Conjunctivitis, commonly known as "pink eye" can be allergic, viral, or bacterial in nature. Pathogens most frequently responsible for bacterial conjunctivitis are Streptococcus pneumoniae, Haemophilus influenza, and Staphylococcus aureus.
One way to differentiate bacterial from viral conjunctivitis is that bacterial conjunctivitis usually presents with a purulent discharge. A watery discharge is commonly seen with viral conjunctivitis. Symptoms of bacterial conjunctivis include red eyes, swelling, eyelids sticking together, itching, watering, and a white or yellow sticky discharge from the eyes.
Bacterial conjunctivitis is frequently self-limiting, resolving spontaneously within seven to 14 days in 60% to 70% of the cases. However, treatment with antibacterial agents provide marginal benefit by leading to a faster clinical and microbiological cure and reducing the rate of disease transmission and the chance of rare complications. In addition, some daycares and schools require children with conjunctivitis to be treated with an ophthalmic antibacterial for at least 24 to 48 hours before they can return.
To help manage symptoms of bacterial conjunctivitis, recommend cold or warm compresses, lubricants, ocular decongestants, etc. Bacterial conjunctivitis can be considered contagious until antibiotics have been on board for 24 to 48 hours or until symptoms clear. I emphasize proper hygiene (e.g., hand washing, not touching the eyes with hands, use clean washcloths, etc) and avoiding close contact with others to prevent spreading the infection. I tell patients who use contact lenses to wear their prescription eyeglasses instead, until the infection is cleared.
The goals when treating bacterial conjunctivitis are to improve patient comfort, reduce the course of infection/inflammation, and prevent the spread of infection. Topical therapy is usually sufficient. Eyedrops have the advantage of not interfering with vision and are generally the preferred form for adults. On the other hand, ointments have the advantage of prolonged contact with the ocular surface and are usually preferable in young children. Improvement is generally seen within three to four days of treatment initiation. Patients should be referred to an ophthalmologist if there is no improvement within the first 24 hours after initiation of therapy or if the condition worsens.
Topical corticosteroids should be avoided since some conditions that present as a red eye with watery discharge, such as herpetic keratitis, can worsen with corticosteroid use.
Treatment options for bacterial conjunctivitis include sulfacetamide (Bleph-10, etc), erythromycin, bacitracin (AK-Tracin), bacitracin-polymyxin B (Polysporin), polymyxin B-neomycin-gramicidin (Neosporin), trimethoprim-polymyxin B (Polytrim), aminoglycosides (e.g., gentamicin, tobromycin, etc), quinolones (ciprofloxacin [Ciloxan], levofloxacin [Quixin], gatifloxacin [Zymar], etc), and azithromycin (AzaSite).
There are no significant differences between the clinical effects of various ophthalmic antibacterial agents used in patients with suspected acute bacterial conjunctivitis. The choice of treatment is based on ease of use, side-effects, bacterial susceptibility, and cost. In general, fewer daily doses yields better compliance to treatment.
Azithromycin ophthalmic solution (AzaSite) is dosed less frequently than other ophthalmic antibacterial agents (one drop twice daily for two days, then one drop daily for five days), but it is considerably more expensive and difficult to use. Fluoroquinolones are highly effective and well-tolerated; however, they are generally not used first-line for routine cases of bacterial conjunctivitis due to concerns of emerging resistance and cost. In general, agents that are less expensive with broad-spectrum coverage are used first-line for acute bacterial conjunctivitis (e.g., Polytrim, Polysporin, etc).
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 Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Friday, September 11, 2009
Wednesday, September 9, 2009
THE PROBLEM OF ABUSIVE HEAD TRAUMA (AHT) AND CHILD ABUSE
A child comes into the ER for a possible fracture. A skeletal survey is performed that reveals a healing right radial neck fracture. The medical record from the urgent care center is obtained. This includes a clinical note dated 4 months prior to patient's presentation to the ED, which described a visit for repeated emesis and irritability. A bruise on the chin was noted on that visit, and the explanation given was a fall inside the patient's crib that occurred 4 days prior to that visit. A report to the Department of Children and Families was found to have been made for missed well-child visits
The level of suspicion for suspected abusive head trauma (AHT) and child abuse should be high. AHT in babies less than 1 year old represents a significant fraction of young children admitted for head injury. Approximately 30% of children aged 0-3 years admitted to pediatric hospitals for intracranial injury have been found to meet the criteria for abuse. Crying is thought to be a trigger for many cases of AHT and prevention efforts are directed toward caregiver response to colicky babies and crying infants.
