Longer CPR Efforts May Improve Survival Chances.

In a front-page story, the New York Times  (9/5, A1, Rabin, Subscription Publication) reports on a new study published online Tuesday in The Lancet, which looked into the duration of cardiopulmonary resuscitation in hospitals. The study suggests that many doctors may be giving up too soon in their efforts to resuscitate their patients. According to the article, "the study found that patients have a better chance of surviving in hospitals that persist with CPR for just nine minutes longer, on average, than hospitals where efforts are halted earlier." The Times says that "the findings challenge conventional medical thinking, which holds that prolonged resuscitation for hospitalized patients is usually futile because when patients do survive, they often suffer permanent neurological damage." In the study, "the researchers found that patients who survived prolonged CPR and left the hospital fared as well as those who were quickly resuscitated," the article adds.

        NBC News  (9/5, Fox) also reports on the story in its "Vitals" blog. Commenting on the study, Dr. Zachary Goldberger of the University of Washington, who led the research, said, "Our findings suggest that prolonging resuscitation efforts by 10 or 15 minutes might improve outcomes." However, the article notes that "there aren't any firm guidelines on how long to keep trying to revive someone whose heart has stopped." The blog adds that the "American Heart Association has detailed pointers on which measurements show a patient has a better chance of living, and on which treatments to give, from simple cardiopulmonary resuscitation or CPR to defibrillation and drugs."

        AFP  (9/5) reports that the study found that "on average, hospitals spent 20 minutes on attempted resuscitation before a patient was declared dead. But hospitals that tried longest (those whose efforts averaged 25 minutes) had a 12-percent higher chance of patient response than those whose efforts (average 16 minutes) were shortest."

CDC: Millions Of Adults Have Uncontrolled Hypertension.

USA Today  (9/5, Hellmich) reports, "Despite the well-known perils of high blood pressure, more than half of the 67 million American adults who have the condition don't have it under control, the Centers for Disease Control and Prevention says in a new report out today." CDC director Thomas Frieden remarked, "High blood pressure is public health enemy No. 2. There is nothing that will save more lives than getting blood pressure under control." Frieden "says major progress could be made with pharmacists, nurse practitioners, physicians and other health care providers working together with the doctor 'as the quarterback.'"

        The Hill  (9/5, Viebeck) reports in its "Healthwatch" blog that the report found that "high blood pressure contributes to nearly 1,000 deaths per day by increasing the risk of heart disease and stroke. Sixty-seven million Americans have high blood pressure, and of these, 36 million cases are uncontrolled, according to the report. Another 16 million Americans take medication from the condition but still struggle, the report found." Furthermore, "The CDC estimates that healthcare costs related to high blood pressure top $130 billion annually."

        The Los Angeles Times  (9/5, Maugh) "Science Now" blog quotes Frieden, who said, "We have to roll up our sleeves and make blood pressure control a priority every day, with every patient, at every doctor's visit." According to the CDC, "Specifically, this means that patients should make sure to take their medications, eat a healthful, low-sodium diet, exercise, maintain a healthy weight and not smoke." Furthermore, "Physicians should be more alert to patients with high blood pressure, and electronic medical records systems could be modified to flag such patients."

        The Boston Globe  (9/5, Kotz) "Daily Dose" blog reports, "The CDC is launching a new campaign tomorrow called 'team up pressure down' to get pharmacists more involved in helping patients manage their hypertension by providing them with fact-sheets and instructions to hand out along with prescriptions."

        Also reporting this story are Reuters  (9/5, Kuo), NPR  (9/5, Hensley) "Shots" blog, the Time  (9/5, de Baca) "Healthland" blog, the Huffington Post  (9/5, Chan), the Detroit Free Press  (9/5, Erb), MedPage Today  (9/5, Neale), andHealthDay  (9/5, Gardner).

