New ACP Guidelines for Nonradicular Low Back Pain Veronica Hackethal, MD
The American College of Physicians (ACP) has released updated guidelines for the noninvasive treatment of nonradicular subacute, acute, and chronic low back pain in primary care. The guidelines, along with updated evidence reviews, are published online February 13 in the Annals of Internal Medicine. Overall, the new guidelines emphasize conservative treatment. First-line therapy should incorporate nondrug therapies. Nonsteroidal anti-inflammatories (NSAIDs) or muscle relaxants should be conside...
February 27, 2017PPIs May Increase Risk for Chronic, Silent Kidney Damage Nicola M. Parry, DVM
Among new users of PPIs, more than half of those who go on to develop chronic kidney damage while taking the medication have no signs of acute kidney injury (AKI) beforehand, a new study shows. Yan Xie, MPH, from Veterans Affairs (VA) Saint Louis Health Care System, Missouri, and colleagues published the results of their study online February 22 in Kidney International. "[W]e show that among new users of acid suppression therapy, incident PPI users have increased risk of chronic renal outcomes...
February 27, 2017Blood Pressure Targets in Older Patients: Many Guidelines, Much Confusion An Interview With Franz Messerli, MD
In 2014, the Joint National Committee (JNC) 8 relaxed the systolic blood pressure (SBP) goal for people ≥ 60 years from < 140 mm Hg to < 150 mm Hg.[1] The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) joint practice guideline reaffirmed this target and suggested a lower goal (< 140 mm Hg) in those with a history of stroke/transient ischemic attack or at high cardiovascular risk.[2] Meanwhile, a prespecified subgroup analysis of the SPRINT tr...
February 23, 2017Treat the Risk, Not Just the Numbers, for Hypertension, From Heartwire CME, Authors: News Author: Larry Hand CME Author: Charles P. Vega, MD
High blood pressure is a highly common finding in the United States, affecting tens of millions of US adults. However, the best practice for the management of high blood pressure remains controversial. The authors of the current study provide a background in the debate over hypertension management. Research from epidemiologic studies suggests a continuous rise in the risk for cardiovascular events among adults as the systolic blood pressure increases past 115 mm Hg. However, the results from cli...
January 21, 2016http://www.medscape.com/cardiology/news BP Targets Far Below Guidelines Cut Mortality, CV Events: SPRINT Trial
WASHINGTON, DC ( updated with commentary ) — A large study funded by the National Institutes of Health (NIH) has found that a more intensive strategy of lowering blood pressure—one that aims to achieve a systolic blood-pressure target of 120 mm Hg—reduces the risk of death and cardiovascular events when compared with a strategy that lowers systolic blood pressure to conventional targets[1]. In the Systolic Blood Pressure Intervention Trial (SPRINT), investigators report that treating high...
September 15, 2015http://www.medscape.org/viewpublication/30113 Treatment vs Risk: Updated Look at ACC/AHA Statin Guidelines.
CLINICAL CONTEXT The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for cholesterol management defined new eligibility criteria for statin treatment. It was previously undetermined whether the new criteria would improve identification of adults at greater risk for cardiovascular events. The goal of the longitudinal, community-based cohort study was to determine whether the ACC/AHA guidelines better identify persons in whom incident cardiovascular disease (CVD...
September 15, 2015Defending Testosterone, Debunking the Myths
Testosterone: A Fear-Fueled Debate The effects of testosterone deficiency (also called "hypogonadism" or, informally, "low T") have been recognized for millennia. The treatment of hypogonadism has been described in medical textbooks for decades, and the symptoms are observed daily in medical practices across the country. Still, the use of supplemental testosterone has always been controversial, perhaps more so today than ever before. Its ability to improve men's sexual symptoms, boost energy, ...
July 30, 2015A pragmatic guide to asymptomatic bacteriuria and testing for urinary tract infections (UTIs) in people aged over 65 years
Asymptomatic bacteriuria is not necessarily bad bacteria It is a common misconception that urine from a healthy person is sterile. In reality bacteria from the gastrointestinal tract can readily enter the bladder via the urethra. Once in the bladder, bacteria are often eliminated by voiding or by the immune system. If this does not occur asymptomatic bacteriuria may result, 1 i.e. the presence of a significant growth of bacteria in the urine with no urinary symptoms. Alternatively, a symptoma...
