Saturday, April 28, 2012

Bath Salts

something that may speak to the level of paranoia and agitation that can trigger. More ominously, over 30 fatalities nationwide have been linked to .

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It is too early to predict that we are at the front end of another drug epidemic and that will become the crack or crystal meth of this decade. Still, these chemicals seem too dangerous to be looked at as a passing fad, and now is the time to promote awareness, vigilance and research around them. Over 38 states have acted to control one or more of the synthetic chemicals involved, but much more work needs to be done before

Use of intravenous magnesium sulfate for the treatment of severe acute asthma in children in emergency department

Asthma is the most common disease in childhood and is a major cause of morbidity, as assessed by school absenteeism, emergency department visits and hospital admissions. In the United Kingdom, asthma affects 5.2 million people, 1.1 million of them children. In the UK, asthma is responsible for approximately 60,000 hospital admissions yearly.(2) Although most children in asthma crisis respond well to initial treatment with inhaled bronchodilators and oral corticosteroids, asthma may still cause death in a number of cases. In the United Kingdom, approximately 25 children die from asthma yearly, and poor quality emergency care may be responsible for up to one-third of these deaths.(3)

Stroke risk high when anti-clotting drugs stopped

April 25, 2012 Study Highlights:Patients with irregular heartbeats who take anti-clotting medications are at high risk of stroke or blood clot whenever the drugs are stopped.The risks are similar whether patients are taking warfarin or a newer anti-clotting drug rivaroxaban.EMBARGOED UNTIL Noon CT/1 pm ET, Wednesday, April 25DALLAS, April 25, 2012 — Some patients with irregular heartbeats who are taken off anti-clotting medication face a high risk of stroke or blood clotting within a month, according to new research presented at the American Heart Association’s Emerging Science Series webinar. Patients with certain types of atrial fibrillation, or irregular heartbeat, take these drugs to reduce the risks of clots that could lead to a stroke. Sometimes they are instructed to stop taking the medication temporarily before surgery or permanently because of side effects. “No matter what drug they are on, patients who need anticoagulation revert back to their intrinsic risk of stroke and embolism after discontinuation, so it shouldn’t be done lightly,” said Manesh Patel, M.D., lead author and assistant professor of medicine at the Duke University School of Medicine. “Unfortunately, it’s unclear how to provide optimal anti-coagulation coverage during periods of transition.” Researchers analyzed data from a clinical trial known as ROCKET AF, finding the risk is similar whether patients are taking the drug warfarin or the newer anticoagulant rivaroxaban. Rivaroxaban is taken once daily and doesn’t require the frequent monitoring of warfarin, which requires frequent dose-adjustment. In ROCKET AF, rivaroxaban was found to be as effective as warfarin in preventing stroke and blood clots in more than 14,000 patients with atrial fibrillation. Patients also had no greater risk of bleeding. However, concerns persisted about possible increased rates of stroke and blood clots after discontinuing rivaroxaban, which led to a warning in the prescribing information. Because of these concerns, the researchers analyzed strokes and blood clots that occurred following temporary interruptions, and between 3 and 30 days after early drug discontinuation or the transition to warfarin at the study’s end.   Strokes and blood clots occurred:At similar rates with both drugs after a temporary interruption – 6.20/100 patient-years for those on rivaroxaban vs. 5.05/100 patient-years for those taking warfarin;At similar rates in both drugs after permanently stopping the medicines – 25.60/100 patient-years for people taking rivaroxaban (vs. 23.38/100 patient-years for those on warfarin;More often in the transition from rivaroxaban to open label therapy (6.42/100 patient-years) vs. warfarin (1.73/100 patient-years). However, the risk seems to be high only for stroke. There was no difference between the drugs when investigators evaluated all blood clot-related events (including strokes, heart attack and vascular death) within 30 days of stopping medication.Co-authors are: Anne S. Hellkamp, M.S.; Yuliya Lokhnygina, Ph.D.; Jonathan P. Piccini, M.D.; Guohua Pan, Ph.D.; Daniel E. Singer, M.D.; Werner Hacke, M.D., Ph.D.; Günter Breithardt, M.D.: Jonathan L. Halperin, M.D.; Graeme J. Hankey, M.D.; Richard C. Becker, M.D.; Christopher C. Nessel, M.D.; Scott D. Berkowitz, M.D.; Robert M. Califf, M.D.; Keith A.A. Fox, M.B., Ch.B.; and Kenneth W. Mahaffey, M.D. Disclosures are on the abstract. The research is funded by the Duke Clinical Research Institute, Johnson & Johnson, and Bayer HealthCare AG. More information about atrial fibrillation is at heart.org/afib. For more about stroke visit strokeassociation.org. ### Statements and conclusions of study authors published in American Heart Association scientific journals or presented at American Heart Association conferences are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12 – 1062 (ESS/Patel) Additional resources, including multimedia, are available in the right column. For Media Inquiries: (214) 706-1173Maggie Francis: (214) 706-1382; maggie.francis

