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September 21, 2007, 5:16 AM CT

Decision-making by residents on-call

Decision-making by residents on-call
The study consisted of the review of approximately 12,000 emergency diagnostic imaging exams that were interpreted after hours by residents. In the midst of our research, a vigorous national debate began concerning the appropriate stage of radiology resident training previous to independent call, said Richard B. Ruchman, MD, lead author of the study. Specifically, the ACGME proposed and subsequently approved a new requirement that would mandate one year of residency training previous to independent call, said Dr. Ruchman. Our study examined the discrepancy rate by year of training, and attempted to answer the question whether it was safe for first year residents to take independent call with faculty back up, he said.

The study showed that the major discrepancy rate (the rate which the interpretation by residents after hours disagreed with the attending physicians final interpretation and the difference in diagnosis had some negative affect on patient care) was 2.6 percent. A significant negative clinical effect of a discrepancy was only found in 0.3 percent. This discrepancy rate is comparable to the discrepancy rates of the attending radiologists in our program, Dr. Ruchman noted.

Most major discrepancies involved abdominal or chest examinations, with the most frequently missed or corrected diagnosis being acute appendicitis, Dr. Ruchman said. The second most usually missed diagnosis was pulmonary embolism.........

Posted by: Janet      Read more         Source


September 20, 2007, 11:59 PM CT

Improving standard of cows' milk allergy care

Improving standard of cows' milk allergy care
New guidelines on the diagnosis and management of cows milk allergy (CMA), published recently in the Archives of Disease in Childhood, are set to improve the standard of care of infants with CMA, the most common food allergy in children.1 The Guidelines for the Diagnosis and Management of Cows Milk Protein Allergy recommend only extensively hydrolysed (eHF) and amino acid-based formulas (AAF), and the Taskforces recommendations warn against the risks of soy and other mammalian milks, such as sheep and goat, in CMA management.

Drawn up by the independent international Taskforce of allergy experts Act Against Allergy, and supported by an educational grant from SHS International, a leader in the field of specialised clinical nutrition, the guidelines offer clear recommendations on how to diagnose and manage CMA as well as two algorithms one for breast-fed infants and one for formula-fed infants addressing all levels of disease severity.

These are the first practical guidelines on CMA diagnosis and management and are specifically aimed at primary care physicians and general paediatricians, says Professor Yvan Vandenplas, Paediatric Gastroenterologist at Vrije Universiteit Brussel, Brussels, Belgium and Chair of the Act Against Allergy Taskforce. Our recommendations will assist in establishing CMA diagnosis and level of severity, offering clear guidance on the recommended management at each stage, whilst debunking some of the misconceptions over the value of soy and other alternative milk sources in CMA.........

Posted by: JoAnn      Read more         Source


September 20, 2007, 11:57 PM CT

Pregnancy, Corticosteroid injections and cerebral palsy

Pregnancy, Corticosteroid injections and cerebral palsy
When pregnant women are at high risk for preterm birth, giving them a single injection of corticosteroids has been shown to reduce the babys chances of having serious lung problems after birth.

But some women receive multiple injections of corticosteroids, and a new study shows that repeat courses of corticosteroids are associated with an increased rate of cerebral palsy among children of these mothers.

Our study shows that you get almost all of the benefit from a single round of treatment and that multiple rounds raise the risk of cerebral palsy, which is a severely disabling condition, said John M. Thorp, M.D., a co-author of study and McAllister distinguished professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine.

Thats why we concluded that exposure to repeat courses should be limited, Thorp said.

The study results are reported in the Sept. 20, 2007, issue of the New England Journal (NEJM). The lead author is Ronald J. Wapner, M.D., of Drexel University in Philadelphia. The study was conducted for the Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development, which provided grant funding. Research took place at 14 sites across the United States, including UNC-Chapel Hill.........

Posted by: Emily      Read more         Source


September 18, 2007, 10:23 PM CT

Osteoporosis drug for breast cancer patients

Osteoporosis drug for breast cancer patients
Breast cancer survivors who took a weekly dose of risedronate, sold as Actonel, lost significantly less bone than those who did not take the drug, as per a two-year study from the University of Pittsburgh School of Medicine presented this week at the 29th annual meeting of the American Society for Bone and Mineral Research. Scientific sessions continue through Wednesday at the Hawaii Convention Center.

