Family Practice News articles from September 2008

Family Practice News archives from September 2008

Jury out on HT's cognitive benefits.(Clinical Rounds)(hormone therapy)
September 1, 2008... [ILLUSTRATION OMITTED] CHICAGO -- Hormone therapy might preserve cognition and memory in postmenopausal women, and even attenuate some of the cognitive deficits that occur in Alzheimer's disease, new research suggests. Controversy...

Top prescription drugs by U.S. sales in 2007.(VITAL SIGNS)(Table)(Brief article)
September 1, 2008... Top Prescription Drugs by U.S. Sales in 2007 (in billions of dollars) Lipitor (atorvastatin) $8.1 Nexium (esomeprazole) $5.5 Advair Diskus (salmeterol/fluticasone) $4.3 Plavix...

Medical-legal partnerships take root across U.S.: resolution calls for an AAFP-led initiative.(News)(American Academy of Family Physicians, medical-legal partnership )
September 1, 2008... Dr. Colleen Cagno recalls a patient who urgently needed help renewing his public housing. She and a lawyer who works down the hall were able not only to document how his medical condition qualified him for public housing, but also to...

Medicare expands list of conditions it will not cover.(News)
September 1, 2008... Starting Oct. 1, Medicare won't pay for a total of 11 preventable conditions acquired during a hospital stay, up from the current 8 such conditions. Added to the list of noncovered preventable conditions are surgical site infections...

FDA issues conflict-of-interest rules for advisers.(News)(Food and Drug Administration)
September 1, 2008... Experts serving on the Food and Drug Administration's advisory committees are now subject to new rules aimed at ensuring that they do not have conflicts of interest that could bias their decisions. In early August, the FDA issued four final...

Alert issued on simvastatin-amiodarone interaction.(News)
September 1, 2008... Patients on amiodarone and simvastatin should not take more than 20 mg of the statin a day, because of an increased risk of rhabdomyolysis when the two drugs are used together, according to a Food and Drug Administration alert. "This risk...

New drugs prominent in rhinitis guidelines.(News)
September 1, 2008... New changes to diagnosis and treatment guidelines for rhinitis emphasize the relative effectiveness of newer medications and treatment combinations for relieving symptoms, especially in determining what drugs are most effective when patients...

Concerns persist about Byetta and pancreatitis risks.(News)
September 1, 2008... The Food and Drug Administration warned physicians to immediately discontinue use of exenatide (Byetta) if pancreatitis is suspected, saying that it has received reports of six cases of necrotizing or hemorrhagic pancreatitis--including two...

2009 CMS outpatient pay will be based on quality.(News)(Centers for Medicare and Medicaid Services )
September 1, 2008... The Centers for Medicare and Medicaid Services has proposed an overall 3% increase in payments for outpatient hospital care in 2009, almost a full percent below the update for 2008. As expected, reporting on quality of care is being tied to the...

Tips for reducing stress in the office.(Letter to the editor)
September 1, 2008... When Dr. Jay Winner talks about falling our schedules and not leaving time for catching up, I have to ask him real-world questions ("Take the Stress Out of Primary Care," Guest Editorial, July 1, 2008, p. 6): * How many patients to you see...

One doctor's tips for stress reduction.(Letter to the editor)(Brief article)
September 1, 2008... I like Dr. Jay Winner's very wise attitude toward stress reduction: that we remain lifetime students in learning how to do these things better, as well as important sources and teachers for our patients and others ("Take the Stress Out of...

Did the AAP's clinical statement on lipid screening get it right? Guidelines outline multilevel approach.(Point/Counterpoint)
September 1, 2008... The clinical report by the American Academy of Pediatrics' Committee on Nutrition, "Lipid Screening and Cardiovascular Health in Childhood," represents a multilevel approach for the screening and management of children with risk factors for...

Did the AAP's clinical statement on lipid screening get it right? Screening and management are unproven.(Point/Counterpoint)(American Academy of Pediatrics)
September 1, 2008... Focusing on cardiac risk factors from a young age is a very worthy goal. In particular, healthy diet, lifestyle, and appropriate weight starting in the toddler years are important. However, I believe that the AAP's clinical report on lipid...

