Among Doctors Blog - The Exclusive Physicians Network

Picks of the Week: Endometriosis, menopausal symptoms and more!

Posted on July 8, 2016 by Harris

More and more medical news are shared by fellow colleagues on the Among Doctors network on a daily basis. Here’s a selection of those the latest ones:

Diagnostic accuracy of cancer antigen 125 for endometriosis: a systematic review and meta-analysis
CA 125 performs well as a rule-in test facilitating expedited diagnosis and ensuring investigation and treatment can be confidently tailored for the management of endometriosis -however, a negative test is unable to rule out endometriosis.
Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis
This meta-analysis of clinical trials suggests that composite and specific phytoestrogen supplementations were associated with modest reductions in the frequency of hot flashes and vaginal dryness but no significant reduction in night sweats.
Patient Navigation for Comprehensive Cancer Screening in High-Risk Patients Using a Population-Based Health Information Technology System
Patient navigation as part of a population-based IT system significantly increased screening rates for breast, cervical, and colorectal cancer in patients at high risk for nonadherence with testing. Integrating patient navigation into population health management activities for low-income and racial/ethnic minority patients might improve equity of cancer care.
Multimodal Randomized Functional MR Imaging of the Effects of Methylene Blue in the Human Brain
Using functional MRI, it was found that a single oral dose of methylene blue increased brain activity in the bilateral insular cortex, as well as the prefrontal cortex and parietal and occipital lobes, compared with placebo.
Hepatitis C Core Antigen Testing for Diagnosis of Hepatitis C Virus Infection
The HCVcAg assays with signal amplification have high sensitivity, high specificity, and good correlation with HCV RNA levels greater than 3000 IU/mL and have the potential to replace NAT in settings with high HCV prevalence.
Effect of Escitalopram on All-Cause Mortality and Hospitalization in Patients With Heart Failure and Depression
Chronic systolic heart failure patients treated for 18 months with escitalopram, an SSRI, did not demonstrate significantly reduced all-cause mortality.
Comparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults
There is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches.

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Posted in Picks of the week endometriosis, escitalopram, heart failure, hepatitis C, menopause

Picks of the Week: The USPSTF advises on colorectal cancer and syphilis screening

Posted on June 28, 2016 by Harris

During the past weeks two important recommendations were published from the US Preventive Services Task Forse (USPSTF) on the screening for colorectal cancer and syphilis. Let’s have a look at them, alongside other news that our members shared in the Among Doctors community:

The US Preventive Services Task Force (USPSTF) published its recommendations on screening for colorectal cancer
The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation).
Screening for Syphilis: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
Screening HIV-positive men or MSM for syphilis every 3 months is associated with improved syphilis detection. Treponemal or nontreponemal tests are accurate screening tests but require confirmation.
Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial
Maternal exercise may be a preventative tool for hypertension and excessive GWG, and may control offspring size at birth while reducing comorbidities related to chronic disease risk.
Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage
The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg.
Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries
Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.
Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children
Current evidence does not support increasing the dose of ICS as part of a self initiated action plan to treat exacerbations in adults and children with mild to moderate asthma. Increased ICS dose is not associated with a statistically significant reduction in the odds of requiring rescue oral corticosteroids for the exacerbation, or of having adverse events, compared with a stable ICS dose.

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Posted in Picks of the week acute cerebral hemorrhage, asthma, blood pressure, chronic asthma, colorectal cancer, inhaled corticosteroids, pregnancy, screening, syphilis

Screen for colorectal cancer, urges USPSTF

Posted on June 19, 2016 by Harris

The US Preventive Services Task Force (USPSTF) recently published its recommendations on screening for colorectal cancer on JAMA, concluding that screening is beneficial in average-risk, asymptomatic adults starting at age 50 and continuing until age 75 years (A recommendation). In adults aged 76 to 85 years, the decision should take into consideration the health and history of the patient (C recommendation).

Screening for colorectal cancer can reduce mortality, whichever strategy is employed, says the USPSTF. Seven different screening approaches are included in the recommendations, despite their difference in effectiveness and potential harm: colonoscopy, fecal immunochemical testing for occult blood (FIT), multitargeted DNA stool test (FIT-DNA), guaiac-based fecal occult blood test, sigmoidoscopy, sigmoidoscopy with FIT, and CT colonography. The economic impact of such a screening is not addressed either.

