Family Practice News back issues from December 2008:
Wilderness course recharges students.(News)
Dec 01, 2008; ... [ILLUSTRATION OMITTED] WESTPORT, N.Y. -- For 30 long minutes, they continued chest compressions, but the patient--who had been struck by lightning and suffered a pneumothorax, head trauma, and then cardiac arrest--was nonresponsive. The physician in charge looked ...
Vascular events reduced by CRP screening, therapy: risk revealed in presumably healthy people.(Cardiovascular Medicine)(C-reactive protein)
Dec 01, 2008; ... NEW ORLEANS -- Rosuvastatin reduced the risk of major cardiovascular events in healthy persons with elevated levels of high-sensitivity C-reactive protein but normal LDL cholesterol levels in a study of nearly 18,000 patients. "In individuals not currently qualifying for ...
Federal report recognizes Gulf War illness, causes.(News)
Dec 01, 2008; ... It's been a long time coming for veterans whose health complaints have been met with skepticism, but a federal panel has determined that Gulf War syndrome is not only real, it is tied to two causes: exposure to pyridostigmine bromide and certain pesticides during the 1990-1991 Persian Gulf ...
Studies support bariatric surgery in the elderly.(News)
Dec 01, 2008; ... SANTA FE, N.M. -- Contrary to an alarming 2005 report, two new studies have found that bariatric surgery is safe and produces good outcomes in obese Medicare and elderly patients. The first study, a retrospective series of 76 patients at Case Western Reserve University in ...
Exercise deemed safe, improves outcomes in heart failure.(News)
Dec 01, 2008; ... NEW ORLEANS -- In the largest study of exercise training as part of the management of heart failure to date, a guided exercise program was safe and modestly effective, although investigators acknowledged that patients found it hard to keep up the routine. The safety of exercise ...
Do the JUPITER results warrant broader screening for C-reactive protein? hsCRP could be a useful screening tool.(Point / Counterpoint)(Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin)
Dec 01, 2008; ... The results from the recent JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial demonstrated that high-sensitivity C-reactive protein (hsCRP) tests were strikingly effective at identifying patients whose cardiovascular event and ...
Do the JUPITER results warrant broader screening for C-reactive protein? Absolute risk demands a more thoughtful approach.(Point / Counterpoint)(Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin)
Dec 01, 2008; ... While the association between high-sensitivity CRP and coronary heart disease has been proved with excellent and robust science, we must pause before using hsCRP widely as a clinical screening tool. Many are hailing JUPITER as evidence for initiation of cholesterol therapy in a ...
Health care is not a commodity.(Letter to the editor)
Dec 01, 2008; ... Dr. Steven Kreisman argues that the assumption of health care as a "'right" is a morally untenable premise that is responsible for the current quagmires of the American health care system ("Health Care Must Be Earned," Letters, July 15, 2008, p. 12). He also asserts that ...
Congenital heart disease guidelines target adults.(Cardiovascular Medicine)
Dec 01, 2008; ... The unique lifetime care needs of adults with congenital heart disease--particularly young adults who are making the transition out of pediatric cardiology care--are the focus of new practice guidelines released jointly by the American College of Cardiology and the American Heart ...
In RA patients, cardiovascular risk matches type 2 diabetes.(Cardiovascular Medicine)
Dec 01, 2008; ... SAN FRANCISCO -- Patients who have rheumatoid arthritis should be assessed annually for cardiovascular risk factors, a recommendation necessitated by a heart disease risk profile that equates to that of those with type 2 diabetes, a European task force concluded. "Cardiovascular ...
Restrictions on ranolazine's label lifted, cuts [HbA.sub.1C].(Cardiovascular Medicine)
Dec 01, 2008; ... The Food and Drug Administration has approved a revised indication and several label additions for the angina drug ranolazine, including a statement that the drug reduced hemoglobin [A.sub.1c] in people with diabetes. The indication is still for "the treatment of chronic angina, ...
Novel thyroid mimetics may play expanded role.(Metabolic Disorders)
Dec 01, 2008; ... CHICAGO -- A new generation of oral selective thyroid hormone receptor agonists shows promise for the treatment of dyslipidemia, obesity, and metabolic syndrome. For one of these agents, 3,5-di-iodothyropropionic acid (DITPA), it's a case of one door opening as another slams ...
Strategy eyes heart disease and diabetes.(Metabolic Disorders)(Endocrine Society's guidelines)
Dec 01, 2008; ... A new clinical practice guideline from he Endocrine Society provides strategies for keeping type 2 diabetes and cardiovascular disease at bay in adults with metabolic syndrome. "This guideline focuses on [those] with the components of the metabolic syndrome who do not yet have ...
