Internal Medicine News back issues from March 2008:
Palliative sedation: proceed with care.(News)
Mar 01, 2008; ... TAMPA -- Palliative sedation to unconsciousness can be an option for terminally ill patients, but its use should be rare, according to experts in palliative medicine. "This is a big deal when you do this, in my opinion, and should be relatively rare," said Dr. Timothy E. Quill, ...
Number of practicing primary care MDs in 2007.(VITAL SIGNS)
Mar 01, 2008 ... Number of Practicing Primary Care MDs in 2007 (per 100,000 population) ...
Bonus pay planned to boost access to medical homes: proposal could yield up to $100K per year.(News)
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 ...
Tamoxifen: 10 years may be better than 5 years.(News)(Clinical report)
Mar 01, 2008; ... SAN ANTONIO -- Current recommendations to limit adjuvant tamoxifen therapy to 5 years were premature, Sir Richard Peto, Ph.D., said at the San Antonio Breast Cancer Symposium. Preliminary data from the ongoing 11,500-patient ATLAS (Adjuvant Tamoxifen: Longer Against Shorter) ...
ABIM holds off on comprehensive certification.(News)(American Board of Internal Medicine )
Mar 01, 2008; ... Directors of the American Board of Internal Medicine have decided to first assess the competencies described in its draft comprehensive internist proposal before formalizing any maintenance of certification pathway. The ABIM board of directors met in February to discuss comments ...
Tool kits for curbing medical errors.(News)(Brief article)
Mar 01, 2008 ... The Agency for Healthcare Research and Quality is offering an array of free online tool kits to help doctors, nurses, hospital managers, patients, and others reduce errors. The kits can be adapted to most health care settings. They include checklists to reconcile medications ...
Panel favors restricted use of IV iron product.(NEWS FROM THE FDA)
Mar 01, 2008; ... SILVER SPRING, MD. -- A federal advisory panel voted against supporting the approval of ferric carboxymaltose injection (Injectafer), a new intravenous iron product, as a first-line treatment for iron deficiency anemia in postpartum women and in women with heavy uterine bleeding. ...
Antiepileptics: FDA cites risk of suicidality; label changes likely.(NEWS FROM THE FDA)
Mar 01, 2008; ... WASHIINGTON -- 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, which issued the alert on ...
Cialis approved for once-daily use.(NEWS FROM THE FDA)
Mar 01, 2008; ... The erectile dysfunction drug Cialis (tadalafil) has been approved by the Food and Drug Administration for once-daily use in 2.5-mg and 5-mg doses, the drug's manufacturer announced. "This low-dose daily treatment option of Cialis may be most appropriate for men with ED who ...
FDA advisory committee meetings.(NEWS FROM THE FDA)
Mar 01, 2008 ... The Food and Drug Administration, responding to a recommendation by the Institute of Medicine, has published in the Federal Register a tentative schedule of 2008 meetings of FDA public advisory committees. ...
FDA issues warning on botulinum toxin injections: postinjection symptoms include dysphagia, ptosis, and shortness of breath, according to the FDA.(News)(Clinical report)
Mar 01, 2008; ... Botulinum toxins have in some cases been linked to respiratory failure and even death, according to a warning issued by the Food and Drug Administration. Physicians should be vigilant for postinjection symptoms such as dysphagia, ptosis, and shortness of breath, the FDA said. If ...
Humira.(NEW & APPROVED)(Drug overview)
Mar 01, 2008; ... Humira (adalimumab, Abbott) A tumor necrosis factor (TNF)-blocker approved for treating adults with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate ....
Moxatag.(NEW & APPROVED)(Moxatag has been approved for the treatment of Streptococcus pyogenes infection )(Drug overview)
Mar 01, 2008; ... Moxatag (amoxicillin extended-release tablets, MiddleBrook Pharmaceuticals Inc.) The FDA also approved once-daily Moxatag (amoxicillin extended-release) tablets 775 mg for treatment of patients aged 12 years and older with pharyngitis and/or tonsillitis secondary to ...
FDA investigates reactions to bolus heparin agent.(News)
Mar 01, 2008; ... A spike in reports of severe allergic reactions in patients receiving bolus injections of heparin made by Baxter Healthcare Corp. prompted the company in February to temporarily stop manufacturing multiple-dose vials of heparin, the Food and Drug Administration announced. Most ...
