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Operation Relaunch: New Website Nearing Completion

Operation Relaunch: New Website Nearing Completion

The next time you visit us, you may see a completely different physiciansweekly.com website. For months we have been biting our tongues as we revamped the site, and if you like us now, we think you’ll be dazzled by what we have in store for you. For starters, we have added some new article categories to the site, including Business of Medicine — encompassing news about healthcare reform — Medical Technology and Career Concerns, and we will be working on enhancing our coverage of these issues in coming months. You should find it easier to locate the information you’re looking for quickly. Articles can be searched by topic (for example, hypertension) from one main menu, with previews of articles displayed for each topic area. You will also be able to share, rate and comment on any article on the site, and reply to comments made by your colleagues. Links to related content will be included alongside every article as well. Our popular eBooks will now be displayed on a virtual bookshelf (think iPad), for convenient browsing through the eBook library. Finally, we would like to invite healthcare professionals to write for our new Guest Blogger column. Submit your idea for a blog or feature article when the site debuts and if we accept your idea, we’ll publish it on the site and send you a Physician’s Weekly coffee mug or t-shirt, along with our gratitude. We’ll keep you informed on our progress in the days leading up to our relaunch, but if you are not a subscriber to our weekly newsletter and would like to be notified when the...

Chronic Pain: Analyzing the Public Health Burden

There has been greater recognition over the past several decades of the pervasiveness of poorly assessed, poorly treated chronic pain, culminating recently in an Institute of Medicine report quantifying this healthcare issue. Evidence also suggests that the quality of and access to assessment and treatment of pain are poorer for racial and ethnic minorities. “This is a very large public health problem,” says Perry G. Fine, MD. “The issue has become even more important because of its concurrent overlap with the liberalization of prescribing patterns for opioid analgesics to treat chronic, non-cancer pain.” Chronic Pain is a Costly Problem Well over 100 million people in the United States are living with chronic pain that has some debilitating effect on their daily lives, costing society over $600 billion a year in direct medical costs and lost productivity. According to the American Pain Foundation, pain affects more Americans than diabetes, heart disease, and cancer combined (Table). The duration of pain in adults aged 20 and older who report having pain is longer than 1 year for 42% of patients (Figure). As these health and economic tolls have made their mark, they have exposed training gaps for healthcare professionals in recognizing and treating chronic pain adequately. “With some additional training and by adopting well-established practice guidelines, the risks of abuse can be managed and limited for both patients and physicians.” “We have not established a systemic approach to comprehensively prevent and treat chronic pain,” says Dr. Fine, “and comorbid psychiatric disorders can further complicate issues of treatment selection and adherence. Physicians are doing their best to return their pain patients to optimal...

Managing Varicose Veins & More Advanced Chronic Venous Diseases

It is estimated that 20% to 25% of American adults have varicose veins, and 6% have more advanced chronic venous diseases (CVDs). While varicose veins were once considered a cosmetic problem, they are associated with discomfort, pain, and poor quality of life. Severe CVDs may also lead to loss of limb or life. In response to the rapid improvement in technology and results from recent randomized clinical trials, the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) jointly released new clinical practice guidelines for the care of patients with varicose veins. The guidelines, published in the May 2011 supplement to the Journal of Vascular Surgery, also provide recommendations for those with more advanced CVDs, including edema, skin changes, or venous ulcers. As the aging population continues to grow, so too will complications related to varicose veins and associated CVDs. Advancements in technology and surgical techniques have resulted in vast improvements in the prevention and management of varicose veins. “It is critical that surgeons are aware of the latest diagnostic strategies and the less invasive and more effective treatment techniques for treating the disease,” says Peter Gloviczki, MD, who chaired the SVS/AVF Venous Guideline Committee. New & Modified Recommendations Numerous recommendations for the management of varicose veins and more advanced CVDs are presented in the SVS/AVF guidelines (Table). The strength of each guideline varies based on the benefits as compared to the risks, burdens, and costs. A key recommendation offered by the new guidelines is duplex scanning of the deep and superficial veins to complement the standard history and physical examination in evaluation of patients with varicose veins...

