6/19/11

Journals


Weighing the Benefits of High-Dose Simvastatin against the Risk of Myopathy.

The Risks and Benefits of 5α-Reductase Inhibitors for Prostate-Cancer Prevention.

Effect of Bronchoconstriction on Airway Remodeling in Asthma.



Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers.

FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer.

Trends in Hospital Volume and Operative Mortality for High-Risk Surgery.

Abstracts and Insights From AAN 2011: Update on Developments in MS Treatment.



regards, taniafdi ^_^

New Eating Disorder Guidelines Issued

News Author: Megan Brooks
CME Author: Laurie Barclay, MD




May 24, 2011 — The Academy of Eating Disorders (AED) has published guidelines for detecting and managing eating disorders in primary care practice.
"Eating disorders are generally first picked up in primary care physicians' offices, but there is very little training in recognition, detection, diagnosis, and treatment of eating disorders in either medical school or residency," Mark Warren, MD, cochair of the task force that wrote the guidelines, noted in an interview with Medscape Medical News.
Eating Disorders: Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders can be downloaded from the academy's Web site. There is also a brochure that can be downloaded for printing and distribution.
Designed to be user-friendly, the document provides a list of signs and symptoms and strategies to help general practitioners make an early diagnosis, medically stabilize patients, and initiate evidence-based care for patients with eating disorders.
Sections include what the physical examination should include; what laboratory and imaging studies to obtain; risk factors and prevention strategies for the refeeding syndrome, a potentially fatal shift of fluid and electrolytes that can occur when refeeding (orally, enterally, or parenterally) a malnourished patient; timely interventions; goals of treatment; and ongoing management.
Eating disorders can have life-threatening physical and psychological consequences, the task force notes, and they affect not only girls and women but also boys and men, people from all ethnicities and socioeconomic backgrounds, and people with a variety of body shapes, weights, and sizes.
"It is important to remember that eating disorders do not only affect females at low weight," the authors note, and that weight is not the only clinical marker of an eating disorder; people who are at normal weight can have an eating disorder.
Endorsed by Pediatricians
"All instances of precipitous weight loss in otherwise healthy individuals should be investigated for the possibility of an eating disorder, including post–bariatric surgery patients. In addition, rapid weight gain or weight fluctuation can be a potential marker of an eating disorder," the authors report.
The possibility of an eating disorder should also be considered in children and adolescents who fail to gain expected weight or height and/or when delayed/interrupted pubertal development is evident.
"We are hoping this resource makes a huge difference for primary care doctors who are the front line of care for people with eating disorders," said Dr. Warren, medical director of the Cleveland Center for Eating Disorders in Ohio.
He said the guidelines have been vetted by experts in the field of eating disorders.
"The Society of Adolescent Medicine has endorsed it, and we just learned that the American Academy of Pediatrics will also endorse it. We're also looking to the American Psychiatric Association and other professional organizations to endorse it — and I think they will — and really encourage their members to use it," Dr. Warren said.
"Too many patients with eating disorders don't get expert care until after a long period of illness," Dr. Warren added. "Better information in the hands of primary care physicians will be of huge value to those who suffer from eating disorders."
"Our hope is that professionals, patients, and families will access this material to ensure that care is prompt, safe, and supported by evidence and that each person with an eating disorder has the opportunity for a full recovery and a productive life," said task force cochair Ovidio Bermudez, MD, medical director of adolescent services at Eating Recovery Center in Denver, Colorado.
The authors have disclosed no relevant financial relationships.

http://www.medscape.org/viewarticle/743265?src=cmemp

regards, taniafdi ^_^

Inhaled Anticholinergic Medications Increase Risk for Acute Urinary Retention Among Men