Approximately 30% of children with AHT may be missed on the initial presentation. Common misdiagnoses include viral gastroenteritis, sepsis, and accidental head injury. Common symptoms at presentation are often the result of acute brain injury (ie, lethargy, decreased level of consciousness, vomiting, apnea, hypotonia, and seizures).
The physical examination findings may include evidence of soft tissue injury, particularly swelling or bruising; however, the absence of bruising or other evidence of trauma neither excludes injury nor abuse.
Funduscopic examination should be performed in any child suspected to have abusive head injury, preferably by an ophthalmologist with sufficient pediatric experience to determine the significance of any identified injury.Retinal hemorrhages are a hallmark finding in abusive head injury, and they are present in a majority of children who carry the diagnosis. They may be unilateral or bilateral and involve 1 or more layers. The mechanism of retinal hemorrhages is unclear, but the leading theory is that they are caused by vitreous traction on the retina during acceleration/deceleration. Lasting visual impairment in those children who survive AHT is common.CT scanning is an essential part of the initial workup of suspected head trauma. CT scanning can also be helpful as a screening neuroimaging study in children with suspected abuse. Even without clinical examination findings of brain injury, a significant number of abused infants will have important findings on neuroimaging.
Unilateral, bilateral, or parafalcine subdural hemorrhages are the most common radiologic finding in infants with AHT. Subdural hemorrhages of mixed attenuation have previously been considered as evidence for repeated head injury, with hyperdense components of the hemorrhage associated with injury occurring in the past 48-72 hours and hypodense components representing older injury occurring more than 3 weeks prior to the scan. Hyperacute bleeding or the mixing of blood and cerebrospinal fluid (CSF), however, can produce mixed-density lesions from a single injury. While the presence of subdural hemorrhage lends supporting evidence to the diagnosis of head trauma, inferences about the timing and mechanism of injury cannot be drawn with certainty from a single noncontrast CT scan.Magnetic resonance imaging (MRI) can be a useful study for demonstrating parenchymal contusion, axonal shearing, extra-axial hemorrhages, and posterior fossa injuries. Diffusion-weighted imaging and apparent diffusion coefficient mapping are particularly useful. Additional supportive evidence for child abuse is obtained through a skeletal survey. The presence of previously healed fractures in infants is strongly suggestive of chronic abuse.
While the cause of subdural hematoma in association with retinal hemorrhage will most commonly be abusive head injury, a differential diagnosis for these findings must be considered. It is important for clinicians to be mindful of the diagnosis of AHT, but first rule out other rare causes that can mimic abuse.
• Coagulopathies have been associated with retinal and intracranial hemorrhage in infants, including hemophilia, vitamin-K deficiency, and disseminated intravascular coagulopathy. Retinal hemorrhages in these disorders are typically confined to the posterior pole, and the nature of the bleeding problem can be detected by laboratory tests. It is recommended to perform a prothrombin time, activated partial-thromboplastin time, and a platelet count as minimum screening tests.
• Glutaric aciduria type I, a rare metabolic disease, is associated with developmental delay and subdural hemorrhages. Performing an assay for organic acids in the urine can test for this disease.
• Other causes of intracerebral hemorrhage include cerebral malaria, intracranial aneurysms, galactosemia, and meningitis.
• Osteogenesis imperfecta is an uncommon connective tissue disorder that frequently results in fractures. Subdural hemorrhage has rarely been described as a complication of this disease.
• Because these disorders can closely mimic abusive head trauma, it is important to maintain a nonaccusatory and open-minded posture during the initial evaluation, as parents are understandably sensitive to the possibility that they are being accused of harming their children. Some helpful statements include "I'm concerned that someone may have harmed your child" and "several diseases can explain this pattern of injury, including trauma. We need to check for other signs of these illnesses to make sure your child is safe."
Notwithstanding the latest negative publicity about CT scans, clinicians should have a low threshold for performing CT scans of the head on infants coming in with nonspecific findings that could be explained by head injury, when appropriate.
While reporting a reasonable suspicion for abuse is mandatory, it is not the job of the healthcare provider to determine the social or legal management of any case.
A child protection team, if available, should be consulted with any concerns of abusive injury. AHT is likely underdiagnosed and underreported, which contributes to the dismal outcomes for children eventually diagnosed with abuse. In multiple series, the mortality is approximately 20%.
The neurologic outcome is also poor, with many survivors having persistent neurologic and behavioral deficits.
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 THE TREATMENT OF PINK EYE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
The level of suspicion for suspected abusive head trauma (AHT) and child abuse should be high. AHT in babies less than 1 year old represents a significant fraction of young children admitted for head injury. Approximately 30% of children aged 0-3 years admitted to pediatric hospitals for intracranial injury have been found to meet the criteria for abuse. Crying is thought to be a trigger for many cases of AHT and prevention efforts are directed toward caregiver response to colicky babies and crying infants.