Preventing Falls in the Elderly: Updated Guidelines

Falls are one of the most common health problems experienced by older adults and are a common cause of loss of functional independence. Studies show that unintended injuries are the fifth leading cause of death in the elderly, and falls cause about two-thirds of those injuries. Fortunately, research continues to evolve in fall prevention. In the January 13, 2011 online issue of the Journal of the American Geriatrics Society, the American Geriatrics Society (AGS) and the British Geriatric Society (BGS) updated the 2001 guideline on preventing falls in older persons based on an accumulation of new data and a literature review. Assessing Fall Risk Factors The first step in preventing falls is to determine if patients are at increased risk. The updated AGS/BGS guidelines recommend that yearly evaluations of elderly patients include questions about any recent falls as well as inquiries about balance and steadiness of gait. Balance and steadiness represent a new addition to the guidelines. These problems can result from a number of causes, so it’s important that physicians consider what may be contributing to the problem before recommending treatment. Patients should also be asked about side effects of any medications that may increase fall risk. Questions about a patient’s comfort with activities of daily living may also reveal areas of concern. If a patient has already sustained a fall, physicians should assess and treat any resulting injuries, evaluate what contributed to the fall, and then recommend interventions to prevent future falls. Take Preventive Measures to Reduce Falls In many cases, preventive measures can be taken to reduce the likelihood of falls. The appropriate course of action...
A Snapshot of Depression in America

A Snapshot of Depression in America

New data from the CDC demonstrate that the prevalence of current depression among people aged 12 or older in the United States appears to be significant. The findings below illustrate new data collected from 2007 to...
15% of Surgeons Abuse Alcohol

15% of Surgeons Abuse Alcohol

Alcohol abuse and dependence appears to be a significant problem among surgeons in the United States, according to a national survey published this month in Archives of Surgery. The online, anonymous poll completed by nearly 7,200 surgeons found that 15% of surgeons appear to suffer from alcohol abuse or dependence, based on the Alcohol Use Disorders Identification Test, version C.  Nearly 14% of male surgeons and 26% of female surgeons had a score consistent with the disorder. These stats exceed the alcohol abuse rates (8% to 12%) typically cited among the general public. While alcohol abuse rates may be significant, studies have shown that direct patient harm associated with impairment due to chemical dependency in surgeons is extremely rare. Overall, alcohol abuse or dependence were less prevalent among male surgeons, as well as among those who were older, had children, worked longer hours, were more often “on call” or were employed by the U.S. Department of Veterans Affairs. The emotional exhaustion and depersonalization domains of burnout were strongly associated with alcohol abuse or dependence. Physician’s Weekly wants to know… Should surgeons undergo random alcohol and drug screenings as do other safety-sensitive professions? What systems should be put in place to support surgeons who may be suffering from burnout?...

Addressing the Antibiotic Resistance Crisis

Antibiotic-resistant infections cost the healthcare system more than $20 billion annually and result in more than 8 million additional days in the hospital. Overcoming the crisis will require comprehensive, multipronged strategies that are aimed at reducing the emergence and spread of antimicrobial-resistant organisms. Few New Antibiotics on the Horizon Many pharmaceutical companies have had less interest in developing new antibiotics because they aren’t as profitable as drugs used to treat chronic conditions or lifestyle issues. Additional barriers include uncertainties about requirements for FDA approval and the scientific and technical challenges that are inherent in identifying new classes of antibiotics. Once a successful new antibiotic clears hurdles and enters the market, the profitability of the drug is limited by effective antimicrobial stewardship programs and by the ability of microbes to rapidly adapt to antibiotics. Since 2008, only two new antibiotics have been approved by the FDA. “As much as 50% of antibiotic use in humans is either unnecessary or inappropriate.” The Infectious Diseases Society of America set forth the 10 x ‘20 Initiative to spur the development of 10 new antibiotics by 2020, a goal that includes new incentives for drug research and development, among other strategies. Unfortunately, little progress has been made in achieving this goal. Accordingly, legislators need to support new incentives for industry, and regulators need to consider the important clinical and public health benefits that antibiotics provide as they develop new guidelines and update existing guidance for the design of clinical trials. Education on Antibiotic Use is Critical As much as 50% of antibiotic use in humans is either unnecessary or inappropriate. Efforts to increase education...

