by Paul Rega, MD — published on July 31st, 2011
http://www.reuters.com/article/2011/03/01/us-bp-meds-study-idUSTRE7207HD20110301
(Reuters Health) – “A thorough look at the medical evidence suggests people who’ve had a stroke or a heart attack might benefit from taking blood pressure medications, even if they don’t have high blood pressure.
Researchers found that for every 1,000 people taking the drugs in clinical trials, on average 15 fewer died from heart disease than when the patients got dummy treatment…..”
Antihypertensive Treatment and Secondary Prevention of Cardiovascular Disease Events Among Persons Without Hypertension: A Meta-analysis
Angela M. Thompson, Tian Hu, Carrie L. Eshelbrenner, Kristi Reynolds, Jiang He, Lydia A. Bazzano JAMA. 2011;305(9):913-922.
“ Among patients with clinical history of CVD but without hypertension, antihypertensive treatment was associated with decreased risk of stroke, CHF, composite CVD events, and all-cause mortality. “
by Paul Rega, MD — published on July 30th, 2011
Medication prescribing errors in the prehospital setting and in the ED
Published online: 11 July 2011
Adi Einan Lifshitz, Lee Hilary Goldstein, Moshe Sharist, Refael Strugo, Einav
Asulin, Shmuael Bar Haim, Zvi Feigenberg, Matitiahu Berkovitch, Eran Kozer
DOI: 10.1016/j.ajem.2011.04.023
American Journal of Emergency Medicine
http://www.ajemjournal.com/article/S0735-6757%2811%2900211-7/abstract
by Paul Rega, MD — published on July 29th, 2011
2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
American Academy of Family Physicians, American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons, R. Scott Wright, Jeffrey L. Anderson, Cynthia D. Adams, Charles R. Bridges, Donald E. Casey, Jr, Steven M. Ettinger, Francis M. Fesmire, Theodore G. Ganiats, Hani Jneid, A. Michael Lincoff, Eric D. Peterson, George J. Philippides, Pierre Theroux, Nanette K. Wenger, and James Patrick Zidar
J Am Coll Cardiol published 28 March 2011, 10.1016/j.jacc.2011.02.009
http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.02.009v1
by Paul Rega, MD — published on July 24th, 2011
The Scope of Nonsuicidal Self-Injury on YouTube
Stephen P. Lewis, Nancy L. Heath, Jill M. St Denis, and Rick Noble
Pediatrics 2011;127 e552-e557
http://pediatrics.aappublications.org/cgi/content/abstract/127/3/e552?etoc
by Paul Rega, MD — published on July 23rd, 2011
http://archsurg.ama-assn.org/cgi/content/abstract/146/1/46
Possible Geographical Barriers to Trauma Center Access for Vulnerable Patients in the United States
An Analysis of Urban and Rural Communities
Renee Hsia, MD, MSc; Yu-Chu Shen, PhD
Arch Surg. 2011;146(1):46-52. doi:10.1001/archsurg.2010.299
“A significant segment of the US population (representing 38.4 million people) does not have access to trauma care within 1 hour of driving time. Moreover, certain vulnerable groups are at higher risk than others for worse access to trauma centers. “
by Paul Rega, MD — published on July 23rd, 2011
Bjornson C, Russell KF, Vandermeer B, Durec T, Klassen TP, Johnson DW.
Nebulized epinephrine for croup in children. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD006619. DOI: 10.1002/14651858.CD006619.pub2.
by Paul Rega, MD — published on July 22nd, 2011
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm263964.htm
http://www.medwire-news.md/38/93533/Cardiology_News/US_FDA_approves_ticagrelor.html
For Immediate Release: July 20, 2011
Media Inquiries: Sandy Walsh, 301-796-4669, sandy.walsh@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA
FDA approves blood-thinning drug Brilinta to treat acute coronary syndromes
Boxed warning says daily aspirin doses above 100 milligrams decrease effectiveness
The U.S. Food and Drug Administration today approved the blood-thinning drug Brilinta (ticagrelor) to reduce cardiovascular death and heart attack in patients with acute coronary syndromes (ACS).
ACS includes a group of symptoms for any condition, such as unstable angina or heart attack, that could result from reduced blood flow to the heart. Brilinta works by preventing the formation of new blood clots, thus maintaining blood flow in the body to help reduce the risk of another cardiovascular event.
Brilinta has been studied in combination with aspirin. A boxed warning to health care professionals and patients warns that aspirin doses above 100 milligrams per day decrease the effectiveness of the medication.
“In clinical trials, Brilinta was more effective than Plavix in preventing heart attacks and death, but that advantage was seen with aspirin maintenance doses of 75 to 100 milligrams once daily,” said Norman Stockbridge, M.D., Ph.D., director of the Division of Cardiovascular and Renal Products in the FDA’s Center for Drug Evaluation and Research.
The boxed warning also says that, like other blood-thinning agents, Brilinta increases the rate of bleeding and can cause significant, sometimes fatal, bleeding. The most common adverse reactions reported by people taking Brilinta in clinical trials were bleeding and difficulty breathing (dyspnea).
