This review from Harvard presents several useful techniques to reduce the unnecessary prescription of pharmaceuticals.
Conservative Prescribing of Pharmaceuticals - Associated Content from Yahoo! - associatedcontent.com
Wednesday, November 30, 2011
Imaging Recurrent Uterine Sarcoma - Associated Content from Yahoo! - associatedcontent.com
PET/CT imaging comparison with conventional imaging inconclusive
Imaging Recurrent Uterine Sarcoma - Associated Content from Yahoo! - associatedcontent.com
Imaging Recurrent Uterine Sarcoma - Associated Content from Yahoo! - associatedcontent.com
The Prevention of Breast Cancer
Simple strategies appear to be the best way to decrease a person's risk of getting breast cancer.
The Prevention of Breast Cancer - Associated Content from Yahoo! - associatedcontent.com
The Prevention of Breast Cancer - Associated Content from Yahoo! - associatedcontent.com
Tuesday, November 29, 2011
Christmas and Your Health
Doc Clarence learns an important lesson from the stars.
Christmas and Your Health - Associated Content from Yahoo! - associatedcontent.com
Christmas and Your Health - Associated Content from Yahoo! - associatedcontent.com
Going Home for Christmas
She was beyond a medical cure, but maybe, just maybe, the physician could do one last thing for her.
Going Home for Christmas - Associated Content from Yahoo! - associatedcontent.com
Going Home for Christmas - Associated Content from Yahoo! - associatedcontent.com
Monday, November 28, 2011
The New Idea Out West
Could the Cowboy doctor save the farmer's arm? A story he heard at the tavern may mean the difference between life and death.
The New Idea Out West - Associated Content from Yahoo! - associatedcontent.com
The New Idea Out West - Associated Content from Yahoo! - associatedcontent.com
Sunday, November 27, 2011
Tuesday, November 22, 2011
Friday, November 18, 2011
Evaluation of diagnostic performance of (18)F-FDG-PET compared to CT in detecting potential causes of fever of unknown origin in an academic centre.
Evaluation of diagnostic performance of (18)F-FDG-PET compared to CT in detecting potential causes of fever of unknown origin in an academic centre.:
Evaluation of diagnostic performance of (18)F-FDG-PET compared to CT in detecting potential causes of fever of unknown origin in an academic centre.
Hell J Nucl Med. 2011 Sep;14(3):255-259
Authors: Rosenbaum J, Basu S, Beckerman S, Werner T, Torigian DA, Alavi A
Abstract
Determining the cause of fever of unknown origin (FUO) often proves challenging to attending physicians and the role of conventional imaging in this setting has been uncertain. In this retrospective study, we examined the role of fluorine-18 fluorodesoxyglucose-positron emission tomography ((18)F-FDG-PET) compared to computed tomography (CT) in diagnosing the potential etiology of FUO. To accomplish this task, we identified patients with FUO who underwent (18)F-FDG-PET for detecting the source of fever. Twenty-four patients (16 males and 8 females, age range = 17-80, mean age = 49.5) were examined with (18)F-FDG-PET of which 18 were also assessed with a diagnostic CT (within 3 weeks, mean interval = 7.5 days). The PET and CT findings were reviewed and the presence of focal (18)F-FDG uptake or gross CT lesions was considered a potential site causing FUO. Of patients who underwent PET alone, ⅚ were reported as positive. Of the18 who had both PET and diagnostic CT, PET was positive in 18 and CT was positive in only 7 cases. Of positive findings on PET, etiologies included infection (11), non-infectious inflammation (8), lymphoma (3), and other cancers (1). Of positive findings on CT, etiologies included infection (3), lymphoma (1), non-infectious inflammation (2) and other cancers (1). Importantly, we found no cases with positive CT and negative PET findings. In conclusion, accordingly to our findings, (18)F-FDG-PET appears to be of great value in assessing patients with FUO, especially when caused by infection or inflammation. Fluorine-18 FDG-PET is more sensitive than diagnostic CT in detecting and localizing diseased sites, and is the optimal imaging modality to evaluate patients with FUO.
PMID: 22087445 [PubMed - as supplied by publisher]
Thursday, November 17, 2011
Wednesday, November 16, 2011
Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk.
Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk.:
Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk.
