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Scientists Pioneer Synthetic Derivatives of “Game-Changing” New Antibiotic that Could Hold Key to Tackling Drug-Resistant Bacteria

Scientists Pioneer Synthetic Derivatives of “Game-Changing” New Antibiotic that Could Hold Key to Tackling Drug-Resistant Bacteria

Scientists at the University of Lincoln, UK, have successfully produced two synthetic derivatives of Teixobactin — the world’s first known antibiotic capable of destroying ‘drug resistant’ bacteria. Last year, the discovery of the antibiotic Teixobactin by researchers in the USA was hailed as a ‘game-changer’ in the fight against antimicrobial resistance. Teixobactin, which kills a range of pathogens without detectable resistance, was isolated from microorganisms (which do not grow under laboratory conditions) found in soil — the natural source of nearly all antibiotics developed since the 1940s. However in order for it to be developed as a potential drug treatment, several versions of the antibiotic must be produced via chemical synthesis in order to overcome the hurdles of drug development. Researchers in laboratories around the world have been working towards this objective since last year’s breakthrough. Now Dr Ishwar Singh from the University of Lincoln and his colleagues have become the first group of scientists to synthetically produce two derivatives of Teixobactin. Dr Singh, a specialist in novel drug design from Lincoln’s School of Pharmacy, said: “Teixobactin originally evolved in soil to kill the bacteria around it, so our challenge was to produce the antibiotic synthetically. The method we created to do this uses commercially available ‘building blocks’ and has a single purification step, and we are delighted with the results — we are now able to present the total synthesis of two derivatives of Teixobactin. “We have also been able to identify some of the properties of the antibiotic which are critical for its antimicrobial activities. This is a very important stepping stone towards an in-depth study of...
CME: Guidance on Transcatheter Pulmonic Valve Replacement

CME: Guidance on Transcatheter Pulmonic Valve Replacement

Treatment for congenital heart disease (CHD) has advanced considerably over the years, allowing for more children with CHD to live into adulthood. Despite these advances, CHD patients may require additional treatment over time. Pulmonary valve replacement may be necessary in patients who have had certain types of CHD that was repaired with reconstruction of the right ventricular outflow tract (RVOT). As patients with CHD live longer, dysfunction of the repair can occur. In the past, these patients would require a repeat open-heart surgery. Fortunately, transcatheter pulmonic valve replacement (TPVR) has emerged as a less invasive treatment option for many of these patients. Transcatheter valve treatments like TPVR are allowing clinicians to offer less invasive options to CHD patients who were previously treatable only with open heart surgery or may not have been eligible for treatment. These procedures are complementing standard surgical approaches, allowing physicians to provide more options for patients. The medical community has recognized the applicability, effectiveness, and practicality of transcatheter valve therapies, which in turn has fueled interest in these treatments.   Reaching a Consensus Recently, an expert consensus paper was released by the Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American College of Cardiology, and Society of Thoracic Surgeons to provide guidance on TPVR for children and adults who were previously treated for CHD. The consensus paper was published simultaneously in Catheterization and Cardiovascular Interventions, the Journal of Thoracic and Cardiovascular Surgery, the Journal of the American College of Cardiology, and Annals of Thoracic Surgery. A committee of cardiac surgeons and interventional cardiologists developed the recommendations. The consensus paper outlines criteria for operator...
What time of day are vaccinations most effective?

What time of day are vaccinations most effective?

New research from the University of Birmingham has shown that flu vaccinations are more effective when administered in the morning. The findings, published in the journal Vaccine, suggest administering vaccinations in the morning, rather than the afternoon, could induce greater, and thus more protective, antibody responses. 24 general practices in the West Midlands, UK, were analyzed between 2011 and 2013 in a cluster-randomized trial during the annual UK influenza vaccination programmed. 276 adults aged over 65 were vaccinated against three strains of influenza, either in morning surgeries (9-11am) or afternoon surgeries (3-5pm). In two of the three given influenza virus strains, those in the morning cohort saw a significantly larger increase in antibody concentration one month following vaccination, when compared with those in the afternoon cohort. In the third strain, there was no significant difference between morning and afternoon. Dr Anna Phillips, the Principal Investigator of the study from the School of Sport, Exercise and Rehabilitation Sciences at the University of Birmingham explained, “We know that there are fluctuations in immune responses throughout the day and wanted to examine whether this would extend to the antibody response to vaccination. Being able to see that morning vaccinations yield a more efficient response will not only help in strategies for flu vaccination, but might provide clues to improve vaccination strategies more generally.” The influenza vaccination is part of the seasonal vaccination programme carried out by general practices across the UK, and in many other countries, with a particular focus on patients over 65 years old. Despite this, the influenza virus is responsible for between 250,000 and 500,000 deaths each year worldwide....
A Look at Unsupervised Pediatric Drug Exposures

