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.


Which breast cancer test is best?

October 7, 2008

New test tells who can avoid adjuvant therapy for ER+ breast cancer

A newly published profile of postoperative clinical and biological markers accurately identifies those women with estrogen receptor-positive breast cancer who would benefit from post-operative adjuvant therapy and those who would not. The report from an international team appears in the current Journal of the National Cancer Institute.

They developed the profile using 60-month followup outcomes from the P024 neoadjuvant chemotherapy trial of letrozole and tamoxifen. They validated it by analyzing data from the IMPACT trial of anastrozole and tamoxifen.

The authors call their panel of indicators the preoperative endocrine prognostic index (PEPI). It includes:

* pathological tumor size
* node status
* level of the cell-cycle marker antigen Ki67, and
* postoperative ER status.

Only last month an editorial in Journal of Clinical Oncology trumpeted a report of another prognostic panel for estrogen receptor-positive breast cancer.

As new tests proliferate, you can use SearchMedica to keep track of them.

Failing to report and assess estrogen-receptor subsets can have a dramatic effect on the results of clinical trials testing adjuvant therapy, according to a report in the latest JCO. The authors urge that every trial should include this information going forward.

Related searches

P024

Ki67

Research/Reviews

Turn to this category for a quick look at recent studies of ER+ breast cancer.

CME

Look here for recent accredited CME courses on the topic.


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..


Sunshine is an antidepressant

September 30, 2008

New data explain why winter causes blues and summer lightens the mood

The amount of circulating serotonin available to the brain correlates with number of daylight hours, which should help to explain why people get the blues during the winter months.

This information comes from a new study that used improved biological methods to test healthy volunteers with no history of depression.

Daylight correlated with a reduction in regional serotonin transporter binding potential, which is related to the amount of serotonin available to the brain. Levels were higher in fall and winter for all volunteers, meaning that more serotonin was bound to the transporter and unavailable.

Then what about the evidence that suicides are most common in the spring, when there’s more daylight? A good question for further research, the authors say.

Maybe it has something to do with the sudden shift in serotonin transporter levels, or with differences in brain regionalization as they change.

Life events also affect levels of this molecule, according to previous studies.

Depression also correlates with time of sunrise, according to a 2003 study from Quebec. The author suggested manipulating daylight savings time with this in mind.

Clinical Trials

The relationship between light and depression is the subject of numerous clinical trials now underway.

Related searches

melatonin seasonal depression

light therapy SAD

photoperiod depression

Seasonal Pattern Assessment Questionnaire

Seasonal Health Questionnaire SAD


Parkinson’s also causes pain

September 23, 2008

Besides depression, pain shown to be non-motor symptom of Parkinson’s

Patients who develop Parkinson’s disease are significantly more likely than other individuals to esperience pain. It is usually associated with dystonia and most likely to occur in the shoulder, back, leg or foot

This information comes from a new multicenter case control study by researchers in Bari, Italy reported in Archives of Neurology.

There is growing recognition of the importance of nonmotor symptoms in Parkinson’s, including depression

However, it’s too soon to find any advice about treating this kind of pain in guidelines about Parkinson’s disease.

Related searches

treatment depression Parkinsons

Evidence-based Articles

What is the relationship between pain and depression? No evidence yet with regard to Parkinson’s per se, but there are insights in studies from other disorders.

CME

The query pain Parkinson’s in this category does turn up an online course about neuropathic pain.


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


Foreign travelers: bad influence on some kids

September 2, 2008

CDC reports highest measles rates for more than a decade

Measles cases in the US this year are at their highest in more than a decade, as the Centers for Disease Control and Prevention (CDC) reports in Morbidity and Mortality Weekly Reports. In 2000, the CDC declared the disease eradicated in the US.

The increase was due not to people catching measles abroad but largely to unvaccinated children catching it from those who carried the infection from outside the US.

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(Source: Centers for Disease Control and Prevention)

States with more lenient vaccine exemption policies have increased infection rates, according to a recent report in the Journal of the American Medical Association.

Patient Education

Look in this category (in the list above the main search results) for take-home information for parents about measles.

Practice Management

This tab (above the search box) offers practical information about what to do when patients (or their parents) refuse immunization.


