A study published by the Journal of Clinical Oncology reviewed the records from visits to three adult clinics and one pediatric oncology clinic in America to determine the rates and types of medication errors and the factors associated with the errors in outpatients with cancer.
More than 10,000 medications were studied, errors were found in adult (7.1%) and in pediatric (18.8%) visits, more than half of the 112 medication errors had the potential to cause harm and 15 resulted in in injury. Most of the errors involved wrong does due to confusion over two sets of orders: at diagnosis and adjusted dose.
The authors wrote that with increasing opportunities for medication errors inthe home setting, better communication could prevent many of the errorrs and help improve cancer care for adults and children.
Source: "Medication Errors Among Adults and Children With Cancer in the Outpatient Setting" Journal of Clinical Oncology, 10.1200/JCO.2008.18.6072 (JCO Early Release, published online ahead of print Dec 29 2008)
Friday, January 09, 2009
Wednesday, December 03, 2008
JUPITER trial poll result
The NEJM Clinical Directions set up a poll and invited readers to respond to questions raised by the results of the JUPITER trial published on its website on 9 November 2008. The poll was closed on 26 November 2008 with 2553 responses.
Poll questions :
Do you believe, on the basis of the JUPITER trial results, that the approach to laboratory screening of apparently healthy adults should be changed?
49% - Yes, the trial results indicate that the approach to laboratory screening should be changed.
51% - No, the trial results do not provide a basis for a change in the approach to laboratory screening.
Do you believe, on the basis of the JUPITER trial results, that the therapeutic use of statins in apparently healthy adults should be changed?
48% - Yes, the trial results indicate that the therapeutic use of statins should be changed.
52% - No, the trial results do not provide a basis for a change in the therapeutic use of statins.
See also post - JUPITER trial - will you change your practice?
Poll questions :
Do you believe, on the basis of the JUPITER trial results, that the approach to laboratory screening of apparently healthy adults should be changed?
49% - Yes, the trial results indicate that the approach to laboratory screening should be changed.
51% - No, the trial results do not provide a basis for a change in the approach to laboratory screening.
Do you believe, on the basis of the JUPITER trial results, that the therapeutic use of statins in apparently healthy adults should be changed?
48% - Yes, the trial results indicate that the therapeutic use of statins should be changed.
52% - No, the trial results do not provide a basis for a change in the therapeutic use of statins.
See also post - JUPITER trial - will you change your practice?
Monday, December 01, 2008
Passing postgradute exams - don't be late
Are you preparing for your exams? Did you know that better-prepared doctors arriving on time were more likely to pass the exam?
In this article - "Disorganized junior doctors fail the MRCP (UK)". Medical Teacher. Feb 2006, 28(1):e40-e42(1) (abstract only) - researchers examined whether organization skills relate to exam outcome amongst junior doctors taking the RCP clinical Part ll exam.
The study was condudcted at 4 clinical courses that prepared the trainees for the exam. Arrival time at registration ( 8.00 am ) for the course was chosen for organisation skills. 81 doctors passed the exam and arrived 14 minutes earlier, 71 doctors failed the exam and arrived 6 minutes later than those who passed.
The study has shown that good time-keeping skills are positively associated with exam outcome and the authors suggested that "arriving on time is a valid marker of organization skills and preparation" and advised prospective candidates that "lateness is a sign of failure: get organised".
The BMJ Careers has published a 4 part series to help doctors maximise their chance of passing postgraduate exams.
Exam technique 1
Exam technique 2: performing
Exam technique 3: revision
Exam technique 4: study
In this article - "Disorganized junior doctors fail the MRCP (UK)". Medical Teacher. Feb 2006, 28(1):e40-e42(1) (abstract only) - researchers examined whether organization skills relate to exam outcome amongst junior doctors taking the RCP clinical Part ll exam.
