Sunday, September 4, 2011

September 4, 2011

BLOG: Where is the consumer’s voice in "Top Doctors/Best Hospital" rankings?
This is a guest post from one of our HealthNewsReview org medical editors, Harold DeMonaco, director of the Innovation Support Center at the Massachusetts General Hospitalfull post

In continuing coverage, WALB-TV Description: Share to FacebookDescription: Share to Twitter Albany, NY/NBC News (8/11, 11:05 am CDT) reported both on its website and on the air, "Researchers looked at the medical records of over a million patients with advanced kidney disease. When they broke down the data by age, they were surprised to find" that African Americans younger than age 50 "were actually twice as likely to die on dialysis when compared to their white counterparts." The study's results may spur physicians to recommend kidney transplantation more often for this subset of patients instead of encouraging them to stay on dialysis, the piece noted. Previous research had indicated that African Americans overall did better on dialysis.

Pauline W. Chen, MD, writes in the New York Times Description: Share to FacebookDescription: Share to Twitter (8/12, Subscription Publication) "Well" blog that "the way doctors and patients approach medical decisions has changed sharply over the last 50 years," with a movement towards giving the patient more power in the process. However, she adds, "a new study Description: Share to FacebookDescription: Share to Twitter reveals that too much physician restraint may not be all that good for the patient -- and perhaps may even be unethical," as many patients do not want to make these decisions for themselves. "For doctors," Chen observes, "the key to preserving patient autonomy --- and patient-centered care -- lies not in letting patients make the final decisions alone, but in respecting their opinions and shouldering the responsibility together."

Sleep Apnea Returns Rapidly When CPAP Stopped Description: CME 
Obstructive sleep apnea and its associated complications recurred rapidly after discontinuation of continuous positive airway pressure, results of a small randomized trial showed.full story

The Los Angeles Times /Chicago Tribune (8/14, Deardorff) reported that the "long-discredited" human chorionic gonadotropin (hCG) "diet is making a comeback, and the renewed interest has spawned a cottage industry for products that haven't been tested for quality, safety or efficacy, including drops and sprays." What's more, the diet is "making inroads in integrative clinics headed by medical doctors, where it's offered as part of a 'medically supervised' weight loss plan." People on the diet eat no more than 500 calories daily for six weeks while regularly injecting themselves with hCG. To date, most researchers have found no evidence that hCG makes the diet work and instead theorize that weight loss results from the extreme restriction of calories.

ABC World News (8/15, story 9, 0:30, Sawyer) reported, "If you need any more convincing that a little bit of exercise can make a huge difference in your life, here's some powerful new proof: A study in the medical journal Lancet looked at 400,000 people and found just 15 minutes of exercise a day increases life expectancy three years."
        The AP Description: Share to FacebookDescription: Share to Twitter (8/16, Chang) reports that "researchers at the National Health Research Institutes in Taiwan" noting that World Health Organization guidance Description: Share to FacebookDescription: Share to Twitter , CDC recommendations Description: Share to FacebookDescription: Share to Twitter , and guidelines from "other countries recommend that adults get at least a half-hour of moderate workout most days of the week," conducted the study to determine whether "exercising less than the recommended half-hour was still helpful." They asked "about 416,000 Taiwanese adults" how much exercising they "did the previous month" and recorded study participants' "progress for eight years on average." The research team found those who "exercised just 15 minutes a day -- or 90 minutes a week -- cut their risk of death by 14 percent" compared with those who did not exercise; and both men and women "benefited equally" from exercising.
        Bloomberg News Description: Share to FacebookDescription: Share to Twitter (8/16, Bennett) reports that the study found those who exercised for 90 minutes per week were also "14-percent less likely to have died after eight years than those who were inactive." Moreover, every additional "15 minutes of exercise reduced the risk" of death by an "additional 4 percent up to 100 minutes a day, after which there was no additional benefit." Notably, the reduction was "as high as 40 percent for those who exercised most often and most vigorously." The results show that even a "small amount of exercise can lower an individual's risk of death and disease, and a nation's health costs," the study authors concluded. Also covering the study are BBC News Description: Share to FacebookDescription: Share to Twitter (8/16, Roberts), AFP Description: Share to FacebookDescription: Share to Twitter (8/16) and HealthDay Description: Share to FacebookDescription: Share to Twitter (8/16, Preidt).

CV/CCC Better Predicts Contrast-Induced Nephropathy Than MACD.
HeartWire Description: Share to FacebookDescription: Share to Twitter (8/16, O'Riordan) reports, "Use of a renal function-based measure to guide contrast dosing in patients undergoing PCI is superior to using maximal acceptable contrast dose (MACD), another method used to decide the threshold for safe contrast exposure, in determining which patients are most likely to develop contrast-induced nephropathy," according to a study Description: Share to FacebookDescription: Share to Twitterpublished in the Aug. 23 issue of the Journal of the American College of Cardiology. Among 58,957 patients, researchers found that overall, contrast volume/calculated creatinine clearance (CV/CCC) "was a better predictor of contrast-induced nephropathy than MACD, as well as a better predictor of nephropathy requiring dialysis."

