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Have We Found a Cure for HIV?

Have We Found a Cure for HIV?

Over 30 years into the epidemic, there is renewed hope that a cure for HIV may have been found following the presentation of two HIV cases at the 19th annual International AIDS Conference in Washington, D.C, last week. Two men who were diagnosed with both HIV and cancer appear to be cured of the HIV virus. The two recent cases appear to be following in the footsteps of the famous “Berlin patient,” who had HIV and was treated for leukemia with a bone marrow transplant. The transplant, which replaced the patient’s own infected cells, came from a donor with a genetic mutation that makes immune cells resist HIV infection. Five years later he is HIV-free. Researchers at Brigham and Women’s Hospital in Boston hoped to accomplish a similar feat with a simpler treatment. Two patients infected with HIV who endured multiple rounds of treatment for lymphoma both had stem-cell treatments while maintaining HIV therapy — which was key to the treatment’s success. It appears that the donor cells killed off and replaced the infected cells. Meanwhile, the HIV drugs protected the donor cells. One patient is HIV-free 2 years later, and the other is seemingly uninfected more than 3 years later. While the patients can’t be told they are cured, they are staying on HIV therapy until they can be carefully taken off under experimental...
World Hepatitis Day 2012 Message Underscores Pervasive Infection

World Hepatitis Day 2012 Message Underscores Pervasive Infection

“It’s closer than you think” is the theme for World Hepatitis Day 2012, which falls on July 28. According to the World Health Organization (WHO), 1 in 3 people globally has been infected with hepatitis, with 1 in 12 chronically infected. This year’s campaign focuses on raising awareness of the different forms of hepatitis: what they are and how they are transmitted; who is at risk; and the various methods of prevention and treatment. Visit the WHO website for more information about World Hepatitis Day as well as hepatitis fact sheets and...

Minimally Invasive Spine System Approved

The FDA has provided 510(k) marketing clearance for a cannulated pedicle screw system (Securis, Custom Spine) for fully seating screws in the bone during rod insertion. The system features a chromium-cobalt rod and a cannulated bone screw. Source: Custom...

Walking Program Benefits Patients With PPC After Resection

Results of a small study of resected patients with pancreas and periampullary cancer (PPC) indicate that a progressive home walking program appears to improve fatigue, physical functioning, and health-related quality of life. When compared with PPC patients who received usual care, participants in the walking program intervention walked twice as far at study completion. Abstract: Journal of the American College of Surgeons, April...

BMI Predicts Postoperative 30-Day Mortality

Researchers at the University of Virginia have found that BMI appears to significantly predict 30-day mortality following surgery, even after adjusting for surgery type and expected risk of death. Study participants with a BMI less than 23.1 kg/m2 had a 40% higher risk of death when compared with participants who had BMIs ranging between 26.3 kg/m2 and 29.7 kg/m2. Abstract: Archives of Surgery, March...

Analyzing Preventive CRT in the Elderly

Published studies have shown that the prevalence of congestive heart failure (CHF) increases as people age, rising from 2% to 3% in the total population to 10% to 20% after patients reach age 75. When compared with younger patients, CHF in the elderly has been associated with higher mortality rates. “Even when medical management is optimized, elderly patients with CHF still require frequent healthcare utilization, including those with the early stages of disease,” says David T. Huang, MD. “While medical therapy can sometimes help, there are concerns about disease recurrence.” Cardiac resynchronization therapy (CRT) can be used in conjunction with implantable cardioverter defibrillators (ICDs), an approach that has been shown to reduce hospitalizations and mortality relative to CHF. “CRT and ICDs have become important components for qualified patients with class III or IV heart failure,” adds Dr. Huang. “CRT has been used in patients of many age ranges in the past, but mostly in the most severe late-stage cases. Symptoms can improve with this therapy, but questions have been raised about whether or not CRT should be used in earlier stages of CHF in order to better prevent symptoms.” When patients with CHF are properly selected, age should not be used as a sole discriminator to exclude device therapy. —David T. Huang, MD The Effect of Age on CRT Outcomes The Multicenter Automatic Defibrillator Implantation Trial with CRT (MADIT-CRT) recently found that CRT utilizing defibrillators (CRT-D) was associated with a 34% reduction in the risk of heart failure or death when compared with ICD-only therapy in asymptomatic or mildly symptomatic patients. However, limited data are available on the benefits...

