Wednesday, June 30, 2010

Cognitive behavioural treatment may work for low-back pain

Low-back pain is a common and costly problem. This study estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care.

Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider.

References:


Image source: Different regions (curvatures) of the vertebral column, Wikipedia, public domain.

Tuesday, June 29, 2010

Episodic hypertension is a strong predictor of stroke risk

The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure.

In each TIA cohort in this study, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SBP 6·22), independent of mean SBP.

Maximum SBP reached was also a strong predictor of stroke (HR 15).

Visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (top-decile HR for stroke: 3·25) independent of mean SBP.

Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events.

References:
Image source: BP device used for measuring arterial pressure. Wikipedia, GNU Free Documentation License.

Monday, June 28, 2010

Alcohol consumption and raised body mass index (BMI) act together to increase risk of liver disease

Drinkers of 15 or more units per week in any BMI category and obese drinkers had raised relative rates for all definitions of liver disease, compared with underweight/normal weight non-drinkers.

The relative excess risk due to interaction between BMI and alcohol consumption was 5.58.

Raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two.

The occurrence of both factors in the same populations should inform health promotion and public health policies.

References:

Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies. BMJ 2010;340:c1240.
Alcohol literally kills: Gary Moore had 380mg/dL in his blood, Winehouse 416mg/dL when she died surrounded by 3 empty vodka bottles. Telegraph UK, 2012
Image source: Wikipedia, public domain.

New Developments in Treatment of Diabetes Type 2

From The Lancet theme issue on diabetes:

Diabetes confers a two-fold excess risk for a wide range of vascular diseases - heart disease and stroke. Adjusted HRs with diabetes were: 2·00 for coronary heart disease; 2·27 for ischaemic stroke; 1·56 for haemorrhagic stroke; 1·84 for unclassified stroke; and 1·73 for the aggregate of other vascular deaths. http://goo.gl/ucF0

Increased occurrence of cough and change in pulmonary function in the group receiving inhaled insulin - Lancet http://goo.gl/ve3G

Once weekly exenatide is an important therapeutic option for patients with type 2 diabetes http://goo.gl/UL3e

Dapagliflozin, sodium-glucose cotransporter-2 inhibitor (SGLT2 inhibitor), provides a new therapeutic option for type 2 diabetes http://goo.gl/FqIM

Saturday, June 26, 2010

The Beautiful Game can kill you: soccer/football managers and viewers at high risk for heart disease

Almost half of England's football managers have "significant" heart problems and their life-consuming, high-pressure jobs are a "recipe for potential disaster" according to cardiovascular experts. This is hardly surprising considering the range of emotions demonstrated by Fabio Capello (age 64), the current manager of the England national football team, in the videos below:



A stressful soccer match affects everybody involved including the spectators.

The Fédération Internationale de Football Association (FIFA) World Cup, held in Germany from June 9 to July 9, 2006, provided an opportunity to examine the relation between emotional stress and the incidence of cardiovascular events. Cardiovascular events occurring in 4,000 patients in the greater Munich area were prospectively assessed by emergency physicians during the World Cup.

On days of matches involving the German team, the incidence of cardiac emergencies was 2.66 times that during the control period. For men, the incidence was 3.26 times that during the control period, and for women, it was 1.82 times that during the control period.

On those days, the highest average incidence of events was observed during the first 2 hours after the beginning of each match.

Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.


Video: Angry Capello [ Algeria Vs England ].

References:

Nearly half of football managers suffer serious heart problems. Independent, 2005.
Cardiovascular events during World Cup soccer. N Engl J Med. 2008 Jan 31;358(5):475-83.
Super Bowl may trigger heart attacks - CNN, 2011.
Top Soccer Players Are Seen to Have Superior Brain Function - NYTimes, 2012 -- Good to know, NYT.

Friday, June 25, 2010

Ethosuximide and valproic acid are more effective than lamotrigine in childhood absence epilepsy

Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine.

Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects.



References:
Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy. NEJM, 2010.

Wednesday, June 23, 2010

Norepinephrine Causes Fewer Adverse Events Than Dopamine in the Treatment of Shock

Both dopamine and norepinephrine (Levophed) are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.

Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events.

References:
Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM, 2010.
Image source: Wikipedia, public domain.

Tuesday, June 22, 2010

Oral ivermectin superior to topical malathion lotion in eradicating difficult-to-treat head-lice infestation

Head-lice infestation is prevalent worldwide, especially in children 3 to 11 years old.

Topical insecticides (i.e., pyrethroids and malathion) used as a lotion, applied twice at an interval of 7 to 11 days, are typically used for treatment. Resistance of lice to insecticides, particularly pyrethroids, results in treatment failure.

For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment.

Why does head louse not infest body and vice versa?

Possible explanation: Body lice lay their eggs on clothing fibers instead of hair fibers (http://emedicine.medscape.com/article/1108991-overview).

References:
Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice. NEJM, 2010.

Updated: 06/24/2010

Monday, June 21, 2010

P.S.A. testing can’t detect prostate cancer, says its discoverer

Richard J. Ablin in the NYTimes:

"Approved by the Food and Drug Administration in 1994, the P.S.A. test’s popularity has led to a hugely expensive public health disaster. It’s an issue I am painfully familiar with — I discovered P.S.A. in 1970.

The annual bill for P.S.A. screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration.

As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t."

References:
The Great Prostate Mistake. NYTimes.
Image source: Wikipedia, public domain.

Saturday, June 19, 2010

Lawyers Opinion: Risky Business - Tweeting the Symptoms of Social Media

From Risky Business - Tweeting the Symptoms of Social Media (PDF):

"To date there are at least 540 hospitals in the United States utilizing social media tools: Hospitals account for 247 YouTube channels, 316 Facebook pages, 419 Twitter accounts, and 67 blogs.

The number of individual and independent medbloggers is in the thousands.

In December of 2009, a hospital employee was forced to resign because of a single tweet.

On October 29, 2008, a patient provided what is believed to be the first live tweet from the operating room. “Bad bad stick. Ow ow ow ow ow.”

In response to online physician rating websites, like Yelp, RateMD, and others, a company now offers physicians an antidefamation service, including contract provisions restricting a patient’s right to make negative comments on rating websites.

There are a number of other scenarios that could lead to liability. For example, what happens if an “off-duty” physician responds to a health question by a neighbor while doing yard work? Suppose the same exchange occurs through online “messages” between a physician and one of the physician’s “friends” on Facebook, creating an electronic record of the exchange that could potentially support the existence of a physician-patient relationship, thereby creating certain liability arising therefrom (e.g., HIPAA, medical malpractice, patient abandonment, etc.).

The authors of a National Law Journal article warn that bosses who “friend” are begging to be sued."

References:

AHLA Connections: Legal Implications of Health Care Social Media.
"If a patient bashes a physician on rating websites there is little that doctor can do", says Medscape, 2012.
Image source: public domain.

Friday, June 18, 2010

The Ultimate Social Media in Medicine Presentation (182 Slides)



The author, Maged Boulos, has published widely on social media uses in medicine and health informatics. He features this website in the presentation as one of the examples of medical blogs but I have had no influence on the inclusion. The link is via Berci.

Related reading:

Social media in medical education - Grand Rounds presentation by IUH Med/Peds residency program director http://goo.gl/Zw3lK

Sexual life expectancy is longer for men than women

A BMJ study of middle aged and older adults showed that men were more likely than women to be sexually active, report a good quality sex life, and be interested in sex.

These gender differences increased with age and were greatest among the 75 to 85 year old group: 38.9% of men compared with 16.8% of women were sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2% versus 11.4% were interested in sex.

People in very good or excellent health were 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health. At age 30, sexually active life expectancy was 34.7 years for men and 30.7 years for women compared with 14.9 to 15.3 years for men and 10.6 years for women at age 55.

At age 55, men in very good or excellent health on average gained 5-7 years of sexually active life compared with their peers in poor or fair health. Women in very good or excellent health gained 3-6 years compared with women in poor or fair health.

References:
Image source: OpenClipart.org, public domain.

Thursday, June 17, 2010

What's new in infectious diseases from UpToDate

- Brain MRI may be useful in patients with endocarditis. In one study including 53 patients, early use of cerebral MRI led to the reclassification from possible to definite IE in 30% of cases.

