Friday, March 12, 2010
Medical News: AAPM: Online Program Helps Manage Pain - in Meeting Coverage, AAPM from MedPage Today
Medical News: AAPM: Online Program Helps Manage Pain - in Meeting Coverage, AAPM from MedPage Today
This might help a lot of people......
Friday, November 20, 2009
Vitamin D - Importance in Humans
From Medscape Medical News
High-Dose Vitamin D Supplement May Reduce Risk of Falling Among Older People
Laurie Barclay, MD
October 1, 2009 — High-dose vitamin D supplementation may reduce the risk of falling among older people, according to the results of a meta-analysis reported in the October 2 Online First issue of the BMJ.
"In several trials of older individuals at risk for vitamin D deficiency, vitamin D supplementation improved strength, function, and balance in a dose-related pattern," write H.A. Bischoff-Ferrari, MD, MPH, from the University of Zurich in Zurich, Switzerland, and colleagues. "Most importantly, these benefits translated into a reduction in falls. Overall, however, results have been mixed for fall prevention with vitamin D; for example, several trials of vitamin D have had non-significant results."
The goal of this meta-analysis was to evaluate the efficacy of supplemental and active forms of vitamin D with or without calcium in preventing falls among older individuals. The reviewers searched for relevant articles in Medline, the Cochrane central register of controlled trials, BIOSIS, and Embase up to August 2008, and they found additional studies from bibliographies and abstracts and by consulting clinical experts. When indicated, the reviewers contacted study authors for additional data.
Inclusion criteria were double-blind, randomized controlled trials enrolling groups of individuals of mean age 65 years or older, with sufficiently specified fall assessment. Participants in included trials were given a defined oral dose of supplemental vitamin D (vitamin D3 [cholecalciferol] or vitamin D2 [ergocalciferol]) or an active form of vitamin D (1α-hydroxyvitamin D3 [1α-hydroxycalciferol] or 1,25-dihydroxyvitamin D3 [1,25-dihydroxycholecalciferol]).
There were 8 randomized controlled trials of supplemental vitamin D that met inclusion criteria, enrolling a total of 2426 participants. The investigators observed heterogeneity among trials for dose of vitamin D (700 - 1000 IU/day vs 200 - 600 IU/day; P = .02) and for achieved 25-hydroxyvitamin D3 concentration (25 [OH)D concentration: < 60 nmol/L vs ≥ 60 nmol/L; P = .005).
In 7 trials enrolling a total of 1921 subjects, use of high-dose supplemental vitamin D was associated with a 19% reduction in fall risk (pooled relative risk (RR), 0.81; 95% confidence interval [CI], 0.71 - 0.92). Achieved serum 25 (OH)D concentrations of at least 60 nmol/L were associated with a 23% reduction in fall risk (pooled RR, 0.77; 95% CI, 0.65 - 0.90).
In contrast, 2 trials enrolling a total of 505 subjects showed that use of low-dose supplemental vitamin D was not associated with a notable reduction in fall risk (pooled RR, 1.10; 95% CI, 0.89 - 1.35). Also, achieved serum 25 [OH)D concentrations of less than 60 nmol/L appeared to affect fall risk significantly (pooled RR, 1.35; 95% CI, 0.98 - 1.84). In 2 randomized controlled trials (n = 624) meeting inclusion criteria, active forms of vitamin D were associated with a 22% reduction in fall risk (pooled RR, 0.78; 95% CI, 0.64 - 0.94).
"Supplemental vitamin D in a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19% and to a similar degree as active forms of vitamin D," the study authors write. "Doses of supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals."
Limitations of this study include potential publication bias and larger-than-expected variation between trials. "Doses of 700 IU to 1000 IU supplemental vitamin D a day could reduce falls by 19% or by up to 26% with vitamin D3," the study authors conclude. "This benefit may not depend on additional calcium supplementation, was significant within 2-5 months of treatment, and extended beyond 12 months of treatment....Active forms of vitamin D do not appear to be more effective than 700-1000 IU of supplemental vitamin D for fall prevention in older persons."
A Swiss National Foundations Professorship grant, the Velux Foundation, the Baugarten Foundation, the Vontobel Foundation, and a fellowship from the Robert Bosch Foundation supported this study. One of the review authors was funded by the National Institute on Aging. The other review authors have disclosed no relevant financial relationships.
BMJ. Published online October 2, 2009.