In continuing coverage, NBC Nightly News (8/16, story 8, 0:40, Williams) reported, "Watching a lot of television shortens your lifespan, at least that's the conclusion of a big, new study out of Australia that says for each hour of TV you watch over the age of 25, it takes 22 minutes off your life at the end of life. Put another way, one researcher said this puts TV in the same category as smoking and obesity. It can speed up a premature death by five years if you're a dedicated TV viewer, which must be why I never make plans for the weekend." The study was published study in the British Journal of Sports Medicine.

The Seattle Times Description: Share to FacebookDescription: Share to Twitter /Minneapolis Star Tribune (8/17, Lerner) reports that a new app called "My Heart Surgery Risk," created by cardiothoracic surgeon Edward Bender, MD, calculates a patient's "risk of making it through heart bypass surgery" by answering simple yes or no questions on an iPad or iPhone. Dr. Bender "said the app, which is free on the Apple iTunes store, was adapted from the website of the Society of Thoracic Surgeons, which has its own 'risk calculator' based on hundreds of thousands of patients." Bender explained that "his contribution was to simplify the calculator so it's easy for lay people to use."

Or you can bookmark the website link to your phone/computer:

The Wall Street Journal Description: Share to FacebookDescription: Share to Twitter (8/17, Veach, Subscription Publication) reports that Awak Technologies Pte. Ltd.'s portable artificial kidney product is now a finalist contender for the Asian Innovation Awards. The device uses just 750 ml of dialysate liquid to perform peritoneal dialysis in patients with end-stage renal disease. The company hopes to submit data on the device to the US Food and Drug Administration sometime in 2013.

The San Jose Business Journal Description: Share to FacebookDescription: Share to Twitter (8/16, Subscription Publication) reports that Redwood City-based Avinger Inc. "said Tuesday it received clearance from the US Food and Drug Administration to market its catheter used in treating peripheral artery disease." The Wildcat catheter, which earlier this year received CE Mark approval in Europe, "creates a small channel in totally blocked peripheral arteries enabling subsequent therapeutic treatment via balloon angioplasty, stent or atherectomy."

Bloomberg News (8/17, Flinn) reports, Savient Pharmaceuticals' "treatment for chronic, severe gout helped patients who didn't respond to other medications," according to a study published online in the Journal of the American Medical Association. Krystexxa (pegloticase), which was approved by the FDA last year, "lowered uric acid levels below targeted amounts in 42 percent of 84 patients given the drug biweekly, compared with 35 percent who took the medicine monthly, and zero response in the placebo group."
        According to HealthDay (8/17, Mozes) the study, which included "212 patients with severe, chronic and previously untreatable gout" indicated Krystexx "will not help all of the estimated 120,000 to 180,000 Americans with this most severe type of gout. In fact, the medication appeared to elicit an all-or-nothing response, greatly helping some patients while having almost no effect on others." The study authors also noted that "90 percent of pegloticase patients experienced at least one side effect, most commonly a brief flare-up of gout"; and about 25 percent of the "bi-weekly pegloticase patients and 42 percent who had monthly injections experienced infusion-related immune responses at the drug injection site."
        Medscape (8/17, Brooks) adds, "Daniel Furst, MD, professor of rheumatology at the University of California, Los Angeles, and member of the American College of Rheumatology," told Medscape that pegloticase "'clearly has a place as second- or third-line' therapy for refractory gout. It fulfills an unmet need, but one that 'is not yet fully characterized,' said Dr. Furst, who was not involved" in the study. MedPage Today (8/17, Smith) also covers the study, noting that it combined the results of "two industry-sponsored clinical trials."

Snuff Use Linked to Heart Failure Description: CME
Use of smokeless tobacco (or snuff) may increase the risk for heart failure, mainly of nonischemic origin and chiefly by increasing blood pressure and heart rate, a Swedish study found. full story

HeartWire Description: Share to FacebookDescription: Share to Twitter (8/18, Wood) reports, "The Japanese Ministry of Health, Labor, and Welfare has issued a safety advisory in that country warning of the potential for adverse events with dabigatran (Prazaxa in Japan; Pradaxa elsewhere, Boehringer Ingelheim), following the deaths of five patients." The advisory noted that there have been "81 cases of serious side effects, including gastrointestinal bleeding, since the launch of dabigatran; the drug has been used in around 64 000 people since its launch in Japan in January 2011." Dr. Reinhard Malin, a spokesman for Boehringer Ingelheim, wrote in an email to HeartWire, "Within this group, treatment with Prazaxa could not be completely ruled out as a cause of death in five patients, one of whom had kidney failure (a contraindication) and four of whom were aged over 80."

