AP, 3/18/08:  A surprising number of people — more than 60 percent — still suffer significant pain a year after a traumatic injury in a car crash or other cause, showing the need for better pain treatment, researchers said.In a study published on Monday in the journal Archives of Surgery, researchers tracked 3,047 patients ages 18 to 84 from 14 U.S. states who survived an acute traumatic injury.

A year after the injury, 63 percent reported that they still experienced pain related to the injury, with most having pain in more than one region of the body.

On average, the patients assessed their pain at 5.5 on a 10-point scale — a level at which they would be expected to have moderate to severe interference with daily activities.

“I was surprised that the pain was as common and as severe as they reported it to be,” said Dr. Frederick Rivara of the University of Washington in Seattle, who led the study.

“The implications are that we need to do a much better job of identifying pain in these patients, treating it adequately and treating it early,” Rivara added in a telephone interview.

The people in the study sustained head injuries, broken limbs, chest or abdominal trauma and other injuries in motor vehicle crashes, falls and other circumstances.

Pain was most commonly seen in joints and limbs (44 percent of patients), the back (26 percent), the head (12 percent) and neck (7 percent).

UPI, 3/18/08:  Drivers and passengers not wearing seat belts in a vehicle crash resulting in an air bag deployment have a higher risk of spinal injuries, a U.S. study says.

Researchers at the University of Pittsburgh used a Pennsylvania trauma database that included approximately 12,700 patients with spinal injuries — 8,500 drivers and 4,200 passengers from 1990 to 2002. Of these, 5,500 patients had fractures of the cervical spine.

Dr. William F. Donaldson III and colleagues says the rate of cervical spine fractures was 54 percent in drivers using an airbag only, compared to 42 percent for drivers using both an airbag and seat belt.

The study, published in the journal Spine, finds that with adjustment for other factors, the relative risk of cervical spine fracture was 70 percent higher for drivers using an airbag without a seat belt, compared to drivers using both protective devices. This was even greater than the 32 percent increase in cervical fracture risk for drivers using neither an airbag nor seat belts.

Airbags were specifically designed to be used with seat belts — serious injuries may result in victims who, because they are not properly restrained by seat belts, are “out of position” when airbags deploy, Donaldson says.

USA Today, 3/18/08: (3/18, Sternberg) reports that on Friday, the Centers for Disease Control and Prevention (CDC) said that “flu activity appears to be waning nationwide.” CDC epidemiologist Anthony Fiore said, “There’s a good chance we’ve seen the worst of it.” Federal “statistics, from multiple sources, indicate that this season was anything but a standout, either in terms of the number of cases or the duration or severity of illness.” However, “[f]lu vaccinations didn’t blunt this year’s epidemic as much as usual, because only one of the three predominant flu strains circulating were covered by the vaccine.”

G’ mornin, fellow practitioners of the healing arts. 

Can D-dimers help DVT diagnosis in pregnancy?  This study used SimpliRED in a prospective study evaluating DVT in symptomatic moms-to-be.  Patients were followed with Dopplers for months.  The authors concluded that a normal D-dimer excluded DVT, and even though the specificity was low, the test is still useful.  Interesting, but total study population was 149 (< 9% had proven DVT).
http://omniphysicians.com/2008/03/18/d-dimers-in-prenancy/

Enbrel is an immunosuppressive anti-arthritic drug.  The FDA has ordered a higher level of warning for it because of the increased risk of infection, particularly TB.  It’ll be black-boxed, highlighted, and the cautioning voice of Eliot Spritzer, currently on sabbatical, will be heard whenever one turns to the Enbrel page in the PDR.
http://omniphysicians.com/2008/03/18/enbrel-tb/

In a case of pediatric anaphylaxis, you can order epinephrine either as a mass concentration (mg/mL) or ratio (mL in a 1:1000 solution).  This study tested the error potential in a simulated anaphylactic scenario.  The authors discovered that using a ratio resulted in higher, possibly inaccurate doses and a longer time to delivery.  This reinforces the previously-held concept that it’s safer to talk mg of a drug instead of mL.
http://omniphysicians.com/2008/03/18/safer-way-to-give-epi-to-kids/