The study was condudcted at 4 clinical courses that prepared the trainees for the exam. Arrival time at registration ( 8.00 am ) for the course was chosen for organisation skills. 81 doctors passed the exam and arrived 14 minutes earlier, 71 doctors failed the exam and arrived 6 minutes later than those who passed.
The study has shown that good time-keeping skills are positively associated with exam outcome and the authors suggested that "arriving on time is a valid marker of organization skills and preparation" and advised prospective candidates that "lateness is a sign of failure: get organised".
The BMJ Careers has published a 4 part series to help doctors maximise their chance of passing postgraduate exams.
Exam technique 1
Exam technique 2: performing
Exam technique 3: revision
Exam technique 4: study
Wednesday, November 26, 2008
Conventional blood pressure test has no prognostic value
Researchers enrolled 556 people aged 65 on average who had high blood pressure despite having been treated with anti-hypertensive drugs and followed up for 4.8 years to determine which form of blood pressure monitoring was a better predictor of risk of cardiovascular disease in people with medication-resistant high blood pressure.
They found that conventional surgery-measured BP did not predict strokes or heart attacks, but readings taken over 24-hour period could. Critics say conventional blood pressure testing by a GP remains essential and is invaluable in detecting and monitoring high blood pressure that often has no symptoms and is difficult to detect.
Source: Salles GF, Cardoso CRL, Muxfeldt ES. Prognostic Influence of Office and Ambulatory Blood Pressures in Resistant Hypertension. Archive of Internal Medicine 2008; 168: 2340-2346(f/t via Athens)
Incompetent boss increases employees' heart disease risk
Many studies have linked employee health to workplace conditions but a new Swedish study called WOLF, involving more than 3200 men aged 19 to 70 without pre-existing ischemic heart disease who were working in Stockholm, suggested a significant effect of concrete managerial skills on employee heart disease risk .
All the participants were asked to rate the leadership style of their senior managers on competencies, researchers found that the poorer the men rated their boss's leadership ability, the higher the risk of heart disease. The risk increased the longer the men worked in the same stressful environment.
The lead researcher said "Enhancing managers' skills -- regarding providing employees with information, support, power in relation to responsibilities, clarity in expectations, and feedback -- could have important stress-reducing effects on employees and enhance the health at workplaces".
Source: Nyberg A, et al "Managerial leadership and ischaemic heart disease among employees: the Swedish WOLF study" Occupational and Environmental Medicine 2008; DOI: 10.1136/oem.2008.039362. (See BBC link )
All the participants were asked to rate the leadership style of their senior managers on competencies, researchers found that the poorer the men rated their boss's leadership ability, the higher the risk of heart disease. The risk increased the longer the men worked in the same stressful environment.
The lead researcher said "Enhancing managers' skills -- regarding providing employees with information, support, power in relation to responsibilities, clarity in expectations, and feedback -- could have important stress-reducing effects on employees and enhance the health at workplaces".
Source: Nyberg A, et al "Managerial leadership and ischaemic heart disease among employees: the Swedish WOLF study" Occupational and Environmental Medicine 2008; DOI: 10.1136/oem.2008.039362. (See BBC link )
Friday, November 21, 2008
Counselling could cut breast cancer
227 women aged between 20 and 85 years who had undergone surgery for breast cancer were enrolled in a study and were randomly assigned into two groups, one group received a psychological intervention, while the other did not.
The psychological intervention aimed to reduce distress, improve quality of life and mood, improve heath related behaviours and to improve the women’s adherence to their cancer treatment and follow-up programme.
After 11 years follow-up and comparison, researchers found that the psychological intervention roughly halved the chances of cancer returning and affected the length of time it took for the disease to reoccur. Critics say the study highlights the importance of appropriate support for women with breast cancer.
Source: Andersen BL, Yang HC, Farrar WB. Psychologic intervention improves survival for breast cancer patients. Cancer 2008; Published Online: 17 Nov 2008
The psychological intervention aimed to reduce distress, improve quality of life and mood, improve heath related behaviours and to improve the women’s adherence to their cancer treatment and follow-up programme.