A Look at Unsupervised Pediatric Drug Exposures

About a decade ago, several reports throughout the United States indicated that ED visits were on the rise for unsupervised pediatric medication exposures. “As a result of these studies, clinicians renewed their efforts to improve rates of these exposures,” explains Daniel S. Budnitz, MD, MPH. “Some of the steps were taken included improving safety packaging and increasing education to both healthcare providers and the general public about ways to avoid these exposures. By examining current trends in unsupervised pediatric medication exposures, it’s possible that this data could inform the development of targeted interventions to further reduce the risk of these events.”   Long-Term Trends For a study published in Pediatrics, Dr. Budnitz and colleagues examined data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project to assess trends in ED visits for unsupervised medication exposures among children younger than the age of 6 from 2004 to 2013. The investigators also identified the dosage form and prescription status of implicated medications from 2010 through 2013. The authors found that approximately 640,000 children were seen in the ED for ingesting drugs between 2004 and 2013. About 70.0% of these children were aged 1 or 2, and nearly 20.0% of this group was hospitalized. The number of pediatric ED visits for unsupervised medication exposures increased by an average of 5.7% annually during the early 2000s and peaked at about 76,000 visits in 2010. After 2010, however, this trend reversed, with the number of ED visits decreasing by an average of 6.7% per year to approximately 59,000 visits in 2013. “While the decreasing trend is encouraging, this figure is still...
Gender, Stress, & Acute Myocardial Infarction

Gender, Stress, & Acute Myocardial Infarction

Studies have shown that women and younger patients are at increased risk for mental stress when compared with the male or older counterparts, respectively. Whether or not the same holds true for young and middle-aged patients presenting with acute myocardial infarction (AMI) has not been well established. “In general, psychosocial factors are increasingly recognized as important influences on patients’ health status and recovery after major health events,” says Xiao Xu, PhD. “However, studies focusing on AMI tend to recruit older patients. Therefore, little is known about how psychosocial factors may influence outcomes among younger people with AMI.”   A Look at Younger Patients Dr. Xu and colleagues conducted a study that looked at the implications of stress on health outcomes and recovery in younger AMI patients. Published in Circulation, the authors used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes in Young AMI Patients) study. “VIRGO is the largest prospective study that has been conducted in the relatively younger AMI patient population,” Dr. Xu explains. “When that data became available, it presented an ideal opportunity to conduct our analysis. Because the VIRGO study focused on a uniquely large sample of young and middle-age patients, we were able to look at how stress is associated with recovery at 1 month in a younger population and also assess how gender affects outcomes.” For the study, the researchers examined gender differences in stress, factors contributing to these differences, and whether these differences helped explain gender-based disparities observed in 1-month recovery after AMI. Data on more than 3,500 AMI patients aged 18 to 55 were assessed. Self-perceived psychological stress...
Medscape Releases 2016 Physician Compensation Report

Medscape Releases 2016 Physician Compensation Report

One of the most anticipated surveys among the physician community has been released by Medscape. Most specialties saw an increase in compensation between 4% and 12%. Two experienced a significant decrease. Where do you stand? Over the past 6 years, the Medscape Physician Compensation Report 2016 has evolved with the changing healthcare landscape as questions focus beyond just compensation. “We have spent more time asking questions about the impact of healthcare reform, such as participation in health insurance exchanges, participation in ACOs, and influx of patients due to the affordable care act,”  says Leslie Kane, senior director, Medscape Business of Medicine, in an interview with Physician’s Weekly. “We have also focused more on paying attention to how doctors are reacting to changing and falling reimbursement by questioning their attitudes toward insurers.” Among comparing many facets of practicing medicine, the report, of course, compares compensation. Internal Medicine and Rheumatology saw the highest increases in salary compared to 2015, both at 12%. Following closely were Dermatology and Nephrology at 11% and  Ob/Gyn at 10%. Allergy and Pulmonary Medicine were the only specialties to experience compensation decreases—and significant ones—at 11% and 5%, respectively. Source: Adapted from: Medscape Physician Compensation Report 2016 Michael Smith, MD, medical director and chief medical editor, WebMD, told us that “despite all the negativity we hear about being a physician in today’s medical practice—paperwork, insurance companies, technology challenges, burnout etc—being a doctor is still a satisfying and financially rewarding career overall.” Dr. Smith sites the income increases for both specialists and primary care physicians, particularly Internists who saw a 12% rise in income, and how it is outpacing...
New Antibiotic Stewardship Guidelines Focus on Practical Advice for Implementation

