Internal Medicine News articles from February 2008

Internal Medicine News archives from February 2008

PCPs lack info on hematologic Ca.(News)(Primary care providers)(cancer)(Reprint)(Survey)
February 1, 2008... ATLANTA -- Primary care providers often have knowledge gaps that undermine their ability to diagnose and manage the few patients they see with hematologic malignancies, according to sample survey responses from 357 participants in a medical...

Projected aggregate physician and clinical service expenditures in the U.S.(VITAL SIGNS)
February 1, 2008... Projected Aggregate Physician and Clinical Service Expenditures in the U.S. (in billions of dollars) Notes: Based on the 2005 version of the National Health Expenditures data. Includes outpatient and laboratory services. Source:...

Guidelines endorse goals for palliative care at end of life: ACP backs five evidence-based measures.(Geriatrics)
February 1, 2008... Palliative care at the end of life should focus on the assessment and alleviation of symptoms of pain, shortness of breath, and depression, according to new guidelines released by the American College of Physicians. "The ACP's drawing a...

Gene profile test effective in node-positive breast Ca.(News)
February 1, 2008... SAN ANTONIO -- The 70-gene profile known as the MammaPrint test is a powerful and independent prognostic marker in breast cancer patients who have one to three positive axillary lymph nodes, according to two studies presented at the annual San...

FDA issues alert on fentanyl patches.(News)(Food and Drug Administration )
February 1, 2008... Recent reports of death and life-threatening side effects associated with the fentanyl patch prompted the Food and Drug Administration to once again issue a warning about improper prescribing and use of the transdermal administration. The last...

Zoledronic acid zaps bone loss in breast cancer.(News)(Clinical report)
February 1, 2008... SAN ANTONIO -- Zoledronic acid proved dramatically effective in preventing the pronounced bone loss that accompanies combination estrogen-reducing adjuvant endocrine therapy in premenopausal breast cancer patients, according to an update from a...

21-gene assay predicts recurrence in node-positive breast Ca.(News)
February 1, 2008... SAN ANTONIO -- The 21-gene assay called Oncotype DX can predict risk of recurrence in postmenopausal women with node-positive, estrogen receptor-positive breast cancers, researchers said at the annual San Antonio Breast Cancer Symposium. ...

Modern evidence lacking on phenylephrine dosages.(News)
February 1, 2008... SILVER SPRING, MD. -- Phenylephrine, a primary ingredient in hundreds of over-the-counter nasal decongestants, appears to be effective at the current dose, but further research is needed to determine whether higher doses might be more...

Intranasal desmopressin tied to hyponatremia.(News)
February 1, 2008... Intranasal formulations of desmopressin acetate are no longer indicated for treating primary nocturnal enuresis because of the risk of severe hyponatremia and seizures associated with these products when used for this indication, according to...

Bystolic.(NEW & APPROVED)(Drug overview)
February 1, 2008... Bystolic (nebivolol, Mylan Bertek Pharmaceuticals and Forest Laboratories Inc.) A [beta]-blocker approved for the treatment of hypertension, alone or in combination with other antihypertensive agents. * Recommended Dosage:...

xTAG Respiratory Viral Panel.(NEW & APPROVED)(Brief article)
February 1, 2008... xTAG Respiratory Viral Panel (Luminex Molecular Diagnostics) A nucleic acid--based test that simultaneously detects and identifies 12 respiratory viruses and viral subtypes. This is the first test cleared by the FDA for "infectious...

Universal screening renews HIV debate.(GUEST EDITORIAL)
February 1, 2008... When a person discloses a positive HIV status to a partner, the disclosure eliminates many of the moral, ethical, and legal considerations inherent in the opposite scenario. Just what is our responsibility as physicians in this regard? Do we...

Internists are not adequately credited.(LETTERS)(Letter to the editor)
February 1, 2008... Many practicing internists assume on a daily basis the responsibilities listed in your article about maintenance of certification ('ABIM Proposes Comprehensive Internist Concept," Dec. 15, 2007, p. 1). This program might help to...