Fraud scheme among insurers investigated in N.Y.(News)(Case overview)
Mar 01, 2008; ... Following a 6-month initial investigation, New York Attorney General Andrew Cuomo announced plans to file suit against UnitedHealth Group and four of its subsidiaries for allegedly systematically underpaying consumers for their out-of-network medical expenses. The attorney ...
A new subspecialty for complex heart failure.(GUEST EDITORIAL)(Editorial)
Mar 01, 2008; ... In the beginning, there were very few cardiologists. At another time and in almost another world, a cardiologist could do very little more than could an internist. After all, an internist could give digitalis and quinidine just as well as a cardiologist, and the fee was the same: very ...
Medical travel: a burgeoning worldwide industry.(GUEST EDITORIAL)(Industry overview)(Report)
Mar 01, 2008; ... An estimated 500,000 Americans traveled outside the United States for medical care in 2006, and a large increase was projected for 2007 as part of the rapidly growing phenomenon of medical travel. Residents of many other countries also sought medical services abroad, thereby making medical ...
Recertification wastes time and money.(LETTERS)(Letter to the editor)
Mar 01, 2008; ... I want to express my opposition to the concept of maintenance of certification in the field of internal medicine ("ABIM Proposes Comprehensive Internist Concept," Dec. 15, 2007, p. 1). I agree with others who have noted that it would further fracture the practice of internal ...
Ultrasound skills offer benefits.(LETTERS)(Letter to the editor)
Mar 01, 2008 ... Some of us in general internal medicine practice are getting an inferiority complex ("It's Getting Curiouser and Curiouser," Letters, Dec. 15, 2007, p. 9, and "General Internal Medicine: Smaller and Smaller?" Adviser's Viewpoint, Nov. 15, 2007, p. 7). Hand-carried ultrasounds, ...
Responding to retail-based clinics.(LETTERS)(Letter to the editor)
Mar 01, 2008; ... Patients who visit retail-based clinics cite convenience, access at odd hours, and lower cost as reasons for their visits. Clearly, these clinics (such as MinuteClinic, RediClinic, Solantic, and Take Care) fill a need. As a result, there are now more than 2,000 retail clinics in the United ...
Don't dismiss abstinence programs.(LETTERS)(Letter to the editor)
Mar 01, 2008 ... Given the politically charged nature of the sex education debate in this country, one would hope that your editorial staff would critically review any information put forth on the topic ("Abstinence Programs Don't Work," Policy & Practice, Dec. 15, 2007, p. 29). Does it seem ...
Identifying risks with warfarin.(LETTERS)(Letter to the editor)
Mar 01, 2008; ... Thank you for an excellent article ("Warfarin Decreases Stroke in Elderly AF Patients," Dec. 1, 2007, p. 29). Too little is said of elderly patients who have fatal bleeding from warfarin. Some risks can be identified. I have found the following questions helpful in limiting ...
Long-term adalimumab proves safe and effective for psoriatic arthritis.(Dermatology)(Clinical report)
Mar 01, 2008; ... SAN ANTONIO -- Adalimumab proved safe and effective when used for up to 2 years for the treatment of psoriatic arthritis in a phase III open-label extension study, according to results that were reported at the annual meeting of the American Academy of Dermatology. In 395 ...
New procedure improves varicose vein stripping.(Dermatology)
Mar 01, 2008; ... CHICAGO -- The minimally invasive venous ablation procedure may breathe new life into surgical ligation and stripping for patients with varicose veins. The procedure--developed at VeinSolutions, a nationwide practice that specializes in cosmetic and therapeutic vein ...
Hybrid technique provides alternative for varicose veins.(Dermatology)
Mar 01, 2008; ... CHICAGO -- A technique that combines occlusion coils and alcohol sclerosis is the latest addition to the array of catheter-based approaches available to treat varicose veins. "We have yet another tool in an area where I don't think we needed another tool; it's coil occlusion and ...
Routine cardiac screening in psoriasis is needed.(Dermatology)
Mar 01, 2008; ... ZURICH -- The time is at hand to institute routine cardiovascular risk assessment in all patients with moderate to severe psoriasis, Dr. Wolfram Sterry said at the annual meeting of the European Society for Dermatological Research. "This is one of the first things we should ...
