Dr Lionel Feuillet, a neurologist at the Universite de al Mediterranee in Marseille, France, described a rare condition in The Lancet. 2007, vol 370, issue 9583, p.262. "Brain of a white-collar worker".
A man went to a Marseille hospital after he had mild weakness in his left leg. Dr. Feuillet and colleagues learned from his medical history that, as an infant, he had had a shunt inserted into his head to drain away hydrocephalus – water on the brain.
The medical team was shocked by the CT and MRI scans that showed the ventricles, normally tiny chambers that contain the cerebrospinal fluid that cushions the brain, were enlarged massively leaving a thin sheet of brain tissue. Tests showed that, the man, father of two children and works as a civil servant, had an IQ of 75, below the average score but not considered mentally retarded. He manages to live a normal life despite his condition. Read more...
Monday, July 23, 2007
Friday, July 20, 2007
Alternative medicine in US medical curriculum
Washington Post reported in a post "Earning a spot in the curriculum" that a consortium of 38 medical schools including the major ones Harvard, Stanford and Duke is working to integrate complementary and alternative (CAM) into mainstream medical curricula.
Medical students are being taught to ask about the use of CAM tretaments when they take patient history to guard against potential interferance between conventional practices and medicines. Students are encouraged to respect patients' cultural and ethnic backgrounds which may include CAM practices. The most widely embraced therapy is acupuncture.
In the UK, many primary care trusts (PCTs) have refused to pay for homoeopathy and cancelled their contracts after some leading doctors have urged NHS trusts to stop using complementary therapies and to fund only therapies that were backed up by scientific evidence. Read the doctors' open letter to the PCTs.
"When doctors become terrorists"
"Why should doctors not be terrorists?" asked Dr Simon Wessely, a professor of psychiatry at King's College London in a perspective article "When doctors become terrorists" published online on July 16 issue of the NEJM and in print August 16, 2007.
Dr Wessely writes about what has driven doctors to be terrorists in history and people's assumptions about terrorists and doctors. An interesting article that worths reading.
Also from The Times, July 4, 2007, an article "Could a doctor really be a bomber? Well, yes".
Dr Wessely writes about what has driven doctors to be terrorists in history and people's assumptions about terrorists and doctors. An interesting article that worths reading.
Also from The Times, July 4, 2007, an article "Could a doctor really be a bomber? Well, yes".
Thursday, July 19, 2007
CT scan may increase lifetime cancer risk
A 64-slice computed tomography coronary angiography (CTCA) is a type of high-tech scan that is used to evaluate heart disease, but there are little data on its associated cancer risk from the radiation exposure.
A group of researchers conducted a study to estimate the lifetime attributable risk (LAR) of cancer associated with standard radiation exposure from a single heart scan using 64-slice CT coronary angiography. They found that the risk varied widely and were the highest with women in their 20s compared with other adults and concluded that CTCA should be used cautiously, especially in young women, using the lowest effective dose of radiation.
The study "Estimating Risk of Cancer Associated With Radiation Exposure From 64-Slice Computed Tomography Coronary Angiography" is published in JAMA. 2007;298(3):317-323 .
A group of researchers conducted a study to estimate the lifetime attributable risk (LAR) of cancer associated with standard radiation exposure from a single heart scan using 64-slice CT coronary angiography. They found that the risk varied widely and were the highest with women in their 20s compared with other adults and concluded that CTCA should be used cautiously, especially in young women, using the lowest effective dose of radiation.
The study "Estimating Risk of Cancer Associated With Radiation Exposure From 64-Slice Computed Tomography Coronary Angiography" is published in JAMA. 2007;298(3):317-323 .
Vitamin C does not prevent common cold
Vitamin C is the most widely used supplement against common colds, but a new analysis of 30 studies in the latest issue of The Cochrane Library has found that the doses of 200mg per day had little effect on reducing the length or severity of colds.
However, the Cochrane researchers acknowledge that vitamin C supplements might have health benefits other than keeping adult colds at bay.
However, the Cochrane researchers acknowledge that vitamin C supplements might have health benefits other than keeping adult colds at bay.