New Antibiotic Stewardship Guidelines Focus on Practical Advice for Implementation

Preauthorization of broad-spectrum antibiotics and prospective review after two or three days of treatment should form the cornerstone of antibiotic stewardship programs to ensure the right drug is prescribed at the right time for the right diagnosis. These are among the numerous recommendations included in new guidelines released by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) and published in the journal Clinical Infectious Diseases. “Initially, antibiotic stewardship was more focused on cost savings, and physicians responded negatively to that, because they often felt it was best to give patients the newest, most expensive drug,” said Tamar Barlam, MD, lead co-author of the guidelines, director of the antibiotic stewardship program at Boston Medical Center and associate professor of medicine at Boston University Medical School. “While these programs do save hospitals money, their most important benefit is that they improve patient outcomes and reduce the emergence of antibiotic resistance. When we say stewardship, we really mean stewardship, and increasingly, doctors are realizing it’s important and necessary.” The White House has called for hospitals and healthcare systems to implement antibiotic stewardship programs by 2020 to ensure appropriate use of these vital drugs and reduce resistance, an escalating problem that threatens the ability to effectively treat often life-threatening infections. The new guidelines replace those originally created to help with the development of programs when antibiotic stewardship was in its infancy, and instead focus on specific strategies that the evidence suggests are most beneficial to ensure the program will be effective and sustainable. They also note it is key that these programs tailor interventions based on...
Beta-Blockade & Mortality in Non-Cardiac Surgery

Beta-Blockade & Mortality in Non-Cardiac Surgery

While use of perioperative β-blockers is a widely accepted practice when managing patients undergoing cardiac surgery, using these medications in people who receive non-cardiac surgery is controversial. Years ago, perioperative β-blockade was recommended liberally for patients undergoing non-cardiac surgery after early research demonstrated initial success in patients with cardiac disease. However, this recommendation was based on findings from randomized clinical trials with small samples that may not have included the broad spectrum of patients seen in routine clinical practice. “While some of the initial studies found a benefit by using β-blockade in non-cardiac surgery, other investigations have shown no advantage to this practice,” says Mark L. Friedell, MD. “In fact, some trials have indicated that patients undergoing non-cardiac surgery could be at greater risk for hypotension and stroke if they use β-blockers.” This has created considerable uncertainty about the use of perioperative β-blockers, particularly in patients at low risk of myocardial ischemic events.   Examining the Effects Dr. Friedell and colleagues had a study published in JAMA Surgery in which they performed a retrospective observational analysis of patients undergoing surgery in Veterans Affairs (VA) hospitals over a 5-year period. Use of β-blockers was established if a dose was ordered at any time between 8 hours before surgery and 24 hours after the procedure. The authors assessed 30-day mortality outcomes after perioperative β-blockade in patients undergoing non-cardiac surgery with different levels of cardiac risk. For the study, the authors analyzed demographics, diagnosis and procedural codes, medications, perioperative laboratory values, and dates of death. They then used a four-point cardiac risk score that was calculated by assigning one point each for...
Predicting Adherence After Emergency Department Visits

Predicting Adherence After Emergency Department Visits

Millions of Americans who use the ED each year are subsequently referred for outpatient care and follow-up with other physicians or clinics and prescribed necessary medications following their ED visit. Adherence with recommendations from ED providers is critical to ensuring that proper treatment of the initial condition be continued upon discharge. Adherence is also critical for identifying potential misdiagnoses and managing possible treatment failures and complications. Despite its importance and cost to the healthcare system, studies suggest that compliance with recommendations by ED patients in the United States is frequently poor. Research has provided little insight on factors that may help predict non-compliance with recommendations from ED physicians. “In the emergency setting, clinicians may benefit from developing a better understanding about why patients don’t always follow recommendations from their physicians,” says Camille Broadwater-Hollifield, PhD, MPH.   Taking a Closer Look In a study published in the American Journal of Emergency Medicine, Dr. Broadwater-Hollifield and colleagues sought to determine predictors of adherence to medical recommendations after an ED visit. They conducted a prospective, observational study at an urban medical center that involved 422 ED patients. Participants provided baseline demographic data as well as information about their insurance status, whether or not they had a primary care physician (PCP), and the impact of costs of care on their ability to follow medical recommendations. Patients were contacted at least 1 week after their initial ED visit and answered questions about adherence to medical recommendations from ED personnel. According to the results, nearly 90% of study participants self-reported that they had complied with at least one recommendation made during their ED visit. “Patients who...
Opioid Use & Infant Outcomes

