Subject: Healthcare After the Tsunami

From: "Medscape Week in Review"<[email-masked]>
Date: Tue, 15 Mar 2005 17:15:48 -0500 (EST)

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Top Stories

Healthcare After the Tsunami: From the Front Lines in Banda Aceh

What Are the Options Available for Anti-inflammatory Drugs in the Aftermath of Rofecoxib's Withdrawal?

Conference Coverage -- American College of Cardiology 2005 Annual Scientific Session

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Feature Articles

Instant Poll
Effect of New Oversight Board on Drug Safety?
In a Medscape Instant Poll that launched March 8, 46% of respondents said that the proposed FDA Drug Safety Oversight Board will slightly improve drug safety. But 37% said it will have no effect on drug safety. As of March 10, a total of 228 respondents had taken part in this poll. To view the full results of the poll, which ended on March 15, click on the title above.

Letters
Readers' Responses to the Webcast Video Editorial Entitled "Evidence-Based Medicine or Faith-Based Medicine?"
Readers respond to the Webcast Video Editorial entitled "Evidence-Based Medicine or Faith-Based Medicine?"
Medscape General Medicine 7(1) 2005

Allergy/Clinical Immunology
The Influence of Smoking on the Treatment Response in Patients With Asthma
This review summarizes the clinical evidence for corticosteroid resistance and the effect smoking has on other drugs commonly used to treat patients with asthma.

Business of Medicine
American Health "System" Reform-- Part 6; How to Grade the Current System and Proposed Reforms
Dr. George Lundberg determined that there were eleven key elements to use to judge a health system. This editorial explains that criteria.
Medscape General Medicine 7(1) 2005

Cardiology
Conference Coverage -- American College of Cardiology 2005 Annual Scientific Session
Read early highlights, including TNT, ASCOT, and head-to-head comparisons of drug-eluting stents... plus see what's to come of our coverage from this year's ACC meeting.

Risk Assessment and Stratification Following High-Risk Myocardial Infarction: Insights From VALIANT
VALIANT was the largest trial so far in high-risk post-MI patients -- now further subanalyses have yielded important insights into using echo, GFR, and QRS to assess these high-risk patients.

Critical Care
Vasoactive Drug Use in Septic Shock
A review of the mechanisms, clinical use, and observed pitfalls of the most common and a few uncommon vasodilator agents.
Semin Respir Crit Care Med 25(6) 2004

Impedance Cardiography to Improve Physician Estimation of Hemodynamic Parameters
The authors examined treating physicians' abilities to assess stroke volume, cardiac output, and systemic vascular resistance by comparing clinicians' estimates of these values to ICG measurements.

Dermatology
Rosacea in a New Light
Learn more about how pulse dye lasers are being optimized to enhance treatment of this common skin disorder.
SKINmed 4(1) 2005

Clinical Use of Restylane
There is no ideal filler substance, but Restylane is a stabilized hyaluronic acid that has proven to be a versatile augmenting agent.

Occupational Allergic Contact Dermatitis from Antioxidant Amines in a Dental Technician
An 18-year-old dental technician presents with dry hyperkeratotic lesions on his left palm.

Diabetes & Endocrinology
PCOS: Differences Between Endocrinologists and Gynaecologists in Diagnosis and Management
This study showed a lack of consensus between endocrinologists and gynecologists in their investigation, diagnosis, and treatment of polycystic ovary syndrome.
Clin Endocrinol 62(3) 2005

Aldosterone - The Future Challenge in Cardiovascular Disease?
The challenge is to transfer the experimental evidence into clinical practice.

Family Medicine/Primary Care
Cognitive Behavioral Therapy May Be Helpful in the Primary Care Setting for Panic Disorder
A randomized study showed that in the primary care setting, cognitive behavioral therapy with pharmacotherapy was better than usual care.
Medscape Medical News2005

Genetic Testing For Alzheimer's Disease And Its Impact on Insurance Purchasing Behavior
Widespread genetic testing for Alzheimer's susceptibility could present dilemmas for long-term care insurance.