Corrections.(Opinion)(Correction notice)
September 1, 2008... The article, "New Combo Vaccines Could Complicate Practice" (July 15, 2008, p. 6), should have stated that "Kinrix is a combination of DTaP and inactivated poliovirus antigens that is indicated for the booster dose at age 4-6 years after the...

Pain relievers.(Cartoon)
September 1, 2008... [ILLUSTRATION OMITTED] "That's my diagnosis--but HEY, what do I know?"

Data back medical therapy for stable angina.(Cardiovascular Medicine)
September 1, 2008... Optimal medical treatment--with or without percutaneous coronary intervention--improved quality of life significantly in most patients with stable angina, according to an analysis of the quality of life of patients in the COURAGE trial. But PCI...

Obesity linked to higher morbidity after coronary bypass.(Cardiovascular Medicine)
September 1, 2008... TORONTO -- Obesity was linked to an increased risk for postsurgical complications in a study of more than 11,000 patients who underwent coronary bypass surgery. But in this series, obesity did not result in a significantly increased risk...

Congenital heart disease prognosis still a mystery: 'no single hemodynamic or electrophysiologic risk factor appears to be sufficiently predictive.'.(Cardiovascular Medicine)
September 1, 2008... TORONTO -- Experts are looking for the best way to assess the risk for sudden death in adults with congenital heart disease. Adults with congenital heart disease face a threat from sudden cardiac death that is far higher than that of the...

Preventing a Tim Russert Event.(Expert Opinion)(heart attack prevention)
September 1, 2008... I am sure that many of you have been asked the same question that I have been posed this summer. It typically occurred at a cocktail party, when a 50-something woman, upon learning that I am a cardiologist, sidled up and motioned toward a...

Atrial volume, ventricular shape predict mortality.(Cardiovascular Medicine)(Clinical report)
September 1, 2008... TORONTO -- Increased left-atrial volume and abnormal left-ventricular geometry were each independent predictors of death among elderly patients with preserved systolic heart function in a study with more than 11,000 subjects. The findings...

Nocturnal BP patterns altered with obesity.(Cardiovascular Medicine)(blood pressure)
September 1, 2008... NEW ORLEANS -- Obesity blunts the normal pattern of nocturnal blood pressure dipping, and this might be one mechanism through which obesity contributes to adverse cardiovascular outcomes, findings from a recent study suggest. Blood...

Omega-3 fatty acid use is associated with reduced risk for new atrial fib.(Cardiovascular Medicine)
September 1, 2008... TORONTO -- Patients with cardiovascular disease on an oral regimen of omega-3 fatty acid had a 73% reduced risk for developing atrial fibrillation in a retrospective, observational study of more than 11,000 patients. Although the study...

Tool helps prompt antihypertensive prescribing.(Cardiovascular Medicine)(Clinical report)
September 1, 2008... TORONTO -- Computerized reminders that were flashed to primary care physicians as they checked and recorded their patients' blood pressures led to a small but significant improvement in the rate of prescribing drugs that followed...

Serial celiac screening urged in all type 1 patients.(Metabolic Disorders)
September 1, 2008... KEYSTONE, COLO. -- All patients with new-onset type 1 diabetes should be screened for serologic evidence of celiac disease in the form of IgA tissue transglutaminase autoantibodies and, if seronegative and asymptomatic, screened again at least...

Food industry responding to needs of diabetic patients with celiac disease.(Metabolic Disorders)
September 1, 2008... KEYSTONE, COLO. -- Many type 1 diabetic patients with comorbid celiac disease say the celiac disease is actually the harder of the two to deal with, according to a presentation at a conference on the management of diabetes in youth. The...

Watch diabetic youth for signs of disturbed eating.(Metabolic Disorders)
September 1, 2008... KEYSTONE, COLO. -- Red flags for disturbed eating behavior in adolescent girls with type 1 diabetes include a persistently high glycosylated hemoglobin level, frequent episodes of diabetic ketoacidosis, and behaviors such as skipping insulin...

Self-reporting helps track adherence in diabetics.(Metabolic Disorders)
September 1, 2008... KEYSTONE, COLO. -- The most popular method of assessing patient adherence to type 1 diabetes management instructions consists of a look at glycosylated hemoglobin values, but it is also one of the least reliable means of doing so. ...

