From Liz Highleyman, Editor-in-Chief and Publisher
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HCV Protease Inhibitor Danoprevir Promising in Early Trial
Experimental HCV protease inhibitor danoprevir (formerly RG7227 and ITMN-191) was safe and showed good antiviral activity at higher doses in a 14-day study of treatment-naive and previously treated genotype 1 chronic hepatitis C patients
Do HIV+ People Have Higher Stroke Risk?
A Danish study finds HIV positive people have a higher risk for stroke, increasing with injection drug use and lower CD4 cell count but not antiretroviral therapy overall.
Experimental HCV protease inhibitor danoprevir (formerly RG7227 and ITMN-191) was safe and showed good antiviral activity at higher doses in a 14-day study of treatment-naive and previously treated genotype 1 chronic hepatitis C patients
Do HIV+ People Have Higher Stroke Risk?
A Danish study finds HIV positive people have a higher risk for stroke, increasing with injection drug use and lower CD4 cell count but not antiretroviral therapy overall.
From Gastro Hep
Improved survival after anatomic vs nonanatomic resection for hepatocellular carcinoma
6/15/2011 GastroHep.com News
As study in this month's Digestive Diseases of Sciences investigates disease-free survival after anatomic vs nonanatomic resection for hepatocellular carcinoma.
Dr Jinggui Chen and colleagues compared the effect on survival of anatomic resection versus nonanatomic resection in patients with hepatocellular carcinoma from all published comparative studies in the literature.
Databases, including Pubmed, Embase, the Cochrane Library, Ovid, and Web of Science, were searched to identify studies comparing anatomic resection with nonanatomic resection for hepatocellular carcinoma.
In this meta-analysis, primary end points were the overall survival and disease-free survival.
The secondary end point was local recurrence rate.
The research team identified 9 comparative studies comprising 1,503 paients.
In the combined results, disease-free survival was significantly higher in the anatomic resection group than in the nonanatomic resection group.
Overall survival did not suggest any significant difference between anatomic resection and nonanatomic resection.
The team observed no statistically significant for local recurrence rate between the 2 resection methods.
Dr Chen's team concludes, "Anatomic resection is associated with better disease-free survival than nonanatomic resection."
"Because heterogeneity was detected, caution is needed in interpretation of the results."
"Better designed, adequately powered studies are required to address this issue."
Dig Dis Sci 2011: 56(6): 1626-33
Published Date: 15 June 2011
Hep C alert as cases hit a ten-year high
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Hepatitis C numbers have hit a record high in the Lothians, sparking a warning from health bosses.
There were 274 new diagnoses of the disease last year - a ten-year-high - and it is estimated as many as 7000 people in the Lothians could be living with it.
Now there are warnings that the infection, often associated with injecting drug users, is also being passed on by snorting cocaine and other "lifestyle" choices.
Experts said that because the disease was blood-borne there were many ways to catch it.
Health Protection Scotland revealed that hepatitis C numbers were at record levels in the Lothians and Scotland as a whole.
It is estimated that as well as the 3500 people infected in the Lothians, there is a similar number undiagnosed.
Health chiefs insist the growing number of positive cases is a good thing, indicating an improvement in the detection of those who may have had it for years.
Now there are warnings that the infection, often associated with injecting drug users, is also being passed on by snorting cocaine and other "lifestyle" choices.
Experts said that because the disease was blood-borne there were many ways to catch it.
Health Protection Scotland revealed that hepatitis C numbers were at record levels in the Lothians and Scotland as a whole.
It is estimated that as well as the 3500 people infected in the Lothians, there is a similar number undiagnosed.
Health chiefs insist the growing number of positive cases is a good thing, indicating an improvement in the detection of those who may have had it for years.
Off The Cuff
From Ed Silverman
FDA Warns Dr. Reddy Over Bad Ingredients In US
Yet another instance in which the supply chain causes concern. This time around, Dr. Reddy’s Laboratories, one of the largest drugmakers in India, was tagged by the FDA for failing to properly validate methods for testing active pharmaceutical ingredients at a plant in Mexico. And this is a problem because adulterated ingredients are now circulating around the US.
