Family Practice News articles from October 2008

Family Practice News archives from October 2008

AAFP: transform practice to survive.(News)(American Academy of Family Physicians)
October 1, 2008... [ILLUSTRATION OMITTED] SAN DIEGO -- Two themes dominated the annual Congress of Delegates of the American Academy of Family Physicians: the risk of the specialty sinking from financial burdens, and a potential lifeboat called the...

Antidepressants show promise for fibromyalgia: tolerability may limit usefulness for some.(News)
October 1, 2008... BARCELONA -- Milnacipran, an antidepressant that equally inhibits both norepinephrine and serotonin uptake, and trazodone, an antidepressant with sedative properties, both appear to relieve pain and improve sleep and overall quality of life for...

Experts continue debate on ezetimibe cancer concerns.(News)
October 1, 2008... MUNICH -- Many experts have been reassured that the signal of a cancer risk that was reported last July for treatment with the lipid-lowering drug ezetimibe was likely the result of chance and was not real, but other cardiologists cautioned...

A high ankle-brachial index also spells trouble.(News)
October 1, 2008... MUNICH -- Just when a low ankle-brachial index is gaining traction in clinical practice as a useful predictor of cardiovascular events, new evidence indicates a high ankle-brachial index also confers significant risk. Historically, high...

Medical home demo seeks coordinating centers.(News)(Brief article)
October 1, 2008... The Commonwealth Fund is gearing up to turn 50 safety net clinics into models of the patient-centered medical home. The demonstration project, called the Safety Net Medical Home Initiative, will run for 5 years with the goal of creating an...

Temptation of tobacco money for Tar Wars ignites debate.(News)
October 1, 2008... AAFP delegates debated long and hard about whether to make a onetime exception to academy policy and seek tobacco industry money to fund its antismoking Tar Wars program. In a year of belt-tightening, the academy decided it no longer could...

Data back benefits of early glucose control.(News)
October 1, 2008... ROME -- Sustained improvements in diabetes-related end points were achieved with early rather than delayed use of intensive glucose control in patients with newly diagnosed type 2 diabetes, according to results from a landmark diabetes study...

No free ride on health care.(Letter to the editor)
October 1, 2008... Miles J. Zaremski continues the misleading "for or against" discussion in his column, "'Has the Time Come for Universal Coverage?" (Law & Medicine, Aug. 1, 2008, p. 48). FAMILY PRACTICE NEWS, the AAFP, and similar organizations need to...

Obama: preserve what works; improve what doesn't.(Election 2008: Physicians' Perspectives)(Barack Obama)
October 1, 2008... As doctors, you know well what ails Our health care system. Are there any among us who have not cared for a patient without health insurance? Who hasn't noticed that the cost of care has risen so high that many can no longer afford the care we...

McCain: control costs; ensure access.(Election 2008: Physicians' Perspectives)
October 1, 2008... For the past several months I have closely followed the health care policies of Sen. John McCain (R-Ariz). I am impressed how the senator places the individual--patient and physician--at the center of this policy. The McCain plan is not simply...

Complex coronary disease poses trade-offs.(Cardiovascular Medicine)
October 1, 2008... MUNICH -- Will patients who need coronary revascularization rather face a small increased risk of a stroke or a larger risk for a repeat procedure within a few months? That is the decision facing patients with complex coronary disease,...

Diabetic patients may fare as well from stents as from CABG.(Cardiovascular Medicine)(Clinical report)
October 1, 2008... MUNICH -- Patients with diabetes who received coronary stents fared just as well as similar patients who underwent coronary bypass surgery in a randomized study. The results seemed to disprove the conventional wisdom that percutaneous...

Heart failure is no longer deadlier than most cancers.(Cardiovascular Medicine)
October 1, 2008... MUNICH -- Five-year survival of patients with heart failure has been dire, worse than for many cancers. But therapeutic advances in the last 2 decades mean that today, for the first time, that's no longer true, according to a large Swedish...

Metformin reduced heart failure morbidly, mortality.(Cardiovascular Medicine)
October 1, 2008... MUNICH -- Metformin-treated diabetic patients with heart failure had strikingly lower morbidity and mortality than did those on oral sulfonylureas, in a long-term observational study. "Our data suggest metformin is probably safe--and...