News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD


May 26, 2011 — Use of short- and long-acting inhaled anticholinergic medications (IACs) is associated with an increased risk for acute urinary retention (AUR) in men with chronic obstructive pulmonary disease (COPD), according to the results of a population-based, nested case-control study reported in the May 23 issue of theArchives of Internal Medicine.
"...IACs are widely used treatments for ...COPD," write Anne Stephenson, MD, PhD, from St. Michael's Hospital in Toronto, Ontario, Canada, and colleagues. "The systemic anticholinergic effects of IAC therapy have not been extensively studied. This study sought to determine the risk of ...AUR in seniors with COPD using IACs."
From April 1, 2003, to March 31, 2009, the investigators used population-based linked databases from Ontario, Canada, to identify 565,073 individuals at least 66 years old with COPD. Case patients — identified as those who had a hospitalization, same-day surgery, or emergency department visit for AUR — were matched with up to 5 control participants. A comprehensive drug benefits database allowed detection of IAC use, and the association between IAC use and AUR was analyzed with conditional logistic regression.
AUR developed in 9432 men and 1806 women. Compared with nonusers of IACs, men who had just started IAC treatment had an increased risk for AUR (adjusted odds ratio [OR], 1.42; 95% confidence interval [CI], 1.20 - 1.68). This risk was further increased in men with evidence of benign prostatic hyperplasia (OR, 1.81; 95% CI, 1.46 - 2.24). Compared with users of a single IAC, men using both short- and long-acting IACs had a significantly higher risk for AUR (OR, 1.84; 95% CI, 1.25 - 2.71). Their risk was also increased to an even greater extent vs nonusers (OR, 2.69; 95% CI, 1.93 - 3.76).
"Use of short- and long-acting IACs is associated with an increased risk of AUR in men with COPD," the study authors write. "Men receiving concurrent treatment with both short- and long-acting IACs and those with evidence of benign prostatic hyperplasia are at highest risk."
Limitations of this study include inability to assess drug dosage; lack of patient-level data on lung function, smoking history, renal impairment, and disease severity; use of prescription data as a proxy for drug use; and difficulty in distinguishing individuals with chronic urinary retention from those with AUR. In addition, there may have been some false-positive COPD diagnoses, and the findings may not be generalizable to individuals treated solely in ambulatory outpatient clinics.
"Physicians and the public need to be aware of the potential for this significant adverse event so that preventive measures and potential therapy can be considered," the study authors conclude.
Patients Should Be Informed
In an accompanying commentary, Sonal Singh, MD, MPH, from The Johns Hopkins University in Baltimore, Maryland, and Curt D. Furberg, MD, PhD, from Wake Forest University in Winston-Salem, North Carolina, discuss the implications of the accumulating evidence regarding serious harm associated with IAC use.
"Physicians should inform patients with COPD about the risk of AUR associated with IACs and determine the optimal choice of therapy for their patients after eliciting patient preferences for various patient-oriented outcomes in a shared decision-making context," Drs. Singh and Furberg write. "Clinicians need reliable, accurate, and comprehensive safety data to determine whether the increasing morbidity and mortality in COPD are due to the underlying disease or are treatment induced. Regulators ought to review safety data for all inhaled bronchodilators, with particular attention to vulnerable subgroups at the highest risk of systemic anticholinergic effects, such as older men with BPH [benign prostatic hyperplasia] or patients with preexisting arrhythmias, who are often excluded from RCTs [randomized controlled trials] of efficacy."
The study was funded by a grant from the Canadian Institutes of Health Research and was conducted at the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-term Care. The study authors have disclosed no relevant financial relationships. Dr. Singh has received support from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and from the NIH Roadmap for Medical Research.
Arch Intern Med. 2011;171:914-920, 920-922. Abstract

