1/7/11

Bajunya Lucu


Suka ama design nya.., bisa buat org yg berhijab.., atasannya juga longgar.., celana juga ga terlalu ngepas.., suka suka sekali.. :)

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1/6/11

Blog Lovin

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yuuppzzzzz...., i love reading... ^_^

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ReSoLuTiOnS



(thanks for all these pictures Shannon Eileen :) )

And i'm still thinking my resolutions. As one of my friend said "Let it be". Just past this year with full of spirit. Yeeaahhhhh!!!! :D

regards, taniafdi ^_^

Quote of the Day

"Take chances and never regrets, 

because at one point, 

everything you did was exactly what you 

wanted."

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Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation


Mark Pimentel, M.D., Anthony Lembo, M.D., William D. Chey, M.D., Salam Zakko, M.D., Yehuda Ringel, M.D., Jing Yu, Ph.D., Shadreck M. Mareya, Ph.D., Audrey L. Shaw, Ph.D., Enoch Bortey, Ph.D., and William P. Forbes, Pharm.D. for the TARGET Study Group
N Engl J Med 2011; 364:22-32


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General Anesthesia, Sleep, and Coma


Emery N. Brown, M.D., Ph.D., Ralph Lydic, Ph.D., and Nicholas D. Schiff, M.D.
N Engl J Med 2010; 363:2638-2650


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Prostate Cancer Screening Guideline Updated by ACS

Nick Mulcahy

source:
http://www.medscape.com/viewarticle/717875?src=top10


March 3, 2010 — For the first time since 2001, the American Cancer Society (ACS) has updated its prostate cancer screening guideline.
The new guideline has a more pronounced emphasis on informed decision-making (IDM) than in the past.Men should only be screened "after they receive information about the uncertainties, risks, and potential benefits associated with prostate cancer screening," states the document.
"We are making a stronger case for informed decision-making," lead author of the guideline, Andrew Wolf, MD, told Medscape Oncology.
"We have explicitly outlined in this guideline what we feel to be the core elements [that need] to be imparted to patients for an informed decision to occur," said Dr. Wolf, who is associate professor of medicine at the University of Virginia School of Medicine in Charlottesville.
Dr. Wolf also explained that "decision aids," or educational tools tailored to patients, are vital to the practicality of the recommendation for IDM.
There are also several new recommendations for men who choose to be tested.
Prostate-specific antigen (PSA) testing is now recommended with or without the digital rectal exam (DRE). "There is little evidence that the digital rectal exam adds significant benefit to the PSA test, except, perhaps, when the PSA is in the borderline range," he said.
The ACS continues to recommend that the PSA value of 4.0 ng/mL be used as a "reasonable threshold" to trigger further evaluation, said Dr. Wolf.
However, there is a new recommendation for men with PSA values between 2.5 and 4.0 ng/mL.
"Recognizing that approximately 25% of men with PSA levels between 2.5 and 4.0 ng/mL harbor prostate cancer, we have added a recommendation that physicians consider an individualized risk assessment for men with PSA values in this indeterminate range," said Dr. Wolf.
An individual assessment should take into account non-PSA risk factors, such as race, family history, results of previous biopsies, and DRE results, he said
ACS also now recommends that the PSA testing interval be reduced to every other year for men whose PSA level is under 2.5 ng/mL. "Such a reduction in testing frequency will lead to significantly reduced false positives, unnecessary biopsies, and overdiagnosis, with only a negligible increase in missed cancers," explained Dr. Wolf.
The American Urological Association (AUA) differs with the ACS on PSA values. "The AUA feels there is no single PSA standard that applies to all men, nor should there be," they write in a press release issued soon after the guideline was made public this week.
"Although prostate cancer risk correlates with serum PSA, there is no PSA value below which a man may be reassured that he does not have biopsy-detectable prostate cancer," the AUA press release adds. The AUA also advocates for a baseline PSA test at the age of 40, and subsequent rescreening that evaluates, among other risk factors, free and total PSA, PSA velocity, and PSA density.
Overall, clinicians will recognize much of the old ACS guideline in the new document, which was published online March 3 in CA: A Cancer Journal for Clinicians.
"The 2010 guideline does not represent a substantive departure from our 2001 guideline," said Dr. Wolf.
Decision Aids to the Rescue
In the context of prostate cancer screening, IDM and shared decision-making (SDM) is no small job, the guideline suggests.
"The challenge of offering every eligible man the opportunity to make an informed decision about prostate cancer screening can be daunting to the healthcare provider," write Dr. Wolf and his coauthors.
Time constraints and the "complexity of the issue" are the "key obstacles" to IDM/SDM, according to healthcare providers, the authors note.
In addition, there is no reimbursement for IDM/SDM.
Dr. Wolfe acknowledged the problem of lack of reimbursement.


"Primary care physicians can be reimbursed for counseling time if it comprises more than half of the office visit and is documented. However, I am not aware of any specific reimbursement for counseling related to prostate cancer early detection," he said.
The time and money problems related to IDM/SDM are not insurmountable, suggested Dr. Wolf.
"This is a vital point that we tackled head on with this revised guideline," he said about these practical challenges.
"Recognizing that insufficient time is cited by physicians as the greatest barrier to engaging men in informed and shared decision-making related to prostate cancer, the American Cancer Society guideline strongly advocates the use of decision aids," he declared.
Decision aids should be given to patients before an office visit, suggested another expert.
"By providing a decision aid in advance of a clinic visit, the patient–provider discussion — the shared decision-making — can be much more efficient, addressing screening decisions in the context of a patient's specific medical conditions, values, and concerns," said Richard Hoffman, MD, MPH, an internist at the Raymond G. Murphy VA Medical Center in Albuquerque, New Mexico, who has studied doctor–patient communication surrounding PSA testing. Dr. Hoffman was approached for independent comment by Medscape Oncology.
Healthcare dollars might be also be saved, he suggested.


"Often, informed patients make more conservative treatment decisions, so decision aids potentially could reduce healthcare costs," said Dr. Hoffman
In the state of Washington, legislation has been passed supporting the use of various decision aids and implementing demonstration projects, noted Dr. Hoffman.
Dr. Wolf agrees that the decision aids have multiple benefits.
"Decision aids lead to improved knowledge, decreased "decisional conflict," and a greater desire to play an active role in the decision," he said, referring to clinical studies.
Exactly how clinicians should use decision aids remains to be seen, explained Dr. Wolf.
"Physicians will still need to figure out how to incorporate decision aids into their own practices," he said.
Problems remain as well. "There are still obstacles to address: we need more decision aids that are tailored to low-literacy and non-English-speaking populations," Dr. Wolf noted.
Still, the new guideline is unequivocal about the need for doctor–patient discussion.
"No man should be tested without having first engaged in an informed decision-making process," summarized Dr. Wolf.
The ACS guideline document includes links to the decision aid materials of different organizations, including the ACS, the Foundation for Informed Medical Decision Making, the Centers for Disease Control and Prevention, the Mayo Clinic, and the University of Cardiff in the United Kingdom.
Informed Decision-Making: By Age and Core Elements
At the age of 50, men at average risk for prostate cancer should start receiving facts about prostate cancer and screening, states the new ACS guideline. Men at higher risk, including African American men and men with a first-degree relative (father or brother) diagnosed with prostate cancer before age 65, should receive this information beginning at age 45.
Men at "appreciably higher risk" (multiple family members diagnosed with prostate cancer before age 65) should receive information beginning at age 40.
The "core elements" of the information to be provided to men to assist with their prostate cancer screening decision include the following:
  • Screening with the PSA blood test detects cancer at an earlier stage than if no screening is performed.
  • Prostate cancer screening might be associated with a reduction in the risk of dying from prostate cancer; however, evidence is conflicting.
  • For men whose prostate cancer is detected by screening, it is not currently possible to predict which men are likely to benefit from treatment.
  • Treatment for prostate cancer can lead to urinary, bowel, sexual, and other health problems that can be significant or minimal, permanent or temporary.
  • The PSA and DRE can produce false-positive or false-negative results.
  • Abnormal results from screening with PSA and DRE require prostate biopsies, which can be painful and lead to complications like infection or bleeding.
  • Not all men whose prostate cancer is detected through screening require immediate treatment. Some require periodic blood tests and prostate biopsies to determine the need for future treatment.
Dr. Hoffman reports receiving partial salary support from the nonprofit Foundation for Informed Medical Decision Making to help develop a prostate cancer screening decision aid.
CA Cancer J Clin. Published online March 3, 2010.