New tests monitor brain health during children’s heart surgery

April 25, 2012 Study Highlights:Two new monitoring methods may help detect brain damage in infants and children undergoing surgery to repair heart defects.One method, called autoregulation monitoring, can non-invasively determine periods during surgery, where blood flow to the brain may be low. A second test requires a small amount of blood to detect brain tissue injury during this kind of surgery.Both may guide future strategies to prevent brain damage.EMBARGOED UNTIL Noon CT/1 pm ET, Wednesday, April 25DALLAS, April 25, 2012 — A new monitoring method and blood test may provide early warnings when a child’s brain isn’t getting enough blood during heart surgery, according to new research presented during the American Heart Association’s Emerging Science Series webinar. Brain injury occurs in 30 percent to 70 percent of infants and children undergoing repair of congenital heart defects. A congenital heart defect is a heart abnormality present at birth. Out of 1,000 live births in the United States, about 8 babies will have some kind of heart defect. Previously, there has been no way to detect brain injury during surgery as it happens. This research was a multi-center observational pilot study to evaluate the feasibility of new monitoring strategies in a high-risk population of children with congenital heart disease. Unlike other organs, the brain can automatically adjust blood vessel size to keep blood flow constant when blood pressure changes. Researchers developed the “hemoglobin volume index,” a non-invasive monitoring technique to assess changes in the brain arteries. This monitoring technique allowed them to determine the lowest pressure before automatic adjustment was compromised. Researchers compared patient blood pressures with blood levels of glial fibrillary acidic protein (GFAP), an indicator of brain damage. In 61 children (aged one week to 17 years) undergoing heart repair surgery, researchers found that:A lower limit of pressure autoregulation or LLA could be identified in 85 percent of the children and varied widely between patients; meaning that 85 percent are at risk of brain hypoperfusion.Both the hemoglobin volume index and GFAP became abnormal when the childrens’ heart and lung function was taken over by cardiopulmonary bypass during surgery, with the worst readings during rewarming, indicating the period of highest risk for the child undergoing heart surgery;The more time spent below LLA was associated with some increase in GFAP, suggesting a link between periods of decreased blood flow autoregulation and decreased brain blood flow and  brain injury.“Because the autoregulatory changes occurred almost concurrently with signs of brain injury, we may have a real-time measure where we can detect when injury is occurring and modify how we are managing the patients, for example being more aggressive with controlling blood pressure,” said R. Blaine Easley, M.D., lead author and associate professor in anesthesiology and pediatrics at Baylor college of Medicine in Houston. The next step is a multi-center study that will correlate intra-operative test results with MRI changes and neurodevelopmental outcomes in the 18 months after surgery. Co-authors are Jacky Jennings, Ph.D., M.D.; Kathleen Kibler, B.S.; Kenneth M. Brady, M.D.; Brittany Serratos, B.S.; Dean B. Andropoulos, M.D.; Marissa Brunetti, M.D.; Eugenie Heitmiller, M.D.; Jennifer K. Lee, M.D.; Michael Smith, B.S.; Pratima Dulloor, B.S.; Bradley S. Marino, M.D., M.P.P.; James Spaeth, M.D.; and Allen D. Everett, M.D. Author disclosures are on the manuscript. The study is funded in part by an American Heart Association clinical research program grant from the Southwest affiliate. For more about congenital heart defects visit heart.org/congenitalheartdefects. ### Statements and conclusions of study authors published in American Heart Association scientific journals or presented at American Heart Association conferences are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12 – 1063 (ESS/Easley) Additional resources are available in the right column.  For Media Inquiries: (214) 706-1173Maggie Francis: (214) 706-1382; maggie.francis

Saturday, April 21, 2012

Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap

50% of hospitals had the ability to provide 24-hour emergency care. For storage of medication, only 18% to 41% of facilities had unexpired drugs and current inventories. Availability of supplies to control infection and safely dispose of hazardous waste was generally poor (less than 50%) across all facilities. As few as 14% of hospitals (and as high as 76%) among those surveyed had training and supervision in place.

Conclusions No surveyed hospital had enough infrastructure to follow minimum standards and practices that the World Health Organization has deemed essential for the provision of emergency and surgical care. The countries where these hospitals are located may be representative of other low-income countries in sub-Saharan Africa. Thus, the results suggest that increased attention to building up the infrastructure within struggling health systems is necessary for improvements in global access to medical care.

Key words Infrastructure developing countries access emergency care surgical care Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine

The impact of consultant delivered service in emergency medicine: the Wrexham Model

0.49) and had a faster turnaround time (p<0.001: Priority 2, 3 and 4) for every triage category. Some of the comparisons were clinically but not statistically significant.