MDs give labs a D on test results

August 26, 2008

Family doctors say labs make mistakes in clinical testing 40% of the time

Mistakes involving laboratory tests have adverse consequences three times out of four, causing the patient physical or emotional harm in 18% of cases, according to a new study based on a survey of family practices.

The poll found a wide variety of errors. More than 40% of them were the fault of the lab, doctors reported, which either did the wrong test or did it incorrectly (18%) or failed to notify the right person about the results (25%).

Errors in interpreting test results were said to be very rare (0.3%)

The survey, reported in the June issue of Quality and Safety in Health Care, involved voluntary responses from 243 clinicians taking part in the American Academy of Family Physicians’ National Research Network. Doctors and office staff reported on their own experience.

If the study was published in June, why is it making headlines now? Because the lead author’s institution (the University of Chicago) sent out a press release.

The survey authors acknowledge that they left it up to respondents to define “test error”. Doctors have widely varying perceptions of how to define the term, according to another study.

It may be a good idea to enlist nurses and office staff to monitor and report errors, University of Vermont researchers suggest in an article recently published in the International Journal for Quality Health Care.

For a topic like this, the perfect place to look for more information is SearchMedica’s new Practice Management option. Find it among the tabs above the main search box.

Practice Management

Find ways to reduce, avoid, or mitigate errors in medical testing.

How useful are electronic reminders in addressing this problem?

Noteworthy recent searches

alternative medicine gastroenterology

A report published this month finds that about 40% of parents are turning to alternative medicine when traditional remedies don’t solve their child’s GI problem. Nobody has yet documented what treatments they’re trying.

(But you might try looking in the article category Complementary Medicine to see what may be recommended for chronic tummyache.)

See: Use of Complementary and Alternative Medicine by Pediatric Patients With Functional and Organic Gastrointestinal Diseases
Pediatrics (free full text)

keratin accumulating cell

British researchers have devised a new antibody test that clarifies the diagnostic subgroups in myasthenia gravis. It may also have important implications for diagnosing other autoimmune diseases that involve the nervous system.

See: IgG1 antibodies to acetylcholine receptors in ’seronegative’ myasthenia gravis
Brain (free full text)

osteoarthritis medial compartment bracing knee

This search turned up a recent comprehensive review for primary care physicians about management of osteoarthritic knees.

See: Managing knee osteoarthritis before and after arthroplasty
Cleveland Clinic Journal of Medicine (free full text)


Breast cancer found early: No clean slate after all

August 26, 2008

Substantial recurrence risk shown to follow systemic breast cancer therapy

MD Anderson researchers found a 20% recurrence risk 10 years after breast cancer patients were declared disease-free following five years of adjuvant treatment. Results of the retrospective registry study appear in the August Journal of the National Cancer Institute.

No guidelines address this situation for premenopausal women. But the range of risk would justify adjuvant or neoadjuvant therapy at the time of diagnosis, according to the authors.

Predictors of late recurrence include:

* Hormone-positive tumors not treated with endocrine therapy
* Higher stage

Very recently the same team reported on the prognostic significance of Her2 status in inflammatory breast cancer.

Practical Articles/News

The query “breast cancer anxiety” in this article category delivers a recent review of psychological factors that predict emotional distress in breast cancer patients.

Research/Reviews

Two recent reports in this article category correlate receptor subtype with location of tumor recurrence in breast cancer.


A new way to feel everyone watching

August 19, 2008

Has reality TV spawned a new form of paranoid delusion?

A psychiatrist at New York’s Bellevue Hospital Center has been collecting cases of patients who have the delusion that their lives are a reality TV show. Because several of them identify with Jim Carrey’s character in the movie “The Truman Show”, a proposed new syndrome is named after that film.

(Looking for news from a wider range of sources than the selective SearchMedica list? Choose the option “The entire Web” just below the search box.)

The Bellevue psychiatrist in question, Joel Gold, was a coauthor of the study that documented PTSD among New York residents after the 9/ll attack.

In the high-surveillance, anti-terror era that came after, it’s no delusion that we’re being watched. But for decades psychiatrists have been reporting delusions that involve television.

Related searches

thought broadcasting

delusions virtual reality

Evidence-based Articles

What defines a new delusional syndrome? Authors from Massachusetts suggest that different delusions are more alike than unlike, in this 1999 review.

Free full text is available by clicking on “View Medline abstract on pubmed.gov” and finding the publisher’s link at the upper right of the next screen.