March 3rd, 2011 by RyanDuBosar in Health Policy, Research
Tags: ACP Internist, American College Of Physicians, Antibiotic Overuse, Antibiotic Prescriptions, Antibiotic-Resistant Infections, BCBSM, Blue Cross Blue Shield Michigan, CDC, Center for Research & Transformation, Centers For Disease Control and Prevention, Children's Health, CHRT, Dr. Gary Freed, Ear Infections, Family Practice, Infectious Disease, Marianne Udow-Phillips, National Committee for Quality Assurance, Pediatrics, Ryan DuBosar, University of Michigan
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High rates of inappropriate antibiotic use continued despite a 15-year campaign by the Centers for Disease Control and Prevention (CDC) aimed at Michigan physicians and consumers on the dangers of antibiotic overuse.
The Center for Healthcare Research & Transformation (CHRT) released an issue brief detailing overall antibiotic prescribing for adult Blue Cross Blue Shield of Michigan (BCBSM) members. (The project is a non-profit partnership between the University of Michigan and BCBSM.)
While antibiotic prescribing in adults decreased 9.3 percent from 2007 to 2009, it increased 4.5 percent for children during the same time period. The studies found significant differences in prescribing patterns between rural southeast Michigan and the rest of the state, particularly for children. Children in rural southeastern Michigan were prescribed an average of .93 antibiotics per year, while elsewhere children were prescribed an average of 1.0 per year.
“The continuing high rate of antibiotic use for viral infections in children and adults — particularly outside of southeast Michigan — is of great concern, as is the increase in the use of broad spectrum antibiotics in children,” said Marianne Udow-Phillips, CHRT’s director. “Using antibiotics when they are unnecessary — or treating simple infections with drugs that should be reserved for the most serious infections — are practices that contribute to antibiotic resistance, making future infections harder to treat.”
Nearly half (49.1 percent) of antibiotic prescriptions in the study population were for broad spectrum antibiotics in 2009, compared to the national rate of 47 percent. Between 2007 and 2009, prescriptions for what the National Committee for Quality Assurance calls “antibiotics of concern” declined slightly in adults, decreasing 0.4 percent during that time period. In the same time period, antibiotics of concern prescribed to children increased 3.4 percent, from 44.9 percent to 46.4 percent.
One possible explanation for the rising rate in children is a rise in resistant pathogens in ear infections, according to the study brief. Other possible reasons are that kids get different infections than adults, and that some drugs that are used in adults are not used for pediatric patients. Read more »
*This blog post was originally published at ACP Internist*
March 3rd, 2011 by David H. Gorski, M.D., Ph.D. in Opinion, Quackery Exposed, Research
Tags: Cancer Research, Cancer Treatment, Committee for Skeptical Inquiry, Dr. David Gorski, Dr. Mark Crislip, Dr. Michael Spector, Healthy Skepticism, Oncology, SBM, Science and Medicine, Science and Nihilism, Science and Skepticism, Science And The Media, Science Based Medicine, Skeptical Inquirer, War On Cancer
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Last Friday, Mark Crislip posted an excellent deconstruction of a very disappointing article that appeared in the most recent issue of Skeptical Inquirer (SI), the flagship publication of the Committee for Skeptical Inquiry (CSI). I say “disappointing,” because I was disappointed to see SI publish such a biased, poorly thought out article, apparently for the sake of controversy. I’m a subscriber myself, and in general enjoy reading the magazine, although of late I must admit that I don’t always read each issue cover to cover the way I used to do. Between work, grant writing, blogging, and other activities, my outside reading, even of publications I like, has declined. Perhaps SI will soon find itself off my reading list.
Be that as it may, I couldn’t miss the article that so irritated Mark, because it irritated me as well. There it was, emblazoned prominently on the cover of the March/April 2011 issue: “Seven Deadly Medical Hypotheses.” I flipped through the issue to the article to find out that this little gem was written by someone named Michael Spector, M.D. A tinge of familiarity going through my brain, I tried to think where I had heard that name before.