Susan Greenspan, M.D., director of the Osteoporosis Prevention and Treatment Center and Bone Health program at the University of Pittsburgh Medical Center, and his colleagues reviewed 87 women, mean age 50, enrolled in the Prevention of Osteoporosis in Postmenopausal Women with Breast Cancer Following Chemotherapy study. All participants in the randomized, double-blind trial received calcium and vitamin D supplements. However, half took 35 milligrams of risedronate once a week while others took a placebo.

Chemotherapy drugs and other medical therapys for breast cancer are known to induce menopause, which can kick-start bone loss, putting survivors at risk for osteoporotic fractures, said Dr. Greenspan, an internationally respected osteoporosis researcher and professor of medicine at Pitt. This study also looked at changes in spine and hip bone mineral density, as well as evidence of bone breakdown.........

Posted by: Janet      Read more         Source


September 18, 2007, 10:19 PM CT

Results of phase 1 metastatic melanoma study

Results of phase 1 metastatic melanoma study
Provectus Pharmaceuticals, Inc. announced preliminary results of its Phase 1 clinical trial of Provecta for the therapy of metastatic melanoma, the most aggressive form of skin cancer. Provecta demonstrated minimal side effects, significant efficacy and bystander effect on melanoma tumors in stage III patients. The study reviewed safety and efficacy of Provecta in a total of 20 subjects at two sites in Australia.

In the study, Provecta was injected once into one to twenty tumors in each subject. In addition to these treated tumors, an additional one to three tumors were left untreated in each subject to allow assessment of a potential "bystander effect" resulting from immune system response to tumor therapy. A total of 114 tumors were injected and 39 bystander tumors were observed in the study. Subjects were followed for 4 to 27 weeks. Study therapys were well tolerated and elicited minimal side effects, the most common being mild to moderate pain at the injection site.

Results for all evaluable tumors were tabulated using the RECIST (Response Evaluation Criteria in Solid Tumors) approach, which objectively grades response for each subject based on change in the sum of the longest diameter for each of the subject's tumors vs. baseline. Subject outcome was scored in terms of complete response (CR -- complete tumor disappearance or negative histopathology), partial response (PR -- 30% or more tumor shrinkage), stable disease (SD -- 29% shrinkage to 20% growth), and progressive disease (PD -- greater than 20% growth).........

Posted by: George      Read more         Source


September 18, 2007, 10:17 PM CT

Less than one-third of women aware of HRT study

Less than one-third of women aware of HRT study
Despite the huge publicity generated by a 2002 study on the potential dangers of hormone treatment for postmenopausal women, new research from the Stanford University School of Medicine observed that only 29 percent of women surveyed knew about the study two years later.

Additionally, the women were able to correctly identify the possible benefits and risks associated with hormone treatment just 40 percent of the time.

Senior author Randall Stafford, MD, PhD, associate professor of medicine at the Stanford Prevention Research Center, said the new study points out that the medical profession hasn't yet figured out an effective way of communicating crucial health information to patients.

"This study suggests that we have a flawed mechanism for getting information down to the level of the population," Stafford said. "Eventhough we looked specifically at menopause and hormone treatment, the findings have consequences for a number of other medical issues".

Stafford's results are reported in the September/recent issue of the journal Menopause.

Few research studies have had the impact on public health recommendations as the 2002 results reported by the federally funded Women's Health Initiative, the longest-ever examination of the health of postmenopausal women. One part of WHI focused on hormone treatment, which is used to ease the symptoms of menopause. Hormone treatment also had been widely prescribed for preventive purposes, based partly on earlier findings based on observation suggesting that it helped protect women against heart disease, weak bones and dementia.........

Posted by: Emily      Read more         Source


September 18, 2007, 10:14 PM CT

Medication for ADHD may help student outcomes

Medication for ADHD may help student outcomes
In an 18-year-study on attention-deficit hyperactivity disorder (ADHD), Mayo Clinic scientists observed that therapy with prescription stimulants is linked to improved long-term academic success of children with ADHD. The Mayo Clinic results are the first population-based data to show stimulant drug treatment helps improve long-term school outcomes.

A related Mayo Clinic study reveals that in comparison to children without AD/HD, children with ADHD are at risk for poor long-term school outcomes such as low achievement in reading, absenteeism, repeating a grade, and dropping out of school. Both studies appear in the current edition of the Journal of Development & Behavioral Pediatrics, (http://www.jrnldbp.com).

Nearly 2 million children, or approximately 3 percent to 5 percent of young children in the United States, have ADHD. This disorder affects a childs ability to focus, concentrate and control impulsive behavior (http://www.nimh.nih.gov/publicat/adhd.cfm). This disorder is so common that most school classrooms have at least one child with clinically-diagnosed ADHD.