After 11 years follow-up and comparison, researchers found that the psychological intervention roughly halved the chances of cancer returning and affected the length of time it took for the disease to reoccur. Critics say the study highlights the importance of appropriate support for women with breast cancer.
Source: Andersen BL, Yang HC, Farrar WB. Psychologic intervention improves survival for breast cancer patients. Cancer 2008; Published Online: 17 Nov 2008
Pepermint oil is effective in treating IBS
A new study of randomised controlled trials comparing fibre, antispasmodics, and peppermint oil with placebo or no treatment in adults with irritable bowel syndrome found that all three were more effective than placebo in the treatment of irritable bowel syndrome (IBS).
However, critics say the treatment effect might have been overestimated by the lack of concealment in the allocation of the treatments. Adverse effects were not reported across studies. The trials have only compared each treatment to placebo, so it cannot be assumed that any one treatment is more effective than the others.
Ford AC, Talley NJ, Spiegel BMR, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 2008; 337:a2313 ( f/t via Athens)
However, critics say the treatment effect might have been overestimated by the lack of concealment in the allocation of the treatments. Adverse effects were not reported across studies. The trials have only compared each treatment to placebo, so it cannot be assumed that any one treatment is more effective than the others.
Ford AC, Talley NJ, Spiegel BMR, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 2008; 337:a2313 ( f/t via Athens)
Large waist doubled death risk
A large scale study involving about 360,000 participants, conducted by research institutions across Europe has found that those with a large waist had twice the risk of premature death even if they were not overweight.
The study ran for 9.7 years and researchers found that BMI, waist circumference and waist-to-hip ratio were all strongly associated with the risk of death. They said the findings suggested that "general adiposity (fat) and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death".
The European co-ordinator of the study said people with large waist should exercise every day, avoid alcohol and improve their diet.
Source: "General and Abdominal Adiposity and Risk of Death in Europe" NEJM 359(20):2105-2120 (November 13, 2008) free f/t
The study ran for 9.7 years and researchers found that BMI, waist circumference and waist-to-hip ratio were all strongly associated with the risk of death. They said the findings suggested that "general adiposity (fat) and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death".
The European co-ordinator of the study said people with large waist should exercise every day, avoid alcohol and improve their diet.
Source: "General and Abdominal Adiposity and Risk of Death in Europe" NEJM 359(20):2105-2120 (November 13, 2008) free f/t
Friday, November 14, 2008
JUPITER trial - will you change your practice?
The findings of a large statins trial presented at the Am Heart Association meeting on 9 November 2008 dominated the news and stirred up debates.
The study, called JUPITER trial, funded by AstraZeneca (maker of rosuvastatin, marketed as Crestor, the drug in the trial) is a large international, double-blinded, placebo controlled randomised clinical trial including 17,802 "healthy" men and women with normal LDL cholesterol but elevated CRP (C-reactive protein) assigned to receive either 20mg of daily dose of rosuvastatin or placebo.
The researchers found the rosuvastatin reduced their risk of heart attack ( 54% ), stroke (48% ), in need of angioplasty or bypass surgery (46% ) and death from any cause ( 20% ). The trial leader, Dr Paul Ridker, who receives grant from the drug company, said expanding the use of statin could prevent 250,000 heart attacks, strokes, vascular procedures or death over 5 years. The JUPITER trial was designed a 4-year study but stopped after 1.9 years because of the benefits found.
Opinions on the findings are mixed and many questions raised. Some said that clinical practice on CRP testing and statin therapy would be affected by this important landmark study while some questioned the short follow-up and long-term safety of low LDL levels achieved in this trial. Dr Mark Hlatky wrote in the NEJM's editorial "the evidence should be examined critically" before drug treatment is expanded and "Long-term safety is clearly important in considering committing low-risk subjects without clinical disease to 20 years or more of drug treatment."
