Advertisement
Progress Elusive for New Antibiotics

Progress Elusive for New Antibiotics

There has been a desperate need for new antibiotics to treat infections caused by multidrug-resistant gram-negative bacilli (GNB) bacteria. In 2010, the Infectious Diseases Society of America (IDSA) launched its 10 x ’20 Initiative, which established a goal to develop 10 new systemic drugs to treat infections caused by resistant GNB bacteria by 2020. Unfortunately, there are still many barriers to the approval of these needed additional antibiotics, and it’s highly unlikely that these new drugs will be developed by 2020. Accelerated Efforts on Antibiotic Development Needed According to recent data, only seven new drugs are currently in development for the treatment of infections caused by GNB bacteria. Since the IDSA’s 10 x ’20 Initiative, only one new systemic antibiotic has been approved. There is also no guarantee that the drugs currently in development will actually gain FDA approval or will work against the most resistant bugs. While some progress has been made, ground is still being lost because new drugs aren’t being developed quickly enough to keep pace with antibiotic resistance.   At this time of greatest need, the number of pharmaceutical companies investing in antibiotic research and development (R&D) has decreased substantially. Only four multinational pharmaceutical companies have engaged in antibacterial discovery. R&D resources are typically strongest for developing drugs for chronic disease like high cholesterol, diabetes, and cancer. These drugs can provide significant financial rewards, partly because they’re intended for use for long periods of time. Antibiotics are a different story because they’re intended to be taken for shorter courses. This has made it less appealing for the pharmaceutical industry to use R&D resources for such...
Antibiotic Safety

Antibiotic Safety

Antibiotics can have side effects, including allergic reactions and a potentially deadly diarrhea caused by Clostridium...

Why Are There Intern “Boot Camps”?

A concept that has been percolating in the medical literature boiled over into the mainstream as the New York Times published this story, “Chicago’s Intern ‘Boot Camp’ ” is a rehearsal for life or death medical issues.” The article describes a new internal medicine intern having to deal with a simulated patient who is critically ill and has alarms flashing. Another intern had to tell a “patient” played by an actor that he had terminal cancer. The performances of both of the young doctors were evaluated by instructors. The 81 interns in the program must “pass graded tests in procedures and communication skills before being allowed to move ahead.” The boot camp described in the Times piece was the subject of a paper published in Academic Medicine earlier this year. It concluded that “Boot-camp-trained interns all eventually met or exceeded the MPS [minimum passing standard] and performed significantly better than historical control interns on all skills (P < .01), even after controlling for age, gender, and USMLE Step 1 and 2 scores (P < .001).” Here is how the Mayo Clinic describes its boot camp for fourth year med students, “An intensive 1-week course, Internship Boot Camp has simulated, longitudinal patient-care scenarios that use high-fidelity medical simulation, standardized patients, procedural task trainers, and problem-based learning to help students apply their knowledge and develop a framework for response to the challenges they will face as interns.” They compared survey results from students who had done the boot camp to those who had not and found the boot camp prepared students for internship better than conventional sub-internships did. Similar “boot camps”...

ASNC 2013: Stress Before Rest in Myocardial Perfusion Imaging

The Particulars: The American Society of Nuclear Cardiology (ASNC) has issued a goal of reducing radiation doses to 9 mSv or lower in 50% of myocardial perfusion imaging (MPI) studies by 2014. To achieve this goal, other approaches may be beneficial. Use of a low-dose stress first, high-dose rest second (stress/rest)—as opposed to rest first, stress second (rest/stress)—single positron emission computed tomography (SPECT) MPI protocol may help achieve this goal. This approach could limit radiation doses by identifying patients with normal reads who would need only lose-dose stress imaging. Data Breakdown: Outpatients, inpatients, and ED patients at high risk for cardiac problems participated in a study and underwent stress/rest, rest/stress, or stress-only imaging. The typical radiation dose for stress-only imaging was 2 mSv, compared with 9 mSv for both stress/rest and rest/stress imaging approaches. Take Home Pearls: Use of a stress/rest SPECT MPI protocol appears to be feasible and may exceed the ASNC’s goal of reducing radiation doses to 9 mSv or lower in 50% of patients by 2014. With this protocol, patients with normal reads on low-dose stress imaging may be able to avoid high-dose rest...

