Family Practice News articles from March 2008

Family Practice News archives from March 2008

'Help me die' calls for swift response.(Clinical Rounds)
March 1, 2008... [ILLUSTRATION OMITTED] TAMPA -- A patient's request for a hastened death--either an explicit request or a hint--should be considered a clinical emergency that offers an important therapeutic opportunity. "When you're in the office and...

Financial rewards proposed for FPs in medical homes: bonuses of up to $100,000 to be awarded.(Practice Trends)
March 1, 2008... One of the nation's largest health care quality coalitions is launching a program that would provide bonuses of up to $100,000 annually to physicians who meet criteria showing that they are offering coordinated care by providing a medical home...

Asthma guidelines spell out treatment in pregnancy.(Women's Health)
March 1, 2008... The ultimate goal of asthma therapy in pregnancy is to maintain adequate oxygenation of the fetus by preventing hypoxia in the mother, and that requires step therapy medical management with the lowest possible doses of medication, according to...

Vital signs.(Table)(Brief article)
March 1, 2008... VITAL SIGNS Top Five Most Expensive Therapeutic Classes Of Prescribed Drugs (in billions of dollars) Metabolic $35.6 Cardiovascular $32.7 Central nervous system $26.1 Psychotherapeutic $17.4...

HIV infected face new challenges.(News)
March 1, 2008... BOSTON -- The increased survival among HIV-infected children seen with effective prevention of perinatal transmission and the widespread adoption of highly-active antiretroviral therapy has been accompanied by the emergence of a new generation...

Congress scrutinizes uses for growth hormone.(News)
March 1, 2008... WASHINGTON -- Congress is taking a tough look at the use of human growth hormone for a wide variety of conditions, which is prompting some concern that payers may react by limiting reimbursement for legitimate purposes. Insurers are...

Concerns about off-label use may derail approval of IV iron.(NEWS FROM THE FDA)
March 1, 2008... SILVER SPRING, MD. -- Concerns about off-label use and a mortality safety signal associated with treatment in clinical trials swayed a federal advisory panel against supporting the approval of ferric carboxymaltose injection (Injectafer), a new...

Antiepileptics' labels likely to include suicidality risks.(NEWS FROM THE FDA)
March 1, 2008... WASHINGTON -- Food and Drug Administration findings of an increased risk of suicidality in patients given antiepileptic drugs likely will lead to broad class labeling changes, according to an FDA alert issued to health care professionals. ...

Asmanex Twisthaler, Moxatag.(New & Approved)
March 1, 2008... Asmanex Twisthaler (mometasone furoate inhalation powder, Schering-Plough Corp.) The Food and Drug Administration approved Asmanex Twisthaler for once-daily maintenance treatment of asthma in children aged 4-11 years. The agency initially...

Dietary guidelines implicated in obesity epidemic.(News)
March 1, 2008... By stressing the importance of a carbohydrate-based, low-fat diet, current U.S. dietary guidelines may have unexpectedly contributed to the current obesity epidemic, according to researchers. In accordance with national recommendations,...

Vaccine refusers pose liability issues.(Letters)(Letter to the editor)
March 1, 2008... Regarding the standardized patients who graded pediatricians on their care, I applaud the physicians who didn't dismiss them because they declined the required/ recommended immunizations, but that wouldn't have been me ("Communication With...

Don't suggest cough drops for kids.(Letters)(Letter to the editor)
March 1, 2008... Regarding the use of honey as a cough suppressant, Dr. James Taylor, described as having "'an interest in complementary medicines," stated that "any soothing cough drop might work equally well" ("Providers Skeptical About Honey for Cough Study...

Heed the call: take On CPT tyrants.(LETTERS)(Letter to the editor)
March 1, 2008... Like Dr. Robert W. Harrington, I have been complaining about coding since it started ("CPT: Current Procedural Tyranny," Letters, Jan. 1, 2008, p. 9). I have two issues with it: 1. It is very time consuming clerical work. I finished my last...

Should primary care physicians provide dementia screening? Too many patients go undiagnosed.(Point/Counterpoint)
March 1, 2008... Alzheimer's disease affects more than 5 million Americans and is the fourth-leading cause of death in the United States. Yet by many accounts, only 50% of the cases are diagnosed, and only 25% of patients receive the medication they need. In 40...

