Treated in time, HIV no longer kills

July 15, 2008 –

Late treatment effects—not so much the virus—threaten new HIV patients

People diagnosed with sexually transmitted HIV in the industrialized world today have no greater risk of death within five years than the general population, according to the latest report from the multicenter European CASCADE study.

Those still at somewhat greater risk:

* Intravenous drug users
* People not treated immediately with the HAART regimen.
* In general, men compared with women.

Patients may yet face some excess mortality risk, starting a decade after they first show evidence of anti-HIV antibodies. This is probably due to the cardiac effects of the treatment regimen.

Related searches

CASCADE Collaboration HIV (Other results from the European study)

DAD study HIV (First evidence of heart risks from antiviral drugs)

SMART study HIV (Why restricting antivirals because of this risk is a bad idea)

CME

Find a free government-sponsored online CME course about HIV management.

Practice Guidelines

Find recent guidelines from the New York State Department of Health that address HIV management in primary care.

These guidelines give special attention to management of anxiety and depression, including increased risk of suicide, in this patient population.

Research/Reviews

Look to this category for more information about HAART toxicity.

By smnewsletters | Posted in Family Medicine, Internal Medicine, Respiratory_Infectious | Tags: , , , | Comments (0)

Antipsychotics won’t stop a bully

July 15, 2008 –

Antipsychotics quell violence in schizophrenia–unless that’s not the cause

In general, antipsychotic medication leads to significant reductions in violent behavior among schizophrenia patients, according to new results from the multicenter CATIE study, sponsored by the National Institute of Mental Health.

However, look also for non-psychotic sources of violent behavior, suggests the report in the British Journal of Psychiatry, which medications will not help and which may require intensive therapy. For instance, among subjects with a childhood history of antisocial conduct problems, adherence to antipsychotic medication had no effect on the prevalence of violent behavior.

The 1445-patient study also revealed the following predictors of violent behavior among schizophrenia patients:

* Childhood conduct problems
* Substance misuse
* History of violent victimization
* Economic deprivation
* Living with others rather than alone

Schizophrenia patients with negative psychotic symptoms were less likely to be violent.

Related searches

victimization of mentally ill

MacArthur study

Practical Articles/News

A search here turns up an article from last month’s Psychiatric Times about how to protect yourself against a violent patient.

Research Reviews

Find studies on the effects of clozapine on violent patients with schizophrenia. (Clozapine was not included for patients in this arm of the CATIE study.)

By smnewsletters | Posted in Psychiatry, Schizophrenia | Tags: , , , , , , | Comments (0)

For resistant depression: Rewire brain

July 8, 2008 –

Deep brain stimulation shows promise for treatment-resistant depression

Deep brain stimulation (DBS) is back in the news, after an Emory University speaker reviewed evidence for its efficacy in treatment-resistant depression at the APA meeting. Patients remain awake during the procedure, and some report an immediate lift.

The FDA has approved DBS for Parkinsonism and then for tremor caused by a number of neurologic disorders.

Investigators are trying the procedure on a host of other illnesses, and more headlines are sure to appear.

Related searches

Helen Mayberg (the speaker at APA)

Brodmann area 25 (the affected cortical region).

Evidence-based Articles

Ponder this: A recent meta-analysis by Johns Hopkins researchers finds a “high rate of suicide” among Parkinson’s patients treated with DBS.
You have the option to purchase full text by clicking the link “View Medline

Clinical Trials

You can learn from information about clinical trials where the procedure is being tested.

By smnewsletters | Posted in Depression, Nervous System | Tags: , | Comments (0)

Eluting stents cleared of death charge

July 8, 2008 –

Medicare claims show no added mortality risk from drug-eluting stents

Doctors at Dartmouth compared outcomes for people who had metal stents before the sirolimus-eluting stent became available with those for who later got the new stent called Cypher. There was virtually no difference in mortality, they report in the Journal of the American Medical Association.

As in prior studies, those who had the drug-eluting stent were less likely to need treatment for restenosis.

The drug-eluting stent certainly does no harm, conclude the authors, who compared data from nearly 67,000 individuals given stents on a non-emergency basis.

But they didn’t study the paclitaxel-eluting stent (Taxus) and could not assess the possible influence of dual-antiplatelet therapy.

Related searches

STEMI stents

Taxus

Evidence-based Articles

What is the existing evidence about the best protocol for dual antiplatelet therapy in patients who are stented?

Research/Reviews

What is the risk of late thrombosis in stent recipients?

Practice Guidelines

What are current practice standards in use of drug-eluting stents?

By smnewsletters | Posted in Cardiovascular | Tags: , | Comments (0)

When enough is too much

July 8, 2008 –

New success measures for late-stage cancer treatment evoke tough questions

Among 11 candidate biomarkers under study in the UK MRC FOCUS trial, the largest-yet trial of metastatic colorectal cancer, levels of topoisomerase-1 (Topo1) appears to be the only one that predicts response to irinotecan in combination with fluorouracil. Patients with a high response to Topo1 gained a median 5.3 months of survival.

In the other arm of the trial, Topo1’s predictive value for fluoruracil-oxaliplatin was suggestive but not significant, at p = 0.05.

Oncologists have been wondering aloud how to communicate with patients when (as in the study above), continuing chemotherapy offers only a few more months of life at the cost of adverse effects.

“When is enough enough?” ask the authors of an article in a recent issue of the Journal of the American Medical Association. 

