Next: Genetic profiles on Facebook?

November 4, 2008

Project seeks volunteers to make their DNA profiles public for researchers

People may be thinking about genetic testing again, after reading recent press reports about the Personal Genome Project.

Late last month, the first few volunteers saw some of their genetic information made public on the Internet.

This effort seeks 100,000 volunteers willing to have their DNA sequenced, databased, and stored online, along with identifying medical and personal information, in order to speed the development of medical genomics.

For a quick brush-up on the pros and cons of reading your own gene map, the search term
risks genetic testing
offers some balanced reflections.

In some cases, diagnosis by history and examination has already given way to genetic testing. For instance, it’s now time to think “genotype first” when you see a child with a developmental issue, said an editorial in the New England Journal of Medicine a few weeks ago.

See what you can find by searching through the article categories with the search term “genetic testing”.

Evidence-based Articles

Scroll down first page of results for genetic testing to find a recent systematic review in JAMA about genetic testing for chronic adult diseases.

Practical Articles/News

This category holds a news article showing that an inconclusive genetic result can be as distressing as a positive one.

Patient Education

Scroll down here to find a Mayo Clinic blog for patients who may want to learn more about the topic on their own time.

No Comments » | Cancer, Cardiovascular, Diabetes_Endocrine, Family Medicine, Gastrointestinal, Internal Medicine, Medical ethics, Nervous System, Psychiatry, Respiratory_Infectious | Tagged: , | Permalink
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Surviving the credit crisis with no bailout

October 28, 2008

Economic downturn spells yet tougher times for primary care, experts say

The current financial crisis could resolve the physician shortage temporarily, because seasoned doctors will probably delay retirement as a result, predict the pundits interviewed in a news report from MedPage Today.

However, because new graduates may opt for more lucrative specialties as a result of the crisis, the shortage of primary care physicians may worsen.

Everything may change after the election. Meanwhile, how should you respond to the current crisis?

Practice Management

In light of current events, learn how to make sensible decisions for your retirement planning.

How can your practice survive in the current credit crunch?

No Comments » | Family Medicine, Internal Medicine | Tagged: , , , | Permalink
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Now you can breathe easier about COPD

October 21, 2008

Spiriva doesn’t slow COPD decline, but it really helps a lot anyway

Tiotropium (Spiriva) did not achieve the main study objective of lowering the rate of decline in forced expiratory volume (FEV1) among COPD patients in the large multicenter UPLIFT trial.

However, the drug was responsible for significant improvements in

* lung function,
* quality of life, and
* time to first exacerbation

Patients in the study were allowed to use any respiratory medications they wanted, except for other inhaled anticholinergic agents.

Data from the same study just prompted the FDA to lift its earlier warning about tiotropium and the risk of stroke.

Like the TORCH study reported earlier this year, the UPLIFT study came close to (but did not succeed in) finding a significant effect on mortality.

The best way to slow the rate of FEV1 decline, of course, is to quit smoking. This helps even patients with severe COPD, according to a new review in the European Respiratory Journal.

Research/Reviews

In this category, you’ll find the latest research into the predictive value of the BODE index in COPD.

Related searches

Find reports from earlier trials of interventions to slow the respiratory decline in COPD:

EUROSCOP

ISOLDE

BRONCUS

No Comments » | Cardiovascular, Family Medicine, Geriatrics, Internal Medicine, Respiratory_Infectious, Uncategorized | Tagged: , | Permalink
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New cardiac test for primary care: Depression screening

October 14, 2008

AHA, APA advise depression screening for all with coronary heart disease

People who have coronary heart disease should all be screened for depression, the American Heart Association and the American Psychiatric Association advise in new recommendations published in Circulation.

The report offers substantial information about links between heart disease and depression. Using SearchMedica, you can quickly locate many of the supporting documents listed in the references.

Recent evidence suggests that young women may be at particularly high risk of depression after myocardial infarction.

Numerous studies link depression and depressive symptoms with poor outcomes in patients with coronary heart disease. Find them using the query “depression cardiac risk factor”.

Or you can retrieve a particular study in the reference list by using words from the title as your search term.

Depression and anxiety predict onset of cardiac events, according to a recent report in the Archives of General Psychiatry, located with the search term “depression anxiety predictors 2-year cardiac events”.