Should primary care physicians provide dementia screening? The evidence for screening is weak.(Point/Counterpoint)
March 1, 2008... At first glance, dementia screening appears likely to be beneficial. But advocates of population-based dementia screening fail to take into account medicine's prime directive: First, do no harm. Screening would indeed identify more...

Vitamin D, heart dysfunction tied in thalassemia.(Cardiovascular Medicine)(Clinical report)
March 1, 2008... ATLANTA -- Vitamin D deficiency was strongly associated with high cardiac iron and increased ventricular dysfunction in a retrospective review of 24 young thalassemia major patients. A review of their medical records showed levels of...

Steps taken to avert pending shortage of cardiac surgeons.(Cardiovascular Medicine)
March 1, 2008... SNOWMASS, COLO. -- The pipeline of future cardiac surgeons is "essentially nonexistent," which will have serious consequences not only for the surgical specialty but for cardiologists and all others who provide care for patients with heart...

Heart failure deemed driving force in excess mortality in RA.(Cardiovascular Medicine)
March 1, 2008... SNOWMASS, COLO. -- Heart failure is a major contributor to the excess mortality in patients with rheumatoid arthritis, Dr. Sherine E. Gabriel said at a symposium sponsored by the American College of Rheumatology. Rheumatoid arthritis (RA)...

Aspirin resistance attributed to noncompliance.(Cardiovascular Medicine)
March 1, 2008... ATLANTA -- Noncompliance is the main cause of aspirin resistance, according to investigators who studied aspirin response in 230 people, most of whom had a history of myocardial infarction. The study initially classified up to 30% of the...

Rebound effect evident after halting clopidogrel.(Cardiovascular Medicine)
March 1, 2008... The risk of myocardial infarction or death spikes during the 90 days after clopidogrel therapy is discontinued among patients treated for acute coronary syndromes, especially those treated medically. Clustering of adverse coronary events...

Idraparinux causes more bleeding than vitamin K antagonists.(Cardiovascular Medicine)
March 1, 2008... Long-term treatment with idraparinux is as effective as vitamin K antagonists for preventing thromboembolism in patients with atrial fibrillation, but it causes significantly more bleeding. Those results, from the Sanofi Aventis--funded...

Warfarin may do harm unless target is met and maintained.(Cardiovascular Medicine)
March 1, 2008... ORLANDO -- Patients with atrial fibrillation who are treated with warfarin must be in their target anticoagulation range at least 50% of the time to get a net benefit from treatment. The longer a patient stays in the target anticoagulation...

High OGTT in pregnancy ups later diabetes risk.(Metabolic Disorders)
March 1, 2008... Women who have an abormal glucose tolerance test result during pregnancy but do not develop gestational diabetes still face an increased risk of developing type 2 diabetes later on. The retrospective study showed that even modestly elevated...

Adjustable gastric banding beats conventional diabetes treatment.(Metabolic Disorders)
March 1, 2008... Laparoscopic adjustable gastric banding produced a 76% remission rate in the first randomized trial to compare the surgery against conventional treatment in obese patients with recent-onset type 2 diabetes. "After 2 years, the surgical...

Diet soda strongly associated, with the metabolic syndrome.(Metabolic Disorders)
March 1, 2008... Diet soda, meat, and fried foods are associated with the development of metabolic syndrome, researchers from the Atherosclerosis Risk in Communities Study reported. The study, which gathered dietary information on 9,514 individuals, then...

Ideal add-on to metformin therapy is still unclear.(Metabolic Disorders)
March 1, 2008... A meta-analysis has failed to clarify whether one drug is better than another when added to metformin in patients with type 2 diabetes. Sulfonylureas and ct-glucosidase inhibitors, and possibly glinides, seem to have about equal efficacy...

Bone fracture, metformin use not associated.(Metabolic Disorders)(Brief article)
March 1, 2008... Use of metformin to treat patients with type 2 diabetes shows no association with bone fractures. Long-term insulin use also showed no association with fractures, whereas current treatment with insulin was associated with an increase in...

Diabetic teens often underestimate their weight: adolescents who did not recognize they had a weight problem were less likely to eat well and exercise.(Metabolic Disorders)
March 1, 2008... More than half of adolescents with type 2 diabetes underestimate their weight, and so do their parents, according to results from interviews with 104 child-parent pairs. "Clinicians should recognize that even extremely overweight children...