regards, taniafdi ^_^

American Diabetes Association Revises Diabetes Guidelines

Laurie Barclay, MD

Source :
http://www.medscape.com/viewarticle/714401?src=top10


December 29, 2009 — The American Diabetes Association (ADA) revised clinical practice recommendations for diabetes diagnosis promote hemoglobin A1c (A1c) as a faster, easier diagnostic test that could help reduce the number of undiagnosed patients and better identify patients with prediabetes. The new recommendations are published December 29 in the January supplement of Diabetes Care.
"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease," Richard M. Bergenstal, MD, ADA president-elect of medicine & science, said in a news release. "Additionally, early detection can make an enormous difference in a person's quality of life. Unlike many chronic diseases, type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."
The A1c test, which measures average blood glucose levels for a period of up to 3 months, was previously used only to evaluate diabetic control with time. An A1c level of approximately 5% indicates the absence of diabetes, and according to the revised evidence-based guidelines, an A1c score of 5.7% to 6.4% indicates prediabetes, and an A1c level of 6.5% or higher indicates the presence of diabetes.
For optimal diabetic control, the recommended ADA target for most people with diabetes is an A1c level no greater than 7%. It is hoped that achieving this target would help prevent serious diabetes-related complications including nephropathy, neuropathy, retinopathy, and gum disease.
Unlike fasting plasma glucose testing and the oral glucose tolerance test, A1c testing does not require overnight fasting. Compliance with screening may therefore be improved through use of the A1c test, which can be determined from a single nonfasting blood sample.
Recommendation Changes for 2010
Specific changes in the 2010 Clinical Practice Recommendations are as follows:
  • A section on diabetes related to cystic fibrosis has been added to "Standards of Medical Care in Diabetes." New evidence has shown that early diagnosis of cystic fibrosis-related diabetes and aggressive treatment with insulin have narrowed the gap in mortality between patients with cystic fibrosis with and without diabetes and have eliminated the sex difference in mortality rates. New recommendations for the clinical management of cystic fibrosis-related diabetes, based on a 2009 consensus conference, will be published in 2010 in a consensus report.
  • Revision of the section "Diagnosis of Diabetes" now includes the use of the A1c level for diabetes diagnosis, with a cutoff point of 6.5%.
  • The section formerly named "Diagnosis of Pre-diabetes" is now named "Categories of Increased Risk for Diabetes." Categories suggesting an increased risk for future diabetes now include an A1c range of 5.7% to 6.4%, as well as impaired fasting glucose and impaired glucose tolerance levels.
  • Revisions to the section "Detection and Diagnosis of GDM [Gestational Diabetes Mellitus]" now include a discussion of possible future changes in this diagnosis, according to international consensus. Screening recommendations for gestational diabetes are to use risk factor analysis and an oral glucose tolerance test, if appropriate. Women diagnosed with gestational diabetes should be screened for diabetes 6 to 12 weeks postpartum and should have subsequent screening for the development of diabetes or prediabetes.
  • Extensive revisions to the section "Diabetes Self-Management Education" are based on new evidence. Goals of diabetes self-management education are to improve adherence to standard of care, to educate patients regarding appropriate glycemic targets, and to increase the percentage of patients achieving target A1c levels.
  • Extensive revisions to the section "Antiplatelet Agents" now reflect evidence from recent trials suggesting that in moderate- or low-risk patients, aspirin is of questionable benefit for primary prevention of cardiovascular disease. The revised recommendation is to consider aspirin treatment as a primary prevention strategy in patients with diabetes who are at increased cardiovascular risk, defined as a 10-year risk greater than 10%. Patients at increased cardiovascular risk include men older than 50 years or women older than 60 years with at least 1 additional major risk factor.
  • Fundus photography may be used as a screening strategy for retinopathy, as described in the section "Retinopathy Screening and Treatment." However, although high-quality fundus photographs detect most clinically significant diabetic retinopathy, they should not act as a substitute for an initial and dilated comprehensive eye examination. Retinal examinations should be carried out annually or at least every 2 to 3 years among low-risk patients with normal eye examination results in the past.
  • Extensive revisions to the section "Diabetes Care in the Hospital" now question the benefit of very tight glycemic control goals in critically ill patients, based on new evidence.
  • Extensive revisions to the section "Strategies for Improving Diabetes Care" are based on newer evidence. Successful strategies to improve diabetes care, which have resulted in improved process measures such as measurement of A1c levels, lipid levels, and blood pressure, include the following:
    • Delivery of diabetes self-management education.
    • Adoption of practice guidelines developed with participation of healthcare professionals and having them readily accessible at the point of service.
    • Use of checklists mirroring guidelines, which help improve adherence to standards of care.
    • Systems changes, including providing automated reminders to healthcare professionals and patients and audit and feedback of process and outcome data to providers.
    • Quality improvement programs, in which continuous quality improvement or other cycles of analysis and intervention are combined with provider performance data.
    • Practice changes, which may include access to point-of-care A1c testing, scheduling planned diabetes visits, and clustering dedicated diabetes visits into specific times.
    • Tracking systems with either an electronic medical record or patient registry to improve adherence to standards of care.
    • Availability of case or (preferably) care management services using nurses, pharmacists, and other nonphysician healthcare professionals following detailed algorithms under physician supervision.
"The most successful practices have an institutional priority for quality of care, involve all of the staff in their initiatives, redesign their delivery system, activate and educate their patients, and use electronic health record tools," the guidelines authors conclude. "It is clear that optimal diabetes management requires an organized, systematic approach and involvement of a coordinated team of dedicated health care professionals working in an environment where quality care is a priority."
Diabetes Care. December 29, 2009; January 2010 Supplement.

regards, taniafdi ^_^

FDA Warns of Suicide Risk for Tramadol

by Robert Lowes

Source :
http://www.medscape.com/viewarticle/722488?src=top10


May 26, 2010 — The US Food and Drug Administration (FDA) announced yesterday that it has added a warning of suicide risk to the labels of tramadol hydrochloride (Ultram) and tramadol hydrochloride/acetaminophen (Ultracet).
The revised labels instruct clinicians not to prescribe tramadol to patients who are suicidal or addiction-prone, and to exercise caution in prescribing the medications to patients who use alcohol excessively, suffer from emotional disturbance or depression, or take tranquilizers or antidepressants.
"Tramadol-related deaths have occurred in patients with previous histories of emotional disturbances or suicidal ideation or attempts as well as histories of misuse of tranquilizers, alcohol, or other [central nervous system–active] drugs," stated letters sent to healthcare professionals by the FDA and PriCara, the maker of the 2 medications and a division of Ortho-McNeil-Janssen Pharmaceuticals.
The letters, 1 for each medication, noted that tramadol, an opioid, can intensify the effects of other opioids as well as alcohol and illicit drugs that depress the central nervous system.
The letters also warned that people with addiction disorders may seek out tramadol and cited the risk of criminal diversion. However, "concerns about abuse, addiction, and diversion should not prevent the proper management of pain," the letters stated.
More information on the FDA announcement is available on the agency's Web site.
To report adverse events related to the 2 pain medications, contact MedWatch by telephone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to 5600 Fishers Lane, Rockville, Maryland 20852-9787.


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Glycemic Control in the ICU


Brian P. Kavanagh, M.B., and Karen C. McCowen, M.D.
N Engl J Med 2010; 363:2540-2546


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Management of Children With Food Allergy: Current Trends and Updates

Chiang Wen Chin, BMedSci, MBBS (Nott), MRCPCH (Lon), FAMS (Singapore); A Wesley Burks, MD



INTRODUCTION

In the last two decades, the prevalence of food allergy has been on the rise.1,2 Recent obser vations that Asian immigrants in North America and Europe have equal or even increased rates of food hypersensitivity compared with their Western counterparts pose a worrying possibility that, with the urbanization and Westernization of Asia, this has resulted in the in creased prevalence of food allergy.The increase in food hypersensitivity expanding to areas of the world where the general awareness of food allergies is relatively low requires attention. In a recent survey in Singapore and the Philippines, the prevalence of peanut allergy appears to be low in both populations—prevalence of 0.3–0.6% in local 4- to 6-year-old children, as compared with 1.2% in the expatriate children (especially those born in the West) residing in Singapore.Conversely, shellfish allergy was more common in the local Singapore children (4–6 years, 1.19%) compared with expatriate children (4–6 years, 0.55%). This observation was also seen in symptomatic food allergic individuals presenting for evaluation, in which peanut sen sitization was the third most common food allergen (present in 27% of subjects) after shellfish sensitization (39% of subjects).5




CLINICAL SYMPTOMS OF FOOD ALLERGY

Different food allergens differ in their food-eliciting reaction profile as well as their prognosis (Table 1).Diagnosing a food allergy requires a history of symptoms and their time of onset after eating, the food or foods eaten prior to the onset of symptoms, the amount of each food eaten, and whether similar reactions have occurred on previous ingestions. Symptoms typically appear within min utes to two hours after a person has eaten the food. Symptoms of food allergy can include a tingling sensation in the mouth, swelling of the tongue and throat, rash, eczema, urticaria, vomiting, abdominal cramps, diarrhoea, wheezing, difficulty breathing, drop in blood pressure, loss of consciousness, and (very rarely) death.