Metabolic syndrome fails to predict CVD risk.(Metabolic Disorders)(Clinical report)
September 1, 2008... Metabolic syndrome is associated with type 2 diabetes but not cardiovascular disease in elderly patients, according to study findings. Criteria for metabolic syndrome were developed to help improve understanding of the links between insulin...

Simple steps can help avert foot ulcers in diabetic patients.(Metabolic Disorders)
September 1, 2008... WASHINGTON -- The use of therapeutic shoes and the home monitoring of foot-skin temperature by diabetic patients who are at high risk for foot ulceration are two simple, low-tech preventive measures that could greatly reduce costs and improve...

Flu shot may not prevent pneumonia in elderly.(Infectious Diseases)
September 1, 2008... Influenza vaccination was not associated with a significantly reduced risk of community-acquired pneumonia in people aged 65 and older, according to the results of a population-based study. In the study of 1,173 cases and 2,346 controls, flu...

C. difficile hospitalizations, deaths spark concern.(Infectious Diseases)
September 1, 2008... A sharp rise in the number of adult hospitalizations and deaths attributable to Clostridium difficile infection over a 6-year period has investigators calling for increased allocation of public health resources aimed at the prevention of...

Drug use, hygiene listed as MRSA risk factors in gay men.(Infectious Diseases)
September 1, 2008... BETHESDA, MD. -- Community-associated methicillin-resistant Staphylococcus aureus infections in gay men might be associated with drug use and low levels of hygiene, especially after having sex. Based on reports from a commercial laboratory...

'Express visits' expedite time to treatment in STD clinics.(Infectious Diseases)
September 1, 2008... NEW YORK -- Busy STD clinics may be able to offer "express visits" that provide disease screening only for asymptomatic patients without missing infected individuals. Researchers with the New York City Department of Mental Health and...

Weigh pros and cons of pediatric wart therapies.(Skin Disorders)
September 1, 2008... STANFORD, CALIF. -- Two approved therapies for pediatric warts and several off-label options each carry advantages and disadvantages that can help inform treatment selection. Watchful waiting may be the best option because most pediatric...

Emerging data link psoriasis to comorbidities.(Skin Disorders)
September 1, 2008... SAN DIEGO -- Emerging scientific data on adults with psoriasis suggest that certain comorbidities, including metabolic syndrome and myocardial infarction, may accompany the disease. People with psoriasis "have a tendency to be obese, have a...

Imiquimod sustains BCC clearance long-term.(Skin Disorders)(basal cell carcinoma)(Brief article)
September 1, 2008... CHICAGO -- Clearance of superficial basal cell carcinoma following successful treatment with imiquimod 5% cream was sustained in a high proportion of patients during 5 years of an open-label study. The initial clinical clearance rate in the...

EpiCeram cream alone clears atopic dermatitis.(Skin Disorders)
September 1, 2008... KYOTO, JAPAN -- Topical EpiCeram is an effective stand-alone therapy for moderate to severe pediatric atopic dermatitis, according to results of a clinical trial. This physiologic skin barrier repair cream proved itself the equal of...

Misperceptions about contraceptives persist.(Women's Health)
September 1, 2008... CALGARY, ALTA. -- Physicians may have a surprising number of misconceptions about birth control, according to recent responses to a survey by 96 family physicians in Kingston, Ont. Contrary to evidence in the medical literature, more than...

First-trimester lamotrigine use tied to oral clefts.(Women's Health)(Brief article)
September 1, 2008... MONTEREY, CALIF. -- Women who take the anticonvulsant lamotrigine during their first trimester of pregnancy have a 10-fold greater risk of having a baby with nonsyndromal cleft lip, cleft palate, or both, according to a peer-reviewed study ...

Congenital malformation risk rose with use of topiramate.(Women's Health)
September 1, 2008... Topiramate is associated with a significantly increased risk of major congenital malformations, whether given as monotherapy or as part of a polytherapy antiepileptic regimen, Dr. Stephen Hunt and his colleagues have reported. Although the...