An earlier article in the same journal pinpointed a direct link between depression and the onset of coronary events.

There’s plenty of evidence that people with depression have poor adherence to treatment for cardiac conditions.

On the other hand, cardiac rehabilitation improves depression.

So, primary care physicians should be looking for, and probably treating, depression in heart patients.

Which screening instruments should they use?

Way back in 2000, the New England Journal published an article identifying ways to manage depression in outpatient practice.

In this case, even using its exact title (”Managing depression in medical outpatients”), that article appears far down the list, on page 3.

That’s not good! Why isn’t it at the top of the list?

(Because the article is so old, and SearchMedica’s default setting ranks newest articles highest.)

Try de-selecting the option “Prioritize results by publication date” just beneath the search box, making relevance to your search term rank higher than publication date. The eight-year-old article appears at the top of the list.

Practice Guidelines

Find a new guideline for treatment of depression in adults in primary care using this article category.

CME

Find a new CME course about treating depression in primary care, from an authoritative source.

No Comments » | Depression, Family Medicine, Internal Medicine | Tagged: , , , | Permalink
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Chelation and autism: End of the line?

October 7, 2008

NIMH pulls the plug on chelation therapy trial for autism

A clinical trial of chelation therapy in autistic children with detectable blood levels of mercury has been cancelled by the NIMH.

The agency explained that a suggested link between mercury-containing vaccines and autism has not been proven.

Also, rat studies suggested that chelation therapy might be dangerous in the absence of blood lead.

No children had been enrolled in the clinical trial before it was cancelled.

All of Medicine tab

This month’s edition of Archives of Disease in Childhood compiles a recent study finding no link between the MMR vaccine and autism with letters responding to that study.

Practical Articles/News

A recent article in Psychiatric Times reviews complementary therapies for autism.

Evidence-based Medicine

Placebo worked just as well as chelation therapy in reducing distress among people concerned about the mercury in their dental fillings, according to an old randomized study found in this article category.

(The chelating drug did elute mercury, but people on placebo scored equally on anxiety and somatization measures after treatment.)

No Comments » | Adolescent, Family Medicine, Internal Medicine, Pediatrics, Psychiatry, Uncategorized | Tagged: , , , , , | Permalink
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Flu shots, cradle to college

October 7, 2008

CDC says far too few tots get influenza vaccine, urges shots from 6 months

All children older than six months should get the flu shot, according to a new advisory from the Centers for Disease Control and Prevention.

Infants between six and 23 months old are at particular risk of hospitalization with influenza. Yet last year only one in five tots in this age range received the influenza vaccine.

The agency is paving the way for your conversation with parents, using a major mass media campaign that targets consumer health blogs and parenting websites.

Twenty two leading agencies, including the American Academy of Family Physicians and the American Academy of Pediatrics, joined last month in a new alliance to bolster public confidence in immunization.

Infants younger than six months can be protected from influenza if the expectant mother gets a flu shot, according to a new study in the New England Journal of Medicine.

Practice Guidelines

Quickly find the latest guidelines on prevention and treatment of influenza in children.

Patient Education

Here’s the place to find reliable information for parents on the question of preventing and treating flu in their kids.

No Comments » | Adolescent, Family Medicine, Influenza, Internal Medicine, Pediatrics, Women | Tagged: , , , , | Permalink
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Primary care: Best for health but worth the least?

September 30, 2008

Primary care docs earn the least, and med students vote with their feet

A radiologist earns twice as much as a primary care doctor on average, and radiologists’ starting salaries are nearly three times as high.

The primary care specialties (pediatrics, family practice, internal medicine) continue to have the lowest salaries. Is it any wonder that senior medical students are least likely to choose primary care?

Comparative salaries and specialty choices on graduation from US medical schools appeared in a letter to the Journal of the American Medical Association earlier this month.

Studies consistently show that having more primary care doctors equates with better health outcomes for a population. What can be done?

A Harvard health policy expert leads you through an analysis of the proposed solutions, writing a commentary in the current New England Journal of Medicine.

A recurrent buzzword in this discussion is medical home. What does that mean, and how would it work?

Practice Management

Some primary care physicians are actually doing better this year than last, but it depends upon their specialty and where they work. This information comes from a survey published last month in Modern Medicine.