Intensive therapy is found to lower mortality by 20% in type 2 patients.(Metabolic Disorders)
March 1, 2008... Intensive intervention for type 2 diabetes, which addressed microalbuminuria, cholesterol, triglycerides, and blood pressure in addition to glucose control, reduced the risk of death by 20% over the course of 13 years in a Danish study. ...

Hyperuricemia named a risk factor for type 2 diabetes.(Metabolic Disorders)(Brief article)
March 1, 2008... High serum uric acid level is an independent risk factor for the development of type 2 diabetes, according to data from a large population-based study. In a study of 4,536 people who were free of diabetes at baseline, those who had serum...

Postprandial glucose rise linked to cardiac risk.(Metabolic Disorders)
March 1, 2008... The blood glucose excursion that patients with type 2 diabetes experience after a meal correlates strongly with their carotid intima-media thickness, a marker for cardiovascular disease, reported Italian researchers in a large, ongoing study....

Acute sore throat? Think retropharyngeal abscess.(Infectous Diseases)
March 1, 2008... Consider a retropharyngeal abscess when faced with a drooling child who has a severe sore throat, according to Dr. Marisol Figueira of Boston University. Retropharyngeal abscess is a common pathology secondary to acute throat infection,...

Risk behaviors drive up HIV in adolescents.(Infectous Diseases)
March 1, 2008... BOSTON -- The adolescent HIV-1 epidemic as reflected in a multisite cohort of U.S. youth is changing from one of vertically transmitted infection to one where infection is acquired through risk behaviors, posing new challenges for providers and...

Vaccine mercury rapidly exits infants' systems.(Infectous Diseases)
March 1, 2008... Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, according to study results. The findings may help to quell chronic concerns that thimerosal-containing vaccines...

MMR shot not linked to autism, large study shows.(Infectous Diseases)
March 1, 2008... Children with autism spectrum disorder had no greater immune response to the measles virus or the measles component of the measles, mumps, and rubella vaccine than did children without the disorder in a large case-control study. British...

Production delays tie up Vaqta vaccine.(Infectous Diseases)
March 1, 2008... A Production delay has caused Merck & Co. to temporarily stop accepting orders for the pediatric and adult vial formulations of Vaqta, the hepatitis A vaccine. It is estimated that the pediatric formulation of Vaqta will be available in...

Melanoma incidence in children is on the rise.(Skin Disorders)(Clinical report)
March 1, 2008... ORLANDO -- Cancer already kills more children aged 1-14 years than does any other disease, and the incidence of childhood melanoma in the United States is on the rise, Dr. Jane M. Grant-Kels said at the annual meeting of the Florida Society of...

Ustekinumab aids long-term control of psoriasis.(Skin Disorders)
March 1, 2008... SAN ANTONIO -- Long-term, continuous use of ustekinumab for maintenance therapy in patients with moderate to severe plaque psoriasis is efficacious and generally well tolerated, according to phase III study findings reported at the annual...

History, physical are cornerstones of melanoma follow-up.(Skin Disorders)
March 1, 2008... SAN DIEGO -- When it comes to follow-up surveillance of melanoma patients, history and physical examination remain the cornerstone of good care, with little solid evidence to support anything else. "The literature on this aspect of melanoma...

Evidence mounts on pediatric anxiety disorders.(Mental Health)(Disease/Disorder overview)
March 1, 2008... NEW YORK -- When treating first-time, uncomplicated cases of anxiety in children and adolescents, it's usually best to start with a 6- to 12-week trial of psychosocial treatment, Dr. Moira Rynn said at a psychopharmacology update sponsored by...

Track lipids, glucose with atypical antipsychotic use.(Mental Health)
March 1, 2008... NEW YORK -- Taking baseline measurements of fasting blood glucose, lipids, weight, and waist circumference and monitoring those measures are essential to the early identification of metabolic complications in patients taking atypical...

Peer support cuts risk of postpartum depression: mothers who received a telephone-based intervention were two times less likely to become depressed.(Mental Health)
March 1, 2008... MONTREAL -- Mother-to-mother support can significantly reduce the development of postpartum depression in women who are at high risk for the condition, Cindy-Lee Dennis, Ph.D., said at the annual conference of the Canadian Psychiatric...