Sibutramine May Be Safe and Effective for Weight Loss in Obese Adolescents
In a randomized, six-month trial, no participant withdrew because of adverse events; there was no difference in blood pressure or heart rate between groups and no echocardiographic changes.

Gastroenterology
A 2-Month-Old With Persistent Diarrhea
The patient was admitted to the hospital for dehydration associated with persistent diarrhea. Read the case report and make the diagnosis.
Medscape General Medicine 7(1) 2005

Outcomes Following Endoscopic Application of Photodynamic Therapy for Advanced Cholangiocarcinoma
The authors assessed the outcome in patients with nonresectable cholangiocarcinoma after endoscopic application of PDT directly into the biliary tract.

General Surgery
Establishment of the World's First Telerobotic Remote Surgical Service
This interesting article reports on the establishment of the world's first telerobotic surgical service between a teaching hospital and a rural community hospital.
Ann Surg 241(3) 2005

Hemorrhagic Complications during Long-Term Postoperative Warfarin Administration
Does postoperative adjunctive use of warfarin with aspirin increase the risk of major hemorrhagic events?

HIV/AIDS
Antiretroviral Therapy and Cardiovascular Risk: An Expert Interview With Richard Elion, MD
Management of cardiovascular and metabolic risks has emerged as a critical task for HIV specialists. Learn the latest about this topic from a clinical expert.
Medscape HIV/AIDS 11(1) 2005

Antiretroviral Drug Interactions: An Expert Interview With Corky Steinhart, MD, PhD
From CROI 2005: Learn more about the latest data on drug interactions that are key to the clinical care of HIV-infected patients.

Fine-Tuning ART: Switch Strategies to Improve Therapy
In this CME-certified review, learn state-of-the-art antiretroviral switch strategies for patients with adherence challenges, toxicities, and other concerns.

Hematology-Oncology
Conference Coverage -- European Society of Medical Oncology Congress
The evidence for the additive benefit of the newer targeted therapies when used with chemotherapy for colorectal cancer is increasing. Read more in coverage.

Adding Temozolomide to Radiotherapy May Improve Survival in Glioblastoma
The editorialist refers to this randomized study, which showed a clinically meaningful and statistically significant survival benefit with minimal additional toxicity, as a landmark trial.

Bladder Preservation Protocols in the Treatment of Muscle-Invasive Bladder Cancer
Bladder-preserving therapy is a safe and effective alternative to cystectomy for carefully selected patients.

Infectious Diseases
Rapid Identification of Emerging Pathogens: Coronavirus
These authors describe a new approach for infectious disease surveillance that facilitates rapid identification of known and emerging pathogens.
Emerg Infect Dis 11(3) 2005

Multidrug-Resistant Acinetobacter baumannii
New epidemiologic data on A. baumannii may explain why the pathogen is so difficult to control.

Internal Medicine
Adding Clopidogrel to Aspirin Improves Outcome in STEMI Patients Receiving Fibrinolytic Therapy
In a randomized study, adding clopidogrel improves the patency rate of the infarct-related artery and reduces ischemic complications in these patients 75 years or younger.
Medscape Medical News2005

Med Students
A Doctor's Duty in a Palestinian Prison Camp in Israel
The following diary describes the first week from a month that Dr. Lev spent as the physician of Palestinian and Israeli soldiers -- detainees and jailers -- in an army camp used as a prison.
Medscape General Medicine 7(1) 2005

Residency Programs Not Preparing Students for Geriatric Population
Nearly three fourths of residency programs have no geriatric component; others offer "minimal" training, a survey found.

Molecular Medicine
Global Gene Expression Profiling in Whole-Blood Samples from Individuals Exposed to Metal Fumes
Data demonstrates that with a paired sampling study design of pre- and postexposed individuals, small changes in gene expression profiling can be measured in whole-blood total RNA
Environ Health Perspect 113(2) 2005

Will Heart Valve Tissue Engineering Change the World?
In the same way as genetic engineering, tissue engineering has captured the imagination of clinicians, scientists, investors and most importantly those who stand to be affected most, patients.

