Bayer is running "advertisements...that claim the product reduces men's risk of prostate cancer." Bayer's radio and TV ads falsely claim that selenium, an ingredient of One-A-Day Men's Health Formula and 50+ Advantage, helps prevent prostate cancer."
The National Institutes of Health" "found no evidence the ingredient selenium prevents prostate cancer in men." "The largest prostate cancer prevention trial has found that selenium is no more effective than a placebo," and Bayer therefore "is ripping people off when it suggests otherwise in these dishonest ads." The study was "halted...last October after it became clear that selenium did not prevent prostate cancer."
A complaint has already been filed with the Federal Trade Commission."
Back in 2007, the FTC "ordered Bayer to stop making unproven health claims for a One-A-Day weight loss product and told the company not to make any unsubstantiated claims for any vitamins in the One-A-Day product line." The recent complaint to the FTC urges the commission to "take swift and strong action to get these deceptive Bayer ads off television, radio, and Internet and out of newspapers and magazines or wherever else they may be displayed."
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
*Tune in later for GETTING YOUR MEDICAL TEST RESULTS IS ALWAYS YOUR RESPONSIBILITY
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Showing posts with label antibiotics. Show all posts
Showing posts with label antibiotics. Show all posts
Friday, August 28, 2009
Sunday, August 2, 2009
NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
Previous guidelines relied more on RISK calculators...and recommended aspirin for patients with a cardiovascular risk of at least 6% over 10 years.
In general, the new recommendations recommend low-dose aspirin for men age 45 to 79...and women age 55 to 79.
These are the ages where the risk of bleeding is usually offset by aspirin's cardiovascular benefits.
Interestingly, the benefits are different for men and for women.
For men, the benefit is to prevent an MI.
For women, the primary benefit is to prevent an ischemic stroke.
Of course, patients are even more likely to benefit if they have additional CV risks...smoking, hypertension, dyslipidemia, etc.
On the other hand, patients may be better off without aspirin if they have additional BLEEDING risks...prior GI ulcers, chronic NSAIDs, etc.
Don't give aspirin to patients with additional GI risks unless their CV risk is high enough to outweigh the higher bleeding risk.
Consider adding a proton pump inhibitor if a patient at high risk for GI bleeding needs to take aspirin.
Patients 80 or older have a high risk of BOTH cardiovascular disease and GI bleeding. Give aspirin only if these seniors have no additional GI risks.
Also make sure BP is controlled before starting aspirin to reduce the risk of hemorrhagic stroke.
Prescribe just 81 mg/day of aspirin. There's no proof that higher doses work better...plus they can increase bleeding risk.
Advise patients to take either regular aspirin with food or use enteric-coated aspirin...IF needed to reduce stomach irritation. But explain that this only helps the local effects...neither approach reduces the risk of bleeding.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for ABLATION FOR ATRIAL FIBRILLATION: NOT RISK FREE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Previous guidelines relied more on RISK calculators...and recommended aspirin for patients with a cardiovascular risk of at least 6% over 10 years.
In general, the new recommendations recommend low-dose aspirin for men age 45 to 79...and women age 55 to 79.
These are the ages where the risk of bleeding is usually offset by aspirin's cardiovascular benefits.
Interestingly, the benefits are different for men and for women.
For men, the benefit is to prevent an MI.
For women, the primary benefit is to prevent an ischemic stroke.
Of course, patients are even more likely to benefit if they have additional CV risks...smoking, hypertension, dyslipidemia, etc.
On the other hand, patients may be better off without aspirin if they have additional BLEEDING risks...prior GI ulcers, chronic NSAIDs, etc.
Don't give aspirin to patients with additional GI risks unless their CV risk is high enough to outweigh the higher bleeding risk.
Consider adding a proton pump inhibitor if a patient at high risk for GI bleeding needs to take aspirin.