Approximately 30% of children with AHT may be missed on the initial presentation. Common misdiagnoses include viral gastroenteritis, sepsis, and accidental head injury. Common symptoms at presentation are often the result of acute brain injury (ie, lethargy, decreased level of consciousness, vomiting, apnea, hypotonia, and seizures).
The physical examination findings may include evidence of soft tissue injury, particularly swelling or bruising; however, the absence of bruising or other evidence of trauma neither excludes injury nor abuse.
Funduscopic examination should be performed in any child suspected to have abusive head injury, preferably by an ophthalmologist with sufficient pediatric experience to determine the significance of any identified injury.Retinal hemorrhages are a hallmark finding in abusive head injury, and they are present in a majority of children who carry the diagnosis. They may be unilateral or bilateral and involve 1 or more layers. The mechanism of retinal hemorrhages is unclear, but the leading theory is that they are caused by vitreous traction on the retina during acceleration/deceleration. Lasting visual impairment in those children who survive AHT is common.CT scanning is an essential part of the initial workup of suspected head trauma. CT scanning can also be helpful as a screening neuroimaging study in children with suspected abuse. Even without clinical examination findings of brain injury, a significant number of abused infants will have important findings on neuroimaging.
Unilateral, bilateral, or parafalcine subdural hemorrhages are the most common radiologic finding in infants with AHT. Subdural hemorrhages of mixed attenuation have previously been considered as evidence for repeated head injury, with hyperdense components of the hemorrhage associated with injury occurring in the past 48-72 hours and hypodense components representing older injury occurring more than 3 weeks prior to the scan. Hyperacute bleeding or the mixing of blood and cerebrospinal fluid (CSF), however, can produce mixed-density lesions from a single injury. While the presence of subdural hemorrhage lends supporting evidence to the diagnosis of head trauma, inferences about the timing and mechanism of injury cannot be drawn with certainty from a single noncontrast CT scan.Magnetic resonance imaging (MRI) can be a useful study for demonstrating parenchymal contusion, axonal shearing, extra-axial hemorrhages, and posterior fossa injuries. Diffusion-weighted imaging and apparent diffusion coefficient mapping are particularly useful. Additional supportive evidence for child abuse is obtained through a skeletal survey. The presence of previously healed fractures in infants is strongly suggestive of chronic abuse.
While the cause of subdural hematoma in association with retinal hemorrhage will most commonly be abusive head injury, a differential diagnosis for these findings must be considered. It is important for clinicians to be mindful of the diagnosis of AHT, but first rule out other rare causes that can mimic abuse.
• Coagulopathies have been associated with retinal and intracranial hemorrhage in infants, including hemophilia, vitamin-K deficiency, and disseminated intravascular coagulopathy. Retinal hemorrhages in these disorders are typically confined to the posterior pole, and the nature of the bleeding problem can be detected by laboratory tests. It is recommended to perform a prothrombin time, activated partial-thromboplastin time, and a platelet count as minimum screening tests.
• Glutaric aciduria type I, a rare metabolic disease, is associated with developmental delay and subdural hemorrhages. Performing an assay for organic acids in the urine can test for this disease.
• Other causes of intracerebral hemorrhage include cerebral malaria, intracranial aneurysms, galactosemia, and meningitis.
• Osteogenesis imperfecta is an uncommon connective tissue disorder that frequently results in fractures. Subdural hemorrhage has rarely been described as a complication of this disease.
• Because these disorders can closely mimic abusive head trauma, it is important to maintain a nonaccusatory and open-minded posture during the initial evaluation, as parents are understandably sensitive to the possibility that they are being accused of harming their children. Some helpful statements include "I'm concerned that someone may have harmed your child" and "several diseases can explain this pattern of injury, including trauma. We need to check for other signs of these illnesses to make sure your child is safe."
Notwithstanding the latest negative publicity about CT scans, clinicians should have a low threshold for performing CT scans of the head on infants coming in with nonspecific findings that could be explained by head injury, when appropriate.
While reporting a reasonable suspicion for abuse is mandatory, it is not the job of the healthcare provider to determine the social or legal management of any case.
A child protection team, if available, should be consulted with any concerns of abusive injury. AHT is likely underdiagnosed and underreported, which contributes to the dismal outcomes for children eventually diagnosed with abuse. In multiple series, the mortality is approximately 20%.
The neurologic outcome is also poor, with many survivors having persistent neurologic and behavioral deficits.
