New England Journal of Medicine is seeking 20 visionary medical students and trainees from North America and west Europen to join the editor in October to explore how NEJM should meet the information needs of the next generation physicians and trainees.
Free accommodation and airticket will be provided for selected participants who will be required to present their ideas at the conference. If you think you have a creative mind and should be selected for attending the conference, submit an application form.
Thursday, July 31, 2008
Wednesday, July 30, 2008
Do certification examination scores reflect quality of care?
Researchers studied some 3600 physicians in US to determine the associations between their performance scores on the American Board of Internal Medicine MOC examination and the subsequent quality of care received by Medicare patients.
They found that physicians scoring in the top quartile were more likely to perform processes of care for diabetes and mammography screening than those in the lowest quartile, but no significant difference in lipid testing of patients with cardiovascular disease. They concluded that the findings suggest that physician's cognitive skills are associated with higher rates of processes of care for Medicare patients.
In the accompanying editorial, the author said that there are several mehtodological limitations in this study, what is needed is a method for measuring physician performance reflective of higher cognitive abilities and processes.
Source: "Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries". Archives of Internal Medicine. 2008;168(13):1396-1403 ( full text via Athens )
They found that physicians scoring in the top quartile were more likely to perform processes of care for diabetes and mammography screening than those in the lowest quartile, but no significant difference in lipid testing of patients with cardiovascular disease. They concluded that the findings suggest that physician's cognitive skills are associated with higher rates of processes of care for Medicare patients.
In the accompanying editorial, the author said that there are several mehtodological limitations in this study, what is needed is a method for measuring physician performance reflective of higher cognitive abilities and processes.
Source: "Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries". Archives of Internal Medicine. 2008;168(13):1396-1403 ( full text via Athens )
Anxiety could double diabetes risk in men
A 10-year study of 5,000 middle-aged Swedish men and women, found that men who suffered stress and sleepless nights were twice as likely to develop type 2 diabetes, the BBC reported.
All participants were asked questions about their lifestyle and had their BMI measured. They also completed a questionnaire to report their ‘psychological distress’. The researchers concluded that self-reported psychological distress was associated with development of type 2 diabetes in men, not in women.
Critics say previous studies have found a link between stress and type 2 diabetes in both men and women. There are also many limitations in the study, further studies are needed.
Source: "Psychological distress and risk of pre-diabetes and type 2 diabetes in a prospective study of Swedish middle-aged men and women". Diabetic Medicine 2008; 25:834-842
All participants were asked questions about their lifestyle and had their BMI measured. They also completed a questionnaire to report their ‘psychological distress’. The researchers concluded that self-reported psychological distress was associated with development of type 2 diabetes in men, not in women.
Critics say previous studies have found a link between stress and type 2 diabetes in both men and women. There are also many limitations in the study, further studies are needed.
Source: "Psychological distress and risk of pre-diabetes and type 2 diabetes in a prospective study of Swedish middle-aged men and women". Diabetic Medicine 2008; 25:834-842
Tuesday, July 29, 2008
45 minutes walk a day can help control diabetes
Newspapers reported a small study of 20 volunteers ( 10 with and 10 without type 2 diabetes)that found walking improved the bodies' ability to store sugar and burn fat, helping to control diabetes.
Each volunteer was given a pedometer and asked to walk an extra 45 minutes each day. After increasing physical activity for 8 weeks, the number of steps had increased to 12,322 a day in the diabetic group, and to 9,187 steps a day in the control group. Researchers found there were no changes in the enzyme ATP use, but lipid metabolism rates increased more in the people with diabetes than in the control group. They concluded that physical activity such as walking can improve cellular metabolism of the diabetes. Further studies would be needed.
Source : "Increased daily walking improves lipid oxidation without changes in mitochondrial function in Type 2 diabetes." Diabetes Care 2008; May 16 [Epub ahead of print]
Each volunteer was given a pedometer and asked to walk an extra 45 minutes each day. After increasing physical activity for 8 weeks, the number of steps had increased to 12,322 a day in the diabetic group, and to 9,187 steps a day in the control group. Researchers found there were no changes in the enzyme ATP use, but lipid metabolism rates increased more in the people with diabetes than in the control group. They concluded that physical activity such as walking can improve cellular metabolism of the diabetes. Further studies would be needed.