A new article in Physician’s Practice offers practical help in coping with Medicare’s PQRI system for reimbursing documented quality in medical care..

No Comments » | Family Medicine, Internal Medicine | Tagged: , , , | Permalink
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From India, online: Toxic “cures”

September 9, 2008

High levels of toxic metals found in Internet-based Ayurvedic remedies

Among Ayurvedic herbal remedies available on the Internet from 37 manufacturers, 21% contained metals such as lead and arsenic at dangerously high levels, according to a report in the Journal of the American Medical Association.

Ayurvedic products from sources in the United States had generally lower levels than those from India, which contained toxic metals at 100 to 10,000 times acceptable levels. Products from American sources that claimed to follow Good Manufacturing Practices or to carry out toxic metal testing did not show lower levels of these metals.

There were similar results from Ayurvedic products bought in ethnic markets in Boston, according to a previous report from the same authors. Since then, several local health departments elsewhere have issued similar warnings.

Complementary Medicine

Learn more about ayurvedic medicine—from clinically authoritative sources—with a search in this article category.

Related searches

arsenic poisoning symptoms

lead poisoning symptoms

mercury poisoning symptoms

No Comments » | Family Medicine, Gastrointestinal, Internal Medicine, Nervous System | Tagged: , , , | Permalink
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Time to rethink who gets treated for HIV

August 19, 2008

New HIV guidelines urge treating healthier infected people sooner

The CD4+ T-cell threshold for treating HIV should be raised from 200 to 500 CD4+ cells/ml, which will include infected individuals whose immune systems are still fairly healthy, according to new guidelines published in the Journal of the American Medical Association.

The change is spurred by the increase in available drug regimens, as well as by new insights into the comorbidities of longstanding HIV infection such as renal disease.

The guidelines were released to coincide with the 17th International AIDS Conference in Mexico City, where Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said a cure for AIDS is theoretically possible.

For news reports like this (from a less selective variety of sources), choose the option “The entire Web” just below the search box.

HIV remains most common in in the US among men who have sex with men and among African Americans. This information comes from the first estimates of HIV incidence in the US based on new tests that can distinguish recent infections from longstanding HIV, which appear in another article in the same issue of JAMA.

Related searches

NNTRI (non-nucleoside reverse transcriptase inhibitor)

nRTI (nucleoside reverse transcriptase inhibitor)

abacavir hypersensitivity

Selzentry

Remember: For authoritative drug information, there’s a link to epocrates.com in the left column of every SearchMedica page.

Also in the News

Determined effort has conquered XDR-TB in a community program, according to a recent article in the New England Journal of Medicine.

In most cases, TB drug resistance in patients with HIV has its origins in another country. This suggestion comes from a new study published by the CDC.

Worldwide, TB is the leading cause of death for HIV patients, according to other information from CDC.

No Comments » | Family Medicine, HIV, Internal Medicine, TB | Tagged: , , , | Permalink
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New “epidemic”: Accidental suicides

August 12, 2008

Meds + booze + street drugs @ home = sharp rise in accidental deaths

Fatal medical errors skyrocketed in the two decades after 1983—but not in hospitals. The increase overwhelmingly involved people who died at home after mixing medicines, street drugs, and alcohol. Death rates in this category rose 30-fold between 1983 and 2003.

Oddly, accidental deaths from any of those three substances in isolation did not increase markedly during the same period.

Don’t just blame substance abusers: At-home deaths involving medications but not street drugs or alcohol increased nearly six-fold during those two decades.

The most common victims were men between the ages of 40 and 59.

The study of death certificates is newly published in the Archives of Internal Medicine.

The increase in these deaths has been accelerating. The article urges medical professionals to address the problem by:

* assessing how well patients can manage their own medicines
* taking pains to educate them about the risks of their medications and
* keeping track of their progress

Related searches

screening alcohol use

self-report alcohol drug

Research/Reviews

What’s the best way to talk with patients about their new prescriptions? We found interesting insights with the query communication risks.

Practical Article/News

In a recent review in Psychiatric Times, a Yale University psychiatrist warns about an emerging problem among aging baby boomers: substance abuse.

No Comments » | Family Medicine, Internal Medicine, Medical ethics, Psychiatry, Uncategorized | Tagged: , , , , , | Permalink
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