In this study, therapy with stimulant medicine during childhood was linked to more favorable long-term school outcomes, explains William Barbaresi, M.D., Mayo Clinic pediatrician and lead author of the reports.........

Posted by: JoAnn      Read more         Source


September 18, 2007, 10:00 PM CT

Nurses Describe Dedication, Frustration

Nurses Describe Dedication, Frustration
"We are the bouncers, the bodyguards, the 'shotgun' riders, the overseers, the maƮtre d's, the stewards, the organizers, the managers and leaders for the patient. Often we are the only thing between them and a sentinel event. See us, hear us, feel us".

Welcome to the nurse's world, through the words of those who live there.

This telling reflection on the profession appears in a paper reported in the current issue of Nursing Forum (July-September 2007) titled appropriately "Giving Voice to Registered Nurses' Decisions to Work".

Suzanne S. Dickerson, D.N.S., associate professor in the University at Buffalo School of Nursing, is first author. The paper presents results of an analysis of written responses to an open-ended question contained in a survey that assessed work satisfaction of registered nurses. The study's quantitative results were published in 2006.

Analysis of the comments identified four major themes: competing priorities, balancing priorities, practice deterrents and collegiate support, which encourages nurses to stay in practice.

"Listening to the nurses' voices, it was amazing that in spite of the volume of deterrents to working, they continued to care for their patients," Dickerson said. "One emphasis that was newly apparent was that nurses repeatedly told about their work patterns or trajectory that reflected the need for flexibility to fit family needs."........

Posted by: Janet      Read more         Source


September 18, 2007, 8:05 PM CT

Eat Smart. Play Hard

Eat Smart. Play Hard
Christina Economos, PhD, principal investigator of Shape Up Somerville: Eat Smart. Play Hard, a large-scale community intervention to curb childhood obesity, will present her research at the second annual Friedman School Symposium at Tufts, October 29th to 31st in Boston.

Shape Up Somerville was a 3 year long obesity prevention intervention targeted at first through third graders in the culturally diverse Boston suburb of Somerville, Massachusetts.

Eager to turn the tide on childhood obesity, the town leaders of Somerville, community partners, and university scientists joined forces to spark community change and build an innovative, health-minded environment for the children. The Shape Up approach emphasized manageable and affordable changes in behavior and nutrition throughout the course of the day. Whats more, it worked. The intervention decreased BMI z score in children at high-risk for obesity, in comparison to the two control communities.

"There are lots of communities around the country attempting to make changes and what this study tells us is they should persevere," Economos said.

"A lot of people making a few small changes added up to produce significant results," says Dr. Economos. "We couldn't go to the kids and say you have to change your lifestyle. We had to change the environment and the community spirit first".........

Posted by: JoAnn      Read more         Source


September 18, 2007, 7:49 PM CT

Eating competence may lower risk of heart disease

Eating competence may lower risk of heart disease
People who are confident, comfortable and flexible with their eating habits may be at a significantly lower risk of cardiovascular disease than people who are not. Scientists at Penn State suggest that a curriculum that helps people understand their eating habits could prove to be an important medical nutrition treatment.

"We wanted to see if people were at higher risk of developing cardiovascular disease if they were not eating competent to begin with," said Barbara Lohse, associate professor of nutritional sciences.

Lohse and her colleagues Sheila G. West, associate professor of biobehavioral health, and Tricia L. Psota, graduate student, measured eating competence among 48 men and women aged 21 to 70, who were at risk for cardiovascular disease. Eating competence, as defined by registered dietitian and mental health professional Ellyn Satter, is a nutritional model termed ecSatter that incorporates processes such as awareness of hunger, appetite and eating enjoyment with the body's biological tendency to maintain a preferred and stable weight.

"This population was already at high risk due to high levels of LDL the bad cholesterol and elevated total cholesterol, but did not have any other type of chronic disease," said Lohse.

Based on their responses to a questionnaire on eating competence, and readings of various biological markers of cardiovascular disease, the scientists observed that participants who were not eating competent were five times more likely to have a LDL greater than the cutoff prescribed by the American Heart Association, and seven times more likely to have levels greater than that for triglyceride.........

Posted by: Daniel      Read more         Source



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Did you know?
Studies in monkeys and women suggest that unlike traditional estrogen therapy, a diet high in the natural plant estrogens found in soy does not increase the risk of uterine cancer in postmenopausal women, according to Mark Cline, D.V.M., Ph.D., an associate professor of comparative medicine at Wake Forest University Baptist Medical Center.

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