Patients 80 or older have a high risk of BOTH cardiovascular disease and GI bleeding. Give aspirin only if these seniors have no additional GI risks.
Also make sure BP is controlled before starting aspirin to reduce the risk of hemorrhagic stroke.
Prescribe just 81 mg/day of aspirin. There's no proof that higher doses work better...plus they can increase bleeding risk.
Advise patients to take either regular aspirin with food or use enteric-coated aspirin...IF needed to reduce stomach irritation. But explain that this only helps the local effects...neither approach reduces the risk of bleeding.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for ABLATION FOR ATRIAL FIBRILLATION: NOT RISK FREE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Thursday, July 16, 2009
WHICH ORAL ANTIBIOTICS ARE SAFE DURING PREGNANCY AND BREASTFEEDING?
Many are okay...and LESS risky than an untreated infection. But some have special precautions...and several should be avoided.
Penicillins and cephalosporins are usually safe.
Consider using a higher or more frequent dose during the 2nd and 3rd trimesters...to compensate for the increased volume of distribution and clearance.
Erythromycin and azithromycin are also generally safe in pregnancy. Don't use clarithromycin...due to concerns about birth defects in animal studies.
Nitrofurantoin is usually okay during pregnancy and breastfeeding. Don't use it close to delivery due to a small chance of hemolytic anemia in the newborn.
TMP/SMX should usually be avoided. Trimethoprim may cause birth defects during the 1st trimester...and sulfonamides may cause high bilirubin and jaundice in the baby if given near term.
Metronidazole is sometimes avoided in the 1st trimester due to concerns about possible malformations. But it can be used during pregnancy if there are no good alternatives.
For a single dose while breastfeeding, suggest stopping breastfeeding for 12 to 24 hours to allow the drug to be eliminated.
Clindamycin is an alternative to metronidazole for anaerobic coverage and is considered safe in pregnancy and lactation.
Fluoroquinolones (ciprofloxacin, etc) are associated with cartilage damage in animals. Even though this isn't confirmed in humans, try to avoid fluoroquinolones during pregnancy.
Tetracyclines should be avoided in pregnancy...especially in the 2nd and 3rd trimesters. They're associated with adverse effects on fetal teeth and bones, other defects, and maternal liver toxicity.
Tell moms that tetracycline can be used during breastfeeding...it only shows up in very low concentrations in breast milk.
On-line resources:
Motherisk. http://www.motherisk.org/index.jsp. Offers consumers answers to questions about morning sickness and the risk or safety of medications, disease, chemical exposure, and more. Provides teratogen information for healthcare professionals and updates on Motherisk's continuing reproductive research.
Perinatology.com. http://www.perinatology.com/. Provides teratogen information for healthcare professionals and links to clinical guidelines and more.
Organization of Teratology Information Specialists (OTIS). http://www.otispregnancy.org/. Provides medical consultation on prenatal exposures for consumers and healthcare professionals.
OBfocus. http://www.obfocus.com/. Provides information for healthcare professionals and consumers on pregnancy related issues, including drug exposure. Provides a list of resources on high risk pregnancy
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for Women Still Drinking During Pregnancy
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Penicillins and cephalosporins are usually safe.
Consider using a higher or more frequent dose during the 2nd and 3rd trimesters...to compensate for the increased volume of distribution and clearance.
Erythromycin and azithromycin are also generally safe in pregnancy. Don't use clarithromycin...due to concerns about birth defects in animal studies.
Nitrofurantoin is usually okay during pregnancy and breastfeeding. Don't use it close to delivery due to a small chance of hemolytic anemia in the newborn.
TMP/SMX should usually be avoided. Trimethoprim may cause birth defects during the 1st trimester...and sulfonamides may cause high bilirubin and jaundice in the baby if given near term.
Metronidazole is sometimes avoided in the 1st trimester due to concerns about possible malformations. But it can be used during pregnancy if there are no good alternatives.
