May 28th, 2011 by GarySchwitzer in Health Tips
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On the NPR Shots blog, Scott Hensley writes, “Quality Prescription For Primary Care Doctors: Do Less,” about an article in the Archives of Internal Medicine. Excerpt:
“A group of docs who want to improve the quality and cost-effectiveness of primary care tinkered with some Top 5 lists for of dos and don’ts for pediatricians, family doctors and internists.
After testing them a bit, they published online by the Archives of Internal Medicine. Most of the advice falls in the category of less is more.
So what should family doctors not be doing? The Top 5 list for them goes like this:
1. No MRI or other imaging tests for low back pain, unless it has persisted longer than six weeks or there are red flags, such as neurological problems.
2. No antibiotics for mild to moderate sinusitis, unless it has lasted a week or longer. Or the condition worsens after first getting better.
3. No annual electrocardiograms for low-risk patients without cardiac symptoms.
4. No Pap tests in patients under 21, or women who’ve had hysterectomies for non-malignant disease.
5. No bone scans for women under 65 or men under 70, unless they have specific risk factors.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
April 25th, 2011 by RyanDuBosar in News
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Drug-resistant strains of Staphylococcus aureus were found in nearly half of meat and poultry samples, and were likely from the animal themselves, a study reported.
Researchers collected and analyzed 136 samples of 80 brands of beef, chicken, pork and turkey from 26 retail grocery stores in Los Angeles, Chicago, Washington, D.C., Fort Lauderdale, Fla., and Flagstaff, Ariz. Among the samples, 47% were contaminated with S. aureus, and 52% of the strains were resistant to at least three classes of antibiotics–and some to nine antibiotics.
Translational Genomics Research Institute, a non-profit research organization, conducted the study and published results in Clinical Infectious Diseases.
DNA testing suggested that the food animals themselves were the major source of contamination. Read more »
*This blog post was originally published at ACP Internist*
April 2nd, 2011 by Toni Brayer, M.D. in Health Policy, Research
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The single most important medicine ever discovered is the antibiotic. Prior to 1930, humans died at early ages of simple infections and even childbirth was a major killer of women because of infection. The mortality rate from simple staph aureus was as high as 80%, but between 1944 and 1972 the human life expectancy jumped by 8 years because of antibiotics. By 1950 the golden age of antibiotics was already looking tarnished as organisms became resistant to the drugs. Now many medical advances that we take for granted, including cancer treatment, surgery, transplantation and neonatal care are endangered by increasing antibiotic resistance and a decline in new medications to combat the super germs.
Drug resistance is both a public health and global security threat. Resistance has emerged for all known antibiotics in use. For most antibiotics, resistant genes have created super bugs that require more combinations of antibiotics to treat and there are certain infections that we cannot effectively treat. Read more »
*This blog post was originally published at EverythingHealth*
March 17th, 2011 by ChristopherChangMD in Health Tips, Opinion
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Occasionally, I see patients who have received throat swabs for strep that have come back positive… even if they have no signs or symptoms of pharyngitis.
In this situation, there are 2 main actions a physician may take (I am biased towards one):
1) Prescribe antibiotics until throat cultures are normal
2) Do nothing
Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for??? Read more »
*This blog post was originally published at Fauquier ENT Blog*
February 8th, 2011 by Harriet Hall, M.D. in Better Health Network, Research
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Ear infections used to be a devastating problem. In 1932, acute otitis media (AOM) and its suppurative complications accounted for 27 percent of all pediatric admissions to Bellevue Hospital. Since the introduction of antibiotics, it has become a much less serious problem. For decades it was taken for granted that all children with AOM should be given antibiotics, not only to treat the disease itself but to prevent complications like mastoiditis and meningitis.
In the 1980s, that consensus began to change. We realized that as many as 80 percent of uncomplicated ear infections resolve without treatment in three days. Many infections are caused by viruses that don’t respond to antibiotics. Overuse of antibiotics leads to the emergence of resistant strains of bacteria. Antibiotics cause side effects. A new strategy of watchful waiting was developed.
Current Medical Guidelines
In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) collaborated to issue evidence-based guidelines based on a review of the published evidence. Something was lost in the transmission: The guidelines have been over-simplified and misrepresented, so it’s useful to look at what they actually said. There were six parts:
1. Criteria were specified for accurate diagnosis.
- History of acute onset of signs and symptoms
- Presence of middle ear effusion (ear drum bulging, lack of mobility, air-fluid level)
- Signs and symptoms of middle ear inflammation: Either red ear drum or ear pain interfering with normal activity or sleep
They stressed that AOM must be distinguished from otitis media with effusion (OME). OME is more common, occurs with the common cold, can be a precursor or a consequence of AOM, and is not an indication for antibiotic treatment. Read more »
*This blog post was originally published at Science-Based Medicine*