DIAGNOSIS AND MANAGEMENT OF FOOD ALLERGY

There are two tests most commonly used for the diagnosis of food allergy—skin prick test and se rum specific IgE levels. These tests have excellent negative predictive values but are less than 50% in their positive predictive values.These diagnostic values (skin prick test or specific IgE) are helpful to the physician in deciding if a food challenge is safe or potentially harmful to the patients, based on various predictive threshold studies by various authors. Unfortunately, differences in diagnostic threshold values exist between study populations, as the age of food challenge and regional differenc es are not often comparable between the studies. Therefore, the allergist combines the available test results along with the medical history to make a food allergy diagnosis. In some cases, the allergist may deem the patient to be at high risk for food-related anaphylaxis, and the patient is advised to continue strict avoidance of the allergen and coun selled to carry an adrenaline auto-injector. In cases in which the food allergy needs to be confirmed, food challenges in the form of open challenges or double-blind food challenges to determine if the child has outgrown the food allergy should be con ducted in places that have adequate facilities to manage food-related anaphylaxis.
However, unlike other allergic diseases, food allergy is the only disorder for which there is no specific therapy available in clinical practice, with dietary avoidance as the only alternative. In fact, food-induced anaphylaxis is now the most common cause of anaphylaxis evaluated at the children’s hospital in Singapore.8
In a recent survey carried out in KK Women’s and Children’s Hospital in Singapore, a survey of 123 local Asian patients with peanut sensitiza tion revealed that 79.7% (98/123) of our patients had ingested peanuts. Of these patients, 83.7% (82/98) developed a reaction and 16.3% (16/98) did not. Of the 82 patients who reacted to peanut, 96.3% (79/82) had skin symptoms, 39.0% (32/82) respiratory, 13.4% (11/82) gastrointestinal, and 4.9% (4/82) systemic involvement. Most (41.5%; 34/82) sought treatment at primary care facilities, 19.5% (16/82) went to the emergency department, and 2.4% (2/82) required hospital admission. Only two children had an adrenaline injection during their first peanut allergic reaction. More than 56% (46/82) had accidental ingestions with peanuts, of which 43.5% (20/46) had more severe reactions and four patients developed anaphylaxis. The sever­ity of peanut reaction in this population of peanut sensitized patients is significant with almost 43% (35/82) of patients having two or more systems in volved after ingestion of peanut.9
The low use of epinephrine in the emergency care setting and the low rate of patient awareness of the correct use of the EpiPen as seen on questionnaire responses in our population of children poses a challenge to treating this potentially life-threatening scenario. As noted in other publica tions, risk of accidental ingestion in peanut-allergic patients is high, ranging from 50% to 86%.10,11 Ef forts must be made to educate our population and to increase the awareness of food allergy and its treatment, especially in the use of EpiPen in the case of anaphylaxis.
The prevalence of repeated reactions second ary to ‘accidental peanut ingestions’ after the di-agnosis of peanut allergy/sensitization was more than 56%, with half of these reactions reported to be more severe than the first symptomatic food re action. Both the clinical characteristics and peanut protein-specific allergen determination suggest a phenotype that is similar to that of European and North American patients.12 Dietary avoidance is the current standard of care, but accidental ingestions of food allergens are common because of the ubiq uitous presence of certain foods, such as peanut, milk, egg and shellfish. This problem is compound-ed by poor labelling practices in the Asia Pacific region (with the exception of Australia and Japan where labelling laws exists) and cross-contami nation during processing, which is not regulated. Furthermore, in cases of multiple food allergies, restricted diets may result in unbalanced nutrition and pose a considerable hardship to the family of a food-allergic child.
Therefore, accurate diagnosis of food allergy is of utmost importance and currently relies on oral food challenges which are not without substantial risks and should be conducted in places that have adequate facilities to manage food-related anaphy laxis. Considering the severity of food allergy as well as its increasing prevalence, improved diag nostic tests and definitive therapies are desirable. This case study and article reviews the recent de velopments in the diagnosis, management and po tential treatments for food allergy.

FUTURE TRENDS IN MANAGEMENT OF FOOD ALLERGY

An area of significant interest in recent years is the use of food oral immunotherapy (OIT) in the management of food allergy. Animal studies sug gest that the high-dose feeding of an antigen re sults in the state of non-responsiveness due to an ergy or deletion of antigen-specific T lymphocytes, whereas continuous low-dose ingestion may induce protective suppressive responses from regulatory T cells.13 Increasingly, evidence from multiple clinical trials have demonstrated that OIT induces ‘desensi tization’ and possible permanent oral tolerance. In a desensitized state, the protective effect depends on the daily, uninterrupted ingestion of the food al lergen; however, when the dosing is interrupted, the protective effect may be lost or significantly de creased. Oral tolerance, however, persists despite the discontinuation of the daily ingestion of food allergen, and the individual can tolerate exposure to the food allergen at anytime. There are a number of allergic side effects to the treatment; up to 20% of individuals may not tolerate the OIT regimen. The immunological effects of OIT include: (1) decreased skin prick tests to the food by 1 year, (2) a change in the allergen-specific response by basophils by 6 months, (3) an initial rise in allergen-specific IgE, followed by a decrease by 18–24 months, (4) an in crease in allergen-specific IgG4, and (5) changes in the Th2 (allergic) cytokines over 36 months of treat­ment. More will be learned in the next few years as we wait to see if this type of therapy is appropriate for food allergy.






ROLE OF PRIMARY PREVENTION OF FOOD ALLERGY: WEANING IN INFANTS

Weaning guidelines have been revised in recent years with a reversal in policy advice in several countries with respect to the optimal timing of complementary food introduction in infants.14 There is insufficient evidence for delaying introduction of solid foods, including potentially allergenic foods, beyond 4–6 months of age, even in infants at risk of developing allergic disease.15–17 The premise for this is that restricting developmentally appropriate solid food variety beyond age 6 months can lead to inadequate nutrient intake, growth deficits, and feeding problems (such as oral food aversion). If the patient develops an allergic reaction, appropriate review by a specialist physician to help in the di agnostic workup and advice for food elimination or reintroduction is advised.
There is consistent evidence that breastfeed ing for at least 4 months, compared with feeding formula made with intact cow milk protein, pre vents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood.18 In studies of infants at high risk for atopy and who are not exclusively breastfed for 4–6 months, there is modest evidence that atopic dermatitis may be prevented in more subjects by the use of hydrolysed formulas compared with formula made with intact cow milk protein. However, no significant differ ence for asthma, allergic rhinitis and food allergy outcomes were noted.19 Comparative studies of the various hydrolysed formulas presently available also indicate that not all formulas have the same protective benefit.20
Some supporting evidence for the above guideline changes is the worrying observation that the prevalence of peanut allergy in children in the UK and North America has doubled over 10 years and approximates 1.8% and 1.2%, respectively.21,22 This occurred despite avoidance of peanuts in preg-nancy and early life in an attempt to prevent peanut allergy for the last two decades. Moreover, recent epidemiological work has shown that peanut al lergy was some 10 times less common in Jewish populations living in Israel where regular exposure to peanut-containing foods in early life is the norm, compared with Jewish origin populations in the UK where peanut ingestion is far less common.23 This has led to the suggestion that early oral exposure to food allergens may be important to induce oral tolerance to foods.
In light of the present evidence available, it is postulated that a ‘window of opportunity’ for the introduction of different food allergens ex ists. This timing may differ between allergens, in a small subset of individuals at risk of developing food allergy, and is influenced by additional envi ronmental and genetic factors. Hence, we would advise that a general cautionary attitude needs be adopted and further studies are needed before a blanket recommendation of weaning strategies to the general population can be implemented to the at-risk population. Preferably, these studies will be of a prospective interventional design in at-risk and non-at-risk populations and in children with diverse genetic and cultural backgrounds

About the Authors
Dr Chiang is Consultant at the Allergy and Immunology Service, Department of Paediatrics, KK Women’s and Children’s Hospi tal, Singapore. Dr Burks is Professor at the Division of Pediatric Allergy and Immunology, Duke University Medical Center in the United States.

Acknowledgement
This paper was made possible through a collaboration between KK Women’s and Children’s Hospital (KKH) and the Journal of Paediatrics, Obstetrics and Gynaecology. KKH is the largest medical facility in Singapore which provides specialized care for women, babies and children.

REFERENCES

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  18. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2006;(3):CD000133.
  19. von Berg A, Filipiak-Pittroff B, Kramer U, et al. Preventive effect of hydrolyzed infant formulas persists until age 6 years: long-term results from the German Infant Nutritional Intervention Study (GINI). J Allergy Clin Immunol 2008;121:1442–1447.
  20. Osborn DA, Sinn J. Formulas containing hydro lysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006;(4):CD003664.
  21. Hourihane JO, Aiken R, Briggs R, et al. The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanut allergy in United Kingdom children at school entry. J Allergy Clin Immunol 2007;119:1197–1202.
  22. Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003;112:1203–1207.
  23. Du TG, Katz Y, Sasieni P, et al. Early consump tion of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008;122:984–991.