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 THE TREATMENT OF PINK EYE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Monday, September 7, 2009
THE DANGERS OF ACID REDUCING MEDICATIONS LIKE NEXIUM AND OTHER PPIs
Increased risks of C.dificile infection, pneumonia, bone fractures.
Though initially "recommended for intensive-care patients to prevent stress ulcers," some 40 to 70 percent of inpatients now receive acid-suppressive drugs" like Nexium [esomeprazole], Prilosec [omeprazole], and Prevacid [lansoprazole], "with about half receiving them for the first time." This increased their risk of contracting pneumonia by 30 percent.
We now know that PPIs also increase the chances of getting C.difficile disease, especially those patients receiving PPIs in the hospital or long term care facility..
Gulmez et al writing in the Arch Intern Med. 2007;167(9):950-955 --Use of Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia --A Population-Based Case-Control Study conclude that the use of PPIs, especially when recently begun, is associated with an increased risk of community-acquired pneumonia. The authors conducted a population-based case-control study using data of all patients with a first-discharge diagnosis of community-acquired pneumonia from a hospital during 2000 through 2004. The adjusted odds ratio (OR) associating current use of PPIs with community-acquired pneumonia was 1.5 (95% confidence interval [CI], 1.3-1.7). N
It is of interest that no association was found with the older histamine2-receptor antagonists like Tagamet, Pepcid and others. (OR, 1.10; 95% CI, 0.8-1.3) or with past use of PPIs (OR, 1.2; 95% CI, 0.9-1.6). Only recent initiation of treatment with PPIs (0-7 days before index date) showed a particularly strong association with community-acquired pneumonia (OR, 5.0; 95% 2.1-11.7), while the risk decreased with treatment that was started a long time ago.
Harvard researchers are also saying that "patients who take proton pump inhibitors (PPIs) are at higher risk for pneumonia than those who do not," a finding that is of note, considering that a "growing number of hospital patients are routinely given drugs to prevent acid reflux."
In a Harvard study all patients included in the study were hospitalized for at least three days, and none were in intensive care units." Slightly "over half -- 52 percent -- received some sort of acid-suppressing medication to help prevent stress ulcers."
Another large retrospective study reported on 6/4/09 has found a strong link between use of proton pump inhibitors (PPIs) and hip fracture risk Those at highest risk were those patients who had at least one other standard risk factor for hip fracture, such as renal impairment, diabetes, or glucocorticoid, estrogen, and bisphosphonates use An analysis of a healthcare company's massive database found that the rate of hip fractures was increased by about 30% in patients using PPIs for two years or more prior to fracture.
The study focused on 33,752 Kaiser members who had suffered a hip or femur fracture along with more than 130,000 controls matched for age, sex, race, and length of Kaiser membership.
In men, the odds ratio for hip fracture with at least two years' PPI use was 1.34 (95% CI 1.18 to 1.51). The odds ratio for women was 1.28 (95% CI 1.17 to 1.39).
The analysis showed no associations with drugs such as ACE inhibitors, calcium channel blockers, or non-narcotic painkillers.
When the researchers looked at the effects of age, they found the greatest increase in risk among those 50 to 59 years old (OR 2.31, 95% CI 1.67 to 3.18).
Another database study published last year indicated that PPI use for at least seven years led to a nearly doubled risk of osteoporotic fracture
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 THE PROBLEM OF ABUSIVE HEAD TRAUMA.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Though initially "recommended for intensive-care patients to prevent stress ulcers," some 40 to 70 percent of inpatients now receive acid-suppressive drugs" like Nexium [esomeprazole], Prilosec [omeprazole], and Prevacid [lansoprazole], "with about half receiving them for the first time." This increased their risk of contracting pneumonia by 30 percent.
We now know that PPIs also increase the chances of getting C.difficile disease, especially those patients receiving PPIs in the hospital or long term care facility..
Gulmez et al writing in the Arch Intern Med. 2007;167(9):950-955 --Use of Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia --A Population-Based Case-Control Study conclude that the use of PPIs, especially when recently begun, is associated with an increased risk of community-acquired pneumonia. The authors conducted a population-based case-control study using data of all patients with a first-discharge diagnosis of community-acquired pneumonia from a hospital during 2000 through 2004. The adjusted odds ratio (OR) associating current use of PPIs with community-acquired pneumonia was 1.5 (95% confidence interval [CI], 1.3-1.7). N
It is of interest that no association was found with the older histamine2-receptor antagonists like Tagamet, Pepcid and others. (OR, 1.10; 95% CI, 0.8-1.3) or with past use of PPIs (OR, 1.2; 95% CI, 0.9-1.6). Only recent initiation of treatment with PPIs (0-7 days before index date) showed a particularly strong association with community-acquired pneumonia (OR, 5.0; 95% 2.1-11.7), while the risk decreased with treatment that was started a long time ago.