Buzzwords no substitute for advocacy.(LETTERS)(Letter to the editor)
February 1, 2008... In reading the list of "core competencies" being proposed by the American Board of Internal Medicine, I was reminded of the TV commercial where the office workers play "buzzword bingo" ("ABIM Proposes Comprehensive Internist Concept," Dec. 15,...

ABIM taking the wrong approach.(LETTERS)(Letter to the editor)
February 1, 2008... These are the people who have ruined internal medicine as a specialty ("ABIM Proposes Comprehensive Internist Concept," Dec. 15, 2007, p. 1). What is the benefit of having boards in IM or being recertified at the present time? There are...

Low-dose dexamethasone beneficial in myeloma.(Hematology)
February 1, 2008... ATLANTA -- Not only reduced toxicity but also less disease progression led to superior overall survival when patients with newly diagnosed multiple myeloma were given low-dose dexamethasone in a pivotal phase III trial comparing high and low...

Immunoglobulin test may signal cancer risk.(Hematology)(Clinical report)
February 1, 2008... ATLANTA -- Healthy blood donors with positive direct antiglobulin tests develop cancer more than twice as often as those who test negative, according to a provocative study that linked thousands of blood bank records to Israel's national cancer...

Reducing iron stores lowers cancer risk in PAD.(Hematology)(peripheral artery disease )
February 1, 2008... ATLANTA -- Patients with peripheral artery disease who were randomized to an iron reduction program significantly reduced their risk of developing a malignancy by 37%, compared with patients who received no iron reduction. After an average...

Elevated ferritin tied to transplant mortality.(Hematology)(Clinical report)
February 1, 2008... ATLANTA -- Elevated ferritin levels were associated with poor outcomes following autologous hematopoietic stem-cell transplantation in a retrospective analysis of 397 patients with hematologic malignancies. A ferritin level of 685 ng/mL or...

Endometriosis not predicted by hormone effect.(Women's Health)(Clinical report)
February 1, 2008... WASHINGTON -- Response to hormonal therapy does not accurately predict whether a patient has endometriosis, Dr. Todd R. Jenkins reported at the annual meeting of the AAGL. Laparoscopy has long been considered the standard for diagnosing...

Histology necessary to confirm diagnosis of endometriosis.(Women's Health)
February 1, 2008... SAN DIEGO -- When it comes to diagnosing endometriosis, visual inspection is not enough, Dr. Georgine Lamvu said at the annual meeting of the International Pelvic Pain Society. "We need to be more careful to use excisional biopsies during...

Routine anal Pap smear testing gains ground.(Women's Health)
February 1, 2008... CHICAGO -- Routine screening for anal intraepithelial neoplasia could pick up missed cancers, Dr. Thomas C. Wright Jr. said at a conference on vulvovaginal diseases. The role of routine anal Pap smear screening is controversial in part...

Cervical cancer screening feasible, effective in STD clinics.(Women's Health)(Sexually transmitted diseases)
February 1, 2008... SAN DIEGO -- Cervical cancer screening in STD clinics is feasible and highly effective, according to results from a 2-year single clinic study. "From previous studies we know that women who attend STD clinics are at greater risk for having...

Prozac no better than placebo in some teens.(Adolescent Health)
February 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...

Initiating substance use linked with major depressive episodes in teenagers.(DATA WATCH)(Statistical table)(Brief article)
February 1, 2008... Initiating Substance Use Linked With Major Depressive Episodes in Teenagers Major depressive No major depressive episode in past year episode in past year Alcohol use 29.2% ...

Adolescent depression.(THE EFFECTIVE PHYSICIAN)(Disease/Disorder overview)
February 1, 2008... Background The diagnosis and management of adolescents with depression is a common issue for primary care physicians. Evidence-based guidelines and tools to assist clinicians in the evaluation and treatment of major depression in 10-to...

Policy on adolescent contraception updated.(Adolescent Health)
February 1, 2008... The revised American Academy of Pediatrics policy statement on contraception and adolescents includes updates on recently introduced contraceptives, as well as an emphasis on the recommendation that adolescents postpone sexual activity "until...