For a single dose while breastfeeding, suggest stopping breastfeeding for 12 to 24 hours to allow the drug to be eliminated.
Clindamycin is an alternative to metronidazole for anaerobic coverage and is considered safe in pregnancy and lactation.
Fluoroquinolones (ciprofloxacin, etc) are associated with cartilage damage in animals. Even though this isn't confirmed in humans, try to avoid fluoroquinolones during pregnancy.
Tetracyclines should be avoided in pregnancy...especially in the 2nd and 3rd trimesters. They're associated with adverse effects on fetal teeth and bones, other defects, and maternal liver toxicity.
Tell moms that tetracycline can be used during breastfeeding...it only shows up in very low concentrations in breast milk.
On-line resources:
Motherisk. http://www.motherisk.org/index.jsp. Offers consumers answers to questions about morning sickness and the risk or safety of medications, disease, chemical exposure, and more. Provides teratogen information for healthcare professionals and updates on Motherisk's continuing reproductive research.
Perinatology.com. http://www.perinatology.com/. Provides teratogen information for healthcare professionals and links to clinical guidelines and more.
Organization of Teratology Information Specialists (OTIS). http://www.otispregnancy.org/. Provides medical consultation on prenatal exposures for consumers and healthcare professionals.
OBfocus. http://www.obfocus.com/. Provides information for healthcare professionals and consumers on pregnancy related issues, including drug exposure. Provides a list of resources on high risk pregnancy
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for Women Still Drinking During Pregnancy
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Saturday, June 6, 2009
The War Of The “Pharmascolds.”
And What Has This To Do With Professors As Impartial Medical Expert Witnesses?
"Men, it has been well said, think in herds; it will be seen that they go mad in herds, while they only recover their senses slowly, and one by one." - Charles Mackay
Henry Kissinger once said that the reason why fights between academics are so vicious is because the stakes are so low.
But not so in this era. The stakes are pretty high -- in the billions of dollars.
Eric G. Campbell points out in “The Future of Research Funding in Academic Medicine” in the NEJM [April,2009] that” medical schools and teaching hospitals in the United States are essential producers of basic scientific and clinical knowledge that drives our supply of new medicines, devices, and other health care innovations. His points:
• The federal government is the single largest source of financial support for academic life-sciences research in the United States. At the 20 most research-intensive medical schools, an average of 80 to 85% of total research revenues, and about one third of all revenues, come from federal research grants. From 1971 through 2003, the average annual increase in the budget of the National Institutes of Health (NIH) was 9%, or 3.4% with adjustment for inflation. However, in the past 5 years there has been no appreciable growth in this budget — indeed, given the rate of inflation, there was a 13% decrease.
• The second major source of support is industry — makers of medical devices, pharmaceuticals, and biotechnology products, which primarily fund clinical trials and other late-stage clinical research. Although it is difficult to determine the amounts of and trends in industry funding specifically targeted for academic research in the life sciences, the National Science Foundation estimates that the industry's share of support for academic research and development in all fields peaked at 7% in 1999 and decreased to its current level of 5% in 2003. Evidence of this decline can be found in a national survey of medical school researchers conducted in 2008. This has been associated with the growth of contract research organizations and increased focus on international research and the generic drug market.”
• “The future of industry support is uncertain,” says Campbell,” but current trends suggest there will be further decreases.
• Industry-sponsored clinical trials are rapidly moving to poorer countries.
• Reductions in industry funding could make it increasingly difficult for U.S. academic health centers to maintain their clinical and translational research enterprises — and may hit the most productive and senior faculty members hardest, since they are the most reliant on such support.
While medical research funds are decreasing medical schools across the U.S. have come under fire for not fully disclosing financial ties between researchers, pharmaceutical and medical-device companies. In October, 2009 Senators Charles Grassley, a Republican from Iowa, and Herb Kohl, a Democrat from Wisconsin inquired about links between 22 university professors and device companies. That shot from Washington started an en masse rush towards the exits.