Bacteremia Rate Drops in Dialysis With Common Antibiotic Description: CME
Dialysis patients had significantly fewer catheter-related infections when a common antibiotic was used as a catheter-lock solution instead of heparin, data from a randomized trial showed. full story

Healthy Living Really Does Postpone Mortality Description: CME 
A low-risk lifestyle, with an emphasis on healthy eating and being active, has a "powerful and beneficial" effect on mortality, CDC researchers found. full story

Government inspectors cite infection-control breakdowns at Texas hospital.
The Dallas Morning News (8/21, Egerton) reports, "In their comprehensive survey of patient safety at" Texas' Parkland Memorial Hospital, "released Friday, government inspectors cited infection-control breakdowns that 'placed patients at risk of severe infection and possibly subsequent death.'" Parkland's "widespread hygiene failures ranged from caregivers not washing their hands to the mishandling of infectious waste, according to the US Centers for Medicare & Medicaid Services, which threatened to cut off Parkland's federal funding."
        The AP (8/22), citing the Dallas Morning News article, pointed out that the hospital "sent letters to dozens of women last year to let them know they may have been treated with instruments that were not properly sterilized."

American Medical News (8/20, O'Reilly) reported the a study in Annals of Emergency Medicine found that while "computed tomography use in US emergency departments more than quadrupled between 1996 and admissions after a scan in the ED fell by more than half." Sandra Schneider, MD, president of the American College of Emergency Physicians, said, "CT scanning is used by emergency physicians because it often makes the diagnosis," but added "that doctors' medical liability concerns play a role." Lead author Keith E. Kocher, MD, MPH, of the University of Michigan Medical School, said, "It appears there's an association between the rate of CT scans going up and physicians being more likely to discharge patients home," but added, "Ultimately, the growth in CT scans is unsustainable."

Study Uncovers Knowledge Gaps Among CKD Patients.
In "Personal Health," the New York Times Description: Share to FacebookDescription: Share to Twitter (8/23, D7, Brody, Subscription Publication) reports, "In a study published in March in The American Journal of Kidney Disease, a research team at Vanderbilt University Medical Center in Nashville uncovered serious knowledge gaps among 401 patients with various stages of" chronic kidney disease (CKD). Researchers "pointed out that within the general population, most people with kidney disease don't know they have it. And among those who do know, a previous study of 676 patients with moderate to advanced kidney disease had found that more than a third knew little or nothing about it, and nearly half knew nothing about treatment options should their kidneys fail completely."

The Los Angeles Times Description: Share to FacebookDescription: Share to Twitter (8/23, Helfand) reports, "Scores of California hospitals, under pressure to reduce infections that kill an estimated 12,000 patients every year, say they have managed to cut costs and save lives through an initiative that has nurses and doctors redoubling efforts to prevent deadly germs from taking root." The initiative "is bringing together 160 hospitals across the state with the aim of reducing an estimated 200,000 hospital-related infections in California that add $600 million to healthcare costs every year." While "the California initiative is credited with saving an estimated 800 lives, based on lower mortality rates than had been projected...leaders say the hospitals can still do better."

Most Hospital Readmissions May Not Be Linked To Poor Care.
MedPage Today Description: Share to FacebookDescription: Share to Twitter (8/22, Gever) reported that "although readmissions after hospital discharge are often taken as evidence of substandard care, most of those reviewed in a multicenter study were judged to have been unavoidable." Just "16% (95% CI 13% to 19%) of 649 patients with urgent readmissions within six months of discharge had conditions that could have been averted with better management, according to" the study Description: Share to FacebookDescription: Share to Twitter published online in CMAJ. The researchers found that "even among readmissions occurring in the first month after discharge -- the most common time interval in the US when readmission rates are used as a hospital quality measure -- only a minority of cases were potentially avoidable."

Efforts to prevent postoperative deep vein thrombosis (DVT) should focus on limiting the use and duration of use of central catheters, and possibly increasing the use of anticoagulation with the catheters, authors of a new study concluded.More...
Central catheters play big role in postoperative DVT
Efforts to prevent postoperative deep vein thrombosis (DVT) should focus on limiting the use and duration of use of central catheters, and possibly increasing the use of anticoagulation with the catheters, authors of a new study concluded.
Researchers at an academic hospital analyzed data on 2,189 general surgery operations in 2008 and 2009. The review of medical records focused on perioperative complications, including DVT, which occurred within 30 days of an index hospitalization for surgery. DVT was defined as the presence of documented venous thrombosis within deep veins that required anticoagulation therapy or placement of a vena cava filter. Main outcomes included location of DVT, time of DVT diagnosis from index operation, presence of a concomitant central catheter, presence of an associated pulmonary embolism (PE), and 30-day mortality. Results were published online Aug. 15 in Archives of Surgery.
Thirty-five patients, or 1.6%, were identified with DVT in the perioperative period. Upper extremity DVT accounted for 40% of cases, lower extremity DVT accounted for 45.7% of cases, and the remaining 14.3% had combined upper and lower extremity DVT. The mean time between diagnosis of DVT and the index operation was 8.6 days; 83% of cases were diagnosed when patients were still in the hospital. Sixty percent of diagnosed patients had an indwelling central or peripherally inserted central catheter, 54% had an upper extremity catheter, and 6% had a femoral catheter. Concomitant PE occurred in 11.4% of patients with DVT, and 30-day mortality of DVT patients was 14.2%. Almost 63% of DVT patients had other complications like ventilator dependence, sepsis, infection, renal failure and pneumonia. Compliance with DVT prophylaxis according to Surgical Care Improvement Program criteria averaged 93% over the study period.
While DVT incidence after general surgery is low when prophylaxis is used, more than half of cases that do occur are caused by central catheters, the authors noted. As such, DVT prevention efforts should include closer scrutiny of the need for central catheters, including limiting the duration of catheter use, they said. Physicians should also consider adding—or increasing the dosage of—anticoagulation when central catheters are used, the authors concluded.
Cholesterol-Lowering Foods Beat Low-Saturated Fat Diet Description: CME 
Eating a predominantly vegetarian diet focused on lowering cholesterol -- and getting advice on how to do so effectively -- can drop LDL levels more than a diet focused only on reducing saturated fat, researchers found.full story
Half of Doctors Practice With NPs, PAs 
Nearly half of all physicians work with ancillary providers such as nurse practitioners or physician assistants, most commonly in large primary care practices and multispecialty groups, according to a new government report. full story

