Family Practice News back issues from March 2008:
'Help me die' calls for swift response.(Clinical Rounds)
Mar 01, 2008; ... [ILLUSTRATION OMITTED] TAMPA -- A patient's request for a hastened death--either an explicit request or a hint--should be considered a clinical emergency that offers an important therapeutic opportunity. "When you're in the office and somebody asks, 'Doctor, will you ...
Financial rewards proposed for FPs in medical homes: bonuses of up to $100,000 to be awarded.(Practice Trends)
Mar 01, 2008; ... One of the nation's largest health care quality coalitions is launching a program that would provide bonuses of up to $100,000 annually to physicians who meet criteria showing that they are offering coordinated care by providing a medical home for their patients. Announced by ...
Asthma guidelines spell out treatment in pregnancy.(Women's Health)
Mar 01, 2008; ... The ultimate goal of asthma therapy in pregnancy is to maintain adequate oxygenation of the fetus by preventing hypoxia in the mother, and that requires step therapy medical management with the lowest possible doses of medication, according to new clinical management guidelines from the ...
Vital signs.(Table)(Brief article)
Mar 01, 2008 ... <Pre> VITAL SIGNS Top Five Most Expensive Therapeutic Classes Of Prescribed Drugs (in billions of dollars) Metabolic$35.6 ...
HIV infected face new challenges.(News)
Mar 01, 2008; ... BOSTON -- The increased survival among HIV-infected children seen with effective prevention of perinatal transmission and the widespread adoption of highly-active antiretroviral therapy has been accompanied by the emergence of a new generation of clinical, public health, and social ...
Congress scrutinizes uses for growth hormone.(News)
Mar 01, 2008; ... WASHINGTON -- Congress is taking a tough look at the use of human growth hormone for a wide variety of conditions, which is prompting some concern that payers may react by limiting reimbursement for legitimate purposes. Insurers are already reluctant to cover scientifically ...
Concerns about off-label use may derail approval of IV iron.(NEWS FROM THE FDA)
Mar 01, 2008; ... SILVER SPRING, MD. -- Concerns about off-label use and a mortality safety signal associated with treatment in clinical trials swayed a federal advisory panel against supporting the approval of ferric carboxymaltose injection (Injectafer), a new intravenous iron product, as a first-line ...
Antiepileptics' labels likely to include suicidality risks.(NEWS FROM THE FDA)
Mar 01, 2008; ... WASHINGTON -- Food and Drug Administration findings of an increased risk of suicidality in patients given antiepileptic drugs likely will lead to broad class labeling changes, according to an FDA alert issued to health care professionals. The agency plans to discuss the data at ...
Asmanex Twisthaler, Moxatag.(New & Approved)
Mar 01, 2008; ... Asmanex Twisthaler (mometasone furoate inhalation powder, Schering-Plough Corp.) The Food and Drug Administration approved Asmanex Twisthaler for once-daily maintenance treatment of asthma in children aged 4-11 years. The agency initially approved this agent for patients aged 12 years and ...
Dietary guidelines implicated in obesity epidemic.(News)
Mar 01, 2008; ... By stressing the importance of a carbohydrate-based, low-fat diet, current U.S. dietary guidelines may have unexpectedly contributed to the current obesity epidemic, according to researchers. In accordance with national recommendations, Americans have slightly reduced their fat ...
Vaccine refusers pose liability issues.(Letters)(Letter to the editor)
Mar 01, 2008; ... Regarding the standardized patients who graded pediatricians on their care, I applaud the physicians who didn't dismiss them because they declined the required/ recommended immunizations, but that wouldn't have been me ("Communication With Vaccine Refusers Could Use Some Work," Jan. 15, ...
Don't suggest cough drops for kids.(Letters)(Letter to the editor)
Mar 01, 2008; ... Regarding the use of honey as a cough suppressant, Dr. James Taylor, described as having "'an interest in complementary medicines," stated that "any soothing cough drop might work equally well" ("Providers Skeptical About Honey for Cough Study Findings," Jan. 15, 2008, p. 19). ...
Heed the call: take On CPT tyrants.(LETTERS)(Letter to the editor)
Mar 01, 2008; ... Like Dr. Robert W. Harrington, I have been complaining about coding since it started ("CPT: Current Procedural Tyranny," Letters, Jan. 1, 2008, p. 9). I have two issues with it: 1. It is very time consuming clerical work. I finished my last clerkship in 1965. I, too, find our ...
