
Dec 01, 2007; ... Treatment with rosuvastatin in older patients with moderate to severe chronic ischemic heart failure due to left ventricular systohc dysfunction did not reduce the risk of death from cardiovascular causes or the rate of nonfatal myocardial infarctions and stroke in the randomized ...
Heart failure patients less responsive to aspirin.(Cardiovascular Medicine)
Dec 01, 2007; ... ORLANDO -- About 10% of patients who presented to a hospital emergency department with chest pain and suspected acute coronary syndrome had platelets that were nonresponsive to aspirin, in a study with about 1,000 patients. The prevalence of aspirin nonresponsiveness was even ...
Preeclampsia, CVD linked; prevention urged.(Cardiovascular Medicine)
Dec 01, 2007; ... Women who have had pre-eclampsia are at increased risk of cardiovascular disease later in life, suggesting that they should be targeted for primary prevention, according to a British review. "The underlying link between pre-eclampsia and cardiovascular disease is unclear ....
Device lowers weight, glucose in type 2 diabetes.(Metabolic Disorders)
Dec 01, 2007; ... AMSTERDAM -- A novel gastric electrical stimulation device can potentially improve glucose levels and induce weight loss in obese patients with type 2 diabetes on oral antihyperglycemic therapy, Dr. Christoph Rosak said in a poster presentation at the annual meeting of the European ...
Treat pregnant women with a history of GDM.(Metabolic Disorders)(gestational diabetes mellitus)
Dec 01, 2007; ... AMSTERDAM -- Treating all women with previous gestational diabetes mellitus for GDM early in their subsequent pregnancies--without rescreening them--is likely to improve maternal and fetal outcomes, Dr. Christina S. Cotzias said at the annual meeting of the European Association for the ...
Atypical antipsychotics tied to adrenal issues.(Metabolic Disorders)
Dec 01, 2007; ... NEW ORLEANS -- It is important to recognize the potential for atypical antipsychotics to cause adrenal insufficiency to ensure that the condition is managed appropriately, according to Dr. Violeta Tan and Dr. Natalie Rasgon. They described the case of a 54-year-old man with a ...
Fenofibrate cuts retinopathy in diabetic patients: those who were treated with the drug also had less progression of albuminuria and fewer amputations.(Metabolic Disorders)
Dec 01, 2007; ... ORLANDO -- Treatment with fenofibrate led to a substantial drop in the need for laser treatments for retinopathy in a controlled trial of nearly 10,000 patients with type 2 diabetes. Physicians should "consider using fenofibrate on all patients with diabetes, even patients ...
40 mg of lisinopril daily is ideal for diabetic nephropathy.(Metabolic Disorders)
Dec 01, 2007; ... AMSTERDAM -- In type 1 diabetic patients with diabetic nephropathy, 40 mg/day of lisinoprll appears to be the ideal dose for renoprotection, Dr. Katrine J. Schjoedt said in a poster presentation at the annual meeting of the European Association for the Study of Diabetes. ...
Cancer patients miss shots in PCP-specialist gap.(Infectious Diseases)
Dec 01, 2007; ... Los ANGELES -- Primary care physicians cannot assume cancer patients are receiving influenza or pneumonia vaccinations while in the care of oncology specialists. When surveyed at the University of Pennsylvania in Philadelphia, a third of radiotherapy patients aged 50 years and ...
Flu vaccine effective despite anti-TNF therapy.(Infectious Diseases)
Dec 01, 2007; ... Patients taking anti-tumor necrosis factor-[alpha] medications show somewhat impaired antibody response to influenza vaccination, but there is no decrease in the proportion of patients achieving a protective titer. A study, by Dr. L.B.S. Gelinck of Leiden (the Netherlands) ...
Flu shot rates are low among high-risk teens.(Infectious Diseases)
Dec 01, 2007; ... SAN DIEGO -- The number of adolescents with asthma and other high-risk conditions who received the influenza vaccine increased between 1992 and 2002, but the coverage remains poor at about 15% overall, results from a large health maintenance organization study showed. "About ...