Inflammatory marker may flag higher cardiac mortality risk.(Cardiovascular Medicine)(Clinical report)
October 1, 2008... TORONTO -- An elevated serum level of a novel inflammatory marker, YKL-40, was linked with a significantly increased risk for all-cause death and cardiovascular death in a study of more than 4,000 patients with a history of myocardial...

A 1% rise in [HbA.sub.1c] bumps up cardio risk by 11%.(Metabolic Disorders)
October 1, 2008... ROME -- For every 1% rise in baseline hemoglobin [A.sub.1c] the risk that a patient with type 2 diabetes would later develop coronary heart disease increased by 11% in a large observational study. Furthermore, there was a 25% decreased risk...

Telmisartan failed to improve cardiac event rates.(Metabolic Disorders)(Brief article)
October 1, 2008... MUNICH -- The disappointing performance of the angiotensin receptor blocker telmisartan for prevention of cardiovascular events and new-onset diabetes in the nearly 6,000-patient TRANSCEND trial leaves the ACE inhihitors securely ensconced as...

Pioglitazone cut ischemic cardiac event rate by 17%.(Metabolic Disorders)
October 1, 2008... MUNICH -- Treating type 2 diabetic patients with the insulin-sensitizing drug pioglitazone conferred a highly significant 17% reduction in ischemic cardiovascular events, according to a large meta-analysis. The relative risk reduction was...

Fitness sharply cut death in high-BMI diabetics.(Metabolic Disorders)(body mass index)
October 1, 2008... MUNICH -- Middle-aged men with type 2 diabetes can reduce their long-term mortality risk by roughly 14% for each 1-MET increase they achieve in peak exercise capacity through improved physical fitness, according to a large epidemiologic study....

Online record access failed to impact outcomes.(Metabolic Disorders)
October 1, 2008... Primary care physicians are more likely to adjust medications for patients with diabetes who are given interactive, online access to their personal health records before an appointment, compared with a control group, according to a randomized...

Most cancer patients don't get flu shots.(Infectious Diseases)
October 1, 2008... STOCKHOLM -- Vaccination coverage for very severe manifestations of influenza remains low in patients with cancer, even though they are at high risk. Just 34% of 112 consecutive cancer patients receiving treatment at the Hopital Cochin,...

Immunization rates continue to increase.(Infectious Diseases)
October 1, 2008... More than three-quarters of the nation's young children have been immunized with the full series of childhood vaccines recommended by the Centers for Disease Control and Prevention. Data from the 2007 National Immunization Survey showed...

Lab tests catch infection risk in febrile infants.(Infectious Diseases)
October 1, 2008... HONOLULU -- A few simple, inexpensive laboratory tests conducted in the outpatient setting could have identified which febrile infants were likely to have serious bacterial infections and should have been considered for hospital admission,...

Infections in athletes demand close attention.(Skin Disorders)
October 1, 2008... VANCOUVER, B.C. -- Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks. ...

Triamcinolone 10 mg is best for psoriatic nails.(Skin Disorders)(Brief article)
October 1, 2008... CHICAGO -- Triamcinolone acetonide 10 mg/mL is the best dose for psoriatic fingernails dystrophy, according to a randomized, dose-comparison study. The 90 psoriatic fingernails included in the study were divided into three groups of 30 and...

Molecular imaging helps in detection of breast cancer.(Women's Health)
October 1, 2008... A novel imaging technique seems to e better than standard mammogaphy at detecting breast cancer in high-risk women with dense breast tissue, according to findings from a study involving 940 women. Molecular breast imaging detected three...

Antirejection drugs.(Drugs, Pregnancy And Lactation)
October 1, 2008... Stopping a medication during pregnancy because of potential risks to the fetus is not an option for women who have had an organ transplant, because they risk losing the transplanted organ. Despite considerable concerns about the reproductive...

Illicit drug use dips in youth, spikes in boomers.(Mental Health)
October 1, 2008... WASHINGTON -- The rate of illicit drug use in adolescents and young adults stayed relatively steady in 2007, showing mild decreases in use for many drugs. But drug use continues to be carried into older age by baby boomers, especially...