ASNC 2013: HS-SPECT Detects CAD in Obese Patients

The Particulars: Little is known about the diagnostic performance of high-speed single positron emission computed tomography (HS-SPECT) for detecting coronary artery disease (CAD). Few studies have compared HS-SPECT with invasive coronary angiography (ICA) in obese patients. Data Breakdown: For a study, investigators reviewed data on obese patients who underwent upright and/or supine HS-SPECT. More than half of these patients had recently undergone ICA. HS-SPECT had a diagnostic accuracy of 50% or greater for detecting CAD and 70% or greater for detecting stenosis. These rates were similar to the respective rates observed for ICA. The specificity of HS-SPECT increased significantly when upright and supine acquisition were both applied, when compared with using either approach alone. Take Home Pearls: HS-SPECT appears to have a similarly high diagnostic accuracy for detecting CAD by both quantitative and visual analyses when compared with ICA. Specificity appears to increase when both upright and supine acquisitions are...

ASNC 2013: Diagnosing ACS With SPECT

The Particulars: Single positron emission computed tomography (SPECT) has been shown in previous research to effectively localize the site or extent of myocardial ischemia and assess myocardial viability. Few studies have looked at the use of SPECT as a diagnostic tool for acute coronary syndromes (ACS) in the ED. Data Breakdown: A meta-analysis of 15 studies was conducted, assessing the use of SPECT for detecting ACS in the ED. Researchers found that the sensitivity and specificity rates for the imaging technique were both 87%. The positive predictive value of SPECT was 96%, and the negative predictive value was 81.5%. Take Home Pearls: SPECT appears to be a reliable tool for diagnosing ACS in the ED. More research is needed to determine the generalizability of these findings in ED...

ASNC 2013: Decreasing Imaging-Associated Radiation, Time, & Costs

The Particulars: Studies have suggested that myocardial perfusion imaging is a poor prognostic factor in patients who achieve a high exercise level during stress testing. However, outcomes data are lacking with regard to testing of protocols in ED patients presenting with chest pain. Data Breakdown: Researchers at Mount Sinai implemented a protocol in which ED patients presenting with chest pain were referred for stress testing. They did not undergo a radioisotope injection if they were younger than age 65 and had a normal rest electrocardiogram (ECG), no history of coronary artery disease (CAD), high levels of exercise, no symptoms, and a negative ECG response. No significant differences were observed between these patients and those who underwent a radioisotope injection with regard to cardiac mortality or repeat function stress tests ordered. However, patients who did not receive a radioisotope injection had significantly fewer angiograms and a trend toward fewer revascularizations. Take Home Pearls: A protocol in which acute chest pain patients referred to imaging do not undergo a radioisotope injection based on age, ECG results, history of CAD, symptoms, and exercise level appears to result in low mortality and few follow-up diagnostic tests. Adoption of the protocol may decrease radiation exposure and save time and related costs, without jeopardizing...

ASNC 2013: A New Imaging Approach in ED Chest Pain Patients

The Particulars: Previous research suggests that performing single photon emission computed tomography (SPECT) during or shortly after chest pain cessation can aid triage decisions. Little is known about the use of this approach in the “real-world” ED. Data Breakdown: For a study, patients presenting to the ED with ongoing or recently resolved acute chest pain underwent SPECT imaging. The study group had an intermediate probability or lower of myocardial ischemia. Results were normal for 90% of patients, and 80% were discharged from the ED. The average time from SPECT referral to discharge was 3.5 hours. Admitted patients were more likely to have abnormal SPECT results, positive troponin I, proven pulmonary embolism, or ongoing symptoms. Take Home Pearls: SPECT imaging of acute chest pain in ED patients appears to be feasible. The procedure can allow for the discharge of patients who may otherwise be unnecessarily...

ASNC 2013: Older Age & Need for Imaging

The Particulars: Previous studies indicate that achieving 10 metabolic equivalents of task (METS) of exercise workload during exercise single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is associated with low risk of significant ischemia and subsequent cardiac events. Whether this association exists in older patients has yet to be determined. Data Breakdown: Study investigators blindly interpreted SPECT MPI scans for patients without known coronary artery disease (CAD) who achieved 10-METS of exercise workload during exercise SPECT MPI. When data for participants aged 65 and older was compared with data for those younger than 65, the prevalence of ischemia was not significantly different (4.7% vs 2.6%). Both groups had a low prevalence of significant left ventricular ischemia. Neither group experienced a cardiac death or non-fatal myocardial infarction. Take Home Pearls: The prevalence of ischemia, cardiac events, or significant left ventricular ischemia does not appear to be affected by age among patients without known CAD who achieve 10-METS of exercise workload during exercise SPECT MPI. Study authors suggest there is no compelling reason for mandating imaging in this older patient...