Authors and Disclosures
Journalist
Laurie Barclay, MD
freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Medscape Medical News © 2009 Medscape, LLC
Thursday, August 30, 2007
Hypertension in 90% of Americans
Lancet focuses on blood pressure: Hypertension "uncontrolled and conquering the world"
August 22, 2007 Michael O'Riordan
New York, NY - With an estimated 1.5 billion people expected to be hypertensive by 2025, an argument making the case that hypertension is "uncontrolled and conquering the world" is not hyperbole. This staggering number, as well as the fact that the risk of becoming hypertensive is greater than 90% for individuals in developed countries, highlights the growing problem of uncontrolled hypertension, both in developed as well as undeveloped countries, according to an editorial appearing in the August 18, 2007 issue of the Lancet [1].
"Many people still believe that hypertension is a disease that can be cured, and stop or reduce medication when blood-pressure levels fall," the Lancet editorialists write. "Physicians need to convey the message that hypertension is the first and easily measurable irreversible sign that many organs in the body are under attack. Perhaps this message will also make people think more carefully about the consequences of an unhealthy lifestyle and help to give preventive measures a real chance of success."
Hypertension, according to the Lancet, remains a problematic disorder, despite functioning healthcare systems, a large number of available effective treatments, and overwhelming evidence in various patient populations. Screening for hypertension, they point out, is not done systematically, and diagnosis is often made at a late stage when target-organ damage has already started. In addition, the optimum time to start treatment remains "under discussion."
Both the editorial and seminar authors point out that compliance remains one of the biggest barriers to treating hypertension, despite very effective and cost-effective treatments. Even a Rhodes scholar, such as former President Bill Clinton, was under the false impression that medication can be stopped once blood pressure is lowered. While lifestyle interventions—low-salt diet, weight loss, exercise, and alcohol restriction—remain the preferred means of lowering blood-pressure levels, adherence to these changes is "notoriously poor," and antihypertensive medications might need to be considered in even some normotensive individuals, argue Messerli, Williams, and Ritz.
The authors note that patients respond differently to the drug classes and that the most "important question to ask when selecting initial drug treatment is which class of drug will deliver the most effective blood-pressure lowering." For patients with blood pressure 20 mm Hg or more above goal, the guidelines recommend two-drug combinations, as monotherapy is likely to be insufficient. High-risk hypertensive patients not only should receive combination therapy for optimum blood-pressure control but also should receive a statin and low-dose aspirin, add Messerli and colleagues.
Monday, July 16, 2007
New Test for Spreading Breast Cancer
FDA Approves First Molecular-Based Lab Test to Detect Metastatic Breast Cancer
The U.S. Food and Drug Administration today approved the first molecular-based laboratory test for detecting whether breast cancer has spread (metastasized) to nearby lymph nodes. The GeneSearch BLN Assay detects molecules that are abundant in breast tissue but scarce in a normal lymph node.
The presence or absence of breast cancer cells in underarm lymph nodes is a powerful predictor of whether the cancer has spread and is used to help decide appropriate therapy for a woman with metastatic breast cancer.
Lymph nodes are part of the system that helps protect the body against infection. The first lymph node that filters fluid from the breast is called the “sentinel node,” because that is where breast cancer cells are likely to spread first.
During a lumpectomy or mastectomy to remove a breast tumor, surgeons commonly remove the sentinel node for examination under a microscope. Sometimes the sentinel node is examined immediately and if tumor cells are found, additional lymph nodes are removed. A more extensive microscopic examination, requiring one to two days for results, is almost always performed. If tumor cells are only found with the later microscopic examination, the patient may require a second surgery to remove the remaining lymph nodes.
“The GeneSearch BLN Assay offers a new approach to sentinel node testing,” said Daniel Schultz, M.D., director of the FDA’s Center for Devices and Radiological Health. “Results of this rapid test are available while patients are on the operating table, providing a way for some women to avoid a second operation.”
In a clinical trial, the GeneSearch BLN Assay showed strong agreement with results from extensive microscopic examination of the lymph nodes of 416 patients. The test accurately predicted that breast cancer had spread nearly 88 percent of the time in women with metastasis. Patients without metastasis were identified accurately 94 percent of the time.
Most of the women were also studied to compare the BLN Assay with immediate microscopic examination during surgery. The test gave fewer false negative results, but slightly more false positive results. A false negative test result, when the cancer has actually spread, may delay the needed removal of additional lymph nodes. A false positive test, indicating metastasis when there is none, may result in a more extensive surgery and puts the women at risk of unnecessary lymphedema (swelling due to fluid build-up following lymph node removal) and other side effects.
The GeneSearch BLN Assay is manufactured by Veridex, a Johnson & Johnson Company, of Warren, N.J.