Source : "Increased daily walking improves lipid oxidation without changes in mitochondrial function in Type 2 diabetes." Diabetes Care 2008; May 16 [Epub ahead of print]
Daily orange juice could increase diabetes risk
Newspapers reported a large study of 70,000 female nurses in the US to determine the links between diet and risk of various outcomes.
During the 18-year follow-up, 4529 new cases of diabetes were reported. Reserachers found that drinking one or more cups of orange juice per day increased the risk of diabetes by about 24% compared with drinking less than one cup a month, whereas the same increase in whole fruit consumption was associated with a lower risk of developing diabetes. Also found that an increase of 1 serving/day in green leafy vegetable consumption was associated with a modestly lower risk of diabetes.
Critics say the link between fruit juice consumption and risk of type 2 diabetes may be related to the high sugar content in the juice and the results warrent further study.
Source :"Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women." Diabetes Care 2008; 31:1311-1317
During the 18-year follow-up, 4529 new cases of diabetes were reported. Reserachers found that drinking one or more cups of orange juice per day increased the risk of diabetes by about 24% compared with drinking less than one cup a month, whereas the same increase in whole fruit consumption was associated with a lower risk of developing diabetes. Also found that an increase of 1 serving/day in green leafy vegetable consumption was associated with a modestly lower risk of diabetes.
Critics say the link between fruit juice consumption and risk of type 2 diabetes may be related to the high sugar content in the juice and the results warrent further study.
Source :"Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women." Diabetes Care 2008; 31:1311-1317
Wednesday, July 23, 2008
Prostate cancer wonder pill trial
Multiple news sources reported a small phase 1 trial involving 21 men with aggressive and incurable form of prostate cancer. The participants were given daily dose of a new drug, abiraterone, in 28-day cycles. Researchers found that 12 of the 21 patients had a 50% decline in PSA ( prostate specific antigen) after one month and 6 had a 90% decline. They also found in some patients, tumor shrank, regression of some of the cancers and reduction of the dose of analgaesics required to ease the pain. Researchers said the results indicated the evidence of the safety of abiraterone.
Critics say the results are preliminary and no survival advantage has been proved in this very small trial. A 2nd larger study is already underway and will provide more information about the effectiveness of the drug in treating the disease to a wider group of people.
Source : "Phase I Clinical Trial of a Selective Inhibitor of CYP17, Abiraterone Acetate, Confirms That Castration-Resistant Prostate Cancer Commonly Remains Hormone Driven." Journal of Clinical Oncology 2008; Jul 21 [Epub ahead of print]
Critics say the results are preliminary and no survival advantage has been proved in this very small trial. A 2nd larger study is already underway and will provide more information about the effectiveness of the drug in treating the disease to a wider group of people.
Source : "Phase I Clinical Trial of a Selective Inhibitor of CYP17, Abiraterone Acetate, Confirms That Castration-Resistant Prostate Cancer Commonly Remains Hormone Driven." Journal of Clinical Oncology 2008; Jul 21 [Epub ahead of print]
Wholegrain bread protects pregnant women against re-eclampsia
A newspaper reported a study that suggests eating slices of brown bread a day protects women against pre-eclampsia in pregnancy.
More than 1,500 women were given food frequency questionnaires at around 13.1 weeks of pregnancy to assess their diet before conception and during the first trimester. The researchers found that women with the highest fibre intake had about 70% reduction of pre-eclampsia risk compared with those in the lowest intake. They also found that women with the highest fibre intake had the lowest levels of blood triglycerides (excess fat) and higher levels of good cholesterol. They said more studies are needed to confirm the health benefits associated with increased fibre consumption before and during early pregnancy.
Source: "Dietary Fiber Intake in Early Pregnancy and Risk of Subsequent Preeclampsia." American Journal of Hypertension 2008; Jul 17 [Epub ahead of print] (Free full text)
More than 1,500 women were given food frequency questionnaires at around 13.1 weeks of pregnancy to assess their diet before conception and during the first trimester. The researchers found that women with the highest fibre intake had about 70% reduction of pre-eclampsia risk compared with those in the lowest intake. They also found that women with the highest fibre intake had the lowest levels of blood triglycerides (excess fat) and higher levels of good cholesterol. They said more studies are needed to confirm the health benefits associated with increased fibre consumption before and during early pregnancy.