Another recent report, this one in the Journal of Clinical Oncology,assesses prognostic factors for 2-month survival among hospitalized patients with advanced solid tumors. A combination of factors proved most predictive:

* Karnofsky index
* Number of metastatic sites
* Low serum albumin, and
* LDH concentration

The patient’s desire to continue treatment was also associated with survival.

Evidence-based Articles

A recent article in BMJ Clinical Evidence by authors from the UK and Canada ponders whether adverse effects data from major trials like the one above can be relevant in community practice, and how to make them more so.

Related searches

topoisomerase-1 irinotecan

chemotherapy decision aids

By smnewsletters | Posted in Cancer, Colorectal, Medical ethics | Tags: , , | Comments (0)

Like it or not, you may have to cough up

July 1, 2008 –

Fewer than one in five medical practices has even a basic EMR system

Primary care practices are significantly more likely than others to have electronic medical record systems, according to a national survey reported in the New England Journal of Medicine. Still, only 21% have even a basic system (as against a mere 17% of all practices).

Two-thirds of respondents without EMR said that cost was a major concern, and half that they weren’t sure it’s a good investment. But 9 in 10 who have EMR say they’re satisfied.

The study predicts that government actions will soon make the investment unavoidable.

US doctors lag those in other Western countries. Two years ago a similar survey in Australia showed that 90% of GPs there were using computerized records.

Practice Management

Find useful information on EMR product assessment in this category.

Practical Articles/News

A recent article examines the impact of electronic medical records on the physician-patient relationship..

By smnewsletters | Posted in Family Medicine, Internal Medicine | Tags: , | Comments (0)

What Botox may hide besides wrinkles

July 1, 2008 –

Brain changes make persistent pain entirely different in older people

Pain is biologically different in older patients, and persistent pain requires entirely different management in the elderly than you’d user for younger people, according to a report in the British Journal of Anaesthesia.

(Do you want the full text of this article? We can’t provide it for you, but you can purchase a copy for $28 by clicking the link “Full text” at the upper right of the abstract.)

Data in the study show brain changes in perception and response to pain that have implications for treatment. In many cases, social isolation also contributes to the problem.

The researchers found that mindfulness meditation may be especially useful for persistent pain in this population.

Related searches:

descending inhibition pain

oral cannabis pain

Research/ Reviews

Find other new information about research into chronic pain in this category.

Practice Guidelines

It’s easy to look up the latest guidelines for management of chronic pain.

Practical Articles/News

How do you manage the risk of addiction while treating pain?

By smnewsletters | Posted in Family Medicine, Geriatrics, Internal Medicine, Nervous System, Uncategorized | Tags: , | Comments (0)

What Botox may hide besides wrinkles

July 1, 2008 –

Brain changes make persistent pain entirely different in older people

Pain is biologically different in older patients, and persistent pain requires entirely different management in the elderly than you’d user for younger people, according to a report in the British Journal of Anaesthesia.

Do you want the full text of this article? We can’t provide it for you, but you can purchase a copy for $28 by clicking the link “Full text” at the upper right of the abstract.

Data in the study show brain changes in perception and response to pain that have implications for treatment. In many cases, social isolation also contributes to the problem.

The researchers found that mindfulness meditation may be especially useful for persistent pain in this population.

Related searches:

descending inhibition pain

oral cannabis pain

Research/ Reviews

Find other new information about research into chronic pain in this category.

Practice Guidelines

It’s easy to look up the latest guidelines for management of chronic pain.

Practical Articles/News

How can you manage the risk of addiction while treating pain?

By smnewsletters | Posted in Geriatrics, Nervous System | Tags: , | Comments (0)

Losing strategy: Purge, don’t binge

June 24, 2008 –

To create an eating-disordered teen: Turn on MTV, then call her chubby

The largest, longest-running study of disordered eating among adolescents and teenagers shows that about 10% of girls and 3% of boys binge eat, purge, or both at least weekly in order to lose weight. Data come from about 11,000 children of women in the national Nurses Health Study II.

A large group of girls who purge without binge eating are going unrecognized, the authors suggest, because they don’t fit current diagnostic criteria.

The study set out to define predictors of disordered eating. These include
* teasing about weight,
* maternal history of eating disorder (but only for adolescent girls), and
* also for girls, wanting to look like young women in the media.

They urge that young women at risk should be educated about issues of media and body image.

Related Searches

bulimia nervosa

binge eating disorder

Research/Reviews
The results show that adolescent girls are at greater risk if their mothers were affected. What is the evidence about heritability of eating disorders?

Evidence-based Articles
The new study adds to already solid evidence that teasing about weight breeds eating disorders and other emotional problems.

By smnewsletters | Posted in Adolescent, Family Medicine, Pediatrics, Psychiatry | Tags: , , | Comments (0)

Totally awesome!!!! (But is it oozing?)

June 24, 2008 –

Increase in body piercings causes headaches for health providers

Doctors should prepare for the consequences as piercing of body parts other than earlobes gains in popularity, according to a government-sponsored study in the UK.

About one in ten adults has had something other than an earlobe or two pierced, the study found. Navels were the most common site (reported by one teen girl in three, with complications in one-third of those cases). Oral piercings are on the increase.

A startling one piercing in ten took place outside a specialist piercing shop. There was at least one report of piercing by self or a friend for every body part mentioned in the study, including nipples and genitals.

One body piercing in 100 ended in hospitalization.

These data confirm and expand on similar results from the United States.

Related searches

auricular perichondritis

tattoos

Research/Reviews

There are numerous reports about the risks that body piercing may cause viral hepatitis.

By smnewsletters | Posted in Adolescent, Family Medicine, Pediatrics, Uncategorized | Tags: , , | Comments (0)