Type 2 among youths triples cardiovascular risks.(Metabolic Disorders)
Dec 01, 2008; ... ROME -- Youth with type 2 diabetes had an average of nearly three cardiovascular risk factors each, compared with just one in healthy controls in an analysis of 295 participants in a large, multicenter, U.S. case-control study. The data come from 106 patients with type 2 ...
Exenatide plus metformin improves metabolic, hormonal status in PCOS.(Metabolic Disorders)(polycystic ovary syndrome)
Dec 01, 2008; ... ROME -- Treating polycystic ovary syndrome with exenatide plus metformin was more effective than either medication alone in improving menstrual cycle frequency and hormonal and metabolic derangements, a study has found. The findings were presented at the annual meeting of the ...
Oral test tracks level of glucose in PCOS.(Metabolic Disorders)(polycystic ovary syndrome )
Dec 01, 2008; ... ROME -- Oral glucose tolerance testing identified abnormal glucose metabolism in 10% more patients with polycystic ovary syndrome than did fasting glucose tests alone, a study has found. Other clinical and paraclinical factors associated with type 2 diabetes were not highly ...
Gaps seen in doctors' knowledge about HPV shot.(Infectious Diseases)
Dec 01, 2008; ... ATLANTA -- Family physicians and pediatricians are knowledgeable about several key aspects of human papillomavirus epidemiology and have largely adopted use of the HPV vaccine in their practices, but some important knowledge gaps about the disease and vaccine remain, results of a survey ...
Oral rotavirus vaccine yields better-than-expected results.(Infectious Diseases)
Dec 01, 2008; ... WASHINGTON -- Two years after approval of an oral rotavirus vaccine, pediatric rotavirus cases and hospitalizations in U.S. hospitals have decreased dramatically, according to two national studies as well as a number of local analyses. That decline is present in nonvaccinated ...
Hospitals in two states confirm cost savings in wake of vaccine coverage.(Infectious Diseases)(Brief article)
Dec 01, 2008; ... ATLANTA -- Hospital-based data from New York and Texas underscore the importance of rotavirus vaccination for reducing disease burden and related hospitalization rates and costs. The findings were reported at the fall meeting of the Centers for Disease Control and Prevention's ...
Rapid test flags S. aureus, methicillin susceptibility.(Infectious Diseases)(Staphylococcus aureus)
Dec 01, 2008; ... WASHINGTON -- A single-use bacteriophage amplification test kit was able to accurately identify Staphylococcus aureus and determine whether it was methicillin sensitive or resistant within 5 hours in a study of clinical bacteremia isolates. The findings suggest that it is ...
C. gattii emerges in Pacific Northwest, kills four.(Infectious Diseases)(Cryptococcus gattii)
Dec 01, 2008; ... WASHINGTON -- Cryptococcus gattii, a meningitis-causing fungus previously confined to tropical and subtropical climates outside of the United States, has caused severe illness in at least 19 individuals--of whom 4 died--in the Pacific Northwest United States since 2006. The ...
Data sought on atopic dermatitis barrier products.(Skin Disorders)
Dec 01, 2008; ... SAN DIEGO -- Barrier products may play a role as adjuvant therapy for patients with atopic dermatitis, but better studies are needed to show how they fit into the armamentarium. That's the conclusion Dr. Andrew C. Krakowski came to about three barrier products--ceramide-based ...
Think efficacy and toxicity in selecting psoriasis medications.(Skin Disorders)
Dec 01, 2008; ... PARIS -- Nonbiologic systemic drugs can be effective choices for the treatment of psoriasis if they are chosen properly, according to Dr. Jonathan Barker. "The important message is that standard, traditional systemic drugs work," said Dr. Barker at the annual congress of the ...
Escitalopram bests duloxetine for severe major depression.(Mental Health)
Dec 01, 2008; ... CHICAGO -- Severely depressed patients who fail to respond to 2 weeks of escitalopram at 10 mg/day typically do better with uptitration to 20 mg/day for 8 weeks than with a switch to 8 weeks of duloxetine at 60 mg/day, according to a multicenter double-blind randomized clinical trial. ...
Paroxetine tied to sperm DNA fragmentation.(Mental Health)
Dec 01, 2008; ... Use of paroxetine (Paxil) appears to put healthy men at greater risk of sperm DNA fragmentation, according to data from a small study. In a study of 35 healthy male volunteers, SSRI treatment was significantly correlated with increased DNA fragmentation (odds ratio 11.12, P = ...