Targeted phototherapy for vitiligo has fewer side effects.(Dermatology)
Mar 01, 2008; ... BUENOS AIRES -- Targeted phototherapy represents a new approach in the treatment of vitiligo, Dr. Giovanni Leone said at the 21st World Congress of Dermatology. "Targeted phototherapies have been developed with the aim of sparing unaffected skin from UV irradiation," said Dr ....
Skin cancer rates soar after combined transplant.(Dermatology)
Mar 01, 2008; ... ZURICH -- The risk of developing nonmelanoma skin cancer following simultaneous pancreas and kidney transplantation is fourfold greater than after kidney transplantation alone, Dr. Irma Wisgerhof said at the annual meeting of the European Society for Dermatological Research. The ...
'Active naturals' may soothe atopic dermatitis.(Dermatology)
Mar 01, 2008; ... SAN FRANCISCO -- Ingredients in oatmeal and other natural products increasingly are being investigated as adjuncts to therapy and as alternatives to medications, Dr. Lawrence F. Eichenfield said at a meeting sponsored by Skin Disease Education Foundation. Some product ...
COPD is increasing in younger, female patients.(Pulmonary Medicine)(Chronic obstructive pulmonary disease)
Mar 01, 2008; ... SAN DIEGO -- Chronic obstructive pulmonary disease, once thought of as a disease of elderly white men, is increasingly a disease of women of all ethnicities. Ranking as the fourth leading cause of death in the United States, COPD is the only leading cause of death that is still ...
Study links idiopathic cough to iron deficiency in women.(Pulmonary Medicine)
Mar 01, 2008; ... CHICAGO -- A small but provocative Italian study suggests that women complaining of chronic idiopathic cough should be evaluated for iron deficiency. Researchers at the University of Turin (Italy) observed that cough and signs and symptoms of pharyngolaryngitis were improved or ...
Diet, activity may influence lung cancer risk.(Pulmonary Medicine)
Mar 01, 2008; ... Eating at least four servings of salad vegetables per week is associated with a reduction in the risk of developing lung cancer in non-Hispanic whites, reported researchers at the University of Texas M.D. Anderson Cancer Center, Houston. Compared with those who consumed four or ...
Coagulation factors may predict thrombosis risk.(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 ...
PMS may raise risk of pelvic floor disorders.(Women's Health)(premenstrual syndrome)(Clinical report)
Mar 01, 2008; ... WASHINGTON -- Women with premenstrual syndrome are at increased risk for pelvic floor disorders, according to results from a study of twin sisters. Women who do not have PMS but who have a first-degree relative with PMS may also be at increased risk for pelvic floor disorders, ...
Less weight gain seen with modern chemo regimens: the classical regimen is notorious for causing nausea; many women self-medicate against nausea by eating.(Women's Health)
Mar 01, 2008; ... SAN ANTONIO -- Weight gain in the first year or two following diagnosis of early-stage breast cancer appears to be less pervasive in the modern era of chemotherapy and endocrine therapy than in times past, results of a retrospective study suggest. Numerous older studies have ...
Incidence and death rates for breast cancer in the U.S.(DATA WATCH)(Statistical table)(Brief article)
Mar 01, 2008 ... <Pre> Incidence and Death Rates for Breast Cancer in the U.S. (per 100,000 population) Incidence Mortality White 132.5 25.0 Black 118.3 33.8 Hispanic ...
Supplemental ultrasound improves breast Cancer detection.(Women's Health)(Clinical report)
Mar 01, 2008; ... CHICAGO -- Supplemental ultrasound screening significantly increased the number of cancers detected, but resulted in a substantial number of false-positive findings in a multicenter study of 2,637 women at high risk for breast cancer. The addition of screening ultrasound to ...
Oral contraceptives give long-term protection against ovarian cancer.(Women's Health)(Clinical report)
Mar 01, 2008; ... The use of oral contraceptives confers long-term protection against ovarian cancer, and the longer birth control pills are used, the greater their protective effect, according to an analysis of 45 epidemiologic studies from around the world. The findings suggest that oral ...
Improving DXA scheduling ups repeat scan rate.(Endocrinology)(dual-energy x-ray absorptiometry )(Clinical report)
Mar 01, 2008; ... Redesigning the callback process for repeat bone mineral density tests among patients with osteoporosis--shifting the focus away from primary care to the rheumatology office--resulted in a dramatically increased percentage of patients undergoing an appropriate follow-up scan in a study ...