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Image credit: Blausen Medical Communications, Inc. – Donated via OTRS, see ticket for details, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=27639260

Posted in Clinical Highlights colonoscopy, colorectal cancer, USPSTF

Unrestricted-calorie, high-vegetable-fat Mediterranean diet associated with no weight gain

Posted on June 7, 2016 by Harris

In a study published yesterday in The Lancet Diabetes & Endocrinology, Ramon Ostrich and colleagues reported on the Spanish PREvención con DIeta MEDiterránea (PREDIMED) randomized controlled trial and on the long-term weight change. In their five-year intervention, nearly 7500 asymptomatic men and women with type 2 diabetes mellitus or more than two cardiovascular risk factors were randomly assigned to receive either one of the two unrestricted-calorie Mediterranean diets (one supplemented with extra-virgin olive oil and one supplemented with nuts) or the control diet which included advice to reduce dietary fat.

The authors reported that although the dietary fat consumption was higher for the participants of the Mediterranean diets, in the five-years follow-up not only was there no weight gain, but they even noticed some evidence of decrease in the weight and waist circumference. The results of the study support the hypothesis that restricting calorie intake of healthy fats does not contribute to bodyweight maintenance.

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Posted in Clinical Highlights calorie intake, diet, mediterranean diet, type 2 diabetes, waist circumference, weight maintenance

Picks of the Week: Chronic insomnia, NSAIDs, opioids for low back pain and more!

Posted on June 4, 2016 by Harris

Besides the 69th World Health Assembly in Geneva that saw the release of many reports and news, this was a week of a plethora of other articles and evidence published worldwide. Fellow physicians selected the most important ones and shared them on the Among Doctors network:

Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline
The American College of Physicians recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder. (Grade: strong recommendation, moderate-quality evidence)
Comparative effectiveness and safety of strategies for preventing NSAID-associated gastrointestinal toxicity: Systematic Review & Metanalysis
The combination of selective COX-2 inhibitors plus PPIs provides the best gastrointestinal protection, followed by selective COX-2 inhibitors, and thirdly by nonselective NSAIDs plus PPIs.
Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: Systematic Review & Meta-analysis
For people with chronic low back pain who tolerate the medicine, opioid analgesics provide modest short-term pain relief but the effect is not likely to be clinically important within guideline recommended doses.
A Systematic Review With Meta-Analysis of Dual Bronchodilation With LAMA/LABA for the Treatment of Stable COPD
Dual bronchodilation is better than a LAMA or a LABA alone, regardless of the drugs used.
Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease
Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease.
World No Tobacco Day 2016
For this year’s World No Tobacco Day, the WHO are calling on countries to get ready for plain (standardized) packaging of tobacco products.
WHO releases report on Attacks on Health Care
Over the two-year period from January 2014 to December 2015, there were 594 reported attacks on health care that resulted in 959 deaths and 1561 injuries in 19 countries with emergencies.
Prevention of sexual transmission of Zika virus
An updated guide to inform the general public, and to be used by health care workers and policy makers to provide guidance on appropriate sexual practices in the context of Zika virus.

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Posted in Picks of the week COPD, emergencies, insomnia, low back pain, opioid, WHO, World No Tobacco Day, Zika, Zika virus

World No Tobacco Day 2016

Posted on May 28, 2016 by Harris

The World #NoTobacco Day is an annual awareness day organized by the World Health Organization (WHO) on 31st May, aiming at highlighting the health risks of tobacco use and prompting governments to take actions against smoking. According to the WHO, while tobacco use kills nearly 6 million people each year, approximately 1 country in 3 has minimal or no restrictions at all on tobacco advertising, promotion and sponsorship.

Over the last three years, the WHO has focused on the advertising ban, increased taxation and tackling the smuggling of tobacco products, all of which are actions based on evidence from epidemiological studies. This year, the World No Tobacco Day promotes the implementation of the standardized plain packaging of tobacco products.

Plain packaging is a proven measure that tackles consumption by making tobacco products less attractive to consumers, curbing the use of promotional material on the package, limiting misleading design techniques suggesting that some products are less harmful than others, and increasing the effectiveness of health warnings. The package should bear only the name of the brand and product name in standardized characters and dark colors.