Experts Predict 165 Million Americans Will Be Obese By 2030.
ABC World News (8/25, story 7, 2:00, Stephanopoulos) reported, "Tonight, sobering new numbers on America's struggle with obesity." A new series Description: Share to FacebookDescription: Share to Twitter on obesity published in "the medical journal Lancet says if trends continue, half of all American men will be obese by 2030."
        Bloomberg News Description: Share to FacebookDescription: Share to Twitter (8/26, Gerlin) reports, "US health-care spending will rise by as much as $66 billion a year by 2030 because of increased obesity if historic trends continue," the study suggested. "Almost 100 million Americans and 15 million Britons are already considered obese, based on body-mass index, a ratio of weight to height, Y. Claire Wang, an epidemiologist at Columbia University's Mailman School of Public Health in New York, said yesterday at a London news conference." Yet "another 65 million American adults and another 11 million British adults would join them in the next two decades based on past trends, said Wang."
        The Washington Post Description: Share to FacebookDescription: Share to Twitter (8/26, Huget) "The Checkup" blog reported that a "four-part series by a number of international public health experts argues that the global obesity crisis will continue to grow worse and add substantial burdens to health-care systems and economies unless governments, international agencies and other major institutions take action to monitor, prevent and control the problem." The blog adds, "The series, which had support from the federal government and foundations, is published in advance of the first High-Level Meeting of the United Nations General Assembly focused on non-communicable disease prevention and control, which will take place in New York City Sept. 19 and 20."
        According to CNN's Description: Share to FacebookDescription: Share to Twitter (8/26, Cooper) "The Chart" blog, one report in the series "includes suggestions for ways governments can implement policies that it says will reduce obesity and save money. Proposals include a tax on unhealthy foods and beverages, school programs to promote good nutrition and physical activity, and cutting junk food advertising."
        HealthDay Description: Share to FacebookDescription: Share to Twitter (8/26, Preidt) reports, "In the United States, the cost of treating obesity-related diseases, such as diabetes, heart disease and stroke, would...represent a 2.6 percent increase in overall health spending." In fact, "spending on obesity problems alone will increase 13 percent to 16 percent per year if US trends continue."
        WebMD Description: Share to FacebookDescription: Share to Twitter (8/26, Boyles) reports that should164 million Americans become obese by 2030, "Wang says the health care burden will include an additional eight million cases of diabetes, 6.8 million additional cases of heart disease and stroke," and "over 0.5 million cases of cancer." But, "the researchers calculate that just a 1% reduction in body mass index (BMI) at the population level would prevent as many as 2.4 million cases of diabetes and 1.7 million cases of heart disease and stroke."
        MedPage Today Description: Share to FacebookDescription: Share to Twitter (8/26, Gever) reports, "The study was supported by the National Collaborative on Childhood Obesity Research, which coordinates childhood obesity research across the National Institutes of Health, the CDC, the Department of Agriculture, and the Robert Wood Johnson Foundation."
        Also covering the story are AFP Description: Share to FacebookDescription: Share to Twitter (8/26), the UK's Independent Description: Share to FacebookDescription: Share to Twitter (8/26, Laurance), and the UK's Press Association Description: Share to FacebookDescription: Share to Twitter(8/26).
        Calorie-Cutting Rule May Result In Less-Than-Expected Weight Loss. MedPage Today Description: Share to FacebookDescription: Share to Twitter (8/26, Gever) reports, "Common rules of thumb exaggerate how much weight people will lose from a given dietary calorie reduction," according to research Description: Share to
FacebookDescription: Share to Twitter published Aug. 27 in the Lancet as part of its four-study obesity series. "Whereas patients are often told that cutting 500 calories a day will let them lose a pound a week, a more realistic formula is that such a caloric reduction would lead to a 50-pound loss over three or more years." But, "even then...such weight loss is possible only if the calorie reduction is actually maintained over that time," the study authors wrote.
        "Researchers now say the formula is wrong because it fails to account for a slowing metabolism, the fact that dieters lose muscle as well as fat, and other factors that influence weight loss," WebMD Description: Share to FacebookDescription: Share to Twitter (8/26, Boyles) reports. "Researcher Kevin Hall, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), says the 3,500-calorie rule leads to unrealistic expectations and may undermine people's efforts to lose extra pounds." Also covering this story are the UK's Independent Description: Share to FacebookDescription: Share to Twitter (8/26, Laurance) and The Australian Description: Share to FacebookDescription: Share to Twitter (8/26, Dunlevy).