Source :
http://www.mims.com/Page.aspx?menuid=PublicationTopic&PubGroup=JPOG&Publication=JPOG&Issue=2010-12&Topic=Management+of+Children+With+Food+Allergy:+Current+Trends+and+Updates&PubGroupCountry=HK,%20ID,%20MY,%20PH,%20SG,%20TH,%20TW,%20VN&HT=8af3b118475f538ccaff52d3ad836000

regards, taniafdi ^_^

Cranberry Juice May Not Prevent Urinary Tract Infection

News Author: Nancy Fowler Larson
CME Author: Charles P. Vega, MD

CME Released: 12/16/2010; Valid for credit through 12/16/2011


Source :
http://www.medscape.org/viewarticle/734361?src=cmemp


December 16, 2010 — Drinking cranberry juice does not appear to ward off urinary tract infection (UTI) in young women, according to a study published in the January 2011 issue of Clinical Infectious Diseases.
One of the most common bacterial infections, UTI affects approximately 11% of all US women each year, with 1 in 5 infections affecting those 18 to 24 years old. Not only are antibiotic prevention plans and treatment of UTI expensive ($1.6 million in 1995 dollars), but they also contribute to drug resistance.
"Because antibiotic therapy is a major driver of resistance, and adversely affects the normal microbiota, preventive strategies that reduce the need for antibiotic therapy are particularly important," write Betsy Foxman, PhD, from the University of Michigan School of Public Health in Ann Arbor, and colleagues.
Relatively inexpensive cranberry juice is a folk remedy shown to be effective in preventing UTI recurrence in observational studies and in small or open randomized trials. Seeking more substantial evidence, the investigators launched a double-blind, placebo-controlled trial testing its impact on recurrent infections.
The researchers studied 319 otherwise healthy college women, with a mean age of 21 years, who were diagnosed with acute UTI at the Michigan Health Service laboratory between August 2005 and October 2007. They observed the participants for 6 months or until a second infection occurred and assumed that 30% of the women would experience another UTI during the observation period.
The subjects were randomly assigned to drink 8 ounces of 27% low-calorie cranberry juice cocktail (n = 155) or the same amount of a placebo juice (n = 164) at 2 times a day throughout the 6-month follow-up. Self-collected vaginal and rectal specimens and a clean-catch midstream urine specimen were presented by the women at baseline and at 3 months and 6 months. These were cultured to determine the presence of uropathogens.
Information about UTI and other symptoms, risk factors for infection, diet, and other factors was collected at various times during the trial through on-site questionnaires, telephone interviews, and online surveys.
Cranberry Juice Drinkers Had Higher UTI Recurrence
At the study’s conclusion, 230 (72%) of the women had completed the full protocol. Self-reported compliance was similar between the cranberry juice group and the placebo group. Pertinent findings, adjusted for sexual activity and UTI history, are as follows:
  • Among all participants, the recurrence rate was 16.9% (95% confidence interval [CI], 12.8% - 21.0%).
  • The group drinking cranberry juice had a slightly higher recurrence rate (20.0% vs 14.0%).
  • Symptoms reported by the participants at 3 days, 1 to 2 weeks, and at 1 month or longer were similar between the groups.
Among those with 2 or more previous UTIs, the risk for occurrence was significantly greater (22% vs 10%; P = .0007), but cranberry juice had no significant impact on those with or without such a history.
Rebecca Kolp, MD, an obstetrician-gynecologist at Massachusetts General Hospital in Boston, has never recommended cranberry juice to patients with UTI. Dr. Kolp told Medscape Medical News that she was not surprised by the findings.
"I've heard a lot of people say they feel cranberry juice helps, but there was never any scientific proof," Dr. Kolp said. "I think there are a lot of other preventative steps they can take such as staying well hydrated and urinating after intercourse."
The investigators acknowledged 3 possible limitations to their study:
  • The placebo may have unintentionally contained the active ingredients in cranberry juice, as the exact ingredients have not been isolated with full certainty.
  • Cranberry juice and the placebo both contain ascorbic acid, which is suggested to reduce the risk for UTI, an association that has not been found in controlled trials.
  • Because the study prescribed liquids, participants may have experienced better hydration than usual, and their more frequent urination may have stunted bacterial growth and decreased mild UTI symptoms.
A strength of the study, according to Andrew Steele, MD, professor of urogynecology at Saint Louis University School of Medicine, in St. Louis, Missouri, is its reliable diagnostics, which exceeded symptoms assessment by culturing specimens.
"When you deal with recurrent urinary tract infection in women, the first question you've always got to always ask yourself is, 'Is this really an infection?'" Dr. Steele said. "There are a lot of other things that can cause infection symptoms."
The researchers noted that their findings are similar to those of 2 previous studies: one, whose 305 subjects had a neuropathic bladder after a spinal cord injury, and another whose participants were much older than the population in which UTI most often occurs.
"Of interest, in the only other large trial of cranberry juice compared with placebo juice, conducted among 376 British inpatients ≥60 years, the incidence of symptomatic UTI was also lower than anticipated in the placebo group, but there was no significant difference between groups," the study authors write.
The National Institutes of Health supported the study. The study authors, Dr. Kolp, and Dr. Steele have disclosed no relevant financial relationships.
Clin Infect Dis. 2011;52:23-30. Abstract


regards, taniafdi ^_^

New Guidelines for Exercise in Type 2 Diabetes

News Author: Fran Lowry
CME Author: Penny Murata, MD

CME Released: 12/16/2010; Valid for credit through 12/16/2011


Source: 
http://www.medscape.org/viewarticle/734359?src=cmemp


December 16, 2010 — New guidelines issued jointly by the American Diabetes Association and the American College of Sports Medicine stress the crucial role that physical activity plays in the management of type 2 diabetes.
They replace recommendations made in the American College of Sports Medicine Position Stand "Exercise and Type 2 Diabetes" that were issued in 2000.
Developed by a panel of 9 experts, the new guidelines are published concurrently in the December issue ofMedicine & Science in Sports & Exercise and Diabetes Care.
"High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently," the expert panel writes, "but it is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay type 2 diabetes mellitus, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life."
Most of the benefits of exercise are realized through acute and long-term improvements in insulin action, accomplished with both aerobic and resistance training, the experts write.
For people who already have type 2 diabetes, the new guidelines recommend at least 150 minutes per week of moderate to vigorous aerobic exercise spread out at least 3 days during the week, with no more than 2 consecutive days between bouts of aerobic activity. These recommendations take into account the needs of those whose diabetes may limit vigorous exercise.
"Most people with type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopaedic or other health limitations," said writing chair Sheri R. Colberg, PhD, professor of exercise science at Old Dominion University and adjunct professor of internal medicine at Eastern Virginia Medical School, Norfolk, Virginia, in a statement. "For this reason, the ADA [American Diabetes Association] and ACSM [American College of Sports Medicine] call for a regimen of moderate-to-vigorous activity and make no recommendation for a lesser amount of vigorous activity."
The panel specifically recommends that such moderate exercise correspond to approximately 40% to 60% of maximal aerobic capacity and states that for most people with type 2 diabetes, brisk walking is a moderate-intensity exercise.
The expert panel also recommends that resistance training be part of the exercise regimen. This should be done at least twice a week — ideally 3 times a week — on nonconsecutive days. The panel also recommends that people just beginning to do weight training be supervised by a qualified exercise trainer "to ensure optimal benefits to blood glucose control, blood pressure, lipids, and cardiovascular risk and to minimize injury risk."
Regular use of a pedometer is also encouraged. In a meta-analysis of 8 randomized controlled trials and 18 observational studies, people who used pedometers increased their physical activity by 27% over baseline. Having a goal, such as taking 10,000 steps per day, was an important predictor of increased physical activity, according to the expert panel.
Finally, the new guidelines emphasise that exercise must be done regularly to have continued benefits and should include regular training of varying types.
Physicians should prescribe exercise, Dr. Colberg said in a statement. "Many physicians appear unwilling or cautious about prescribing exercise to individuals with type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity."
Dr. Colberg and the other authors have disclosed no relevant financial relationships.
Med Sci Sports Exerc. 2010;42:2282-2303.


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1/7/11

Bajunya Lucu


Suka ama design nya.., bisa buat org yg berhijab.., atasannya juga longgar.., celana juga ga terlalu ngepas.., suka suka sekali.. :)

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1/6/11

Blog Lovin

Follow my blog with bloglovin


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Be Reader

yuuppzzzzz...., i love reading... ^_^

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ReSoLuTiOnS



(thanks for all these pictures Shannon Eileen :) )

And i'm still thinking my resolutions. As one of my friend said "Let it be". Just past this year with full of spirit. Yeeaahhhhh!!!! :D

regards, taniafdi ^_^

Quote of the Day

"Take chances and never regrets, 

because at one point, 

everything you did was exactly what you 

wanted."

regards, taniafdi ^_^

Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation


Mark Pimentel, M.D., Anthony Lembo, M.D., William D. Chey, M.D., Salam Zakko, M.D., Yehuda Ringel, M.D., Jing Yu, Ph.D., Shadreck M. Mareya, Ph.D., Audrey L. Shaw, Ph.D., Enoch Bortey, Ph.D., and William P. Forbes, Pharm.D. for the TARGET Study Group
N Engl J Med 2011; 364:22-32


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General Anesthesia, Sleep, and Coma


Emery N. Brown, M.D., Ph.D., Ralph Lydic, Ph.D., and Nicholas D. Schiff, M.D.
N Engl J Med 2010; 363:2638-2650


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Prostate Cancer Screening Guideline Updated by ACS

