Thursday, October 27, 2011

Hepatitis News Ticker; Infection Clusters in Chemo Clinics

From Medscape; If you read only 1 article this year about infectious diseases, it should be this summary with practice implications by Dr. John Bartlett.

Cheryl Clark, for HealthLeaders Media, October 27, 2011
Imagine you're a cancer patient like Evelyn McKnight. You're getting your next dose of chemotherapy at an outpatient clinic, or perhaps in a special infusion room attached to your oncologist's office.
You pray the horrible process will kill your disease. You don't expect it will infect you with a life-threatening virus or bacteria.
But just before you arrive, the clinic nurse draws blood from the infusion port of another patient – call him Mr. Jones – to send to the lab. She changes the needle on the syringe, then inserts it into a large, multi-dose saline bag to draw out saline for Mr. Jones' port flush. But in doing so, the negative pressure draws particles of Mr. Jones' blood into the bag.

Now it's your turn. The nurse repeats the process, again drawing from the saline bag to flush the line, the one now entering your bloodstream.
Unfortunately, Mr. Jones is infected with hepatitis C, and this simple procedural error ends up transmitting his virus to you and every other patient who unknowingly comes in contact with the fluid in that bag...Continue Reading..

Liver Cancer

October 27, 2011 — "Hepatocellular carcinoma, one of the most lethal human cancers, is largely amenable to primary prevention with existing knowledge and technology," according to American researchers. They report a study showing strong links between liver cancer and the modifiable risk factors of smoking, heavy alcohol consumption, and obesity, and between liver cancer and chronic infection with hepatitis B and C.
The findings, from a team led by Dimitrios Trichopoulos, MD, PhD, from the Department of Epidemiology at the Harvard School of Public Health, Boston, Massachusetts, were published online October 21 in the Journal of the National Cancer Institute.
The data come from the European Prospective Investigation Into Cancer and Nutrition (EPIC), a study that followed about 500,000 individuals from 1992 to 2000 in 10 countries in Europe. From this database, Dr. Trichopoulos and colleagues identified 115 patients with hepatocellular carcinoma, and matched them with 229 control subjects.
Investigators found that the highest risk factors for liver cancer were chronic hepatitis B infection (odds ratio [OR], 9.10) and chronic hepatitis C infection (OR 13.36), followed by obesity (OR, 2.13), former or current smoking (OR, 1.98 and 4.55, respectively), and heavy alcohol intake (OR, 1.77).
Smoking a Major Contributor
The researchers highlight smoking in particular. In this European cohort, smoking was associated with more hepatocellular carcinoma than chronic hepatitis infections.
Smoking contributed to almost half of all liver cancer cases (47.6%), whereas chronic hepatitis B and C infections contributed 13.2% and 20.9% respectively, they report. Obesity contributed to 16.1% of cancer cases, and heavy alcohol intake contributed to 10.2%.
When taken together, these documented risk factors accounted for 65.7% of all liver cancer in the European cohort.
An accompanying editorial also highlights the "remarkable and controversial" finding that smoking increases the risk for liver cancer.
"Somewhat surprisingly, smoking carried an attributable risk of almost 50%, a figure that challenges our current knowledge," write editorialists Morris Sherman, MD, and Joseph Llovet, MD, both from the Mount Sinai School of Medicine in New York City.
These data are compelling and we should take note.
Although they outline some limitations to the study — including the fact that smoking was reported in more than twice as many patients with liver cancer as in control subjects — they say: "These data are compelling and we should take note."
"We should be counseling our patients who have other risk factors for hepatocellular carcinoma to quit smoking," they write.
"There are many other health reasons to stop smoking," they acknowledge, adding: "Here is one more."
The authors have disclosed no relevant financial relationships.
J Natl Cancer Inst. Published online October 21, 2011. Abstract, Editorial


From Medscape Business of Medicine

Shelly Reese
Science and religion have always had a complicated relationship, so it's not surprising that, as interest in holistic care grows, physicians are trying to come to grips with whether they should play a role in patients' spiritual care.
"We've always talked about the limitations of the biomedical model that would reduce people to our physiology," says Carol Taylor, PhD, director of the Center for Clinical Bioethics at Georgetown University. "When we talk about holistic health, we talk about biological, psychological, and social needs and now we're talking about spiritual needs as well. They're all interrelated."
More than half of physicians believe that religion and spirituality affect patient health in some way, according to research conducted by the University of Chicago. In a survey of 2000 physicians, 56% believed that religion and spirituality have much or very much influence on health, but only 6% believed they often changed "hard" medical outcomes.[1] Rather, respondents suggested that religion and spirituality help patients cope, give them a positive state of mind, or provide emotional and practical support via the religious community.

