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New Migraine Guidelines Issued

New guidelines released this week by the American Academy of Neurology focus on the preventive treatment of migraine headache.  In a new study published in Neurology, the author panel addresses the million-dollar question: What drugs are effective in preventing migraines? Among the recommendations for prescription pharmacologic agents: Most antiepileptic drugs (divalproex sodium, topiramate, sodium valproate), certain beta-blockers (metoprolol, propranolol, timolol), and one triptan (frovatriptan) are effective and should be offered to patients. Certain antidepressants (amitriptyline, venlafaxine), other beta-blockers (atenolol, nadolol), and other triptans (naratriptan, zolmitriptan) are probably effective and should be considered. Lamotrigine is not effective and should not be given. In the guideline on NSAIDs and complementary therapies: Petasites is effective and should be offered to reduce frequency and severity of attacks. Several NSAIDs (fenoprofen, ibuprofen, ketoprofen, naproxen), riboflavin, magnesium, feverfew, and histamine SC are probably effective and should also be considered. Montelukast is probably ineffective and should not be considered. Physician’s Weekly wants to know…what has worked for you and your...
Win an iPad from the Patient Education Center!

Win an iPad from the Patient Education Center!

Soon we will be sending you a FREE updated header for placement at the top of your Patient Education Center fixture. Simply complete this short service update and we’ll also enter your name in our drawing for a new iPad 3. iPad Giveaway Rules & Regulations iPad® is a registered trademark of Apple...

Bariatric Surgery for Diabetes: Significant Benefits Observed

In the United States, more than 90% of 25.8 million adults with diabetes have type 2 disease, according to the CDC. More than 1.9 million cases were diagnosed in 2010 alone among adults aged 20 and older. Approximately 90% of type 2 diabetes has been attributable to excess weight and obesity. “The results of noninvasive interventions for type 2 diabetes and obesity, such as lifestyle changes and pharmacotherapy, have been disappointing,” says Jon C. Gould, MD. “Bariatric surgery appears to be one of the most effective, long-lasting treatments for obesity. In many clinical trials, these procedures have been quite effective for individuals who are obese and have type 2 diabetes.” Riveting New Data on Bariatric Surgery Results In the June 2011 Archives of Surgery, a systematic review was published demonstrating that bariatric surgery leads to marked and long-lasting weight reduction, and may be capable of improving or even curing type 2 diabetes. The analysis reviewed findings from nine studies that followed obese patients with diabetes who underwent either gastric bypass or gastric banding for 1 year. Rick Meijer, MD, and colleagues from Amsterdam found that Roux-en-Y gastric bypass led to a reversal rate of type 2 diabetes of 83%. Adjustable gastric banding led to a reversal rate of 62%, and this effect was achieved later after surgery (Figure 1). “The presence of diabetes is a compelling argument to perform bariatric surgery in eligible patients according to nationally recognized criteria for the procedure,” says Dr. Gould. “Dr. Meijer’s study showed that glycemic control improved in the months after laparoscopic adjustable gastric banding, but it improved more rapidly and completely after...

Improving Cardiac Catheterization

More than 1 million cardiac catheterizations are per­formed in the United States annually, and most of these procedures are performed via the femoral arter­ies through the groin. With transfemoral catheterization, patients must lie flat for 4 to 6 hours after the procedure. This is necessary to ensure the puncture site reaches hemostasis and to prevent bleeding complications. Transfemoral cath­eterization can be painful for patients once the procedure is completed because there is a need to compress the artery for 20 minutes manually. The decreased mobility after the proce­dure can also lead to other problems during hospitalization. An alternative approach that is being used by more and more clinicians nationwide is transradial catheterization. In these procedures, the coronary arteries are accessed via the wrist, enabling patients to become mobile almost immediately after the procedure. After the surgery, patients can walk, sit upright, use the bathroom, and eat and drink more quickly than with the transfemoral approach. The transradial approach has also been associated with lower complication rates and increased patient comfort. The complication rate for the transfemoral approach varies but can be as high as 3% to 5%. For transra­dial approaches, the rate drops to less than 1%. In addition, the bleeding associated with transfemoral approaches can be more dangerous than for that of transradial procedures. History of Transradial Catheterization The first transradial diagnostic catheterization was per­formed in the late 1980s in Europe. In 1993, a research team in Amsterdam began using the technique for interventional procedures. In recent years, the methods for catheterization have become increasingly enhanced. Some interventional cardiologists view transradial catheterization as the optimal choice for a...