Guideline Adherence & Post-Mastectomy Radiation Use

Radiation therapy after mastectomy is not always necessary for women with low-risk breast cancer, but it is frequently recommended for high-risk breast cancers. For intermediate breast cancers, use of radiation therapy after surgery remains controversial. Following the publication of three landmark trials in the mid- 1990s showing that post-mastectomy radiation therapy decreases locoregional recurrence and improves survival in patients with high-risk breast cancer, rates of this type of radiation increased from 36.5% to 57.7% from 1996 to 1998 (Table 1). In the late 1990s, several major associations released treatment guidelines endorsing the use of post-mastectomy radiation therapy in this population, most notably the American Society of Clinical Oncology and the National Comprehensive Cancer Care Network. A New Analysis of Post-Mastectomy Radiation In the October 15, 2011 issue of Cancer, investigators sought to determine if the use of post-mastectomy radiation has increased since national guidelines have recommended this approach for high-risk breast cancer patients. Researchers analyzed data from the SEER-Medicare database on 38,332 women aged 66 or older who underwent mastectomy for invasive breast cancer between 1992 and 2005. “Our study found that about 55% of women with high-risk breast cancer were receiving post-mastectomy radiation therapy,” says Benjamin D. Smith, MD, lead author of the analysis. “That is substantially lower than what we had anticipated.” “About 55% of women with high-risk breast cancer were receiving post-mastectomy radiation therapy. That is substantially lower than what we had anticipated.” Dr. Smith says that the rate of radiation therapy when indicated following lumpectomy is about 90%. “It’s paradoxical,” he adds. “Although radiation after lumpectomy has been shown to lower risk of cancer recurrence...
Symptom Duration in Lumbar Disc Herniation

Symptom Duration in Lumbar Disc Herniation

A lumbar disc herniation occurs when part of the jellylike material in the center of a disc between two vertebrae in the lower back forces its way through a weakened area of the disc and pushes on a nerve. Patients with lumbar disc herniation usually experience significant back pain and radiating leg pain, numbness, and even weakness. Studies have shown that symptomatic lumbar disc herniation affects 1% to 2% of Americans at some point in their lives, most often in their 30s or 40s. Typically, symptoms of lumbar disc herniation improve within 6 to 8 weeks. Treatments usually involve nonsurgical approaches at first, such as medications, patient education and counseling, and physical therapy. Current guidelines recommend that surgery be considered only for patients who experience pain beyond a reasonable course of non-operative therapy. Others who may be considered for surgery on a more emergent basis include those who have progressive muscle weakness in the legs, or loss of bladder or bowel control from nerve compression. Symptom Duration in Disc Herniation In a study published in the October 19, 2011 Journal of Bone and Joint Surgery, my colleagues and I observed 1,192 patients enrolled in the Spine Patient Outcomes Research Trial, which was conducted at 13 spinal practices in 11 states. Patients were aged 18 or older and suffered from various symptoms of lumbar disc herniation. They were assigned to undergo either operative treatment or non-operative treatment. At different intervals after receiving treatment, we compared outcomes of patients who had symptoms for 6 months or less to those who had symptoms lasting longer than 6 months prior to enrollment in...
Surprise Findings: Satisfied Patients Pay More, Die Sooner

Surprise Findings: Satisfied Patients Pay More, Die Sooner

Unexpected findings from a new study published in Archives of Internal Medicine found that higher patient satisfaction, while associated with less emergency department use, was also associated with greater inpatient use, higher overall healthcare and prescription drug expenditures, and increased mortality. In an analysis of over 50,000 patients, researchers from the University of California Davis in Sacramento found that those who rated themselves as most satisfied with their physicians incurred 8.8% higher health expenses in a 2-year period and were 26% more likely to die shortly thereafter than those who rated themselves less satisfied. The findings highlight the dangers in putting too much emphasis on always giving patients what they want—including unnecessary services and prescriptions. But in a system that penalizes physicians if they risk not doing enough, that’s a tightrope walk. Physician’s Weekly wants to know … What your opinion is about these findings? Are physicians trapped between a rock and a hard place or is there more in their...