ACIP clarifies its suggestions for PCV7 catch-up.(Infectious Diseases)(Advisory Committee on Immunization Practices)(pneumococcal conjugate vaccine)(Brief article)
Dec 01, 2007; ... ATLANTA -- Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices ...
STD rates continue to increase in select groups.(Infectious Diseases)(sexually transmitted diseases)
Dec 01, 2007; ... Rates of chlamydia, gonorrhea, and syphilis increased in the United tares during the past year and continued recent upward trends, according to a report from the Centers for Disease Control and Prevention "Young women, racial and ethnic populations, and men who have sex with men ...
Two- and three-dose PCV7 schedules aren't equivalent.(Infectious Diseases)(pneumococcal conjugate vaccine)
Dec 01, 2007; ... CHICAGO -- Trimming the septivalent pneumococcal conjugate vaccine schedule from three prebooster doses to two may leave children more vulnerable to infection, according to data presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. "Our study ...
Risk-based SCC subtype classification is proposed.(Skin Disorders)(squamous cell carcinoma)
Dec 01, 2007; ... MONTEREY, CALIF. -- Cutaneous squamous cell carcinoma can take many forms, with vastly different biologic behaviors and risk profiles. Yet, "with relatively few exceptions, they have a tendency to simply be lumped by the nondermatologist clinician, the general surgeon, and the ...
Tracking actinic keratoses: here, there, nowhere.(Skin Disorders)
Dec 01, 2007; ... AMSTERDAM -- The natural history of actinic keratoses involves high turnover and far greater lability than generally recognized, according to a first-of-its-kind study. "When you count three or four AKs on a person at time zero and come back and find three or four at time one, ...
Social rhythm therapy prevents bipolar episodes.(Mental Health)
Dec 01, 2007; ... VIENNA -- A psychosocial intervention aimed at instilling greater regularity of daily routines in patients with bipolar disorder effectively protects against recurrences of both mania and depression, Ellen Frank, Ph.D., said at the annual congress of the European College of ...
Tools aim to streamline child mental services.(Mental Health)
Dec 01, 2007; ... SAN FRANCISCO -- There's no quick way around the barriers faced by children who need mental health care, so pediatricians are developing a string of strategies to improve delivery of mental health services, Dr. Jane M. Foy said. These strategies offer primary care physicians ...
Breast cancer risk high in Hodgkin's survivors.(Women's Health)
Dec 01, 2007; ... LOS ANGELES -- Increased risk of breast cancer after successful treatment for Hodgkin's lymphoma "definitely exists," and is very much a matter of time, according to a researcher who reviewed records for 248 women cured of Hodgkin's lymphoma from 1964 through 2001. Women who ...
Increasing folic acid supplementation.(Drugs, Pregnancy, And Lactation)
Dec 01, 2007; ... This month, the Society of Obstetricians and Gynecologists of Canada is releasing new guidelines on folic acid supplementation in pregnant women, recommending prenatal vitamins that include 5 mg of folate in certain patients. Unless providers can ensure excellent daily compliance with the ...
Ginger, vitamin [B.sub.6] ease nausea in pregnancy.(Women's Health)
Dec 01, 2007; ... SAN FRANCISCO -- Multiple clinical trials have shown that both ginger and vitamin [B.sub.6] can safely help reduce the nausea and vomiting of "morning sickness" in pregnancy. Cathi Dennehy, Pharm.D., reviewed the evidence for the efficacy and safety of the two supplements at a ...
Bazedoxifene may not harm the endometrium.(Women's Health)(Brief article)
Dec 01, 2007; ... Bazedoxifene, a novel selective estrogen-receptor modulator, is as safe as placebo in terms of effects on the endometrium and promises to be an excellent new therapy for the prevention and treatment of postmenopausal osteoporosis, Dr. David F. Archer said at the annual meeting of the North ...
Combo asthma therapies may deliver same control.(Pulmonary Medicine)
Dec 01, 2007; ... CHICAGO -- Equivalent or better asthma control using combination therapy may be achieved with less budesonide/formoterol than with fluticasone/salmeterol in the first year of use, Samy Suissa, Ph.D., said at the annual meeting of the American College of Chest Physicians, He and ...