The issue arose last November, when FDA inspectors visited the Dr. Reddy’s facility in Mexico and found several “significant deviations” from good manufacturing practice. The drugmaker responded the following month but, in a June 3 warning letter, theagency makes clear that Dr. Reddy’s may have completed some validations, but then there is the matter of APIs already on the market.
15 June 2011
Outpatient Malpractice Payments Outnumbered Inpatient
By: MARY ANN MOON, Internal Medicine News Digital Network
More malpractice payments were made in 2009 for adverse events that happened in the outpatient setting than in the inpatient setting, according to a report in the June 15 issue of JAMA.
The outcomes of adverse events among outpatients "were not trivial," with death and major injury accounting for nearly two-thirds of those claims, said Dr. Tara F. Bishop of the department of public health at Weill Cornell Medical College, New York, and her associates.
The findings may come as a surprise, given that most initiatives addressing patient safety have centered on inpatient care. "For example, in the past 5 years, the number of studies funded by the Agency for Healthcare Research and Quality on inpatient safety has been almost 10-fold that of outpatient studies," the investigators noted (JAMA 2011;305:2427-31).
"Our findings provide empirical support for suggestions that patient safety initiatives should focus on the outpatient setting, not just on inpatient care," they said.
The researchers assessed trends in malpractice payments using data from the National Practitioner Data Bank, "a repository of all malpractice payments paid on behalf of practitioners in the United States." They performed a retrospective analysis of payments involving only MDs and DOs, including residents, and compared payments for adverse events that occurred in inpatient settings with those that occurred in outpatient settings between 2005 and 2009, the first and last dates for which complete data were available.
The researchers noted that their results are underestimates of actual malpractice payments, because the NPDB doesn’t track payments made on behalf of corporate entities.
Adverse events were classified into six categories: diagnostic, surgical, obstetric, treatment/medication, anesthesia, or other. The outcomes of those adverse events were classified as involving death, lifelong care, major injury, minor injury, or emotional injury.
In 2009, 10,739 payments were made on malpractice claims against physicians. In all, 4,910 of those (48%) were for adverse events that occurred in an inpatient setting, 4,448 (43%) were for events that occurred in an outpatient setting, and 966 (9%) were for events that occurred in both settings.
Thus, more than half (52%) of the adverse events "occurred in the outpatient setting, at least in part," the investigators noted.
The average payment amount for outpatient malpractice claims was approximately $300,000, and that amount did not change over time. "Almost $1.3 billion in malpractice claims was paid for outpatient events in 2009," the investigators noted.
Major injury was the most common patient outcome in both settings, accounting for 38% of inpatient and 36% of outpatient claim payments. Death was the next most common patient outcome, accounting for 36% of the inpatient and 31% of the outpatient claim payments.
For outpatients, the most common types of adverse events were diagnostic (46%), treatment (30%), and surgical (14%). In contrast, the most common type of adverse events for inpatients was surgical (34%), followed by diagnostic (21%) and treatment (20%). That indicates that "more attention should be paid to adverse events related to diagnostic errors" in outpatient practice, Dr. Bishop and her colleagues said.
"Events related to diagnosis may be particularly important in the outpatient setting, where follow-up is more difficult than in the hospital and where patients often present with symptoms and signs that may be subtle or not adequately noted amid the many short-term, long-term, and preventive care activities often undertaken in a single outpatient visit," they added.
Moreover, "the importance of adverse events related to diagnosis may be particularly relevant as pay-for-performance and public reporting programs increasingly demand attention from clinicians," Dr. Bishop and her associates said. "These programs do not reward diagnostic acuity or punish diagnostic error and may divert clinicians’ time and attention from the critical area of diagnosis."
The number of malpractice claims declined significantly over time in both inpatient and outpatient settings, but the rate of the decrease was lower for outpatient claims.
Dr. Bishop was supported in part as a Nanette Laitman Clinical Scholar in Public Health at Weill Cornell Medical College. An associate was supported in part by a grant from the Agency for Healthcare Research and Quality
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View on The News
General Internists Now at Risk for Malpractice Claims
When doctors are asked to list the specialties that carry the highest malpractice risk, invariably they first cite obstetrics/gynecology, anesthesia, or surgery. This study shows that general internal medicine should be added to that list.
