Physician's First Watch: Archives

FDA Testing Confirms Contamination in Steroids from Tennessee Compounder

By Joe Elia

The FDA has found bacteria and fungi in unopened vials from two lots of injectable steroids prepared by Main Street Family Pharmacy, a compounder in Tennessee that supplies clients in almost half the states.

The agency says it has received no reports of meningitis associated with the product, preservative-free methylprednisolone acetate. Skin and soft tissue abscesses have occurred.

Clinicians should report any adverse events to the FDA's MedWatch program.

LINK(S):

FDA MedWatch safety alert (Free)

Background: Physician's First Watch coverage of initial FDA warning on compounder's products (Free)

Published in Physician's First Watch June 10, 2013

CDC Issues Update on Novel SARS-like Coronavirus

By Amy Orciari Herman

Reports of new cases of the novel SARS-like coronavirus, now known as MERS-CoV, indicate continued risk for transmission in the Arabian Peninsula, according to an update from MMWR.

To date, MERS-CoV has been confirmed in 55 people, 31 of whom have died. All cases have been linked to Saudi Arabia, Qatar, Jordan, or the United Arab Emirates. Infections among close contacts of cases, including healthcare personnel and family members, "provide clear evidence of human-to-human transmission," MMWR says.

The CDC recommends that MERS-CoV be considered in people who develop severe acute lower respiratory illness within 14 days of traveling from the Arabian Peninsula or nearby areas. The virus should also be considered for close contacts of symptomatic travelers. To improve detection, specimens should be taken from multiple locations (for example, the nasopharynx and lower respiratory tract); the CDC is performing testing.

LINK(S):

MMWR article (Free)

CDC guidance on MERS-CoV (Free)

Background: HIV and ID Observations blog on MERS-CoV (Free)

Published in Physician's First Watch June 10, 2013

ID Learning Unit: Aminoglycosides

By the Journal Watch Editors

"You young whippersnappers out there may not believe it, but we once used aminoglycosides all the time — literally every day on inpatient medical and surgical services, especially in the ICUs," writes Paul Sax in his HIV and ID Observations blog.

Although aminoglycoside prescribing has rapidly dropped off over the years, the drugs still have their place. Sax offers a brief refresher for those clinicians who might be unfamiliar with the role of aminoglycosides today.

LINK(S):

HIV and ID Observations blog (Free)

Published in Physician's First Watch June 10, 2013

Depression Care Management Extends Survival in Older Primary Care Patients

By Amy Orciari Herman

Involving a depression care manager in primary care practices can improve survival among older adults, according to a BMJ study.

Twenty U.S. primary care practices were randomized to an intervention or usual care. In the intervention group, depression care managers worked with physicians to provide algorithm-based care that included psychotherapy, antidepressant dose management, and monitoring of symptoms and adverse drug effects. The study included roughly 1200 adults aged 60 and older, about half of whom had major or minor depression at baseline.

During a median 8 years' follow-up, one third of the patients died. In the usual-care group, patients with major depression had almost twice the mortality risk as patients without depression. In the intervention group, however, patients with major depression showed no increased risk. In addition, patients with major depression in the intervention group had a 24% lower mortality risk than those in the usual-care group.

LINK(S):

BMJ article (Free)

Background: Journal Watch General Medicine summary of study's early results (Your Journal Watch registration required)

Published in Physician's First Watch June 7, 2013

FDA Advisers Vote to Modify Restrictions on Avandia

By Amy Orciari Herman

An FDA advisory panel voted on Thursday to modify restrictions on the much-embattled diabetes drug rosiglitazone (Avandia), Reuters reports.

There were 13 votes in favor of changing the restrictions, seven votes to remove the restrictions entirely, and five to leave the restrictions as they are. One adviser voted to withdraw the drug from the market altogether. The extent of the proposed modifications is unknown at present.

Rosiglitazone's use is currently limited to patients who are already taking the drug and to those whose diabetes is not controlled by other treatments and who do not want to take pioglitazone.