Conclusion A consultant based service delivery offers many advantages. These cannot be matched by either junior or middle grades. This would be in addition to the consultants' supervisory role. Consultant expansion is urgently required to achieve this sustainably. A further study evaluating the cost benefits of this service model is now underway.

Consultant delivered service consultant workload senior based service delivery 4-h target performance, length of stay audit emergency care systems emergency care systems admission aviodance emergency care systems effieciency management risk management Footnotes Competing interests None.

Provenance and peer review Not commissioned; externally peer reviewed.

Treatment of vitamin D deficiency: divergence between clinical practice and expert advice

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Myocardial protection with mild hypothermia

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Eating low-fat dairy foods may reduce your risk of stroke

April 19, 2012 Study Highlights:Eating low-fat dairy foods was associated with a reduced risk of stroke in adult men and women compared to those who ate full-fat dairy foods.Low-fat dairy is one part of the Dietary Approaches to Stop Hypertension (DASH) Diet, which effectively reduces blood pressure, a major risk factor for stroke.Video story available in our Podcast/Vodcast Library. DALLAS, April 19, 2012 — If you eat low-fat dairy foods, you may be reducing your risk of stroke.In a Swedish study published in the American Heart Association’s journal Stroke, people who drank low-fat milk and ate low-fat yogurt and cheese had a lower risk of stroke compared to those who consumed full-fat dairy foods. Among 74,961 adults 45 to 83 years old, those who ate low-fat dairy foods had a 12 percent lower risk of stroke and a 13 percent lower risk of ischemic stroke than those who ate high-fat dairy foods. Participants were free of heart disease, stroke and cancer at the start of the study. All completed a 96-item food and beverage questionnaire to determine dietary habits. Food and drink consumption frequency was divided into eight categories, ranging from never to four servings per day. During the 10-year follow-up, 4,089 strokes occurred (1,680 in women and 2,409 in men): 3,159 ischemic, 583 hemorrhagic and 347 unspecified strokes. “This is the largest study to date to examine the association between consumption of total, low-fat, full-fat and specific dairy foods and the risk of stroke in adult men and women,” said Susanna Larsson, Ph.D., the study’s first author and associate professor of epidemiology in the Division of Nutritional Epidemiology, National Institute of Environmental Medicine, at the Karolinska Institute in Stockholm, Sweden.“From a public health perspective, if people consume more low-fat dairy foods rather than high-fat dairy foods, they will benefit from a reduced risk of stroke and other positive health outcomes.” The benefits of low-fat dairy foods are likely due to the vitamins and minerals they contain: calcium, potassium, magnesium and vitamin D.“It is possible that vitamin D in low-fat dairy foods may explain, in part, the observed lowered risk of stroke in this study because of its potential effect on blood pressure,” Larsson said. Low-fat dairy food is one part of the Dietary Approaches to Stop Hypertension (DASH) Diet, which reduces blood pressure. High blood pressure is a major risk factor for stroke. Northern Europeans and North Americans traditionally consume much more dairy foods than other global populations. So switching to low-fat dairy products could impact stroke risk for millions of people, Larsson said. More research on the link between low-fat dairy consumption and risk of stroke is needed, Larsson said. Co-authors are Jarmo Virtamo, M.D., and Alicja Woik, DMSc. Author disclosures are on the manuscript.The Swedish Council for Working Life and Social Research and the Swedish Research Council funded the study. The American Heart Association offers information on Diet and Lifestyle Recommendations and Milk Products. For information on stroke visit strokeassociation.org. Additional multimedia resources are available on the right column of this link:http://newsroom.heart.org/pr/aha/_prv-eating-low-fat-dairy-foods-may-232092.aspx ###Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12– 1058 (Stroke/Larsson) For media inquiries:  (214) 706-1173Karen Astle: (214) 706-1392; Karen.Astle

American Heart Association develops program to increase cardiac arrest survival

April 17, 2012 Highlights:.The American Heart Association’s Mission: Lifeline® Cardiac Resuscitation program aims to increase cardiac arrest survival by establishing systems of care to respond and treat cardiac arrest in communities throughout the United States.Deaths from cardiac arrest can decrease with efficient systems that quickly deliver appropriate treatment.DALLAS, April 17, 2012 — The American Heart Association has developed a program to help more people survive cardiac arrest. During a cardiac arrest, the heart stops beating, and unless it is restarted within minutes, the person usually dies. Mission: Lifeline® is expanding to include a Cardiac Resuscitation program to establish and streamline systems of care for response and treatment to improve survival rates. The program will provide public education and support for coordination among the lay public, public health agencies, legislators and city officials with emergency medical services (EMS) providers and hospitals to improve care for patients with cardiac arrest. Mission: Lifeline was originally launched in 2007 as a program to improve care for people suffering from ST-elevation myocardial infarction (STEMI)