The New York Times (8/29, Wilson, Subscription Publication) reports that an experimental drug designed to "prevent blood clots exceeded already high expectations as a better therapy for millions of people with atrial fibrillation," according to final results of the ARISTOTLE trial presented Sunday at the European Society of Cardiology congress in Paris. Over an average "1.8 years," Eliquis prevented "21 percent more strokes" than the blood-thinner warfarin, which is the "standard treatment for heart arrhythmia." Eliquis -- developed jointly by Bristol-Myers Squibb and Pfizer -- will be submitted "for FDA review later this year."
        The Wall Street Journal (8/29, Winslow, Rockoff, Subscription Publication) adds, Eliquis also reduced the number of major bleeding incidents among the study patients by 31%; and it lowered their mortality risk by 11%. Notably, severe bleeding is one of the adverse events associated with warfarin. The company-funded study was published online Sunday in the New England Journal of Medicine to coincide with the congress presentation.
        Also covering the ARISTOTLE study results are Bloomberg News (8/29, Kresge, Torsoli), Forbes (8/29) columnist Matthew Herper, the Forbes (8/29, Husten) "Cardiobrief" blog, MedPage Today (8/29, Peck) and HealthDay (8/29, Reinberg).

HealthDay (8/26, Preidt) reported, "Aerobic exercise is better than resistance training if you want to lose the belly fat that poses a serious threat to your health," according to a study published Aug. 25 in the American Journal of Physiology. After comparing the "effectiveness of aerobic exercise (such as jogging), resistance training (such as weight lifting), or a combination of the two activities in 196 overweight, sedentary adults aged 18 to 70" followed for eight months, researchers also found that "aerobic exercise significantly reduced visceral and liver fat and improved risk factors for heart disease and diabetes, such as insulin resistance, liver enzymes and triglyceride levels."

FDA: Profit drive, quality issues driving shortage of critical medicines.
PBS' Newshour (8/29, 7:36 p.m. EDT, Ifill) broadcast that over 180 "critical drugs" are "in short supply all over the country." Cap. Valerie Jensen, associate director of the FDA's Drug Shortage Program agreed that the drugs in short supply include those "that literally create a life and death situation." Jensen said, "When we ask firms why they discontinue these drugs, the usual reason that we receive back is that these are not profitable drugs," although she added that "quality issues" also have "been a major reason for shortages." PBS (Boswer) added that meanwhile, "unscrupulous suppliers hoard drugs in anticipation of a shortage, and, when it happens, they jack up the price." A text version of this story and an in-page video clip are available on the network's webpage.
        "The Rundown" blog of PBS (8/29, Kane) reports, "The gray market is an expanding world fueled by a deepening drug-shortage crisis in which secondary retailers buy up medication outside of the normal, tightly controlled pharmaceutical distribution channels and then sell their stockpiled supplies to desperate pharmacists and hospitals at exorbitant mark-ups," such as "4,533 percent." FDA's Jensen said that while the FDA "Office of Criminal Investigations looks into complaints about blatant safety concerns in the gray market...the agency defers to the states to do the bulk of regulation." Meanwhile, "the crisscrossing nature of the gray market can throw the safety of a drug into serious doubt," as "many drugs become ineffective or harmful if they haven't been stored in the right environment and at precise temperatures."
        Utah hospitals rationing, prescribing second-choice meds. The Salt Lake Tribune (8/30, Stewart) reports, Utah hospitals have "resorted to hoarding drugs for existing patients"; and some physicians are prescribing less-preferred medications "as the first drugs of choice, from cancer treatments to surgical sedatives." The shortage is also impacting hospital "workhorse staples," including antibiotics, electrolytes, and "injectable drugs used for sedation and in emergencies to prevent strokes and treat heart attacks and allergic reactions." The shortage is "reaching a crisis," said Erin Fox, manager of the University of Utah's Drug Information Service, which "monitors and verifies shortages for reporting to the American Society of Health-System Pharmacists" and the FDA.
        Shortage affecting thousands of Houston patients. KPRC-TV Houston, TX (8/30) reports on its website that in Houston, "thousands of patients" have been impacted by "drug shortages hitting hospital after hospital. The largest backlogs appear to be with cancer drugs and anesthesia medicines needed for surgeries, but hospitals said the shortage is affecting everything from infant eye drops to antiviral medicines for organ transplant patients."
        Unaffected ED preparing for drug shortage to hit. The PBS Newshour (8/30, Klune, Kane) on its website reports, Dr. Bill Frohna, the "chairman of Emergency Medicine at Washington Hospital Center," said it "seems more and more frequently that we're being alerted to some shortage of a medication that really has been a staple in the emergency department." Although the shortage "hasn't yet adversely affected patients at his hospital, the largest private hospital in Washington, struggling to come up with workarounds for the shortage list."