regards, taniafdi ^_^

Most Antibiotics Safe to Use During Pregnancy

News Author: Emma Hitt, PhD
CME Author: Laurie Barclay, MD



May 31, 2011 — During the second and third trimester of pregnancy, sulfonamides and nitrofurantoins may be used as first-line agents for urinary tract and other infections, but in the first trimester, these agents may be used when no alternatives are available, according to a Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG).
The opinion is published in the June issue of Obstetrics & Gynecology. According to the study authors, a 2009 case-control study of data from the National Birth Defects Prevention Study found that nitrofurans and sulfonamides were significantly associated with multiple birth defects, whereas penicillins, erythromycin, cephalosporins, and the quinolones were not.
However, the authors acknowledge several limitations of the 2009 study. In addition, they note that "other studies have not found such risks among other populations or when using different epidemiologic methods."
According to the authors, antibiotics "should be prescribed for pregnant women only for appropriate indications and for the shortest effective duration."
They add that many urine cultures show bacterial contaminants that do not represent true infection. However, when selecting an antibiotic for a true infection during the first trimester, "health care providers should consider and discuss with patients the benefits as well as the potential unknown risks of teratogenesis and maternal adverse reactions."
They suggest that prescribing sulfonamides or nitrofurantoins in the first trimester is still considered appropriate when no other suitable alternative antibiotics are available.
"During the second and third trimesters, sulfonamides and nitrofurantoins may continue to be used as first-line agents for the treatment and prevention of urinary tract infections and other infections caused by susceptible organisms," they write.
They also caution that "pregnant women should not be denied appropriate treatment for infections because untreated infections can commonly lead to serious maternal and fetal complications."
Obstet Gynecol. 2011;117:1484-1485. Abstract
Related Link 
The National Women’s Health Information Center, a service of the US Department of Health and Human Service’s Office on Women’s Health, provides a comprehensive Web site, useful for patient education, on the subject ofPregnancy and Medicines.

regards, taniafdi ^_^

Cell Phones of Hospital Patients Carry Pathogenic Bacteria

Laurie Barclay, MD



June 7, 2011 — Mobile phones (MPs) of hospital patients and their visitors carry a higher risk for nosocomial pathogen colonization than do the MPs of healthcare workers (HCWs), according to the results of a cross-sectional study published in the June issue of theAmerican Journal of Infection Control.
"In contrast to [the] benefits of these devices, some investigators have reported that MPs of medical personnel may be a potential source of bacterial pathogens in the hospital setting," write Mehmet Sait Tekerekoglu, MD, from the Department of Medical Microbiology, Faculty of Medicine, Inonu University in Malatya, Turkey, and colleagues. "However, there are little data about the infection threat offered by the MPs of the persons except HCWs. The present study was conducted to determine whether MPs of patients, patients' companions, and visitors carry any pathogenic bacteria likely to cause infection in hospital wards."
Swab samples were collected from the keypads, microphones, and earpieces of 200 MPs, including 67 MPs belonging to HCWs and 133 belonging to patients, patients' companions, and visitors.
Pathogenic bacteria were cultured from 39.6% of MPs of the patients and visitors compared with 20.6% of MPs of the HCWs (P = .02). Multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus, extended-spectrum b-lactamase-producing Escherichia coliKlebsiella species, high-level aminoglycoside-resistant Enterococcus species, and carabepenem-resistant Acinetobacter baumanii, were cultured from 7 MPs of patients and visitors compared with none of the MPs of HCWs.
"Our findings suggest that [MPs] of patients, patients' companions, and visitors represent higher risk for nosocomial pathogen colonization than those of HCWs," the study authors write. "Specific infection control measures may be required for this threat."
Limitations of this study include its cross-sectional design and the relatively low number of medical personnel included in the study.
"However, regardless of the number of HCWs inclusions, the types of bacteria that were found on the patients' MPs and their resistance patterns were very worrisome," the study authors conclude. "We thought that low socioeconomic status of the patients and awareness about the hospital hygiene were the most possible reasons for the colonization of [multidrug-resistant] pathogen on their MPs. In addition to medical personnel, infection control professionals must consider patients' MPs as a potential source of infection."
The study authors have disclosed no relevant financial relationships.
Am J Infect Control. 2011;39:379-381. Abstract


regards, taniafdi ^_^

6/19/11

Journals


Weighing the Benefits of High-Dose Simvastatin against the Risk of Myopathy.