Older women's depression burden heavier than men's.(Mental Health)
March 1, 2008... The burden of depression is disproportionately higher among older women than older men because of their greater susceptibility to depression and--once depressed--their greater tendency to have persistent depression and their lower probability...

Prozac no better than placebo in teens with substance abuse issues.(Mental Health)
March 1, 2008... BOSTON -- Fluoxetine is not an effective treatment for depression in adolescents with comorbid substance-related disorders, suggest results of a placebo-controlled trial presented at the annual meeting of the American Academy of Child and...

Comprehensive treatment essential for vulvodynia.(Women's Health)
March 1, 2008... SAN FRANCISCO -- Vulvodynia so profoundly affects quality of life that management needs to address the physical, psychological, sexual, and relationship problems caused by the pain. "Support, support, support" patients with vulvodynia by...

Coagulation factors may predict the risk of thrombosis from HT.(Women's Health)
March 1, 2008... ATLANTA -- Women who opt for hormone therapy to ease their discomfort from hot flashes and other menopausal symptoms often do so without knowing their risk of developing adverse effects. Now, data from the Women's Health Initiative trials...

Nonhormonal therapy eases postmenopausal hot flashes.(Women's Health)
March 1, 2008... Treatment with desvenlafaxine succinate, an experimental nonhormonal therapy, continues to reduce the frequency and severity of moderate to severe hot flashes out to 26 weeks. The drug, a selective serotonin norepinephrine reuptake...

Exposure to monoclonal antibodies.(Drugs, Pregnancy, And Lactation)
March 1, 2008... Excluding those classified as orphan drugs, there are 10 monoclonal antibodies currently used to treat cancer, asthma, or rheumatoid arthritis. Five are composed of various types of humanized immunoglobulin G (IgG) and two of murine IgG. The...

Obesity-related biomarkers obscure PSA findings.(Men's Health)
March 1, 2008... ATLANTA -- Elevated C-peptide and hemoglobin [A.sub.1c] levels were associated with low levels of prostate-specific antigen in obese, nondiabetic black and white men in a cross-sectional study. PSA levels were approximately 50% lower among...

Brachytherapy is of benefit in young prostate cancer patients.(Men's Health)
March 1, 2008... LOS ANGELES -- Contrary to conventional wisdom among many urologists, brachytherapy is a good option for younger prostate cancer patients, according to investigators who reviewed outcomes for 1,763 men treated with radiation seed implants. ...

Direct talk, practical advice help put prostate cancer in perspective.(Men's Health)
March 1, 2008... WASHINGTON -- "You're not going to die of prostate cancer." That's the first thing Dr. Tanya B. Dorff, a specialist in genitourinary oncology, tells most of the patients with localized prostate cancer who are referred to her. That simple...

Obesity derails RA remission; infliximab helps.(Musculoskeletal Disorders)
March 1, 2008... BOSTON -- Overweight patients with early rheumatoid arthritis were less likely to achieve remission during treatment with conventional disease-modifying drugs than were those with a normal body mass index. Overweight and obese patients...

Variability key to lumbar diagnosis.(Musculoskeletal Disorders)
March 1, 2008... SNOWMASS, COLO. -- The neurogenic or pseudoclaudication symptoms characteristic of lumbar spinal stenosis can be distinguished from peripheral vascular disease by their day-to-day variability, Dr. Zacharia Isaac said at a symposium sponsored by...

Follow-up after colon cancer surgery falls short.(Digestive Disorders)(Brief article)(Clinical report)
March 1, 2008... ORLANDO -- Most colorectal cancer patients who undergo potentially curative resection of their tumors after age 65 do not receive the follow-up care recommended by clinical practice guidelines, the results of a large population-based study...

Hepatectomy of benefit in elderly cancer patients.(Digestive Disorders)
March 1, 2008... ORLANDO -- Liver resection of colorectal metastases was associated with good long-term survival among patients over age 70 years in an analysis based on 20 years of data from an international registry Five-year survival after surgery was...