Society of Critical Care Medicine’s 2012 Annual Congress

New research was presented at the 2012 Society of Critical Care Medicine’s Critical Care Congress from February 4-8 in Houston. The features below highlight just some of the studies that emerged from the conference. >> Analyzing Short-Course Antibiotic Use for VAP >> Caloric Restrictions & Acute Lung Injury >> Assessing VTE Prophylaxis After Intracranial Hemorrhage Analyzing Short-Course Antibiotic Use for VAP The Particulars: Antibiotic treatment for ventilator-associated pneumonia (VAP) caused by organisms other than non–lactose-fermenting Gram-negative bacilli (NLFGNB) is typically stopped after 8 days. Data suggest that infections persist at Day 8 when VAP is caused by NLF-GNB. It is unknown if an 8-day course of antibiotics for NLF-GNB infection would be adequate or result in persistent primary infection. Data Breakdown: A retrospective review of 77 patients with VAP showed that persistent primary infection was present in 60% of patients with NLF-GNB infection after 8 days of antimicrobial therapy. Among those with NLF-GNB, only 56% of pathogens obtained on repeat bronchoalveolar lavage remained sensitive to the antimicrobial therapy. Take Home Pearls: An 8-day course of antimicrobial therapy for VAP caused by NLF-GNB infection appears to be insufficient. Study results suggest this course of treatment may result in persistent primary infection.  Caloric Restrictions & Acute Lung Injury The Particulars: Mechanically ventilated patients are generally provided some form of artificial nutrition, but the optimal nutritional strategy in critically ill patients is undetermined. Some studies suggest better outcomes with initial full enteral feeding, while others indicate that hypocaloric feeding improves short-term outcomes. Data Breakdown: A study of mechanically ventilated patients randomized participants to receive trophic feeding (400 kcal/ day) or full enteral...

Surgery Associated With New-Onset AF

A Canadian study has found that new-onset atrial fibrillation (AF) occurs in about onethird of patients without a history of AF who undergo transcatheter aortic valve implantation (TAVI). The incidence of new-onset AF was higher in those with larger left atrial size and those who underwent transapical TAVI. At both 1-month and 1-year follow-up, new onset AF was associated with higher rates of stroke and systemic embolism but not a higher mortality rate. Source: Journal of the American College of Cardiology, January 10,...

Examining TAVI With & Without PCI

A small German investigation has found that preprocedural PCI in patients undergoing transcatheter aortic valve implantation (TAVI) appears to be both feasible and safe. When compared with isolated TAVI, PCI plus TAVI resulted in decreased mortality rates. Both treatment strategies had similar rates of 30-day stroke, major bleeding, major vascular complications, and adverse events at 6 months. Abstract: American Journal of Cardiology, February 15,...

A New Neurostimulation System for Chronic Pain

A neurostimulation system (AdaptiveStim with RestoreSensor, Medtronic) has received FDA approval for treating chronic pain. Using motion sensor technology, the system automatically adapts stimulation levels to the needs of patients with chronic back and/or leg pain. Source:...

Comparing Options for Native Coarctation

Results of a national, multisite comparison of surgical, stent, and balloon angioplasty (BA) treatment of native coarctation suggest that acute complications are significantly lower for those receiving stents than for those undergoing surgery or BA. When compared with BA patients, surgical and stent patients achieved superior hemodynamic and integrated aortic arch imaging outcomes at both short-term and intermediate follow-up. The authors noted, however, that stent patients were most likely to require planned reinterventions. Abstract: Journal of the American College of Cardiology, December 13,...

Advance Directives in High-Risk Surgery

According to a national survey of vascular, neurologic, and cardiothoracic surgeons, almost half (48%) appear to not routinely discuss advanced directives prior to surgery. All respondents of the survey, however, reported discussing potential unanticipated outcomes, and 95% discussed the need for postoperative life support. In addition, 81% of respondents discussed patient preferences to limit postoperative life support. More than half (54%) said they would not operate on patients with directives that limit postoperative care. Abstract: Annals of Surgery, March...

Preoperative Aspirin & Cardiac Surgery Outcomes

Preoperative aspirin therapy appears to be associated with a significantly lower risk of major cardiocerebral complications and renal failure, according to results from a large study of patients undergoing cardiac surgery. The authors also found that preoperative aspirin was linked to shorter ICU stays and lower 30-day mortality when compared with no aspirin therapy. Abstract: Annals of Surgery, February...

Aneurysm Repair Technology Gains FDA Approval

The FDA has granted 510(k) marketing clearance for an endovascular aneurysm repair system (HeliFX, Aptus Endosystems). The device allows for independent endograft fixation. The helical anchor technology is designed to mimic hand suturing performed during open surgical repair. Source: Aptus...