Nick Mulcahy

source:
http://www.medscape.com/viewarticle/717875?src=top10


March 3, 2010 — For the first time since 2001, the American Cancer Society (ACS) has updated its prostate cancer screening guideline.
The new guideline has a more pronounced emphasis on informed decision-making (IDM) than in the past.Men should only be screened "after they receive information about the uncertainties, risks, and potential benefits associated with prostate cancer screening," states the document.
"We are making a stronger case for informed decision-making," lead author of the guideline, Andrew Wolf, MD, told Medscape Oncology.
"We have explicitly outlined in this guideline what we feel to be the core elements [that need] to be imparted to patients for an informed decision to occur," said Dr. Wolf, who is associate professor of medicine at the University of Virginia School of Medicine in Charlottesville.
Dr. Wolf also explained that "decision aids," or educational tools tailored to patients, are vital to the practicality of the recommendation for IDM.
There are also several new recommendations for men who choose to be tested.
Prostate-specific antigen (PSA) testing is now recommended with or without the digital rectal exam (DRE). "There is little evidence that the digital rectal exam adds significant benefit to the PSA test, except, perhaps, when the PSA is in the borderline range," he said.
The ACS continues to recommend that the PSA value of 4.0 ng/mL be used as a "reasonable threshold" to trigger further evaluation, said Dr. Wolf.
However, there is a new recommendation for men with PSA values between 2.5 and 4.0 ng/mL.
"Recognizing that approximately 25% of men with PSA levels between 2.5 and 4.0 ng/mL harbor prostate cancer, we have added a recommendation that physicians consider an individualized risk assessment for men with PSA values in this indeterminate range," said Dr. Wolf.
An individual assessment should take into account non-PSA risk factors, such as race, family history, results of previous biopsies, and DRE results, he said
ACS also now recommends that the PSA testing interval be reduced to every other year for men whose PSA level is under 2.5 ng/mL. "Such a reduction in testing frequency will lead to significantly reduced false positives, unnecessary biopsies, and overdiagnosis, with only a negligible increase in missed cancers," explained Dr. Wolf.
The American Urological Association (AUA) differs with the ACS on PSA values. "The AUA feels there is no single PSA standard that applies to all men, nor should there be," they write in a press release issued soon after the guideline was made public this week.
"Although prostate cancer risk correlates with serum PSA, there is no PSA value below which a man may be reassured that he does not have biopsy-detectable prostate cancer," the AUA press release adds. The AUA also advocates for a baseline PSA test at the age of 40, and subsequent rescreening that evaluates, among other risk factors, free and total PSA, PSA velocity, and PSA density.
Overall, clinicians will recognize much of the old ACS guideline in the new document, which was published online March 3 in CA: A Cancer Journal for Clinicians.
"The 2010 guideline does not represent a substantive departure from our 2001 guideline," said Dr. Wolf.
Decision Aids to the Rescue
In the context of prostate cancer screening, IDM and shared decision-making (SDM) is no small job, the guideline suggests.
"The challenge of offering every eligible man the opportunity to make an informed decision about prostate cancer screening can be daunting to the healthcare provider," write Dr. Wolf and his coauthors.
Time constraints and the "complexity of the issue" are the "key obstacles" to IDM/SDM, according to healthcare providers, the authors note.
In addition, there is no reimbursement for IDM/SDM.
Dr. Wolfe acknowledged the problem of lack of reimbursement.


"Primary care physicians can be reimbursed for counseling time if it comprises more than half of the office visit and is documented. However, I am not aware of any specific reimbursement for counseling related to prostate cancer early detection," he said.
The time and money problems related to IDM/SDM are not insurmountable, suggested Dr. Wolf.
"This is a vital point that we tackled head on with this revised guideline," he said about these practical challenges.
"Recognizing that insufficient time is cited by physicians as the greatest barrier to engaging men in informed and shared decision-making related to prostate cancer, the American Cancer Society guideline strongly advocates the use of decision aids," he declared.
Decision aids should be given to patients before an office visit, suggested another expert.
"By providing a decision aid in advance of a clinic visit, the patient–provider discussion — the shared decision-making — can be much more efficient, addressing screening decisions in the context of a patient's specific medical conditions, values, and concerns," said Richard Hoffman, MD, MPH, an internist at the Raymond G. Murphy VA Medical Center in Albuquerque, New Mexico, who has studied doctor–patient communication surrounding PSA testing. Dr. Hoffman was approached for independent comment by Medscape Oncology.
Healthcare dollars might be also be saved, he suggested.


"Often, informed patients make more conservative treatment decisions, so decision aids potentially could reduce healthcare costs," said Dr. Hoffman
In the state of Washington, legislation has been passed supporting the use of various decision aids and implementing demonstration projects, noted Dr. Hoffman.
Dr. Wolf agrees that the decision aids have multiple benefits.
"Decision aids lead to improved knowledge, decreased "decisional conflict," and a greater desire to play an active role in the decision," he said, referring to clinical studies.
Exactly how clinicians should use decision aids remains to be seen, explained Dr. Wolf.
"Physicians will still need to figure out how to incorporate decision aids into their own practices," he said.
Problems remain as well. "There are still obstacles to address: we need more decision aids that are tailored to low-literacy and non-English-speaking populations," Dr. Wolf noted.
Still, the new guideline is unequivocal about the need for doctor–patient discussion.
"No man should be tested without having first engaged in an informed decision-making process," summarized Dr. Wolf.
The ACS guideline document includes links to the decision aid materials of different organizations, including the ACS, the Foundation for Informed Medical Decision Making, the Centers for Disease Control and Prevention, the Mayo Clinic, and the University of Cardiff in the United Kingdom.
Informed Decision-Making: By Age and Core Elements
At the age of 50, men at average risk for prostate cancer should start receiving facts about prostate cancer and screening, states the new ACS guideline. Men at higher risk, including African American men and men with a first-degree relative (father or brother) diagnosed with prostate cancer before age 65, should receive this information beginning at age 45.
Men at "appreciably higher risk" (multiple family members diagnosed with prostate cancer before age 65) should receive information beginning at age 40.
The "core elements" of the information to be provided to men to assist with their prostate cancer screening decision include the following:
  • Screening with the PSA blood test detects cancer at an earlier stage than if no screening is performed.
  • Prostate cancer screening might be associated with a reduction in the risk of dying from prostate cancer; however, evidence is conflicting.
  • For men whose prostate cancer is detected by screening, it is not currently possible to predict which men are likely to benefit from treatment.
  • Treatment for prostate cancer can lead to urinary, bowel, sexual, and other health problems that can be significant or minimal, permanent or temporary.
  • The PSA and DRE can produce false-positive or false-negative results.
  • Abnormal results from screening with PSA and DRE require prostate biopsies, which can be painful and lead to complications like infection or bleeding.
  • Not all men whose prostate cancer is detected through screening require immediate treatment. Some require periodic blood tests and prostate biopsies to determine the need for future treatment.
Dr. Hoffman reports receiving partial salary support from the nonprofit Foundation for Informed Medical Decision Making to help develop a prostate cancer screening decision aid.
CA Cancer J Clin. Published online March 3, 2010.

