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Physician's First Watch:
Medical News from Journal Watch

November 20, 2009

ACOG Releases New Cervical Screening Guidelines into Politically Charged Environment

New clinical management guidelines for cervical cytology screening advise that screening should begin at age 21, not at the age of first sexual intercourse.

The guidelines, released in the American College of Obstetricians and Gynecologists' ACOG Practice Bulletin, say the change is "based on the potential for adverse effects associated with follow-up of young women."

Initially, screening is recommended every 2 years. For women over 30 who have had three consecutive negative screenings, screening may occur at 3-year intervals. Women with certain risk factors may require more frequent screenings: those infected with HIV, the immunosuppressed, those with in utero exposure to DES, women with a history of cancer or cervical intraepithelial neoplasia.

Screening can be discontinued for most women between 65 and 70, or who have had a hysterectomy for benign indications and no history of high-grade CIN.

The guidelines also give recommendations on HPV screening.

Both the New York Times and the Washington Post report that release of the cervical screening guidelines and those on mammography within the same week was a coincidence. Both recognized that the ACOG guidelines would add fuel to the political firestorm over health care reform.

LINK(S):

ACOG Practice Bulletin (Free PDF)

New York Times story (Free)

Washington Post story (Free)

Published in Physician's First Watch November 20, 2009

'QFracture' Score Offers 10-Year Risk Prediction for Osteoporotic Fractures

A 10-year risk algorithm for osteoporotic fracture, called the QFractureScore, "shows some evidence of improved discrimination" over the World Health Organization's FRAX algorithm, according to an online BMJ report.

Researchers derived the algorithm from a cohort of some 2.4 million men and women in England and Wales and validated it against roughly 1.3 million others. The data were gathered from electronic medical records ranging over 15 years.

Significant associations with overall fracture risk among men included age, BMI, smoking status, alcohol use, rheumatoid arthritis, cardiovascular disease, type 2 diabetes, asthma, use of tricyclic antidepressants or corticosteroids, liver disease, and a history of falls. For women, additional associations included hormone replacement therapy, parental history of osteoporosis, gastrointestinal malabsorption, and menopausal symptoms.

The authors comment that no lab tests are needed, and that the necessary information is already in the patient's record or can be readily ascertained. They provide a web site (www.qfracture.org) to allow patients to measure their own risk.

LINK(S):

BMJ article (Free)

QFracture risk score calculator (Free)

Published in Physician's First Watch November 20, 2009

Talking Points: Diabetes and Obesity Most Prevalent in Southeastern U.S.

Diabetes and obesity are most prevalent in southeastern U.S. counties, MMWR reports.

CDC researchers used census and telephone survey data to estimate the prevalence of diabetes and obesity among adults in all 3141 U.S. counties in 2007. They found that the southeastern U.S. comprised the majority of counties that were in the top quintiles of diabetes prevalence (at least 10.6%) and obesity prevalence (at least 30.9%).

LINK(S):

MMWR article (Free)

Published in Physician's First Watch November 20, 2009

November 19, 2009

FDA Approves New Treatment for Shingles-Related Pain

The FDA has approved Qutenza, a patch containing 8% capsaicin, to treat postherpetic neuralgia.

Qutenza must be applied to the skin by a healthcare professional. It can be used for 60 minutes, as often as once every 3 months, according to the manufacturer.

Before placing a patch, providers should treat the affected area with a topical anesthetic. In addition, they should monitor patients for at least 1 hour after patch application because of the risk for increased blood pressure. Other side effects may include pain, swelling, itching, redness, and bumps at the application site.

Capsaicin, a compound in chili peppers, is available in over-the-counter products in lower concentrations, but this is the first prescription-level formulation approved by the FDA.

LINK(S):

FDA news release (Free)

Qutenza prescribing information (Free PDF)

Journal Watch General Medicine summary on capsaicin and chronic pain (Your Journal Watch registration required)

Published in Physician's First Watch November 19, 2009

Moderate-to-High Alcohol Intake Linked to Reduced CHD Risk in Men

Men who drink moderate to very high amounts of alcohol may have a reduced risk for coronary heart disease, according to an observational study in Heart.

Over 40,000 Spanish men and women completed questionnaires about their lifestyles, including alcohol intake, and were followed for a median of 10 years. During that time, 1.5% developed CHD.

After adjustment for lifestyle factors and comorbid conditions, men who regularly consumed moderate to very high amounts of alcohol (range: 5 to at least 90 g/day — the equivalent of roughly one to six standard drinks) had about half the risk for CHD as those who never drank. Findings were similar for all kinds of beverages consumed.

Among women, alcohol intake was not significantly associated with CHD.

LINK(S):

Heart article (Free abstract; full text requires subscription)

Published in Physician's First Watch November 19, 2009

Updated PCI And STEMI Guidelines from ACC/AHA

The American College of Cardiology and the American Heart Association have released updated guidelines on managing patients with ST-segment-elevation myocardial infarction and those undergoing percutaneous coronary intervention.

Based on studies and meta-analyses published since the 2007 update, the recommendations range from use of glycoprotein receptor antagonists to the timing of interventions in unstable angina. Among the items:

• The writing group would not make an official recommendation on the use of dual antiplatelet therapy with proton-pump inhibitors, citing a lack of published evidence. (The FDA, on Tuesday, warned that clopidogrel's efficacy can be severely affected by omeprazole.)
  
• The group reduced slightly the anticipated benefits of using insulin to control blood glucose in STEMI and recommends its use for levels above 180 mg/dL.
  

LINK(S):

Journal of the American College of Cardiology guidelines (Free)

Published in Physician's First Watch November 19, 2009

News from AHA 2009

This week, Journal Watch Cardiology, Journal Watch Psychiatry, and Physician's First Watch have been bringing you breaking news from the American Heart Association meeting in Orlando. Please have a look (most of the studies were presented at the meeting and published in peer-reviewed journals at the same time):

Journal Watch Cardiology summary of ARBITER 6 trial showing niacin superior to ezetimibe (Free)

Physician's First Watch ARBITER coverage (Free)

Journal Watch Cardiology summary of cangrelor study — a setback for the antiplatelet agent (Free)

Journal Watch Cardiology summary of study on right-ventricular pacing (Your Journal Watch subscription required)

Physician's First Watch coverage of study on ECG findings and cardiac death (Free)

Journal Watch Cardiology summary of study on high-dose losartan in heart failure (Your Journal Watch subscription required)

Physician's First Watch coverage of losartan study (Free)

Journal Watch Cardiology summary of study on iron for heart failure patients (Your Journal Watch subscription required)

Journal Watch Cardiology summary of study on continuous LV assistance for heart failure (Your Journal Watch subscription required)

Journal Watch Psychiatry summary of study on treating depression after CABG (Your Journal Watch subscription required)

Journal Watch Cardiology summary of study on hospital report cards and patient outcomes (Your Journal Watch subscription required)

Physician's First Watch coverage of STEMI and PCI guidelines (Free)

Published in Physician's First Watch November 19, 2009

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