Should primary care physicians provide dementia screening? Too many patients go undiagnosed.(Point/Counterpoint)
Mar 01, 2008; ... Alzheimer's disease affects more than 5 million Americans and is the fourth-leading cause of death in the United States. Yet by many accounts, only 50% of the cases are diagnosed, and only 25% of patients receive the medication they need. In 40 years, more than 15 million Americans may ...
Should primary care physicians provide dementia screening? The evidence for screening is weak.(Point/Counterpoint)
Mar 01, 2008; ... At first glance, dementia screening appears likely to be beneficial. But advocates of population-based dementia screening fail to take into account medicine's prime directive: First, do no harm. Screening would indeed identify more Alzheimer's patients earlier. But what then? A ...
Vitamin D, heart dysfunction tied in thalassemia.(Cardiovascular Medicine)(Clinical report)
Mar 01, 2008; ... ATLANTA -- Vitamin D deficiency was strongly associated with high cardiac iron and increased ventricular dysfunction in a retrospective review of 24 young thalassemia major patients. A review of their medical records showed levels of vitamin D(25[OH]D), the predominant ...
Steps taken to avert pending shortage of cardiac surgeons.(Cardiovascular Medicine)
Mar 01, 2008; ... SNOWMASS, COLO. -- The pipeline of future cardiac surgeons is "essentially nonexistent," which will have serious consequences not only for the surgical specialty but for cardiologists and all others who provide care for patients with heart disease. "When I began my cardiac ...
Heart failure deemed driving force in excess mortality in RA.(Cardiovascular Medicine)
Mar 01, 2008; ... SNOWMASS, COLO. -- Heart failure is a major contributor to the excess mortality in patients with rheumatoid arthritis, Dr. Sherine E. Gabriel said at a symposium sponsored by the American College of Rheumatology. Rheumatoid arthritis (RA) patients have twice the risk of ...
Aspirin resistance attributed to noncompliance.(Cardiovascular Medicine)
Mar 01, 2008; ... ATLANTA -- Noncompliance is the main cause of aspirin resistance, according to investigators who studied aspirin response in 230 people, most of whom had a history of myocardial infarction. The study initially classified up to 30% of the participants as aspirin resistant, but in ...
Rebound effect evident after halting clopidogrel.(Cardiovascular Medicine)
Mar 01, 2008; ... The risk of myocardial infarction or death spikes during the 90 days after clopidogrel therapy is discontinued among patients treated for acute coronary syndromes, especially those treated medically. Clustering of adverse coronary events has been reported after cessation of ...
Idraparinux causes more bleeding than vitamin K antagonists.(Cardiovascular Medicine)
Mar 01, 2008; ... Long-term treatment with idraparinux is as effective as vitamin K antagonists for preventing thromboembolism in patients with atrial fibrillation, but it causes significantly more bleeding. Those results, from the Sanofi Aventis--funded multinational open-label AMADEUS trial, ...
Warfarin may do harm unless target is met and maintained.(Cardiovascular Medicine)
Mar 01, 2008; ... ORLANDO -- Patients with atrial fibrillation who are treated with warfarin must be in their target anticoagulation range at least 50% of the time to get a net benefit from treatment. The longer a patient stays in the target anticoagulation range the better, but when target ...
High OGTT in pregnancy ups later diabetes risk.(Metabolic Disorders)
Mar 01, 2008; ... Women who have an abormal glucose tolerance test result during pregnancy but do not develop gestational diabetes still face an increased risk of developing type 2 diabetes later on. The retrospective study showed that even modestly elevated glucose levels double the risk of ...
Adjustable gastric banding beats conventional diabetes treatment.(Metabolic Disorders)
Mar 01, 2008; ... Laparoscopic adjustable gastric banding produced a 76% remission rate in the first randomized trial to compare the surgery against conventional treatment in obese patients with recent-onset type 2 diabetes. "After 2 years, the surgical group displayed a 5 times higher remission ...
Diet soda strongly associated, with the metabolic syndrome.(Metabolic Disorders)
Mar 01, 2008; ... Diet soda, meat, and fried foods are associated with the development of metabolic syndrome, researchers from the Atherosclerosis Risk in Communities Study reported. The study, which gathered dietary information on 9,514 individuals, then followed them for 9 years, found that the ...
Ideal add-on to metformin therapy is still unclear.(Metabolic Disorders)
Mar 01, 2008; ... A meta-analysis has failed to clarify whether one drug is better than another when added to metformin in patients with type 2 diabetes. Sulfonylureas and ct-glucosidase inhibitors, and possibly glinides, seem to have about equal efficacy when used as add-ons to failed metformin ...
