Top News

Reduce the risk of heparin-associated thrombocytopenia The risk of heparin-associated thrombocytopenia is more duration-related than dose-related, and higher with unfractionated heparin when used for an extended duration. These findings suggest that although heparin-associated thrombocytopenia is uncommon among patients aged <40 years and women following delivery, the incidence can be minimized by use of low-molecular-weight heparin, particularly if extended prophylaxis or extended treatment is required. The American Journal of Medicine (10/2009)

	Keep your patients informed and help them be prepared with specially designed, easy-to-read documents explaining specific diagnostic tests for the evaluation of heart failure. Available to download and print. Click to learn more.

Clinical Updates

   From AJM and other Elsevier publications

Hormone replacement therapy and lung cancer deaths Although treatment with oestrogen plus progestin in postmenopausal women did not increase incidence of lung cancer, it increased the number of deaths from lung cancer, in particular deaths from non-small-cell lung cancer. These findings should be incorporated into risk–benefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer. (Free registration required.) The Lancet (9/20)

Predicting heart failure Abdominal obesity is an independent predictor of heart failure hospitalization and recurrent cardiovascular events in patients with stable coronary heart disease. This association does not appear to be mediated by co-morbid conditions, cardiac disease severity, insulin resistance, inflammation, neurohormones or adipokines. The American Journal of Cardiology (10/2009)

What happens if she's pregnant and on nicotine replacement therapy? Although race, poor pregnancy history, and use of analgesics were associated with serious adverse events, randomization to nicotine replacement therapy during pregnancy was not a significant factor. Further research is needed to examine the safety of analgesic medications during pregnancy. American Journal of Obstetrics & Gynecology (10/2009)

Can it be pancreatic TB? Pancreatic tuberculosis is a very rare condition that usually resembles a pancreatic tumor and is, therefore, both difficult to diagnose and rarely detected during surgery. The authors present a case of primary pancreatic tuberculosis initially identified as a pseudotumor during exploratory laparotomy in an immune-deficient patient presenting with obstructive jaundice. (Article in English.) Masson/La Presse Medicale (9/2009)

How much does it hurt? Answers from the dementia patient This study undertook developing and assessing a new tool for pain assessment among residents with dementia in nursing homes. The Certified Nursing Assistant Pain Assessment Tool (CPAT) requires minimal training of Certified Nursing Assistants. CPAT proved easy to use with evidence of reliability pointing to a need for further study to evaluate reproducibility of these results in a larger population. Free abstract only. Journal of the American Medical Directors Association (10/2009)

Multisystemic therapy works in adolescent weight loss Multisystemic Therapy (MST), an intensive, home-based treatment developed for youth exhibiting antisocial behavior, significantly reduced percents overweight and body fat in a pilot study of African-American adolescents. Full-text access is time-limited. Journal of Adolescent Health (10/2009)

	Keep your patients informed and help them be prepared with specially designed, easy-to-read documents explaining specific diagnostic tests for the evaluation of heart failure. Available to download and print. Click to learn more.

Medical News

• Diabetes raises atrial fibrillation risk for women
  A Kaiser Permanente study in Diabetes Care that compared 17,372 diabetic patients to nondiabetics found 3.6% of those who had diabetes got atrial fibrillation, compared with 2.5% of nondiabetics. Researchers said men in both groups had higher fibrillation rates than women but only among women did diabetes specifically increase the risk. NYTimes.com (9/28)

• Midlife obesity raises health risks for women later
  Obese middle-aged women are 79% more likely to suffer from chronic health problems and impaired mental fitness, compared with their slimmer counterparts, by the time they turn 70, a study in BMJ found. Every 2.2 pounds of extra weight lowered the odds of healthy survival by 5%, researchers said. HealthDay News (9/29)

• Chronic pain causes old-age problems in middle-age adults
  A report in the Journal of the American Geriatrics Society showed people ages 50 to 59 who suffer chronic pain have physical limitations comparable to those ages 80 to 89 who don't have pain. Researchers said it may be better to evaluate and treat pain and disability together rather than as separate issues. Medscape (free registration) (9/29)

Business Practice News

• Hospitals say drive-throughs for H1N1 flu treatment effective
  Some U.S. hospitals are using drive-throughs and drive-up tent clinics to test and treat the growing number of patients with H1N1 flu symptoms in an effort to separate those patients from the very ill patients and to prevent overcrowding in emergency departments. The programs have been effective and have facilitated the quick identification of those who need to be admitted and those who can be sent home, doctors participating in the initiative said. The News Tribune (Tacoma, Wash.)/The Associated Press (9/29)

• New model of care adds mental health to primary care
  A trend toward incorporating basic mental health services into primary care is catching on in the U.S., including at Kaiser Permanente, federally funded health centers and Veterans Affairs medical centers. The programs are designed to detect and address behavioral issues, such as stress, that often go untreated. The Philadelphia Inquirer (9/28)

• Other News

• Community health centers to see 2 million more patients
  The Wall Street Journal (tiered subscription model) (9/28)

• Board will launch pilot for hospitalist certification
  Modern Healthcare (free registration) (9/29)

Patient's Perspective

• Survey: Americans unaware of exercise recommendations
  A survey found only one-third of participants were aware of national recommendations to get a minimum of 30 minutes of exercise daily, and fewer than 50% of people met that goal. Researchers said 14 years of public campaigns on the recommendations may be having a limited impact due to the "highly generalized, saturating effect of media in the current environment." The report was published in the journal Medicine & Science in Sports & Exercise. Yahoo!/HealthDay News (9/29)

SmartQuote

At the present rate of progress, it is almost impossible to imagine any technical feat that cannot be achieved -- if it can be achieved at all -- within the next few hundred years." --Arthur C. Clarke, British author and inventor