JAMA. 2011 Nov 2;306(17):1884-90
Authors: Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC
Abstract
CONTEXT: Multiple studies have linked alcohol consumption to breast cancer risk, but the risk of lower levels of consumption has not been well quantified. In addition, the role of drinking patterns (ie, frequency of drinking and "binge" drinking) and consumption at different times of adult life are not well understood.
OBJECTIVE: To evaluate the association of breast cancer with alcohol consumption during adult life, including quantity, frequency, and age at consumption.
DESIGN, SETTING, AND PARTICIPANTS: Prospective observational study of 105,986 women enrolled in the Nurses' Health Study followed up from 1980 until 2008 with an early adult alcohol assessment and 8 updated alcohol assessments.
MAIN OUTCOME MEASURES: Relative risks of developing invasive breast cancer.
RESULTS: During 2.4 million person-years of follow-up, 7690 cases of invasive breast cancer were diagnosed. Increasing alcohol consumption was associated with increased breast cancer risk that was statistically significant at levels as low as 5.0 to 9.9 g per day, equivalent to 3 to 6 drinks per week (relative risk, 1.15; 95% CI, 1.06-1.24; 333 cases/100,000 person-years). Binge drinking, but not frequency of drinking, was associated with breast cancer risk after controlling for cumulative alcohol intake. Alcohol intake both earlier and later in adult life was independently associated with risk.
CONCLUSIONS: Low levels of alcohol consumption were associated with a small increase in breast cancer risk, with the most consistent measure being cumulative alcohol intake throughout adult life. Alcohol intake both earlier and later in adult life was independently associated with risk.
PMID: 22045766 [PubMed - indexed for MEDLINE]
Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies.
Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies.:
Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies.
BMJ. 2011;343:d6617
Authors: Aune D, Chan DS, Lau R, Vieira R, Greenwood DC, Kampman E, Norat T
Abstract
OBJECTIVE: To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer.
DESIGN: Systematic review and meta-analysis of prospective observational studies.
DATA SOURCES: PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses.
STUDY SELECTION: Prospective cohort and nested case-control studies of dietary fibre or whole grain intake and incidence of colorectal cancer.
RESULTS: 25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I(2)=0%), for fruit fibre (n=9) was 0.93 (0.82 to 1.05, I(2)=23%), for vegetable fibre (n=9) was 0.98 (0.91 to 1.06, I(2)=0%), for legume fibre (n=4) was 0.62 (0.27 to 1.42, I(2)=58%), and for cereal fibre (n=8) was 0.90 (0.83 to 0.97, I(2)=0%). The summary relative risk for an increment of three servings daily of whole grains (n=6) was 0.83 (0.78 to 0.89, I(2)=18%).
CONCLUSION: A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.
PMID: 22074852 [PubMed - in process]
FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study.
FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study.:
FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study.
Ann Nucl Med. 2011 Jun;25(5):355-64
Authors: Kubota K, Nakamoto Y, Tamaki N, Kanegae K, Fukuda H, Kaneda T, Kitajima K, Tateishi U, Morooka M, Ito K, Minamimoto R, Murakami K
Abstract
OBJECTIVE: To evaluate the clinical value of 2-[(18)F]fluoro-2-deoxy-D: -glucose positron emission tomography (FDG-PET) for the diagnosis of fever of unknown origin (FUO), we performed a Japanese multi-center retrospective survey.
METHODS: A total of 81 consecutive patients with FUO who underwent FDG-PET at 6 institutions between July 2006 and December 2007 were retrospectively evaluated. FDG uptake was visually evaluated using a 4-grade scale. The efficacy of FDG-PET for the evaluation of FUO, the provision of additional diagnostic information, the clinical impact on therapeutic decisions (4-grade scale), and the diagnostic performance compared with the final diagnosis were evaluated.