NEJM published this article and the accompanying editorial ( free f/t ) on its website on 9 November 2008 and invited doctors to contirbute their thoughts on the JUPITER results.
Source: "Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein" Published at www.nejm.org November 9, 2008 (10.1056/NEJMoa0807646)
The study, called JUPITER trial, funded by AstraZeneca (maker of rosuvastatin, marketed as Crestor, the drug in the trial) is a large international, double-blinded, placebo controlled randomised clinical trial including 17,802 "healthy" men and women with normal LDL cholesterol but elevated CRP (C-reactive protein) assigned to receive either 20mg of daily dose of rosuvastatin or placebo.
The researchers found the rosuvastatin reduced their risk of heart attack ( 54% ), stroke (48% ), in need of angioplasty or bypass surgery (46% ) and death from any cause ( 20% ). The trial leader, Dr Paul Ridker, who receives grant from the drug company, said expanding the use of statin could prevent 250,000 heart attacks, strokes, vascular procedures or death over 5 years. The JUPITER trial was designed a 4-year study but stopped after 1.9 years because of the benefits found.
Opinions on the findings are mixed and many questions raised. Some said that clinical practice on CRP testing and statin therapy would be affected by this important landmark study while some questioned the short follow-up and long-term safety of low LDL levels achieved in this trial. Dr Mark Hlatky wrote in the NEJM's editorial "the evidence should be examined critically" before drug treatment is expanded and "Long-term safety is clearly important in considering committing low-risk subjects without clinical disease to 20 years or more of drug treatment."
NEJM published this article and the accompanying editorial ( free f/t ) on its website on 9 November 2008 and invited doctors to contirbute their thoughts on the JUPITER results.
Source: "Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein" Published at www.nejm.org November 9, 2008 (10.1056/NEJMoa0807646)
Poor sleep links to heart disease
In a study of 1,255 Japanese adults with high blood pressure aged 70.4 in average, researchers recorded each participant's blood pressure changes over 24-hour period and followed them for about 50 months.
During the follow-up, there were 99 cardiovascular disease events, they also found that participants who slept less than 7.5 hours a night had 68% high risk of one of these complications than those who had longer sleep.
They also found that the risk was higher among participants who also had an increase in overnight blood pressure than those who did not have an increase in blood pressure. Researchers concluded that "shorter duration of sleep is a predictor of incident cardiovascular disease in elderly individuals with hypertension, .......Physicians should inquire about sleep duration in the risk assessment of patients with hypertension."
Source: "Short Sleep Duration as an Independent Predictor of Cardiovascular Events in Japanese Patients With Hypertension" Arch Intern Med. 2008;168(20):2225-2231 (f/t via Athens)
During the follow-up, there were 99 cardiovascular disease events, they also found that participants who slept less than 7.5 hours a night had 68% high risk of one of these complications than those who had longer sleep.
They also found that the risk was higher among participants who also had an increase in overnight blood pressure than those who did not have an increase in blood pressure. Researchers concluded that "shorter duration of sleep is a predictor of incident cardiovascular disease in elderly individuals with hypertension, .......Physicians should inquire about sleep duration in the risk assessment of patients with hypertension."
Source: "Short Sleep Duration as an Independent Predictor of Cardiovascular Events in Japanese Patients With Hypertension" Arch Intern Med. 2008;168(20):2225-2231 (f/t via Athens)
Calcium and vitamin D do not prevent breast cancer
Previous studies have reported vitamin D supplements may reduce breast cancer risk but a new study, published online in the Journal of the National Cancer Institute, found that calcium and vitamin-D supplements do not reduce breast cancer incidence in postmenopausal women.
More than 36,000 postmenopaused women were randomly assigned to take 1000 mg of calcium plus 400 IU of vitamin D daily or placebo. Researchers found that the incidence of breast cancer was similar in the supplement ( 528) and placebo ( 546) groups. The authors concluded that " the main findings do not support a causal realtionship between calcium and vitamin D supplement use and reduced breast cancer incidence".