Treat obesity before using anticholesterol drugs.(Adolescent Health)
February 1, 2008... STANFORD, CALIF. -- Picture a 15-year-old Hispanic girl who is 152.5 cm tall, weighs 88.7 kg, and has a body mass index of 38 kg/[m.sup.2]. Her father has hyperlipidemia, but she has no family history of a premature coronary artery event (such...

Little known about effective treatments for delirium.(Geriatrics)
February 1, 2008... LONG BEACH, CALIF. -- So little is known about effective interventions for delirium that efforts to help elderly patients with the condition leave many clinicians, well, delirious. The goal of treating delirium is not just to control...

Treatment of insomnia in elderly can be tricky.(Geriatrics)
February 1, 2008... MINNEAPOLIS -- Metabolic changes and comorbid conditions are just a few of the factors that challenge clinicians when they treat insomnia in older adults. "The predictability of your giving drug X to patient A and knowing what is going to...

Geriatric assessments require individualization.(Geriatrics)
February 1, 2008... PHILADELPHIA -- People in their 80s are much more varied in their physical condition than people in their 20s, Dr. Moira Fordyce said at a conference sponsored by the American Society on Aging. As a result, a physician must carefully assess...

Treating insomnia may reduce osteoarthritis pain.(Geriatrics)
February 1, 2008... SAN FRANCISCO -- Cognitive-behavioral therapy for comorbid insomnia in patients with osteoarthritis not only improved sleep but also reduced self-reported pain in a randomized, controlled pilot study of 51 patients, reported Michael V Vitiello,...

Older adults receptive to trying lifestyle changes.(Geriatrics)(Clinical report)
February 1, 2008... SAN FRANCISCO -- A surprisingly high 85% of older adults with hypertension, hyperglycemia, or hyperlipidemia reported engaging in lifestyle modifications, such as diet change or exercise, in a longitudinal study of 666 people, Eleanor M....

Diabetes found in one-third of nursing home residents.(Geriatrics)(Report)
February 1, 2008... SAN FRANCISCO -- The prevalence of diabetes mellitus in a study of 2,317 U.S. nursing home residents was 33%, higher than previous reports that pegged the prevalence at 11%-27% of residents. Previous estimates predominantly relied on the...

Tai Chi improved cognitive function in older adults.(Geriatrics)
February 1, 2008... SAN FRANCISCO -- The Eastern exercise, tai chi, improved scores on a measure of cognitive function in a yearlong, randomized, controlled study of 132 healthy older adults. This is the first study to document mental improvements resulting...

Identifying hereditary cancer syndromes.(GENETICS IN YOUR PRACTICE)
February 1, 2008... In the Dec. 1, 2007, issue of INTERNAL MEDICINE NEWS, Dr. Michael F. Murray reviewed the importance of the family health history as a risk assessment tool for internists. The renewed interest in family history information in the era of "genetic...

Novel anticancer agents have autoimmune toxicities.(Clinical Rounds)
February 1, 2008... AMSTERDAM -- The highly promising new class of investigational anticancer agents known at cytotoxic T-lymphocyte antigen 4 blockers has a characteristic group of side effects, Dr. Alexander M.M. Eggermont said at the 11th World Congress on...

Prevalence of peripheral artery disease rising in United States.(Cardiovascular Medicine)(Survey)
February 1, 2008... ORLANDO -- The prevalence of peripheral artery disease in asymptomatic adults is increasing in the United States, according to data collected on a total of more than 5,000 people by the National Health and Nutrition Examination Survey during...

Coronary calcium IDs young men at cardiac risk.(Cardiovascular Medicine)
February 1, 2008... ORLANDO -- Coronary artery calcium identified young men at relatively high risk for a coronary heart disease event even when their Framingham risk score was low, in a study with more than 1,600 men. The new findings "challenge the notion...

Ezetimibe fails to further slow atherosclerosis.(Cardiovascular Medicine)
February 1, 2008... Results of a controversial study assessing ezetimibe's ability to slow atherosclerotic progression, when used in conjunction with a high-dose statin regimen, have cardiologists split on whether the findings signal a flawed study or a flawed...

Calcium supplementation increases MI risk in older women.(Cardiovascular Medicine)(myocardial infarction )
February 1, 2008... Calcium supplementation significantly increased the risk of a myocardial infarction among healthy, postmenopausal women, compared with those taking placebo, in a secondary analysis of an osteoporosis study. Physicians should consider this...