Cognitive-behavioral therapy backed for PTSD in children.(Mental Health)(posttraumatic stress disorder )
October 1, 2008... Only cognitive-behavioral therapy, of all the major interventions being used to reduce psychological harm in children and adolescents who have witnessed or been victims of trauma or violence, has strong evidence to show it is effective,...

Trends in teen sexual risk behavior veer from positive.(Mental Health)
October 1, 2008... MEXICO CITY -- Some of the favorable trends in sexual risk behaviors achieved among U.S. adolescents in recent decades appear to be stalling, particularly in certain subgroups, according to a study reported at the International AIDS Conference....

Hepatic encephalopathy can impair driving.(Digestive Disorders)
October 1, 2008... Patients with minimal hepatic encephalopathy typically rate themselves as good drivers, but they have significantly worse performance and more accidents on a driving simulator. The poor driving skills of these patients were corroborated by...

No difference in high-def endoscopy comparison.(Digestive Disorders)
October 1, 2008... A new high-definition, wide-angle videoendoscope did not detect significantly more colorectal adenomas or polyps, compared with a conventional colonoscope in a randomized study. The study's researchers noted that although it seemed logical...

Physical activity offset effect of "obesity genes".(Obesity)
October 1, 2008... Two gene variants were found to confer risk for obesity, but that risk was offset by an intensely physical lifestyle in a study of an Amish community. The findings suggest that in people genetically predisposed to obesity, high levels of...

Drug, lifestyle combo promotes weight loss.(Obesity)
October 1, 2008... Pramlintide treatment combined wwith lifestyle intervention resulted in sustained weight loss at 12 months in a single-blind, placebo-controlled extension study. Pramlintide (Symlin) is an injectable synthetic analogue of human amylin, a...

Apnea risk in bronchiolitis may be exaggerated.(Pulmonary Medicine)
October 1, 2008... DENVER -- Apnea risk may be lower than previously believed in otherwise normal infants with bronchiolitis. Early studies included many children with serious comorbid conditions that may have compounded their apnea risk, a systematic review of...

Steroids might stem resistance to [[beta].sub.2] agonists.(Pulmonary Medicine)(Brief article)
October 1, 2008... Steroids may prevent or reverse the desensitization occurring with prolonged exposure to short-acting [[beta].sub.2]-adrenergic receptor agonists in treating chronic obstructive pulmonary disease and asthma. Phillip R. Cooper, Ph.D., and...

Pediatric SLE's course varies by ethnicity, age.(Musculoskeletal Disorders)(systemic lupus erythematosus)
October 1, 2008... DESTIN, FLA. -- Ethnicity appears to play an important role in the incidence and clinical manifestations of pediatric systemic lupus erythematosus, data from a recent study suggest. Findings from the study of 87 white and 154 nonwhite...

Combo prevents progression of early rheumatoid arthritis.(Musculoskeletal Disorders)
October 1, 2008... PARIS -- The addition of infliximab to intensive combination disease-modifying therapy in early rheumatoid arthritis resulted in higher rates of remission and no radiographic progression at 2 years in a placebo-controlled trial of 100 patients....

Factors may predict response to less aggressive RA therapy.(Musculoskeletal Disorders)(rheumatoid arthritis )
October 1, 2008... PARIS -- Factors that predict which patients with rheumatoid arthritis will achieve and maintain stable remission following treatment with traditional disease-modifying drugs include low body mass index, low erythrocyte sedimentation rate...

Red blood cell measure linked to stroke death.(Clinical Rounds)
October 1, 2008... NEW ORLEANS -- Red blood cell distribution width appears to be a significant predictor of stroke mortality, according to data from the third National Health and Nutrition Examination Survey. An analysis of data from 480 participants in...

Look for four signs of serious disease in microhematuria.(Clinical Rounds)
October 1, 2008... STANFORD, CALIF. -- Asymptomatic microscopic hematuria is usually benign in children but should prompt an assessment for the big four signs of serious underlying renal disease--asymptomatic microhematuria and recurrent or persistent gross...

Pregabalin deemed safe add-on for refractory seizures.(Clinical Rounds)
October 1, 2008... MADRID -- Pregabalin is an effective add-on therapy for refractory partial seizures in adults aged 50 years and older, according to a post hoc analysis that included 335 patients. The analysis extracted data on patients aged 50 years and...