The Risks and Benefits of 5α-Reductase Inhibitors for Prostate-Cancer Prevention.

Effect of Bronchoconstriction on Airway Remodeling in Asthma.



Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers.

FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer.

Trends in Hospital Volume and Operative Mortality for High-Risk Surgery.

Abstracts and Insights From AAN 2011: Update on Developments in MS Treatment.



regards, taniafdi ^_^

New Eating Disorder Guidelines Issued

News Author: Megan Brooks
CME Author: Laurie Barclay, MD




May 24, 2011 — The Academy of Eating Disorders (AED) has published guidelines for detecting and managing eating disorders in primary care practice.
"Eating disorders are generally first picked up in primary care physicians' offices, but there is very little training in recognition, detection, diagnosis, and treatment of eating disorders in either medical school or residency," Mark Warren, MD, cochair of the task force that wrote the guidelines, noted in an interview with Medscape Medical News.
Eating Disorders: Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders can be downloaded from the academy's Web site. There is also a brochure that can be downloaded for printing and distribution.
Designed to be user-friendly, the document provides a list of signs and symptoms and strategies to help general practitioners make an early diagnosis, medically stabilize patients, and initiate evidence-based care for patients with eating disorders.
Sections include what the physical examination should include; what laboratory and imaging studies to obtain; risk factors and prevention strategies for the refeeding syndrome, a potentially fatal shift of fluid and electrolytes that can occur when refeeding (orally, enterally, or parenterally) a malnourished patient; timely interventions; goals of treatment; and ongoing management.
Eating disorders can have life-threatening physical and psychological consequences, the task force notes, and they affect not only girls and women but also boys and men, people from all ethnicities and socioeconomic backgrounds, and people with a variety of body shapes, weights, and sizes.
"It is important to remember that eating disorders do not only affect females at low weight," the authors note, and that weight is not the only clinical marker of an eating disorder; people who are at normal weight can have an eating disorder.
Endorsed by Pediatricians
"All instances of precipitous weight loss in otherwise healthy individuals should be investigated for the possibility of an eating disorder, including post–bariatric surgery patients. In addition, rapid weight gain or weight fluctuation can be a potential marker of an eating disorder," the authors report.
The possibility of an eating disorder should also be considered in children and adolescents who fail to gain expected weight or height and/or when delayed/interrupted pubertal development is evident.
"We are hoping this resource makes a huge difference for primary care doctors who are the front line of care for people with eating disorders," said Dr. Warren, medical director of the Cleveland Center for Eating Disorders in Ohio.
He said the guidelines have been vetted by experts in the field of eating disorders.
"The Society of Adolescent Medicine has endorsed it, and we just learned that the American Academy of Pediatrics will also endorse it. We're also looking to the American Psychiatric Association and other professional organizations to endorse it — and I think they will — and really encourage their members to use it," Dr. Warren said.
"Too many patients with eating disorders don't get expert care until after a long period of illness," Dr. Warren added. "Better information in the hands of primary care physicians will be of huge value to those who suffer from eating disorders."
"Our hope is that professionals, patients, and families will access this material to ensure that care is prompt, safe, and supported by evidence and that each person with an eating disorder has the opportunity for a full recovery and a productive life," said task force cochair Ovidio Bermudez, MD, medical director of adolescent services at Eating Recovery Center in Denver, Colorado.
The authors have disclosed no relevant financial relationships.

http://www.medscape.org/viewarticle/743265?src=cmemp

regards, taniafdi ^_^

Inhaled Anticholinergic Medications Increase Risk for Acute Urinary Retention Among Men

