2012 February 16

Burkitt’s lymphoma.

Feb 162012

Burkitt's lymphoma.

Lancet. 2012 Feb 10;

Authors: Molyneux EM, Rochford R, Griffin B, Newton R, Jackson G, Menon G, Harrison CJ, Israels T, Bailey S

Abstract
Burkitt's lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma and is the fastest growing human tumour. The disease is associated with Epstein-Barr virus and was one of the first tumours shown to have a chromosomal translocation that activates an oncogene (c-MYC). Burkitt's lymphoma is the most common childhood cancer in areas where malaria is holoendemic. The incidence is very high in immunosuppressed patients in non-endemic areas, especially when associated with HIV infection. Outcome with intensive chemotherapy has improved and is now excellent in children, but the prognosis is poor in elderly adults. The success of intensive treatment relies on good supportive care. The therapy offered in oncology units in low-income countries is not as aggressive as in centres in high-income countries and outcomes are less successful. Adjuvant monoclonal antibody therapy with rituximab shows promise for improved outcomes and reduced toxic effects in the future.

PMID: 22333947 [PubMed - as supplied by publisher]

Link to Article at PubMed

Management of antithrombotic therapy for acute coronary syndromes and atrial fibrillation in patients with hemophilia.

Expert Opin Pharmacother Start a Discussion »

Feb 162012

Management of antithrombotic therapy for acute coronary syndromes and atrial fibrillation in patients with hemophilia.

Expert Opin Pharmacother. 2012 Feb 15;

Authors: Mannucci PM

Abstract
Introduction: Patients with hemophilia now have a life expectancy very close to that of the unaffected male population and, hence, are at risk of developing the classic age-related morbidities, i.e., cardiovascular diseases. The peculiarity of the management of these diseases in hemophilia is that antithrombotic drugs impinge on the already compromised hemostasis of these lifelong bleeders. Areas covered: This opinion article outlines the strategies we have developed, based on our clinical experience, for the antithrombotic treatment of two common cardiovascular diseases - acute coronary syndromes and chronic atrial fibrillation - in patients with hemophilia A and B. Expert opinion: In the absence of specific evidence-based guidelines for patients with coagulation defects, antithrombotic treatment is currently based on expertise and adaptation of the guidelines developed for non-hemophilic patients. Replacement therapy should be tailored with the deficient coagulation factor so as to control the increased risk of bleeding inherent in the use of antiplatelet and anticoagulant drugs.

PMID: 22332913 [PubMed - as supplied by publisher]

Link to Article at PubMed

To compare PubMed Clinical Queries and UpToDate in teaching information mastery to clinical residents: a crossover randomized controlled trial.

PLoS ONE Start a Discussion »

Feb 162012

To compare PubMed Clinical Queries and UpToDate in teaching information mastery to clinical residents: a crossover randomized controlled trial.

PLoS One. 2011;6(8):e23487

Authors: Sayyah Ensan L, Faghankhani M, Javanbakht A, Ahmadi SF, Baradaran HR

Abstract
PURPOSE: To compare PubMed Clinical Queries and UpToDate regarding the amount and speed of information retrieval and users' satisfaction.
METHOD: A cross-over randomized trial was conducted in February 2009 in Tehran University of Medical Sciences that included 44 year-one or two residents who participated in an information mastery workshop. A one-hour lecture on the principles of information mastery was organized followed by self learning slide shows before using each database. Subsequently, participants were randomly assigned to answer 2 clinical scenarios using either UpToDate or PubMed Clinical Queries then crossed to use the other database to answer 2 different clinical scenarios. The proportion of relevantly answered clinical scenarios, time to answer retrieval, and users' satisfaction were measured in each database.
RESULTS: Based on intention-to-treat analysis, participants retrieved the answer of 67 (76%) questions using UpToDate and 38 (43%) questions using PubMed Clinical Queries (P<0.001). The median time to answer retrieval was 17 min (95% CI: 16 to 18) using UpToDate compared to 29 min (95% CI: 26 to 32) using PubMed Clinical Queries (P<0.001). The satisfaction with the accuracy of retrieved answers, interaction with UpToDate and also overall satisfaction were higher among UpToDate users compared to PubMed Clinical Queries users (P<0.001).
CONCLUSIONS: For first time users, using UpToDate compared to Pubmed Clinical Queries can lead to not only a higher proportion of relevant answer retrieval within a shorter time, but also a higher users' satisfaction. So, addition of tutoring pre-appraised sources such as UpToDate to the information mastery curricula seems to be highly efficient.