And then I remembered.
Dr. Spector, it turns out, first got on my nerves about a year ago, when he wrote an article for the January/February 2010 issue of SI entitled “The War on Cancer: A Progress Report for Skeptics.” I remember at that time being irritated by the article and wanting to pen a discussion of the points in that article but don’t recall why I never did. It was probably a combination of the fact that SI doesn’t publish its articles online until some months have passed and perhaps my laziness about having to manually transcribe with my own little typing fingers any passages of text that I wanted to cite. By the time the article was available online, I forgot about it and never came back to it — until now. I should therefore, right here, right now, publicly thank Mark (and, of course, Dr. Spector) for providing me the opportunity to revisit that article in the context of piling on, so to speak, Dr. Spector’s most recent article. After all, Deadly Hypothesis Seven (as Dr. Spector so cheesily put it) is:
From a cancer patient population and public health perspective, cancer chemotherapy (chemo) has been a major medical advance.
Dr. Spector then takes this opportunity to cite copiously from his 2010 article, sprinkling “(Spector, 2010)” throughout the text like powdered sugar on a cupcake. There’s the opening I needed to justify revisiting an article that’s more than a year old! And what fantastic timing, too, hot on the heals of my post from a couple of weeks ago entitled “Why Haven’t We Cured Cancer Yet?” Read more »
*This blog post was originally published at Science-Based Medicine*
March 2nd, 2011 by Jon LaPook, M.D. in News, Research, Video
Tags: CBS News, CDC, Centers For Disease Control and Prevention, Cervical Cancer, Dr. Aimee Kreimer, Dr. Anna Giuliano, Dr. Jon LaPook, Gardasil, Genital Infection, Head and Neck Cancer, HPV, HPV Strain 16, HPV Vaccine, Human Papillomavirus, Infectious Disease, Johns Hopkins, Men's Health, Moffitt Cancer Center, National Cancer Institute, NCI, Number of Sex Partners, Oncology, Oral Sex, Oropharyngeal Cancer, Otolaryngology, Preventive Health, Preventive Medicine, Public Health, Safe Sex, Sex and Your Health, Sex Education, Sexual Health, Sexual History, sexually transmitted diseases, Sexually Transmitted Infections, STD Protection, STDs, STIs, The Lancet, Tonsil and Tongue Cancer, Unprotected Sex, Women's Health
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A new study finds that half of men in America are infected with the HPV virus. Dr. Jon LaPook reports on the growing concern that the virus in men could be responsible for an increase in head and neck cancers.
HPV Affects Half Of U.S. Men
A study out [yesterday] in The Lancet by Moffitt Cancer Center researcher Anna Giuliano, Ph.D., and her colleagues finds that 50 percent of men ages 18 to 70 in Brazil, Mexico, and the U.S. have genital infection with human papillomavirus (HPV). HPV is the virus that causes cervical cancer in women. It also causes warts and cancer of the genitals and anus in both men and women. Over the past several years, researchers have realized that the virus can also cause cancer of the head and neck.
Aimee R. Kreimer, Ph.D., of the National Cancer Institute, estimates that about 65 percent of the approximately 8,000 cancers of the tonsils and base of the tongue (oropharynx) seen in the U.S. in 2010 were from HPV infection; eighty percent of these are in men. The rates for HPV-associated cancers like these are increasing; for sites like the mouth and larynx that are associated with tobacco and alcohol use, the rates are decreasing (though still too high since too many people still smoke and abuse alcohol).