Insulin may curb plaques in Alzheimer's patients.(Clinical Rounds)
October 1, 2008... CHICAGO -- A postmortem analysis of subjects with Alzheimer's disease and diabetes found up to 80% fewer amyloid beta plaques in the brains of those who took both insulin and oral diabetic medication while alive. Although epidemiologic...

Antihistamine may play a role in Alzheimer's.(Clinical Rounds)
October 1, 2008... CHICAGO -- An off-the-market antihistamine, previously shown to slow cognitive decline over 1 year in Alzheimer's patients, continued to preserve cognition and memory in a 6-month open-label extension trial. The drug, dimebon, also...

Brain stimulation trumps drugs for parkinson's.(Clinical Rounds)
October 1, 2008... CHICAGO -- Preliminary data suggest that deep brain stimulation may be superior to medical therapy in Parkinson's disease, and that stimulating specific targets may lead to different outcomes. Complete data on 230 of 255 patients with...

CMS proposes to switch to ICD-10 codes by 2011.(Practice Trends)(Centers for Medicare and Medicaid Services )
October 1, 2008... Officials at the Centers for Medicare and Medicaid Services plan to replace the ICD-9-CM diagnosis and procedure code set with a significantly expanded set of codes--the ICD-10--by Oct. 1, 2011. But physician groups are calling the agency's...

Media influences tobacco use.(Policy & Practice)(Brief article)
October 1, 2008... Media communications--including movies, advertising, and news--play a key role in shaping tobacco use, according to a lengthy report from the National Cancer Institute. It noted that cigarettes are among the most heavily marketed products in...

Tobacco control support drops.(Policy & Practice)(Brief article)
October 1, 2008... Budgets for tobacco control programs in most states are either staying level or declining, despite increases in payments from the 1997 Tobacco Master Settlement Agreement, designed to compensate states for some of the cost of smoking-related...

'Free' Rx samples expensive.(Policy & Practice)(Brief article)
October 1, 2008... Free drug samples provided to physicians by pharmaceutical companies actually could cost uninsured patients more in the long run, because those patients are prescribed brand-name drugs rather than generics, according to a study done by...

Grants to doctors in hurricanes.(Policy & Practice)(AMA Foundation's Health Care Recovery Fund )(Brief article)
October 1, 2008... The AMA Foundation's Health Care Recovery Fund will provide grants of up to $2,500 to physicians in places that have been declared disaster areas by the Federal Emergency Management Agency, and the foundation currently is accepting donations to...

Tools' usefulness limited.(Policy & Practice)(Brief article)
October 1, 2008... Although health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools" pervasiveness and usefulness are limited, according to a study by the Center for Studying Health...

Many reach 'doughnut hole'.(Policy & Practice)(Brief article)
October 1, 2008... One in four Medicare Part D enrollees who filled prescriptions in 2007 reached the gap in coverage known as the "doughnut hole," and most remained in the doughnut hole for the rest of the year, according to an analysis from the Kaiser Family...

Good Samaritan acts.(Law & Medicine)
October 1, 2008... Question: During a flight from Los Angeles to Newark, a passenger developed acute chest pain and diaphoresis. A flight attendant put out an emergency call, but Dr. Brown, a general internist nearing retirement, failed to respond because he was...

CMS steps up oversight of the Joint Commission.(Practice Trends)(Centers for Medicare and Medicaid Services)(Brief article)
October 1, 2008... The Joint Commission on the Accreditation of Healthcare Organizations, which provides the standard in hospital accreditation in the United States, will soon be subjected to greater federal oversight. Congress recently eliminated the Joint...

Newborn Screening.(GENOMIC MEDICINE)
October 1, 2008... Technological advances in recent years have made it possible for newborn infants in the United States to be screened for more than two dozen conditions. The first genetic screen for newborns was a simple, reliable test for phenylketonuria...

Pain relievers.(Practice Trends)(Cartoon)
October 1, 2008... "It's not perfect, but it's the only peer review system we have." [ILLUSTRATION OMITTED]

Whoa, that's heavy, man.(Indications)(Brief article)
October 1, 2008... When 29 young men in Leipzig, Germany, last year presented with possible poisoning symptoms--stomach cramps, nausea, anemia, and fatigue--public health doctors and officials were puzzled. But there were quite a few clues: The patients were all...