Cognitive and prolonged exposure therapies beat SSRI for early PTSD.(Mental Health)(selective serotonin reuptake inhibitor, posttraumatic stress disorder)
Dec 01, 2008; ... BARCELONA -- When given within a month of the precipitating event, cognitive therapy and prolonged exposure therapy are equally effective at decreasing the incidence of posttraumatic stress disorder--and both strategies are significantly more effective than treatment with escitalopram, ...
Obesity in black women may signal depression.(Mental Health)
Dec 01, 2008; ... CHICAGO -- The odds of comorbid depression are 41% greater in obese than in non-obese African American women, according to a large national study. Based upon this finding, obese African American women should routinely be screened for depression during office visits, Stephanie ...
Full exam guides ADHD diagnosis in preschoolers.(Mental Health)
Dec 01, 2008; ... CHICAGO -- The diagnosis and treatment of attention-deficit/hyperactivity disorder in preschoolers are tricky, although there is evidence to support the use of stimulants in their treatment, Dr. Alison Schonwald said. Diagnosing children as young as 3 and 4 years is difficult in ...
Avoid empiric treatment for vulvar skin disorders.(Women's Health)
Dec 01, 2008; ... LAKE BUENA VISTA, FLA. -- Empiric treatment with corticosteroids should be avoided in patients who present with vulvar symptoms such as burning, itching, pain, and dyspareunia, according to Dr. Andrew T. Goldstein. These patients should have a careful examination of the vulva ...
As menarche starts earlier, expert reviews 'normal' cycles in teens.(Women's Health)
Dec 01, 2008; ... STANFORD, CALIF. -- A teenage patient complains of "heavy" menstrual periods. Her mother mentions that her daughter never gets periods during soccer season. Should you evaluate the girl for abnormal uterine bleeding? Test your knowledge of what's normal or abnormal ...
Think Behcet's when aphthous ulcers recur.(Women's Health)
Dec 01, 2008; ... LAKE BUENA VISTA, FLA. -- The diagnosis of Behcet's disease must be considered in any patient with recurrent oral and vulvar aphthous ulcers, even if the deep, full-thickness ulcers in the mouth and vulva develop at different times. Behcet's disease is a chronic inflammatory ...
Pulmonary hypertension still high risk in pregnancy.(Women's Health)
Dec 01, 2008; ... PHILADELPHIA -- A Milwaukee cardiologist seems to have defied the textbook on what happens to women who develop pulmonary hypertension while pregnant. The medical literature generally says that about half of these women will die during or soon after delivery if they carry the ...
Cigarette smoking cessation.(Drugs, Pregnancy, And Lactation)
Dec 01, 2008; ... The rate of cigarette smoking during pregnancy has declined to about 11%, but the prevalence is higher in younger (under 20 years) and older (over 35 years) women. Smoking is a significant cause of embryonic, fetal, neonatal, infantile, and adolescent toxicity that includes ...
Psychotherapy shows promise for fibromyalgia.(Musculoskeletal Disorders)
Dec 01, 2008; ... PARIS -- Success rates for nonpharmacologic therapy in patients with fibromyalgia are climbing to previously unattainable levels by tailoring psychotherapy in accord with patient characteristics. It is best to intervene before the physical and psychological impairments have ...
Foot complications found common in psoriatic arthritis.(Musculoskeletal Disorders)
Dec 01, 2008; ... PARIS -- When it comes to psoriatic arthritis, don't forget the feet. The burden of foot pain and deformity is high and the level of foot care provision is low, Deborah E. Turner, Ph.D., reported at the annual European Congress of Rheumatology A big part of the ...
Expert gives the lowdown on diagnosing, assessing back pain.(Musculoskeletal Disorders)
Dec 01, 2008; ... SAN DIEGO -- The good news about low back pain is that it's often self-resolving. The bad news is it tends to reoccur. "One in five people at any time will have low back pain," said Dr. Francis O'Connor, medical director of the Consortium for Health and Military Performance at ...
Prescribed drugs, supplements tied to liver injury: antimicrobials are the most frequent offenders, with some CNS and immunomodulatory agents following.(Digestive Disorders)(central nervous system)
Dec 01, 2008; ... A wide variety of prescription and nonprescription medications and nutritional supplements are at the root of drug-induced liver injury in the United States. Moreover, combinations of potentially hepatotoxic agents, rather than single agents, account for at least 20% of cases ...