The Flu and You
I found this video the other day while I was over at Scope. In this short, fast video by TakePart, we find out how a viral pandemic could start with the video explaining how influenza viruses are spread, and the precautions we can take to prevent spreading it. The video is in connection with the Steven Soderbergh move Contagion, but still worth watching.

(Reuters) - As Americans line up for flu shots, they should consider that the vaccines may be far less effective than thought, according to a new study.

Michael Osterholm, an infectious disease specialist at the University of Minnesota, and his colleagues found that the most common flu vaccine in the United States is effective for 59 percent of healthy adults, well below the 70 percent to 90 percent level previously reported.
"We're stuck with a vaccine that has been around for 60 years and not changed much," Osterholm said in recorded remarks. He stressed the need for a new generation of flu shots, particularly in the face of a future pandemic.

There is also a lack of information about how well the vaccine works in children and in adults over the age of 65, he said. These two groups are most at risk from flu-related illness or death.
U.S. health officials recommend that all Americans over six months of age get a flu shot. Nearly 131 million people, or 43 percent of the U.S. population, received the influenza vaccine last season, according to the Centers for Disease Control and Prevention (CDC).
Sanofi, GlaxoSmithKline, Novartis, the AstraZeneca unit MedImmune, and CSL make vaccines for the U.S. market.

While Osterholm does not dispute the need for the current vaccines, he said the common perception that they are "good enough" hinders the development of novel therapies.
In a study published in The Lancet Infectious Diseases journal, Osterholm and colleagues screened 5,707 vaccine studies published in the last 40 years.
They narrowed their analysis to 31 studies that tested for the presence of flu in laboratory tests rather than counting an increase in flu antibodies -- a faster method but one that researchers say tends to overestimate the vaccine's efficacy.

They also limited results to those that used randomized controlled trials or other observational methods that did not have "selection bias," which could lead to sicker people getting excluded from the study.

A meta-analysis of the 31 studies also showed that a newer type of vaccine that uses a live virus was 83 percent effective in protecting children between six months and seven years old.
However, this type of vaccine, which is made by MedImmune, is not currently recommended as the best treatment for children by the CDC group that decides immunization practices in the United States, the study's authors said.
The Lancet study was published ahead of a meeting of this group on Wednesday.
SOURCE: The Lancet Infectious Diseases, online October 26, 2011.

For Your Reading Pleasure
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.
Hosted this week by Laika's MedLibLog:
Welcome to the Grand Rounds, the weekly summary of the best health blog posts on the Internet. I am pleased to host the Grand Rounds for the second time. The first time, 2 years ago, was theme-less, but during the round we took a trip around the library. Because, for those who don’t know me, after years of biomedical research I became a medical librarian. This also explains my choice for the current theme: DATA, INFORMATION & COMMUNICATION

A few submissions from this weeks grand rounds, to read more click here

The quite tech savvy surgeon Dr. Dheeraj (aka Techknowdoc) explores the alternatives to the invasive and uncomfortable colonoscopy procedure at Techknowdoc’s Surgical Adventures! This post is a short illustrated guide, visualizing the differences between regular colonoscopy, capsule endoscopy and Virtual Colonoscopy. It is not hard to imagine which approach people would prefer.

Another blogger, unique in its kind, “raps” his stories. Yes I’m talking about Zubin, better known as ZDoggMD. Watch how he and his mates colleagues rap “Doctors Today!” where he ”informs” folks of what it’s like to actually practice primary care medicine on the front lines

Just thought I would post one of his videos here, check it out folks.

Doctor’s Today—A Parody of Tonight Tonight

We all know that adherence to prescriptions is a problem. But will the Star Ratings system increase adherence? The big question, according to Georg van Antwerp, author of Enabling Healthy Decisions, is whether consumers care about Star Ratings or just focus on lowest price point and access to pharmacies or specific medications.

The post that Reflex Hammer submitted (the one above was just picked by me) concerns informing young children about vegetables. A few weeks ago he and a classmate were invited to give a presentation to 1st graders at an inner-city school. Wishing to combat obesity, they developed a lesson plan about vegetables. They were heartened by how much the adorable kids already knew about vegetables and how enthusiastic they became about eating their greens. An adorable initiative and a great post to end this Grand Rounds, since it illustrates the importance of doctors who enjoy to take their time to inform people.

To read all submissions click here

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