RESULTS: The diagnostic results were analyzed according to 4 groups of final diagnoses: infection, arthritis/vasculitis/autoimmune/collagen disease (A/V), tumor/granuloma (T/G), and other/unknown (O/U). Sensitivity was highest in T/G, followed by infection, A/V and O/U [100%(7/7), 89%(24/27), 65%(11/17), 0%(0/1) respectively]. Clinical impact and mean FDG score showed the same tendency. Additional information was highest in infection followed by T/G, A/V, and O/U [76%(22/29), 75%(6/8), 43%(9/21), 23%(5/22), respectively]. The O/U group showed a high specificity (84%, 16/19) and accurately excluded active focal inflammatory diseases and malignancy. The use of steroids for the treatment of fever seemed to mask the lesions and modified the results, especially in the A/V group (4 false negatives in 8 steroid users out of 21 A/V patients). The prevalence of each disease in each hospital significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. The mean FDG uptake score and additional information (70%, 31/44 vs. 30%, 11/37, respectively) in national hospital (NH) was significantly higher than in university hospitals (UH). A Grade 3 clinical impact, in which the FDG PET results changed the clinical decision, was seen in 50% (22/44) of the patients in the NH group and 13.5% (5/37) of the patients in the UH group. The sensitivity (91%, 30/33; 63%, 12/19) and specificity (60%, 6/10; 86%, 12/14) of the results in the NH and UH groups differed. The total sensitivity was 81% (42/52), specificity was 75% (18/24). The NH group included a large number of cases with infectious diseases (50%, 23/44), while the UH group included a large number of A/V cases (38%, 14/37) and O/U cases (41%, 15/37).
CONCLUSION: FDG-PET for the diagnosis of FUO provided additional diagnostic information and had a high clinical impact, especially among patients with infectious diseases. It was also helpful in cases with unknown or other miscellaneous diseases by allowing the exclusion of focally active diseases. The prevalence of diseases in hospitals significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. FDG-PET is a useful examination providing various degrees of clinical impact for the management of FUO, depending on the characteristics of the patient and the hospital.
PMID: 21344168 [PubMed - indexed for MEDLINE]
The vasodilator stress ECG: Should depression cause anxiety?
The vasodilator stress ECG: Should depression cause anxiety?:
The vasodilator stress ECG: Should depression cause anxiety?
J Nucl Cardiol. 2011 Nov 15;
Authors: Abbott BG
PMID: 22083393 [PubMed - as supplied by publisher]
Tuesday, November 15, 2011
Monday, November 14, 2011
Results of the Medicare Health Support disease-management pilot program.
Results of the Medicare Health Support disease-management pilot program.:
Results of the Medicare Health Support disease-management pilot program.
N Engl J Med. 2011 Nov 3;365(18):1704-12
Authors: McCall N, Cromwell J
Abstract
BACKGROUND: In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program.
METHODS: The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries.
RESULTS: The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures.
CONCLUSIONS: In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.
PMID: 22047561 [PubMed - in process]
Omega-3 Fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events.
Omega-3 Fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events.:
Omega-3 Fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events.
J Am Coll Cardiol. 2011 Nov 8;58(20):2047-67
Authors: Mozaffarian D, Wu JH
Abstract
We reviewed available evidence for cardiovascular effects of n-3 polyunsaturated fatty acid (PUFA) consumption, focusing on long chain (seafood) n-3 PUFA, including their principal dietary sources, effects on physiological risk factors, potential molecular pathways and bioactive metabolites, effects on specific clinical endpoints, and existing dietary guidelines. Major dietary sources include fatty fish and other seafood. n-3 PUFA consumption lowers plasma triglycerides, resting heart rate, and blood pressure and might also improve myocardial filling and efficiency, lower inflammation, and improve vascular function. Experimental studies demonstrate direct anti-arrhythmic effects, which have been challenging to document in humans. n-3 PUFA affect a myriad of molecular pathways, including alteration of physical and chemical properties of cellular membranes, direct interaction with and modulation of membrane channels and proteins, regulation of gene expression via nuclear receptors and transcription factors, changes in eicosanoid profiles, and conversion of n-3 PUFA to bioactive metabolites. In prospective observational studies and adequately powered randomized clinical trials, benefits of n-3 PUFA seem most consistent for coronary heart disease mortality and sudden cardiac death. Potential effects on other cardiovascular outcomes are less-well-established, including conflicting evidence from observational studies and/or randomized trials for effects on nonfatal myocardial infarction, ischemic stroke, atrial fibrillation, recurrent ventricular arrhythmias, and heart failure. Research gaps include the relative importance of different physiological and molecular mechanisms, precise dose-responses of physiological and clinical effects, whether fish oil provides all the benefits of fish consumption, and clinical effects of plant-derived n-3 PUFA. Overall, current data provide strong concordant evidence that n-3 PUFA are bioactive compounds that reduce risk of cardiac death. National and international guidelines have converged on consistent recommendations for the general population to consume at least 250 mg/day of long-chain n-3 PUFA or at least 2 servings/week of oily fish.