Family history is key after a serious gastroesophageal event.(Digestive Disorders)
Dec 01, 2008; ... DENVER, COLO. -- A careful physical examination and history, with special attention to the family history, will detect most infants with gastroesophageal reflux who need an intensive work-up following an apparent life-threatening event, according to a review of 313 cases. ...
Data mixed on anticholinergic use for COPD.(Pulmonary Medicine)
Dec 01, 2008; ... PHILADELPHIA -- Despite recent hints of danger, inhaled anticholinergic drugs remain a mainstay of treatment for many patients with chronic obstructive pulmonary disease. Inhaled anticholinergic drugs such as ipratropium and tiotropium should not be used in patients with chronic ...
Infant acetaminophen use tied to asthma later.(Pulmonary Medicine)
Dec 01, 2008; ... Exposure to acetaminophen may be an important risk factor for the development of asthma later in childhood, according to new data from an international asthma study. In a sample of more than 200,000 children from 31 countries, those children given acetaminophen--known outside ...
Obese lose 14% of weight on novel combo drug.(Obesity)
Dec 01, 2008; ... PHOENIX -- Obese individuals lost 14% of their weight on average at the highest dose in a blinded, randomized, placebo-controlled trial of a novel weight loss drug combining slow-release formulations of the anticonvulsant zonisamide and the antidepressant bupropion. Weight loss ...
Meal replacements double weight loss, support maintenance.(Obesity)
Dec 01, 2008; ... WASHINGTON -- What is a safe, drug-free, and effective method for treating obesity and its comorbidities in patients with diabetes or those who are at risk for it? Tell them to try prepackaged, nutritionally balanced, and calorie-controlled meal replacements. "Meal replacements ...
Model predicts pain in patients with dementia.(Geriatric Medicine)
Dec 01, 2008; ... Many nursing home residents with dementia are at risk for undiagnosed, underestimated, and undermanaged pain because of their difficulty in communicating, but ongoing study suggests that objective assessment of a resident's health status can identify those with dementia who are in pain but ...
Predicting pain in the elderly.
Dec 01, 2008 ... Dr. Christie Teigland noted that men and older residents are less likely to report pain; obese individuals and those with arthritis are more likely to experience pain. Fractures increase the risk of pain by 100%. Numerous risk factors related to incontinence are related to pain ....
Stroke data reassuring on presurgical bisoprolol.(Clinical Rounds)(Clinical report)
Dec 01, 2008; ... MUNICH -- Patients undergoing noncardiac surgery benefited from pre-and postoperative treatment with the f3-blocker bisoprolol and had no excess risk for stroke, based on an analysis of about 2,000 patients who had been enrolled in three separate studies. This finding contrasts ...
Venous thromboembolism risk in cancer patients cut by statins.(Clinical Rounds)(Clinical report)
Dec 01, 2008; ... PHILADELPHIA -- Statin treatment was linked with a significantly reduced risk for venous thromboembolism in a case-control, observational study of 740 patients with solid organ tumors at one center. The next step is to test the role of statin therapy for preventing venous ...
Nonfasting triglyceride levels tied to stroke risk.(Clinical Rounds)
Dec 01, 2008; ... Nonfasting triglyceride levels show a linear correlation with the risk of ischemic stroke, according to a report in JAMA. In a large population-based Danish study with 31 years of follow-up, people with the highest levels of nonfasting triglycerides had a three-to fourfold ...
Retinal thinning may be a window on Parkinson's.(Clinical Rounds)(Clinical report)
Dec 01, 2008; ... SALT LAKE CITY -- The inner and outer layers of the retina were found to be significantly thinner in patients with Parkinson's disease, compared with those found in normal age-matched controls in a study conducted at the SUNY Downstate Medical Center in Brooklyn, N.Y. The ...
Soldiers with TBI face long-term medical, cost challenges.(Clinical Rounds)
Dec 01, 2008; ... SALT LAKE CITY -- Neurologic injuries figure prominently in the 33,409 U.S. soldiers who have been wounded in Iraq, and traumatic brain injury alone or with posttraumatic stress disorder presents a "significant challenge" to the Department of Veterans Affairs, according to Col. Cornelius ...
Rescue techniques may add new risks.(Clinical Rounds)(Brief article)
Dec 01, 2008 ... Some modern life-saving techniques developed in war theaters in Iraq and Afghanistan may actually increase the chance of secondary traumatic brain injury in the first 24 hours after a combat injury, said Dr. Lowenstein. He cited the following interventions as possibly ...