Figure 1. TEE shows AV Endocarditis in a patient with IVDA. There is a large vegetation on the aortic valve with 2-3+ AI (click to enlarge the image). Source: Double Hit – Right and Left-Sided Endocarditis in a Heroin Abuser.

- Cotrimoxazole prophylaxis was associated with a 50 percent reduction in deaths in patients starting antiretroviral therapy with CD4 counts lower than 200 cells.

- Universal influenza immunization: In 2010, the CDC expanded the recommendation for influenza vaccination to include all individuals 6 months of age and older. Previous guidelines recommended influenza vaccination for individuals over age 50 and for those at increased risk of influenza complications and close contacts of such individuals.


35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page.

The page does not provide RSS feed for the different specialties. One solution is to copy/paste the URL address of each subspecialty page you are interested in the Google Reader "Add a subscription" field (top left corner). Google Reader will automatically create a RSS feed from this "feedless" page.



References:
What's new in infectious diseases. UpToDate, 2010.

Wednesday, June 16, 2010

Electronic Prescribing Decreases Prescribing Errors Seven Fold

For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions at baseline to 6.6 per 100 prescriptions one year after adoption.

For non-adopters, error rates remained high at 37 per 100 prescriptions at baseline and 38 per 100 prescriptions at one year.

Illegibility errors were very high at baseline, and not surprisingly, were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year).

Prescribing errors may occur much more frequently in community-based practices than previously reported. This study findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety.

References:
Electronic Prescribing Improves Medication Safety in Community-Based Office Practices. Journal of General Internal Medicine, 2010.

Friday, June 11, 2010

The Lancet is alive and kicking on social media networks

As per its editor Richard Horton, the journal Lancet is alive and kicking on social media networks with a Twitter and Facebook pages. He commented on the social media involvement of the journal on the regular podcast available from the links below:

Thursday, June 10, 2010

18% tax on pizza and soda can decrease U.S. adults' weight by 5 pounds (2 kg) per year


Nearly a third of American children are overweight or obese. In our inner cities a prevalence of obesity of more than 50% is not uncommon. Too many calories in, too little energy out.

With two-thirds of Americans either overweight or obese, policymakers are increasingly looking at taxing as a way to address obesity on a population level.

The tobacco experience showed that education is not enough: regulation, litigation, and legislation are needed too. Increasing taxes on cigarettes has been the single most effective strategy in reducing smoking.

An important part of the obesity story is clearly the huge increase in consumption of sugar sweetened beverages (SSBs): carbonated sodas, sweet teas, energy drinks, flavoured water, and sports drinks. Their use has more than doubled in recent years.

"Sadly, we are currently subsidizing the wrong things including the product of corn, which makes the corn syrup in sweetened beverages so inexpensive."

Instead, the agricultural subsidies should be used to make healthful foods such as locally grown vegetables, fruits and whole grains less expensive.

Danish government imposed 25% tax on ice cream, chocolate, sweets, and will increase taxes on soft drinks, tobacco, alcohols to combat obesity, heart disease, and other illnesses. BMJ. http://goo.gl/ixc0

 Some pizzas are 'saltier than the sea' (NHS blog).

References:
Tax soda, pizza to cut obesity, researchers say | Reuters.
Image source: Soft drinks, Wikipedia, public domain.

Wednesday, June 9, 2010

EMR or "How Computers are Harming Doctor-Patient Relations" - Rick Payne



EMR or How Computers are Ruining the Doctor's Office and Harming Doctor-Patient Relations - a presentation by Rick Payne.

My experience with EMR has been mostly positive but it is certainly useful to be aware of other points of view.

Related:

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.

Monday, June 7, 2010

Deep Vein Thrombosis - Videos by Cleveland Clinic and Mayo Clinic



Deep Vein Thrombosis - Cleveland Clinic.



John Heit, M.D., a cardiovascular physician at Mayo Clinic.

Oral factor Xa inhibitor apixaban - more effective than enoxaparin for thromboprophylaxis after knee replacement

Low-molecular-weight heparins such as enoxaparin are preferred for prevention of venous thromboembolism after major joint replacement. Apixaban, an orally active factor Xa inhibitor, might be as effective, have lower bleeding risk, and be easier to use than is enoxaparin.