Brilinta was approved with a Risk Evaluation and Mitigation Strategy, a plan to help ensure that the drug’s benefits outweigh its risks. As part of that plan, the company must conduct educational outreach to physicians to alert them about the risk of using higher doses of aspirin. In addition, Brilinta will be dispensed with a Medication Guide that informs patients of the most important information about the medication. The guide will be distributed each time a patient fills their prescription.
Brilinta is made by AstraZeneca of Wilmington, Del.
For information:
National Heart, Lung and Blood Institute: Heart Attack1
Approved Drug: Questions and Answers2
by Paul Rega, MD — published on July 22nd, 2011
Oral Osteoporosis Drugs (bisphosphonates): Drug Safety Communication – Potential Increased Risk of Esophageal Cancer
Includes: Fosamax (alendronate), Actonel (risedronate), Boniva (ibandronate), Atelvia (risedronate delayed release), Didronel (etidronate), and Skelid (tiludronate)
[Posted 07/21/2011]
AUDIENCE: Geriatrics, Family Practice, Internal Medicine
ISSUE: FDA notified healthcare professionals and patients about its ongoing review of data from published studies to evaluate whether use of oral bisphosphonate drugs is associated with an increased risk of cancer of the esophagus. FDA has not concluded that taking an oral bisphosphonate drug increases the risk of esophageal cancer. There are insufficient data to recommend endoscopic screening of asymptomatic patients. FDA will continue to evaluate all available data supporting the safety and effectiveness of bisphosphonate drugs and will update the public when more information becomes available.
BACKGROUND: Oral bisphosphonates are commonly used for the prevention and treatment of osteoporosis as well as to treat other bone diseases such as Paget’s disease. There have been conflicting findings from studies evaluating the risk of esophageal cancer. Esophagitis and other esophageal events have been reported, particularly in patients who do not follow the specific directions for use of oral bisphosphonates. See the Data Summary in the Drug Safety Communication for additional details.
RECOMMENDATION: Patients should talk with their healthcare professional about the benefits and risks of taking oral bisphosphonates and how long they should expect to take them. Patients should talk with their healthcare professional if they develop swallowing difficulties, chest pain, new or worsening heartburn, or have trouble or pain when swallowing. Patients should be instructed to carefully follow the directions for use of the oral bisphosphonate drug they are prescribed.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:
- Complete and submit the report Online: www.fda.gov/MedWatch/report.htm1
- Download form2 or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
[07/21/2011 - Drug Safety Communication3 - FDA]
by Paul Rega, MD — published on July 22nd, 2011
Ball, Chad G.; Wyrzykowski, Amy D.; Nicholas, Jeffrey M.; Rozycki, Grace S.; Feliciano, David V. Journal of Trauma-Injury Infection & Critical Care. 70(2):330-333, February 2011. doi: 10.1097/TA.0b013e318203285c
Balloon catheter tamponade can be used in multiple anatomic regions and for variable patterns of injury to arrest ongoing hemorrhage.
by Paul Rega, MD — published on July 14th, 2011
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6027a1.htm?s_cid=mm6027a1_e&source=govdelivery
Smoking in Top-Grossing Movies — United States, 2010
MMWR WeeklyJuly 15, 2011 / 60(27);910-913
Number of tobacco incidents in top-grossing movies, by movie rating — United States, 1991–2010. The figure above shows the number of tobacco incidents in top-grossing movies, by rating, in the United States during 1991-2010. From 2005 to 2010, the total number of tobacco incidents in top-grossing movies decreased 56.0%, from 4,152 to 1,825. The total number of incidents in G or PG movies decreased 93.6%, from 472 to 30, whereas the number in PG-13 movies decreased 65.1%, from 1,621 to 565, and the number in R-rated movies decreased 40.5%, from 2,059 to 1,226.
Number of tobacco incidents per top-grossing youth-rated movie (G, PG, and PG-13) among motion picture companies with and without published policies* aimed at reducing smoking — United States, 2002–2010. The figure above shows the number of tobacco incidents per top-grossing youth-rated movie (G, PG, and PG-13) among motion picture companies, with and without published policies aimed at reducing smoking in the United States, from 2002-2010. From 2005 to 2010, among the three major motion picture companies (half of the six members of the Motion Picture Association of America [MPAA]) with policies aimed at reducing tobacco use in their movies, the number of tobacco incidents per youth-rated movie decreased 95.8%, from an average of 23.1 incidents per movie to an average of 1.0 incident. For independent companies (which are not MPAA members) and the three MPAA members with no antitobacco policies, tobacco incidents decreased 41.7%, from an average of 17.9 incidents per youth-rated movie in 2005 to 10.4 in 2010, a 10-fold higher rate than the rate for the companies with policies.
by Paul Rega, MD — published on July 10th, 2011
JAAPA. 2011 Jun;24(6):34, 36-8.
PAs in the ED: do physicians think they increase the malpractice risk?
Gifford A, Hyde M, Stoehr JD
Abstract
“…..As physicians gain clinical experience with PAs, their perceived risk of malpractice tends to decrease…….”
by Paul Rega, MD — published on July 10th, 2011
Lawn mower injuries: Another reason why God invented asphalt