regards, taniafdi ^_^

American Diabetes Association Revises Diabetes Guidelines

Laurie Barclay, MD

Source :
http://www.medscape.com/viewarticle/714401?src=top10


December 29, 2009 — The American Diabetes Association (ADA) revised clinical practice recommendations for diabetes diagnosis promote hemoglobin A1c (A1c) as a faster, easier diagnostic test that could help reduce the number of undiagnosed patients and better identify patients with prediabetes. The new recommendations are published December 29 in the January supplement of Diabetes Care.
"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease," Richard M. Bergenstal, MD, ADA president-elect of medicine & science, said in a news release. "Additionally, early detection can make an enormous difference in a person's quality of life. Unlike many chronic diseases, type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."
The A1c test, which measures average blood glucose levels for a period of up to 3 months, was previously used only to evaluate diabetic control with time. An A1c level of approximately 5% indicates the absence of diabetes, and according to the revised evidence-based guidelines, an A1c score of 5.7% to 6.4% indicates prediabetes, and an A1c level of 6.5% or higher indicates the presence of diabetes.
For optimal diabetic control, the recommended ADA target for most people with diabetes is an A1c level no greater than 7%. It is hoped that achieving this target would help prevent serious diabetes-related complications including nephropathy, neuropathy, retinopathy, and gum disease.
Unlike fasting plasma glucose testing and the oral glucose tolerance test, A1c testing does not require overnight fasting. Compliance with screening may therefore be improved through use of the A1c test, which can be determined from a single nonfasting blood sample.
Recommendation Changes for 2010
Specific changes in the 2010 Clinical Practice Recommendations are as follows:
  • A section on diabetes related to cystic fibrosis has been added to "Standards of Medical Care in Diabetes." New evidence has shown that early diagnosis of cystic fibrosis-related diabetes and aggressive treatment with insulin have narrowed the gap in mortality between patients with cystic fibrosis with and without diabetes and have eliminated the sex difference in mortality rates. New recommendations for the clinical management of cystic fibrosis-related diabetes, based on a 2009 consensus conference, will be published in 2010 in a consensus report.
  • Revision of the section "Diagnosis of Diabetes" now includes the use of the A1c level for diabetes diagnosis, with a cutoff point of 6.5%.
  • The section formerly named "Diagnosis of Pre-diabetes" is now named "Categories of Increased Risk for Diabetes." Categories suggesting an increased risk for future diabetes now include an A1c range of 5.7% to 6.4%, as well as impaired fasting glucose and impaired glucose tolerance levels.
  • Revisions to the section "Detection and Diagnosis of GDM [Gestational Diabetes Mellitus]" now include a discussion of possible future changes in this diagnosis, according to international consensus. Screening recommendations for gestational diabetes are to use risk factor analysis and an oral glucose tolerance test, if appropriate. Women diagnosed with gestational diabetes should be screened for diabetes 6 to 12 weeks postpartum and should have subsequent screening for the development of diabetes or prediabetes.
  • Extensive revisions to the section "Diabetes Self-Management Education" are based on new evidence. Goals of diabetes self-management education are to improve adherence to standard of care, to educate patients regarding appropriate glycemic targets, and to increase the percentage of patients achieving target A1c levels.
  • Extensive revisions to the section "Antiplatelet Agents" now reflect evidence from recent trials suggesting that in moderate- or low-risk patients, aspirin is of questionable benefit for primary prevention of cardiovascular disease. The revised recommendation is to consider aspirin treatment as a primary prevention strategy in patients with diabetes who are at increased cardiovascular risk, defined as a 10-year risk greater than 10%. Patients at increased cardiovascular risk include men older than 50 years or women older than 60 years with at least 1 additional major risk factor.
  • Fundus photography may be used as a screening strategy for retinopathy, as described in the section "Retinopathy Screening and Treatment." However, although high-quality fundus photographs detect most clinically significant diabetic retinopathy, they should not act as a substitute for an initial and dilated comprehensive eye examination. Retinal examinations should be carried out annually or at least every 2 to 3 years among low-risk patients with normal eye examination results in the past.
  • Extensive revisions to the section "Diabetes Care in the Hospital" now question the benefit of very tight glycemic control goals in critically ill patients, based on new evidence.
  • Extensive revisions to the section "Strategies for Improving Diabetes Care" are based on newer evidence. Successful strategies to improve diabetes care, which have resulted in improved process measures such as measurement of A1c levels, lipid levels, and blood pressure, include the following:
    • Delivery of diabetes self-management education.
    • Adoption of practice guidelines developed with participation of healthcare professionals and having them readily accessible at the point of service.
    • Use of checklists mirroring guidelines, which help improve adherence to standards of care.
    • Systems changes, including providing automated reminders to healthcare professionals and patients and audit and feedback of process and outcome data to providers.
    • Quality improvement programs, in which continuous quality improvement or other cycles of analysis and intervention are combined with provider performance data.
    • Practice changes, which may include access to point-of-care A1c testing, scheduling planned diabetes visits, and clustering dedicated diabetes visits into specific times.
    • Tracking systems with either an electronic medical record or patient registry to improve adherence to standards of care.
    • Availability of case or (preferably) care management services using nurses, pharmacists, and other nonphysician healthcare professionals following detailed algorithms under physician supervision.
"The most successful practices have an institutional priority for quality of care, involve all of the staff in their initiatives, redesign their delivery system, activate and educate their patients, and use electronic health record tools," the guidelines authors conclude. "It is clear that optimal diabetes management requires an organized, systematic approach and involvement of a coordinated team of dedicated health care professionals working in an environment where quality care is a priority."
Diabetes Care. December 29, 2009; January 2010 Supplement.

regards, taniafdi ^_^

FDA Warns of Suicide Risk for Tramadol

by Robert Lowes

Source :
http://www.medscape.com/viewarticle/722488?src=top10


May 26, 2010 — The US Food and Drug Administration (FDA) announced yesterday that it has added a warning of suicide risk to the labels of tramadol hydrochloride (Ultram) and tramadol hydrochloride/acetaminophen (Ultracet).
The revised labels instruct clinicians not to prescribe tramadol to patients who are suicidal or addiction-prone, and to exercise caution in prescribing the medications to patients who use alcohol excessively, suffer from emotional disturbance or depression, or take tranquilizers or antidepressants.
"Tramadol-related deaths have occurred in patients with previous histories of emotional disturbances or suicidal ideation or attempts as well as histories of misuse of tranquilizers, alcohol, or other [central nervous system–active] drugs," stated letters sent to healthcare professionals by the FDA and PriCara, the maker of the 2 medications and a division of Ortho-McNeil-Janssen Pharmaceuticals.
The letters, 1 for each medication, noted that tramadol, an opioid, can intensify the effects of other opioids as well as alcohol and illicit drugs that depress the central nervous system.
The letters also warned that people with addiction disorders may seek out tramadol and cited the risk of criminal diversion. However, "concerns about abuse, addiction, and diversion should not prevent the proper management of pain," the letters stated.
More information on the FDA announcement is available on the agency's Web site.
To report adverse events related to the 2 pain medications, contact MedWatch by telephone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to 5600 Fishers Lane, Rockville, Maryland 20852-9787.


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Glycemic Control in the ICU


Brian P. Kavanagh, M.B., and Karen C. McCowen, M.D.
N Engl J Med 2010; 363:2540-2546


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regards, taniafdi ^_^

Management of Children With Food Allergy: Current Trends and Updates

Chiang Wen Chin, BMedSci, MBBS (Nott), MRCPCH (Lon), FAMS (Singapore); A Wesley Burks, MD



INTRODUCTION

In the last two decades, the prevalence of food allergy has been on the rise.1,2 Recent obser vations that Asian immigrants in North America and Europe have equal or even increased rates of food hypersensitivity compared with their Western counterparts pose a worrying possibility that, with the urbanization and Westernization of Asia, this has resulted in the in creased prevalence of food allergy.The increase in food hypersensitivity expanding to areas of the world where the general awareness of food allergies is relatively low requires attention. In a recent survey in Singapore and the Philippines, the prevalence of peanut allergy appears to be low in both populations—prevalence of 0.3–0.6% in local 4- to 6-year-old children, as compared with 1.2% in the expatriate children (especially those born in the West) residing in Singapore.Conversely, shellfish allergy was more common in the local Singapore children (4–6 years, 1.19%) compared with expatriate children (4–6 years, 0.55%). This observation was also seen in symptomatic food allergic individuals presenting for evaluation, in which peanut sen sitization was the third most common food allergen (present in 27% of subjects) after shellfish sensitization (39% of subjects).5




CLINICAL SYMPTOMS OF FOOD ALLERGY

Different food allergens differ in their food-eliciting reaction profile as well as their prognosis (Table 1).Diagnosing a food allergy requires a history of symptoms and their time of onset after eating, the food or foods eaten prior to the onset of symptoms, the amount of each food eaten, and whether similar reactions have occurred on previous ingestions. Symptoms typically appear within min utes to two hours after a person has eaten the food. Symptoms of food allergy can include a tingling sensation in the mouth, swelling of the tongue and throat, rash, eczema, urticaria, vomiting, abdominal cramps, diarrhoea, wheezing, difficulty breathing, drop in blood pressure, loss of consciousness, and (very rarely) death.