"This unrecognized risk, and the associated absence of risk management programs in ambulatory care settings across the country, is a cause for concern," said Dr. Gianna Zuccotti and Dr. Luke Sato.
"The study is a wake-up call for physicians who practice primarily in ambulatory settings and for physicians and administrators with the ability to set policy for these areas," they said.
Gianna Zuccotti, M.D., M.P.H., and Luke Sato, M.D., are at the risk Management Foundation of Harvard Medical Institutions, Boston. Dr. Zuccotti is also with Partners HealthCare Systems and is a contributing editor at JAMA. Dr. Sato also is at Brigham and Women’s Hospital. These remarks were taken from their editorial accompanying Dr. Bishop’s report (JAMA 2011;305:2464-5).
Grand Rounds Vol. 7 No. 38
June 14th, 2011 by David E. Williams of the Health business blog
Grand Rounds is a weekly summary of the best health blog posts on the Internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week. Here are a few examples of this weeks submissions....
Read More Here..........
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Healthy You
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Chronic Pot Smoking Affects Brain Chemistry, Scans Show
Damage may be reversible if the drug use stops, researchers say
TUESDAY, June 7 (HealthDay News) -- Imaging scans show that chronic daily use of marijuana can have a detrimental effect on the brain, according to a new report.
In the study, researchers revealed that chronic use of the drug caused a decrease in the number of receptors involved in a wide array of important mental and bodily functions, including concentration, movement coordination, pleasure, pain tolerance, memory and appetite.
Marijuana, also known as cannabis, is abused more than any other illegal drug in America, according to the U.S. National Institute on Drug Abuse. When smoked or ingested, the drug's psychoactive chemical binds to numerous cannabinoid receptors in the brain and throughout the body, which influence a range of mental states and actions. One of two known types of cannabinoid receptors, called CB1, is involved primarily in the central nervous system.
In conducting the study, researchers compared the brains of 30 chronic daily marijuana smokers to non-smokers over the course of roughly four weeks. Using molecular imaging, researchers were able to visualize changes in the participants' brains and found the cannabinoid CB1 receptors of the smokers had decreased by roughly 20 percent compared to the otherwise healthy people with limited lifetime exposure to marijuana.
"With this study, we were able to show for the first time that people who abuse cannabis have abnormalities of the cannabinoid receptors in the brain," lead author Dr. Jussi Hirvonen said in a Society of Nuclear Medicine news release.
The researchers re-scanned 14 of the smokers after one month of abstinence and found a notable increase in receptor activity in areas that were deficient at the beginning of the study. These findings, the investigators concluded, suggest the adverse effects of chronic marijuana use are reversible.
"This information may prove critical for the development of novel treatments for cannabis abuse. Furthermore, this research shows that the decreased receptors in people who abuse cannabis return to normal when they stop smoking the drug," Hirvonen added.
The study, which was a collaboration between the U.S. National Institute of Mental Health and U.S. National Institute on Drug Abuse, was slated for presentation Monday at the annual meeting of the Society of Nuclear Medicine in San Antonio, Texas. Because this study was presented at a medical meeting, the dataand conclusions should be viewed as preliminary until published in a peer-reviewed journal.
More information
The U.S. National Institute on Drug Abuse has more on marijuana and its effects on the brain.
Copyright © 2011 HealthDay. All rights reserved.
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New On The Blog
.Hepatitis C: Drugmakers set aside rivalries to lif...
Telaprevir/Incivek Isn't Useful for All HCV Genoty...
Noninvasive liver tests may predict hepatitis C pa...
Eat your fruits and vegetables!
When doctors are asked to list the specialties that carry the highest malpractice risk, invariably they first cite obstetrics/gynecology, anesthesia, or surgery. This study shows that general internal medicine should be added to that list.
"This unrecognized risk, and the associated absence of risk management programs in ambulatory care settings across the country, is a cause for concern," said Dr. Gianna Zuccotti and Dr. Luke Sato.