Genital wart treatment options expanding.(Infectious Diseases)
February 1, 2008... CHICAGO -- A topical ointment containing components derived from green tea leaves is the latest addition to the available therapies for genital warts, Dr. Thomas C. Wright Jr. said at a conference on vulvovaginal diseases. The ointment was...

Dexamethasone beneficial in bacterial meningitis.(Infectious Diseases)(Clinical report)
February 1, 2008... CHICAGO -- The use of dexamethasone therapy either before or with the first dose of standard antibiotics was associated with a favorable outcome in adults with community-acquired bacterial meningitis, according to preliminary data from a...

Image-enhanced endoscopy has 'come of age'.(Gastroenterology)
February 1, 2008... In the not-so-distant past, endoscopists always sought the input of pathologists when diagnosing gastrointestinal cancers. Now, thanks to the maturation of image-enhanced endoscopy, endoscopists are sometimes able to make a diagnosis on the...

Diabetes tied to colorectal cancer risk in women.(Gastroenterology)
February 1, 2008... Diabetes may significantly increase a woman's risk of developing colorectal cancer, based on the findings of a study involving more than 45,000 women across the United States. "There was about a 50% increased risk of colorectal cancer in...

Laparoscopic-assisted colonoscopy useful for treating difficult polyps.(Gastroenterology)
February 1, 2008... SAN FRANCISCO -- A combined laparoscopic-endoscopic approach can be effective in treating difficult colonic polyps, Dr. Morris E. Franklin Jr. said at the annual meeting of the Society of Laparoendoscopic Surgeons. In a case series of 144...

Low-income seniors helped.(POLICY & PRACTICE)(Brief article)
February 1, 2008... The Centers for Medicare and Medicaid Services has proposed new rules that would allow more low-income Medicare beneficiaries to remain in their current prescription drug plan without having to pay a premium. Each year, CMS recalculates the...

Coverage improves health.(POLICY & PRACTICE)(Brief article)
February 1, 2008... Uninsured adults 55-64 years old, particularly those with cardiovascular disease or diabetes, saw their health improve significantly once they became eligible for Medicare, a study from Harvard Medical School, Boston, reported. The study looked...

Grant funds medical home study.(POLICY & PRACTICE)(Brief article)
February 1, 2008... The American College of Physicians has received a $225,000 grant from the Commonwealth Fund to study the cost of providing a patient-centered medical home. The grant, part of the Commonwealth Fund's Patient-Centered Primary Care Initiative,...

Retiree benefits can be cut.(POLICY & PRACTICE)(Brief article)
February 1, 2008... A new federal regulation will allow employers to provide more limited health care benefits for retirees who are eligible for Medicare. The rule, which the Equal Employment Opportunity Commission released in late December, responds to a court of...

Expanded INR monitor coverage.(POLICY & PRACTICE)(international normalized ratio)(Brief article)
February 1, 2008... CMS is considering expanding coverage for home prothrombin time (international normalized ratio) monitoring. Currently, monitoring is limited to patients with mechanical heart valves. The agency proposes to expand coverage to those patients...

Judge overturns Rx info law.(POLICY & PRACTICE)(Brief article)
February 1, 2008... A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John...

Study charts success of physicians in recovery.(Practice Trends)
February 1, 2008... CORONADO, CALIF. -- Of 104 physicians in New York state who were admitted to substance abuse treatment programs between 2003 and 2004 and were monitored for a mean of 41 months by the state's Committee for Physicians' Health, only 9 (9%) were...

Simple interventions make a big difference in Bolivia.(WORLD WIDE MED)(Interview)
February 1, 2008... For Dr. Susan Hou, the practice of medicine is a family affair. Far from her U.S. career in nephrology, Dr. Hou's family connection to medicine is rooted in the rain forest of Bolivia, where in 2001, she cofounded a clinic called Centro Medico...

MedPAC recommends 1.1% fee increase for 2009.(Practice Trends)(Report)
February 1, 2008... WASHINGTON -- The Medicare Payment Advisory Commission has voted to recommend that Congress increase the fees that physicians receive from Medicare by 1.1% in 2009. The recommendation will be included in MedPAC's final report to Congress...