Testosterone supplements may help heart failure patients

April 17, 2012 Study Highlights:Testosterone supplements helped stable heart failure patients with moderate to severe disease breathe better and exercise more, according to a review of four previous studies.None of the male patients developed signs of prostate disease and there was no increase in cardiovascular events.However, large clinical trials are needed before being able to translate these findings to clinical practice.EMBARGOED UNTIL 3 pm CT/4 pm ET, Tuesday, April 17DALLAS, April 17, 2012 – Testosterone supplements helped heart failure patients breathe better and exercise more, according to research in Circulation Heart Failure, an American Heart Association journal. Researchers analyzed four randomized clinical trials of patients with moderate to severe chronic heart failure. Patients were given commercial testosterone supplements by injection, patch or gel. Based on the analysis of these studies, those who received supplemental testosterone scored 50 percent better in a six-minute walking test than those receiving placebo. Also, in two of the studies, the severity of heart failure as measured by the New York Heart Association classification system improved one to two grades in 35 percent of treated patients compared to 9.8 percent of those who didn’t receive the supplements. Researchers noted gains in muscle and skeletal endurance that appeared quickly and lasted for a least one year. “The improvement in exercise capacity was consistent across all of the studies,” said Justin A. Ezekowitz, M.D., M.Sc., study author and assistant professor and director of the Heart Function Clinic at the University of Alberta in Edmonton, Canada. “Compared to patients in placebo groups, the differences were striking.” If the findings are confirmed in larger clinical trials, testosterone therapy could be one of the first heart failure therapies targeting the peripheral (skeletal) muscle rather than the cardiac muscle, he said. The studies included 198 patients, 84 percent men, averaging 67 years of age. One study exclusively in women who were taking lower doses of testosterone than men, found similar improvements. No significant adverse events were reported, including treatment- or exercise-related cardiovascular events, and there was no increase in prostate cancer or abnormal prostate health parameters in the men. While the results are encouraging, larger studies are needed as well as studies of the various testosterone delivery methods, Ezekowitz said. “We don’t want patients and their loved ones rushing to buy testosterone supplements online, or physicians to misinterpret the findings. First the results need to be corroborated in large clinical trials.” Co-authors are Jeffrey Bakal, Ph.D.; Paul Armstrong, M.D.; Mustafa Toma, M.D.; Erin Coglianese, M.D.; Venketesan Vidi, M.D.; and Samip Vasaiwala, M.D. Author disclosures are on the manuscript. The study was partly funded by New Investigator Awards from the Canadian Institutes of Health Research and Alberta Innovates – Health Solutions. Learn about managing heart failure at www.heart.org/heartfailure. ### Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12 – 1060 (Circ Heart Failure/Ezekowitz) Additional resources are available in the right column. For Media Inquiries: (214) 706-1173For other information, contact:Bridgette McNeill (214) 706-1135; bridgette.mcneill