Harvard researchers are also saying that "patients who take proton pump inhibitors (PPIs) are at higher risk for pneumonia than those who do not," a finding that is of note, considering that a "growing number of hospital patients are routinely given drugs to prevent acid reflux."
In a Harvard study all patients included in the study were hospitalized for at least three days, and none were in intensive care units." Slightly "over half -- 52 percent -- received some sort of acid-suppressing medication to help prevent stress ulcers."
Another large retrospective study reported on 6/4/09 has found a strong link between use of proton pump inhibitors (PPIs) and hip fracture risk Those at highest risk were those patients who had at least one other standard risk factor for hip fracture, such as renal impairment, diabetes, or glucocorticoid, estrogen, and bisphosphonates use An analysis of a healthcare company's massive database found that the rate of hip fractures was increased by about 30% in patients using PPIs for two years or more prior to fracture.
The study focused on 33,752 Kaiser members who had suffered a hip or femur fracture along with more than 130,000 controls matched for age, sex, race, and length of Kaiser membership.
In men, the odds ratio for hip fracture with at least two years' PPI use was 1.34 (95% CI 1.18 to 1.51). The odds ratio for women was 1.28 (95% CI 1.17 to 1.39).
The analysis showed no associations with drugs such as ACE inhibitors, calcium channel blockers, or non-narcotic painkillers.
When the researchers looked at the effects of age, they found the greatest increase in risk among those 50 to 59 years old (OR 2.31, 95% CI 1.67 to 3.18).
Another database study published last year indicated that PPI use for at least seven years led to a nearly doubled risk of osteoporotic fracture
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 THE PROBLEM OF ABUSIVE HEAD TRAUMA.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Saturday, September 5, 2009
LONGER-TERM HORMONE THERAPY APPEARS TO BE THE STANDARD OF CARE IN ADVANCED PROSTATE CANCER
Research suggests prolonged chemical castration may be needed to suppress prostate tumor-fueling hormones.
There is, however, much debate regarding the appropriate treatment for tumors that have metastasized to both prostate lobes. While androgen-deprivation therapy has increased patients' survival odds, those subjected to the treatment for extended periods of time often experienced hot flashes, a sluggish libido, and other unwanted side effects. But this much appears certain at this time.
Prostate cancer patients need three years of treatment known as chemical castration to suppress the production of tumor-fueling hormones and improve their chance of survival," according to researchers in France who had hoped that "cutting back on the drugs would provide the same benefit as longer-term treatment." What they found instead was that "patients treated for six months were more likely to die than those on the drugs for several years."
So, the French team decided to see "if six months of androgen suppression could provide the same benefit as three years of treatment, but with fewer adverse effects. Study participants "had confirmed but nonmetastatic prostate cancer in either T1c to T2a-b clinical stage with pathological nodal stage N1 or N2 or stages T2c to T4 with clinical nodal stages N0 to N2." Following "external beam radiation, all of the men received six months of androgen blockade with a luteinizing hormone-releasing hormone analogue -- started on the first day of radiation -- and a daily antiandrogen agent started a week earlier." Six months later, "patients whose disease had not progressed were randomly assigned to no further treatment (and formed the short-term therapy group) or to another 2.5 years of androgen blockade with the luteinizing hormone-releasing hormone analogue but without the antiandrogen agent." Altogether, "970 men were randomized -- 483 to short-term suppression and 487 to long-term suppression."
By study end, investigators noted that "the five-year death rate of men in the longer-treatment group was 15.2 percent, compared with 19 percent for those in the shorter-term treatment group,"
COMMENT:
These results pretty much mirror those of a similar American trial according to Dr. Eric M. Horwitz, of the Fox Chase Cancer Center in Philadelphia, who led the group that did the US study of 1,554 men who were followed for 10 years. That work revealed that the disease-free survival rate for the short-term group was 13.2 percent, compared with 22.5 percent for those treated longer." "We have long believed that longer-term hormone therapy is the standard of care, and "these studies support that belief.
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 THE DANGERS OF ACID REDUCING MEDICATIONS LIKE NEXIUM AND OTHER PPIs-.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
There is, however, much debate regarding the appropriate treatment for tumors that have metastasized to both prostate lobes. While androgen-deprivation therapy has increased patients' survival odds, those subjected to the treatment for extended periods of time often experienced hot flashes, a sluggish libido, and other unwanted side effects. But this much appears certain at this time.