Fleshy facebook photos.(Indications)(patient's flesh posted by a nurse on her Facebook account)(Brief article)
October 1, 2008... And speaking of unscrupulous dealings, a nurse at a hospital in Stockholm may lose her job because she posted images to her Facebook page from a couple of surgeries-brain and spinal--on which she assisted. In one shot (via her cell phone,...

Auricular therapy eases chronic pain.(Clinical Rounds)
October 15, 2008... [ILLUSTRATION OMITTED] In 2005, family physician Robert Bonakdar was searching through PubMed in preparation for a lecture he was about to deliver to physicians on the nonpharmacologic treatment of chronic pain. He came across two...

Direct patient care hours similar among family medicine work settings, 2007.(VITAL SIGNS)(Statistical table)(Brief article)
October 15, 2008... Direct Patient Care Hours Similar Among Family Medicine Work Settings, 2007 Mean clinical hours per week Family practice: sports medicine (n = 26) 38.2 Family practice: urgent care (n = 96) 38.1 Family...

Mental health care parity signed into law; starts in 2009: health plans can decide what to cover.(News)
October 15, 2008... After a 12-year fight led by mental health advocates, patients, families, clinicians, and a handful of members of Congress, some 113 million Americans will soon have equality of coverage between their benefits for physical health care and...

Even subclinical thyroid dysfunction ups mortality.(Metabolic Disorders)(Clinical report)
October 15, 2008... CHICAGO -- Subclinical hyperthyroidism significantly increases the risks of both cardiovascular and all-cause mortality, according to a prospective Brazilian cohort study. Subclinical hypothyroidism was similarly an independent risk factor...

Kudos to family doctor Regina M. Benjamin.(News)(Brief article)
October 15, 2008... Dr. Regina M. Benjamin received "the call" last month. The once-in-a-lifetime kind from the John D. and Catherine T. MacArthur Foundation, which awarded the family physician and 24 other individuals $500,000 each in "no strings attached"...

Pediatric OTC cough, cold drugs await standards.(NEWS FROM THE FDA)(over-the-counter)
October 15, 2008... BELTSVILLE, MD. -- The use of over-the-counter cough and cold products in children continued to be questioned by pediatricians and consumer advocates at a Food and Drug Administration public hearing on this issue-the latest step in the agency's...

FDA warns five ADHD medication manufacturers on false label claims.(News)(Food and Drug Administration, attention-deficit/hyperactivity disorder)
October 15, 2008... The Food and Drug Administration has warned five manufacturers of drugs for attention-deficit /hyperactivity disorder against using what it terms "false or misleading" promotional materials that overstate the drugs' .efficacy and downplay...

Flu virus detection test gains approval.(News)(Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel )(Brief article)
October 15, 2008... The Food and Drug Administration approved a new test that can diagnose human influenza infections, including the highly pathogenic influenza A (H5N1) virus, and produce results within 4 hours. The device, known as the Human Influenza Virus...

Medicaid substance abuse screening funds unused.(News)
October 15, 2008... WASHINGTON -- More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National...

Medical home promise & problems.(Editorial)
October 15, 2008... The patient-centered medical home is an idea being promoted by various health care organizations as a way to repair the U.S. health care system. While we can all agree that having a trusted physician coordinate our care is an ideal to strive...

Peer review is vital.(Letter to the editor)
October 15, 2008... I am troubled by trial lawyer Miles J. Zaremski's attempt to mischaracterize peer review of expert witness testimony as an effort to silence those who would give such testimony ("Expert Witnesses Under Fire," Law & Medicine, May 1, 2008, p....

Anticholinergics linked to CV events in COPD.(Cardiovascular medicine)
October 15, 2008... The use of two widely prescribed inhaled anticholinergics significantly increased the risk of cardiovascular death, myocardial infarction, or stroke by about 58% among patients with chronic obstructive pulmonary disease, according to the...