Massage may relieve systemic sclerosis edema.
Medscape (8/30, Kelly) reports a study in Arthritis Care & Research showing that a "massage technique, known as manual lymph drainage," which is "designed to increase lymphatic system circulation, remove excess interstitial fluid, and improve vascular tone," could "offer patients with systemic sclerosis (SSc) some relief from hand edema." In a group of 20 patients, it was observed that the technique significantly improved the patients' edema. Professor of occupational therapy Dr. Janet Poole said she would like to see "a larger, multicenter study" and also pointed out that insurance likely will not cover the massage.

The American Society for Parenteral and Enteral Nutrition (ASPEN) last week published a position paper with recommendations for using parenteral nutrition glutamine supplementation. More...

The antidepressant citalopram hydrobromide (Celexa) should no longer be used at doses greater than 40 mg/d, according to a new warning from the FDA. More...

MR Renography May Diagnose Kidney Graft Dysfunction.
Health Imaging & IT Description: Share to FacebookDescription: Share to Twitter (8/31, Fratt) reports, "Low-dose MR renography may offer a noninvasive means to differentiate between acute kidney rejection and acute tubular necrosis after kidney transplantation, according to a study published in the September issue of Radiology." Health Imaging notes that "the current gold standard for diagnosis is the percutaneous renal transplant biopsy, but the invasive procedure may result in complications and mask certain etiologies." Researchers using MR renography found that a high ratio of "mean transit time for the vascular compartment" to "mean transit time for the whole kidney" would suggest "acute rejection over acute tubular necrosis." The study authors acknowledged that more work is needed to improve diagnosis.

Waiting An Hour After Dinner Before Sleep May Reduce Stroke Risk.
WebMD Description: Share to FacebookDescription: Share to Twitter (8/31, Laino) reports, "A new study suggests that waiting at least an hour after dinner before going to sleep reduces your risk of stroke by about two-thirds." The study, presented at the European Society of Cardiology meeting, also found that "for every 20 minutes more that you wait, stroke risk drops another 10%." Cardiologist David Holmes, MD, said, "When we eat, blood sugar changes, cholesterol levels change, blood flow changes," all of which "may affect stroke risk."

Dipstick Proteinuria as a Screening Strategy to Identify Rapid Renal 

William F. Clark, Jennifer J. Macnab, Jessica M. Sontrop, Arsh K. Jain, 
Louise Moist, Marina Salvadori, Rita Suri, and Amit X. Garg
J Am Soc Nephrol 2011;22 1729-1736

Description: MedWatch logoDescription: MedWatch - The FDA Safety Information and Adverse Event Reporting Program
Reclast (zoledronic acid): Drug Safety Communication - New Contraindication and Updated Warning on Kidney Impairment

AUDIENCE: Endocrinology, Pharmacy, Patient
ISSUE: FDA notified healthcare professionals and patients of an update to the drug label for Reclast (zoledronic acid) regarding the risk of kidney failure. Cases of acute renal failure requiring dialysis or having a fatal outcome following Reclast use have been reported to FDA. The revised label states that Reclast is contraindicated in patients with creatinine clearance less than 35 mL/min or in patients with evidence of acute renal impairment. The label also recommends that healthcare professionals screen patients prior to administering Reclast in order to identify at-risk patients.
The Reclast Medication Guide for patients is being updated to contain information about the risk of severe kidney problems. In addition, the manufacturer of Reclast will issue a Dear Healthcare Provider letter to inform healthcare professionals about this risk.
BACKGROUND: Risk factors for developing renal failure include underlying moderate to severe renal impairment, use of kidney-damaging (nephrotoxic) or diuretic medications at the same time as Reclast, or severe dehydration occurring before or after Reclast is given. The risk of developing renal failure in patients with underlying renal impairment also increases with age.
These labeling changes are being made to the Reclast label only, although zoledronic acid, also sold as Zometa, is approved for treatment of cancer-related indications. Renal toxicity is already addressed in the Warnings and Precautions section of the Zometa label. Dose reductions for Zometa are provided for patients with renal impairment.
RECOMMENDATIONS: Reclast is contraindicated in patients with creatinine clearance less than 35 mL/min, or in patients with evidence of acute renal impairment. Healthcare professionals should screen patients prior to administering Reclast in order to identify at-risk patients. Healthcare professionals should also monitor renal function in patients who are receiving Reclast. 