Infliximab cuts ulcerative colitis colectomy rate.(Digestive Disorders)(Clinical report)
Dec 01, 2007; ... PHILADELPHIA -- Patients with moderate to severe ulcerative colitis treated with infliximab had their colectomy rate cut by more than a third during the first year of treatment, compared with control patients, according to a review of more than 600 patients enrolled in two pivotal studies ....
Number of adenomas, rather than size, are predictors of colonic recurrence risk.(Digestive Disorders)
Dec 01, 2007; ... PHILADELPHIA -- A finding of three or more adenomas on colonoscopy was the strongest predictor of identifying high-risk individuals on follow-up colonoscopy in a review of 800 patients with colonic adenomas identified during their baseline examination. Those are individuals that harbor ...
Mesalamine, folic acid cut cancer risk in IBD.(Digestive Disorders)
Dec 01, 2007; ... PHILADELPHIA -- Treatment with either folic acid or mesalamine was linked to about a 90% reduction in the incidence of colorectal cancer in a case-control study including 48 patients with inflammatory bowel disease. Both agents "appear to be very promising cancer ...
Methotrexate not best option for psoriatic arthritis.(Musculoskeletal Disorders)
Dec 01, 2007; ... BOSTON -- Rheumatologists need to rethink their reflex to prescribe methotrexate for psoriatic arthritis given mounting data showing that anti-tumor necrosis factor agents are more effective for this indication, Dr. Christopher Ritchlin said at a rheumatology conference sponsored by ...
Combo helps early RA patients attain remission.(Musculoskeletal Disorders)
Dec 01, 2007; ... BOSTON -- Half of patients with early rheumatoid arthritis treated with a combination of etanercept and methotrexate achieved disease remission within 1 year in the first major trial to use remission as the primary end point, Dr. Paul Emery reported in a late-breaking abstract session at ...
Disability in obese elderly is rising, not declining.(Obesity)
Dec 01, 2007; ... Some types of disability are increasing in older obese Americans, even though recent improvements in cardiovascular health care have reduced the risk of disability in older normal-weight people, according to researchers at the University of Pennsylvania, Philadelphia. Data from ...
Low-carb diet may be best in type 2.(Obesity)
Dec 01, 2007; ... NEW ORLEANS -- A low-carbohydrate diet, which used to be the only treatment for diabetes before the advent of insulin, may turn out to be the preferred diet for overweight individuals with type 2 diabetes, researchers said at the annual meeting of NAASO, the Obesity Society. In ...
Vascular dysfunction and preeclampsia.(Clinical Capsules)(Brief article)
Dec 01, 2007 ... Women with type 1 diabetes who are going to develop preeclampsia during pregnancy have signs of vascular dysfunction early in the pregnancy, according to Danish researchers who followed 83 women. The researchers measured a number of markers of maternal vascular function in the ...
Racial disparities in diabetes control.(Clinical Capsules)(Brief article)
Dec 01, 2007 ... The disparity in glycemic control between white Americans and those of other ethnic groups may be strongly related to unexplored issues such as medication nonadherence and diabetes-related emotional stress, according to Dr. Michele Heisler of the Veterans Affairs Ann Arbor Healthcare ...
Depression erodes health scores.(Clinical Capsules)(Survey)(Brief article)
Dec 01, 2007 ... Depression is more disabling than four other chronic conditions--angina, arthritis, asthma, and diabetes, reported Saba Moussavi, Ph.D., and colleagues in the World Health Organization's Department of Measurement and Health Information Systems. And when it is comorbid with any ...
CKD more pervasive than thought, and increasing.(Clinical Rounds)
Dec 01, 2007; ... The prevalence of chronic kidney disease in the general U.S. population is higher than was previously estimated and has increased in recent years, reported Dr. Josef Coresh of Johns Hopkins University, Baltimore, and his associates. With the most recent data available from the ...