When human data are lacking.(Drugs, Pregnancy, And Lactation)
September 1, 2008... In 2007, the Food and Drug Administration approved 16 new molecular entities and several new biologics. None of these agents have human pregnancy experience, but some will be prescribed to women of reproductive age and exposure in early...

Prepregnancy diabetes triples risk of birth defects.(Women's Health)
September 1, 2008... Women who are diagnosed with diabetes prior to pregnancy are three to four times more likely to have a child with birth defects, compared with women who don't have diabetes prior to pregnancy, based on results from a study of more than 15,000...

Teens and marijuana.(Guest Editorial)
September 1, 2008... A report, released by the Office of National Drug Control Policy, highlights the clinically important finding that teenage drug use is correlated with many negative outcomes, such as drug dependence, mental illness, and school failure, and it...

Varenicline may help curb heavy drinking.(Mental Health)
September 1, 2008... WASHINGTON -- The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small study show. Nondependent heavy drinkers taking varenicline (Chantix) were nine times more likely to...

Stay alert to health complications from dancing.(Sports Medicine)
September 1, 2008... VANCOUVER, B. C. -- Overtraining, disordered eating, and lower extremity injuries are some of the many health issues that physicians who care for young dancers may encounter, according to a pediatric sports medicine specialist. Several...

Clinical criteria help guide return to activity after mono.(Sports Medicine)
September 1, 2008... VANCOUVER, B.C. -- Physical findings, laboratory values, and imaging results are of little use in determining when it is safe for young athletes with infectious mononucleosis to return to play. Ultimately, the decision on how long to keep them...

Physicians can play a key role in keeping sports in balance.(Sports Medicine)
September 1, 2008... VANCOUVER, B. C. -- Physicians can help young athletes and parents keep sports in balance and avoid problems such as overuse injuries and overtraining syndrome, according to a sports medicine specialist. "So many of our kids are involved in...

Biologic gains FDA panel backing for RA patients.(Musculoskeletal Disorders)
September 1, 2008... SILVER SPRING, MD. -- Tocilizumab's many side effects prompted much discussion during a meeting of the Food and Drug Administration's Arthritis Advisory Committee but did not prevent the drug from winning its recommendation for approval. ...

Neuropsychiatric issues common in early lupus.(Musculoskeletal Disorders)
September 1, 2008... DESTIN, FLA. -- Neuropsychiatric manifestations of systemic lupus erythematosus occur in more than 80% of patients during the course of disease, and can pose challenges in caring for these patients. Not only can such manifestations of lupus...

Insulin resistance differs in rheumatoid arthritis, lupus.(Musculoskeletal Disorders)
September 1, 2008... DESTIN, FLA. -- The prevalence of metabolic syndrome is increased in patients with rheumatoid arthritis, corn pared with the general population, as is the prevalence of insulin resistance, data from numerous studies show. Likewise, insulin...

Belimumab is steroid sparing in systemic lupus erythematosus.(Musculoskeletal Disorders)
September 1, 2008... PARIS -- Treatment of patients with systemic lupus erythematosus with the monoclonal antibody belimumab permitted reductions in corticosteroids through 3 years of observation, according to a post hoc analysis of a large phase II study. ...

H. pylori eradication cuts gastric cancer incidence.(Digestive Disorders)
September 1, 2008... Eradication of Helicobacter pylori in patients with early-stage gastric cancer reduced the risk of subsequent metachronous gastric carcinoma significantly, compared with controls, in a Japanese study of more than 500 patients. H. pylori is...

Extensive Crohn's disease may elevate risk of colon cancer, dysplasia.(Digestive Disorders)(Clinical report)
September 1, 2008... Data from a prospective colonic surveillance program involving 259 patients with chronic extensive Crohn's disease revealed a 25% cumulative risk of developing definite dysplasia or cancer by the 10th surveillance exam after an initial negative...

History may portend better cancer outcome.(Digestive Disorders)
September 1, 2008... A family history of colon cancer raises the risk of developing the disease, but it also appears to be associated with a better prognosis, researchers reported. Patients with stage III colon cancer who had a family history of the disease...