GPs earn over £100,000
The NHS data revealed 46% of GPs earned more than £100,000 in 2004-5 in the new contract. It also showed that one in 200 has an income of more than £250,000.
GPs and the government have been criticised for the high income they now earn. Read more..
GPs and the government have been criticised for the high income they now earn. Read more..
Taking cancer drugs with food may be more effective
Previously experts have warned of the potential dangers of interactions between food and drugs, but a research published in the Journal of Clinical Oncology showed that taking the breast cancer drug, lapatinib (TYKERB), with food could improve the effectiveness of drugs. This means patients could take lower doses therefore reducing the costs of treating patients.
Researchers call for more research to assess the effects of drug-combinations on patients and warn patients against their own experiments. Read more...
Researchers call for more research to assess the effects of drug-combinations on patients and warn patients against their own experiments. Read more...
Wednesday, July 18, 2007
Folic acid enriched flour reduces neural tube defetcs
Dr Philippe De Wals of Universite Laval compared the prevalence of neural tube defects before and after the introduction of folic-acid enriched flours for over 2 million births in Canada between 1993 and 2002 and found that addition of floic acid to flours has led to significant drop in the incidence of neural tube defects in Canada. He said that it is better to integrate folic acid into the food chain than focus on taking vitamin supplements.
The study "Redudction in neural-tube defects after folic acid fortification in Canada" is published in NEJM, July 12, 2007, no.2; 357:135-142. Read more....
Currently only Canada, USA and Chile implement folic acid fortification in flour. Folic acid in the UK is unresolved.
The study "Redudction in neural-tube defects after folic acid fortification in Canada" is published in NEJM, July 12, 2007, no.2; 357:135-142. Read more....
Currently only Canada, USA and Chile implement folic acid fortification in flour. Folic acid in the UK is unresolved.
HRT risk for older women - WISDOM trial
A new multicentre, randomised, doubled blind placebo controlled trial was carried out in the UK, Australia and New Zealand to assess the risks and benefits of combined HRT vs placebo or oestrogen alone.
The results are consistent with the findings of the WHI ( US) study, researchers concluded that HRT "increases cardiovascular and thromboembolic risk when started many years after the menopause."
The study is published in the early online issue of BMJ, 11 July 2007. "Main morbidities recorded in the women's international study of long duration oestrogen after menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women". Read the abstract .
The trial was prematurely closed after the WHI publication of the early results of the danger of HRT on older women. Read more...
See also previous post "Estrogen therapy and healthier arteries"
The results are consistent with the findings of the WHI ( US) study, researchers concluded that HRT "increases cardiovascular and thromboembolic risk when started many years after the menopause."
The study is published in the early online issue of BMJ, 11 July 2007. "Main morbidities recorded in the women's international study of long duration oestrogen after menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women". Read the abstract .
The trial was prematurely closed after the WHI publication of the early results of the danger of HRT on older women. Read more...
See also previous post "Estrogen therapy and healthier arteries"
Friday, July 13, 2007
Antibiotics won't prevent urinary tract infections in children
It is estimated that 70,000 to 180,000 children born in a given year will have urinary tract infection (UTI) by the age of 6.
According to a new study in the July 11 issue of the JAMA, "Recurrent urinary tract infection: risk factors and effectiveness of prophylaxis in a primary care cohort", researchers found 611 children had a first UTI and 83 had a recurent UTI, daily antibiotics may not prevent UTI from recuring in children and may increase the risk of drug resistance. A child's age and race may paly a role in the risk of UTI and being resistant to antibiotics.
This is the first large study of children diagnosed with UTI to estimate the effectiveness of antibiotices in a primary care setting. The researchers suggested that it is appropriate for physicians to discuss with parents the risks and unclear benefits of daily antibiotic treatment after a child has had a first UTI. Read the press release at Medical News Today.
Some pediatricians said the findings may change the practice for the better.