Bone health information on CD and online.(Endocrinology)(Brief article)
Mar 01, 2008 ... The National Institute of Arthritis and Musculoskeletal and Skin Diseases is offering a CD-ROM that provides health professionals and the general public with easy access to the latest information on bone health and diseases. The CD, titled "Bone Health Information for You and ...
Combat 'diabesity' with nutrition and exercise.(Endocrinology)(Medical condition overview)
Mar 01, 2008; ... SAN DIEGO -- "Diabesity," as Dr. David Heber calls type 2 diabetes, is a lifestyle disease, not a diagnosis that necessarily requires heavy lifting of the prescription pad. Too many physicians begin and end the conversation by saying, "You have diabetes and I have a drug for ...
Low health numeracy can be a challenge in diabetes care.(Endocrinology)(Clinical report)
Mar 01, 2008; ... ST. LOUIS -- In addition to problems with health literacy in general, diabetes patients are susceptible to problems with a specific aspect of health literacy known as health numeracy, Dr. Russell Rothman said at the annual meeting of the American Association of Diabetes Educators. ...
Brachytherapy an option for younger patients: 'age should not be a deterrent when considering radiation seed implantation for prostate cancer.'.(Urology)
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 ...
Brachytherapy beats watchful waiting in local prostate cancer.(Urology)
Mar 01, 2008 ... LOS ANGELES -- A study of 11,453 men diagnosed with local prostate cancer from 1999 to 2001 found that brachytherapy reduced their relative risk of dying from the disease by 55%, compared with watchful waiting. Radical prostatectomy was the best option and hormone therapy was ...
Provider volume tied to brachytherapy outcomes.(Urology)
Mar 01, 2008 ... LOS ANGELES -- Men receiving brachytherapy for prostate cancer have a lower risk of relapse and of death from the disease if they are treated by a radiation oncologist who has done a high volume of procedures, according to a review of 5,595 cases diagnosed from 1991 to 1999. ...
Prostate Ca therapy best after watchful waiting.(Urology)(cancer)
Mar 01, 2008; ... VANCOUVER, B.C. -- Men live longer when a "watchful waiting" prostate cancer strategy is followed by treatment later in the course of the disease, compared with aggressive initial treatment, Dr. Li Li said at the annual meeting of the North American Primary Care Research Group. ...
Statin use tied to fewer relapses in prostate Ca.(Urology)(cancer)
Mar 01, 2008; ... LOS ANGELES -- Men who happened to be on statins when given radiotherapy for prostate cancer were significantly more likely to be disease free 10 years later, according to researchers who reviewed 871 patients treated from 1994 to 2000 at a New York City cancer center. Based on ...
Cetrorelix shows promise in prostatic hyperplasia.(Urology)
Mar 01, 2008; ... NEW YORK -- A new treatment paradigm for benign prostatic hyperplasia is on the horizon, according to Dr. Herbert Lepor. During the past 2 decades, there has been a shift in the management of benign prostatic hyperplasia (BPH) away from surgery and toward earlier medical ...
Vasopressin antagonists effective for hyponatremia.(Nephrology)
Mar 01, 2008; ... SAN FRANCISCO -- Satavaptan and conivaptan appear to be effective in the treatment of dilutional hyponatremia, a frequent consequence of heart failure and of renal failure. Study findings supporting the efficacy of the vasopressin receptor antagonists for this indication were ...
Gout raises risk of death in dialysis.(Nephrology)
Mar 01, 2008; ... SAN FRANCISCO -- Contrary to previous assumptions, gout is not rare in patients on dialysis. Moreover, a single episode of gout increases the risk of death in these patients by 49%, according to Dr. Scott D. Cohen and associates. In a retrospective cohort study of 259,209 ...
Chronic kidney disease promotes premature cardiovascular disease.(Nephrology)
Mar 01, 2008; ... ORLANDO -- Chronic kidney disease is a predictor of premature stroke, MI, and death, on the basis of a review of data collected from about 30,000 people. The data "suggest that the biologic changes that occur with chronic kidney disease promote cardiovascular disease at an ...
Hyperuricemia associated with type 2 diabetes.(Nephrology)(Brief article)
Mar 01, 2008; ... High serum uric acid level was an independent risk factor for the development of type 2 diabetes in a large population-based study. Among 4,536 people aged 55 years and older in the Rotterdam Study who were free of diabetes at baseline and followed for a mean of 10 years, 462 ...