ASNC 2013: Incidental SPECT/CT Findings Enhance Care

The Particulars: Data are lacking on whether incidental findings for cardiac single photon emission computed tomography (SPECT)/CT exams can enhance patient care. Data Breakdown: Among patients who underwent SPECT/CT myocardial perfusion imaging for a study, CT scans were evaluated for various issues. Many patients had health issues that were unknown before scanning, including gastrointestinal findings (34%), pulmonary issues (32%), extensive atherosclerosis (50%), and suspected cancerous lesions (20%). Overall, 94% of patients were found to have incidental findings. Take Home Pearls: Most patients who undergo SPECT/CT appear to have incidental findings when CT scans are evaluated. Reporting these findings to referring physicians may improve patient care and follow-up...

ASNC 2013: Prone Position Adds to SPECT MPI

The Particulars: Single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is typically performed with patients lying in the supine position. Previous research indicates that adding prone imaging improves the specificity and overall accuracy for detecting coronary artery disease (CAD). The impact of this addition on a nuclear cardiology laboratory’s standard imaging protocol has yet to be defined. Data Breakdown: For a study, researchers compared data for patients who underwent SPECT MPI only in the supine position with data for those who underwent imaging in both the supine and prone positions. Significantly more studies were interpreted as normal with supine plus prone imaging, when compared with supine only (73% vs 66%). The percentages of patients referred to angiography and found to have CAD were similar in both groups. Take Home Pearl: Adding prone imaging to supine SPECT MPI appears to increase the percentage of studies interpreted as normal without impacting the rate of patients found to have...
Portable Brain-Scan Headsets – Video Highlight

Portable Brain-Scan Headsets – Video Highlight

Emotiv Lifesciences unveiled Emotiv Insight, a faster, next-generation wireless brain scanner that collects real-time data on the wearer’s thoughts and feelings and delivers it directly to a computer, phone, or other device through Android, iOS, OSX, Linux, and Windows platforms. Source: National...
Enhancing QOL During Radiotherapy for Advanced Cancer

Enhancing QOL During Radiotherapy for Advanced Cancer

Cancer patients often experience a reduction in quality of life (QOL) during and after cancer treatment. Many experience pain, nausea, fatigue, sleep, and distress, among others. Family members caring for these patients often experience a lower QOL. Many studies have tested approaches to improve psychosocial functioning, but most have focused on only one aspect of psychosocial functioning. QOL is comprehensive and consists of five domains: cognitive, physical, emotional, social, and spiritual well-being. Testing a New Intervention for Patients Receiving Radiation In a study published in Cancer, my colleagues and I conducted a randomized trial in which we sought to help patients with advanced cancer receiving radiation therapy. Family members were also included in the study. While half of the participants stayed with their usual care during treatment, the other half participated in a multidisciplinary program of six, 90-minute sessions that formally addressed the five aforementioned domains of QOL. Each session included: • Physical therapy exercises to improve fatigue. • Discussions of topics like coping strategies or spiritual concerns. • Deep breathing or guided imagery to reduce stress.   Our results demonstrated that the multidisciplinary intervention was effective in maintaining the QOL of patient participants. Conversely, patients who stayed with their standard routines showed a decline in QOL measures. Much of our program’s success was attributable to active engagement from patients. They also received support and encouragement to continue to practice the coping strategies, such as physical activity, spirituality—and relaxation—when cancer treatment was completed. More to Come: Maintaining Improved QOL Our study showed that our intervention can maintain QOL during cancer treatment, but unfortunately, our follow-up conducted 6 months after...
3-Year Medical Degrees for PCPs?

3-Year Medical Degrees for PCPs?

More medical schools are turning to a 3-year solution to hedge against the looming primary care physician (PCP) shortage, offering an accelerated program and major savings to future primary care doctors. The American Association of Medical College Center for Workforce Studies estimates the country will need 45,000 more PCPs and 46,000 more surgeons and medical specialists within the next decade. A recent post by our guest blogger, Skeptical Scalpel, questions the benefit of a fourth year in medical school entirely in a related blog, Law School Revamps Final Year, Will Med Schools Follow? One of the roadblocks to careers in primary care is a skyrocketing medical education debt, followed by inferior pay. Georgia’s Mercer University School of Medicine launched an accredited 3-year accelerated program for students committed to family medicine in hopes of addressing these deterrents. Mercer, Lake Erie College of Osteopathic Medicine (LECOM) and Texas Tech all used similar strategies to consolidate their curricula, cutting most of the fourth year rotations. Supporters of the 3-year program also propose teaching core science courses during undergraduate years. Robert Pallay, residency director and chair of family medicine at Mercer notes the financial rewards of a condense schedule. He says students “pay one year less of tuition, which saves $40,000 to $50,000,” he says. “They get out a year earlier, so rather than making $50,000 as a resident, they [may] end up earning $200,000-plus as a regular doctor.” Gaining traction, the 3-year primary care programs are also being planned for East Tennessee, Indian, University of Wisconsin, East Carolina, and Kentucky. Arguments against it? There are plenty. Some opponents to the idea argue...

