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Thursday, June 28, 2007
Computerized Ordering Cuts Medication Errors
The findings are published online in the journal Health Services Research.
Almost 25 percent of U.S. hospital patients experience medication errors, such as receiving an incorrect dosage, the wrong drug, medication at the wrong time, or no medication at all. Each year, medication errors injure or kill more than 500,000 U.S. hospital patients, according to background information in the review.
Illegible handwriting on prescriptions and transcription mistakes cause as many as 61 percent of medication errors, the experts said.
"These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake," lead author Tatyana Shamliyan, a research associate at the University of Minnesota School of Public Health, said in a prepared statement.
She and her colleagues found that hospitals with the highest rate of medication errors -- more than 12 percent -- showed the most improvement when they switched to computerized drug ordering systems.
They also found that while the use of computerized systems reduced medication errors overall, there was no decrease in one type of error -- prescribing the wrong drug.
Currently, only about 9 percent of U.S. hospitals have computerized prescription systems, which can take 12 to 36 months to implement.
More information
The Institute for Safe Medication Practices explains how to protect yourself against medication errors.
Monday, June 25, 2007
Body Fat Might Be Healthy for Type 1 Diabetics
According to a team at the University of Pittsburgh Schools of the Health Sciences, people with diabetes tend to develop cardiovascular disease at a much younger age than non-diabetics. Cardiovascular complications, including heart disease, are a leading cause of death among diabetics.
However, for people with the type 1, inherited form of the diabetes, "Gaining weight may reflect good or better treatment with insulin therapy, which may partly explain why participants who gained weight over time [in the study] had lower mortality rates," Dr. Trevor Orchard, professor of epidemiology at the University of Pittsburgh Graduate School of Public Health, said in a prepared statement.
He and his colleagues studied 315 patients with type 1 diabetes who took part in the 18-year Pittsburgh Epidemiology of Diabetes Complications Study, which began in 1986. CT scans were used to assess coronary artery calcification in the patients, who were also evaluated for body mass index (BMI), waist circumference, abdominal fat, and fat underneath the skin.
Coronary artery buildup of calcium is a known marker for heart disease.
Overall, the more fat a person had, the more likely they were to have coronary artery calcification. But among the two-thirds of patients with calcification, people with more fat had less severe calcification.
There were some gender-specific findings. Women with more fat under the skin had less calcification than those with less fat. Men with a higher BMI had less calcification than thinner men.
"This is not a firm recommendation to people with type 1 diabetes to put on weight, but it does raise the possibility that weight recommendations in type 1 diabetes may be somewhat different than those for the general population, and emphasizes the complex relationship between body fat and cardiovascular risk in diabetes," Orchard said.
The study was to be presented at the American Diabetes Association's annual meeting, June 22-26, in Chicago.
More information
The American Academy of Family Physicians has more about type 1 diabetes.
Monday, June 18, 2007
Vitamin D Cuts Cancer Risk: Study
The research adds to growing evidence that vitamin D can help protect against many forms of cancer as well as other diseases, Creighton University researchers said.
But an American Cancer Society spokeswoman urged caution in interpreting the findings, saying it was premature to recommend taking vitamins to reduce cancer risk.
Joan Lappe, a Creighton University professor of medicine and nursing and lead author of the study, said, "What we can say from our study is that 1,100 international units (IUs) a day of vitamin D definitely decreased the incidence of cancer."
That amount of the vitamin is nearly triple the recommended intake for the age group studied -- women who were 55 and older when the four-year study started.
Lappe's team followed 1,179 study participants who were all postmenopausal and lived in rural Nebraska. The women were free of known cancers for the 10 years before entering the study. They were assigned to one of three groups and followed for four years.
One group took 1,400 to 1,500 milligrams of supplementary calcium a day, another group took that same amount of calcium plus 1,100 IUs of vitamin D daily, while the third group took placebo pills every day.
After four years, those in the combination vitamin D and calcium group had a 60 percent lower risk of developing cancer, compared to the placebo group. The calcium-only group had a 47 percent reduced risk.
Then the researchers eliminated data from the first year of the study, figuring some women may have entered the study with cancer that had not yet been diagnosed. The results were more dramatic, Lappe said.
When the researchers looked at results from just the last three years of the trial, they found the combination calcium-and-vitamin D group had a 77 percent reduced risk of cancers, compared to the placebo group. The risk for the calcium-only group was essentially unchanged.
In all, a total of 50 women got non-skin cancers during the study, with breast cancer the most common. The other cancers included lung and colon tumors.
The findings are published in the June edition of the American Journal of Clinical Nutrition.
In May, Harvard Medical School researchers reported in the Archives of Internal Medicine that high intakes of vitamin D and calcium cut the risk of breast cancer by nearly one-third in premenopausal women, but not women past menopause.