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
·         Complete and submit the report Online:
·         Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

Read the MedWatch safety alert, including links to the Drug Safety Communication, including a Data Summary, and prescribing information, at:

FDA Warns Physicians To Test Kidney Function Before Prescribing Reclast.
The Wall Street Journal Description: Share to FacebookDescription: Share to Twitter /Dow Jones Newswires (9/2, Dooren, Subscription Publication) reports that the Food and Drug Administration has updated a warning regarding kidney failure and use of Novartis' Reclast (zoledronic acid). The FDA said that kidney failure "was a rare but serious condition associated with the use of Reclast in patients with a history of or risk factors for [kidney] impairment." Physicians are being warned, therefore, to check patient kidney function before prescribing Reclast and to check those who are already taking the drug.
        MedPage Today Description: Share to FacebookDescription: Share to Twitter (9/2, Gever) says, "The new warning indicates that patients with creatinine clearance of less than 35 mL/min or evidence of acute renal impairment should not be given zoledronic acid for osteoporosis." The warning also lists risk factors including "advanced age, concurrent treatment with other nephrotoxic drugs, and dehydration secondary to fever, sepsis, gastrointestinal losses, or diuretic therapy."
        WebMD Description: Share to FacebookDescription: Share to Twitter (9/2, McMillen) reports, "The warning is targeted at patients who already suffer from kidney impairment. It's also aimed at those who are taking potentially kidney-damaging (nephrotoxic) medications or diuretics at the same time as Reclast." The FDA also reported that "by April 2011, there were 11 more Reclast-related deaths due to kidney failure. Nine cases of kidney injury were also reported."

Reuters Description: Share to FacebookDescription: Share to Twitter (9/2, Marcus) reports that according to a study Description: Share to FacebookDescription: Share to Twitter published in the September issue of the American Journal of Clinical Nutrition, increasing consumption of beans while simultaneously decreasing consumption of white rice may help lower the chances of developing the metabolic syndrome. In a study of some 1,900 people in Costa Rica, researchers found that those who favored bean consumption over rice had a 35% decreased probability of displaying symptoms indicative of metabolic syndrome.

Study: Changing Message May Prompt Clinicians To Wash Hands More Often.
The New York Times Description: Share to FacebookDescription: Share to Twitter (9/2, O'Connor, Subscription Publication) "Well" blog reports, "Compliance rates for hand washing in American hospitals are only around 40 percent, and years of awareness programs urging doctors to wash up or use disinfectant gels have had little effect." But, according to a study to appear in the journal Psychological Science, "changing the message from 'Wash Your Hands to Protect Yourself' to 'Wash Your Hands to Protect Your Patients'...could motivate some doctors and nurses to wash their hands more frequently."

States: Hospitals' marketing conflicts with efforts to reduce ED visits.
The Washington Post (8/23, Galewitz) reports, "State officials complain that...hospitals' aggressive marketing of ERs to increase admissions and profits" hampers their "efforts to reduce unnecessary ER visits by patients in Medicaid." While hospital officials "reject the assertion that marketing the efficiency of their ERs attracts patients who don't belong there," some states are changing how they pay for non-emergency emergency department care. Researchers said, however, the appropriateness of an ER visit is "difficult to measure." Additionally, "the American College of Emergency Physicians thinks government efforts to divert Medicaid patients from ERs are misguided." Sandra Schneider, MD, FACEP, president of the American College of Emergency Physicians, said, "Most emergency patients are seeking emergency care appropriately."

Early Plasma Exchange May Help Manage Diarrhea-Associated HUS.
Medscape Description: Share to FacebookDescription: Share to Twitter (8/24, Fox) reported that "early plasma exchange may hold promise in managing diarrhea-associated hemolytic uremic syndrome [HUS], a rare but potentially fatal complication of Escherichia coli infection, according to results from a small study carried out in Denmark and published The Lancet."
        According to MedPage Today Description: Share to FacebookDescription: Share to Twitter (8/24, Smith), the researchers reported that "the procedure rapidly increased platelet counts and glomerular filtration rates, while decreasing lactate dehydrogenase concentrations." The five patients in the study "were neurologically normal at the time of discharge after between five and eight days of treatment."

Seriously, based on 5 patients?? No wonder healthcare costs are rising…

Some Texas Hospitals Seeking To Reduce Hospitalizations.
The Austin American-Statesman Description: Share to FacebookDescription: Share to Twitter (8/30, Roser) reports that "the Seton Healthcare Family, the largest hospital operator in Central Texas, has a five-year goal of reducing hospitalizations that includes programs that steer patients toward care that is less expensive than at a hospital, said Seton executive Greg Hartman. Seton operates several programs that help hospital staffers communicate with chronically ill people to see that they follow up with primary care doctors and take other steps to prevent another hospital admission." Meanwhile, "other hospital systems, including Scott & White and St. David's HealthCare, said they also have strategies to keep people from filling their emergency departments and hospital rooms."