Addressing ED Crowding With Patient Flow Strategies

The number of ED visits has grown by 25% in the past decade, but the number of hospital EDs and inpatient beds has declined during that same time-frame, resulting in crowded conditions nationwide. Nearly half of EDs are operating at or above capacity, and few consistently achieve recommended wait times for all ED patients. The impact of ED crowding has been profound, leading to poor quality care, increased mortality rates, and lower patient and staff satisfaction. Major Findings on Improving Patient Flow In an effort to strengthen the evidence base for patient flow improvement strategies, Megan C. McHugh, PhD, and colleagues evaluated the efforts of five hospitals that participated in a collaborative aimed at improving patient flow and reducing ED crowding. Results were published in the September 13, 2011 Journal for Healthcare Quality. Participating hospitals implemented seven improvement strategies over 18 months as part of the collaborative. By the end of the study, four of the five hospitals had at least one fully implemented improvement strategy and had experienced modest improvements in patient flow, including reduced length of stay and fewer patients left without being seen. The improvement strategies and their impact varied considerably in the study, according to Dr. McHugh. “Several factors appeared to influence the impact of strategies, including ability to overcome implementation challenges, the timing of implementation, and the type of strategy selected. We also found that the staff time and expenses involved in the adoption of the ED strategies were highly variable.” Few studies have considered time and expenses associated with implementing patient flow strategies. In Dr. McHugh’s study, time spent planning and implementing the...

Managing Low-Functioning Schizophrenics

Research suggests that one-third to one-half of patients with schizophrenia continue to experience residual symptoms or have intolerable adverse effects relating to their treatment. The effect of medications on functional outcomes has been modest, even when drug regimens are optimized. Compounding the problem are the disorganized and negative symptoms associated with schizophrenia, which are less responsive to medications than hallucinations and delusions. Today, more patients with schizophrenia are being treated in the community, but many continue to function at a low level. As such, additional interventions like cognitive therapy have been explored for schizophrenia, but these approaches have had varied success. Most cognitive therapy treatments assessed in studies have addressed delusions and hallucinations and have not focused on patients with neurocognitive impairment and poor functioning. A Novel Approach in Managing Schizophrenia In the October 3, 2011 Archives of General Psychiatry, my colleagues and I had a study published in which we assessed a novel version of cognitive therapy aimed at increasing functional outcomes and promoting recovery in low-functioning patients with schizophrenia. In addition to residual positive and negative symptoms, these individuals had trouble with information processing for memory, attention, and executive functioning. By design, our intervention shifted the emphasis from taking a symptom-oriented approach to using a person-oriented therapeutic strategy based on interests, assets, and strengths. We wanted to improve the level of functioning by enhancing productivity, independence, and the quantity and quality of social interactions. The intervention treated functional outcomes as a primary target of therapy. More patients with schizophrenia are being treated in the community, but many continue to function at a low level. Participants in the...

Our Broken Healthcare System – Feeding the Fat Cats

We have a cat. He’s fat. His name is Zander, but we call him “Cat,” “Kitty,” “Loaf of Bread” (because that’s what he looks like when he lies down and his fat spreads), Lard Butt, and “Fatso Catso.” In the picture above he is sitting on a puzzle because…well, because he’s a cat. There are two main reasons he is fat: 1. He always wants to eat. 2. We feed him too much. Lest you think that we are bad cat servants (which is what you call people who own cats … I mean, people who live in the cat’s house), let me paint a picture: It’s 6 AM and I go downstairs. The cat immediately meows continuously until I feed him. Then I go upstairs and do my normal morning routine. While I am up in the shower, my wife comes downstairs and is met by meowing and an empty bowl. We’ve learned that the cat’s desperation for food is not indicative of his eating history, but my wife’s natural reaction is to assume I did not feed the cat to often with food for cats, and so give him a second bowl for regular food. He will do this every morning, sometimes tricking us into feeding him 3 times. The same routine happens in the afternoon (we feed him at 6 PM).  Around 3 o’clock, the cat begins his campaign of meow assaults on whomever he can bother. If you walk to the door of the garage, he rushes to it, knowing that behind that door is his food.  Naturally, the only reason we would walk to...