Patients often stop taking heart drugs during Medicare coverage gaps

April 17, 2012 Study Highlights:Patients in the Medicare Part D prescription drug coverage gap without supplemental insurance were more likely than others to discontinue their heart disease medication.No short-term differences in health outcome occurred, but long-term effects of stopping these drugs as a result of reduced drug coverage are unclear.EMBARGOED UNTIL 3 pm CT/4 pm ET, Tuesday, April 17DALLAS, April 17, 2012 — Patients who paid for heart medications solely through Medicare were 57 percent more likely to not take them during coverage gaps compared to those who had a Part D low-income subsidy or additional insurance, according to research published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal. Neither group was more likely to switch to other drugs during coverage gaps. “Rather than prompting patients to switch to lower-cost alternatives, we found that sudden exposure to 100 percent of drug costs in the Part D coverage gap led to abrupt discontinuation of essential cardiovascular medications,” said Jennifer M. Polinski, Sc.D., M.P.H., study lead author and instructor in medicine at Harvard Medical School in Boston, Mass. “Any drug insurance policy that negatively influences essential cardiovascular drug use needs to be changed.” Heart and blood vessel, or cardiovascular disease, is the leading cause of death in the United States. The risk of disease increases with age, but complications often can be prevented with medication and lifestyle changes. During the study, the Medicare prescription drug benefit, known as Part D, stopped paying for medicine when spending reached a certain amount. Payments resumed when patients’ out-of-pocket expenses reached qualifying levels or the benefit restarted in the next calendar year, but long-term effects of the coverage gap, or “donut hole,” on drug compliance and health are unclear. Patients who did not receive financial assistance during the coverage gap were no more likely to die or be hospitalized for cardiovascular-related conditions than those who did have financial assistance — contrasting with previous research results that looked at the impact of lapses in drug coverage in other, non-Part D settings. The difference could be due to the current study’s relatively short follow-up of 119 days, the typical amount of time patients spent in the coverage gap, said Polinski, who is also an epidemiologist at Brigham and Women’s Hospital and an instructor in epidemiology at the Harvard School of Public Health.  The coverage gap’s impact on cardiovascular health outcomes in the long-term remains unclear. The initial study group comprised 122,255 heart disease patients who reached the Medicare Part D coverage gap in either 2006 or 2007. Researchers then compared drug termination rates between 3,980 Medicare beneficiaries without supplemental insurance to an equal number with additional coverage. Participants were predominately white, and nearly half were 65 to 74 years old and female. Most had high blood pressure and about one-third had heart failure. Both of these conditions can be fatal without proper medical and prescription drug treatment. Study limitations include the relatively short follow-up, the small number of hospitalizations and deaths observed, and the observational design that can’t control for all possible influences. Recent reforms include provisions in the Affordable Care Act that will help close the coverage gap over time. As of January 1, 2011, Medicare beneficiaries receive a 50 percent discount on brand name drugs and a 7 percent discount on generic drugs while in the coverage gap. The size of the discount increases over time until the coverage gap is eliminated in 2020. However, efforts to repeal or strike down the Affordable Care Act, if successful, would eliminate these discounts for Medicare beneficiaries, reinstating the coverage gap and once again requiring them to pay all drug costs during the coverage gap. Co-authors are: William H. Shrank, M.D., M.S.H.S.; Robert J. Glynn, Ph.D., Sc.D.; Haiden A. Huskamp, Ph.D.; M. Christopher Roebuck, M.B.A.; and Sebastian Schneeweiss, M.D., Sc.D. Author disclosures are on the manuscript. The National Institutes of Health, The Robert Wood Johnson Foundation and CVS Caremark funded the study. Some public and private programs offer discounted or free medicines. Learn the ways heart and stroke patients are benefitting from health care reform. ### Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12 – 1059 (CircQ&O/Polinski) Additional resources, including multimedia, are available in the right column.  For Media Inquiries: (214) 706-1173Carrie Thacker: (214) 706-1665; carrie.thacker

Wednesday, April 4, 2012

More Fake Avastin Found in U.S., FDA Says

WEDNESDAY, April 4 (HealthDay News) -- The U.S. Food and Drug Administration says it has confirmed another counterfeit version of the cancer drug bevacizumab, most commonly known as Avastin, is being sold in the United States.

This time, the counterfeit product -- which the FDA says contains no active ingredient -- is posing as injectable Altuzan (bevacizumab) 400 mg/16ml, a Roche cancer medication that is approved for use in Turkey but not in the United States.

"Packaging or vials found in the U.S. that claim to be Roche's Altuzan with lot number B6021 should be considered counterfeit," the FDA said in a statement released Wednesday.

According to the FDA, medical practices got the fake Altuzan from "foreign sources" that include Richards Pharma (aka Richards Services), Warwick Healthcare Solutions or Ban Dune Marketing Inc (BDMI).

"Many, if not all of the products sold and distributed through this distributor have not been approved by the FDA," the agency said. The agency is urging all medical practices that believe they have received unapproved products from the three companies to "stop using

Better Safeguards Needed for Imported Food, Drugs: Report

WEDNESDAY, April 4 (HealthDay News) -- A new report urges the U.S. Food and Drug Administration (FDA) and other government agencies to play a stronger part in poor countries to ensure the safety of food and medications coming into the United States.

The report, prepared by an independent panel at the Institute of Medicine (IOM) and released Wednesday, said efforts to bolster safety systems should take three to five years.

"The recommendations in this report represent the committee's consensus on how to best bridge the gaps in food and medical product regulatory systems in low- and middle-income countries," report committee chair Jim Riviere said in an IOM statement.

A consumer advocacy group spokesman commented on the recommendations.

"Many parts of the report make good sense," said Jaydee Hanson, a senior policy analyst at the Center for Food Safety. "But having a good inspection system requires money."

And, according to Hanson, who was not involved in the report, the FDA doesn't have enough funds to institute more overseas inspections, much less expand its efforts in the United States.

"You don't have money going into the food safety system nationally or internationally," he said. "Basically, the FDA is supposed to accomplish more with the same or less money."

The need for these measures appears pressing as the United States imports more of its food and medicines than ever before and was highlighted earlier this year when a counterfeit version of the cancer drug Avastin was brought into the country.

On Wednesday, the FDA confirmed that another counterfeit version of Avastin -- containing no active ingredients -- has turned up in U.S. medical practices.

Counterfeit vials of Avastin were probably not harmful, but did not contain the active ingredient in the real drug, according to Roche, the Swiss drug maker.

Regulators in Europe said traces of salt, starch and acetone, a solvent found in paint thinner, were found in an analysis of the fake drug's contents, the Associated Press reported in February.