According to a new study in the July 11 issue of the JAMA, "Recurrent urinary tract infection: risk factors and effectiveness of prophylaxis in a primary care cohort", researchers found 611 children had a first UTI and 83 had a recurent UTI, daily antibiotics may not prevent UTI from recuring in children and may increase the risk of drug resistance. A child's age and race may paly a role in the risk of UTI and being resistant to antibiotics.
This is the first large study of children diagnosed with UTI to estimate the effectiveness of antibiotices in a primary care setting. The researchers suggested that it is appropriate for physicians to discuss with parents the risks and unclear benefits of daily antibiotic treatment after a child has had a first UTI. Read the press release at Medical News Today.
Some pediatricians said the findings may change the practice for the better.
Wednesday, July 11, 2007
Wellcome images
Human cells in culture ( Wellcome images)
Aspirin crystals ( Wellcome images)
Launched on 15 June 2007, "Wellcome images" is a unique collection of clinical, biomedical and historical images provided by the Wellcome Library in London. Online access to these images is free under the Creative Commons Licence that allows users to copy, distribute and display the images for non-commercial purposes provided the source is fully attributed.
Online access to clinical images that are photographs of patients showing signs or symptoms of a disease is restricted to healthcare professionals. Read more....
Selenium supplements may increase diabetes risk
US researchers expected to find selenium improves gluocose metabolism as suggseted by animal studies, but in a new randomized, double-blinded and placebo-controlled study of 1202 patients who were taking part in a clinical trial to assess the effect of selenium supplementation on skin cancer, the researchers were surprised to find that the incidence of type 2 diabetes was significantly higher in the selenium group than in the placebo group.
They concluded that long term use of selenium supplements may increase the risk of developing type 2 diabetes. More significantly, the higher the blood level of selenium, the greater the risk for developing the disease.
This is an important finding for public health because selenium supplements (30 - 200 mg) are used by people throughout the US and the western world. Read more...
The findings will be published in the August issue of Annals of Internal Medicine: 21 August 2007, vol 147, issue4. "Effects of Long-Term Selenium Supplementation on the Incidence of Type 2 Diabetes: A Randomized Trial"
They concluded that long term use of selenium supplements may increase the risk of developing type 2 diabetes. More significantly, the higher the blood level of selenium, the greater the risk for developing the disease.
This is an important finding for public health because selenium supplements (30 - 200 mg) are used by people throughout the US and the western world. Read more...
The findings will be published in the August issue of Annals of Internal Medicine: 21 August 2007, vol 147, issue4. "Effects of Long-Term Selenium Supplementation on the Incidence of Type 2 Diabetes: A Randomized Trial"
Tuesday, July 10, 2007
Electronic health records alone do not improve quality of care
A group of Stanford and Harvard researchers assessed the association between electronic health records (EHR) use and the quality of care in a national survey and were suprised to find that EHR use made no difference in 14 of the 17 ambulatory qulaity indicators. They expected better quality from physicians using EHRs.
In 2 quality areas : not prescribing tranquilizers for depression and not ordering routine urinalysis in general medical examinations - doctors using EHRs performed significantly better than those who did not. But in the area of prescribing statins for patients with high cholestrol, physicians using EHRs performed significantly worse than those who did not.
The researchers said sophisticated EHR systems can be a valuable tool for physicians in improving care in outpatient settings, but it is not sufficient to have an EHR system that provides patient data and decision support, physicians have to be willing to act on that input.
The study is published in the July 9 issue of the Archives of Internal Medicine. 2007;167:1400-1405 "Electronic health record use and the quality of ambulatory care in the United States" Read the abstract .
Read the press release.
In 2 quality areas : not prescribing tranquilizers for depression and not ordering routine urinalysis in general medical examinations - doctors using EHRs performed significantly better than those who did not. But in the area of prescribing statins for patients with high cholestrol, physicians using EHRs performed significantly worse than those who did not.
The researchers said sophisticated EHR systems can be a valuable tool for physicians in improving care in outpatient settings, but it is not sufficient to have an EHR system that provides patient data and decision support, physicians have to be willing to act on that input.
The study is published in the July 9 issue of the Archives of Internal Medicine. 2007;167:1400-1405 "Electronic health record use and the quality of ambulatory care in the United States" Read the abstract .