        CDC Director: Healthcare System Should Better Control Hypertension. CQ  (9/5, Subscription Publication) reports that Tuesday, CDC Director Tom Frieden told reporters that "health care systems should use electronic records to identify and more closely monitor patients with high blood pressure. " He said that "controlling hypertension is the 'single most important thing the health care system can do.'" According to Frieden, after tobacco, hypertension poses the biggest danger to the health of Americans. He also said that "if hospitals and health care professionals were to focus on" this problem, "about 10 million Americans' blood pressure could be under control within the next five years."

        Stiffening Of Aortic Wall May Be Linked To Increased Hypertension Risk. HealthDay  (9/5) reports, "Stiffening of the wall of the aorta is linked with increased risk of high blood pressure, according to a new study  " published in the Journal of the American Medical Association. Investigators "looked at seven years of data from more than 1,700 people enrolled in the US National Heart, Lung, and Blood Institute's Framingham Heart Study. Average age was 60."

        MedPage Today  (9/5, Kaiser) reports that the researchers found that "several measures of aortic wall stiffness, including carotid-femoral pulse wave velocity, forward wave amplitude, and augmentation index, were found to correlate with a higher odds of incident hypertension after a seven-year follow-up." But, "higher baseline blood pressure did not correlate with aortic stiffness, which suggests that 'arterial stiffness precedes the development of hypertension rather than vice versa.'" The investigators "also found that a higher resting brachial artery flow and a lower flow-mediated dilation at baseline were associated with a higher odds of developing hypertension."

        HeartWire  (9/5, Nainggolan) reports that "in an editorial  accompanying the paper, Dr Debabrata Mukherjee" writes, "Future studies are indicated to assess whether vascular therapy focused on improving arterial elasticity or reducing stiffness will reduce risk of hypertension and cardiovascular morbidity and mortality."

Review: Insufficient evidence exists about the effectivness of nutritional support in acute kidney injury.

ACP JournalWise link

Li Y, Tang X, Zhang J, et al. Nutritional support for acute kidney injury. Cochrane Database Syst Rev. 2012 Aug 15;8:CD005426. (Review)

BACKGROUND: Treatment for acute kidney Injury (AKI) primarily relies on treating the underlying cause and maintaining the patient until kidney function has recovered. Enteral and parenteral nutrition are commonly used to treat nutritional disorders in AKI patients, however their efficacy in treating AKI are still debated. This review was first published in 2010.

OBJECTIVES: To evaluate the effectiveness and safety of nutritional support for patients with AKI. SEARCH

METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Chinese Biomedical Disc, VIP and China National Knowledge Infrastructure (CNKI).Date of last search: 4 July 2012

SELECTION CRITERIA: All randomised controlled trials (RCTs) reported for AKI and nutrition were included.

DATA COLLECTION AND ANALYSIS: Authors independently assessed study quality and extracted data. Results were expressed as risk ratio (RR) with 95% confidence intervals (CI) or mean difference (MD).

MAIN RESULTS: Eight studies (257 participants) were included. An overall pooled analysis was not performed due to the different interventions used and different outcomes measured. Selection bias was not reported (unclear) in six studies and was adequately reported (low) for random sequence generation in two studies. Participant/personnel blinding was adequately reported in one study and unclear in seven. Incomplete outcome reporting bias was low in six studies and high in two. Selective reporting was low in six studies, unclear in one study, and high in one study. No other biases were detected. There was a significant increase in recovery rate for AKI (RR 1.70, 95% CI 1.70 to 2.79) and survival in dialysed patients (RR 3.56, 95% CI 0.97 to 13.08) for intravenous essential L-amino acids (EAA) compared to hypertonic glucose alone. Compared to lower calorie-total parenteral nutrition (TPN), higher calorie-TPN did not improve estimated nitrogen balance, protein catabolic rate, or urea generation rate; but increased serum triglycerides, glucose, insulin need and nutritional fluid administration. There was no difference between groups in estimated nitrogen balance, but there were differences between urea nitrogen appearance (MD 0.98, 95% CI 0.25 to 1.71) and net protein utilisation (MD 21.50%, 95% CI 0.39 to 42.61). Urea nitrogen appearance was lower in the low nitrogen intake group than in the high nitrogen intake group. There was no significant difference in death between EAA and general amino acids (GAA) (RR 1.52, 95% CI 0.63 to 3.68). High dose amino acids did not improve cumulative water excretion, furosemide requirement, nitrogen balance or death compared to normal dose amino acids. Glucose+EAA+histidin had better nitrogen balance than glucose+GAA; glucose+nitrogen+fat significantly increased serum creatinine compared with glucose+GAA; glucose+EAA+histidin significantly improved nitrogen balance, U/P urea and serum creatinine, but increased plasma urea compared to glucose+nitrogen+fat.