The Need for Ensuring Medication Continuity

Discontinuation of medications with proven efficacy for treating chronic diseases is a critical problem, especially during or following hospitalization. Research has suggested that transitions in care, specifically those that occur during an ICU admission, may be partly to blame because they can result in medical errors. Examining Transitions in Care In a study published in the August 2011 JAMA, Chaim M. Bell, MD, PhD, and colleagues set out to evaluate rates of unintentional discontinuation of medication following hospitalization. Rates of medication discontinuation were compared across three groups: 1) patients admitted to the ICU, 2) patients hospitalized without ICU admission, and 3) non-hospitalized patients (controls). “We evaluated the effect of hospitalization and ICU admission on discontinuation of five medication groups with strong benefit-to-risk ratios,” explains Dr. Bell. “This is also one of the first studies to our knowledge that assesses the impact of discontinuation on outcomes at 1 year after discharge.” Dr. Bell’s population-based cohort study analyzed medical records on almost 400,000 elderly patients hospitalized between 1997 and 2009 who were taking at least one of five medications: Statins. Antiplatelet or anticoagulant agents. Levothyroxine. Respiratory inhalers. Gastric acid–suppressing drugs. Patients were required to demonstrate a minimum of 1 year of continuous use of the medication for study entry, thus minimizing the possibility of deliberate medication withdrawals. At 90 days after study participants were discharged, potentially unintentional discontinuation of medication was assessed. The authors also tracked deaths, hospitalizations, and ED visits up to 1 year after hospital discharge. New Findings on Medication Discontinuation In the JAMA article, the investigators found that hospitalization was associated with an increased risk of medication discontinuation...
Conference Highlights: ISET 2012

Conference Highlights: ISET 2012

New research was presented at ISET 2012, the annual International Symposium on Endovascular Therapy, on January 15-19 in Miami Beach. The features below highlight just some of the studies that emerged from the meeting. » A New Approach to Managing Unstoppable Nosebleeds  » Cryoablation Deemed Effective in Ovarian Cancer » MS Patients Report Benefits With Angioplasty » Fibromuscular Dysplasia Frequently Undiagnosed Treating DVT in Pregnant Women The Particulars: Studies have shown that DVT is four to six times more common in pregnant women than in non-pregnant women. Research suggests that many pregnant women with DVT often forgo the most effective treatments—surgery or catheter-directed thrombolysis—because they fear that doing so may harm their unborn children. Data Breakdown: In a study of 11 pregnant women with DVT, two underwent surgery to remove the clot, and nine were treated with a bath of thrombolytic medications delivered directly into the clot. Removal of the clot was successful in all cases, and all but one pregnancy resulted in successful birth. One woman who miscarried 1 week after treatment suffered from antiphospholipid antibody syndrome, which the researchers believe likely caused the miscarriage. Take Home Pearl: Aggressive treatment with surgery or catheter-directed thrombolysis for pregnant women with DVT appears to be safe. Aggressive treatment was also shown to prevent serious complications and death.     A New Approach to Managing Unstoppable Nosebleeds [back to top] The Particulars: Unstoppable nosebleeds can cause anemia and may lead to other more serious complications, including heart attack. When packing the nose with gauze, inflating a balloon to stop blood flow, or cauterizing the vessels in the nose fail, surgery or embolization are the...
A Tool to Assess Depression Remission