Prostate cancer patients need three years of treatment known as chemical castration to suppress the production of tumor-fueling hormones and improve their chance of survival," according to researchers in France who had hoped that "cutting back on the drugs would provide the same benefit as longer-term treatment." What they found instead was that "patients treated for six months were more likely to die than those on the drugs for several years."
So, the French team decided to see "if six months of androgen suppression could provide the same benefit as three years of treatment, but with fewer adverse effects. Study participants "had confirmed but nonmetastatic prostate cancer in either T1c to T2a-b clinical stage with pathological nodal stage N1 or N2 or stages T2c to T4 with clinical nodal stages N0 to N2." Following "external beam radiation, all of the men received six months of androgen blockade with a luteinizing hormone-releasing hormone analogue -- started on the first day of radiation -- and a daily antiandrogen agent started a week earlier." Six months later, "patients whose disease had not progressed were randomly assigned to no further treatment (and formed the short-term therapy group) or to another 2.5 years of androgen blockade with the luteinizing hormone-releasing hormone analogue but without the antiandrogen agent." Altogether, "970 men were randomized -- 483 to short-term suppression and 487 to long-term suppression."
By study end, investigators noted that "the five-year death rate of men in the longer-treatment group was 15.2 percent, compared with 19 percent for those in the shorter-term treatment group,"
COMMENT:
These results pretty much mirror those of a similar American trial according to Dr. Eric M. Horwitz, of the Fox Chase Cancer Center in Philadelphia, who led the group that did the US study of 1,554 men who were followed for 10 years. That work revealed that the disease-free survival rate for the short-term group was 13.2 percent, compared with 22.5 percent for those treated longer." "We have long believed that longer-term hormone therapy is the standard of care, and "these studies support that belief.
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 THE DANGERS OF ACID REDUCING MEDICATIONS LIKE NEXIUM AND OTHER PPIs-.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Thursday, September 3, 2009
MORE MEDICAL SCHOOLS BEEF UP CONFLICTS POLICIES
But report says many medical schools have inadequate conflict-of-interest, medical-device policies.
Wall Street Journal Health Blogger, Shirley S. Wang points out that although "more medical schools are improving their conflict-of-interest policies to police their ties with drug and medical-device makers," more than half of the schools "still have inadequate policies or no policies at all," according to data from the American Medical Student Association and the Pew Prescription Project. In the report, "45, or a third, of medical schools rated earned a 'A' or 'B' grade on the latest AMSA PharmFree Scorecard, which means the school made 'a serious attempt to think and address the appropriate relationship of medical faculty to the pharmaceutical and medical-device industry.'" Last year, "just 21 schools were awarded one of these top grades.
More medical schools are improving their conflict-of-interest policies to police their ties with drug and medical-device makers.
But more than half the schools still have inadequate policies or no policies at all.
Forty-five, or a third, of medical schools rated earned a “A” or “B” grade on the latest AMSA PharmFree Scorecard, which means the school made “a serious attempt to think and address the appropriate relationship of medical faculty to the pharmaceutical and medical-device industry,” Last year, just 21 schools were awarded one of these top grades.
The groups’ goal isn’t to sever relationships between the academic medical community and the private sector, which are needed to advance new technology.Rather, “company marketing should become less of a driver of prescribing. Gifts, free meals and paying doctors to be on speaker’s bureaus are undesirable in the groups’ eyes.
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 LONGER-TERM HORMONE THERAPY APPEARS TO BE THE STANDARD OF CARE IN ADVANCED PROSTATE CANCER.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Wall Street Journal Health Blogger, Shirley S. Wang points out that although "more medical schools are improving their conflict-of-interest policies to police their ties with drug and medical-device makers," more than half of the schools "still have inadequate policies or no policies at all," according to data from the American Medical Student Association and the Pew Prescription Project. In the report, "45, or a third, of medical schools rated earned a 'A' or 'B' grade on the latest AMSA PharmFree Scorecard, which means the school made 'a serious attempt to think and address the appropriate relationship of medical faculty to the pharmaceutical and medical-device industry.'" Last year, "just 21 schools were awarded one of these top grades.
More medical schools are improving their conflict-of-interest policies to police their ties with drug and medical-device makers.
But more than half the schools still have inadequate policies or no policies at all.
Forty-five, or a third, of medical schools rated earned a “A” or “B” grade on the latest AMSA PharmFree Scorecard, which means the school made “a serious attempt to think and address the appropriate relationship of medical faculty to the pharmaceutical and medical-device industry,” Last year, just 21 schools were awarded one of these top grades.