In a hurried response medical schools across the country like Johns Hopkins University’s medical school say [NYT 4/8/09] that they will restrict interactions between doctors and industry representatives. Stanford University School of Medicine, said ON April 1, 2009 that it will require doctors to post industry income and royalty payments on a school Web site. Harvard Medical School also promised that it will review its policies on conflicts of interest in drug research. Columbia University is doing the same thing.
“The outrage comes easily for Grassley — but there are some gray areas” say observers. Medical-school professors get their jobs in the first place because they know their fields. Forbid such educated people to consult with the companies that develop new medicines and you cut off a valuable source of knowledge. What's more, pharma's largesse also flows to the schools themselves in the form of multimillion-dollar endowments. Whether or not the companies are trying to curry favor, they're also building labs and bankrolling scholarships — something that becomes increasingly important as the deteriorating 2009 economy causes philanthropic giving to dry up. No one disagrees that isolating academia from the industry may be ideal, but even many academics concede that the cooperation yields more good than harm.
Though admitting that “working with industry is essential to fulfilling our academic mission, “we have to do it in a way that removes potential bias and preserves the public trust in our institutions,” said Eugene Braunwald, a noted cardiologist. In other words we don’t like the bad publicity. "We don't want our faculty being on the road" as "hired guns," chimed in Dr. Peter Slavin, president of the prestigious Mass. General Hospital who joined the herd rushing to the exits. Slavin maintains that he wants to prohibit physicians from eating meals on a company's tab, including lunches bought for doctors-in-training in the hospital, because it "doesn't promote a positive image of physicians and increases healthcare costs." How does it increase healthcare costs—he doesn’t say.
These new university policies also prohibit gifts like pads, pens and pencils, entertainment or food to underlings like house-staff or even attending physicians— regardless of low value — from drug and medical device companies.
Talk about using a crisis to get what you want — here’s the kicker—donations [if any] from industry will have to be given to the Medical schools themselves rather than individual doctors. This puts the dollars right where the deans and university presidents have always wanted it.
Although Campbell above has shown that industry dollars are dwindling a harsh critic of industry medical school partnerships — Dr. Arnold Relman, a Harvard Medical School professor and former editor of the New England Journal of Medicine, complains that the medical education provisions don't go far enough. "There should be no, zero, industry funding for any particular educational program," he says. "If you know your . . . program is dependent on money from a company, it's impossible not to be influenced by that fact."
Critics on the opposite side of the fence like Dr. Thomas Stossel, say restrictions on the interactions between doctors and industry could ultimately hurt patient care. "We have all these tools now for caring for patients, and those tools have come from physicians working with industry." Dr. Stossel, professor of medicine at Harvard, was joined by David A. Shaywitz, a management consultant to add [4/9/09, NYT] that this situation is "largely because of the disproportionate influence of a coterie of prominent critics we have previously dubbed 'pharmascolds’. They routinely vilify the medical products industry and portray academics working with it as traitors and sellouts."
“Given the vital role of medical products companies and the magnitude of their challenges, one might imagine that this industry would be admired,” they say. “These critics are pious academics, self-righteous medical journal editors, and opportunistic politicians and journalists. Their condemnation of anyone's legitimate profit — it's all "corruption" in their book -- has in fact materially enhanced their own careers. They extrapolate from occasional behavioral lapses in industry -- which is equally, if not more prevalent, in universities — to demonize the market and portray scientific medicine as an ascetic religion, which it is not.”
Are the problems of the full time salaried academic medical expert who should be impartial in court not solved by these “reforms?”