In an accompanying editorial "Breast Cancer Prevention Using Calcium and Vitamin D: A Bright Future?" ( free f/t), the authors say that the study results may have been affected by multiple "important confounders" and that vitamin D and calcium may still have a "bright future" in breast cancer prevention and further studies will be needed.
Source: "Calcium Plus Vitamin D Supplementation and the Risk of Breast Cancer" Journal of the National Cancer Institute. Advance Access published online on November 11, 2008 JNCI, doi:10.1093/jnci/djn360
More than 36,000 postmenopaused women were randomly assigned to take 1000 mg of calcium plus 400 IU of vitamin D daily or placebo. Researchers found that the incidence of breast cancer was similar in the supplement ( 528) and placebo ( 546) groups. The authors concluded that " the main findings do not support a causal realtionship between calcium and vitamin D supplement use and reduced breast cancer incidence".
In an accompanying editorial "Breast Cancer Prevention Using Calcium and Vitamin D: A Bright Future?" ( free f/t), the authors say that the study results may have been affected by multiple "important confounders" and that vitamin D and calcium may still have a "bright future" in breast cancer prevention and further studies will be needed.
Source: "Calcium Plus Vitamin D Supplementation and the Risk of Breast Cancer" Journal of the National Cancer Institute. Advance Access published online on November 11, 2008 JNCI, doi:10.1093/jnci/djn360
Folic acid and B vitamins do not affect cancer risk
Folic acid and B vitamins are thought to have an important role in cancer prevention, but a study published in JAMA found that these supplements had no significant effects on overall cancer risk.
More than 5000 women health professionals, aged 42 or older, enrolled in a RCT designed to evaluate the effects of folic acid and B vitamins on cancer risk in women with high risk cardiovascular disease. They were randomly assigned to receive a daily combination of folic acid and B vitamin or a placebo for 7.3 years.
Researchers found that the supplement group had similar risk of developing cancer or death and there was a significant reduced risk of cancer in women aged 65 or older at study entry. The authors said "if the findings is real and substantiated, the results may have public health signficance because the incidence rates of cancer are high in elderly perosns...."
Source: Effect of Combined Folic Acid, Vitamin B6, and Vitamin B12 on Cancer Risk in Women. JAMA, 2008; 300 (17): 2012-2021 ( f/t via Athens)
More than 5000 women health professionals, aged 42 or older, enrolled in a RCT designed to evaluate the effects of folic acid and B vitamins on cancer risk in women with high risk cardiovascular disease. They were randomly assigned to receive a daily combination of folic acid and B vitamin or a placebo for 7.3 years.
Researchers found that the supplement group had similar risk of developing cancer or death and there was a significant reduced risk of cancer in women aged 65 or older at study entry. The authors said "if the findings is real and substantiated, the results may have public health signficance because the incidence rates of cancer are high in elderly perosns...."
Source: Effect of Combined Folic Acid, Vitamin B6, and Vitamin B12 on Cancer Risk in Women. JAMA, 2008; 300 (17): 2012-2021 ( f/t via Athens)
Thursday, October 30, 2008
Statins lower prostate cancer risk?
Rising blood levels of PSA (prostate-specific antigen) is used to diagnose prostate cancer, but there is conflicting evidence that statins ( cholesterol-lowering drug) may be associated with a reduced risk of prostate cancer.
Researchers at Duke University studied changes in PSA levels in 1,214 men who were prescribed statins and found PSA level drops slightly in men who lower their cholestrol with statin drugs. They said that the reduction could mean that statins may affect prostate biology or statins may lower their PSA levels without lowering the risk of prostate cancer, making the disease more difficult to diagnose.
Critics said further research is needed and men who currently take Statins should not be worried by these findings. In the UK, PSA testing is not rountinely carried out.