This study found in Ann Intern Med concludes that pain in most sicklers is an omnipresent occurrence — much more than what healthcare pros ever considered.
http://omniphysicians.com/2008/03/18/pain-in-sicklers/

One of Obama’s top medical advisers spoke out recently.  Sounds like a squeeze of the medical profession is inevitable, at least with the Barackian Democrats.  If we perform medicine like obedient seals, then we might get an extra share of 3-day-old cod.  And forget about malpractice caps on pain & suffering.  That’ll be gone too.
http://omniphysicians.com/2008/03/17/obama-pay-for-performance-tort-reform/

Don’t bank on WHO and other global health agencies to diagnose TB early on every patient with the disease.  A couple of these factoids serve to heighten your awareness of the problem and to consider the diagnosis in patients coming in from other parts of the world or who have travelled to those areas.
http://omniphysicians.com/2008/03/18/global-tb/star porn taylor adamporn adams familyadana porn videosporn adaultto test porn addictedporn full length addictingaddiction drug pornporn addictions Map

AP, 3/18/08:  Younger ER patients with heart attack symptoms should be asked if they’ve recently used cocaine, which can cause similar chest pain, the American Heart Association warns doctors. For these patients, honesty can be a matter of life or death: Some heart attack treatments can be deadly to someone using cocaine.

New guidelines published online Monday in the American Heart Association journal Circulation say that emergency room doctors need to be aware that symptoms of a heart attack in younger patients with no heart disease risk factors may be caused by cocaine use.

The drug can cause chest pain, shortness of breath, anxiety, palpitations, dizziness, nausea and heavy sweating — all symptoms of a heart attack.

“Not knowing what you are dealing with and giving the wrong therapies could mean death rather than benefit,” said Dr. James Reiffel, professor of clinical medicine at Columbia University Medical Center/New York Presbyterian Hospital.

The number of cocaine-related users visiting ERs rose 47 percent from 1995 to 2002, increasing from 135,711 to 199,198, according to the government’s Substance Abuse and Mental Health Services Administration. (That’s a tiny percentage of the more than 100 million patient visits to emergency rooms each year.)

“The symptoms that they get with the cocaine are very similar to a heart attack,” said Dr. James McCord, who chaired the statement writing committee.

Cocaine can cause a heart attack, but only about 1 percent to 6 percent of patients with cocaine-associated chest pain actually have a heart attack, the statement says. Still, doctors say it’s important for anyone with chest pain to get it checked out.

Cocaine increases blood pressure and the heart rate, constricting arteries into the heart, said McCord, cardiology director of the chest pain unit for the Henry Ford Health System in Detroit.

“Your heart rate goes up because your heart needs more oxygen, then it shrinks the arteries to the heart,” McCord said.

The statement says that since most cocaine-associated chest pain isn’t a heart attack, such patients should be monitored instead of being admitted to the hospital. They would have an electrocardiogram and other tests to rule out a heart attack.

“If you admit everyone to hospital with chest pain, you use valuable resources,” said Reiffel.

Two typical heart attack treatments can be dangerous to those using cocaine:

_ Clot-busting drugs carry an extra risk of bleeding into the brain in patients whose blood pressure is high due to cocaine use.

_ Betablockers that can lower blood pressure without constricting arteries in typical heart attack patients have the opposite effect in cocaine users, raising blood pressure and squeezing cocaine-narrowed arteries.

Reiffel said doctors should explain why it’s important to know if a patient is using cocaine. He said that admitting use of an illegal substance is confidential information that won’t be reported to law enforcement. “The caregiver is not here to judge.”

The statement also recommends that cocaine users who do have a coronary artery blockage get a bare metal stent instead of a drug-coated one since chronic drug users may not reliably take the medication needed to prevent new blockages.

McCord said that the drug counseling available in observation units varies among hospitals, and that more could to improve the counseling cocaine-using patients get.