Popularity of personal health records growing.(Practice Trends)
February 1, 2008... As physicians struggle to decide whether and when to incorporate electronic health records into their practices, personal health records are gaining popularity. Personal health records (PHRs) allow patients to store and access their...

Medicare payment situation makes planning difficult.(Practice Trends)
February 1, 2008... Doubt and low morale are rampant in many primary care practices in light of the uncertainty surrounding Medicare physician payment rates this year. Although members of Congress averted a 10% cut in the Medicare physician fee schedule,...

Medicare training, brochures available.(Practice Trends)(Brief article)
February 1, 2008... The Centers for Medicare and Medicaid Services offers an updated Web-based training course to explain Medicare's coverage and billing for women's preventive health services. The 90-minute course features billing guidelines for services...

Health care spending varies widely according to region.(Practice Trends)
February 1, 2008... Dramatic regional differences exist in the way in which severely chronically ill patients, who consume 75% of Medicare's budget, are treated in their last 2 years of life, according to a report based on data from nearly 5 million Medicare...

Cupid's all-natural fix, guaranteed.(INDICATIONS)(Brief article)
February 1, 2008... Valentine's Day is nearly upon us, and the Bureau of Indications would like to pass along some recent warnings from the Food and Drug Administration. According to a press statement, the use of the following supposedly "all-natural" erectile...

Till rehab do us part.(INDICATIONS)(rehabilitation)(Brief article)
February 1, 2008... Spouses who report discordant drug use--meaning one uses and one does not--are the least satisfied with their marriages, leading researchers to conclude that the best way to get high while married is secretly, according to a recent report in...

Alpha kappa Drosophila.(INDICATIONS)(Brief article)
February 1, 2008... "Disinhibited sexual behavior is highly associated with alcohol consumption; however, the physiological support for this notion is largely lacking and a suitable animal model to address this issue is instrumental," researchers wrote in PLoS...

Primal attraction, macaque-style.(INDICATIONS)(Brief article)
February 1, 2008... A new study of the copulation habits of Barbary macaques may shed some light on the nature of your romantic Valentine's evening tryst. Researchers at the German Primate Center wondered whether the loud and frequent calls by female Barbary...

Pain relievers.(Comic)(Cartoon)
February 1, 2008... "I was a 24-hour bug, but thanks to antibiotics, I'm now a 48-hour bug."

Fighting needle fear in diabetes.(News)
February 15, 2008... Needle fear can complicate many doctor-patient relationships, but for patients with insulin-treated diabetes, fear of needles can become a serious barrier to compliance. Studies show that up to one-quarter of people with diabetes have...

Who should pay for Americans' health insurance?(VITAL SIGNS)(Table)(Brief article)
February 15, 2008... Who Should Pay for Americans' Health Insurance? Individuals, employers, and government should share costs 66% Mostly government 15% Mostly employers 8%...

ACCORD trial casts doubt on intensive glucose control: mortality up 20% in high-risk patients.(News)(Action to Control Cardiovascular Risk in Diabetes)
February 15, 2008... Stringent glucose control targets for high-risk patients are receiving new scrutiny following the decision by the National Heart, Lung, and Blood Institute to discontinue intensive glucose reduction as part of an ongoing study of cardiovascular...

Varenicline may increase depression, suicide risk.(News)
February 15, 2008... The Food and Drug Administration is evaluating post-marketing adverse event reports of serious neuropsychiatric symptoms--including agitation, depressed mood, and suicidal ideation and behavior--in people taking the smoking-cessation drug...

Bisphosphonates can cause severe pain.(NEWS FROM THE FDA)
February 15, 2008... The Food and Drug Administration has issued an alert about the possibility that patients on bisphosphonates can develop severe musculoskeletal pain days, months, or even years after initiating treatment. Although the precautions section of...

FDA adds warning to carbamazepine label for patients of Asian ancestry.(NEWS FROM THE FDA)(Food and Drug Administration)
February 15, 2008... Patients of Asian ancestry are at significantly increased risk for fatal skin reactions when treated with carbamazepine and should undergo genetic testing to assess their risk before initiating therapy, according to an alert issued by the Food...