Source: Hamilton RJ, Goldberg KC, Platz EA, Freedland SJ. The Influence of Statin Medications on Prostate-specific Antigen Levels. Journal of the National Cancer Institute 2008; Advance Access published online on October 28, 2008
Researchers at Duke University studied changes in PSA levels in 1,214 men who were prescribed statins and found PSA level drops slightly in men who lower their cholestrol with statin drugs. They said that the reduction could mean that statins may affect prostate biology or statins may lower their PSA levels without lowering the risk of prostate cancer, making the disease more difficult to diagnose.
Critics said further research is needed and men who currently take Statins should not be worried by these findings. In the UK, PSA testing is not rountinely carried out.
Source: Hamilton RJ, Goldberg KC, Platz EA, Freedland SJ. The Influence of Statin Medications on Prostate-specific Antigen Levels. Journal of the National Cancer Institute 2008; Advance Access published online on October 28, 2008
HRT can increase joint problems
A study funded by Cancer Research UK, the NHS Breast Screening Program and the Medical Research Council followed 1.3 million women for an average of 6.1 years and collected information on reproductive history, use of hormonal therapies, other medical history and lifestyle.
Researchers found that women using HRT are more likely to need a knee replacement due to arthritis than women who have never used HRT. There is also increased risk of hip replacement. The researchers conclude that ‘hormonal and reproductive factors increase the risk of hip and knee replacement, more so for the knee than for the hip. The reasons for this are unclear.’
Critics say that there are limitations of its data collection method and the findings conflict with those of previous studies.
Source: Liu B, Balkwill A, Cooper C et al. Reproductive history, hormonal factors and the incidence of hip and knee replacement for osteoarthritis in middle-aged women. Annals of Rheumatic Diseases 2008; Oct 28 ( via press release)
Researchers found that women using HRT are more likely to need a knee replacement due to arthritis than women who have never used HRT. There is also increased risk of hip replacement. The researchers conclude that ‘hormonal and reproductive factors increase the risk of hip and knee replacement, more so for the knee than for the hip. The reasons for this are unclear.’
Critics say that there are limitations of its data collection method and the findings conflict with those of previous studies.
Source: Liu B, Balkwill A, Cooper C et al. Reproductive history, hormonal factors and the incidence of hip and knee replacement for osteoarthritis in middle-aged women. Annals of Rheumatic Diseases 2008; Oct 28 ( via press release)
Wednesday, October 29, 2008
New diet pill doubles weight loss
A phase II trial ( funded by Neurosearch, a pharmaceutical company in Denmark and other sources) in which 203 obese patients were randomised to receive three different daily doses of tesofensine ( a new diet drug) or placebo pills found that those who received tesofensine lost more weight than those received placebo.
Dieting patients on the highest doses lost up to 12.8kg (28.2lbs) in six months, roughly twice the level achieved by best weight loss drugs already used in Europe. However, side effects have been experienced by these patients.
Critics said more trials are needed and the efficacy and safety of the drug need confirmation in larger phrase III trials. ( Note: The maker of tesofensine, Neurosearch, is seeking approval for the drug in the US and Europe).
Source: Astrup A, Madsbad S, Breum L, et al. Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial. The Lancet. Early Online Publication, 23 October
Dieting patients on the highest doses lost up to 12.8kg (28.2lbs) in six months, roughly twice the level achieved by best weight loss drugs already used in Europe. However, side effects have been experienced by these patients.
Critics said more trials are needed and the efficacy and safety of the drug need confirmation in larger phrase III trials. ( Note: The maker of tesofensine, Neurosearch, is seeking approval for the drug in the US and Europe).
Source: Astrup A, Madsbad S, Breum L, et al. Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial. The Lancet. Early Online Publication, 23 October
Leukaemia drug halts MS
Researchers compared alemtuzumab (a drug to treat leukaemias or blood cell cancers) in treating MS with interferon beta-1a (a drug that is already used to treat the condition) and found that it halted and reversed the effects of the disease. However, there were some serious side effects in a few patients.