Nephrology
Journal Scan
Should gentamicin cream at the exit site be the prophylaxis of choice for PD patients? Is therapy with half-doses of an ACE and ARB better than full-dose therapy with either agent alone?
Medscape Nephrology 1(1) 2005

Neurology & Neurosurgery
Paraneoplastic Disorders of the Central Nervous System: Update on Diagnostic Criteria and Treatment
Learn about clinical features and treatment of classic paraneoplastic disorders (PND) of the CNS, and review evidence of a hypothetically effective antitumor immunity in patients with PND.
Semin Neurol 24(4) 2004

Triptan Nonresponder Studies: Implications for Clinical Practice
Patients with a poor response to one triptan can benefit from subsequent treatment with a different triptan.

Nursing
Healthcare After the Tsunami: From the Front Lines in Banda Aceh
Where are we 2 months out? The emergency is clearly over, clean up is progressing well, and previously existing infrastructures are beginning to be re-established. But some problems persist.
Medscape Nurses 5(1) 2005

Curriculum Models for the Practice Doctorate in Nursing
The NONPF Practice Doctorate Task Force offers the first published elaboration of the different models for the practice doctorate curriculum.

The Nursing Shortage and Relation to Modern Stereotypes
A nursing student offers her thoughts on the nursing shortage.

Ob/Gyn and Women's Health
Uterine Anomalies
Management of these conditions typically relates to 3 primary issues: menstrual problems, fertility problems, and sexual function problems.
Medscape Ob/Gyn

Ophthalmology
Journal Scan
Several retinal studies are the focus of this month's Journal Scan, including developments in anti-VEGF agents and delivery approaches.
Medscape Ophthalmology 6(1) 2005

Orthopaedics
Journal Scan
The latest in ACL reconstruction, the role of CT in planning ACL surgery, and the utility of MRI studies in hip arthroscopy are key topics spotlighted in this Journal Scan.
Medscape Orthopaedics

Pathology & Lab Medicine
Relative Microvessel Area of the Primary Tumour Predicts Presence of Bone Marrow Micrometastases
New data are consistent with a model of direct haematogenous spread from the primary breast cancer without orderly progression from local to nodal, and then to distant disease.
Breast Cancer Res 7(2) 2005

Pediatrics
Clinical Evidence Reviewed for Common Botanical Dietary Supplements in Children
This review discusses Andrographis paniculata, cranberry, echinacea, evening primrose seed oil, garlic, ivy leaf, and valerian.
Medscape Medical News2005

Oral Dexamethasone May Benefit Children With Moderate to Severe Pharyngitis
In a randomized study, children given a single dose of oral dexamethasone had earlier onset of pain relief and shorter duration of sore throat than did those given placebo.

Sunflower Oil May Help Reduce Nosocomial Infections in Preterm Infants
A randomized study showed that daily application of sunflower oil, but not Aquaphor, compared with no treatment significantly reduced nosocomial infections for preterm infants.

Pharmacist
FDA Approvals: Clarinex, Abilify, Isovorin
The FDA has approved desloratadine/pseudoephedrine sulfate extended-release tablets, (Clarinex-D 24-hour), a new indication for aripiprazole tablets and oral solution (Abilify), and two indications for the orphan drug levofolinic acid (Isovorin).
Medscape Medical News2005

ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing
The investigators noted an increase in the use of evidence-based clinical practice guidelines, suggesting the emergence of more comprehensive approaches to improving prescribing.

Effect of a Computerized Prescriber-Order-Entry System on Reported Medication Errors
The Institute of Medicine recently recommended that hospitals adopt computerized prescriber-order-entry (CPOE) systems with medication clinical decision support.