Kidney risk may rise with high fructose consumption.(Nephrology)
Mar 01, 2008; ... Mounting evidence linking high consumption of fructose to an increased risk of kidney disease could have clinical implications for the treatment of high-risk patients. Data from recent studies suggest that high fructose intake causes elevated uric acid levels, which might ...
Consider palliative care for patients with ESRD: patients on hemodialysis have a symptom burden that is similar to that of patients with cancer.(Nephrology)(end-stage renal disease)(Clinical report)
Mar 01, 2008; ... TAMPA -- Patients with end-stage renal disease are good candidates for palliative care and hospice, but many are not referred for such care, according to Dr. Alvin H. Moss. "Nephrologists, by nature, are not inclined toward talking about end-of-life care" and are not trained to ...
Warfarin may do harm unless target is reached.(Cardiovascular Medicine)
Mar 01, 2008; ... ORLANDO -- Patients with atrial fibrillation who are treated with warfarin need to be in their target anticoagulation range at least 50% of the time to get a net benefit from treatment, according to a review of more than 13,000 patients. The longer a patient stays in the target ...
Aspirin resistance attributed to noncompliance.(Cardiovascular Medicine)(Drug overview)(Clinical report)
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 ...
Childhood trauma boosts risk of CHD, depression.(Cardiovascular Medicine)(coronary heart disease )
Mar 01, 2008; ... 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 ...
Implantable cardioverter defibrillators can trigger psychiatric sequelae.(Cardiovascular Medicine)(Clinical report)
Mar 01, 2008; ... VIENNA -- Psychiatric assessment of 82 Turkish patients who had received implantable cardioverter defibrillators showed that the recipients had a high prevalence of sexual dysfunction, posttraumatic stress disorder, major depressive disorder, panic disorder, and generalized anxiety ...
Take a biofilm approach to infected foot wounds.(Infectious Diseases)(Clinical report)
Mar 01, 2008; ... WASHINGTON -- Monotherapy may not be enough in the treatment of diabetic wound infections. These infections are not caused by the planktonic or individual cellular form of mainly single-species bacteria proliferating in the wound, but rather are caused by a complex, multicell ...
Ventilator bundles not adequate in trauma ICU.(Infectious Diseases)
Mar 01, 2008; ... COLORADO SPRINGS -- Implementation of a widely advocated bundle of evidence-based practices aimed at reducing ventilator-associated pneumonia had the desired effect in a busy medical ICU but not in the same hospital's level I trauma/surgical ICU, Dr. Patrick J. Offner reported at the ...
Chest radiographs may be overused in severe pneumonia.(Infectious Diseases)
Mar 01, 2008; ... CHICAGO -- Routine follow-up chest radiography may not be appropriate for patients with severe community-acquired pneumonia who clinically respond to initial antibiotic therapy, according to a multicenter study presented at the Interscience Conference on Antimicrobial Agents and ...
Elderly benefit from colorectal cancer screening.(Gastroenterology)
Mar 01, 2008; ... ORLANDO -- Colorectal cancer screening 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 ...
KRAS status predicts response to colorectal Ca treatment.(Gastroenterology)(cancer)(Kirsten rat sarcoma)
Mar 01, 2008; ... ORLANDO -- KRAS tumor status has emerged as an important biomarker for the success or failure of therapies for metastatic colorectal cancer and should be assessed before starting treatment, researchers said at a meeting on gastrointestinal cancers sponsored by the American Society of ...
Aspirin plus PPI safe in Barrett's patients.(Gastroenterology)(proton pump inhibitor)
Mar 01, 2008; ... ORLANDO -- Early findings from the Aspirin Esomeprazole Chemoprevention Trial indicate that therapy with aspirin and esomeprazole is safe and well tolerated for preventing the progression of Barrett's esophagus to adenocarcinoma. Since the start of the randomized Aspirin ...
Carvedilol beats band ligation for variceal bleed.(Gastroenterology)(Brief article)
Mar 01, 2008; ... BOSTON -- Carvedilol is more effective than band ligation in preventing the first bleed from esophageal varices, Dr. Dhiraj Tripathi said at the annual meeting of the American Association for the Study of Liver Diseases. Because the drug is also well tolerated, "it should be the ...