Bone fracture, metformin use not associated.(Metabolic Disorders)(Brief article)
Mar 01, 2008; ... Use of metformin to treat patients with type 2 diabetes shows no association with bone fractures. Long-term insulin use also showed no association with fractures, whereas current treatment with insulin was associated with an increase in the risk of fractures in men but not in ...
Diabetic teens often underestimate their weight: adolescents who did not recognize they had a weight problem were less likely to eat well and exercise.(Metabolic Disorders)
Mar 01, 2008; ... More than half of adolescents with type 2 diabetes underestimate their weight, and so do their parents, according to results from interviews with 104 child-parent pairs. "Clinicians should recognize that even extremely overweight children and their parents may not accurately ...
Intensive therapy is found to lower mortality by 20% in type 2 patients.(Metabolic Disorders)
Mar 01, 2008; ... Intensive intervention for type 2 diabetes, which addressed microalbuminuria, cholesterol, triglycerides, and blood pressure in addition to glucose control, reduced the risk of death by 20% over the course of 13 years in a Danish study. Diabetes patients with persistent ...
Hyperuricemia named a risk factor for type 2 diabetes.(Metabolic Disorders)(Brief article)
Mar 01, 2008; ... High serum uric acid level is an independent risk factor for the development of type 2 diabetes, according to data from a large population-based study. In a study of 4,536 people who were free of diabetes at baseline, those who had serum uric acid levels that were in the top ...
Postprandial glucose rise linked to cardiac risk.(Metabolic Disorders)
Mar 01, 2008; ... The blood glucose excursion that patients with type 2 diabetes experience after a meal correlates strongly with their carotid intima-media thickness, a marker for cardiovascular disease, reported Italian researchers in a large, ongoing study. The research also showed that the ...
Acute sore throat? Think retropharyngeal abscess.(Infectous Diseases)
Mar 01, 2008; ... Consider a retropharyngeal abscess when faced with a drooling child who has a severe sore throat, according to Dr. Marisol Figueira of Boston University. Retropharyngeal abscess is a common pathology secondary to acute throat infection, Dr. Figueira said in an interview. "'It is ...
Risk behaviors drive up HIV in adolescents.(Infectous Diseases)
Mar 01, 2008; ... BOSTON -- The adolescent HIV-1 epidemic as reflected in a multisite cohort of U.S. youth is changing from one of vertically transmitted infection to one where infection is acquired through risk behaviors, posing new challenges for providers and the health care system, said Dr. Allison L ....
Vaccine mercury rapidly exits infants' systems.(Infectous Diseases)
Mar 01, 2008; ... Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, according to study results. The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental ...
MMR shot not linked to autism, large study shows.(Infectous Diseases)
Mar 01, 2008; ... Children with autism spectrum disorder had no greater immune response to the measles virus or the measles component of the measles, mumps, and rubella vaccine than did children without the disorder in a large case-control study. British researchers said their community sample ...
Production delays tie up Vaqta vaccine.(Infectous Diseases)
Mar 01, 2008; ... A Production delay has caused Merck & Co. to temporarily stop accepting orders for the pediatric and adult vial formulations of Vaqta, the hepatitis A vaccine. It is estimated that the pediatric formulation of Vaqta will be available in the early third quarter of 2008 while the ...
Melanoma incidence in children is on the rise.(Skin Disorders)(Clinical report)
Mar 01, 2008; ... ORLANDO -- Cancer already kills more children aged 1-14 years than does any other disease, and the incidence of childhood melanoma in the United States is on the rise, Dr. Jane M. Grant-Kels said at the annual meeting of the Florida Society of Dermatologic Surgeons. A 2007 study ...
Ustekinumab aids long-term control of psoriasis.(Skin Disorders)
Mar 01, 2008; ... SAN ANTONIO -- Long-term, continuous use of ustekinumab for maintenance therapy in patients with moderate to severe plaque psoriasis is efficacious and generally well tolerated, according to phase III study findings reported at the annual meeting of the American Academy of Dermatology. ...
History, physical are cornerstones of melanoma follow-up.(Skin Disorders)
Mar 01, 2008; ... SAN DIEGO -- When it comes to follow-up surveillance of melanoma patients, history and physical examination remain the cornerstone of good care, with little solid evidence to support anything else. "The literature on this aspect of melanoma management is incomplete, mainly ...
