2008 April 13

New algorithm for the treatment of gastro-oesophageal reflux disease.

Aliment Pharmacol Ther Start a Discussion »

Apr 132008

New algorithm for the treatment of gastro-oesophageal reflux disease.

Aliment Pharmacol Ther. 2008 Feb 1;27(3):249-56

Authors: Tytgat GN, McColl K, Tack J, Holtmann G, Hunt RH, Malfertheiner P, Hungin AP, Batchelor HK

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is associated with a variety of typical and atypical symptoms. Patients often present in the first instance to a pharmacist or primary care physician and are subsequently referred to secondary care if initial management fails. Guidelines usually do not provide a clear guidance for all healthcare professionals with whom the patient may consult. AIM: To update a 2002-treatment algorithm for GERD, making it more applicable to pharmacists as well as doctors. METHODS: A panel of international experts met to discuss the principles and practice of treating GERD. RESULTS: The updated algorithm for the management of GERD can be followed by pharmacists, for over-the-counter medications, primary care physicians, or secondary care gastroenterologists. The algorithm emphasizes the importance of life style changes to help control the triggers for heartburn and adjuvant therapies for rapid and adequate symptom relief. Proton pump inhibitors will remain a prominent treatment for GERD; however, the use of antacids and alginate-antacids (either alone or in combination with acid suppressants) is likely to increase. CONCLUSION: The newly developed algorithm takes into account latest clinical practice experience, offering healthcare professionals clear and effective treatment options for the management of GERD.

PMID: 17973975 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Iron and thrombosis.

Ann Hematol Start a Discussion »

Apr 132008

Iron and thrombosis.

Ann Hematol. 2008 Mar;87(3):167-73

Authors: Franchini M, Targher G, Montagnana M, Lippi G

Although essential for cell physiology, an increase or depletion of body iron has harmful effects on health. Apart from iron deficiency anemia and iron overload-related organ tissue damage, there are increasing evidences that body iron status is implicated in atherosclerotic cardiovascular diseases. The hypothesis formulated in 1981 that iron depletion may protect against cardiovascular events is intriguing and has generated a significant debate in the last two decades. Indeed, to study this phenomenon, several investigators have tried to design appropriate experimental and clinical studies and to identify useful biochemical and genetic markers of iron status. The results of the literature on the effect of iron deficiency and overload on vascular health are critically reviewed in this study from a pathogenic and clinical point of view.

PMID: 18066546 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

The natural history of back pain after a randomised controlled trial of acupuncture vs usual care–long term outcomes.

Acupunct Med Start a Discussion »

Apr 132008

The natural history of back pain after a randomised controlled trial of acupuncture vs usual care--long term outcomes.

Acupunct Med. 2007 Dec;25(4):121-9

Authors: Prady SL, Thomas K, Esmonde L, Crouch S, MacPherson H

INTRODUCTION: There is growing evidence about the effectiveness of acupuncture in the short term treatment of chronic low back pain but little is known about long term outcomes. To address this question we followed up participants of a past randomised controlled trial of acupuncture to assess outcomes after 5.5 to 7 years. METHODS: A postal questionnaire assessing pain, quality of life, disability, experience with back pain and healthcare resource use was sent to all 239 participants of the York Acupuncture for Back Pain trial. RESULTS: Response to the survey was low at 43.9%. Pain measured by the SF-36 Bodily Pain dimension was maintained in the acupuncture group since the last follow up 3.5 to 5 years previously. The usual care group had improved over the intervening years and there was now no evidence of a difference between the groups (difference -0.4 points, 95% confidence interval -10.1 to 9.7). The results were unchanged on sensitivity analysis using multiple imputation. In both groups back pain had not completely resolved and worry about back health was moderate. Physiotherapy and acupuncture were used at similar rates for continuing treatment. DISCUSSION: We theorise that exposure to a short course of acupuncture speeds natural recovery from a back pain episode, but improvements plateau after two years. Acupuncture is often accessed privately for long term management of back pain but is rarely available within the health service. While our study methods were robust, the low response rate means that our findings should be interpreted with caution.