AUTHORS' CONCLUSIONS: There was insufficient evidence found to support the effectiveness of nutritional support for AKI. Further high quality studies are required to provide reliable evidence of the effect and safety of nutritional support.

FDA approves new prostate cancer drug.

The New York Times (8/31, Pollack, Subscription Publication) (8/31, Pollack, Subscription Publication) reported that the FDA "approved a new life-prolonging drug for men with late-stage prostate cancer on Friday, adding to an increasingly crowded field. The new drug, which will be called Xtandi, was developed by Medivation, a small San Francisco pharmaceutical company, in partnership with the Japanese firm Astellas Pharma." The Times adds that in clinical trials, "men who received the drug, which was previously known as MDV3100, lived a median of 18.4 months, nearly five months longer than the median of 13.6 months for those who received a placebo."

        Bloomberg News (9/1, Armstrong) quoted Richard Pazdur, the FDA director of the Office of Hematology and Oncology Products, who said in a statement, "The need for additional treatment options for advanced prostate cancer continues to be important for patients. Xtandi is the latest treatment for this disease to demonstrate its ability to extend a patient's life."

        The AP (9/1) reported, "More than 241,000 men will be diagnosed with prostate cancer this year and 28,170 will die from the disease, according to an estimate by the National Cancer Institute." Also reporting this story are Reuters (9/3), the San Francisco Business Times (9/1, Leuty, Subscription Publication), HealthDay (9/1), MedPage Today (9/1, Bankhead), and Medscape (9/4).

Researchers say e-cigarettes cause lung damage.

Bloomberg News (9/4, Kitamura) reports that according to a study from University of Athens researchers, presented at the European Respiratory Society annual meeting, "electronic cigarettes cause damage to the lungs," which "challenges earlier research suggesting the devices to quit smoking are harmless." In a statement, study author Christina Gratziou remarked, "We do not yet know whether unapproved nicotine delivery products, such as e-cigarettes, are safer than normal cigarettes, despite marketing claims that they are less harmful. This research helps us to understand how these products could be potentially harmful." The piece notes that "the study follows a separate paper presented last month by researchers at the Athens-based Onassis Cardiac Surgery Center at the European Society of Cardiology annual meeting that said e-cigarettes prompted no adverse effects on cardiac function."

Up to 10,000 Yosemite visitors at risk for hantavirus.

The AP (9/2, Cone) reported, "Up to 10,000 people who were guests in certain lodging cabins at Yosemite National Park might have been exposed to a deadly mouse-borne virus, park officials confirmed Friday as rangers handled a slew of calls from frightened visitors." Last week, "park concessionaire Delaware North Co. sent letters and e-mails...to nearly 3,000 people who reserved the insulated Signature cabins between June and August, warning them that they might have been exposed" to hantavirus. On Friday, "park spokesman Scott Gediman said...that means up to 7,000 more visitors might have been exposed to the virus that so far has killed two people and sickened four others."