DIAGNOSIS AND MANAGEMENT OF FOOD ALLERGY

There are two tests most commonly used for the diagnosis of food allergy—skin prick test and se rum specific IgE levels. These tests have excellent negative predictive values but are less than 50% in their positive predictive values.These diagnostic values (skin prick test or specific IgE) are helpful to the physician in deciding if a food challenge is safe or potentially harmful to the patients, based on various predictive threshold studies by various authors. Unfortunately, differences in diagnostic threshold values exist between study populations, as the age of food challenge and regional differenc es are not often comparable between the studies. Therefore, the allergist combines the available test results along with the medical history to make a food allergy diagnosis. In some cases, the allergist may deem the patient to be at high risk for food-related anaphylaxis, and the patient is advised to continue strict avoidance of the allergen and coun selled to carry an adrenaline auto-injector. In cases in which the food allergy needs to be confirmed, food challenges in the form of open challenges or double-blind food challenges to determine if the child has outgrown the food allergy should be con ducted in places that have adequate facilities to manage food-related anaphylaxis.
However, unlike other allergic diseases, food allergy is the only disorder for which there is no specific therapy available in clinical practice, with dietary avoidance as the only alternative. In fact, food-induced anaphylaxis is now the most common cause of anaphylaxis evaluated at the children’s hospital in Singapore.8
In a recent survey carried out in KK Women’s and Children’s Hospital in Singapore, a survey of 123 local Asian patients with peanut sensitiza tion revealed that 79.7% (98/123) of our patients had ingested peanuts. Of these patients, 83.7% (82/98) developed a reaction and 16.3% (16/98) did not. Of the 82 patients who reacted to peanut, 96.3% (79/82) had skin symptoms, 39.0% (32/82) respiratory, 13.4% (11/82) gastrointestinal, and 4.9% (4/82) systemic involvement. Most (41.5%; 34/82) sought treatment at primary care facilities, 19.5% (16/82) went to the emergency department, and 2.4% (2/82) required hospital admission. Only two children had an adrenaline injection during their first peanut allergic reaction. More than 56% (46/82) had accidental ingestions with peanuts, of which 43.5% (20/46) had more severe reactions and four patients developed anaphylaxis. The sever­ity of peanut reaction in this population of peanut sensitized patients is significant with almost 43% (35/82) of patients having two or more systems in volved after ingestion of peanut.9
The low use of epinephrine in the emergency care setting and the low rate of patient awareness of the correct use of the EpiPen as seen on questionnaire responses in our population of children poses a challenge to treating this potentially life-threatening scenario. As noted in other publica tions, risk of accidental ingestion in peanut-allergic patients is high, ranging from 50% to 86%.10,11 Ef forts must be made to educate our population and to increase the awareness of food allergy and its treatment, especially in the use of EpiPen in the case of anaphylaxis.
The prevalence of repeated reactions second ary to ‘accidental peanut ingestions’ after the di-agnosis of peanut allergy/sensitization was more than 56%, with half of these reactions reported to be more severe than the first symptomatic food re action. Both the clinical characteristics and peanut protein-specific allergen determination suggest a phenotype that is similar to that of European and North American patients.12 Dietary avoidance is the current standard of care, but accidental ingestions of food allergens are common because of the ubiq uitous presence of certain foods, such as peanut, milk, egg and shellfish. This problem is compound-ed by poor labelling practices in the Asia Pacific region (with the exception of Australia and Japan where labelling laws exists) and cross-contami nation during processing, which is not regulated. Furthermore, in cases of multiple food allergies, restricted diets may result in unbalanced nutrition and pose a considerable hardship to the family of a food-allergic child.
Therefore, accurate diagnosis of food allergy is of utmost importance and currently relies on oral food challenges which are not without substantial risks and should be conducted in places that have adequate facilities to manage food-related anaphy laxis. Considering the severity of food allergy as well as its increasing prevalence, improved diag nostic tests and definitive therapies are desirable. This case study and article reviews the recent de velopments in the diagnosis, management and po tential treatments for food allergy.

FUTURE TRENDS IN MANAGEMENT OF FOOD ALLERGY

An area of significant interest in recent years is the use of food oral immunotherapy (OIT) in the management of food allergy. Animal studies sug gest that the high-dose feeding of an antigen re sults in the state of non-responsiveness due to an ergy or deletion of antigen-specific T lymphocytes, whereas continuous low-dose ingestion may induce protective suppressive responses from regulatory T cells.13 Increasingly, evidence from multiple clinical trials have demonstrated that OIT induces ‘desensi tization’ and possible permanent oral tolerance. In a desensitized state, the protective effect depends on the daily, uninterrupted ingestion of the food al lergen; however, when the dosing is interrupted, the protective effect may be lost or significantly de creased. Oral tolerance, however, persists despite the discontinuation of the daily ingestion of food allergen, and the individual can tolerate exposure to the food allergen at anytime. There are a number of allergic side effects to the treatment; up to 20% of individuals may not tolerate the OIT regimen. The immunological effects of OIT include: (1) decreased skin prick tests to the food by 1 year, (2) a change in the allergen-specific response by basophils by 6 months, (3) an initial rise in allergen-specific IgE, followed by a decrease by 18–24 months, (4) an in crease in allergen-specific IgG4, and (5) changes in the Th2 (allergic) cytokines over 36 months of treat­ment. More will be learned in the next few years as we wait to see if this type of therapy is appropriate for food allergy.






ROLE OF PRIMARY PREVENTION OF FOOD ALLERGY: WEANING IN INFANTS

Weaning guidelines have been revised in recent years with a reversal in policy advice in several countries with respect to the optimal timing of complementary food introduction in infants.14 There is insufficient evidence for delaying introduction of solid foods, including potentially allergenic foods, beyond 4–6 months of age, even in infants at risk of developing allergic disease.15–17 The premise for this is that restricting developmentally appropriate solid food variety beyond age 6 months can lead to inadequate nutrient intake, growth deficits, and feeding problems (such as oral food aversion). If the patient develops an allergic reaction, appropriate review by a specialist physician to help in the di agnostic workup and advice for food elimination or reintroduction is advised.
There is consistent evidence that breastfeed ing for at least 4 months, compared with feeding formula made with intact cow milk protein, pre vents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood.18 In studies of infants at high risk for atopy and who are not exclusively breastfed for 4–6 months, there is modest evidence that atopic dermatitis may be prevented in more subjects by the use of hydrolysed formulas compared with formula made with intact cow milk protein. However, no significant differ ence for asthma, allergic rhinitis and food allergy outcomes were noted.19 Comparative studies of the various hydrolysed formulas presently available also indicate that not all formulas have the same protective benefit.20
Some supporting evidence for the above guideline changes is the worrying observation that the prevalence of peanut allergy in children in the UK and North America has doubled over 10 years and approximates 1.8% and 1.2%, respectively.21,22 This occurred despite avoidance of peanuts in preg-nancy and early life in an attempt to prevent peanut allergy for the last two decades. Moreover, recent epidemiological work has shown that peanut al lergy was some 10 times less common in Jewish populations living in Israel where regular exposure to peanut-containing foods in early life is the norm, compared with Jewish origin populations in the UK where peanut ingestion is far less common.23 This has led to the suggestion that early oral exposure to food allergens may be important to induce oral tolerance to foods.
In light of the present evidence available, it is postulated that a ‘window of opportunity’ for the introduction of different food allergens ex ists. This timing may differ between allergens, in a small subset of individuals at risk of developing food allergy, and is influenced by additional envi ronmental and genetic factors. Hence, we would advise that a general cautionary attitude needs be adopted and further studies are needed before a blanket recommendation of weaning strategies to the general population can be implemented to the at-risk population. Preferably, these studies will be of a prospective interventional design in at-risk and non-at-risk populations and in children with diverse genetic and cultural backgrounds

About the Authors
Dr Chiang is Consultant at the Allergy and Immunology Service, Department of Paediatrics, KK Women’s and Children’s Hospi tal, Singapore. Dr Burks is Professor at the Division of Pediatric Allergy and Immunology, Duke University Medical Center in the United States.

Acknowledgement
This paper was made possible through a collaboration between KK Women’s and Children’s Hospital (KKH) and the Journal of Paediatrics, Obstetrics and Gynaecology. KKH is the largest medical facility in Singapore which provides specialized care for women, babies and children.

REFERENCES

  1. Grundy J, Matthews S, Bateman B, et al. Rising prevalence of allergy to peanut in children: data from 2 sequential cohorts. J Allergy Clin Immunol 2002;110:784–789.
  2. Kagan RS, Joseph L, Dufresne C, et al. Preva lence of peanut allergy in primary-school children in Montreal, Canada. J Allergy Clin Immunol 2003;112:1223–1228.
  3. Cataldo F, Accomando S, Fragapane ML, et al. Are food intolerances and allergies increasing in immigrant children coming from developing coun tries? Pediatr Allergy Immunol 2006;17:364–369.
  4. Shek LP, Cabrera-Morales EA, Soh SE, et al. A population-based questionnaire survey on the prevalence of peanut, tree nut, and shellfish allergy in 2 Asian populations. J Allergy Clin Immunol 2010;126:324–331, 331.
  5. Chiang WC, Kidon MI, Liew WK, et al. The changing face of food hypersensitivity in an Asian community. Clin Exp Allergy 2007;37:1055–1061.
  6. Lee BW, Aw M, Chiang WC, et al. Academy of Medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy. Singapore Med J 2010;51:599–607.
  7. Sampson HA. Food allergy – accurately iden tifying clinical reactivity. Allergy 2005;60(suppl 79):19–24.
  8. Liew WK, Chiang WC, Goh A, et al. Changing face of paediatric anaphylaxis. Poster presented at: 8th Asia Pacific Congress of Allergy, Asthma and Clinical Immunology; 6–9 November 2010; Singapore.
  9. Chiang WC, Goh SH, Liew WK, et al. Clinical characteristics in children with peanut allergy. Poster presented at: 29th Congress of the European Academy of Allergy and Clinical Immunology; 5–9 June 2010; London, UK.
  10. Hourihane JO, Kilburn SA, Dean P, et al. Clinical characteristics of peanut allergy. Clin Exp Allergy 1997;27:634–639.
  11. Sicherer SH, Burks AW, Sampson HA. Clinical features of acute allergic reactions to peanut and tree nuts in children. Pediatrics 1998;102:e6.
  12. Chiang WC, Pons L, Kidon MI, et al. Serological and clinical characteristics of children with peanut sensitization in an Asian community. Pediatr Allergy Immunol 2010;21:e429–e438.
  13. Chehade M, Mayer L. Oral tolerance and its relation to food hypersensitivities. J Allergy Clin Immunol 2005;115:3–12.
  14. Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydro lyzed formulas. Pediatrics 2008;121:183–191.
  15. Fiocchi A, Assa’ad A, Bahna S. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse Reactions to Foods Committee, American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 2006;97:10–20.
  16. Host A, Koletzko B, Dreborg S, et al. Dietary products used in infants for treatment and preven tion of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediat ric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999;81:80–84.
  17. Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydro lyzed formulas. Pediatrics 2008;121:183–191.
  18. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2006;(3):CD000133.
  19. von Berg A, Filipiak-Pittroff B, Kramer U, et al. Preventive effect of hydrolyzed infant formulas persists until age 6 years: long-term results from the German Infant Nutritional Intervention Study (GINI). J Allergy Clin Immunol 2008;121:1442–1447.
  20. Osborn DA, Sinn J. Formulas containing hydro lysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006;(4):CD003664.
  21. Hourihane JO, Aiken R, Briggs R, et al. The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanut allergy in United Kingdom children at school entry. J Allergy Clin Immunol 2007;119:1197–1202.
  22. Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003;112:1203–1207.
  23. Du TG, Katz Y, Sasieni P, et al. Early consump tion of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008;122:984–991.