The measure was first adopted in Australia in 2012, where early evidence suggests that it has begun to achieve its public health objectives. Since then plain packaging laws have been passed in France, Ireland and the United Kingdom, while several other countries are evaluating the implementation of such a measure.

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Posted in Clinical Highlights public health, smoking, smoking cessation, tobacco, WHO, World No Tobacco Day

WHO establishes a Health Emergencies Programme, adds operational capabilities

Posted on May 26, 2016 by Harris

During the 69th World Health Assembly, the WHO announced the establishment of a new Health Emergencies Programme, which adds operational capabilities for outbreaks and humanitarian emergencies to complement the traditional technical and normative roles of the organisation. The programme aims at delivering support to contexts as they prepare for, face or recover from emergencies, whether disease outbreaks, natural or man-made disasters or conflicts.

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Image credit: WHO/L. Cipriani

Posted in Clinical Highlights emergencies, Global Health, outbreaks, WHA, WHO

A new report launched on NCDs and workplace wellness

Posted on May 25, 2016 by Harris

NCD Alliance and Bupa published a report on the potential of workplaces for the prevention and control of noncommunicable diseases (NCDs). The report, launched in Geneva, where the 69th World Health Assembly currently takes place, examines the evidence for the effectiveness of existing policy and regulatory measures, presents a set of recommendations, and calls upon governments, civil society and private sector to take shared responsibility for health and wellbeing through innovative partnerships, with a commitment to share expertise and knowledge, and mobilise resources.

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Posted in Clinical Highlights employer, NCDs, policy, workplace, World Health Assembly

Picks of the Week: Medical error as one of the leading causes of death

Posted on May 14, 2016 by Harris

Over the last days fellow colleagues shared many articles, evidence, opinion papers and other noteworthy news on the Among Doctors network. Let’s have a look at the top picks of these news:

Association between rotating night shift work and risk of coronary heart disease among women
Among women who worked as registered nurses, longer duration of rotating night shift work was associated with a statistically significant but small absolute increase in CHD risk.
Medical error is the third leading cause of death in the US
A recently published article in BMJ estimates that medical error is the third biggest cause of death in the US, after heart disease and cancer. The authors mention that medical errors leading to patient death may be under-recognised in many countries, such as the UK and Canada.
Systematic review of antibiotic treatment for acute calculous cholecystitis
Antibiotics are not indicated for the conservative management of acute calculous cholecystitis or in patients scheduled for cholecystectomy.
Addition of dipeptidyl peptidase-4 inhibitors to sulphonylureas and risk of hypoglycaemia
Addition of DPP-4 inhibitors to sulphonylurea to treat people with type 2 diabetes is associated with a 50% increased risk of hypoglycaemia and to one excess case of hypoglycaemia for every 17 patients in the first six months of treatment.
Effects of a mindfulness-based weight loss intervention in adults with obesity
Mindfulness enhancements to a diet-exercise program did not show substantial weight loss benefit but may promote long-term improvement in some aspects of metabolic health in obesity that requires further study.
Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis
There might be an improvement in symptom severity, polyps size and condition of the sinuses when assessed using CT scans in patients taking oral corticosteroids when these are used as an adjunct therapy to antibiotics or intranasal corticosteroids.
Is physician burnout a looming public danger?
With over 50% of doctors feeling burned out, physician burnout should not be considered as a mere professional problem, as its repercussions may affect patients.

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Posted in Picks of the week burnout, coronary heart disease, DDP-4, medical error, oral steroids, professionalism, sulphonylureas, weight loss

More evidence on inappropriate antibiotic prescriptions in outpatient settings

Posted on May 10, 2016 by Harris

An annual antibiotic prescription rate of 506 per 1,000 population was estimated in the United States in 2010-2011 in a study published on JAMA. According to the authors, only 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship. Sinusitis, suppurative otitis media and pharyngitis were the diagnosis associated with the most antibiotic prescriptions. Only approximately half of the acute respiratory conditions were estimated to be appropriate for these conditions.

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Image credit: Bmramon at English Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9825471

Posted in Clinical Highlights antibiotics, appropriateness, otitis media, pharyngitis, sinusitis

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