Undiagnosed COPD is common in heart failure.(Cardiovascular Medicine)(Clinical report)
October 15, 2008... MUNICH -- Chronic obstructive pulmonary disease is an extremely common yet often unrecognized comorbid condition in patients with systolic heart failure, according to the findings of two studies. "Data on COPD and heart failure are really...

Resistant hypertension.(Clinical Guidelines For Family Physicians)
October 15, 2008... Resistant hypertension is defined as blood pressure that is above goal despite the use of three or more appropriate antihypertensive agents at maximal or near maximal doses, with one of the agents being a diuretic. As many as 30% of patients...

High vitamin C intake may reduce hip fracture risk.(Metabolic Disorders)
October 15, 2008... MONTREAL -- Consumption of vitamin C at sufficiently high levels is associated with nearly a 50% decrease in the risk of hip and nonvertebral osteoporotic fractures in elderly men and women, according to a 15- to 17-year follow-up of...

Sitagliptin plus metformin shows 2-year benefit for glucose.(Metabolic Disorders)
October 15, 2008... ROME -- A 1.7% reduction in hemoglobin [A.sub.1c] was achieved in patients with type 2 diabetes given the combination of sitagliptin plus metformin in a 1-year extension of a 54-week phase III trial. This reduction, seen after 104 weeks of...

Imaging unjustified in asymptomatic diabetes.(Metabolic Disorders)(Brief article)
October 15, 2008... BOSTON -- Screening asymptomatic diabetes patients for myocardial ischemia using advanced imaging does not improve their 5-year prognosis for coronary events, compared with standard care, study results have shown. In addition, of the 561...

Hyperglycemia, ethnicity tied to cardiac risk.(Metabolic Disorders)
October 15, 2008... SAN FRANCISCO -- Hyperglycemia and ethnicity each were independently associated with a greater risk for cardiovascular problems in a large, prospective study of 48,444 New Zealanders. The information came from a New Zealand Ministry of...

HPV vaccine's safety trumps concerns about sex.(Infectious Diseases)(human papillomavirus)
October 15, 2008... Safety, not sexuality, was a key factor in the reluctance of mothers to have their teenage daughters vaccinated against human papillomavirus, according to results from a questionnaire-based study. The Centers for Disease Control and...

K. kingae complicates osteomyelitis diagnosis.(Infectious Diseases)(Kingella kingae )
October 15, 2008... CHICAGO -- Consider Kingella kingae as a cause of infection when diagnosing and treating children with suspected acute osteomyelitis, an infectious disease specialist advised. The incidence of acute osteoarticular infections in young...

Consider testing vitamin D levels in winter.(Skin Disorders)
October 15, 2008... SANTA BARBARA, CALIF. -- A "care collision" with vitamin D proponents can be avoided by ensuring that patients receive supplements to compensate for their lack of exposure to ultraviolet light, a California-based dermatologist suggested. ...

AHA: screen heart disease patients for depression.(Mental Health)(Clinical report)
October 15, 2008... Patients with heart disease are at increased risk of depression and should be screened routinely, and referred and treated as necessary for the condition, a new science advisory from the American Heart Association states. Depression has...

Symptoms can persist despite long-term SSRI treatment.(Mental Health)
October 15, 2008... BARCELONA -- Despite long-term treatment with selective serotonin reuptake inhibitors, many depressed patients cared for by primary care physicians continue to experience symptoms that affect their daily lives, according to a survey conducted...

Many pregnant women may be iodine deficient.(Women's Health)
October 15, 2008... WASHINGTON -- More than 70% of women with access to dietary iodine may remain at risk for unrecognized iodine deficiency during pregnancy, based on results from an observational study conducted in 53 pregnant women in Canada. The average...

Nearly 25% of U.S. women have pelvic floor disorders.(Women's Health)
October 15, 2008... An estimated 25% of women in the United States have pelvic floor disorders including urinary incontinence, pelvic organ prolapse, and fecal incontinence, according to national survey results. The prevalence of these disorders rises with...

Women underreport bowel problems, study suggests.(Women's Health)(Brief article)
October 15, 2008... CHICAGO -- Despite a high prevalence of most bowel symptoms among Women seeking urogynecologic care, few tell their physicians about their symptoms, according to a study of 463 patients. The finding indicates that "bowel symptoms should be...