Not according to Dr. Arnold Relman who complains above that the medical education provisions don't go far enough and that there should be no, zero, industry funding for any particular educational program," ..because "If you know your . . . program is dependent on money from a company, it's impossible not to be influenced by that fact." In other words it’s hard for an academician receiving money even indirectly from drug companies to not be biased. It is difficult for a medical expert witness who draws his salary from a medical school and now indirectly from a drug company to be fair about anything involving the company’s drugs —especially if the case involves a patient receiving one of these drugs
That’s it in a nutshell. How is bias removed from a medical expert whose fulltime salary is paid by a fund granted by industry? Does not the expert know which drug company[s] are paying his weekly salary? Does he not know which drugs are being worked on by his medical school —and his colleagues? And does he not know that money coming in to pay his salary depends on the medical school’s relationship with the drug company?
The opposing attorney knows full well that you cannot leap a chasm in two jumps. Removing food and do-dads from medical student lunch boxes and replacing the saved money into the deans coffers offers no consolation to the academic medical expert if his salary is now being paid by the drug company. In fact, where there were only a few academic full timers on a drug company payroll there are now hundreds more who are on the entire medical school full time faculty payroll — feeding from the same trough.
Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site, http://www.wntn.com
"Men, it has been well said, think in herds; it will be seen that they go mad in herds, while they only recover their senses slowly, and one by one." - Charles Mackay
Henry Kissinger once said that the reason why fights between academics are so vicious is because the stakes are so low.
But not so in this era. The stakes are pretty high -- in the billions of dollars.
Eric G. Campbell points out in “The Future of Research Funding in Academic Medicine” in the NEJM [April,2009] that” medical schools and teaching hospitals in the United States are essential producers of basic scientific and clinical knowledge that drives our supply of new medicines, devices, and other health care innovations. His points:
• The federal government is the single largest source of financial support for academic life-sciences research in the United States. At the 20 most research-intensive medical schools, an average of 80 to 85% of total research revenues, and about one third of all revenues, come from federal research grants. From 1971 through 2003, the average annual increase in the budget of the National Institutes of Health (NIH) was 9%, or 3.4% with adjustment for inflation. However, in the past 5 years there has been no appreciable growth in this budget — indeed, given the rate of inflation, there was a 13% decrease.
• The second major source of support is industry — makers of medical devices, pharmaceuticals, and biotechnology products, which primarily fund clinical trials and other late-stage clinical research. Although it is difficult to determine the amounts of and trends in industry funding specifically targeted for academic research in the life sciences, the National Science Foundation estimates that the industry's share of support for academic research and development in all fields peaked at 7% in 1999 and decreased to its current level of 5% in 2003. Evidence of this decline can be found in a national survey of medical school researchers conducted in 2008. This has been associated with the growth of contract research organizations and increased focus on international research and the generic drug market.”
• “The future of industry support is uncertain,” says Campbell,” but current trends suggest there will be further decreases.
• Industry-sponsored clinical trials are rapidly moving to poorer countries.
• Reductions in industry funding could make it increasingly difficult for U.S. academic health centers to maintain their clinical and translational research enterprises — and may hit the most productive and senior faculty members hardest, since they are the most reliant on such support.
While medical research funds are decreasing medical schools across the U.S. have come under fire for not fully disclosing financial ties between researchers, pharmaceutical and medical-device companies. In October, 2009 Senators Charles Grassley, a Republican from Iowa, and Herb Kohl, a Democrat from Wisconsin inquired about links between 22 university professors and device companies. That shot from Washington started an en masse rush towards the exits.
In a hurried response medical schools across the country like Johns Hopkins University’s medical school say [NYT 4/8/09] that they will restrict interactions between doctors and industry representatives. Stanford University School of Medicine, said ON April 1, 2009 that it will require doctors to post industry income and royalty payments on a school Web site. Harvard Medical School also promised that it will review its policies on conflicts of interest in drug research. Columbia University is doing the same thing.