Source: "Dietary Fiber Intake in Early Pregnancy and Risk of Subsequent Preeclampsia." American Journal of Hypertension 2008; Jul 17 [Epub ahead of print] (Free full text)
Epilepsy drug may increase risk of birth defects
A newspaper reported that the epilepsy drug, topiramate, which is also used for people with migraines, increased risk of birth defects if it is taken during pregnancy.
The finding is based on a small study of 203 pregnant women who were exposed to topiramate during the first 12 weeks of pregnancy. 70 of the partcipants used topiramate only, and the rest were exposed to topiramate plus at least one other antiepileptic drug during pregnancy.
Critics say the findings reflect what is already known that a number of antiepileptic drugs including topiramate, carry a risk of harming the developing foetus. Care should be provided to women who become pregnant while taking the drugs.
Source: "Topiramate in pregnancy: Preliminary experience from the UK Epilepsy and Pregnancy Register". Neurology 2008; 71:272–276
The finding is based on a small study of 203 pregnant women who were exposed to topiramate during the first 12 weeks of pregnancy. 70 of the partcipants used topiramate only, and the rest were exposed to topiramate plus at least one other antiepileptic drug during pregnancy.
Critics say the findings reflect what is already known that a number of antiepileptic drugs including topiramate, carry a risk of harming the developing foetus. Care should be provided to women who become pregnant while taking the drugs.
Source: "Topiramate in pregnancy: Preliminary experience from the UK Epilepsy and Pregnancy Register". Neurology 2008; 71:272–276
Tuesday, July 22, 2008
Art class will make better doctors?
Art courses are now offered to medical students in medical schools in the US to help improve their observation and diagnostic skills, reported The Boston Globe.
Dr Joel Katz, an internist at an American hospital, runs art courses for medical students and wrote about a study that showed medical students' ability to make accurate observations increased after completing the art course while the control group who did not take the course did not change. He said that doctors' physical examination skills are declining and many rely on technology to do their work. He believes that art class will train students to look more carefully at patients for clues and do not make assumptions about what they see.
Source: "Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills" Journal of General Internal Medicine 2008; 23(7) : 991-7
Doctors from all walks of life
This is an interesting perspective article on age as a factor in admissions decisions to medical schools and has attracted much online discussions from people all over the world.
The author, a Ph D in condensed-matter physics, entered medical school at 26, now assistant professor of medicine in NY, writes in The New England Journal of Medicine about nontraditional medical students who enter medicine at a later age and without the traditional pre-med background. He said that these nontraditional students are often a challenge to medical educators but the class is definitely enhanced by their presence.
Medical schools now routinely admit older students who already have families or another career. The author writes ".... perhaps they believe that medicine needs new voices…"
Source: "From All Walks of Life — Nontraditional Medical Students and the Future of Medicine" NEJM 2008, 359(3) : 224-227 ( free full text)
The author, a Ph D in condensed-matter physics, entered medical school at 26, now assistant professor of medicine in NY, writes in The New England Journal of Medicine about nontraditional medical students who enter medicine at a later age and without the traditional pre-med background. He said that these nontraditional students are often a challenge to medical educators but the class is definitely enhanced by their presence.
Medical schools now routinely admit older students who already have families or another career. The author writes ".... perhaps they believe that medicine needs new voices…"
Source: "From All Walks of Life — Nontraditional Medical Students and the Future of Medicine" NEJM 2008, 359(3) : 224-227 ( free full text)
Medical and social disabilities of preterm birth
Advances in perinatal care have increased the survival of very premature infants, however this has led to concerns about the ability of these children to cope as adults.
A new study published in the NEJM reported a cohort of nearly 1 millions infants in Norway, researchers used data from national registries to examine adult outcomes of these infants who were born without anomalies between 1967 and 1983. They found that the risks of medical and social disabilities in adulthood increased with decreasing gestational age at birth.
Source: "Long-Term Medical and Social Consequences of Preterm Birth" New England Journal of Medicine 2008, 359(3):262-273 ( abstract only)
A new study published in the NEJM reported a cohort of nearly 1 millions infants in Norway, researchers used data from national registries to examine adult outcomes of these infants who were born without anomalies between 1967 and 1983. They found that the risks of medical and social disabilities in adulthood increased with decreasing gestational age at birth.
Source: "Long-Term Medical and Social Consequences of Preterm Birth" New England Journal of Medicine 2008, 359(3):262-273 ( abstract only)
Friday, July 18, 2008
Low-carbohydrate diet more effetcive for weight loss
322 moderately obese employees of a research centre were assigned randomly to 3 different diets : low-carbohydrate, Mediterranean and low-fat diets over a 2-year period with support from the workplace. Researchers found that those on low-carbohydrate and Mediterranean diets lost about 10 pounds while those on low-fat diet an average of 6.4 pounds.