Pregnancy Among Women Surgeons

A paper reporting the results of a survey of women surgeons on the topic of pregnancy appears in Archives of Surgery online ahead of print. Responses were received from 1,937 female surgeons — 49.6% of those who were sent surveys. Not surprisingly, the findings were that women surgeons feel stigmatized about pregnancy during surgical residency training. Things are improving, but slowly. The percentage of women reporting that pregnancy during training is stigmatized fell from 76% for women who graduated more than 30 years ago, all the way down to 67% for women who graduated less than 10 years ago. The difference was statistically significant [p = 0.001] but hardly significant in the real world. At this rate, pregnancy among female surgical residents should be no longer stigmatized by about the year 2127. According to Table 3 of the paper, the cumulative rate of pregnancy of female surgery residents who graduated fewer than 30 years ago is 32.2%. To put it another way, 1/3 of all female surgery residents became pregnant at least once during their five years of training. The most interesting finding was that even women faculty and women residents were perceived as having a negative influence on women surgeons contemplating childbearing, and this negativity has not abated over the years. Meanwhile, the percentage of both residents who are women and those who become pregnant is increasing. Male residents can get sick or be injured and miss time. Should there be any reason to deal with pregnancy differently? What do you think about this? Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency...

Enhancing Communication on Stroke Risks in AF

Atrial fibrillation (AF) affects an estimated 2.3 million Americans every year, increasing their risk of stroke by nearly five times that of individuals without AF. To assess general awareness of and attitudes toward the link between AF and stroke, my colleagues and I conducted a survey that was fielded by Harris Interactive on behalf of Boehringer Ingelheim and the National Stroke Association. The national survey—called AFib STROKE (Atrial Fibrillation Survey To Reveal Opinions, Knowledge, and Education Gaps)—was conducted among 507 patients, 150 cardiologists, 150 primary care physicians, and 217 nurse practitioners in the United States in 2010. It’s critical that clinicians capitalize on teachable moments and provide information in writing. More than half (56%) of the patients in the AFib STROKE survey said that AF negatively impacted their lives. While 80% said they wanted to know more about AF and its relationship with stroke, 49% said they didn’t have a conversation with their physician about this link or didn’t remember anything specific about what was discussed when they received their AF diagnosis. About three-fourths of physicians reported having the conversation and educating their patients on the link between AF and stroke, indicating that there’s room for improvement from healthcare providers (see also, Updated Guidelines for Secondary Stroke Prevention). Failing to See the Complete Picture of AF and Stroke While physicians and patients generally may recognize some of the links between AF and stroke, they may not understand the full picture. For example, strokes associated with AF are twice as deadly as non-AF-related strokes, but less than half of healthcare providers surveyed were aware of this fact. About two in...

2012 ADA Annual Scientific Sessions

New research was presented at the American Diabetes Association’s 72nd Scientific Sessions from June 8-12, 2012 in Philadelphia. The features below highlight just some of the studies that emerged from the conference Heart & Cancer Risks With Insulin The Particulars: Previous research suggests that there may be an association between insulin use and an increased risk of myocardial infarction, stroke, and several types of cancer. However, the long-term impacts of insulin on serious cardiovascular outcomes and cancers in patients at high risk for type 2 diabetes have not been examined. Data Breakdown: A study randomized people at high risk for type 2 diabetes or in the early stages of it to daily insulin glargine injections or no insulin for an average of 6.2 years. No differences in cardiovascular outcomes or the development of any cancer type were observed in the two groups. Patients who received insulin maintained normal glucose levels (90 to 94 mg/dL) throughout the study. Take Home Pearl: Long-term use of insulin glargine in patients at high risk for type 2 diabetes or in the early stages of the disease does not appear to put them at greater risk of developing cardiovascular conditions or cancer. Type 1 & 2 Diabetes Prevalence Increasing in the Young The Particulars: For years, the prevalence of type 1 and type 2 diabetes has been increasing in younger people worldwide. Few data, however, have explored trends in both type 1 and type 2 disease in the United States among younger individuals. Data Breakdown: An analysis from the CDC and NIH found that the prevalence of type 2 diabetes increased 21%, and the...