“The outrage comes easily for Grassley — but there are some gray areas” say observers. Medical-school professors get their jobs in the first place because they know their fields. Forbid such educated people to consult with the companies that develop new medicines and you cut off a valuable source of knowledge. What's more, pharma's largesse also flows to the schools themselves in the form of multimillion-dollar endowments. Whether or not the companies are trying to curry favor, they're also building labs and bankrolling scholarships — something that becomes increasingly important as the deteriorating 2009 economy causes philanthropic giving to dry up. No one disagrees that isolating academia from the industry may be ideal, but even many academics concede that the cooperation yields more good than harm.
Though admitting that “working with industry is essential to fulfilling our academic mission, “we have to do it in a way that removes potential bias and preserves the public trust in our institutions,” said Eugene Braunwald, a noted cardiologist. In other words we don’t like the bad publicity. "We don't want our faculty being on the road" as "hired guns," chimed in Dr. Peter Slavin, president of the prestigious Mass. General Hospital who joined the herd rushing to the exits. Slavin maintains that he wants to prohibit physicians from eating meals on a company's tab, including lunches bought for doctors-in-training in the hospital, because it "doesn't promote a positive image of physicians and increases healthcare costs." How does it increase healthcare costs—he doesn’t say.
These new university policies also prohibit gifts like pads, pens and pencils, entertainment or food to underlings like house-staff or even attending physicians— regardless of low value — from drug and medical device companies.
Talk about using a crisis to get what you want — here’s the kicker—donations [if any] from industry will have to be given to the Medical schools themselves rather than individual doctors. This puts the dollars right where the deans and university presidents have always wanted it.
Although Campbell above has shown that industry dollars are dwindling a harsh critic of industry medical school partnerships — Dr. Arnold Relman, a Harvard Medical School professor and former editor of the New England Journal of Medicine, complains that the medical education provisions don't go far enough. "There should be no, zero, industry funding for any particular educational program," he says. "If you know your . . . program is dependent on money from a company, it's impossible not to be influenced by that fact."
Critics on the opposite side of the fence like Dr. Thomas Stossel, say restrictions on the interactions between doctors and industry could ultimately hurt patient care. "We have all these tools now for caring for patients, and those tools have come from physicians working with industry." Dr. Stossel, professor of medicine at Harvard, was joined by David A. Shaywitz, a management consultant to add [4/9/09, NYT] that this situation is "largely because of the disproportionate influence of a coterie of prominent critics we have previously dubbed 'pharmascolds’. They routinely vilify the medical products industry and portray academics working with it as traitors and sellouts."
“Given the vital role of medical products companies and the magnitude of their challenges, one might imagine that this industry would be admired,” they say. “These critics are pious academics, self-righteous medical journal editors, and opportunistic politicians and journalists. Their condemnation of anyone's legitimate profit — it's all "corruption" in their book -- has in fact materially enhanced their own careers. They extrapolate from occasional behavioral lapses in industry -- which is equally, if not more prevalent, in universities — to demonize the market and portray scientific medicine as an ascetic religion, which it is not.”
Are the problems of the full time salaried academic medical expert who should be impartial in court not solved by these “reforms?”
Not according to Dr. Arnold Relman who complains above that the medical education provisions don't go far enough and that there should be no, zero, industry funding for any particular educational program," ..because "If you know your . . . program is dependent on money from a company, it's impossible not to be influenced by that fact." In other words it’s hard for an academician receiving money even indirectly from drug companies to not be biased. It is difficult for a medical expert witness who draws his salary from a medical school and now indirectly from a drug company to be fair about anything involving the company’s drugs —especially if the case involves a patient receiving one of these drugs
That’s it in a nutshell. How is bias removed from a medical expert whose fulltime salary is paid by a fund granted by industry? Does not the expert know which drug company[s] are paying his weekly salary? Does he not know which drugs are being worked on by his medical school —and his colleagues? And does he not know that money coming in to pay his salary depends on the medical school’s relationship with the drug company?