Medicare rule focuses on outpatient imaging, quality.(Practice Trends)
Dec 01, 2008; ... Medicare is making good on a promise to reduce what it sees as runaway costs for certain imaging services in its final rule on hospital outpatient payments for 2009. The Centers for Medicare and Medicaid Services (CMS) also said that it will continue to hold outpatient ...
MedPAC mulls bundling for hospital-SNF readmissions.(Practice Trends)(Medicare Payment Advisory Commission, skilled nursing facilities)
Dec 01, 2008; ... WASHINGTON -- The Medicare Payment Advisory Commission recently debated whether to recommend that payments for the hospital and postacute care be bundled together. The issue arose out of concerns about frequent rehospitalizations and readmissions to skilled nursing facilities ...
Poor marks for PQRI.(Policy & Practice)(Physician Quality Reporting Initiative )(Brief article)
Dec 01, 2008; ... Most physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download ...
Many have drug 'gap' coverage.(Policy & Practice)
Dec 01, 2008; ... A total of 13% of Medicare beneficiaries enrolled in Part D prescription drug plans and 630/0 of those in Medicare Advantage plans with prescription benefits had some form of coverage in the "doughnut hole," or coverage gap, according to a Centers for Medicare and Medicaid Services study ...
Resuscitation practices ineffective.(Policy & Practice)(Brief article)
Dec 01, 2008; ... An overwhelming majority of emergency physicians believe that resuscitation practices in the United States are not very effective, according to a survey released by the American College of Emergency Physicians. In addition, more than half of emergency physicians surveyed believe that poor ...
HIPAA enforcement 'limited'.(Policy & Practice)(Health Insurance Portability and Accountability Act of 1996)(Brief article)
Dec 01, 2008; ... The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only "limited actions" to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according ...
Mass. Blues require e-prescribing.(Policy & Practice)(Blue Cross Blue Shield of Massachusetts )(Brief article)
Dec 01, 2008; ... Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 in order to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the ...
Program cuts illicit drug use.(Policy & Practice)(Brief article)
Dec 01, 2008; ... A government-supported program used to screen patients seeking health care for signs of substance abuse can reduce illicit drug use among patients seeking medical care in a wide variety of health care settings, a study found. The Screening, Brief Intervention, and Referral to Treatment ...
LTC does not figure in health reform debate.(Practice Trends)
Dec 01, 2008; ... WASHINGTON -- The topic of long-term care isn't making the cut as part of otherwise animated discussions of possible health care reform in the next administration, according to speakers at a meeting sponsored by the Brookings Institution. Sen. Ron Wyden (D-Ore.) said although ...
Loss of a chance.(Law & Medicine)
Dec 01, 2008; ... A doctor runs a walk-in clinic to treat acute conditions such as minor trauma and provide services such as flu shots and prescription refills. The clinic staff does not routinely measure blood pressure (BP). A patient who has used the facility for many years comes in and asks for a BP ...
A positive turn-off.(Genomic Medicine)
Dec 01, 2008; ... Remember when you took Bio 101 and learned that DNA is transcribed to RNA, which in turn is translated to produce the proteins that make organisms and that abnormal proteins are the cause of most human disease? Well, now there is a new twist to that understanding, which is ...
Hatchet vs. scalpel approach to reform debated.(Practice Trends)
Dec 01, 2008; ... WASHINGTON -- Can President-elect Barack Obama really shepherd through major health reform? Not until the Medicare physician payment system gets fixed, according to Robert Laszewski. "How do you plan a health care budget in Medicare and the private sector for years on out if you ...
Physician survey shows widespread use of active placebos; AMA policy murky.(Practice Trends)(American Medical Association)
Dec 01, 2008; ... A survey of internists and rheumatologists suggests that prescribing active "placebos" is relatively common, even though ethicists generally frown on the use of such therapies, especially if the patient is not informed. The survey was conducted by five ethicists from the ...
Aetna's physician rating program meets standards.(Practice Trends)
Dec 01, 2008; ... Aetna Inc.'s physician-rating program recently received a passing grade from the National Committee for Quality Assurance. The evaluation was conducted under a 2007 agreement between Aetna and New York Attorney General Andrew Cuomo, and was aimed at addressing allegations that ...
Plugging the blog.(Indications)(Bob Finn's weirdmedicalnews.wordpress.com)(Brief article)
Dec 01, 2008; ... Devoted followers of Indications are no doubt aware that the Internet offers a vast array of Web sites devoted to weird science, weird medicine, weird behavior, and general weirdness. But in case ...