Colon cancer screening helps patients over 80.(Digestive Disorders)
March 1, 2008... ORLANDO -- Colorectal cancer screenhag plays an important role in cancer prevention and detection, not just in the "young-old," but also in the "old-old"--people in their eighties and beyond. And if a cancer is found, the elderly can also...

Drug combo yields better weight loss.(Obesity)
March 1, 2008... NEW ORLEANS -- Combination-therapy with bupropion and naltrexone resulted in superior weight loss, compared with placebo or either drug alone, Dr. Frank L. Greenway said at the annual meeting of NAASO, the Obesity Society. Patients...

Pediatric programs emphasize lifestyle changes.(Obesity)
March 1, 2008... Two programs developed by Children's Healthcare of Atlanta successfiflly promote healthier lifestyles in children, and one of the programs specifically targets prevention of type 2 diabetes. Fit Kids is a program for overweight children...

Alcohol abuse treatment depends on age at onset.(Geriatric Medicine)
March 1, 2008... CORONADO, CALIF. -- One decisive factor that sets older adults who abuse alcohol apart from their younger counterparts is a generally lower level of tolerance for the substance. "'They may have problems with lower intake due to the...

Auditory exercises improved memory in seniors.(Geriatric Medicine)
March 1, 2008... SAN FRANCISCO -- An auditory training program designed to improve brain plasticity bestowed the side benefit of improved memory in a randomized, controlled, double-blind trial in 468 adults older than 65 years with normal cognition. The...

Index guides discharge after pulmonary embolism.(Pulmonary Medicine)
March 1, 2008... CHICAGO -- The Pulmonary Embolism Severity Index provides clinicians with a useful tool for selecting patients with acute pulmonary embolism for outpatient therapy, Col. Lisa K. Moores, MC USA, said. Recent evidence suggests that many...

MRI could rival chest x-ray in pediatric lung disease assessment.(Pulmonary Medicine)(magnetic resonance imaging)
March 1, 2008... CHICAGO -- Optimized low-field magnetic resonance imaging has the potential to replace plain chest radiographs in the assessment of lung disease in children, according to results of a poster study presented at the annual meeting of the...

Reasons for quitting smoking depend on the patient's age.(Pulmonary Medicine)(Report)
March 1, 2008... CHICAGO -- Older smokers are motivated to quit smoking by very different factors than are younger smokers, and tailoring cessation services to recognize these unique differences can improve quit rates, Virginia Reichert, N.R, said at the annual...

Printed forms ease primary care, oncology collaboration.(Clinical Rounds)
March 1, 2008... WASHINGTON -- Collaboration between primary care physicians and oncologists can ensure seamless care for cancer patients, according to a hematologist and a family practice physician who gave a joint presentation at the annual Community Oncology...

ESRD cases in U.S. to rise 60% during 2005-2020.(Clinical Rounds)(end-stage renal disease )(Brief article)
March 1, 2008... SAN FRANCISCO -- There will be an estimated 785,000 U.S. patients with end-stage renal disease by 2020, an increase of more than 60% from 2005 levels, according to a report presented at the annual meeting of the American Society of Nephrology....

Early referral to nephrologist cut ESRD mortality.(Clinical Rounds)(end-stage renal disease)
March 1, 2008... SAN FRANCISCO -- Patients who were treated by a nephrologist at least 12 months before their diagnosis of end-stage renal disease had 29% lower mortality during their first year after the diagnosis than did patients who had no nephrology care,...

Upward swing in CAD prevalence.(Clinical Capsules)(coronary artery disease)(Brief article)
March 1, 2008... The prevalence of coronary artery disease declined between 1981 and 2004, leveling off toward the end of that period, but it might be on the increase again. These findings suggest that the decrease previously noted in heart disease...

DASH diet ditched.(Clinical Capsules)
March 1, 2008... Few Americans with hypertension follow the DASH dietary pattern "even modestly." The DASH (Dietary Approaches to Stop Hypertension) trial results, published in 1997, suggested a dietary pattern rich in fruits, vegetables, low-fat dairy...

Macular degeneration and race.(Clinical Capsules)
March 1, 2008... White patients with age-related macular degeneration seem to be at greater risk of progressing to advanced, vision-disabling disease than do black patients. There is no difference between the two races in the prevalence of drusen, but...