News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD


May 26, 2011 — Use of short- and long-acting inhaled anticholinergic medications (IACs) is associated with an increased risk for acute urinary retention (AUR) in men with chronic obstructive pulmonary disease (COPD), according to the results of a population-based, nested case-control study reported in the May 23 issue of theArchives of Internal Medicine.
"...IACs are widely used treatments for ...COPD," write Anne Stephenson, MD, PhD, from St. Michael's Hospital in Toronto, Ontario, Canada, and colleagues. "The systemic anticholinergic effects of IAC therapy have not been extensively studied. This study sought to determine the risk of ...AUR in seniors with COPD using IACs."
From April 1, 2003, to March 31, 2009, the investigators used population-based linked databases from Ontario, Canada, to identify 565,073 individuals at least 66 years old with COPD. Case patients — identified as those who had a hospitalization, same-day surgery, or emergency department visit for AUR — were matched with up to 5 control participants. A comprehensive drug benefits database allowed detection of IAC use, and the association between IAC use and AUR was analyzed with conditional logistic regression.
AUR developed in 9432 men and 1806 women. Compared with nonusers of IACs, men who had just started IAC treatment had an increased risk for AUR (adjusted odds ratio [OR], 1.42; 95% confidence interval [CI], 1.20 - 1.68). This risk was further increased in men with evidence of benign prostatic hyperplasia (OR, 1.81; 95% CI, 1.46 - 2.24). Compared with users of a single IAC, men using both short- and long-acting IACs had a significantly higher risk for AUR (OR, 1.84; 95% CI, 1.25 - 2.71). Their risk was also increased to an even greater extent vs nonusers (OR, 2.69; 95% CI, 1.93 - 3.76).
"Use of short- and long-acting IACs is associated with an increased risk of AUR in men with COPD," the study authors write. "Men receiving concurrent treatment with both short- and long-acting IACs and those with evidence of benign prostatic hyperplasia are at highest risk."
Limitations of this study include inability to assess drug dosage; lack of patient-level data on lung function, smoking history, renal impairment, and disease severity; use of prescription data as a proxy for drug use; and difficulty in distinguishing individuals with chronic urinary retention from those with AUR. In addition, there may have been some false-positive COPD diagnoses, and the findings may not be generalizable to individuals treated solely in ambulatory outpatient clinics.
"Physicians and the public need to be aware of the potential for this significant adverse event so that preventive measures and potential therapy can be considered," the study authors conclude.
Patients Should Be Informed
In an accompanying commentary, Sonal Singh, MD, MPH, from The Johns Hopkins University in Baltimore, Maryland, and Curt D. Furberg, MD, PhD, from Wake Forest University in Winston-Salem, North Carolina, discuss the implications of the accumulating evidence regarding serious harm associated with IAC use.
"Physicians should inform patients with COPD about the risk of AUR associated with IACs and determine the optimal choice of therapy for their patients after eliciting patient preferences for various patient-oriented outcomes in a shared decision-making context," Drs. Singh and Furberg write. "Clinicians need reliable, accurate, and comprehensive safety data to determine whether the increasing morbidity and mortality in COPD are due to the underlying disease or are treatment induced. Regulators ought to review safety data for all inhaled bronchodilators, with particular attention to vulnerable subgroups at the highest risk of systemic anticholinergic effects, such as older men with BPH [benign prostatic hyperplasia] or patients with preexisting arrhythmias, who are often excluded from RCTs [randomized controlled trials] of efficacy."
The study was funded by a grant from the Canadian Institutes of Health Research and was conducted at the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-term Care. The study authors have disclosed no relevant financial relationships. Dr. Singh has received support from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and from the NIH Roadmap for Medical Research.
Arch Intern Med. 2011;171:914-920, 920-922. Abstract