"More than 80 percent of active pharmaceutical ingredients and 40 percent of finished drugs come from abroad, as does 85 percent of the seafood Americans eat, according to federal estimates," the IOM statement noted.

Last year, the FDA did only 600 inspections internationally, so it is likely that things fall through the cracks, Hanson said. "If you're talking doubling that each year, with the volume of foods and drugs we import, that's not much."

The FDA-sponsored report calls for a number of changes to improve inspection of food and drugs abroad, including working with other developed countries around the world that also inspect food and drugs so efforts are not duplicated.

"These are multi-sectoral recommendations that involve action from a variety of stakeholders. We believe that the changes we suggest could greatly improve the safety of food and medical products around the world," said committee chair Riviere, director of the Center for Chemical Toxicology Research and Pharmacokinetics at the College of Veterinary Medicine at North Carolina State University in Raleigh.

The report also recommends developing low-cost technologies to prevent fraud and looking into whether the FDA pilot program, Secure Supply Chain, can be expanded. It rewards drug firms that track their products from manufacture to market by speeding entry of their products into the U.S. market.

The report also called for investing in safe food and drug programs in developing countries. Various U.S. agencies could provide technical expertise, training and tools to improve the surveillance systems in these countries, the report said, and provide this assistance directly or through international organizations such as the World Health Organization.

But, it's not as if food safety in the United States is all that good, Hanson said. "There is a need for better food safety inspection all along the way. We have folks who have not been able to get salmonella out of turkeys in the U.S.," he said.

The report said the FDA and the U.S. Department of Agriculture should provide incentives to businesses and academics to develop inexpensive technologies that can be used in developing nations to prevent and detect fraud and provide tracking and verification of products.

But, Hanson said, the government needs to be able to prosecute importers of bad food and drugs and cut off imports from countries where these problems are endemic. "One of the things that got cut from the Food Safety Modernization Act was real criminal penalties," he added.

Moreover, the FDA needs to be more transparent and post violations on the Internet, something the report doesn't call for, Hanson said.

More information

To learn more, visit Food Safety.gov.

Narcissists Often Ace Job Interviews, Study Finds

WEDNESDAY, April 4 (HealthDay News) -- Really, really liking yourself may give you the edge in your next job interview, a new study suggests.

That's because narcissists, known to be obnoxiously high on self-esteem, are better able to talk about and promote themselves, which projects confidence and expertise to interviewers, University of Nebraska-Lincoln researchers explained.

In their two-part study, narcissists scored much higher in a simulated job interview than equally qualified non-narcissists.

"This is one setting where it's OK to say nice things about yourself and there are no ramifications. In fact, it's expected," study co-author Peter Harms, an assistant professor of management, said in a university news release. "Simply put, those who are comfortable doing this tend to do much better than those who aren't."

The study, which appears in the Journal of Applied Social Psychology, first involved 72 people being videotaped as job applicants. While non-narcissistic people eased up on their self-promotion when challenged by expert interviewers, the narcissists actually increased their attempts to promote themselves, the researchers found.

In the second part of the study, 222 expert interviewers rated videos of applicants with similar job skills and varying degrees of narcissism. The self-promoters -- those who spoke quickly and at length and used such "ingratiation tactics" as smiling, gesturing and complimenting others -- received far more positive evaluations than equally qualified applicants who used tactical modesty, the researchers reported.

"This shows that what is getting (narcissists) the win is the delivery," Harms said. "These results show just how hard it is to effectively interview, and how fallible we can be when making interview judgments. We don't necessarily want to hire narcissists, but might end up doing so because they come off as being self-confident and capable."

The findings also suggest that interviewers need to be aware of the tactics used by narcissists, Harms said.

"On the whole, we find very little evidence that narcissists are more or less effective workers. But what we do know is that they can be very disruptive and destructive when dealing with other people on a regular basis," he said.

And, he added, "If everything else is equal, it probably is best to avoid hiring them."

More information

The U.S. National Library of Medicine explains narcissistic personality disorder.