July 23, 2015Aspirin Benefits Outweigh Risks in Macular Degeneration
VIENNA — Patients can continue to take aspirin as recommended by their primary care physicians without fear of worsening their macular degeneration, researchers say. "Taking patients off aspirin can cause premature morbidity and mortality," said Kent Small, MD, from Los Angeles, California. He presented a meta-analysis on aspirin, cardiovascular disease, and age-related macular degeneration here at the American Society of Retina Specialists (ASRS) 2015 Annual Meeting. Dr Small explained tha...
July 19, 2015The ABCDEFs of Direct Oral Anticoagulant Monitoring
NEW YORK (Reuters Health) - The first six letters of the English alphabet form the basis of a new checklist for monitoring patients receiving direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation. "The checklist was designed as a knowledge-translation tool to assist clinicians in providing best-practice follow-up care for patients receiving DOACs," Dr. David J. Gladstone, from Sunnybrook Health Sciences Centre, University of Toronto, Canada, told Reuters Health by emai...
July 16, 2015FDA Strengthens NSAID Warning for Heart, Stroke Risks
The US Food and Drug Administration (FDA) has strengthened an existing label warning that nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for heart attack or stroke, according to an agency alert sent today. Following a comprehensive review of new safety information, the FDA is requiring the drug labels of all prescription and over-the-counter (OTC) NSAIDs to be updated to reflect the increased risk. Prescription and OTC nonaspirin NSAIDs already include informatio...
July 16, 2015Calcium Supplements and Cardiovascular Risk 5 Years OnMark J. Bolland, MBChB, PhD, Andrew Grey, MD Ian R. Reid, MDDisclosures Ther Adv in Drug Safe. 2013;4(5):199-210.
Abstract and Introduction Abstract Calcium supplements have been widely used by older men and women. However, in little more than a decade, authoritative recommendations have changed from encouraging the widespread use of calcium supplements to stating that they should not be used for primary prevention of fractures. This substantial shift in recommendations has occurred as a result of accumulated evidence of marginal antifracture efficacy, and important adverse effects from large randomized con...
May 21, 2015Topol: Time to End Routine Mammography Eric J. Topol, MD Disclosures May 06, 2015
Mammography Is a Recipe for Net Harm The medical community prides itself on evidence to drive important decision-making. But when the evidence is contrary to entrenched medical practice, it has a hard time coming to terms. Such is the case for mammography recommendations. All of the data now available point to significant net harm—far more risk than benefit— for routine mammography. If this were a drug, the US Food and Drug Administration (FDA) would never approve it. Last year, the Swiss Me...
May 21, 2015Advances in Prostate Cancer: 2014
The year 2014 has again provided important developments in the area of prostate cancer. New data and new treatments span the spectrum of prostate cancer management, from prevention and screening to optimal strategies for localized, locally advanced, and metastatic disease. Prostate Cancer Prevention Epidemiologic and case-control studies have suggested that several agents may lower the risk for prostate cancer; however, these types of studies are not sufficient to prove benefit. Randomized con...
March 12, 2015Folate Intake, Serum Folate Levels, and Prostate Cancer Risk: A Meta-analysis of Prospective StudiesNew post
Abstract Background Studies have reported inconsistent results concerning the existence of associations of folate intake and serum folate levels with prostate cancer risk. This study sought to summarise the evidence regarding these relationships using a dose–response meta-analysis approach. Methods In January 2014, we performed electronic searches of PubMed, Embase, and the Cochrane Library to identify studies examining the effect of folate on the incidence of prostate cancer. Only prospectiv...
March 12, 2015PSA Screening Does Reduce Deaths, but Is Not Recommended
By Roxanne Nelson, August 06, 2014 Routine prostate-specific antigen (PSA) screening for prostate cancer does save lives: the updated results from the European Randomised study of Screening for Prostate Cancer (ERSPC) confirm that there is a substantial reduction in prostate cancer mortality attributable to PSA screening. The updated results were initially presented in April at the European Association of Urology 29th Annual Congress and have now been published in the Lancet. However, desp...
March 3, 2015Fever in the returning child traveller: approach to diagnosis and management
Correspondence to Dr Jay Halbert, Department of Paediatrics, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK; J.Halbert@nhs.netAbstract During the last half century there has been an exponential increase in international travel including to more exotic and long-haul destinations. The assessment of febrile returning child travellers present...