Evidence mounts on pediatric anxiety disorders.(Mental Health)(Disease/Disorder overview)
Mar 01, 2008; ... NEW YORK -- When treating first-time, uncomplicated cases of anxiety in children and adolescents, it's usually best to start with a 6- to 12-week trial of psychosocial treatment, Dr. Moira Rynn said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent ...
Track lipids, glucose with atypical antipsychotic use.(Mental Health)
Mar 01, 2008; ... NEW YORK -- Taking baseline measurements of fasting blood glucose, lipids, weight, and waist circumference and monitoring those measures are essential to the early identification of metabolic complications in patients taking atypical antipsychotics, Dr. Harold E. Carlson said. ...
Peer support cuts risk of postpartum depression: mothers who received a telephone-based intervention were two times less likely to become depressed.(Mental Health)
Mar 01, 2008; ... MONTREAL -- Mother-to-mother support can significantly reduce the development of postpartum depression in women who are at high risk for the condition, Cindy-Lee Dennis, Ph.D., said at the annual conference of the Canadian Psychiatric Association. "Meta-analyses and predictive ...
Older women's depression burden heavier than men's.(Mental Health)
Mar 01, 2008; ... The burden of depression is disproportionately higher among older women than older men because of their greater susceptibility to depression and--once depressed--their greater tendency to have persistent depression and their lower probability of death, suggest the results of a lon ...
Prozac no better than placebo in teens with substance abuse issues.(Mental Health)
Mar 01, 2008; ... BOSTON -- Fluoxetine is not an effective treatment for depression in adolescents with comorbid substance-related disorders, suggest results of a placebo-controlled trial presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry. Previous studies ...
Comprehensive treatment essential for vulvodynia.(Women's Health)
Mar 01, 2008; ... SAN FRANCISCO -- Vulvodynia so profoundly affects quality of life that management needs to address the physical, psychological, sexual, and relationship problems caused by the pain. "Support, support, support" patients with vulvodynia by reassuring them that they're not crazy ...
Coagulation factors may predict the risk of thrombosis from HT.(Women's Health)
Mar 01, 2008; ... ATLANTA -- Women who opt for hormone therapy to ease their discomfort from hot flashes and other menopausal symptoms often do so without knowing their risk of developing adverse effects. Now, data from the Women's Health Initiative trials of hormone therapy (HT) may help women ...
Nonhormonal therapy eases postmenopausal hot flashes.(Women's Health)
Mar 01, 2008; ... Treatment with desvenlafaxine succinate, an experimental nonhormonal therapy, continues to reduce the frequency and severity of moderate to severe hot flashes out to 26 weeks. The drug, a selective serotonin norepinephrine reuptake inhibitor (SNRI), has been shown to be ...
Exposure to monoclonal antibodies.(Drugs, Pregnancy, And Lactation)
Mar 01, 2008; ... Excluding those classified as orphan drugs, there are 10 monoclonal antibodies currently used to treat cancer, asthma, or rheumatoid arthritis. Five are composed of various types of humanized immunoglobulin G (IgG) and two of murine IgG. The approved indications include leukemia, ...
Obesity-related biomarkers obscure PSA findings.(Men's Health)
Mar 01, 2008; ... ATLANTA -- Elevated C-peptide and hemoglobin [A.sub.1c] levels were associated with low levels of prostate-specific antigen in obese, nondiabetic black and white men in a cross-sectional study. PSA levels were approximately 50% lower among black men with higher levels of ...
Brachytherapy is of benefit in young prostate cancer patients.(Men's Health)
Mar 01, 2008; ... LOS ANGELES -- Contrary to conventional wisdom among many urologists, brachytherapy is a good option for younger prostate cancer patients, according to investigators who reviewed outcomes for 1,763 men treated with radiation seed implants. Five years after treatment, men 60 ...
Direct talk, practical advice help put prostate cancer in perspective.(Men's Health)
Mar 01, 2008; ... WASHINGTON -- "You're not going to die of prostate cancer." That's the first thing Dr. Tanya B. Dorff, a specialist in genitourinary oncology, tells most of the patients with localized prostate cancer who are referred to her. That simple sentence "opens the mind to receive all ...
Obesity derails RA remission; infliximab helps.(Musculoskeletal Disorders)
Mar 01, 2008; ... BOSTON -- Overweight patients with early rheumatoid arthritis were less likely to achieve remission during treatment with conventional disease-modifying drugs than were those with a normal body mass index. Overweight and obese patients fared better on a regimen that included ...