Dr. Michael Holick, professor of medicine, physiology and biophysics at the Boston University School of Medicine and a long-time vitamin D researcher, said the Lappe study adds to growing evidence of the health and disease-fighting effects of vitamin D.
"It's very clear the data are significant," he said of the Lappe study.
Vitamin D is thought to act through the immune system to help prevent the formation of abnormal cells, Lappe said.
To date, both Lappe and Holick said, high intake of vitamin D has been found to reduce the risk of many forms of cancer as well as type 1 diabetes, multiple sclerosis, rheumatoid arthritis and high blood pressure.
Both researchers think the current recommendations for daily vitamin D intake should be boosted. The U.S. Institute of Medicine, which makes recommendations on vitamin and mineral requirements, considers 200 IUs of vitamin D adequate for children and adults up to age 50;
400 IUs adequate for adults 51 to 70, and 600 for those 71 and older. The levels aren't Recommended Dietary Allowances, or RDAs, because the institute doesn't think there's enough evidence to establish an RDA for vitamin D.
"I think it's safe to say the current recommendations are much too low," Lappe said, adding that postmenopausal women should "probably be taking 1,100 IUs a day."
She recommends vitamin D3 supplements, the type used in the study, over D2, because D3 is more active, she said.
But Marji McCullough, strategic director of nutritional epidemiology for the American Cancer Society, who is familiar with the new study and other similar research, said in a prepared statement that the society doesn't currently recommend taking vitamin or mineral supplements to reduce cancer risk. But it has joined other health organization to weigh the evidence of vitamin D, and a joint panel recommends supplementation and small amounts of ultraviolet exposure "as the best way to achieve proper vitamin D status."
While she called the new study "intriguing,'' she said the number of participants was small and the research needs to be replicated before firmer conclusions can be drawn.
Discuss vitamin D intake with your doctor. And be aware that the Institute of Medicine has declared that 2,000 IUs is the upper tolerable, or safe, level for most people. For babies up to 1 year old, the limit is 1,000 IUs, McCullough said.
Vitamin D, which is important for strong bones, is found in salmon and other fish, and fortified milk and fortified cereals, among other foods.
Supplements aren't the only potential way to fight disease. In the same issue of the journal, another report found that a high intake of whole grain foods reduced the risk of atherosclerosis, or hardening of the blood vessels, which can lead to heart disease.
U.S. researchers tracked 1,178 men and women, from 40 to 69 years old at the start of the study, and found that eating more whole grains was associated with a lower risk of atherosclerosis.
More information
To learn more about vitamin D and cancer, visit the American Cancer Society.
Tuesday, June 12, 2007
Alzheimer's Drug Trials Offer Promising Results
Two drugs, Dimebon and the diabetes medication Avandia, may help curb Alzheimer's in different ways. And close to five years of follow-up data suggest that an "Alzheimer's vaccine" might someday harness the power of the immune system to protect against dementia.
All of these agents work to alter the progression of the underlying disease, not just mask or limit its symptoms, as current Alzheimer's drugs do.
With so many varied means of attacking Alzheimer's disease on the horizon, "the clinician will have more of an arsenal to treat the patient from different approaches," said Dr. Paul Sanberg, director of the Center of Excellence for Aging and Brain Repair at the University of South Florida in Tampa.
"And what we don't even know yet is whether there are synergistic effects we could get by combining these approaches," he added.
Sanberg was not involved in the studies, the results of which were presented Monday at a special press briefing at the Alzheimer's Association's International Conference on Prevention of Dementia, in Washington, D.C.
Alzheimer's disease now affects more than 5 million Americans, according to the Alzheimer's Association. Scientists project that unless new ways are found to prevent or treat the disease, that total could climb to 16 million by mid-century. The exact causes of the illness are not known, but disease progression is highly associated with the build-up of clumped beta amyloid proteins in the brain.
One compound showing promise in a one-year trial is Dimebon, which targets Alzheimer's on a variety of fronts. According to Dr. William Thies, vice president of medical and scientific affairs at the Alzheimer's Association, the drug has symptom-limiting properties similar to anticholinesterase medications (such as Aricept) and another class of Alzheimer's drugs, called glutamate antagonists.
Dimebon may also protect vulnerable brain cells from amyloid build-up by boosting the energy output of cellular "power plants" called mitochondria.
So, besides affecting the symptoms of Alzheimer's disease, Dimebon "also has disease-modifying effects, bringing neurons long-term protection against loss of function," Thies explained.
In the trial, 120 patients in Russia with mild to moderate Alzheimer's were randomly chosen to receive either oral Dimebon or a placebo three times daily for 12 months. A team of researchers led by Dr. Rachelle Doody of Baylor College of Medicine in Houston then followed changes in the four most frequently studied aspects of the disease -- cognition, clinical function, activities of daily living and behavioral issues.