        The USA Today (8/31, Winter) "On Deadline" blog reported, "The park is receiving more than 1,000 calls a day from frightened visitors seeking information or reassurance," according to a report by the AP. Meanwhile, "the park has posted an FAQ on hantavirus, which is contracted from contact with the urine, feces or saliva of infected rodents, usually deer mice. The symptoms, which appear between one week and six weeks after exposure, include fever, severe headache, and muscle ache," then progress to severe difficulties breathing and even death.

        The Wall Street Journal (9/1, McKay, Vara, Subscription Publication) reported that health advisories issued by the Centers for Disease Control and Prevention are asking public health officials and healthcare practitioners across the US to keep an eye out on Hantavirus-like symptoms in patients. Reuters (9/1, Whitcomb, Cohen) also covers the story.

Stanford study questions benefits of organic food.

Interesting though studies of not long enough duration to really be meaningful in my opinion.

There has been widespread coverage of a new study by Stanford University scientists, which compared organic and conventional foods. The reporting on the study, which published Monday afternoon in the Annals of Internal Medicine, has focused largely on how the findings cast doubt on the benefits of organic food. For its part, the New York Times (9/4, Chang, Subscription Publication) reports that the researchers "concluded that fruits and vegetables labeled organic were, on average, no more nutritious than their conventional counterparts, which tend to be far less expensive. Nor were they any less likely to be contaminated by dangerous bacteria like E. Coli." Utlimately, "the researchers also found no obvious health advantages to organic meats," the Times notes.

        In a related story, the Washington Post (9/4, Huget) "The Checkup" blog reports that "Crystal Smith-Spangler of Stanford University culled the scientific literature for research into the health benefits and risk of contamination among organic and conventional produce and meats." The blog further details that "her review of 17 human studies and 223 evaluations of nutrient and contaminant levels in foods ranging from milk and grains to pork, beef and chicken detected mostly minor differences between organic and conventionally farmed versions." It adds that "overall, her research...found little scientific evidence to support organic food's superiority over conventionally farmed food."

        ABC World News (9/3, story 9, 2:10, Muir) (9/3, story 9, 2:10, Muir) broadcast, "the study found organics actually scored equally on vitamin and mineral content as conventional produce." However, it also noted that "the study found organic produce is 30% less likely to have pesticide residue on it."

        For its part, the Los Angeles Times (9/4, Mestel) reports that "two studies found that children who ate conventional produce had higher levels of pesticide residues in their urine, and the levels fell when the children switched to organic foods. But, again, it's not clear whether there would be clinical consequences, Smith-Spangler and coauthors wrote." According to the report, "studies generally found that levels of contamination were within safe ranges and may not differ much between organic and conventionally grown food."

        Also covering the story, the AP (9/4, Neergaard) notes that "organic foods account for 4.2 percent of retail food sales, according to the U.S. Department of Agriculture." Further, it observes that "consumers can pay a lot more for some organic products but demand is rising: Organic foods accounted for $31.4 billion sales last year, according to a recent Obama administration report."

        Bloomberg News (9/4, Pettypiece) reports on how the organic food industry is responding to the study. According to the article, "Laura Batcha, executive vice president of the industry trade group, said the benefits found by the study supports the value of organic food." Batcha states, "This study confirms that choosing organic foods reduces consumers' exposure to pesticide residues, and that the overuse of antibiotics in non-organic production leads to higher level of bacteria resistant to antibiotics in meat." She adds, "Studies have increasingly shown the importance of minimizing young children's exposure to even low levels of chemical pesticides."

        Meanwhile, USA Today (9/4, Weise) reports that "the findings suggest that a key reason behind why many people buy organic products - a $28.6 billion market last year - may not be borne out by the science." The article points out that "the data don't fit well with consumers' stated motivations for buying organic foods. A 2010 Nielsen study found that 76% bought them believing they are healthier, 53% because they allowed them to avoid pesticides and other toxins, 51% because they are more nutritious and 49% because organic farming is better for the environment."