ASNC 2013

New research is being presented at ASNC 2013, the annual meeting of the American Society of Nuclear Cardiology, from September 26 to 29 in Chicago. Meeting Highlights Prone Position Adds to SPECT MPI Incidental SPECT/CT Findings Enhance Care Older Age & Need for Imaging A New Imaging Approach in ED Chest Pain Patients Decreasing Imaging-Associated Radiation, Time, & Costs Diagnosing ACS With SPECT HS-SPECT Detects CAD in Obese Patients Stress Before Rest in Myocardial Perfusion Imaging   News From the Conference Much New on Table for Nuclear Cardiologists LV Dyssynchrony Linked to HF Arrhythmia Enhanced Cardiac PET Picks Up More Heart Disease Stress Test Agents Equal for Predicting CAD Risk   More  From the Conference The ASNC 2013 App Final Program Program Planner Meeting On Demand CME – Ancillary Programs Program Tracks About the Meeting Exhibit Hall Floor Plan Registration & Housing Chicago Highlights Future Meetings ASNC 2013 Social...
Examining a Protocol for Transfusing Plasma to Severely Injured Patients

Examining a Protocol for Transfusing Plasma to Severely Injured Patients

Patients with a trauma-induced coagulopathy account for more than half of hemorrhagic deaths in the United States. About 25% of severely injured patients are already coagulopathic and thrombocytopenic upon arrival to trauma centers. Mortality rates have been shown to decrease in these patients when they receive higher ratios of plasma and platelets. “Early transfusion of red blood cells (RBCs) has been established as a core element of trauma resuscitation,” says Bryan A. Cotton, MD, MPH. “Most trauma centers store RBCs in their EDs, but few store plasma in their EDs. This makes it challenging to achieve high plasma-RBC ratios early during care, which in turn can worsen coagulopathy and increase patient mortality.” Expediting Plasma Delivery Over the past several years, more and more trauma centers have implemented massive transfusion (MT) protocols to ensure that severely injured patients receive higher plasma-RBC ratios early. “This was shown to markedly reduce the time to release of plasma, but the time to transfusion was still excessively long,” Dr. Cotton says. In an effort to expedite the delivery of plasma for patients requiring MT, some medical centers began keeping thawed plasma (TP) in their blood banks (BBs).   MT protocols vary throughout trauma centers in the U.S., but those reporting the most marked changes in survival are the ones that have implemented concurrent TP programs. Furthermore, trauma centers that develop TP programs concurrent with MT protocols have shown that they can reduce the time to first plasma transfusion and the overall number of blood components transfused. Testing a New Thawed Plasma Protocol In 2006, Dr. Cotton and colleagues began a TP program in their...

HFSA 2013: Medication Management in Heart Failure

The Particulars: Previous analyses suggest that there is a high prevalence of medication non-adherence among patients with heart failure (HF), and that this phenomenon is associated with poor outcomes. Few studies have sought to understand the causes for medication non-adherence among HF patients. Data Breakdown: Researchers developed and tested a novel medication management assessment tool in which patients with HF were provided five pill bottles that represented common HF medications. The authors found that 91% of patients were confident in managing their medications, but only 11% completed the model without errors. Of the patients involved in the study, 93% were able to read pill bottle labels, 89% were able to open pill bottles, and 72% were able to locate the correct slot in a pillbox. Just 18% could correctly allocate mock medications into a pillbox. Take Home Pearls: Among patients hospitalized with HF, there appears to be a discrepancy between self-perceived ability to manage medications and actual ability. This inability to manage medications may be a key component of poor medication adherence in patients with...

#HFSA 2013: Predicting HF Readmissions

The Particulars: Published research has suggested that there are several predictors of readmission among patients with heart failure (HF). However, prediction models have yet to take a broad-based approach to establishing factors that increase the risk of HF readmissions. Data Breakdown: For a study, clinical predictors for readmissions were used by investigators to create and propose a model for 30-day HF readmissions that was derived from a multivariate analysis. Five variables remained significant and were predictive of 30-day, all-cause readmissions: 1) longer length of stay, 2) other admissions within the prior year, 3) lower systolic blood pressure on admission, 4) use of pressors or inotropes, and 5) previous diagnosis of pneumonia. Take Home Pearls: Several broad factors appear to predict 30-day readmission among patients with HF. Clinicians should consider these factors as they provide treatment for...
Page 1 of 41234
[ HIDE/SHOW ]