November 24th, 2010 by Toni Brayer, M.D. in Better Health Network, Health Tips, News, Research
Tags: AF, Alzheimer's Disease, Atrial Fibrillation, Benefits of Exercise, Cleveland Journal of Medicine, Clinical Trials, Cognitive Decline, Cognitive Function, Colinesterase Inhibitors, Coumadin, Dabigatran, Dialysis, Dr. Toni Brayer, Elderly People, Everything Health, Evidence Based Medicine, Family Medicine, Flu Vaccine, General Medicine, Geriatrics, Internal Medicine, Medical Research, Medical Science, Older Adults, Pradaxa, Preventing Falls and Fractures, Primary Care, Science and Medicine, Vitamin D, Warfarin
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New clinical trials and published research are giving us information on how to improve health in elderly patients. Here are some brief points from the Cleveland Journal of Medicine that were surprising to me:
— Each year 30 percent of people age 65 or older fall and sustain serious injuries so preventing falls and fractures is important. Vitamin D prevents both falls and fractures, but mega doses of Vitamin D (50,000 mg) might cause more falls. A better dose is 1,000mg a day in people who consume a low-calcium diet.
— Exercise boosts the effect of influenza vaccine.
— The benefits of dialysis in older patients is uncertain, as it does not improve function in people over age 80. We don’t even know if it improves survival. Older patients who receive dialysis for kidney failure had a decline in function (eating, bed mobility, ambulation, toileting, hygiene, and dressing) after starting treatment.
— Colinesterase inhibitors (Aricept, Razadyne and Exelon) are commonly used to treat Alzheimer disease, but they all can have serious side effects. Syncope (fainting), hip fractures, slow heart rate, and the need for permanent pacemaker insertion were more frequent in people taking these drugs. The benefits of these drugs on cognition is modest.
— A new drug called Pradaxa (dabigatran) will likely prove to be safer than Coumadin (warfarin). Over two million adults have atrial fibrillation and the median age is 75. The blood thinner warfarin is critical for prevention of strokes but it caries a high risk of bleeding and drug levels have to be monitored frequently. Dabigatran will probably replace warfarin, but it will probably also be a lot more expensive.
As I often say, medicine and science are constantly changing and evolving. As new evidence comes forth, physicians and patients need to re-evaluate they way we do things.
*This blog post was originally published at EverythingHealth*
November 23rd, 2010 by RyanDuBosar in Better Health Network, Health Tips, News, Research
Tags: ACP Internist, Advice For Parents, American College Of Physicians, Antibiotics, Children's Health, Epidemiology, Infant Health, Infectious Disease, Inner Ear Infections, JAMA, Journal of the American Medical Association, Middle Ear Infection, Otitis Media, Parent Preferences, Pediatrics, Ryan DuBosar
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Kids get inner ear infections and then they get antibiotics, despite a long-standing knowledge that it’s not always best. Any physician knows this, but who hasn’t faced an irate or anxious parent in the exam room insisting on a prescription, whether the evidence warrants it or not?
Reuters reports that the tally for all those antibiotics is $2.8 billion dollars, or $350 per child annually. And there’s only a slight benefit to them.
While hardly comforting to the parents, physicians can add more heft to their argument that antibiotics are only modestly more effective than nothing, and they can avoid the rashes and diarrhea that antibiotics incur. Read more »
*This blog post was originally published at ACP Internist*
November 23rd, 2010 by Glenn Laffel, M.D., Ph.D. in Better Health Network, News, Research
Tags: Alain Finkielkraut, Dr. Glenn Laffel, Fit and Trim, Fitness and Exercise, Fitness As A Lifestyle, Fitness Centers, Fitness Centres, Fitness First, France, Fred Hoffman, French People, International Health Racquet and Sportsclub Association, Italy, Jogging, Michel Parada, MSNBC, Paris, Personal Trainer, Physical Exercise, Pizaazz, President Nicolas Sarkozy, Public Fitness Facilities, Regular Exercise, Spain, Sweaty, UK, Working Out At The Gym, Workout Regimes
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Like their counterparts in other first-world countries, French people know about the health benefits of exercise. And French culture has emphasized, even worshipped, good looks (which these days translates to “fit and trim.”)
So it’s surprising that the French avoid fitness centers as vigorously as factory-produced croissants. But they do.
According to the International Health, Racquet and Sportsclub Association, just 5.4 percent of French people were members of a fitness club in 2008. That’s substantially less than their counterparts in Italy (9.5 percent), the UK (11.9 percent), and Spain (16.6 percent).
“It appears that more people are sitting in cafes smoking cigarettes and drinking coffee than working out … the French don’t see fitness as a lifestyle,” American-born fitness consultant Fred Hoffman told MSNBC. Hoffman has lived in Paris for two decades. Read more »
*This blog post was originally published at Pizaazz*
November 23rd, 2010 by GruntDoc in Better Health Network, Opinion, Research
Tags: Dr. Allen Roberts, Dr. Graham Walker, Evidence Based Medicine, General Medicine, GruntDoc, Medical Ratings, Medical Recommendations, Medical Reviews, Medical Summaries, Numbers Needed To Treat, Online Tools For Medical Professionals, TheNNT.com
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I think I blogged this before, but didn’t describe it much. Allow me to rectify that mistake.
The NNT.com (“Number Needed To Treat”) is an ever-expanding website which boils down high-quality reviews of medications and interventions and presents its recommendations in a much more approachable green-yellow-red “warning triangle” format rather than some ratio.
While I won’t use this as a single source to change my practice, I’m going to have to do some more research on some of the [questionables] of our age (i.e. Octreotide for variceal bleeding, PPI infusions for upper GI bleeding, etc.) — just two of the studies that fly in the face of current practice.
An aside: While inhaled corticosteroids for asthma aren’t beneficial in the review, what it doesn’t tell you is that the Feds think they are, and will grade your asthma care on how many of your asthma patients get a prescription for them, so be aware.
Graham Walker, M.D. is behind this, and good for him.
*This blog post was originally published at GruntDoc*
November 22nd, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, News, Research
Tags: American Recovery and Reinvestment Act of 2009, ARRA, Cost-Effective Medical Care, Dr. Stanley Feld, Federal Coordinating Council for Comparative Effectiveness Research, HHS, National Coordinator for Health Information Technology, NCFHIT, Practicing Physicians, Repairing The Healthcare System, U.S. Department of Health and Human Services
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What is the Federal Coordinating Council for Comparative Effectiveness Research?
The mission of the Federal Coordinating Council for Comparative Effectiveness Research will be to decide on best practices and most cost effective practices. The council will recommend cost effective treatments for diseases to the National Coordinator for Health Information Technology (NCFHIT). The NCFHIT will determine treatment at the time and place of care. It is charged with deciding the course of treatment for the diagnosis given by the doctor.
The U.S. Department of Health and Human Services (HHS) announced the formation and membership of the Federal Coordinating Council for Comparative Effectiveness Research that will be funded by President Obama’s stimulus program the American Recovery and Reinvestment Act (ARRA). The council was allocated $1.1 billion to set up comparative effectiveness of medical practice.
Why was this $1.1 billion funded from the economic stimulus package?
Unknown. The missions are based on the premise that practicing physicians do not have the ability to recommend the most cost-effective medical treatment for their patients. (See executive summary.)
Who are the members?
The members of the committee were picked without congressional approval immediately after the economic stimulus bill was passed. They are all bureaucrats working for the government in one capacity or another. There are no practicing physicians on the panel.
*This blog post was originally published at Repairing the Healthcare System*