regards, taniafdi ^_^

Most Antibiotics Safe to Use During Pregnancy

News Author: Emma Hitt, PhD
CME Author: Laurie Barclay, MD



May 31, 2011 — During the second and third trimester of pregnancy, sulfonamides and nitrofurantoins may be used as first-line agents for urinary tract and other infections, but in the first trimester, these agents may be used when no alternatives are available, according to a Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG).
The opinion is published in the June issue of Obstetrics & Gynecology. According to the study authors, a 2009 case-control study of data from the National Birth Defects Prevention Study found that nitrofurans and sulfonamides were significantly associated with multiple birth defects, whereas penicillins, erythromycin, cephalosporins, and the quinolones were not.
However, the authors acknowledge several limitations of the 2009 study. In addition, they note that "other studies have not found such risks among other populations or when using different epidemiologic methods."
According to the authors, antibiotics "should be prescribed for pregnant women only for appropriate indications and for the shortest effective duration."
They add that many urine cultures show bacterial contaminants that do not represent true infection. However, when selecting an antibiotic for a true infection during the first trimester, "health care providers should consider and discuss with patients the benefits as well as the potential unknown risks of teratogenesis and maternal adverse reactions."
They suggest that prescribing sulfonamides or nitrofurantoins in the first trimester is still considered appropriate when no other suitable alternative antibiotics are available.
"During the second and third trimesters, sulfonamides and nitrofurantoins may continue to be used as first-line agents for the treatment and prevention of urinary tract infections and other infections caused by susceptible organisms," they write.
They also caution that "pregnant women should not be denied appropriate treatment for infections because untreated infections can commonly lead to serious maternal and fetal complications."
Obstet Gynecol. 2011;117:1484-1485. Abstract
Related Link 
The National Women’s Health Information Center, a service of the US Department of Health and Human Service’s Office on Women’s Health, provides a comprehensive Web site, useful for patient education, on the subject ofPregnancy and Medicines.

regards, taniafdi ^_^

Cell Phones of Hospital Patients Carry Pathogenic Bacteria

Laurie Barclay, MD



June 7, 2011 — Mobile phones (MPs) of hospital patients and their visitors carry a higher risk for nosocomial pathogen colonization than do the MPs of healthcare workers (HCWs), according to the results of a cross-sectional study published in the June issue of theAmerican Journal of Infection Control.
"In contrast to [the] benefits of these devices, some investigators have reported that MPs of medical personnel may be a potential source of bacterial pathogens in the hospital setting," write Mehmet Sait Tekerekoglu, MD, from the Department of Medical Microbiology, Faculty of Medicine, Inonu University in Malatya, Turkey, and colleagues. "However, there are little data about the infection threat offered by the MPs of the persons except HCWs. The present study was conducted to determine whether MPs of patients, patients' companions, and visitors carry any pathogenic bacteria likely to cause infection in hospital wards."
Swab samples were collected from the keypads, microphones, and earpieces of 200 MPs, including 67 MPs belonging to HCWs and 133 belonging to patients, patients' companions, and visitors.
Pathogenic bacteria were cultured from 39.6% of MPs of the patients and visitors compared with 20.6% of MPs of the HCWs (P = .02). Multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus, extended-spectrum b-lactamase-producing Escherichia coliKlebsiella species, high-level aminoglycoside-resistant Enterococcus species, and carabepenem-resistant Acinetobacter baumanii, were cultured from 7 MPs of patients and visitors compared with none of the MPs of HCWs.
"Our findings suggest that [MPs] of patients, patients' companions, and visitors represent higher risk for nosocomial pathogen colonization than those of HCWs," the study authors write. "Specific infection control measures may be required for this threat."
Limitations of this study include its cross-sectional design and the relatively low number of medical personnel included in the study.
"However, regardless of the number of HCWs inclusions, the types of bacteria that were found on the patients' MPs and their resistance patterns were very worrisome," the study authors conclude. "We thought that low socioeconomic status of the patients and awareness about the hospital hygiene were the most possible reasons for the colonization of [multidrug-resistant] pathogen on their MPs. In addition to medical personnel, infection control professionals must consider patients' MPs as a potential source of infection."
The study authors have disclosed no relevant financial relationships.
Am J Infect Control. 2011;39:379-381. Abstract


regards, taniafdi ^_^