Natalizumab gets the nod for use in selected Crohn's disease patients.(NEWS FROM THE FDA)
February 15, 2008... The Food and Drug Administration's approval of natalizumab for the treatment of moderate to severe Crohn's disease in selected patients includes the requirement that the drug will be administered only through a restricted distribution program,...

Restricted ESA use could deplete U.S. blood supply.(News)(erythropoiesis-stimulating agents)
February 15, 2008... WASHINGTON -- Limiting the use of erythropoiesis-stimulating agents in patients with chemotherapy-induced anemia would greatly increase demand for blood products and impose considerable pressure on the available U.S. blood supply, according to...

Vitamin D: growing evidence of longevity benefit.(News)(Clinical report)
February 15, 2008... SNOWMASS, COLO. -- Mounting evidence strongly suggests vitamin D supplementation reduces all-cause mortality. "We may finally have a vitamin that translates into greater longevity," said Dr. Robert A. Vogel, professor of medicine at the...

Reimbursement system is flawed.(LETTERS)(Letter to the editor)
February 15, 2008... After 40 years as an internist, I feel relatively well qualified to comment on the report by the American Board of Internal Medicine ("ABIM Proposes Comprehensive Internist Concept," Dec. 15, 2007, p. 1). I practiced with my wife--also an...

Certification won't help IM shortage.(LETTERS)(Letter to the editor)
February 15, 2008... I believe that to become fairly capable internists we already have to demonstrate competence in the eight aspects that were mentioned in the recent article on a proposed ABIM certification module ("ABIM Proposes Comprehensive Internist...

Correction.(Correction notice)
February 15, 2008... In "Consider Quality of Life Before Liver Transplant" (Jan. 15, 2008, p. 32), an incorrect affiliation was given for Dr. John Brems of Loyola University in Chicago.

Looking beyond the ezetimibe controversy.(GUEST EDITORIAL)
February 15, 2008... "Rumors of my death have been greatly exaggerated." Mark Twain is said to have made the remark above regarding premature reports of his own demise. The same thing might be said today about ezetimibe. One could not possibly escape the...

Pain relievers.(Opinion)(Cartoon)
February 15, 2008... "The good news is that your health plan speaks very highly of you."

CDC announces plans to investigate Morgellons.(Dermatology)
February 15, 2008... The Centers for Disease Control and Prevention is launching a study to improve understanding of an unexplained and controversial dermatologic condition known as Morgellons, which is affecting an increasing number of individuals both in the...

Diet plus low-dose cyclosporine very effective in obese psoriasis patients.(Dermatology)
February 15, 2008... ZURICH -- Combining a supervised weight-loss diet with substandard-dose cyclosporine in obese patients with severe chronic plaque psoriasis makes for very effective therapy, Dr. Paolo Gisondi reported at the annual meeting of the European...

Psoriasis drug excels in phase III study.(Dermatology)(Clinical report)
February 15, 2008... More than two thirds of patients with moderate to severe plaque psoriasis achieved at least a 75% reduction in area and severity after just two subcutaneous doses of ustekinumab, according to phase III study results presented at the 21st...

Adjust treatment of skin disorders in black patients.(Dermatology)(Clinical report)
February 15, 2008... BUENOS AIRES -- The five most common skin disorders of black patients can be effectively managed by understanding that not all skin types are treated the same, Dr. Susan C. Taylor reported at the 21st World Congress of Dermatology. Acne is...

Stem cells hold hope for genetic skin diseases.(Dermatology)
February 15, 2008... Researchers who have been struggling to overcome barriers to genetics-based therapies for skin disorders say cure may not be far off, particularly in light of a revolutionary advance by Italian researchers that effectively cured regions of skin...

Few patients carry melanoma-linked p16 gene mutation.(Dermatology)
February 15, 2008... MONTEREY, CALIF. -- Recommend p16 mutation genetic testing only in patients with multiple primary melanomas or a family history that includes multiple cases of melanoma or pancreatic cancer, Dr. Susan Swetter advised at the annual meeting of...