The groups’ goal isn’t to sever relationships between the academic medical community and the private sector, which are needed to advance new technology.Rather, “company marketing should become less of a driver of prescribing. Gifts, free meals and paying doctors to be on speaker’s bureaus are undesirable in the groups’ eyes.
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 LONGER-TERM HORMONE THERAPY APPEARS TO BE THE STANDARD OF CARE IN ADVANCED PROSTATE CANCER.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Tuesday, September 1, 2009
INVESTING HEAVILY IN PREVENTION MEASURES MAY NOT REDUCE HEALTHCARE COSTS, RESEARCH SUGGESTS.
Even though past efforts have yielded "little success," lawmakers on both sides of the aisle are fixated on "one idea" when it comes to reigning in the healthcare system's spiraling costs: "A bigger government role in disease prevention." This is the conventional Washington wisdom. “The health-care system is tilted toward a disease system rather than a wellness system," said Health and Human Services Secretary Kathleen Sebelius in an interview.
But what if they built this big edifice of preventive care and no one came?
Many previous government prevention efforts aimed at costly chronic diseases have had little success in reducing illness or costs. Medicare has conducted seven pilot programs in the past decade testing the theory on some of the most costly chronic diseases. Each showed little if any cost savings or measurable improvement in patients' health.
The largest experiment, the Medicare Health Support program, started in 2005 and eventually included about 200,000 patients. Groups were assigned to companies that specialize in helping people with chronic health conditions lower their medical costs and keep from getting sicker. Most of the patients had diabetes or congestive heart failure.
Nurses contacted the patients to make sure they were following doctors' instructions to take medication and reduce sodium intake. They also mailed patients packets about their diseases and directed them toward community health classes.
Overall, the program didn't reduce the group's rate of acute-care hospitalizations, hospital readmissions, emergency-room visits or death. It also didn't meet its goal of lowering patients' Medicare payments in an amount equal to the cost of the prevention services. The company that achieved the highest cost savings recouped only 26% of the fees spent on the program through lower Medicare spending.
There are studies which corroborate the "benefits of a healthy lifestyle." But the "problem is that when testing becomes too widespread, or heavy investments are made in monitoring people with chronic diseases, the rewards often fail to match the costs." This was exemplified in a 2008 NEJM report "which examined 279 spending ratios in published studies of health-oriented prevention measures, and another 1,221 on treatments for people who were already sick and "concluded that most preventive measures reviewed didn't save money. For instance, screening all 65-year-olds for diabetes would cost an extra $590,000 for every healthy year of life it adds over just screening people that age with high blood pressure."
To cap it all off the Congressional Budget Office, in its report, concluded that greater use of preventive care would at best generate modest reductions in costs over 10 years, and might even result in increases.
One reason cost savings are hard to achieve, is that much of the money spent on disease prevention goes for people who aren't going to get sick anyway. Also, people have trouble making difficult lifestyle changes, such as taking up regular exercise or eating healthier food.
CQ Today reports that preventive care's financial benefits is a "myth.” Although such initiatives would, in many cases, result in better health, it is less clear that they would reduce total spending for healthcare. ... Many other studies that have examined the impact of such initiatives do not indicate net savings."
So much for the conventional wisdom and saving money for Health care reform by increasing preventive care.
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 MORE MEDICAL SCHOOLS BEEF UP CONFLICTS POLICIES.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
But what if they built this big edifice of preventive care and no one came?
Many previous government prevention efforts aimed at costly chronic diseases have had little success in reducing illness or costs. Medicare has conducted seven pilot programs in the past decade testing the theory on some of the most costly chronic diseases. Each showed little if any cost savings or measurable improvement in patients' health.
The largest experiment, the Medicare Health Support program, started in 2005 and eventually included about 200,000 patients. Groups were assigned to companies that specialize in helping people with chronic health conditions lower their medical costs and keep from getting sicker. Most of the patients had diabetes or congestive heart failure.
Nurses contacted the patients to make sure they were following doctors' instructions to take medication and reduce sodium intake. They also mailed patients packets about their diseases and directed them toward community health classes.
Overall, the program didn't reduce the group's rate of acute-care hospitalizations, hospital readmissions, emergency-room visits or death. It also didn't meet its goal of lowering patients' Medicare payments in an amount equal to the cost of the prevention services. The company that achieved the highest cost savings recouped only 26% of the fees spent on the program through lower Medicare spending.