“I think an ideal scenario would be someone whose job is to talk to them about this — explain the extent of the health problems, give them information about resources to help them quit cocaine,” McCord said.

(3/18, Rapaport) reports that “Amgen, Inc. and Wyeth added the strongest U.S. Food and Drug Administration (FDA) warning to the prescribing information for the arthritis drug Enbrel (etanercept) to highlight the risk of infections, including tuberculosis.”

Although this information is “already in boldface, [it] must now be highlighted inside a boxed border,” after “global studies of more than 20,000 patients taking Enbrel” found that “tuberculosis was observed in about 200 people.”

Next Monday is World TB Day.  Some facts about TB around the world:

* Globally, there were 9.2 million new cases and 1.7 million deaths from tuberculosis in 2006, the latest year for which statistics are available. Of these, 700,000 cases and 200,000 deaths were among people infected with HIV.

*  The African, Southeast Asian and Western Pacific regions accounted for 83 percent of total cases reported. India, China, Indonesia, South Africa and Nigeria rank as the top five countries in terms of absolute numbers of tuberculosis cases. The African region has the highest incidence rate per capita, 363 per 100,000.

Source:  NY Times, 3/18/08

Title:  A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy. 

Source:  Ann Intern Med. 2007 Aug 7;147(3):165-70.

BACKGROUND: D-Dimer testing is often used with compression ultrasonography for the diagnosis of deep venous thrombosis (DVT) in nonpregnant patients. The D-dimer test is highly sensitive, and a negative result can obviate the need for further testing for DVT. This test has not been studied for DVT diagnosis in pregnancy because its specificity was deemed too poor.

OBJECTIVE: To determine the sensitivity and specificity and assess the utility of the SimpliRED assay (Agen Biomedical, Brisbane, Australia) for the diagnosis of DVT in pregnant women. DESIGN: Prospective cohort study.

SETTING: 5 tertiary university-affiliated Canadian hospitals providing care to obstetric patients.

PATIENTS: 149 consecutive pregnant women with suspected DVT who presented to 1 of the participating centers over 5 years.

INTERVENTION: Participating women were tested with compression leg ultrasonography (single or serially on days 0, 3, and 7) and received 3 months’ clinical follow-up for the presence or absence of DVT. Whole blood was tested with the SimpliRED assay at initial presentation, and results were correlated with ultrasonography and clinical findings for the presence or absence of DVT.

MEASUREMENTS: The sensitivity, specificity, and negative predictive value of the SimpliRED assay were calculated, along with the prevalence of false-positive SimpliRED assay results (with 95% CIs).

RESULTS: The prevalence of DVT in the cohort was 8.7% (95% CI, 5.2% to 14.4%). The sensitivity of the SimpliRED assay was 100% (CI, 77% to 100% [13 of 13 patients]), the specificity was 60% (CI, 52% to 68% [81 of 135]), and the negative predictive value was 100% (CI, 95% to 100% [81 of 81]). The SimpliRED assay was positive in 0% (CI, 0% to 60%), 24% (CI, 14% to 37%), and 51% (CI, 40% to 61%) of women in the first, second, and third trimesters, respectively, among pregnant patients in whom DVT was not diagnosed.

Limitations: The prevalence of DVT in the cohort was low, resulting in wide CIs. The clinician’s previous impression was used to determine pretest probability in the absence of a validated clinical prediction rule for pregnant women.

CONCLUSION: The SimpliRED assay may be useful in pregnancy because a normal result excludes DVT and occurs frequently enough to be clinically helpful.

The Effect of Drug Concentration Expression on Epinephrine Dosing Errors

A Randomized Trial

Daniel W. Wheeler, PhD; Joseph J. Carter, MBChB; Louise J. Murray; Beverley A. Degnan, PhD; Colin P. Dunling, BSc; Raymond Salvador, PhD; David K. Menon, MD, PhD; and Arun K. Gupta, PhD
Ann Int Med 1 January 2008 | Volume 148 Issue 1 | Pages 11-14