The opposing attorney knows full well that you cannot leap a chasm in two jumps. Removing food and do-dads from medical student lunch boxes and replacing the saved money into the deans coffers offers no consolation to the academic medical expert if his salary is now being paid by the drug company. In fact, where there were only a few academic full timers on a drug company payroll there are now hundreds more who are on the entire medical school full time faculty payroll — feeding from the same trough.
Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site, http://www.wntn.com
Monday, June 1, 2009
EMR vs. no EMR
Will Electronic medical records in the doctors office improve quality medical care.
The last time I looked there still was as yet no desirable uniform system for all physicians.
Data from more than 50,000 patient records in more than 2,500 practices over two years showed that comparing physicians who used an electronic medical record with those who didn't produced only a handful of statistically significant differences on quality-of-care metrics. The figures show in what percentage of relevant cases each type of practice adhered to some commonly accepted quality guidelines.
Quality indicator EMR No EMR
Antithrombotic therapy for atrial fibrillation 54% 60%
Aspirin use for coronary artery disease 45% 40%
Beta-blocker use for coronary artery disease 40% 38%
Diuretic and beta-blocker use for hypertension 64% 60%
Statin use* 33% 47%
Inhaled corticosteroid use for asthma 44% 44%
Treatment of depression 82% 86%
No benzodiazepine use for depression* 91% 84%
Selected antibiotic use for acute otitis media 68% 67%
Smoking cessation counseling 30% 23%
Diet counseling for high-risk adults 28% 33%
Exercise counseling for high-risk adults 20% 21%
Blood pressure check 68% 71%
No routine electrocardiogram 97% 96%
No routine urinalysis* 94% 91%
No routine hemoglobin/hematocrit 86% 86%
Avoiding potentially inappropriate prescribing in elderly patients 93% 93%
* Statistically significant
Source: "Electronic Health Record Use and the Quality of Ambulatory Care in the United States," by Jeffrey A. Linder, MD, MPH, et al., July 9 Archives of Internal Medicinecq whole thing.
The last time I looked there still was as yet no desirable uniform system for all physicians.
Data from more than 50,000 patient records in more than 2,500 practices over two years showed that comparing physicians who used an electronic medical record with those who didn't produced only a handful of statistically significant differences on quality-of-care metrics. The figures show in what percentage of relevant cases each type of practice adhered to some commonly accepted quality guidelines.
Quality indicator EMR No EMR
Antithrombotic therapy for atrial fibrillation 54% 60%
Aspirin use for coronary artery disease 45% 40%
Beta-blocker use for coronary artery disease 40% 38%
Diuretic and beta-blocker use for hypertension 64% 60%
Statin use* 33% 47%
Inhaled corticosteroid use for asthma 44% 44%
Treatment of depression 82% 86%
No benzodiazepine use for depression* 91% 84%
Selected antibiotic use for acute otitis media 68% 67%
Smoking cessation counseling 30% 23%
Diet counseling for high-risk adults 28% 33%
Exercise counseling for high-risk adults 20% 21%
Blood pressure check 68% 71%
No routine electrocardiogram 97% 96%
No routine urinalysis* 94% 91%
No routine hemoglobin/hematocrit 86% 86%
Avoiding potentially inappropriate prescribing in elderly patients 93% 93%
* Statistically significant
Source: "Electronic Health Record Use and the Quality of Ambulatory Care in the United States," by Jeffrey A. Linder, MD, MPH, et al., July 9 Archives of Internal Medicinecq whole thing.
Sunday, May 31, 2009
TENDON RUPTURE WITH THE USE OF FLUOROQUINOLONE ANTIBIOTICS
We have reviewed antibiotic associated diarrheas [AAD] in a previous article.
We have also reviewed the bacterial resistance that evolves with the use of antibiotics-especially the resistant C.difficle arising from the (over) use of fluoroquinolones.
Levaquin (levofloxacin) is an antibiotic that is part of a group of drugs known as fluoroquinolones. Approved by the FDA in December 2006, Levaquin has become one of the more commonly prescribed antibiotics. In 2005, annual sales exceeded $2.3 billion. The use of Levaquin, however, has been associated with an increased risk of tendon ruptures, tendon damage and tendonitis, which has left some users permanently disabled after taking the drug.