'Mild to moderate' hearing loss underappreciated.(Clinical Rounds)
March 1, 2008... Many children and adolescents with "mild to moderate" hearing loss are not getting the help they need, either because their impairment is not recognized or because its consequences are not fully appreciated, according to several experts. ...

Intervention, surveillance emphasized for infant hearing loss.(Clinical Rounds)
March 1, 2008... Updated guidelines from the American Academy of Pediatrics call for prompt intervention when infants fail hearing tests and for ongoing surveillance of all infants--regardless of risk factors for hearing loss--during well baby exams and other...

What should we do with carrier screening?(Genomic Medicine)
March 1, 2008... Screening for preclinical disease is a core feature of primary care medicine. On a busy day, we usually do this without much conscious thought. For example, we take blood pressures and measure developmental milestones. Often, we are measuring a...

OncoVue shown to rival Gail model on cancer risk prediction.(Clinical Rounds)
March 1, 2008... SAN ANTONIO -- A novel test for prediction of an individual's breast cancer risk that incorporates gene-based information along with clinical and lifestyle data significantly outperformed the widely used Gail model in a validation study. ...

Group advises against using test to predict possible response to SSRIs.(Clinical Rounds)(Selective serotonin reuptake inhibitors)
March 1, 2008... A host of developments has made it increasingly possible to determine how patients will likely metabolize antidepressants, including selective serotonin reuptake inhibitors--and thus whether they are more or less likely to benefit from the...

Inpatient VTE prophylaxis subpar worldwide.(Clinical Rounds)(venous thromboembolism )(Report)
March 1, 2008... More than half of hospitalized patients worldwide are at risk for venous thromboembolism, and despite the availability of evidence-based guidelines, the rate of appropriate prophylaxis remains low. With pulmonary embolism accounting for...

Short-term anticoagulation prevents recurrence of DVT.(Clinical Rounds)
March 1, 2008... ATLANTA -- Patients who have had an episode of idiopathic deep vein thrombosis can be adequately protected against a recurrence with just 3 months of oral anticoagulation therapy, providing they do not have residual vein thrombosis. The...

Heart failure on sunitinib worse than thought: in a trial, 8% of treated patients experienced declines in heart function; the updated incidence was 21%.(Clinical Rounds)(Clinical report)
March 1, 2008... The incidence of heart failure during cancer treatment with sunitinib may be much higher in the general population than has been reported in randomized clinical trials. A small retrospective study found grade 3 or 4 heart failure occurred...

Psychosocial care set as new standard for all cancer patients.(Clinical Rounds)
March 1, 2008... WASHINGTON -- The Institute of Medicine's report "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs" has established routine provision of psychosocial services as a new standard in oncology, Dr. Jimmie C. Holland said at the...

Mental health screen part of Mass. well-child visits.(Practice Trends)
March 1, 2008... MassHealth, Massachusetts' Medicaid program, has begun requiring primary care doctors and nurses to use a standardized behavioral health screening tool at every well-child visit for children under the age of 21. The new requirement, which...

Programs cut smoking rates.(Policy & Practice)(Brief article)
March 1, 2008... State tobacco control programs are effective at cutting adult smoking rates, according to a study by researchers at the Centers for Disease Control and Prevention and RTI International. The researchers were able to quantify the link between...

Individual mandates necessary.(Policy & Practice)
March 1, 2008... Unless the United States adopts a single-payer health system, it Hill not be possible to achieve universal coverage without a mandate that requires individuals to purchase health insurance, a report from the Urban Institute concluded. A system...

Recertification could improve care.(Policy & Practice)
March 1, 2008... The quality of care provided to patients with hypertension seems to erode as the time since the physician's last board certification increases, a study published online in Circulation found. Researchers analyzed treatment of more than 8,000...

Part D costs drop.(Policy & Practice)
March 1, 2008... The projected cost of providing Medicare beneficiaries with a prescription drug benefit through private health plans has dropped again, according to the Centers for Medicare and Medicaid Services. CMS said in its fiscal year 2009 budget...

Patient safety goals updated.(Policy & Practice)(Brief article)
March 1, 2008... The Joint Commission has released a preliminary version of its 2009 National Patient Safety Goals for hospitals and critical care facilities, and is seeking to add several new requirements to its list of priorities. According to the draft, the...