Read the press release.
Monday, July 09, 2007
1.5m misdiagnosed heart disease risk
A BMJ study "Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study" (BMJ Online First) that tracked 1.28 million healthy adults aged 35-74 over a period of 12 years and used GP records from 318 practices found that the traditional score over- estimated cardiovascular disease risk by 35%.
It suggests the current estimates of the number of UK adults at risk of cardiovascular disease are 1.5 million too high.
The study found that white middle-aged men had a lower risk than previously thought and women from poorer backgrounds had a significantly higher risk. It also found that 1 in 3 women, (not 1 in 4 as previously thought ) in their 60s are at risk of heart disease. This has raised the concern of " potentially missing the right people for treatment" and the possibility of over-prescription of statins to many patients who do not need it.
The authors argued that over-predicted estimates of heart disease were derived from the out-dated American model which involves a score based on smoking, blood pressure and cholesterol, along with age and sex, but the the new score used by the BMJ study also takes into account social deprivation, genetic factors and weight, reducing estimates. Read more...
It suggests the current estimates of the number of UK adults at risk of cardiovascular disease are 1.5 million too high.
The study found that white middle-aged men had a lower risk than previously thought and women from poorer backgrounds had a significantly higher risk. It also found that 1 in 3 women, (not 1 in 4 as previously thought ) in their 60s are at risk of heart disease. This has raised the concern of " potentially missing the right people for treatment" and the possibility of over-prescription of statins to many patients who do not need it.
The authors argued that over-predicted estimates of heart disease were derived from the out-dated American model which involves a score based on smoking, blood pressure and cholesterol, along with age and sex, but the the new score used by the BMJ study also takes into account social deprivation, genetic factors and weight, reducing estimates. Read more...
Heart patients unclear when to dial 999
A study shows that many heart patients are not able to tell the difference between angina pain and a heart attack and tend to delay in calling an ambulance when experience chest pain.
In a BMJ "Editorial : Advising patients on dealing with acute chest pain", 335;3-4 ( 6 July 2007), heart experts warn that high-risk patients with heart disease are confused by the varying advice given by different sources on how to use the GTN sprays to relieve their symptoms and when they should call an ambulance. Some high-risk patients may be waiting too long before seeking help as one research showed the average time from onset of symptoms to cardiac rest is 10 minutes.
The authors recommend that high-risk patients need clear guidance on how to distinguish between the symptoms of chest pain and heart attack and wait 5 minutes before calling an ambulance.
In a BMJ "Editorial : Advising patients on dealing with acute chest pain", 335;3-4 ( 6 July 2007), heart experts warn that high-risk patients with heart disease are confused by the varying advice given by different sources on how to use the GTN sprays to relieve their symptoms and when they should call an ambulance. Some high-risk patients may be waiting too long before seeking help as one research showed the average time from onset of symptoms to cardiac rest is 10 minutes.
The authors recommend that high-risk patients need clear guidance on how to distinguish between the symptoms of chest pain and heart attack and wait 5 minutes before calling an ambulance.
Thursday, July 05, 2007
A little dark chocolate daily lowers blood pressure
A German study of 44 adults showed that eating a small amount of dark chocolate every day could lower blood pressure without increasing weight or other health risks.
Researchers stressed that although the reduction in blood pressure was small, the effects are clinically noteworthy. They also suggested asking people to consume just 6 g of dark chocolate daily would be much easier than encouraging them to stick to complex diet programs to help them reduce their blood pressure.
The British Heart Foundation warned chocolate is high in fat and calories and is not good for the heart.
The study is published in the July 4 issue of JAMA - "Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide - A Randomized Controlled Trial" JAMA. 2007;298:49-60.
Researchers stressed that although the reduction in blood pressure was small, the effects are clinically noteworthy. They also suggested asking people to consume just 6 g of dark chocolate daily would be much easier than encouraging them to stick to complex diet programs to help them reduce their blood pressure.
The British Heart Foundation warned chocolate is high in fat and calories and is not good for the heart.