Guidelines-based CPR saves more non-shockable cardiac arrest victims

April 02, 2012 Study Highlights:CPR can save someone with cardiac arrest even if they don’t respond to a defibrillator.People with non-shockable cardiac arrest are more likely to live if they receive CPR based on recent guidelines emphasizing chest compressions.The American Heart Association’s CPR guidelines emphasizing chest compressions are saving more lives, according to a new study.EMBARGOED UNTIL 3 pm CT/4 pm ET, Monday, April 2DALLAS, April 2, 2012 — People who have a cardiac arrest that can’t be helped by a defibrillator shock are more likely to survive if given CPR based on updated guidelines that emphasize chest compressions, according to research reported in the American Heart Association journal, Circulation. “By any measure — such as the return of pulse and circulation or improved brain recovery — we found that implementing the new guidelines in these patients resulted in better outcomes from cardiac arrest,” said Peter J. Kudenchuk, M.D., lead author of the study and professor of medicine at the University of Washington in Seattle, Wash. The American Heart Association changed its CPR guidelines in 2005 to recommend more chest compressions with fewer interruptions. The emphasis on chest compressions continued in the 2010 guidelines update. After the 2005 guidelines, several studies showed improved survival from shockable cardiac arrest. However, new evidence shows that most cardiac arrests — nearly 75 percent — are due to conditions that don’t respond to shocks. In such patients there have been few, if any, life-saving treatments and it was uncertain whether CPR guidelines changes were beneficial. “Now, for the first time, we have seen a treatment that improves survival specifically in these patients,” Kudenchuk said. “And that treatment is simply providing the more intense, quality CPR recommended in the new guidelines. You could save 2,500 more lives each year in North America alone by implementing these changes.” Researchers identified 3,960 patients in King County, Wash., who suffered a type of cardiac arrest that doesn’t respond to shock from a defibrillator, known as non-shockable cardiac arrest. They compared survival rates among patients who had non-shockable cardiac arrests from 2000-2004 — before the 2005 guidelines changes — to those who had non-shockable arrests from 2005-2010 and found:The likelihood of survival to discharge from the hospital improved from 4.6 percent before to 6.8 percent after the new guideline changes.The proportion of patients who survived with good brain function increased from 3.4 percent to 5.1 percent between study periods.One-year survival almost doubled from 2.7 percent to 4.9 percent.Although survival in patients with non-shockable cardiac arrest is low, the important message from this study is that it can be improved. Potentially thousands of lives could be saved each year in this group if CPR guidelines are properly implemented, said Kudenchuk. Further research is needed to find better treatments for cardiac arrest and to verify these study results. Researchers continue to study new approaches to resuscitation through clinical trials, such as those currently being conducted by the Resuscitation Outcomes Consortium, which is supported by the American Heart Association; the National Heart, Lung, and Blood Institute; and the Canadian Institutes of Health Research. Co-authors are Jeffrey D. Redshaw, B.S.; Benjamin A. Stubbs, M.P.H.; Carol E. Fahrenbruch, M.S.P.H.; Florence Dumas, M.D.; Randi Phelps, B.S.; Jennifer Blackwood; Thomas D. Rea, M.D., M.P.H.; and Mickey S. Eisenberg, M.D., Ph.D. Author disclosures are on the manuscript. The Laerdal Foundation provided research funding to the King County emergency responder system, but this study was not directly supported by any sponsor. Learn more about Hands-Only CPR. Or find a CPR course developed by the American Heart Association at the course locator. Click here for additional resources about the 2010 guidelines. ### Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12 – 1054 (Circulation/Kudenchuk) Additional resources, including multimedia, are available in the right column. For Media Inquiries, please call: (214) 706-1173Tagni McRae: (214) 706-1383; Tagni.McRae

American Heart Association updates online course to treat STEMI

April 03, 2012 DALLAS, April 3, 2012 — The American Heart Association has updated its Learn:® Rapid STEMI ID course with new science and key changes from its revised 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The self-directed, online course prepares healthcare professionals to:Evaluate and assess patients with potential symptoms of heart attack.Interpret electrocardiograms (ECGs) to identify ST-elevation myocardial infarction (STEMI), a severe form of heart attack that occurs when blood supply is totally blocked to a large area of the heart.Activate a system of care to quickly open the blocked coronary artery.The course is part of the American Heart Association’s Mission: Lifeline®, a program launched in 2007 to improve systems of care for people experiencing STEMI. Each year, more than 250,000 Americans have a STEMI

Study Supports CPR Chest Compressions for Cardiac Arrest

MONDAY, April 2 (HealthDay News) -- People in cardiac arrest who can't be helped by a defibrillator are more apt to survive if they receive CPR in accordance with updated guidelines that stress chest compressions, a new study finds.

Researchers reporting in April 2 in Circulation said their findings are significant, since nearly 75 percent of cardiac arrests are "non-shockable," meaning they will not respond to a defibrillator.

"By any measure -- such as the return of pulse and circulation or improved brain recovery -- we found that implementing the new guidelines in these patients resulted in better outcomes from cardiac arrest," the study's lead author, Dr. Peter J. Kudenchuk, professor of medicine at the University of Washington, Seattle, said in a journal news release.

Although there have been few life-saving options for patients who suffer non-shockable cardiac arrest, the study's authors said changes the American Heart Association (AHA) made to its CPR guidelines in 2005 have improved patients' chances of survival. The AHA's changes shifted the focus to more chest compressions with fewer interruptions.