The risk of tendon ruptures has been associated with all fluroquinolone antibiotics, but the risk appears to be greater with Levaquin. According to reports received by the FDA, tendon ruptures, tendon damage and tendonitis accounted for 61% of all fluoroquinolone-associated ruptures between November 1997 and December 2005.A tendon rupture is a very painful injury that often requires surgery to repair the tendon damage. Symptoms associated with a Levaquin induced tendon rupture could include swelling, inflammation or pain.
The most frequent rupture is the Achilles tendon found in the heel. However, reports have also indicate Levaquin side effects could cause tendon ruptures of the shoulder, biceps, hand and thumb.
The risk of Levaquin tendon rupture side effects is said to be higher among those who are 60 years of age or older
In August 2006, the consumer advocacy group Public Citizen filed a petition with the FDA requesting that these stronger warnings be provided, but the drug makers and FDA failed to take steps at that time to warn users.
In July 2008, the FDA announced that the makers of all fluoroquinolone antibiotics, including Levaquin, will add more prominent language about this risk. In addition, the manufacturers will provide a medication guide which better informs users about the potential side effects of the drugs, and that they should consult with a doctor at the first sign of tendon pain. Meanwhile as with all antibiotics-the rule is do not use unless necessary. Doctors are placed under a lot of pressure by patients for antibiotics to knock out a cold or flu. A cold or viral upper respiratory infection or allergy does not warrant antibiotics. Do not pressure your medical provider to supply antibiotics –especially fluoroquinolones. Take his advice when he tells you antibiotics are not indicated for your “infection,”
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
We have also reviewed the bacterial resistance that evolves with the use of antibiotics-especially the resistant C.difficle arising from the (over) use of fluoroquinolones.
Levaquin (levofloxacin) is an antibiotic that is part of a group of drugs known as fluoroquinolones. Approved by the FDA in December 2006, Levaquin has become one of the more commonly prescribed antibiotics. In 2005, annual sales exceeded $2.3 billion. The use of Levaquin, however, has been associated with an increased risk of tendon ruptures, tendon damage and tendonitis, which has left some users permanently disabled after taking the drug.
The risk of tendon ruptures has been associated with all fluroquinolone antibiotics, but the risk appears to be greater with Levaquin. According to reports received by the FDA, tendon ruptures, tendon damage and tendonitis accounted for 61% of all fluoroquinolone-associated ruptures between November 1997 and December 2005.A tendon rupture is a very painful injury that often requires surgery to repair the tendon damage. Symptoms associated with a Levaquin induced tendon rupture could include swelling, inflammation or pain.
The most frequent rupture is the Achilles tendon found in the heel. However, reports have also indicate Levaquin side effects could cause tendon ruptures of the shoulder, biceps, hand and thumb.
The risk of Levaquin tendon rupture side effects is said to be higher among those who are 60 years of age or older
In August 2006, the consumer advocacy group Public Citizen filed a petition with the FDA requesting that these stronger warnings be provided, but the drug makers and FDA failed to take steps at that time to warn users.
In July 2008, the FDA announced that the makers of all fluoroquinolone antibiotics, including Levaquin, will add more prominent language about this risk. In addition, the manufacturers will provide a medication guide which better informs users about the potential side effects of the drugs, and that they should consult with a doctor at the first sign of tendon pain. Meanwhile as with all antibiotics-the rule is do not use unless necessary. Doctors are placed under a lot of pressure by patients for antibiotics to knock out a cold or flu. A cold or viral upper respiratory infection or allergy does not warrant antibiotics. Do not pressure your medical provider to supply antibiotics –especially fluoroquinolones. Take his advice when he tells you antibiotics are not indicated for your “infection,”
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
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