Physician's First Watch: Archives

AAP Offers Recommendations for Treating Homeless Children

By Kelly Young

The American Academy of Pediatrics offers guidance for pediatricians treating children and adolescents who are homeless or at risk for being homeless.

In Pediatrics, the AAP recommends that pediatricians facilitate Medicaid enrollment for families. Clinicians should also ask questions about sensitive topics, including intimate partner violence and substance abuse, to identify causes of homelessness in families. They should provide comprehensive care when possible, such as using an existing appointment to update immunizations in children who are behind schedule.

Pediatricians should also help connect families with appropriate community resources and partner with dental and mental healthcare providers to develop shelter-based care.

LINK(S):

Pediatrics article (Free PDF)

Published in Physician's First Watch May 28, 2013

British Menopause Society Issues Guidelines on Hormone Replacement Therapy

By Joe Elia

Declaring that "our key recommendation is that all women should be able to access advice on how they can optimize their menopause transition and beyond," the British Menopause Society and Women's Health Concern look at the pros and cons of hormone replacement therapy.

In Menopause International, the groups briefly examine the therapy's effects on specific areas, such as immediate effects on vasomotor symptoms and the long-term effects on osteoporosis. The document also includes references to supporting studies listed by area.

Editor's note: the document will be available free through the journal for a limited time, after which free access will be given through the society's website.

LINK(S):

Menopause International article (Free)

British Menopause Society website (Free)

Published in Physician's First Watch May 28, 2013

Featured in Journal Watch: Stopping HBV with ART

By The Journal Watch Editors

Antiretroviral regimens containing 3TC, tenofovir, or both, reduced the risk for incident hepatitis B virus infection by approximately 90% compared with other or no antiretrovirals, according to an article in Clinical Infectious Diseases.

LINK(S):

Journal Watch HIV/AIDS Clinical Care summary (Free)

Published in Physician's First Watch May 28, 2013

FDA Concerned Over Possible New Steroid Contamination

By Joe Elia

The FDA says clinicians should not use any "sterile" products compounded by Main Street Family Pharmacy of Newbern, Tenn., following reports of seven adverse events (all skin abscesses) associated with the pharmacy's steroid injections.

Clinicians should "quarantine them until further guidance is provided."

The pharmacy, acquired by a holding company in 2010, said at the time it sold supplies to medical facilities in 23 states. The New York Times reports that two of the seven cases occurred in North Carolina, and five in Illinois.

LINK(S):

FDA news release (Free)

Acquisition announcement from 2010 (Free)

New York Times story (Free)

Published in Physician's First Watch May 28, 2013

ACP Recommends Against Intensive Insulin Therapy for Hospitalized Patients

By Joe Elia

Hospitalized patients will probably experience more harm than benefit from intensive insulin therapy (IIT), according to an American College of Physicians committee on clinical guidelines.

Writing in the American Journal of Medical Quality, the panel finds "some evidence of a marginally significant reduction" in infection and sepsis with IIT. However, panelists point to IIT's increased risk for hypoglycemia, which was associated with increased mortality in some studies.

Their advice? In medical/surgical intensive care units, the glucose target with insulin therapy should be between 7.8 and 11.1 mmol/L (140 to 200 mg/dL); targets under 7.8 mmol/L (140 mg/dL) should be avoided "because harms are likely to increase" with lower targets.

LINK(S):

American Journal of Medical Quality article (Free)

Background: Journal Watch Hospital Medicine summary of meta-analysis on IIT (Your Journal Watch registration required)

Published in Physician's First Watch May 28, 2013

USPSTF Recommends Screening for Gestational Diabetes After 24 Weeks

By Joe Elia

The U.S. Preventive Services Task Force recommends screening for gestational diabetes in asymptomatic women after 24 weeks' gestation, according to its first draft recommendation on gestational diabetes screening since 2008. There is insufficient evidence, it says, to assess the balance of benefits and harms of screening before that point in pregnancy.

In an evaluation of available evidence on the matter (published in the Annals of Internal Medicine) the authors conclude that treatment "reduced preeclampsia, shoulder dystocia, and macrosomia (birthweight >4000 g)."

LINK(S):

Draft recommendation from USPSTF (Free)

Evidence review on treatment in Annals of Internal Medicine (Free)

Review of screening tests for gestational diabetes in Annals of Internal Medicine (Free)

Published in Physician's First Watch May 28, 2013

Diagnosis-Oriented Hemoglobin A1c Test Approved

By Joe Elia

The FDA has approved the Tina-quant HbA1cDx assay to diagnose diabetes. The agency says it "is the first HbA1c test that FDA has allowed to be marketed for this use."

An FDA official said: "Physicians can have confidence that this test is reasonably safe and effective when used for its intended purposes of monitoring and diagnosing diabetes."

The agency says there was less than 6% difference in results from the Tina-quant HbA1cDx assay versus the standard reference, based on 141 blood samples.

Whether the test is more accurate than other HbA1c assays wasn't discussed. Roche, the product's manufacturer, has not yet posted information about the assay on its website.

LINK(S):

FDA news release (Free)

Published in Physician's First Watch May 28, 2013

Lancet Series Looks at Transfusion Medicine

By The Editors

A three-part series in the Lancet examines the relatively new specialty of patient blood management — and its effects on blood utilization, alternatives to transfusions, and management of the blood supply.

LINK(S):

Lancet transfusion series home page (Free)

Published in Physician's First Watch May 24, 2013

Frequent Acid Reflux Associated with Throat Cancers

By Joe Elia

Gastric reflux is a risk factor for cancers of the pharynx and larynx, and the use of antacids seems to lower that risk, according to an observational study in Cancer Epidemiology, Biomarkers and Prevention.

In a multicenter collaboration, researchers matched some 630 cases of laryngopharyngeal squamous cell carcinomas with twice the number of controls without cancer. Analyses were adjusted for demographics, smoking history, and HPV16 seropositivity.

Among patients who were not heavy smokers or drinkers, a history of self-reported frequent heartburn was significantly associated with throat cancers relative to those without heartburn (odds ratio, 1.78). Use of antacids for heartburn was associated with a lower risk (OR, 0.59). However, there was no such inverse association seen with the use of proton-pump inhibitors or histamine H2 receptor antagonists — possibly due to confounding from increased disease severity leading to their use.

The authors speculate that acid reflux may cause cancers by, for example, inducing chronic inflammation or activating signaling pathways of cellular proliferation.

LINK(S):

Cancer Epidemiology, Biomarkers and Prevention article (Free abstract)

Background: Journal Watch Gastroenterology summary on GERD and laryngeal cancer (Your Journal Watch registration required)

Published in Physician's First Watch May 24, 2013

Featured in Journal Watch: Penicillin-Susceptible S. aureus Bacteremia — Treat with Penicillin, if Possible!

By The Journal Watch Editors

In patients with penicillin-susceptible Staphylococcus aureus bacteremia, risk for 30-day mortality was 2.5-fold higher with cefuroxime treatment than with penicillin treatment.

LINK(S):

Journal Watch Infectious Diseases summary (Free)

Published in Physician's First Watch May 24, 2013