Physician's First Watch: Archives

Featured in Journal Watch: The 'Oregon Experiment' at 2 Years

By The Journal Watch Editors

A lottery for Medicaid enrollment simulated a randomized trial in the New England Journal of Medicine.

LINK(S):

Journal Watch General Medicine summary (Free)

Published in Physician's First Watch May 13, 2013

Challenges in Making a Vaccine for H7N9 Influenza

By Kelly Young

U.S. researchers have pointed out some of the potential challenges in developing a vaccine if the H7N9 influenza reaches pandemic levels.

In a JAMA viewpoint, the researchers note that early studies indicate that an H7N9 vaccine would probably require more antigen than seasonal vaccines or would require an adjuvant. In a best-case scenario, it would take about 4 months from when vaccines were ordered to the start of distribution.

In addition, approval of an H7N9 vaccine would require a different regulatory process than the 2009 H1N1 vaccine because H7N9 is a novel human virus strain.

To date, about 130 people in China have been infected with H7N9 influenza. The WHO says there is currently no evidence of sustained transmission between humans.

LINK(S):

JAMA viewpoint (Free)

WHO update (Free)

Background: Journal Watch Infectious Diseases summary of H7N9 influenza study (Free)

Published in Physician's First Watch May 13, 2013

Continued Warfarin Better Approach to Cardiac Device Surgery

By Amy Orciari Herman

Higher-risk patients undergoing cardiac device surgery are better off continuing warfarin than switching to heparin as guidelines recommend, according to a New England Journal of Medicine study.

The study included nearly 700 patients at moderate-to-high risk for thromboembolic events who were taking warfarin and required nonemergency pacemaker or implantable cardioverter-defibrillator surgery. Patients were randomized to either continue warfarin (target INR: 3.0 or less; 3.5 or less for patients with mechanical valves) or receive bridging therapy with heparin as recommended by the American College of Chest Physicians.

The study was stopped early after an interim analysis found that the primary outcome — device-pocket hematoma — had occurred four times as often with heparin as with warfarin (16% vs. 3.5%). Continued warfarin didn't increase major perioperative bleeding.

One explanation for the "counterintuitive" finding, the authors write, "is the concept of an 'anticoagulant stress test.' That is, if patients undergo surgery while receiving full-dose anticoagulation therapy, any excessive bleeding will be detectable and appropriately managed while the wound is still open. In contrast, if bridging therapy with heparin is used, such bleeding may be apparent only when full-dose anticoagulation therapy is resumed postoperatively."

LINK(S):

NEJM article (Free)

Background: Journal Watch General Medicine coverage of ACCP guidelines (Free)

Published in Physician's First Watch May 10, 2013

Pets — Especially Dogs — Are Good for the Heart

By Kelly Young

The American Heart Association (AHA) recommends pet ownership as a reasonable option for reducing cardiovascular risk. Dog ownership in particular seems to improve cardiovascular fitness, possibly because of the need to regularly walk a dog.

In a scientific statement published in Circulation, the AHA notes that people should not get a pet solely to improve their cardiovascular health.

LINK(S):

Circulation article (Free PDF)

Published in Physician's First Watch May 10, 2013

Memory Loss, Confusion Noted by Many Older Adults

By Cara Adler

One in eight noninstitutionalized adults aged 60 and older reported an increase in memory problems during the preceding year, according to a CDC analysis of 2011 data from the Behavioral Risk Factor Surveillance System survey published in MMWR.

Of 60,000 respondents, 13% reported having confusion or memory loss that had gotten worse or more frequent during the past year; of those with memory problems, 35% reported interference with work, social, volunteer, or household activities. People with these functional difficulties were more likely to report needing or getting help from family or friends. Only about one in three people with memory problems reported discussing them with a healthcare provider.

MMWR's editors say these findings provide baseline estimates of the scope of the problem and "underscore the need to facilitate timely discussions with healthcare and service providers so that linkages can be made to accurate information and needed services."

LINK(S):

MMWR article (Free)

Published in Physician's First Watch May 10, 2013

Featured in Journal Watch: HIV Opportunistic Infection Guidelines Updated

By The Editors

In his blog HIV and ID Observations, Paul Sax highlights some of the notable changes in the updated guidelines by the CDC, NIH, and the Infectious Diseases Society of America for preventing and treating opportunistic infections in patients with HIV.

LINK(S):

HIV and ID Observations blog (Free)

Published in Physician's First Watch May 10, 2013

Your New Gym: A Kitchen Chair

By Joe Elia

High-intensity interval training (periods of intense exercise near one's peak capacity followed by brief recovery periods) could allow shortening of exercise regimens, according to a Health and Fitness Journal study.

The New York Times' Well blog calls it "the scientific 7-minute workout," and the only equipment that one apparently needs is a simple chair and a wall to lean (not slouch) against. Twelve exercises are performed in strict order using 15 repetitions each, allowing opposing muscle groups to alternate between work and rest.

Caution: the authors say the regimen is not for the overweight, detrained, injured, or elderly.

LINK(S):

Health and Fitness Journal article (Free)

New York Times blog (Free)

Published in Physician's First Watch May 10, 2013

Lessons Learned from the Medical Response to the Marathon Bombings

By Joe Elia

Clinical Conversations podcast spent 10 minutes with Ron Walls, head of the Department of Emergency Medicine at Boston's Brigham and Women's Hospital. It's the first in a series of conversations planned to extract lessons from last month's bombings at the Boston Marathon.

LINK(S):

Clinical Conversations podcast (Free)

Published in Physician's First Watch May 10, 2013

Genetic Test May Guide Treatment for Prostate Cancer

By Kelly Young

A genetic test that hit the market on Wednesday may be able to better predict which prostate cancers will turn out to be aggressive and which will be slow to grow, the New York Times reports.

The Oncotype DX Prostate Cancer Test, which analyzes 17 genes, will cost about $3800. It is among a dozen forthcoming tests that use advanced genetic techniques to manage prostate cancer.

In a study presented at the American Urological Association meeting on Wednesday, researchers examined archived prostate biopsy samples from some 400 patients who had been considered low or intermediate risk based on Gleason scores and then underwent prostatectomy. The Oncotype DX test considered 26% of the samples to be very low risk, while existing methods only considered 5% to 10% of the samples to be very low risk. Conversely, the new test was also more accurate in predicting which tumors would turn out to be aggressive.

The Times quotes the senior study investigator: "Certainly for a group of men it will have an impact. ... The question is how many men and how many physicians."

LINK(S):

New York Times story (Free)

Associated Press story (Free)

Published in Physician's First Watch May 9, 2013

Featured in Journal Watch: Omega-3 Fatty Acid Supplementation in Patients with Risk Factors

By The Journal Watch Editors

Omega-3 supplementation failed to improve any cardiovascular outcome in a randomized trial published in the New England Journal of Medicine.

LINK(S):

Journal Watch General Medicine summary (Free)

Published in Physician's First Watch May 9, 2013