Source :
http://www.mims.com/Page.aspx?menuid=PublicationTopic&PubGroup=JPOG&Publication=JPOG&Issue=2010-12&Topic=Management+of+Children+With+Food+Allergy:+Current+Trends+and+Updates&PubGroupCountry=HK,%20ID,%20MY,%20PH,%20SG,%20TH,%20TW,%20VN&HT=8af3b118475f538ccaff52d3ad836000

regards, taniafdi ^_^

Cranberry Juice May Not Prevent Urinary Tract Infection

News Author: Nancy Fowler Larson
CME Author: Charles P. Vega, MD

CME Released: 12/16/2010; Valid for credit through 12/16/2011


Source :
http://www.medscape.org/viewarticle/734361?src=cmemp


December 16, 2010 — Drinking cranberry juice does not appear to ward off urinary tract infection (UTI) in young women, according to a study published in the January 2011 issue of Clinical Infectious Diseases.
One of the most common bacterial infections, UTI affects approximately 11% of all US women each year, with 1 in 5 infections affecting those 18 to 24 years old. Not only are antibiotic prevention plans and treatment of UTI expensive ($1.6 million in 1995 dollars), but they also contribute to drug resistance.
"Because antibiotic therapy is a major driver of resistance, and adversely affects the normal microbiota, preventive strategies that reduce the need for antibiotic therapy are particularly important," write Betsy Foxman, PhD, from the University of Michigan School of Public Health in Ann Arbor, and colleagues.
Relatively inexpensive cranberry juice is a folk remedy shown to be effective in preventing UTI recurrence in observational studies and in small or open randomized trials. Seeking more substantial evidence, the investigators launched a double-blind, placebo-controlled trial testing its impact on recurrent infections.
The researchers studied 319 otherwise healthy college women, with a mean age of 21 years, who were diagnosed with acute UTI at the Michigan Health Service laboratory between August 2005 and October 2007. They observed the participants for 6 months or until a second infection occurred and assumed that 30% of the women would experience another UTI during the observation period.
The subjects were randomly assigned to drink 8 ounces of 27% low-calorie cranberry juice cocktail (n = 155) or the same amount of a placebo juice (n = 164) at 2 times a day throughout the 6-month follow-up. Self-collected vaginal and rectal specimens and a clean-catch midstream urine specimen were presented by the women at baseline and at 3 months and 6 months. These were cultured to determine the presence of uropathogens.
Information about UTI and other symptoms, risk factors for infection, diet, and other factors was collected at various times during the trial through on-site questionnaires, telephone interviews, and online surveys.
Cranberry Juice Drinkers Had Higher UTI Recurrence
At the study’s conclusion, 230 (72%) of the women had completed the full protocol. Self-reported compliance was similar between the cranberry juice group and the placebo group. Pertinent findings, adjusted for sexual activity and UTI history, are as follows:
  • Among all participants, the recurrence rate was 16.9% (95% confidence interval [CI], 12.8% - 21.0%).
  • The group drinking cranberry juice had a slightly higher recurrence rate (20.0% vs 14.0%).
  • Symptoms reported by the participants at 3 days, 1 to 2 weeks, and at 1 month or longer were similar between the groups.
Among those with 2 or more previous UTIs, the risk for occurrence was significantly greater (22% vs 10%; P = .0007), but cranberry juice had no significant impact on those with or without such a history.
Rebecca Kolp, MD, an obstetrician-gynecologist at Massachusetts General Hospital in Boston, has never recommended cranberry juice to patients with UTI. Dr. Kolp told Medscape Medical News that she was not surprised by the findings.
"I've heard a lot of people say they feel cranberry juice helps, but there was never any scientific proof," Dr. Kolp said. "I think there are a lot of other preventative steps they can take such as staying well hydrated and urinating after intercourse."
The investigators acknowledged 3 possible limitations to their study:
  • The placebo may have unintentionally contained the active ingredients in cranberry juice, as the exact ingredients have not been isolated with full certainty.
  • Cranberry juice and the placebo both contain ascorbic acid, which is suggested to reduce the risk for UTI, an association that has not been found in controlled trials.
  • Because the study prescribed liquids, participants may have experienced better hydration than usual, and their more frequent urination may have stunted bacterial growth and decreased mild UTI symptoms.
A strength of the study, according to Andrew Steele, MD, professor of urogynecology at Saint Louis University School of Medicine, in St. Louis, Missouri, is its reliable diagnostics, which exceeded symptoms assessment by culturing specimens.
"When you deal with recurrent urinary tract infection in women, the first question you've always got to always ask yourself is, 'Is this really an infection?'" Dr. Steele said. "There are a lot of other things that can cause infection symptoms."
The researchers noted that their findings are similar to those of 2 previous studies: one, whose 305 subjects had a neuropathic bladder after a spinal cord injury, and another whose participants were much older than the population in which UTI most often occurs.
"Of interest, in the only other large trial of cranberry juice compared with placebo juice, conducted among 376 British inpatients ≥60 years, the incidence of symptomatic UTI was also lower than anticipated in the placebo group, but there was no significant difference between groups," the study authors write.
The National Institutes of Health supported the study. The study authors, Dr. Kolp, and Dr. Steele have disclosed no relevant financial relationships.
Clin Infect Dis. 2011;52:23-30. Abstract


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New Guidelines for Exercise in Type 2 Diabetes

News Author: Fran Lowry
CME Author: Penny Murata, MD

CME Released: 12/16/2010; Valid for credit through 12/16/2011


Source: 
http://www.medscape.org/viewarticle/734359?src=cmemp


December 16, 2010 — New guidelines issued jointly by the American Diabetes Association and the American College of Sports Medicine stress the crucial role that physical activity plays in the management of type 2 diabetes.
They replace recommendations made in the American College of Sports Medicine Position Stand "Exercise and Type 2 Diabetes" that were issued in 2000.
Developed by a panel of 9 experts, the new guidelines are published concurrently in the December issue ofMedicine & Science in Sports & Exercise and Diabetes Care.
"High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently," the expert panel writes, "but it is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay type 2 diabetes mellitus, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life."
Most of the benefits of exercise are realized through acute and long-term improvements in insulin action, accomplished with both aerobic and resistance training, the experts write.
For people who already have type 2 diabetes, the new guidelines recommend at least 150 minutes per week of moderate to vigorous aerobic exercise spread out at least 3 days during the week, with no more than 2 consecutive days between bouts of aerobic activity. These recommendations take into account the needs of those whose diabetes may limit vigorous exercise.
"Most people with type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopaedic or other health limitations," said writing chair Sheri R. Colberg, PhD, professor of exercise science at Old Dominion University and adjunct professor of internal medicine at Eastern Virginia Medical School, Norfolk, Virginia, in a statement. "For this reason, the ADA [American Diabetes Association] and ACSM [American College of Sports Medicine] call for a regimen of moderate-to-vigorous activity and make no recommendation for a lesser amount of vigorous activity."
The panel specifically recommends that such moderate exercise correspond to approximately 40% to 60% of maximal aerobic capacity and states that for most people with type 2 diabetes, brisk walking is a moderate-intensity exercise.
The expert panel also recommends that resistance training be part of the exercise regimen. This should be done at least twice a week — ideally 3 times a week — on nonconsecutive days. The panel also recommends that people just beginning to do weight training be supervised by a qualified exercise trainer "to ensure optimal benefits to blood glucose control, blood pressure, lipids, and cardiovascular risk and to minimize injury risk."
Regular use of a pedometer is also encouraged. In a meta-analysis of 8 randomized controlled trials and 18 observational studies, people who used pedometers increased their physical activity by 27% over baseline. Having a goal, such as taking 10,000 steps per day, was an important predictor of increased physical activity, according to the expert panel.
Finally, the new guidelines emphasise that exercise must be done regularly to have continued benefits and should include regular training of varying types.
Physicians should prescribe exercise, Dr. Colberg said in a statement. "Many physicians appear unwilling or cautious about prescribing exercise to individuals with type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity."
Dr. Colberg and the other authors have disclosed no relevant financial relationships.
Med Sci Sports Exerc. 2010;42:2282-2303.


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