334 patients with early symptoms of MS were recruited from 49 centres across Europe and the US between December 2002 and July 2004 and randomised to receive interferon beta-1a or alemtuzumab at a dose of either 12mg or 24mg. Researchers found that those who took alemtuzumab had a reduction in disability (71%) and reduction in the risk of relapse (74%) compared with beta-interferon.
Critics said that it is not known if the drug would be beneficial for more advanced MS and the result of restoration of brain tissue will need confirmation in larger phase 3 trials.
Source: The CAMMS223 Trial Investigators. Alemtuzumab vs. Interferon Beta-1a in Early Multiple Sclerosis. NEJM 2008; 359: 1786-1801
334 patients with early symptoms of MS were recruited from 49 centres across Europe and the US between December 2002 and July 2004 and randomised to receive interferon beta-1a or alemtuzumab at a dose of either 12mg or 24mg. Researchers found that those who took alemtuzumab had a reduction in disability (71%) and reduction in the risk of relapse (74%) compared with beta-interferon.
Critics said that it is not known if the drug would be beneficial for more advanced MS and the result of restoration of brain tissue will need confirmation in larger phase 3 trials.
Source: The CAMMS223 Trial Investigators. Alemtuzumab vs. Interferon Beta-1a in Early Multiple Sclerosis. NEJM 2008; 359: 1786-1801
Tuesday, October 28, 2008
Doctors often prescribe placebo treatments
The use of placebos is controversial, researchers at the NIH ( National Institute of Health) surveyed 1200 internists and rheumatologists to examine the doctors' attitudes towards and the use of placebo treatments in the US.
679 physicians returned the survey questionnaires, half said they prescribed placebo treatments on a regular basis, 62% believed the practice ethically acceptable and were happy to recommend or prescribe placebo treatments. 68% of those prescribe placebo drugs said that they describe the placebo treatments to patients as "a potentially beneficial medicine or treatment not typically used for their condidtion", only a small number of physicians inform patients of the placebo treatment.
The most commonly prescribed placebo treatments were painkillers (41%) or vitamins (38%), some prescribed antibiotics (13%) and sedatives (13%), a few using sugar pills.
The authors concluded that precribing painkillers or vitamins to promote positive expections may not raise serious concerns but prescribing antibiotics and sedatives when they are not clearly indicated could have adverse effects for patients and public health.
Some doctors said the survey is misleading and the conclusions need disputed.
Source: "Prescribing "placebo treatments": results of national survey of US internists and rheumatologists" BMJ 2008;337:a1938 ( f/t via Athens)
679 physicians returned the survey questionnaires, half said they prescribed placebo treatments on a regular basis, 62% believed the practice ethically acceptable and were happy to recommend or prescribe placebo treatments. 68% of those prescribe placebo drugs said that they describe the placebo treatments to patients as "a potentially beneficial medicine or treatment not typically used for their condidtion", only a small number of physicians inform patients of the placebo treatment.
The most commonly prescribed placebo treatments were painkillers (41%) or vitamins (38%), some prescribed antibiotics (13%) and sedatives (13%), a few using sugar pills.
The authors concluded that precribing painkillers or vitamins to promote positive expections may not raise serious concerns but prescribing antibiotics and sedatives when they are not clearly indicated could have adverse effects for patients and public health.
Some doctors said the survey is misleading and the conclusions need disputed.
Source: "Prescribing "placebo treatments": results of national survey of US internists and rheumatologists" BMJ 2008;337:a1938 ( f/t via Athens)
Friday, October 24, 2008
JAMA editoral argues against preemption
JAMA published an editorial in the October issue in urging the US Supreme Court not to endorse preemption and argues for patients' right to sue drugmakers in state court for harms caused by defective drugs that were approved by FDA.
The editorial states that " ......if the court rules in favors of Wyeth, endorsing preemption, patients will lose an irreplaceable method for seeking remedies for injuries resulting from pharmaceutical agents that were approved by FDA."