There are studies which corroborate the "benefits of a healthy lifestyle." But the "problem is that when testing becomes too widespread, or heavy investments are made in monitoring people with chronic diseases, the rewards often fail to match the costs." This was exemplified in a 2008 NEJM report "which examined 279 spending ratios in published studies of health-oriented prevention measures, and another 1,221 on treatments for people who were already sick and "concluded that most preventive measures reviewed didn't save money. For instance, screening all 65-year-olds for diabetes would cost an extra $590,000 for every healthy year of life it adds over just screening people that age with high blood pressure."
To cap it all off the Congressional Budget Office, in its report, concluded that greater use of preventive care would at best generate modest reductions in costs over 10 years, and might even result in increases.
One reason cost savings are hard to achieve, is that much of the money spent on disease prevention goes for people who aren't going to get sick anyway. Also, people have trouble making difficult lifestyle changes, such as taking up regular exercise or eating healthier food.
CQ Today reports that preventive care's financial benefits is a "myth.” Although such initiatives would, in many cases, result in better health, it is less clear that they would reduce total spending for healthcare. ... Many other studies that have examined the impact of such initiatives do not indicate net savings."
So much for the conventional wisdom and saving money for Health care reform by increasing preventive care.
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 MORE MEDICAL SCHOOLS BEEF UP CONFLICTS POLICIES.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Sunday, August 30, 2009
GETTING YOUR MEDICAL TEST RESULTS IS ALWAYS YOUR RESPONSIBILITY
DON’T ASSUME THAT ‘NO NEWS IS GOOD NEWS’ WHEN YOU HAVE TESTS DONE.
Bottom line:
“Don’t assume that ‘no news is good news’ when you have tests done. That’s a very dangerous assumption. If you’ve had a test done and you don’t hear about it after a week or two goes by, call the doctor’s office.”
Dr. Lawrence P. Casalino, an associate professor at Weill Cornell Medical College, and his colleagues reviewed the records of 5,434 patients at 19 independent primary care practices and four based in academic medical centers in a study , published in The Archives of Internal Medicine.
After extracting the records that contained abnormal results for blood tests or X-rays and other imaging studies, they then searched for documentation that the patient had been properly informed of the problem in a timely way.
After accounting for these and other ambiguous cases, the researchers found that of 1,889 abnormal results, there were 135 failures to inform.
In two of the largest academic medical centers, with a combined 80 primary care specialists, 23 percent of abnormal results were never mentioned to the patients.
The truth of the matter is that a lot of things can fall through the cracks. Information is handed down from one person to another to another before the doctor actually sees it.
Using information from a study of the literature and an earlier pilot study, the authors concluded that following 5 relatively simple procedures could eliminate most errors:
• results are routed to the responsible doctor,
• the doctor signs off on them,
• the office informs patients of all results,
• the practice documents that patients have been informed,
• and finally patients are told to call after a certain time interval if they have not learned the results of their tests.
COMMENT
The only thing for sure is #5. Every patient should be responsible to call the doctor’s office after 2 weeks of a test to find out the results. And call back over and over again till you learn the results.
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 INVESTING HEAVILY IN PREVENTION MEASURES MAY NOT REDUCE HEALTHCARE COSTS, RESEARCH SUGGESTS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Bottom line:
“Don’t assume that ‘no news is good news’ when you have tests done. That’s a very dangerous assumption. If you’ve had a test done and you don’t hear about it after a week or two goes by, call the doctor’s office.”
Dr. Lawrence P. Casalino, an associate professor at Weill Cornell Medical College, and his colleagues reviewed the records of 5,434 patients at 19 independent primary care practices and four based in academic medical centers in a study , published in The Archives of Internal Medicine.
After extracting the records that contained abnormal results for blood tests or X-rays and other imaging studies, they then searched for documentation that the patient had been properly informed of the problem in a timely way.
After accounting for these and other ambiguous cases, the researchers found that of 1,889 abnormal results, there were 135 failures to inform.
In two of the largest academic medical centers, with a combined 80 primary care specialists, 23 percent of abnormal results were never mentioned to the patients.
The truth of the matter is that a lot of things can fall through the cracks. Information is handed down from one person to another to another before the doctor actually sees it.
Using information from a study of the literature and an earlier pilot study, the authors concluded that following 5 relatively simple procedures could eliminate most errors:
• results are routed to the responsible doctor,
• the doctor signs off on them,
• the office informs patients of all results,
• the practice documents that patients have been informed,
• and finally patients are told to call after a certain time interval if they have not learned the results of their tests.
COMMENT
The only thing for sure is #5. Every patient should be responsible to call the doctor’s office after 2 weeks of a test to find out the results. And call back over and over again till you learn the results.
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 INVESTING HEAVILY IN PREVENTION MEASURES MAY NOT REDUCE HEALTHCARE COSTS, RESEARCH SUGGESTS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
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