Infectious gastroenteritis may precipitate IBD.(Digestive Disorders)(inflammatory bowel disease)
September 1, 2008... An episode of infectious gastroenteritis might be a factor in the onset of inflammatory bowel disease. Dr. Chad K. Porter and his colleagues conducted a nested case-control study to determine whether the risk of IBD was higher in patients...

Antibiotic cut peritonitis in liver disease patients.(Digestive Disorders)
September 1, 2008... SAN DIEGO -- Antibiotic prophylaxis seems to prevent spontaneous bacterial peritonitis in advanced liver disease and also reduces mortality, especially in the short term, according to a report at the annual Digestive Disease Week. ...

Antidepressants show promise for irritable bowel syndrome.(Digestive Disorders)
September 1, 2008... SAN DIEGO -- There is a strong rationale as well as some evidence supporting the use of tricyclic antidepressants and selective serotonin reuptake inhibitors for the treatment of irritable bowel syndrome, Dr. Lin Chang said at the annual...

Helicobacter pylori may protect against asthma.(Pulmonary Medicine)
September 1, 2008... Early childhood colonization with the major human commensal microbe Helicobacterpylori may be protective against asthma, study findings show. According to the "hygiene hypothesis," the rise in asthma and allergic disorders that occurred...

Nut consumption in pregnancy may increase asthma risk in child.(Pulmonary Medicine)
September 1, 2008... Women who eat nut products such as peanut butter daily throughout pregnancy may significantly increase their children's risk of developing asthma symptoms, according to a Dutch cohort study. At 8 years of age, children whose mothers...

Pirfenidone is promising as pulmonary fibrosis therapy.(Pulmonary Medicine)(Clinical report)
September 1, 2008... TORONTO -- Treatment of patients with idiopathic pulmonary fibrosis with pirfenidone was "encouraging" in a phase III study conducted in Japan. Few treatment options are available for patients with idiopathic pulmonary fibrosis (IPF), Dr....

Mediterranean diet offsets diabetes.(Clinical Capsules)
September 1, 2008... A Mediterranean diet high in vegetables, fruits, and cereal grains and low in meat can significantly reduce the risk of diabetes in initially healthy people. In a median of 4 years of follow-up with more than 13,000 Spanish university...

Benign obesity.(Clinical Capsules)
September 1, 2008... A "considerable proportion" of overweight and obese adults show no cardiometabolic abnormalities and can be considered to have "benign" obesity, according to data from two separate research groups. In the first study, Rachel 12. Wildman,...

Nicotine replacement in pregnancy.(Clinical Capsules)(Brief article)
September 1, 2008... Women using nicotine replacement therapy during pregnancy do not increase their risk of stillbirth, according to a large Danish study. The study of 87,032 women who gave birth to single babies between 1996 and 2002 found the risk of stillbirth...

Study ties smoking volume to stroke in young women.(Clinical Rounds)
September 1, 2008... With every 10 cigarettes young women smoked each day, their risk for ischemic stroke increased significantly, based on results from a retrospective study of more than 1,000 women aged 15-49 years. Many studies have shown that current...

Adiposity trumps BMI in cerebrovascular event prediction.(Clinical Rounds)(body mass index)
September 1, 2008... Measures of abdominal adiposity appear to be better predictors of stroke or transient ischemic attack than does body mass index, based on a German study of more than 1,100 individuals. "Three different statistical approaches uniformly...

Blood test in pipeline may help diagnose Alzheimer's.(Clinical Rounds)(Clinical report)
September 1, 2008... CHICAGO -- A simple blood test could soon allow primary care providers to diagnose Alzheimer's disease accurately if a final validation study proceeds as well as optimistic researchers hope. In a study of 88 patients, the test findings...

Higher fitness level may slow brain atrophy in Alzheimer's.(Clinical Rounds)
September 1, 2008... CHICAGO -- Keeping fit may help reduce brain atrophy in patients with early Alzheimer's, researchers said at the International Conference on Alzheimer's Disease. An exercise-tolerance study confirmed that the hippocampus, one of the first...

Thunderclap headache a sign of reversible CVS, not vasculitis.(Clinical Rounds)
September 1, 2008... PARIS -- A severe headache with near-instantaneous onset--a "thunderclap" headache--is likely to represent a reversible cerebral vasoconstrictive process rather than central nervous system vasculitis, Dr. Leonard H. Calabrese said at the annual...