American legislation states that federal regulation preempts state law - this means that patients have no legal right to sue drugmakers in state court for injuries caused by FDA-approved drugs.
Source: Catherine D. DeAngelis, Phil B. Fontanarosa Prescription Drugs, Products Liability, and Preemption of Tort Litigation JAMA 2008;300(16) :1939-1941 ( f/t via Athens)
The editorial states that " ......if the court rules in favors of Wyeth, endorsing preemption, patients will lose an irreplaceable method for seeking remedies for injuries resulting from pharmaceutical agents that were approved by FDA."
American legislation states that federal regulation preempts state law - this means that patients have no legal right to sue drugmakers in state court for injuries caused by FDA-approved drugs.
Source: Catherine D. DeAngelis, Phil B. Fontanarosa Prescription Drugs, Products Liability, and Preemption of Tort Litigation JAMA 2008;300(16) :1939-1941 ( f/t via Athens)
Top tips for good surgical sign-out practice
In America, 80-hour workweek was recently adopted to reform medical care and resident education with the benefits of reducing fatigue among physicians and reducing medical errors. The change of work hours also brings new challenge of the continuity of care as residents have to depend more on colleagues to assume the care of patients at different times.
Surveys show that there is no standardised sign-out process and transitions of care among residents as policies and procedures for sign-out practices vary widely among institutions, services and individuals.
The surgical interns at The Johns' Hopkins Hospital carried out a review of current literature on this topic and develop a list for safe and effective sign-outs based on their personal experiences.
Source: "The Top 10 List for a Safe and Effective Sign-out" Archives of Surgery. 2008;143(10):1008-1010
Surveys show that there is no standardised sign-out process and transitions of care among residents as policies and procedures for sign-out practices vary widely among institutions, services and individuals.
The surgical interns at The Johns' Hopkins Hospital carried out a review of current literature on this topic and develop a list for safe and effective sign-outs based on their personal experiences.
Source: "The Top 10 List for a Safe and Effective Sign-out" Archives of Surgery. 2008;143(10):1008-1010
Doubts over aspirin use in diabetes
UK guidelines recommend a daily dose of aspirin as a "preventive" treatment in the diabetics as they are at a much higher risk of cardiovascular disease. However, a study published in the BMJ found no benefit from either aspirin or antioxodants in preventing heart attacks. It also increases the risk of internal bleeding.
The study invloved 1,276 adult patients with diabetes mellitus from 16 diabetic clinics in Scotland between November 1997 and July 2001. Participants were randomly assigned in four groups to receive the aspirin tablet + antioxidant capsule, or aspirin tablet + placebo capsule, or placebo tablet + antioxidant capsule or both a placebo tablet and a placebo capsule.
The findings show that in adults with diabetes and no symptoms of cardiovascular disease, there was no evidence that aspirin or antioxidants use prevented heart attacks, strokes, amputations or death. However, the drug was beneficial in people who already have a history of heart attack or stroke.
Experts said the study was "extremely important" because it confirms the concerns of aspirin use by the general population and it is worth revisiting the guidelines.
Source: Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008; Published 16 October ( f/t via Athens)
The study invloved 1,276 adult patients with diabetes mellitus from 16 diabetic clinics in Scotland between November 1997 and July 2001. Participants were randomly assigned in four groups to receive the aspirin tablet + antioxidant capsule, or aspirin tablet + placebo capsule, or placebo tablet + antioxidant capsule or both a placebo tablet and a placebo capsule.
The findings show that in adults with diabetes and no symptoms of cardiovascular disease, there was no evidence that aspirin or antioxidants use prevented heart attacks, strokes, amputations or death. However, the drug was beneficial in people who already have a history of heart attack or stroke.
Experts said the study was "extremely important" because it confirms the concerns of aspirin use by the general population and it is worth revisiting the guidelines.
Source: Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008; Published 16 October ( f/t via Athens)
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