They also found that participants who followed low-carbohydrate and Mediterranean diets had better cardiovascular health than those in the low-fat group. For people with cholestero, low-carbohydrate diet seemed best, for those with diabetes, the Mediterranean diet. Critics say it is not clear whether individuals would have the same results without workplace support.
Source: "Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet." New England Journal of Medicine 2008; 359:229-241
They also found that participants who followed low-carbohydrate and Mediterranean diets had better cardiovascular health than those in the low-fat group. For people with cholestero, low-carbohydrate diet seemed best, for those with diabetes, the Mediterranean diet. Critics say it is not clear whether individuals would have the same results without workplace support.
Source: "Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet." New England Journal of Medicine 2008; 359:229-241
Is background TV bad for young children?
A newspaper reported a randomised controlled trial that looked at the effects of background TV on young children’s play behaviour. Researchers observed 50 children of 12 - 36 months old play with toys for 1 hour. A TV was on with commercials in the background for half an hour, then turned off for half an hour.
The researchers found that “very young children’s toy play was disrupted by background television” and said this may have a cumulative effect if the child has long periods of TV exposure at home. However, critics say it is not clear from this study whether this has any effect on development but this is an area of topical interest that will benefit from further research.
Source: "The Effects of Background Television on the Toy Play Behavior of Very Young Children." Child Development 2008; 79:1137–1151
The researchers found that “very young children’s toy play was disrupted by background television” and said this may have a cumulative effect if the child has long periods of TV exposure at home. However, critics say it is not clear from this study whether this has any effect on development but this is an area of topical interest that will benefit from further research.
Source: "The Effects of Background Television on the Toy Play Behavior of Very Young Children." Child Development 2008; 79:1137–1151
Breast self-examinations questioned?
According to a new Cochrane review, breast self-examination by itself does not increase survival. The finding is based on 2 studies of 120,000 Russian women and 266,000 Chinese women in 2003 and 2002 respectively.
Both suggest that self-examination actually increase benign biopsies but does not get the patient into earlier treatment. However, the study does not say women should not do self-examinations, but researchers wrote "screening by self-examination or physical examination cannot be recommended".
Source: "Regular self-examination or clinical examination for early detection of breast cancer." The Cochrane Database of Systematic Reviews 2008 Issue 3 ( full text via Athens from Cochrane Library)
Both suggest that self-examination actually increase benign biopsies but does not get the patient into earlier treatment. However, the study does not say women should not do self-examinations, but researchers wrote "screening by self-examination or physical examination cannot be recommended".
Source: "Regular self-examination or clinical examination for early detection of breast cancer." The Cochrane Database of Systematic Reviews 2008 Issue 3 ( full text via Athens from Cochrane Library)
Thursday, July 17, 2008
Eating too many nuts could increase childhood asthma risk
Newspapers reported that eating too many nuts in pregnancy could put babies at risk of asthma.
More than 4,000 expectant mothers and their children were followed over 8 years, researchers found that children who developed asthma-like symptoms were significantly more likely to be born to mothers who ate nut products daily dudring their pregnancy, than women who ate nuts rarely.
Critics say that the headline is inaccurate because there were no significant links found between nut consumption and child asthma. The increased asthma symptoms in the child were only found when comparing daily consumption with rare nut product consumption, but not with regular vs rare consumption. It is recommended that pregnant women should have a healthy balanced diet and avoid excessive consumption of one particular food.
Source: "Maternal Food Consumption during Pregnancy and the Longitudinal Development of Childhood Asthma". Am J Respiratory Critical Care Medicine 2008; 178:124-131
More than 4,000 expectant mothers and their children were followed over 8 years, researchers found that children who developed asthma-like symptoms were significantly more likely to be born to mothers who ate nut products daily dudring their pregnancy, than women who ate nuts rarely.
Critics say that the headline is inaccurate because there were no significant links found between nut consumption and child asthma. The increased asthma symptoms in the child were only found when comparing daily consumption with rare nut product consumption, but not with regular vs rare consumption. It is recommended that pregnant women should have a healthy balanced diet and avoid excessive consumption of one particular food.