Reducing VTE Risk After Hip & Knee Replacement

Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is one of the most common reasons for readmission following primary hip or knee replacement surgery. However, recent studies suggest that only 0.7% to 0.9% of patients undergoing hip or knee replacements require rehospitalization because of VTE in the first 3 months after surgery. “These surgeries put patients at risk for thromboembolic disease because they affect multiple aspects of Virchow’s triad,” explains Joshua J. Jacobs, MD. Virchow’s triad consists of hypercoagulability, venous stasis, and injury to the vascular endothelium. All three components of the triad can be present following hip or knee replacement surgery and predispose individuals to thrombosis, according to Dr. Jacobs. “DVT occurs in about 37% of patients following primary hip or knee replacement surgery who have not been treated with prophylactic agents. The rate of clinically symptomatic VTE events is far less, but VTE should be an important concern of orthopedic surgeons performing these procedures.” New Guidelines on Preventing VTE Dr. Jacobs chaired a workgroup that updated guidelines from the American Academy of Orthopaedic Surgeons (AAOS) on preventing VTE in patients undergoing elective hip and knee arthroplasty. The guidelines were released on September 24, 2011 and are available for free at www.aaos.org/guidelines. “The AAOS felt it was necessary to update these guidelines for the first time since 2007 because of the increasing availability of study data that impacted the previous recommendations and to maintain inclusion in the AHRQ’s National Guideline Clearinghouse, which requires an update every 5 years,” says Dr. Jacobs. The American College of Chest Physicians has also published guidelines on VTE...

Cognitive Decline Affects the Elderly After Hospitalization

Cognitive functioning appears to decline substantially after older patients are hospitalizations, according to Rush University Medical Center investigators. More severe illness, longer hospital stay, and older age were each associated with quicker post-hospitalization cognitive decline. However, none of these factors negated the effect of hospitalization. Abstract: Neurology, March 21, 2012...

CPAP Improves LV Function in OSA

British research suggests that continuous positive airway pressure (CPAP) therapy appears to improve structural and functional changes in left ventricular (LV) function that result from moderate-to-severe obstructive sleep apnea (OSA). The study noted that CPAP therapy resulted in a reduction of posterior wall thickness, and an improvement in LV ejection fraction, systolic velocity, and diastolic LV impairment parameters among patients with OSA. Abstract: Circulation: Heart Failure, March...

Sleep Disordered Breathing Linked With Depression

CDC investigators have found that major depression appears to be associated with snorting or stopping breathing during sleep in a national sample of American adults. Men and women with sleep apnea also had higher risks for probable major depression in the study. Snorting or stopping breathing five or more nights a week was strongly associated with probably major depression in men (odds ratio, 3.1) when compared with never snorting or stopping breathing. More research is needed to establish if regular screening for these conditions should be recommended. Abstract: Sleep, April 1,...
Cardiovascular Health Metrics Linked to Mortality

Cardiovascular Health Metrics Linked to Mortality

An investigation of a large, nationally representative sample of adult Americans suggests that the risk of total and cardiovascular disease (CVD) mortality appears to be lower in those who meet a greater number of CVD health metrics. However, just 1.2% of participants met all seven cardiovascular health metrics in 2005-2010. These metrics included not smoking, being physically active, staying at a healthy weight, having healthy diet, and maintaining normal blood pressure, glucose, and total cholesterol levels. The data indicated the following absolute risks for 1,000 person-years: Source: JAMA, March 16, 2012...

Predicting NSCLC Survival

A Mayo Clinic study has found that overall quality of life (QOL) measured at the time of a non-small cell lung cancer (NSCLC) diagnosis appears to significantly and independently predict survival. For patients with poor baseline QOL, the average survival was 1.6 years, compared with 5.6 years for those with strong QOL measures at diagnosis. The following were also significantly associated with overall survival among patients with NSCLC: Performance status. Older age. Smoking history Male gender Treatment factors Disease stage. Abstract: Journal of Clinical Oncology, March 26, 2012...

Drug Approved for Parkinson’s & RLS

The FDA has approved the rotigotine transdermal system (Neupro, UCB) for signs and symptoms of advanced stage idiopathic Parkinson’s disease (PD) and for treating moderate-to-severe primary restless legs syndrome, or RLS. The drug was previously approved for early stage idiopathic PD. Abstract:...

A Look Back at Mortality Rates

A report from the CDC has found that the age-adjusted risk of dying decreased 60% from 1935 to 2010. The report, available at www.cdc.gov/nchs, reviewed changes in causes of death, risk of dying, the gender gap in death rates, and more during the 75-year period. Abstract:...
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