Role of HPV in head, neck cancers elucidated.(Clinical Rounds)(human papillomavirus)
September 1, 2008... SAN FRANCISCO -- While the relationship of the human papillomavirus to cervical cancer is well known, it is less commonly recognized that oral HPV appears to be associated with head and neck cancers, Dr. Maura L. Gillison said at the Seventh...

Tracking melanoma's genetic tentacles.(Genomic Medicine)
September 1, 2008... The American Cancer Society and the National Cancer Institute estimate that 62,480 people in the United States will be diagnosed with melanoma this year, and that 8,420 people will die from it. Although melanoma rates have risen steadily in...

Demo results indicate incentives improve quality of care, safety.(Practice Trends)
September 1, 2008... Providing financial incentives to hospitals has resulted in significant gains in quality of care for patients with acute myocardial infarction, heart failure, and pneumonia, and for those undergoing coronary artery bypass graft and hip and knee...

CMS plans five-star rating system for nursing homes.(Practice Trends)
September 1, 2008... The federal government will soon be rating the nation's nursing homes on a five-star quality scale. Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, announced the plan during a teleconference. The new,...

Health care access fell in 2007, quality lagged behind.(Practice Trends)
September 1, 2008... Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system...

Part D premiums to rise $3 in 2009.(Practical Trends)(Medicare Part D)(Brief article)
September 1, 2008... On average, Medicare beneficiaries can expect to pay about $28 per month for standard Part D prescription drug coverage next year. The estimates from the Centers for Medicare and Medicaid Services are based on bids submitted for both...

Health searches level off.(Policy & Practice)(Brief article)
September 1, 2008... The number of adults going online for health information has plateaued or declined, according to a Harris Interactive poll. According to the pollster, a total of 150 million people--66% of all adults and 81% of those who have online...

Home drug errors rise.(Policy & Practice)(Brief article)
September 1, 2008... A shift in the number of medications being taken outside of the hospital has correlated with a sharp increase in the number of fatal medication errors in the home, researchers reported in the Archives of Internal Medicine. In the study,...

GAO: Part D problems continue.(Policy & Practice)(Government Accountability Office, Medicare Part D)(Brief article)
September 1, 2008... Almost 3 years after the Medicare Part D drug program went into effect, the Centers for Medicare and Medicaid Services still face significant and continuing problems resolving beneficiaries' complaints and grievances, a Government...

Calif. stops cancellation practice.(Policy & Practice)(rewards for canceling employees' health insurance)(Brief article)
September 1, 2008... California's Gov. Arnold Schwarzenegger (R) has signed legislation banning health insurance companies from rewarding employees for canceling or limiting a patient's health insurance. According to the bill's sponsor, Assemblyman Ted Lieu...

Laws won't help uninsured.(Policy & Practice)
September 1, 2008... New legislation in Florida and Georgia--states in which the percentage of uninsured is well above the national average of 18%--likely won't reduce the ranks of the uninsured, according to a report from the Center on Budget and Policy...

Grants aimed at risk pools.(Policy & Practice)(Brief article)
September 1, 2008... CMS has awarded more than $49 million in grants to 30 states that provide health insurance to residents who cannot get conventional health coverage because of their health status. The grants will be used by the states to offset losses that they...

The perils of credentialing.(Law & Medicine)(Kadlec Medical Center v. Lakeview Anesthesia Associates)
September 1, 2008... Worried about how to deal with physician credentialing in your office or hospital? Wondering which questions you should ask references about potential employees, or what to say when someone asks you for a reference? Well, a recent decision in a...

Personal health records should ensure privacy; task force says.(Law & Medicine)
September 1, 2008... Privacy should be the top priority when developing certification criteria for personal health records, a task force created by the Certification Commission for Healthcare Information Technology has recommended. Adequate security and...

Voters back more children's health care spending.(Practice Trends)
September 1, 2008... Nearly four out of five Americans planning to vote in the upcoming presidential election are concerned with issues related to children's health care, a nationwide telephone survey of 800 registered voters shows. The survey found that 79%...

Maneuvering begins on Capitol Hill for health care reform.(Practice Trends)
September 1, 2008... Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the...