RAS blockade can help reduce cardiac, renal events in kidney disease patients.(Clinical Rounds)
Dec 01, 2007; ... CHICAGO -- Routine use of renin angiotensin system blockers is indicated in patients with chronic kidney disease as part of a strategy to reduce cardiovascular and renal events, Dr. Matthew Weir said at the annual meeting of the American Society of Hypertension. Patients with ...
Fish oil improves heart risk markers in dialysis patients.(Clinical Rounds)
Dec 01, 2007; ... ORLANDO -- Giving hemodialysis patients oral fish oil supplements boosts their red blood cell fatty acid levels and may afford them protection against cardiovascular disease by improving serum levels of cardiovascular risk markers, according to a poster presented at a meeting sponsored by ...
Kucinich is lone candidate for a single-payer system.(Practice Trends)
Dec 01, 2007; ... WASHINGT0N -- Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas--such as the Iraq war. "Health care spending does not occur in a vacuum," Rep. Kucinich said at a forum on health care policy ...
Work-based coverage cuts take toll.(Policy & Practice)(Brief article)
Dec 01, 2007; ... The number of uninsured Americans rose by nearly 9 million, from 38 million in 2000 to 47 million in 2006, mostly as a result of a decline in employer-provided health coverage for workers and their families, according to an analysis by the Economic Policy Institute. Although the affected ...
Patent losses choke drug sales.(Policy & Practice)
Dec 01, 2007; ... The growth of pharmaceutical sales in the United States is expected to increase by 4%-5% next year, a historic low, according to a report by IMS Health Inc. The Norwalk, Conn.-based research firm attributed the slowdown to a leveling of the growth triggered by the Medicare Part D program, ...
Bill aims to boost OTC oversight.(Policy & Practice)(over-the-counter )(Brief article)
Dec 01, 2007; ... Another bill introduced by Rep. Waxman and Sen. Kennedy, along with Rep. Tom Allen (D-Maine), would give the FDA the authority to quickly amend or appeal over-the-counter drug monographs without being required to pursue notice and comment rulemaking, as required under the Administrative ...
Data on elderly glossed over.(Policy & Practice)(Brief article)
Dec 01, 2007; ... Food and Drug Administration regulations for drug makers conducting clinical trials encourage the inclusion of elderly participants and the reporting of data by age, but the agency is not effective in getting its medical officers to include data on elderly patients in their new drug ...
Depression no. 2 in disability days.(Policy & Practice)(Brief article)
Dec 01, 2007; ... Major depression accounts for the second-largest number of days lost to disability in the United States--387 million days a year at the population level, second only to back and neck pain, at 1.2 billion days--according to a study by Harvard University and National Institute of Mental ...
Pregnant women eschew meds.(Policy & Practice)
Dec 01, 2007; ... A minority of women believe it is safe to take depression medication while they are pregnant, according to a survey by the Society for Women's Health Research. The survey of 1,000 women was conducted by telephone in October; 500 family physicians, general practitioners, and internists were ...
Beware of direct-to-consumer testing.(Genomic Medicine)
Dec 01, 2007; ... The American consumer seems to be growing weary of TV advertisements for erectile dysfunction drugs. Yet the adverts have not gone away. No surprise--they sell product, and often, to individuals who really don't need the medications. Now get ready for a new round of discussions with your ...
EHR alerts boost vaccination rates in urban kids.(Practice Trends)
Dec 01, 2007; ... Building clinical alerts and recommendations into electronic health records significantly improved immunization rates for inner-city children in a primary care network affiliated with the Children's Hospital of Philadelphia. During the first year the system was in place, ...
Should you do this deal?(The Office)
Dec 01, 2007; ... If you've ever wondered whether you should buy a DXA machine or start offering botox in your practice, read on: Learning how to calculate the net present value of that venture would go a long way toward helping you figure out if it's truly a good move. For all their training and ...
Paging Dr. Fabio.(Indications)(Brief article)
Dec 01, 2007; ... The Bureau of Indications knows truth is stranger than fiction. That's why we love a new study exploring the plot of medical romance novels for clues about "the romantic possibilities of primary care settings and the apparent inevitability of uncontrolled passions in the context of ...