October 29, 2014Vitamin D and Mortality Risk: Should Clinical Practice Change? An Expert Interview With Cedric F. Garland, DrPH Linda Brookes, MSc, Cedric F. Garland, DrPHDisclosures August 13, 2014
Vitamin D and Mortality -- Are They Linked?Vitamin D, "the sunshine vitamin," is rarely out of the news nowadays, with reports of new studies contributing regularly to the ongoing debate about optimal levels of the hormone, indications for testing, and need for supplementation. Traditionally associated with skeletal disease including osteoporosis and fractures, low levels of serum 25-hydroxyvitamin D (25[OH]D), the metabolite usually measured as a mark of vitamin D status, more recently have bee...
August 21, 2014Medscape Medical News > Oncology Children Face the Highest Health Risk From Cell Phones Roxanne Nelson August 13, 2014
The potential harm from microwave radiation (MWR) emitted by wireless devices, particularly for children and unborn babies, is the highlight of a new review.Although the data are conflicting, associations between MWR and cancer have been observed. The review, by L. Lloyd Morgan, senior science fellow at Environmental Health Trust, and colleagues, was published online July 15 in the Journal of Microscopy and Ultrastructure. The authors reviewed the current literature show...
August 20, 2014Medscape Emergency Medicine Ebola: What US Clinicians Need to Know Robert Glatter, MDDisclosures August 04, 2014
IntroductionAs Ebola virus continues to spread across West Africa, an infected US physician has arrived at Emory University Hospital in Atlanta for treatment, while a second infected American will leave Liberia on Tuesday for treatment at the same hospital. It is now important that all healthcare providers be well informed about this worsening epidemic. In the past, most outbreaks of Ebola in West Africa have been localized and well contained. What distinguishes this outbreak, which began in Mar...
August 8, 2014Medscape Infectious Diseases > Ignorance Might Be Bliss: Asymptomatic Bacteriuria Paul G. Auwaerter, MDDisclosures July 10, 2014
Hello. I am Paul Auwaerter, for Medscape Infectious Diseases, speaking from the Division of Infectious Diseases at Johns Hopkins University School of Medicine. Today I want to talk about asymptomatic bacteriuria.Many of us in the ID field know that if we use the term "asymptomatic bacteriuria," we are not supposed to give antibiotics to that patient. When this comes up on the wards and I am working with medical students or residents, the admonition "Don't do something; stand there" often comes i...
July 17, 2014Medscape Internal Medicine Statins and Antibiotics: Which Combination Is Safest? Douglas S. Paauw, MDDisclosures June 12, 2014
The combination of simvastatin and gemfibrozil, both medications the patient was taking at the time of his presentation, can lead to rhabdomyolysis. Simvastatin combined with clarithromycinalso presents a potential for this potentially serious adverse event. Rhabdomyolysis rarely occurs as a result of administration of a statin only; this complication is almost always seen in patients taking multiple drugs that can interact with a statin and increase the potential for this life-threatening ...
June 18, 2014New European Guidelines Address Hyponatremia Management
New guidelines on the diagnosis, classification, and treatment of true hypotonic hyponatremia have been published online in theEuropean Journal of Endocrinology. The guidelines focus on managing patients, rather than on treating absolute sodium levels, the authors emphasize."Hyponatremia, defined as a serum sodium concentration of less than 135 mmol/L, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice," write Goce Spasovski, MD, PhD, fro...
May 14, 2014Medscape Oncology No Amount of Alcohol Is Safe Laura A. Stokowski, RN, MSDisclosures April 30, 2014
Responsible Drinking? Not Very"Responsible drinking" has become a 21st-century mantra for how most people view alcohol consumption. But when it comes to cancer, no amount of alcohol is safe.[1] That is the conclusion of the 2014 World Cancer Report (WCR), issued by the World Health Organization's International Agency for Research on Cancer (IARC). Declared a carcinogen by the IARC in 1988,[2] alcohol is causally related to several cancers. "We have known for a long time that alcohol ca...
May 5, 2014Proteinuria Is Underdiagnosed, Leading to Inadequate Treatment By Bridgett Novak April 30, 2014
NEW YORK (Reuters Health) - Proteinuria is undetected and untreated in many patients, according to a study presented April 23 at the National Kidney Foundation's 2014 Spring Clinical Meeting in Las Vegas.The findings are from Dr. Vishesh Kumar, who reviewed the records of 298 patients admitted to Albany Medical College in Albany, New York, where he is a resident, and St. James Hospital in Chicago between January 1 and June 1, 2013. On routine urinalysis, 40% had proteinuria, but just 37% of them...
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