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Physician's First Watch:
Medical News from Journal Watch

A free daily alert on current news that affects your practice — from medical journals, government agencies, scientific conferences, and major media reports.

May 25, 2012

Ultrasound-Guided Corticosteroid Injection Relieves Plantar Fasciitis Pain — in the Short-Term

Ultrasound-guided corticosteroid injection relieves plantar fasciitis pain at 4 weeks — but offers no significant benefit over placebo at 8 and 12 weeks, according to a randomized, double-blind study in BMJ.

Eighty-two adults with ultrasound-confirmed plantar fasciitis unrelated to systemic inflammatory disease received an ultrasound-guided injection of dexamethasone or saline. (To limit pain during heel injection, all patients first received a tibial nerve block with lidocaine.)

At 4 weeks, pain scores were 11 points lower (on a 100-point scale) with dexamethasone than with saline. At 8 and 12 weeks, pain scores still favored dexamethasone, but the between-group differences were no longer significant. Dexamethasone significantly reduced plantar fascia thickness more than saline at all time points.

The authors calculated that roughly three patients would need to be treated for one successful pain outcome at 4 weeks. They call their findings "important for clinical practice," while advising providers to note that pain relief was not significant beyond the short term.

LINK(S):

BMJ article (Free)

Published in Physician's First Watch May 25, 2012

Specialized Treatment May Help Ease Tinnitus Impairment

Cognitive-behavioral therapy with tinnitus retraining counseling is associated with improvement in tinnitus symptoms and better quality of life, according to a Lancet study.

Some 500 adults with subjective tinnitus underwent up to 8 months of stepped care. They were randomized to either usual care (step 1, standard audiological intervention; step 2, counseling with social worker) or specialized care (step 1, cognitive-behavioral therapy with tinnitus retraining counseling; step 2, 12 weeks' group or individual therapy). If tinnitus was deemed severe after step 1, patients moved on to step 2.

At 12 months' follow-up, specialized treatment was superior to usual care for all of the primary outcomes — health-related quality of life, tinnitus severity, and tinnitus impairment.

A commentator concludes that this study "should not only set standards for tinnitus treatment ... but should also be the first of many steps towards more effective and evidence-based treatments for this disorder."

LINK(S):

Lancet article (Free abstract)

Lancet comment (Subscription required)

Published in Physician's First Watch May 25, 2012

May 24, 2012

Aspirin Associated with Lower VTE Recurrence

Aspirin lowers the risk for recurrence after unprovoked venous thromboembolism (VTE), according to a New England Journal of Medicine study.

Some 400 patients who'd suffered an unprovoked VTE and then underwent 6 to 18 months of oral anticoagulant therapy with vitamin K antagonists were randomized to either daily aspirin (100 mg) or placebo. After 24 months of treatment, VTE recurred in the aspirin group at a rate of 7% per year, versus 11% per year in the placebo group. In post hoc analyses, treatment was more effective among those who'd had a pulmonary embolism, as opposed to deep vein thrombosis. Rates of adverse events were similar between groups.

An editorialist calls the effect "perhaps greater than one might have anticipated," but cautions that "confirmatory studies will be required to establish a role in daily clinical practice" for patients at high risk for bleeding.

LINK(S):

NEJM article (Free abstract)

NEJM editorial (Subscription required)

Published in Physician's First Watch May 24, 2012

Long-Acting Contraceptives 20 Times More Effective Than the Pill, Patch, and Ring

Long-acting contraceptives are 20 times more effective than shorter-acting methods, according to a New England Journal of Medicine study.

Nearly 7500 U.S. women at risk for unintended pregnancy were counseled about various reversible contraceptive methods, with a special emphasis on the lower failure rates with the two long-acting reversible methods: intrauterine devices and subdermal implants. The women were then allowed to choose any contraceptive method to use at no cost for up to 3 years.

Overall, there were 334 unintended pregnancies. In age-adjusted analyses, pregnancy risk was significantly higher among women using birth control pills, the patch, or the ring than among those using IUDs or implants (hazard ratio, 21.8). Participants under age 21 who used short-acting contraceptives had nearly twice the pregnancy risk as older participants using the same methods, while risk did not differ between age groups for long-acting contraceptives.

Dr. Eleanor Bimla Schwarz of Journal Watch Women's Health commented: "These findings highlight the need to ensure that young women are informed about and have access to IUDs and contraceptive implants."

LINK(S):

NEJM article (Free abstract)

Published in Physician's First Watch May 24, 2012

Calcium Supplements Might Increase MI Risk

Use of calcium supplements is associated with a near doubling of risk for myocardial infarction, but calcium intake through diet does not confer increased risk, according to a study in Heart.

German researchers analyzed data from nearly 24,000 residents aged 35 to 64 who completed questionnaires about diet and supplement use. After 11 years' follow-up, some 350 people had experienced an MI. People who were in the third quartile of dietary calcium consumption had a lower MI risk, relative to those in the lowest quartile (hazard ratio, 0.69). However, those who took calcium supplements had increased MI risk, compared with nonusers (HR, 1.86).

The authors conclude that calcium supplementation "should be taken with caution." Editorialists note: "The evidence is ... becoming steadily stronger that it is not safe, nor is it particularly effective. ... We should return to seeing calcium as an important component of a balanced diet and not as a low-cost panacea to the universal problem of postmenopausal bone loss."

LINK(S):

Heart article (Free)

Heart editorial (Free abstract)

Previous Journal Watch General Medicine summary on calcium and CV risk (Your Journal Watch registration required)

Published in Physician's First Watch May 24, 2012

Clinicians Should Check Carpuject Prefilled Cartridges for Overfill

The FDA is advising clinicians to visually inspect certain prefilled syringe cartridges (manufactured by Hospira and marketed as Carpuject) before administering them to patients because they might contain up to twice as much medication as expected.

The warning, issued by the agency Wednesday, affects some 280 lots of 15 drugs — including diazepam, fentanyl, and heparin — that were manufactured between June 2010 and February 2012. A link to the full product list appears below.

No adverse events have been reported so far. Hospira recently recalled cartridges of morphine sulfate and hydromorphone due to overfill.