Comparing Transfusion Strategies in High-Risk Hip Surgery

Using a liberal transfusion strategy following hip fracture surgery in elderly patients with high cardiovascular risks appears to result in similar outcomes to those using a more restrictive transfusion strategy. Findings from a randomized study demonstrated that utilizing a liberal strategy did not appear to increase or decrease in-hospital morbidity and mortality rates. Abstract: New England Journal of Medicine, December 29,...
Physician’s Weekly is Looking for Healthcare Bloggers

Physician’s Weekly is Looking for Healthcare Bloggers

Do you have any thoughts or opinions you would like to share with your peers? Physician’s Weekly is looking for healthcare bloggers. We would especially like to hear from healthcare professionals who have had a recent patient encounter, experience with the U.S. healthcare system, or a strong reaction to a recent healthcare news story. If you’re interested, email us! Is there a particular topic you would like us to cover on our website or posters?  We’d like to hear about that, too. Click here to submit a brief description of your idea, and let us know if you have a stand-alone or related photo or video available for publication as well. If we use your idea we’ll send you a PW coffee...
Mobile Devices Up Patient Data-Breach Risk

Mobile Devices Up Patient Data-Breach Risk

Data theft and compromise in healthcare are on the rise, and the mobile landscape is further complicating security. A new 2012 HIMSS Analytics Report: Security of Patient Data reassesses the state of patient data security in the wake of recent technological developments. The 2012 HIMSS report has found that the rapidly rising use of devices not tethered to a workstation brings an increased risk of data loss and/or compromise that many organizations are not properly prepared to address.  For example, the use of electronic health records (EHR) makes patient data more mobile and accessible. It may also introduce third parties who are entrusted with patient data, extending patient data security beyond hospital walls. According to the report, 27% of respondents indicated that their organization had experienced at least one security breach that required notification in the past 12 months. This was up from 19% in 2010 and 13% in 2008. The main sources of security breaches in 2012 were: 56% unauthorized access by employee 34% unauthorized access to paper records 22% laptop/handheld device 10% data housed by a third-party vendor 9% improper destruction of paper records 3% network breach by outsider 2% data accessed from second-hand computer As the use of mobile devices becomes more common in exam rooms and administrative areas, so do the risks of security breaches due to employee negligence and outdated organizational policies. The report stresses that as healthcare moves toward more digital frontiers with an aggressive transition to EHR and mobile-based devices, privacy and security no longer should be treated as separate issues. Physician’s Weekly wants to know…do you feel that patient data is...

A Multipronged Approach to Improve Hand Hygiene

A multipronged hand hygiene program that includes a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback appears to be associated with significant and sustained increases in hand hygiene practices among various types of healthcare professionals. Following implementation of the program and maintaining it consistently for 20 months, the Johns Hopkins University analysis reported a two-fold increase in overall hand hygiene compliance. Abstract: Infection Control and Hospital Epidemiology, February...

Subclinical Hypothyroidism Linked to Preeclampsia

A University of Texas-Southwestern Medical Center study indicates that women diagnosed with subclinical hypothyroidism during pregnancy appear to be at increased risk for severe preeclampsia when compared with women who have normal thyroid function. In hyperthyroid, normal thyroid, and subclinical hypothyroid groups, overall incidences of hypertension during pregnancy were 6.2%, 8.5%, and 10.9%, respectively. After adjusting for confounding factors, significant association was observed between subclinical hypothyroidism and severe preeclampsia. Abstract: Obstetrics & Gynecology, February...

Assessing Lifetime CVD Risks

Differences in risk-factor burden appear to translate into marked differences in lifetime risk of cardiovascular disease (CVD), according to findings from a large meta-analysis. Adults with the following characteristics at age 55 had substantially lower risk of CVD-related death through age 80 than those with two or more major CVD risk factors: Total cholesterol less than 180 mg/dL. Blood pressure less than 120/80 mm Hg. Non-smoking. Non-diabetic. These individuals also had lower lifetime risks of fatal coronary heart disease and non-fatal myocardial infarction. Abstract: New England Journal of Medicine, January 26,...

New Guidelines for Pediatric ADHD

Contributing author: Mark L. Wolraich, MD. In 2000, the American Academy of Pediatrics (AAP) released its first clinical recommendations for the diagnosis and evaluation of ADHD in children and followed that a year later with treatment recommendations. In 2011, the AAP updated these guidelines due to new evidence that has emerged in the management of children with ADHD. Important Changes to the Guidelines The AAP’s 2011 guideline update recommends that primary care physicians (PCPs) evaluate children for ADHD from age 4 through 18. The earlier version of the guidelines covered children ages 6 to 12. This change was made because of an accumulation of evidence in recent years in a broader pediatric population. Enough evidence has emerged that we now feel comfortable about the criteria being appropriate for preschoolers and adolescents. Previously, the AAP had one guideline for diagnosis and evaluation and another for treatment. Now, the academy has included diagnosis, evaluation, and treatment in a single document. The revised guideline also includes recommendations for managing pediatric patients who exhibit some signs and symptoms of ADHD but don’t meet current diagnostic criteria for the condition. This information is particularly applicable to PCPs. Furthermore, a new process-of-care algorithm has been developed to provide physicians with step-by-step guidance on implementing the recommendations, and the AAP’s ADHD toolkit has been revised based on this algorithm. Key Action Statements for Pediatric ADHD The 2011 AAP guideline includes a summary of several key action statements: PCPs should initiate an ADHD evaluation for any child aged 4 to 18 who has school or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. Symptoms and behavior must...
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