An infection rate of 50 percent for a virus that can cause cancer sounds scary. But knowing a few more facts about HPV helps put the risk in perspective. About 90 percent of men and women infected with HPV virus get rid of it on their own within about two years. There are many different strains of HPV — some that cause cancer and some that don’t. Only about 6 percent of men have genital infection with HPV 16 — the strain linked to more than 90 percent of cancers of the head and neck. And only about 0.6 percent of men have HPV 16 in specimens taken from their mouths; what percentage of those men go on to develop head and neck cancer is unknown. Read more »
March 2nd, 2011 by Medgadget in Better Health Network, Research
Tags: Biomedical Research, Biomedicine, Cancer Detection, Cancer Research, Circulating Tumor Cells, Dr. Shuming Nie, EGFR-Targeting Gold Nanoparticles, Emory University, Georgia Tech, Head and Neck Cancer, Low Molecular Weight Peptides, Medgadget, Radiation Oncology, Wallace H. Coulter Department of Biomedical Engineering
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Our modern armamentarium for treating cancer is impressive, but sometimes despite our best treatments, tumor cells continue to lurk in the bloodstream, seeding metastases throughout the body. Researchers at Emory have developed a way to monitor for these circulating tumor cells using gold nanoparticles.
This technique has been used before, but difficulty was encountered because white blood cells are close to the same size as some tumor cells, so they would both be tagged, necessitating a laborious multi-antibody staining process.
“The key technological advance here is our finding that polymer-coated gold nanoparticles that are conjugated with low molecular weight peptides such as EGF are much less sticky than particles conjugated to whole antibodies,” says Shuming Nie, Ph.D., a professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University. “This effect has led to a major improvement in discriminating tumor cells from non-tumor cells in the blood.”
Once these tumor cells are tagged with the gold nanoparticles, laser illumination reveals which cells are tumors in the bloodstream. This technique was tested on 19 patients with head and neck cancer, and showed excellent correlation with previous techniques. If this method can be validated in larger studies, it shows promise as a faster, more economical method to detect circulating tumor cells.
Full story: Nanoparticles May Enhance Circulating Tumor Cell Detection …
Abstract in Cancer Research : Quantification of circulating tumor cells in peripheral blood using EGFR-targeting gold nanoparticles
*This blog post was originally published at Medgadget*
March 1st, 2011 by RyanDuBosar in Health Policy, Research
Tags: ACP Internist, American College Of Physicians, Bacteria Colony Counts, Bacterial Contamination, Denver Health, Doctors' White Coats, Epidemiology, Healthcare Garments, Infectious Diseases, Journal of Hospital Medicine, Methicillin-Resistant Staphylcoccal Auerus, MRSA, Patient Safety, Professionalism, Public Health, Public Safety, Ryan DuBosar
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Bacterial contamination of physicians’ newly laundered uniforms occurs within three hours of putting them on, making them no more or less dirty than the traditional white coats, researchers reported.
Researchers sought to compare bacterial and methicillin-resistant Staphylococcus aureus contamination of physicians’ white coats to freshly laundered short-sleeved uniforms, and to determine the rate at which bacterial contamination happens. They reported results in the Journal of Hospital Medicine.
ACP Internist‘s blog recently took up the debate as well. The issue has cropped up over the years, assessing not only the cleanliness but the professionalism inherent in the white lab coat.
Researchers conducted a prospective, randomized, controlled trial among 100 residents and hospitalists on an internal medicine service at Denver Health, a university-affiliated public safety-net hospital. Subjects wore a white coat or a laundered, short-sleeved uniform.
At the end of an eight-hour workday, no significant differences were found between the extent of bacterial or MRSA contamination of infrequently-washed white coats compared to the laundered uniforms. Sleeve cuffs of white coats were slightly but significantly more contaminated than the pockets or the midsleeves, “but interestingly, we found no difference in colony count from cultures taken from the skin at the wrists of the subjects wearing either garment,” researchers wrote.
And, there was no association found between the extent of bacterial or MRSA contamination and the frequency with which white coats were washed or changed. Colony counts of newly laundered uniforms were essentially zero, but after three hours they were nearly 50 percent of those counted at eight hours.
*This blog post was originally published at ACP Internist*