In conducting the study, Kudenchuk and colleagues researchers identified almost 4,000 people who experienced non-shockable cardiac arrest from 2000 to 2010. The patients were divided into two groups: those who had their arrest before the CPR guidelines were changed and those who had their non-shockable arrest after the changes took effect.

After comparing the survival rates of these two groups, the study revealed the patients' likelihood of survival rose from 4.6 percent to 6.8 percent once the new guidelines were in place. The researchers also found the proportion of patients who survived with good brain function increased from 3.4 percent to 5.1 percent and the patients' one-year survival almost doubled, from 2.7 percent to 4.9 percent.

"Now, for the first time, we have seen a treatment that improves survival specifically in these patients," said Kudenchuk. "And that treatment is simply providing the more intense, quality CPR recommended in the new guidelines. You could save 2,500 more lives each year in North America alone by implementing these changes."

Although more research is needed to confirm their findings, the study's authors argued that survival rates among those who suffer non-shockable cardiac arrest can be improved if the AHA's updated CPR guidelines are properly followed.

More information

The U.S. National Institutes of Health provides more information on CPR.

Young Women Who Drink and Drive at Higher Risk of Fatal Accident

TUESDAY, April 3 (HealthDay News) -- Young women who drink and drive in the United States are at increasing risk for being in a fatal accident, according to a new study.

Although men had roughly double the risk for a fatal crash as women with the same blood-alcohol level in 1996, that gender gap had closed by 2007, the researchers pointed out. And although reasons for that trend remain unclear, they said it may be because young women are taking more risks on the road.

"Young women who drink and drive may be behaving more like young men who drink and drive," said the study's lead researcher, Robert Voas, of the Pacific Institute for Research and Evaluation in Calverton, Md., in a news release from the Journal of Studies on Alcohol and Drugs.

Using data from a government reporting system on fatal traffic accidents across the country, researchers compared the blood-alcohol information from nearly 6,900 fatal crashes in 2006 with information from about 6,800 drivers who took part in a roadside survey in 2007.

The study, published in the May issue of Journal of Studies on Alcohol and Drugs, found that regardless of drivers' age, their risk of being killed or being involved in a fatal crash increased as their blood alcohol levels climbed.

Drivers ranging from 16- to 20-years old with a blood-alcohol level of .02 percent to .049 percent had almost a three times higher risk of being involved in a fatal crash than sober drivers of similar age. Their odds of dying in a single-vehicle crash were almost four times greater, the study also revealed.

The study's authors added that the findings also showed the risk of a fatal car crash doubled for sober male drivers between 1996 and 2007. The researchers said distracted driving may well be the cause.

"Sober kids are more at risk, and we think it may be related to texting and the other new technologies they are using so much," said the study's co-author, Eduardo Romano, in the news release.

The researchers concluded drunk-driving and distracted-driving prevention education is needed for both boys and girls.

More information

The U.S. Centers for Disease Control and Prevention has more information on drunk driving.

BBQ Danger: Wires From Grill Cleaners Swallowed in Food

TUESDAY, April 3 (HealthDay News) -- Several Rhode Island residents had a brush with the emergency room because of sharp wire bristles that made their way from barbecue grills into their digestive tracts.

The wire bristles, which came from the metallic brushes used to clean grills, apparently ended up in barbecued beef or chicken that the patients ate, a new report said. From there, the bristles went to their throats and stomachs and caused serious medical issues.

Emergency physicians elsewhere said they'd never seen this happen. So might the nation's smallest state be the home to its biggest problem with renegade grill-cleaner bristles? Report lead author Dr. David Grand isn't so sure.

"Certainly, we all love to grill, though I can't say for certain that Rhode Islanders grill anymore than other Americans. More likely, once we became aware of this problem we began looking for it, and if we don't specifically look for this we will not find it," said Grand, a radiologist at Rhode Island Hospital in Providence.

Within an 18-month period from 2009 to 2010, six patients appeared at the hospital with symptoms of abdominal pain or painful swallowing. The patients -- aged 11 to 75 and including five females -- didn't know the cause, although they'd all eaten grilled meats within the last two to 24 hours.

Scans or x-rays revealed metallic bristles in their necks or lower in their digestive systems. The bristles caused serious problems in some cases; for instance, a bristle perforated the stomach and liver of one patient who had to stay in the hospital for six days.

"Treatment for these patients involves removal of the wire," Grand said. "If the wire is lodged in the mouth or throat, this may be accomplished by an ear, nose and throat doctor or gastroenterologist who can use a small scope to find and remove the wire. If, however, the wire has perforated the intestine at the time of presentation, surgery with removal of the affected bowel segment will usually be required."

In each case, the patients had eaten food grilled on a barbecue that had been cleaned just before cooking. It seems that the bristles fell off the brushes, landed on the grill and ended up in the food. "All of the patients in our