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Physician's First Watch:
Medical News from Journal Watch

February 9, 2010

Usual Care for Low Back Pain Doesn't Align with Guideline Recommendations

General practitioners rarely follow guidelines when managing new episodes of low back pain, reports the Archives of Internal Medicine. (The analysis was conducted in Australia, but the guidelines assessed match those in the U.S.)

Researchers examined data on some 1700 visits to GPs for new low back pain from 2005 to 2008, after national guidelines for treating musculoskeletal pain were released. Among the findings:

• Although guidelines recommend acetaminophen as a first-line analgesic, it was prescribed for only 18% of patients. NSAIDs and opioids were prescribed for 37% and 20%, respectively.
  
• One fourth of patients were referred for imaging, despite guidelines advising against routine referral.
  
• Only one fifth of patients received advice and education as recommended.
  

These findings were similar to those from the period before guideline publication.

The authors conclude: "The results indicate that in most cases, usual care is not evidence-based care and so is not likely to provide the best outcomes."

LINK(S):

Archives of Internal Medicine article (Free)

Archives of Internal Medicine commentary (Subscription required)

American College of Physicians/American Pain Society guideline on managing low back pain (Free)

Published in Physician's First Watch February 9, 2010

FDA Approves Expanded Use of Crestor

Rosuvastatin (Crestor) has been approved for use as primary prevention in patients without elevated LDL cholesterol but with a combination of other risk factors that put them at increased risk for heart disease, the FDA announced on Monday.

The statin is now indicated for men aged 50 or older and women 60 or older who have elevated C-reactive protein levels (2 mg/L or higher) and at least one additional cardiovascular risk factor such as low HDL cholesterol or high blood pressure.

LINK(S):

FDA Q & A for healthcare professionals (Free)

Reuters story (Free)

Physician's First Watch coverage of advisory panel's recommendation to expand Crestor use (Free)

Published in Physician's First Watch February 9, 2010

Outpatients with Inflammatory Bowel Disease at Increased Risk for VTE

Nonhospitalized patients with inflammatory bowel disease have a nearly 16-fold increased risk for venous thromboembolism during acute flare-ups, according to a Lancet study released online.

Using a U.K. general practice database, researchers identified some 14,000 bowel disease patients with a recent prescription for corticosteroids and some 72,000 controls without inflammatory bowel disease matched for age, sex, and provider. In the 4 months after patients received the prescription (corresponding to a likely disease flare-up), the relative risk for VTE outside the hospital setting was roughly 16 (absolute risk, 6.4 per 1000 person-years).

Risks were increased at all stages of disease, including remission.

Commentators caution against a drug-based approach to prophylaxis in these patients until further studies are done. They recommend, instead, educating patients on the symptoms of VTE and the use of support stockings.

LINK(S):

Lancet article (Free abstract; full text requires subscription)

Lancet comment (Subscription required)

Published in Physician's First Watch February 9, 2010

Automated Calls for Colorectal Cancer Screening Reminders Don't Work

Automated telephone calls to patients do not improve screening rates for colorectal cancer, according to an Archives of Internal Medicine study.

Roughly 20,000 people ages 50 to 64 were randomized either to usual care or to a single 3-minute automated telephone call using speech recognition that encouraged people to call their healthcare providers for screening. In the year after the call, the rate of any colorectal cancer screening — the primary outcome — did not differ between the two groups.

These results, the authors suggest, show yet another instance in which "potentially ineffective policies and programs achieve widespread acceptance before evidence is available from controlled trials."

LINK(S):

Archives of Internal Medicine article (Free abstract; full text requires subscription)

Published in Physician's First Watch February 9, 2010

February 8, 2010

H1N1 Update: Flu Activity Levels Off, but CDC Official Warns Against 'Complacency'

"H1N1 flu activity seems to have leveled off," according to the CDC, but vaccination "remains a good idea."

In an online briefing, Dr. Anne Schuchat, the agency's director for immunization, added that most current flu activity is from the 2009 H1N1 virus and that "we're not seeing seasonal flu strains yet in any substantial numbers." She said that although some people believe the H1N1 outbreak is over, "it's too soon for us to have that type of complacency."

Dr. Schuchat reported that vaccine safety monitoring has been "extremely reassuring."

LINK(S):

CDC news briefing (Free)

Published in Physician's First Watch February 8, 2010

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