PMID: 22051327 [PubMed - in process]
Prospective comparison of combined (18)F-FDG and (18)F-NaF PET/CT vs. (18)F-FDG PET/CT imaging for detection of malignancy.
Prospective comparison of combined (18)F-FDG and (18)F-NaF PET/CT vs. (18)F-FDG PET/CT imaging for detection of malignancy.:
Prospective comparison of combined (18)F-FDG and (18)F-NaF PET/CT vs. (18)F-FDG PET/CT imaging for detection of malignancy.
Eur J Nucl Med Mol Imaging. 2011 Nov 8;
Authors: Lin FI, Rao JE, Mittra ES, Nallapareddy K, Chengapa A, Dick DW, Gambhir SS, Iagaru A
Abstract
PURPOSE: Typically, (18)F-FDG PET/CT and (18)F-NaF PET/CT scans are done as two separate studies on different days to allow sufficient time for the radiopharmaceutical from the first study to decay. This is inconvenient for the patients and exposes them to two doses of radiation from the CT component of the examinations. In the current study, we compared the clinical usefulness of a combined (18)F-FDG/(18)F-NaF PET/CT scan with that of a separate (18)F-FDG-only PET/CT scan. METHODS: There were 62 patients enrolled in this prospective trial. All had both an (18)F-FDG-alone PET/CT scan and a combined (18)F-FDG/(18)F-NaF PET/CT scan. Of the 62 patients, 53 (85%) received simultaneous tracer injections, while 9 (15%) received (18)F-NaF subsequent to the initial (18)F-FDG dose (average delay 2.2 h). Images were independently reviewed for PET findings by two Board-Certified nuclear medicine physicians, with discrepancies resolved by a third reader. Interpreters were instructed to only report findings that were concerning for malignancy. Reading the (18)F-FDG-only scan first for half of the patients controlled for order bias. RESULTS: In 15 of the 62 patients (24%) neither the (18)F-FDG-only PET/CT scan nor the combined (18)F-FDG/(18)F-NaF PET/CT scan identified malignancy. In the remaining 47 patients who had PET findings of malignancy, a greater number of lesions were detected in 16 of 47 patients (34%) using the combined (18)F-FDG/(18)F-NaF PET/CT scan compared to the (18)F-FDG-only PET/CT scan. In 2 of these 47 patients (4%), the (18)F-FDG-only scan demonstrated soft tissue lesions that were not prospectively identified on the combined study. In 29 of these 47 patients (62%), the combined scan detected an equal number of lesions compared to the (18)F-FDG-only scan. Overall, 60 of all the 62 patients (97%) showed an equal or greater number of lesions on the combined scan than on the (18)F-FDG-only scan. CONCLUSION: The current study demonstrated that (18)F-FDG and (18)F-NaF can be combined in a single PET/CT scan by administering the two radiopharmaceuticals simultaneously or in sequence on the same day. In addition to patient convenience and reduced radiation exposure from the CT component, the combined (18)F-FDG/(18)F-NaF PET/CT scan appeared to increase the sensitivity for detection of osseous lesions compared to the (18)F-FDG-only PET/CT scan in the studied population.
PMID: 22065013 [PubMed - as supplied by publisher]
Effect of mobile cell phone ringing on function of gamma camera.
Effect of mobile cell phone ringing on function of gamma camera.:
Effect of mobile cell phone ringing on function of gamma camera.
Clin Nucl Med. 2011 Dec;36(12):1131-2
Authors: Azizmohammadi Z, Baharfar N, Javadi H, Shafiei B, Delavari S, Babaei AA, Ahmadi A, Assadi M, Neshandarasli I
Abstract
After the start of renal scintigraphy in a 32-year-old woman, there was an abnormal view in frame 6 that was simultaneous with the start of ringing of a mobile cell phone that was in the patient's trousers pocket. In frame 6 of the flow phase, some bright dots were observed, suggesting photomultiplier tubes. Immediately after that frame, in spite of continued ringing of the mobile cell phone (up to 1-2 minutes), the imaging frames came back to a normal situation. In the case, electromagnetic interference from the mobile cell phone may disrupt the photoelectric functioning of photomultiplier tubes during scintigraphy.
PMID: 22064091 [PubMed - in process]
FDG-PET/CT in the diagnosis of recurrent breast cancer.
FDG-PET/CT in the diagnosis of recurrent breast cancer.:
FDG-PET/CT in the diagnosis of recurrent breast cancer.