Source: "Maternal Food Consumption during Pregnancy and the Longitudinal Development of Childhood Asthma". Am J Respiratory Critical Care Medicine 2008; 178:124-131
Tuesday, July 15, 2008
Fish oil supplements may reduce asthma risk
A newspaper reported a trial that gave women fish oil supplements during their third trimester and compared the effects on their child’s health with olive oil capsules or no supplements.
Researchers found that the children of those mothers taking fish oil supplements were about 60% less likely to have asthma 16 years after the study began and concluded that their results suggest that fish oils intake in the third trimester may protect the offspring against asthma, however they said there is a need for large randomised controlled trials to examine this further.
Source: "Fish oil intake compared with olive oil intake in late pregnancy and asthma in the offspring: 16 y of registry-based follow-up from a randomized controlled trial." Am J Clin Nutr 2008; 88:167-175
Researchers found that the children of those mothers taking fish oil supplements were about 60% less likely to have asthma 16 years after the study began and concluded that their results suggest that fish oils intake in the third trimester may protect the offspring against asthma, however they said there is a need for large randomised controlled trials to examine this further.
Source: "Fish oil intake compared with olive oil intake in late pregnancy and asthma in the offspring: 16 y of registry-based follow-up from a randomized controlled trial." Am J Clin Nutr 2008; 88:167-175
Monday, July 14, 2008
Pregnant women have increased risk of heart attack
According to a new study, pregnant women have the risk of having a heart attack 3 to 4 times the normal risk. Since many women today delay having children until later in life, they could potentially increase the risk of suffering heart problems.
The review is based on a systematic review of 103 cases of pregnancy-related acute myocardial infarction (AMI) in the last 10 years and compared them to 125 cases diagnosed prior to that time. Critics say the review did not look at whether the increasing age is affecting pregnant women's risk of heart attack. Women should not worry as the risk of pregnancy-related heart attack is very low if they are healthy and they can reduce their risk of heart attack by not smoking and by reducing the intake of saturated fat at all times.
Source: "Acute Myocardial Infarction Associated With Pregnancy." J of Am College Cardiology 2008; 52:171–180
Tuesday, July 01, 2008
Heavier babies may have higher risk of arthritis later in life
According to a study published in the Annals of Rheumatic Diseases, a birthrate of over 4.54 kg or 10 pounds doubled the risk of developing rheumatic arthritis (RA) when they are adults compared with individuals with average birthweight.
The finding is based on a review of the data on 87,077 participants in the Nurses' Health Study. Although the mechanism for the association was not clear to the investigators, researchers said that foetal growth is influenced by nutrition and enviroment independent of genetics, if nutrition has an impact on rheumatoid arthritis, it is a potentially modifiable factor.
Source: "Is birthweight associated with risk of arthritis? Data from a large cohort study." Annals of Rheumatic Diseases 2008; Jul 1 [Epub ahead of print]"
The finding is based on a review of the data on 87,077 participants in the Nurses' Health Study. Although the mechanism for the association was not clear to the investigators, researchers said that foetal growth is influenced by nutrition and enviroment independent of genetics, if nutrition has an impact on rheumatoid arthritis, it is a potentially modifiable factor.
Source: "Is birthweight associated with risk of arthritis? Data from a large cohort study." Annals of Rheumatic Diseases 2008; Jul 1 [Epub ahead of print]"
Can eating chocolate reduce cancer risk?
News sources reported that eating chocolate can help fight cancer. This is based on a laboratory study that investigated the chemical GECGC, a man-made antioxidants called procyanidins, which naturally occur in cocoa beans. The scientists added GECGC to 16 different types of cancer cells and found that it inhibited the growth of some cells, with the greatest effect in two types of bowel cancer cells.
Critics say this study cannot be taken as evidence that eating chocolate will reduce any type of cancer. Exercises and healthy balanced diet are the best ways to maintain good health.
Source: "Selective cytotoxicity of synthesized procyanidin 3-O-Galloylepicatechin-4b,8-3-O-galloylcatechin to human cancer cells." Cell cycle 2008; 7: 1648 – 1657
Critics say this study cannot be taken as evidence that eating chocolate will reduce any type of cancer. Exercises and healthy balanced diet are the best ways to maintain good health.
Source: "Selective cytotoxicity of synthesized procyanidin 3-O-Galloylepicatechin-4b,8-3-O-galloylcatechin to human cancer cells." Cell cycle 2008; 7: 1648 – 1657
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