Opioid Use & Infant Outcomes

Recent data show that that the number of prescriptions being written for opioids to manage pain has quadrupled over the past decade in the United States. In 2012, it was estimated that 259 million prescriptions were written for opioids, a figure that amounts to one prescription for every American adult currently living in the U.S. Research suggests that opioids are commonly prescribed in pregnancy, however studies evaluating their association with neonatal outcomes are limited. In the past, studies have described the effect of drug withdrawal on infants born to mothers who used drugs illicitly, such as heroin or among women receiving medication-assisted treatment. Few studies, however, have examined the dispensing of legal opioid prescriptions for pregnant women. “In light of the nation’s current prescription opioid epidemic, it’s important to look at how these drugs are used by pregnant women and its impact on outcomes for mothers and infants,” says Stephen W. Patrick, MD, MPH, MS.   Exploring the Issue In a study published in Pediatrics, Dr. Patrick and colleagues sought to identify neonatal complications that were associated with antenatal opioid exposure. The authors also examined predictors of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants following birth that—according to previous research—has been linked to about $720 million per year in national healthcare expenditures for treatment. Previously, studies have suggested that opioid use during pregnancy increases risks for NAS. The study group used prescription and administrative data that was linked to vital statistics for mothers and infants who were enrolled in the Tennessee Medicaid program between 2009 and 2011. The authors then looked at a random sample of...
New BMI Cut Points for Diabetes in Asian Americans

New BMI Cut Points for Diabetes in Asian Americans

This Physician’s Weekly feature on new BMI cut points for diabetes in Asian Americans was completed in cooperation with the experts at the American Diabetes Association. According to recent data, Asian Americans are among the nation’s fastest growing ethnic group in the United States, and with this surge has been an increase in the number of those who are at risk for type 2 diabetes. Studies show that Asian Americans experiencea higher prevalence  (the number of people in a given group or population who are reported to have a disease) type 2 diabetes more than whites and some subgroups of Asian Americans—most notably Filipinos and South Asians—have even higher rates of the disease. “Asian Americans are a heterogeneous group and have historically been underrepresented in clinical research,” says Alka Kanaya, MD. “The research that is available suggests that Asian Americans have a higher prevalence of type 2 diabetes at a relatively lower BMI than whites or other ethnic groups.” Among Asian Americans, rates of type 2 diabetes are higher than expected despite these people having lower rates of obesitya condition in which a greater than normal amount of fat is in the body; more severe than overweight; having a body mass index of 30 kg/m2 or more.X). The paradox may be partly explained by a difference in body fat distribution. Asians more commonly develop visceral rather than subcutaneous adiposity. Visceral adiposity is more closely linked to insulin resistance and type 2 diabetes than overall adiposity. Additionally, Asians have been shown to have a higher percentage of body fat at any given BMI level when compared with Caucasians. This suggests...
Treadmill Performance & Cardiac Mortality

Treadmill Performance & Cardiac Mortality

Exercise stress tests are commonly used to determine if patients need invasive cardiac testing and to inform treatment decisions. Patients with abnormal electrocardiograms (EKG) findings during exercise or who develop symptoms suggestive of abnormal heart strain during tests are referred for angiography. Those with normal EKG readings and no alarming symptoms during exercise typically do not require further testing. “Stress test results are currently interpreted as ‘either/or’ results, but we know that heart disease is not binary—it’s a continuum of disease,” explains Haitham M. Ahmed, MD, MPH. “Coronary heart disease starts at a young age and continues to progress over decades. It’s a mistake to wait until coronary blockages are severe enough to cause symptoms, a heart attack, or death. Several exercise-based risk scoring systems are already in use, but these often focus on patients with established heart disease or overt signs of cardiovascular trouble. It would be beneficial to find exercise stress test variables that are most helpful for estimating long-term cardiovascular risks earlier in the continuum.”   Quantifying Risk For a study published in Mayo Clinic Proceedings, Dr. Ahmed and colleagues analyzed data from more than 58,000 exercise stress tests to determine which routinely collected variables most strongly correlate with survival. The authors then derived a fitness risk score, dubbed the FIT Treadmill Score, to predict 10-year survival. “We wanted to precisely quantify risk by age, gender, and fitness level, and with a simple equation that required no additional testing beyond the standard stress test,” says Dr. Ahmed. According to the study, fitness level was the single most powerful predictor of death and survival, even after accounting...
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