FDA's Maisel says breast implants are safe.
The New York Times (9/1, Harris, Subscription Publication) reports, "After two days of discussion and testimony about silicone breast implants, ... Dr. William Maisel, chief scientist for the Food and Drug Administration's Center for Devices, said silicone breast implants were safe." Dr. Maisel noted the existence of risks "including ruptures, a hardening of the area around the implants, the need to remove the implants, scarring, pain, infection and asymmetry." One expert said that "the two companies that manufacture silicone breast implants - Johnson & Johnson [Mentor] and Allergan - had done a poor job of studying patients who got the implants," and "Dr. Maisel agreed that the studies conducted by the two companies had failed to follow as many patients as the agency had hoped."
        The Wall Street Journal /Dow Jones (9/1, Subscription Publication) quotes Dr. Maisel saying, "FDA continues to believe currently approved devices are safe and effective," and adding, "There is a significant complication rate." The article explains that the follow-up studies being conducted have not followed enough of the patients to authoritatively answer questions about safety. Dr. Maisel said that the FDA would work with the companies to improve the studies.
        MSNBC (9/1, Rubin) also quotes Dr. Maisel saying, "We believe that the benefits and risks are sufficiently well understood." Regarding follow-up studies, "Mentor has three-year data for only one out of every five women in its study, while Allergan has two-year data for three out of every five, according to the FDA."
        CNN (9/1, Young) also says, "Makers of silicone breast implants have not followed up on thousands of women who received them as required by the Food and Drug Administration as a condition of approval."
        MedPage Today (9/1, Walker) reports, "The FDA's General and Plastic Surgery Devices Panel, which wrapped up a two-day meeting Wednesday afternoon, said that current data collection demands are too onerous."

FTC criticizes drugmakers' agreements to delay generic competition.
The New York Times (9/1, B2, Wilson, Subscription Publication) reports, "Some drug makers are using an indirect method to delay competition from low-cost generic products by promising not to introduce their own generic versions if a potential competitor delays its entry into the market, the Federal Trade Commission said in a report on Wednesday." In its report, "the FTC says they are illegal sweetheart deals that cost consumers $3.5 billion a year." In response, "the Generic Pharmaceutical Association called the study part of a 'misguided policy to ban pro-consumer patent litigation settlements.'"

The AP (9/1, Stobbe) reports, "Half of Americans drink a soda or sugary beverage each day -- and some are downing a lot." According to figures released Aug. 31 in a data brief (pdf) by the Centers for Disease Control and Prevention, "one in 20 people drinks the equivalent of more than four cans of soda each day, even though health officials say sweetened beverages should be limited to less than half a can."
        "About 5% of people ages two and older consume at least 567 calories a day from such drinks," USA Today (9/1, Hellmich) reports. "Some people are getting a lot of their daily calories from the drinks, says Cynthia Ogden, an epidemiologist with the National Center for Health Statistics." The Chicago Tribune (9/1) reports that "the problem is worst among minorities, the poor and the young."
        The Los Angeles Times (9/1, Stein) "Booster Shots" blog reports, "Using data from the National Health and Nutrition Examination Survey from 2005 to 2008, researchers found that a quarter...consume at least 200 calories a day of sugary drinks -- more than the equivalent of a 12-ounce can of cola." Boys "ages 12 to 19 guzzle the most sugary drinks, about 273 calories' worth per day on average," while "older women drink the least, about 42 calories a day of the stuff." In general, the largest consumers of sugary beverages were adolescents and younger adults.
        The Cleveland (OH) Plain Dealer (9/1, Theiss) reports, "Coincidentally, the findings were released the same day that a number of cities and health groups announced a new campaign to reduce soda consumption." The Plain Dealer adds, "That campaign, a joint effort of health departments in several major cities as well as the nonprofit Center for Science in the Public Interest, the American Heart Association and the American Diabetes Association, will try to decrease the average consumption of sugary drinks to roughly three cans a week per person by 2020."
        Also covering the story are the Washington Post (9/1, Stein) "The Checkup" blog, CNN (9/1, Park), the NPR (9/1, Hensley) "Shots" blog, and the Huffington Post (9/1, Pearson).

FDA cites Pfizer website for promoting drugs without offering risk information.
The Wall Street Journal /Dow Jones (9/2, Dooren, Subscription Publication) reports that the Food and Drug Administration issued a letter to Pfizer Wednesday which the FDA posted on its website yesterday citing the company for having made "representations or suggestions" on the company website regarding the benefits of Lipitor, Caduet, Chantix and Norvasc, but not providing "any risk information associated with use of these drugs." The FDA did acknowledge that on the web pages devoted to each particular drug there was risk information but declared that "insufficient to mitigate the misleading omission of risk information from the online resources page." In response, Pfizer released a statement saying that it is "in the process of reviewing and responding to the FDA letter and has already removed the cited content from the Lipitor website."

Small little tidbit but could be revolutionary…..very interesting concept
Virus Targets, Kills Cancers in Early Trial  
A genetically engineered virus selectively infected and killed cancer tissue without harming adjacent normal tissue, results of a phase I clinical study showed. full story