The study is published in the July 4 issue of JAMA - "Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide - A Randomized Controlled Trial" JAMA. 2007;298:49-60.
Living with MTAS
This week's BMJ Careers provides a collection of articles focusing on the issue of the current job situation as a result of MMC and MTAS.
The Editor's choice : "living with MTAS" suggests junior doctors should be flexible and consider options and alternative careers.
This week and the next two, the BMJ Careers will feature articles about careers outside the NHS with the hope that junior doctors will be inspired and informed to consider alternative careers. There are some interesting articles :
The Editor's choice : "living with MTAS" suggests junior doctors should be flexible and consider options and alternative careers.
This week and the next two, the BMJ Careers will feature articles about careers outside the NHS with the hope that junior doctors will be inspired and informed to consider alternative careers. There are some interesting articles :
- Working for the pharmaceutical industry
- Voluntary work is a good idea
- Pastures green - working abroad
- Having the best of both worlds - locuming
- Banking on it - a medical student's experience of working in the City finance sector
- Career decision making in an age of uncertainty
Impact of MTAS on junior doctors' mental health
In a BMJ letter "Mental health of applicants seems to be deteriorating", BMJ 2007;334:1335 (30 June 2007), The Royal College of Psychiatrists reported the preliminary findings of an online survey about the imapct of MMC and MTAS on junior doctors' mental health.
The results showed that there were 790 anonymous responses that indicated increased level of stress and disturbances, most attributing it to MMC/MTAS. The authors said that this requires an urgent response.
A SHO said he doubted the validity of the survey and that doctors and other professionals need resilience and MTAS has reflected that.
The results showed that there were 790 anonymous responses that indicated increased level of stress and disturbances, most attributing it to MMC/MTAS. The authors said that this requires an urgent response.
A SHO said he doubted the validity of the survey and that doctors and other professionals need resilience and MTAS has reflected that.
Wednesday, July 04, 2007
Opt-out approach to HIV testing
Many HIV patients are not diagnosed until they have advanced disease.
A group of doctors called for using a routine opt-out testing that would increase the knowledge of HIV infection status and cut infection rate, in the article "Time to move towards opt-out testing for HIV in the UK", BMJ 2007;334:1352-1354 (30 June 2007)
The call was echoed in another article, "Routine testing to reduce late HIV diagnosis in France", BMJ 2007;334:1354- 1356 (30 June 2007)
The "Editorial: reducing the length of time between HIV infection and diagnosis", BMJ 2007;334:1329- 1330 ( 30 June 2007), discussed the specific goal for changes in policy.
Read the report "Standards for HIVClinical Care" produced by the British HIV association (BHIVA)
A group of doctors called for using a routine opt-out testing that would increase the knowledge of HIV infection status and cut infection rate, in the article "Time to move towards opt-out testing for HIV in the UK", BMJ 2007;334:1352-1354 (30 June 2007)
The call was echoed in another article, "Routine testing to reduce late HIV diagnosis in France", BMJ 2007;334:1354- 1356 (30 June 2007)
The "Editorial: reducing the length of time between HIV infection and diagnosis", BMJ 2007;334:1329- 1330 ( 30 June 2007), discussed the specific goal for changes in policy.
Read the report "Standards for HIVClinical Care" produced by the British HIV association (BHIVA)
Needlestick injuries among surgeons in training
Medical News Today reported a survey of nearly 700 surgeons in training at 17 medical centers in the US about previous needlestick injuries. The findings were published in the NEJM, "Needlestick injuries among surgeons in training" Volume 356:2693-2699 , June 28, 2007, Number 26. Read the abstract.
The survey showed that 95% responded, nearly all surgeon residents had had a needlestick injury while in training and more than half of the injuries had involved a high-risk patient, but most failed to report the injuries. Lack of time was the most cited reason for not reporting such injuries.
The survey showed that 95% responded, nearly all surgeon residents had had a needlestick injury while in training and more than half of the injuries had involved a high-risk patient, but most failed to report the injuries. Lack of time was the most cited reason for not reporting such injuries.
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