PMID: 21858142 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Defining and measuring the effort needed for inpatient medicine work.

J Hosp Med Start a Discussion »

Feb 162012

Defining and measuring the effort needed for inpatient medicine work.

J Hosp Med. 2012 Feb 14;

Authors: Lamba R, Schapira MM, Singh S, Fletcher KE

Abstract
BACKGROUND: Current metrics for assessing physician workload are inadequate. Understanding the effort associated with work tasks could make workload assessments more robust. OBJECTIVE: To assess the physical, mental, and psychological effort needed for the tasks performed by internal medicine doctors while admitting a patient to the hospital. DESIGN: Cross-sectional survey. SETTING: A single Midwest academic institution. SUBJECTS: Internal medicine housestaff, hospitalists, and nonhospitalist internal medicine faculty. MEASUREMENTS: Subjects rated 99 tasks across 3 domains: physical, mental, and psychological effort using a scale of 1-7 (1 = least effort, 7 = most effort). A composite effort score was calculated for each task and for each of 6 task categories: direct patient care, indirect patient care, searching for/finding things, educational/academic activities, personal/downtime activities, and other. RESULTS: Overall, the most difficult task was going to codes, which was also the most difficult psychological task. The most difficult physical task was placing a central line, and the most difficult mental task was transferring an unstable patient to the intensive care unit. The easiest task was using the Internet. That was also the easiest physical, mental, and psychological task. Direct patient care was more difficult than indirect patient care overall (3.58 vs 3.21; P < 0.001). CONCLUSION: We began the process of describing the workload of inpatient doctors by measuring the difficulty of the tasks they perform while admitting patients. To assess the relationship between workload and other outcomes (such as physician burnout and patient safety), it is essential that we be able to accurately measure workload. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine.

PMID: 22334486 [PubMed - as supplied by publisher]

Link to Article at PubMed

Is urinary free cortisol of value in the diagnosis of Cushing’s syndrome?

Curr Opin Endocrinol Diabetes Obes Start a Discussion »

Feb 162012

Is urinary free cortisol of value in the diagnosis of Cushing's syndrome?

Curr Opin Endocrinol Diabetes Obes. 2011 Aug;18(4):259-63

Authors: Alexandraki KI, Grossman AB

Abstract
PURPOSE OF REVIEW: Cushing's syndrome results from prolonged and inappropriately high exposure of tissues to glucocorticoids. Biochemical tests are always needed to confirm the clinical suspicion: these include measurement of excess total endogenous cortisol secretion assessed by 24-h urinary free cortisol (UFC), loss of the normal feedback of the hypothalamo-pituitary-adrenal axis assessed by suppressibility after dexamethasone testing, and disturbance of the normal circadian rhythm of cortisol secretion assessed by midnight serum or salivary cortisol. This review focuses on recent data emerging on the value of UFC as a screening test for Cushing's syndrome.
RECENT FINDINGS: Considerable evidence has emerged regarding the utility of UFC in the diagnosis of Cushing's syndrome because of its long-term use in clinical practice. Despite the fact that UFC assesses the active (free) component of cortisol, the methodological difficulties in 24-h urine collection and in assay precision have rendered this screening technique increasingly unpopular. Furthermore, the increased prevalence of mild, preclinical or cyclic Cushing's syndrome along with the fact that cortisol is not uniformly secreted during the day do not support its use as a screening test, although strikingly high levels can be useful.
SUMMARY: Since the sensitivity and specificity of UFC are less than ideal when compared with other diagnostic modalities, we suggest the use of other more novel tests as first-step diagnostic tests to screen for hypercortisolaemia.

PMID: 21681089 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

February 2012
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