"The study is a wake-up call for physicians who practice primarily in ambulatory settings and for physicians and administrators with the ability to set policy for these areas," they said.
Gianna Zuccotti, M.D., M.P.H., and Luke Sato, M.D., are at the risk Management Foundation of Harvard Medical Institutions, Boston. Dr. Zuccotti is also with Partners HealthCare Systems and is a contributing editor at JAMA. Dr. Sato also is at Brigham and Women’s Hospital. These remarks were taken from their editorial accompanying Dr. Bishop’s report (JAMA 2011;305:2464-5).
Grand Rounds Vol. 7 No. 38
June 14th, 2011 by David E. Williams of the Health business blog
Grand Rounds is a weekly summary of the best health blog posts on the Internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week. Here are a few examples of this weeks submissions....
Chronic illness can put marital vows to the test, as you can read in the various entries at In Sickness and In Health: A Place for Couples Dealing with Illness. Read the thoughtful post on “how to claim your alone time without giving the impression you are rejecting your partner.”
Prepared Patient explains Why Angry Birds Gets More Play Than Health Apps and offers developers pointers on creating apps for people with chronic conditions. One suggestion: test apps on older people with multiple chronic conditions who have the most to gain from them.
Diabetes Mine attracted over 100 entries to its 2011 Design Challenge. The best: Pancreum (a “wearable artificial pancreas”), BLOB (a portable insulin delivery device with its own coolant for warm climes), and diaPETIC (bringing elements of gaming to the diabetes world).
If you are one of the many who regard hospital websites as authoritative, responsible voices, then it’s time to wise up. At least when it comes to robotic surgery, hospitals seem to have abdicated their responsibility to educate by turning their web real estate over to the marketing departments of the robot makers. Gary Schwitzer’s HealthNewsReview Blog has the story.
Read More Here..........
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Healthy You
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Chronic Pot Smoking Affects Brain Chemistry, Scans Show
Damage may be reversible if the drug use stops, researchers say
TUESDAY, June 7 (HealthDay News) -- Imaging scans show that chronic daily use of marijuana can have a detrimental effect on the brain, according to a new report.
In the study, researchers revealed that chronic use of the drug caused a decrease in the number of receptors involved in a wide array of important mental and bodily functions, including concentration, movement coordination, pleasure, pain tolerance, memory and appetite.
In conducting the study, researchers compared the brains of 30 chronic daily marijuana smokers to non-smokers over the course of roughly four weeks. Using molecular imaging, researchers were able to visualize changes in the participants' brains and found the cannabinoid CB1 receptors of the smokers had decreased by roughly 20 percent compared to the otherwise healthy people with limited lifetime exposure to marijuana.
"With this study, we were able to show for the first time that people who abuse cannabis have abnormalities of the cannabinoid receptors in the brain," lead author Dr. Jussi Hirvonen said in a Society of Nuclear Medicine news release.
The researchers re-scanned 14 of the smokers after one month of abstinence and found a notable increase in receptor activity in areas that were deficient at the beginning of the study. These findings, the investigators concluded, suggest the adverse effects of chronic marijuana use are reversible.
"This information may prove critical for the development of novel treatments for cannabis abuse. Furthermore, this research shows that the decreased receptors in people who abuse cannabis return to normal when they stop smoking the drug," Hirvonen added.
The study, which was a collaboration between the U.S. National Institute of Mental Health and U.S. National Institute on Drug Abuse, was slated for presentation Monday at the annual meeting of the Society of Nuclear Medicine in San Antonio, Texas. Because this study was presented at a medical meeting, the dataand conclusions should be viewed as preliminary until published in a peer-reviewed journal.
More information
The U.S. National Institute on Drug Abuse has more on marijuana and its effects on the brain.
Copyright © 2011 HealthDay. All rights reserved.
.
New On The Blog
.Hepatitis C: Drugmakers set aside rivalries to lif...
Telaprevir/Incivek Isn't Useful for All HCV Genoty...
Noninvasive liver tests may predict hepatitis C pa...
Eat your fruits and vegetables!
..
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