Psychiatry
Schizophrenia and Recovery: An Expert Interview With Stephen R. Marder, MD
Schizophrenia is one of the 10 most disabling conditions worldwide, according to the WHO. Can people with this disorder fully function? What is the most effective approach to rehabilitation?
Medscape Psychiatry

Alcohol Screening in Young Persons Attending a Sexually Transmitted Disease Clinic
Is the CAGE screening test adequate for young persons with suspected alcohol use disorders?

Genetic Testing For Alzheimer's Disease And Its Impact on Insurance Purchasing Behavior
Widespread genetic testing for Alzheimer's susceptibility could present dilemmas for long-term care insurance.

Public Health & Prevention
March is DVT Awareness Month
Up to 2 million Americans are affected by DVT annually, yet 74% of Americans have little or no awareness of this deadly condition.
APHA 2007

Pulmonary Medicine
1-Year-Old With Dyspnea
The least likely cause for unilateral hyperlucent lung at this age is....
Appl Radiol Online 4(2) 2005

The Interactions Between Cigarette Smoking and Reduced Lung Function on Systemic Inflammation
Active smoking increased the odds of having elevated CRP levels by 63%.

Radiology
Successful Treatment of Hepatocellular Adenoma with Percutaneous Radiofrequency Ablation
The objective of this study was to report the safe and successful treatment of hepatocellular adenoma with percutaneous radiofrequency ablation.
Am J Roentgenol 184(3) 2005

Imaging of Acute Stroke
The authors review the use of computed tomography (CT), magnetic resonance (MR) imaging, diffusion/perfusion MR, perfusion CT, and CT angiography in the setting of acute stroke.

Rheumatology
What Are the Options Available for Anti-inflammatory Drugs in the Aftermath of Rofecoxib's Withdrawal?
The withdrawal of rofecoxib (a selective COX-2 inhibitor) has led to an intense debate (and significant confusion) about the benefits and risks of other NSAIDs.
Medscape Rheumatology 6(1) 2005

Transplantation
Liver Transplantation in Patient With Suspected Hepatoma
How would you estimate the risk of tumor recurrence in a liver transplant candidate with a ruptured hepatoma? Would you consider this patient a candidate for liver transplantation?
Medscape Transplantation 6(1) 2005

Auxiliary Partial Orthotopic Living Donor Liver Transplantation: Kyoto University Experience
Results of this study suggest that the indications for APOLT should be reconsidered in view of the risk for complications and retransplantation.

Urology
Premature Ejaculation: Past, Present, and Future Perspectives
Focus on the epidemiology of premature ejaculation (PE), its impact on both patients and partners, and current therapies.

Is Coronal CT Imaging a More Accurate Method of Measuring the Size of Urinary Tract Stones?
In this commentary on an article from the Journal of Urology by Nadler and colleagues, the use of coronal images is held to be necessary only in "complex and difficult cases."

What Are The Latest Treatments For Managing Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) and chronic constipation are 2 of the most prevalent conditions seen in primary care practices in the United States. For the latest information on managing IBS, visit the IBS and Chronic Constipation Resource Center.

What Are The Latest Treatment Options For Major Depressive Disorders?
Major depression is the leading cause of disability worldwide among persons aged 5 and older. Read the latest news and information on effective diagnostic tools and clinical interventions to treat depression at Medscape.com's Depression Resource Center.

Product Spotlight
Product Information from Industry

ULTRACET (37.5 mg tramadol HCl / 325 mg acetaminophen tablets) for short-term management of acute pain - Learn more about Ultracet for relief of acute pain associated with osteoarthritis flare pain, postsurgical pain, joint/muscle pain, strains, and sprains. Get clinical findings, WHO Pain Relief Recommendations, full prescribing information, and more.

Aranesp® (darbepoetin alfa) for treatment of anemia associated with chronic kidney disease - Aranesp® is indicated for treatment of anemia associated with chronic kidney disease, including patients on dialysis and patients not on dialysis.

Namenda® (memantine hydrochloride) - Indicated for the treatment of moderate to severe dementia of the Alzheimer's type. Review clinical findings, read full Prescribing Information.

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