PMID: 18160922 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Low-grade inflammation in white-coat hypertension.

Med Sci Monit Start a Discussion »

Apr 132008

Low-grade inflammation in white-coat hypertension.

Med Sci Monit. 2007 Dec;13(12):CR570-3

Authors: Ozdogan M, Bozcuk H, Coban E

BACKGROUND: C-reactive protein (CRP), a marker of systemic low-grade inflammation, is frequently elevated in essential hypertension and predicts cardiovascular prognosis independently of conventional risk factors. The risk profile of white-coat hypertension is not yet completely clear. The aim of this study was to determine the levels of high-sensitivity CRP (hs-CRP) in white-coat hypertensive subjects. MATERIAL/METHODS: Thirty-six age-, sex-, and body mass index-matched white-coat hypertensive subjects, 36 essential hypertensive patients, and 36 normotensive subjects were included in the study. RESULTS: Hs-CRP levels were significantly higher in the essential hypertensive and white-coat hypertensive groups than in the normotensive group (0.66+/-0.29, 0.47+/-0.32, and 0.27+/-0.22 mg/dl, respectively, p<0.001). It was also higher in the essential hypertensive group than in the white-coat hypertensive group (p=0.014). CONCLUSIONS: Our data show that patients with white-coat hypertension have higher hs-CRP levels than normotensive patients and this may be an indication of increased risk.

PMID: 18049438 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Diabetes care in hospital–the impact of a dedicated inpatient care team.

Diabet Med Start a Discussion »

Apr 132008

Diabetes care in hospital--the impact of a dedicated inpatient care team.

Diabet Med. 2008 Feb;25(2):147-51

Authors: Flanagan D, Moore E, Baker S, Wright D, Lynch P

AIMS: At any given time, people with diabetes occupy approximately 5-10% of acute hospital beds. In addition, diabetes is associated with a greater length of stay (LOS). This is partially because of increased complexity of the cases but also because of unfamiliarity of dealing with the condition by other specialist teams. METHODS: In 2002, with increasing pressure on acute hospital beds, a team was established to improve the care of inpatients with diabetes admitted to Derriford Hospital. The team consisted of five diabetes specialist nurses dedicated to inpatient care, supported by a consultant and specialist registrar diabetologist. A link nurse responsible for diabetes was appointed on every ward and each individual with a diagnosis of diabetes was identified on admission. We have compared LOS of all patients with diabetes admitted between January 2002 and December 2006. RESULTS: LOS fell from a mean +/- se of 8.3 +/- 0.18 days in 2002 to 7.7 +/- 0.10 days in 2006 (P = 0.002). Significant falls were seen for emergency admissions (9.7 +/- 0.23 vs. 9.2 +/- 0.20, P < 0.001) but not elective admissions. The data show significant reductions in LOS for medical admissions (9.2 +/- 0.24 vs. 8.4 +/- 0.20, P < 0.001) but not surgical admissions. Over the same period, LOS for the total hospital population fell by 0.3 days (P < 0.001). CONCLUSION: In conclusion, a team specifically employed to focus on inpatient diabetes care has a significant impact on LOS of this patient group.

PMID: 18201215 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Bacteremia and infective endocarditis caused by a non-daptomycin-susceptible, vancomycin-intermediate, and methicillin-resistant Staphylococcus aureus strain in Taiwan.

J Clin Microbiol Start a Discussion »

Apr 132008

Bacteremia and infective endocarditis caused by a non-daptomycin-susceptible, vancomycin-intermediate, and methicillin-resistant Staphylococcus aureus strain in Taiwan.

J Clin Microbiol. 2008 Mar;46(3):1132-6

Authors: Huang YT, Hsiao CH, Liao CH, Lee CW, Hsueh PR

We describe the development of nonsusceptibility to daptomycin and vancomycin during treatment for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia associated with infective endocarditis and probable septic thrombophlebitis in a uremic patient. MRSA bacteremia persisted during glycopeptide and subsequent daptomycin treatment but cleared after 5 days' treatment with linezolid and fusidic acid.

PMID: 18199793 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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