Variability key to lumbar diagnosis.(Musculoskeletal Disorders)
Mar 01, 2008; ... SNOWMASS, COLO. -- The neurogenic or pseudoclaudication symptoms characteristic of lumbar spinal stenosis can be distinguished from peripheral vascular disease by their day-to-day variability, Dr. Zacharia Isaac said at a symposium sponsored by the American College of Rheumatology. ...
Follow-up after colon cancer surgery falls short.(Digestive Disorders)(Brief article)(Clinical report)
Mar 01, 2008; ... ORLANDO -- Most colorectal cancer patients who undergo potentially curative resection of their tumors after age 65 do not receive the follow-up care recommended by clinical practice guidelines, the results of a large population-based study suggest. Follow-up fell short in 74% of ...
Hepatectomy of benefit in elderly cancer patients.(Digestive Disorders)
Mar 01, 2008; ... ORLANDO -- Liver resection of colorectal metastases was associated with good long-term survival among patients over age 70 years in an analysis based on 20 years of data from an international registry Five-year survival after surgery was 37% in a cohort of 729 patients aged 70 ...
Colon cancer screening helps patients over 80.(Digestive Disorders)
Mar 01, 2008; ... ORLANDO -- Colorectal cancer screenhag plays an important role in cancer prevention and detection, not just in the "young-old," but also in the "old-old"--people in their eighties and beyond. And if a cancer is found, the elderly can also derive considerable benefit from ...
Drug combo yields better weight loss.(Obesity)
Mar 01, 2008; ... NEW ORLEANS -- Combination-therapy with bupropion and naltrexone resulted in superior weight loss, compared with placebo or either drug alone, Dr. Frank L. Greenway said at the annual meeting of NAASO, the Obesity Society. Patients randomized to the experimental ...
Pediatric programs emphasize lifestyle changes.(Obesity)
Mar 01, 2008; ... Two programs developed by Children's Healthcare of Atlanta successfiflly promote healthier lifestyles in children, and one of the programs specifically targets prevention of type 2 diabetes. Fit Kids is a program for overweight children aged 6-12 years and their families. Since ...
Alcohol abuse treatment depends on age at onset.(Geriatric Medicine)
Mar 01, 2008; ... CORONADO, CALIF. -- One decisive factor that sets older adults who abuse alcohol apart from their younger counterparts is a generally lower level of tolerance for the substance. "'They may have problems with lower intake due to the increased sensitivity to the alcohol, and ...
Auditory exercises improved memory in seniors.(Geriatric Medicine)
Mar 01, 2008; ... SAN FRANCISCO -- An auditory training program designed to improve brain plasticity bestowed the side benefit of improved memory in a randomized, controlled, double-blind trial in 468 adults older than 65 years with normal cognition. The study is one of the first to show ...
Index guides discharge after pulmonary embolism.(Pulmonary Medicine)
Mar 01, 2008; ... CHICAGO -- The Pulmonary Embolism Severity Index provides clinicians with a useful tool for selecting patients with acute pulmonary embolism for outpatient therapy, Col. Lisa K. Moores, MC USA, said. Recent evidence suggests that many patients presenting in the emergency ...
MRI could rival chest x-ray in pediatric lung disease assessment.(Pulmonary Medicine)(magnetic resonance imaging)
Mar 01, 2008; ... CHICAGO -- Optimized low-field magnetic resonance imaging has the potential to replace plain chest radiographs in the assessment of lung disease in children, according to results of a poster study presented at the annual meeting of the Radiological Society of North America. "The ...
Reasons for quitting smoking depend on the patient's age.(Pulmonary Medicine)(Report)
Mar 01, 2008; ... CHICAGO -- Older smokers are motivated to quit smoking by very different factors than are younger smokers, and tailoring cessation services to recognize these unique differences can improve quit rates, Virginia Reichert, N.R, said at the annual meeting of the American College of Chest ...
Printed forms ease primary care, oncology collaboration.(Clinical Rounds)
Mar 01, 2008; ... WASHINGTON -- Collaboration between primary care physicians and oncologists can ensure seamless care for cancer patients, according to a hematologist and a family practice physician who gave a joint presentation at the annual Community Oncology Conference. Routine use of printed ...
ESRD cases in U.S. to rise 60% during 2005-2020.(Clinical Rounds)(end-stage renal disease )(Brief article)
Mar 01, 2008; ... SAN FRANCISCO -- There will be an estimated 785,000 U.S. patients with end-stage renal disease by 2020, an increase of more than 60% from 2005 levels, according to a report presented at the annual meeting of the American Society of Nephrology. This represents a decrease of ...