A Tool to Assess Depression Remission

For many years, the standard tool for monitoring depression has been the 9-item Patient Health Questionnaire (PHQ-9), and it has been useful when starting patients on treatment and determining their response to therapy. Patients receive scores ranging from 0 (no depression) to 27 (severe depression). A score ranging between 10 and 14 indicates moderate depression. Clinical experience, however, has shown that once patients reach scores of about 10 on the PHQ-9, the tool becomes less useful. Typically, a score of 10 would trigger clinicians to continue recommending medication use. Some individuals with this score report that they are feeling better, are back to their daily routines, and feel like their mood has improved. Others with a score of around 5 on the PHQ-9—indicating that their depression has resolved—say they aren’t feeling like their normal selves. Assessment of other depression symptoms may be necessary to further flesh out what patients consider as being back to normal. A Tool to Assess Depression Remission My colleagues and I recently developed the Remission Evaluation and Mood Inventory Tool (REMIT). This tool can be used to ask patients with PHQ-9 scores of 12 and under an additional five questions that go beyond the PHQ-9. Specifically, patients are asked how often, over the previous 2 weeks, they felt: Happy Content In control of their emotions That they could bounce back when things went wrong That the future seemed dark In a study published in the May/June 2011 issue of General Hospital Psychiatry, my colleagues and I recruited 1,000 patients to test REMIT. Our tool appeared to add to our ability to determine which patients were...
Many New Docs Regret Their Career Choice

Many New Docs Regret Their Career Choice

Almost one-third of new physicians said they would choose a different field if they had to it over again, according to a new survey by the recruitment firm, Merritt Hawkins. Residents were asked if they would study medicine again if they had their education to do over or if they would select another field. While the majority (71%) said they would choose medicine, a significant minority (29%) said they would choose another field—up from 18% in 2008. When asked to rate those factors causing them most concern as they prepare to enter their first professional practice, the following were the top five things listed as “most concerning”: Availability of free time (48%) Dealing with payers (42%) Earning a good income (41%) Malpractice (40%) Health reform (39%) “With declining reimbursement, increasing costs, malpractice worries, and the uncertainty of health reform, it is not surprising that many newly trained doctors are concerned about what awaits them,” company representatives said in a press release. Physician’s Weekly wants to know…if you had to do it over again, would you choose a different field considering the current environment of the medical...
Docs Divided Over Cholesterol Screening in Kids

Docs Divided Over Cholesterol Screening in Kids

At the end of last year, an expert panel convened by the National Heart, Lung, and Blood Institute (NHLBI) recommended that all children be screened for high cholesterol—a decision that has divided support from healthcare professionals. One in 500 children has an inherited disorder that causes high levels of LDL cholesterol that may require medication control. The NHLBI panel recommended children get screened once between the ages of 9 and  11 and again between ages 17 and 21. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening primarily based on family history or in children who had risks factors (ie, obesity or diabetes). Some clinicians find that universal screening is critical in identifying children who are genetically predisposed to high cholesterol, as well as determine others who may benefit from treatment. However others express concern that screening may do more harm than good, requiring doctors to cast a wide and expensive net to identify a relatively small number of children who would require medical treatment. Those opposed also worry that children may be needlessly prescribed cholesterol-lowering medications. While the benefits of statins in adults has been extensively studied and validated, little literature ensures the safety and effectiveness of statins in children. Physician’s Weekly wants to know…where do you stand on this issue? Should treatment instead focus on lifestyle interventions?...
3 Medical Peripherals for the iPad or iPhone

3 Medical Peripherals for the iPad or iPhone

by Katie Matlack The iPhone and iPad are changing the world of medical devices as we know it. Thanks to their familiar interface, Web connectivity, and powerful processing capabilities, with the right app and plug-in these iOS devices can work as super smart medical devices that make sharing as easy as the push of a touchscreen button. Your patients can now access increasingly high-quality medical devices, making it easy to be more actively engaged in their own health and provide you with information needed for better patient care. And home and rural caregivers can benefit from the portability and versatility of iPad and iPhone based devices. Below are three examples of powerful iOS medical devices I’ve found that already exist.  1) The Withings Blood Pressure Monitor French company Withings developed this blood pressure monitor that features an app and a cuff that fits most average-sized people. Accurate data on blood pressure can help patients monitor hypertension, reducing the risk of serious consequences to their heart, brain and kidney. The Withings monitor can even work with an iPod Touch, and runs at $129. Patients can use the device to share their data with you.   2) ECEM Pulse Oximeter This device isn’t yet available to the masses, but given its utility, I imagine it will be soon. It features a small clip that attaches to your fingertip. The clip beams a light through your fingertip to a receiver on the opposite side; the amount of light received is used to determine how much oxygen is saturated in your blood. Developed by the Electrical and Computer Engineering in Medicine research group together with the Pediatric Anesthesia Research...
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