The researchers said patients on Dimebon achieved statistically significant improvements in all of these endpoints, and those improvements remained stable or even increased over the 12 months of the study. The dropout rate was similar between those on a placebo or Dimebon (about one-third of patients), and side effects were relatively low and included dry mouth (18 percent) and depression (14.6 percent).
"The natural history of untreated Alzheimer's disease includes decline in thinking abilities, social behavior and function," Doody said in a prepared statement released by the makers of Dimebon, Medivation. "By contrast, after a full year of therapy, Dimebon-treated patients did not decline in any of these areas." Medivation plans a six-month phase 3 clinical trial of the drug beginning in 2008.
A second study focused on a "Holy Grail" of neurological research: an Alzheimer's vaccine. One immune antibody-based shot called AN 1792 did show promise in small clinical trials involving 129 Alzheimer's patients, which were conducted nearly five years ago. However, hopes for the vaccine were dashed after 6 percent of the participants developed treatment-linked brain inflammation.
Although none of the affected patients died from the encephalopathy, the side effects "really did sidetrack AN 1792 as a product," Thies said, bringing a halt to further trials.
But doctors have continued to follow the mental-health histories of the trial's 25 "antibody responders" -- patients whose immune systems reacted favorably to the injection.
Antibodies are still active in blood samples taken from those patients, the researchers reported on Monday. Furthermore, these "responders showed significantly slower decline on the Disability Assessment for Dementia than placebo patients," according to the international team of researchers, led by Dr. Leon Thal of the University of California, San Diego.
"We've also seen a steady stream of autopsy data from people who were in the study demonstrating less amyloid than what one could expect," Thies noted.
So, even though AN 1792 may never make it to patients, these positive long-term outcomes mean immunotherapy research is very much alive.
"In fact, there are next-generation immunotherapies that are going forward as we speak," Thies said.
Then there's Avandia, a drug used by millions to combat diabetes, which has also appeared useful in slowing Alzheimer's in prior studies. In a new study, drugs maker GlaxoSmithKline presented safety data from a 16-month clinical trial involving 337 patients with mild to moderate Alzheimer's. The patients received either Avandia (rosiglitazone XR) or a placebo daily.
The trial, which was only designed to assess the safety and tolerability of the drug in Alzheimer's patients, found that 82 percent of participants did complete the 16 months of treatment. While about half of the patients experienced some side effects (for example, swelling), only a very few (less than 2 percent) experienced any cardiovascular abnormalities tied to the drug.
That's important, because an article last month in the New England Journal of Medicine tied long-term Avandia use by diabetics to increased heart risk. On June 6, the FDA asked that the medication carry a "black box" warning label, noting a potentially heightened risk of congestive heart failure in some patients using Avandia.
However, when it comes to treating Alzheimer's, Thies believes that "the relatively modest risk would be reasonably well-accepted by the community because of the [drug's] benefits against Alzheimer's."
Experts aren't quite sure how Avandia might ease Alzheimer's. The drug has anti-inflammatory properties, which might help, and it also helps boost the brain cell's energy supply, giving it more resilience against amyloid build-up and other Alzheimer's-related brain insults, Thies said.
A fourth study -- on an amyloid-clearing agent-- was presented at the conference on Monday with no clear message for patients yet.
Researchers at drug company Neurochem Inc. said that the results of their phase III trial of Alzhemed (tramiprosate) are in, but that the findings are too varied across the trial sites and too complex to determine the drug's efficacy at this point.
The Alzhemed study results were highly anticipated because this was the first phase III trial of any amyloid-clearing agent.
"Basically what Alzhemed does is interfere with that clumping of amyloid, so that normal clearance mechanisms can remove the amyloid before it forms plaques," Thies explained.
More information
Find out more about Alzheimer's disease at the Alzheimer's Association
Saturday, June 02, 2007
Energizing Vegetables and Fruits
Fruits are also a source of energy. You can start the day with a stewed apple, and if you feel hungry in between meals, try snacking on a juicy pear.
If you are feeling heavy and bloated after lunch, eat a fresh papaya, because they contain enzymes that aid digestion. If you have a strong digestion and more Pitta in your constitution, mangoes are a rich ojas-producing food, and half a mango contains 2 mg. beta-ccarotene and is a rich source of Vitamin C.
According to Ayurveda, raisins are among the best of fruits because they enhance sattva (purity), pacify the mind and heart and increase the coordination between them.
They are also a rich source of iron and Vitamin B6, and provide magnesium, calcium, zinc, and potassium. Raisins aid digestion and elimination when they are soaked in water overnight. One handful per person is a good amount.
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