Acta Radiol. 2011 Nov 8;
Authors: Murakami R, Kumita SI, Yoshida T, Ishihara K, Kiriyama T, Hakozaki K, Yanagihara K, Iida S, Tsuchiya SI
Abstract
BackgroundAn advantage of PET/CT has been demonstrated for diagnosis of several tumor entities. In patients with breast cancer, early diagnosis and accurate restaging of recurrence after surgery is important for selection of the most appropriate therapeutic strategy.PurposeTo evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG), for follow-up of patients with suspected recurrent breast cancer.Material and MethodsForty-seven patients with suspected recurrent breast cancer underwent PET/CT. The PET and PET/CT images were interpreted without knowledge of the results of other diagnostic modalities, and compared with each other with reference to the final diagnosis.ResultsTwenty-five (53%) patients suffered tumor recurrence. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT were 96%, 91%, 92%, 95%, and 94%, respectively. In comparison with PET, PET/CT had a higher sensitivity and accuracy (96% vs. 80% and 94% vs. 81%, respectively). The difference in diagnostic accuracy between PET/CT and PET was significant (P < 0.05).ConclusionThe present findings indicate that PET/CT is an accurate, sensitive and reliable modality for screening and detection of breast cancer recurrence. PET/CT appears to be an effective surveillance tool, as it is able to cover the whole body in a single procedure and shows good performance.
PMID: 22067206 [PubMed - as supplied by publisher]
Association between physician billing and cardiac stress testing patterns following coronary revascularization.
Association between physician billing and cardiac stress testing patterns following coronary revascularization.:
Association between physician billing and cardiac stress testing patterns following coronary revascularization.
JAMA. 2011 Nov 9;306(18):1993-2000
Authors: Shah BR, Cowper PA, O'Brien SM, Jensen N, Patel MR, Douglas PS, Peterson ED
Abstract
CONTEXT: The degree to which financial factors may influence use of cardiac stress imaging procedures is unknown.
OBJECTIVE: To examine the association of physician billing and nuclear stress and stress echocardiography testing following coronary revascularization.
DESIGN, SETTING, AND PATIENTS: Using data from a national health insurance carrier, 17,847 patients were identified between November 1, 2004, and June 30, 2007, who had coronary revascularization and an index cardiac outpatient visit more than 90 days following the procedure. Based on overall billings, physicians were classified as billing for both technical (practice/equipment) and professional (supervision/interpretation) fees, professional fees only, or not billing for either. Logistic regression models were used to evaluate the association between physician billing and use of stress testing, after adjusting for patient and other physician factors.
MAIN OUTCOME MEASURES: Incidence of nuclear and echocardiographic stress tests within 30 days of an index cardiac-related outpatient visit.
RESULTS: The overall cumulative incidence of nuclear or echocardiography stress testing within 30 days of the index cardiac-related outpatient visit following revascularization was 12.2% (95% CI, 11.8%-12.7%). The cumulative incidence of nuclear stress testing was 12.6% (95% CI, 12.0%-13.2%), 8.8% (95% CI, 7.5%-10.2%), and 5.0% (95% CI, 4.4%-5.7%) among physicians who billed for technical and professional fees, professional fees only, or neither, respectively. For stress echocardiography, the cumulative incidence of testing was 2.8% (95% CI, 2.5%-3.2%), 1.4% (95% CI, 1.0%-1.9%), and 0.4% (95% CI, 0.3%-0.6%) among physicians who billed for the technical and professional fees, professional fees only, or neither, respectively. Adjusted odds ratios (ORs) of nuclear stress testing among patients treated by physicians who billed for technical and professional fees and professional fees only were 2.3 (95% CI, 1.8-2.9) and 1.6 (95% CI, 1.2-2.1), respectively, compared with those patients treated by physicians who did not bill for testing (P < .001). The adjusted OR of stress echocardiography testing among patients treated by physicians billing for both or professional fees only were 12.8 (95% CI, 7.6-21.6) and 7.1 (95% CI, 4.0-12.9), respectively, compared with patients treated by physicians who did not bill for testing (P < .001).
CONCLUSION: Nuclear stress testing and stress echocardiography testing following revascularization were more frequent among patients treated by physicians who billed for technical fees, professional fees, or both compared with those treated by physicians who did not bill for these services.
PMID: 22068991 [PubMed - in process]
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