LINK(S):

Reuters story (Free)

Background: Physician's First Watch coverage of FDA's Risk Evaluation and Mitigation Strategy for rosiglitazone (Free)

Published in Physician's First Watch June 7, 2013

Small Changes Make a Big Difference in Stroke Risk

By Joe Elia

An overall measure of cardiovascular health serves as a good predictor of stroke risk, and small behavioral changes can have significant effects, a study in Stroke finds.

The measure, Life's Simple 7 (or LS7), includes blood pressure, cholesterol, glucose, body-mass index, smoking, physical activity, and diet. Each factor is assigned a rating of up to 2 points (0, 1, or 2 for poor, average, or ideal score, respectively), for a maximum score of 14.

Researchers collected LS7 data on some 23,000 black and white Americans averaging 65 years of age without cardiovascular disease. Subjects were followed for 5 years.

Compared with adults with inadequate LS7 scores (0–4), those with average (5–9) or optimal (10–14) scores showed a 25% to 50% lower risk for stroke. A 1-point increase in LS7 score conferred an 8% lower risk.

LINK(S):

Stroke article (Free abstract)

Published in Physician's First Watch June 7, 2013

Preparing for Extreme Heat Might Reduce Deaths

By Cara Adler

Planning for periods of extreme heat and targeting interventions to vulnerable populations seems to reduce heat-related deaths, according to an MMWR article.

The report describes 32 heat-related deaths in Maryland, Ohio, West Virginia, and Virginia during a 2-week period in the summer of 2012, when temperatures topped 100 degrees and a storm knocked out power. Decedents' median age was 65; most were men living alone, and most died at home, without air conditioning.

The death rate was much lower than during comparable periods in the previous 20 years. The authors report that the development of heat response plans in the four states, along with targeting interventions to vulnerable populations, may have contributed to the lower rate. Interventions included home visits to elderly and socially isolated people, restoration of power to vulnerable populations first, and public health messages about heat exposure risks.

LINK(S):

MMWR article (Free)

Published in Physician's First Watch June 7, 2013

ACC/AHA Update Their Guidelines on Heart Failure

By the Editors

The American College of Cardiology and the American Heart Association have announced the release of an expanded clinical practice guideline for managing heart failure.

The guideline, available from the Journal of the American College of Cardiology, covers both inpatient and outpatient care through all stages of the illness. The guideline emphasizes quality improvement and adherence to performance measures. It was developed in collaboration with the American Academy of Family Physicians and other organizations.

LINK(S):

Journal of the American College of Cardiology guideline (Free PDF)

Published in Physician's First Watch June 6, 2013

Knee Arthritis Guidelines Issued

By Joe Elia

The American Academy of Orthopaedic Surgeons has released revised guidelines for treating osteoarthritis of the knee. The document is large, running over 1200 pages, but it's accompanied by a 13-page summary of recommendations.

The AAOS recommends that patients engage in self-management programs including low-impact aerobic exercise. The group says it can't recommend use of acupuncture or chondroitin and glucosamine. Nor can it recommend the use of hyaluronic acid or arthroscopy with lavage and/or debridement in patients whose primary diagnosis is symptomatic osteoarthritis.

Evidence on the usefulness of electrotherapy and manual therapies was found to be inconclusive.

LINK(S):

American Academy of Orthopaedic Surgeons guidelines, full document (Free PDF)

American Academy of Orthopaedic Surgeons guidelines, recommendations summary (Free PDF)

Published in Physician's First Watch June 6, 2013

Atrial Fibrillation Linked to Cognitive Decline

By Amy Orciari Herman

Cognitive decline appears to speed up after diagnosis of atrial fibrillation (AF), according to a prospective study in Neurology.

Over 5000 U.S. adults, aged 65 and older and without stroke or AF at baseline, were followed for about 7 years. During that time, 11% developed AF. After multivariable adjustment, mean scores on two cognitive tests declined faster after participants were diagnosed with AF, relative to those without AF.

The researchers say their finding "suggests that people with atrial fibrillation are likely to reach thresholds of cognitive impairment or dementia at earlier ages." They point out that the association between AF and cognitive decline was attenuated after excluding participants with heart failure; therefore, "low cardiac output due to concomitant heart failure" might partly explain the association.

LINK(S):

Neurology article (Free abstract)

Published in Physician's First Watch June 6, 2013