The primary outcome in this Lancet study was the composite of asymptomatic and symptomatic deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and all-cause death during treatment. The primary outcome was reported in 15% of apixaban patients and 24% of enoxaparin patients (relative risk 0·62), absolute risk reduction 9·3%.

Major or clinically relevant non-major bleeding occurred in 4% of patients receiving apixaban and 5% of treated with enoxaparin.

The authors concluded that apixaban 2·5 mg twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.

References:
Image source: Apixaban, Wikipedia, public domain.

Friday, June 4, 2010

Are Almonds a Good Source of Calcium?

Over all, you would still get some calcium by eating almonds, but at a lot higher calorie cost than from other foods, like milk.

The amount of calcium in a cup of whole almonds, 378 milligrams, is slightly more than in a cup of milk, about 300 milligrams, but you would be consuming about eight times as many calories.

References:
Q and A - Almonds for Calcium? - Question - NYTimes.com.

Thursday, June 3, 2010

Video: Heart Disease Myths Dispelled by a Cleveland Clinic Cardiologist



Cleveland Clinic — May 14, 2010 — Dr. Rimmerman, cardiologist and author of "The Cleveland Clinic Guide to Speaking With Your Cardiologist,"dispels common myths regarding heart disease.

Wednesday, June 2, 2010

Misconceptions about medical blogs

From the newsletter Australian Pharmacists:

"At the heart of social media is the blog, an online diary where news, gossip, industry issues, opinion and scandal jostle for space."

I cover medical news from educational perspective on CasesBlog but I try not to include "gossip, industry issues, opinion and scandal" and with one post per day, they never "jostle for space".

There are many different types of medical blogs, of course.

Image source: public domain.

Health Benefits of Pets - Mayo Clinic Video



May 10, 2010 — Health Benefits of Pets.

People will do a lot for their pets - see below:

- Somebody found a solution: Smokers are motivated to quit to protect their pets from secondhand smoke http://is.gd/iZ58

- "Do it for Fido: smokers may quit smoking because of their pet" http://is.gd/iZtQ

Tuesday, June 1, 2010

Gendercide or the worldwide war on baby girls

From The Economist:

"Gendercide" is often seen as an unintended consequence of China’s one-child policy, or as a product of poverty or ignorance. The surplus of bachelors—called in China guanggun, or “bare branches”— seems to have accelerated between 1990 and 2005, in ways not obviously linked to the one-child policy, which was introduced in 1979. And, as is becoming clear, the war against baby girls is not confined to China.

The use of sex-selective abortion was banned in India in 1994 and in China in 1995. It is illegal in most countries. But since it is almost impossible to prove that an abortion has been carried out for reasons of sex selection, the practice remains widespread. An ultrasound scan costs about $12, which is within the scope of many—perhaps most—Chinese and Indian families. In one hospital in Punjab, in northern India, the only girls born after a round of ultrasound scans had been mistakenly identified as boys, or else had a male twin.

References:
Image source: Wikipedia, GNU Free Documentation License.

How Twitter Brings Patients to Mayo Clinic



From Mayo Clinic: May 11, 2010 — People use Twitter to share information: The latest news, current events, what people are talking about, even what's for dinner. Now, people are using it to get access to health care. Last year Mayo Clinic teamed up with USA today and scheduled a Twitter chat about a painful wrist injury. Today a woman who joined that chat is pain free.

If you work for Mayo Clinic, social media is not an option, it's a job requirement http://bit.ly/IHf3lM - Others will follow.

Cleveland Clinic is also active on Twitter by asking staff to participate in scheduled chats with patients on a variety of health topics.

See an example here: Heart numbers to know - by Cleveland Clinic

Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:



Related reading:

Erin Turner's Mayo Clinic e-Patient Success Story

How Should Hospitals Use Twitter? This Twitter discussion in 2008 prompted @EdBennett to start his world-famous list.

Top U.S. Hospitals Are On Twitter

Social media in medicine: How to be a Twitter rockstar and help your patients and your practice