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19-08-2012 | Article

Global medical news in review: August 12-18, 2012

medwireNews: A roundup of select stories of interest to US physicians from the Merck Medicus Medical News wire.

High-cost imaging at the end of life

High-cost diagnostic imaging is increasingly being used for elderly patients with stage IV cancer of the breast, lung, and prostate, and colorectal cancer in the USA, according to a study published in the Journal of the National Cancer Institute.

The use of computed tomography, magnetic resonance imaging, positron emission tomography, and nuclear medicine scans in this population increased by a relative 4.6% over a decade lasting from 1995 to 2006, whereas use in stage I‑II patients fell by 2.5% over the same period.

Of a "recent-care" cohort of stage IV patients, diagnosed between 2002 and 2006, 95.9% underwent at least one high-cost imaging procedure, at an average of 9.79 scans per patient and 1.38 scans per patient per month of survival. The majority (75.3%) of patients underwent further scans, with more than one-third (34.3%) undergoing a high-cost imaging procedure in their last month of life, report Caprice Greenberg (University of Wisconsin Hospitals and Clinics, Madison, USA) and co-authors.

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Infection rates rise when nurses overworked

The rate of "burnout" felt by nurses could be directly related to the rate of hospital-acquired infections (HAIs), via staffing rates, indicate US study results.

The researchers found a significant positive association between the number of patients assigned to nurses and the rate of urinary tract and surgical site infection. But after accounting for nurse burnout, measured with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), this staffing effect was no longer significant.

"We hypothesize that the cognitive detachment associated with high levels of burnout may result in inadequate hand hygiene practices and lapses in other infection control procedures among registered nurses," suggest Jeannie Cimiotti (The State University of New Jersey, Newark) and co-researchers in the American Journal of Infection Control.

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Some antibiotics risk liver injury in elderly

Regulatory warnings should be considered for the antibiotics moxifloxacin and levofloxacin because of a potential risk for liver injuries in the elderly, Canadian researchers suggest.

"Fluoroquinolones are among the most widely prescribed antibiotic agents in North America, and the use of broad-spectrum fluoroquinolones such as levofloxacin and moxifloxacin is increasing," say David Juurlink (Institute for Clinical Evaluative Sciences, Toronto, Ontario) and co-investigators in the Canadian Medical Association Journal.

Compared with patients who received clarithromycin, those treated with moxifloxacin were 2.20 times more likely to be admitted to hospital for acute liver injury, and those treated with levofloxacin were 1.85 times more likely. Both associations were statistically significant.

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Cardiac death rates higher among underinsured

Patients admitted to hospital with an acute cardiac event have higher rates of mortality if they are underinsured rather than having private insurance, show US study results.

The association was independent of race, age, disease severity, and other patient-related factors, say Derek Ng (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland) and colleagues in the Journal of General Internal Medicine.

After excluding such potential confounders, being underinsured increased the mortality risk by a significant 31% in patients admitted for acute MI.

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Monitor for arrhythmias in COPD patients starting on bronchodilators

Patients with chronic obstructive pulmonary disease are at increased risk for arrhythmia when they begin taking long-acting β agonists (LABA) and short-acting β agonists (SABA), suggests new research.

The findings, reported in Chest, come from two studies by Samy Suissa (Jewish General Hospital-Lady Davis Research Institute, Montreal) and colleagues.

New use for 60 days or less of the anticholinergic ipratropium bromide as well as LABAs increased the risk for arrhythmia in the first, small study.

In a second, larger study, patients had a 47% increased risk for arrhythmia within the first 60 days of taking a LABA and a 27% increased risk within the first 60 days of starting a SABA, relative to patients who never received the treatments. In contrast to the authors' earlier study, use of ipratropium was not associated with a significant increase in the risk for arrhythmia.

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Ubiquitous antibiotic weakens muscles

Research suggests that the antibacterial chemical triclosan, commonly used in personal-care products and antibacterial soaps, may impair the function of cardiac and skeletal muscle.

Isaac Pessah (University of California, Davis) and colleagues exposed mice and fish to levels of the chemical equivalent to those that humans might be exposed to in the environment. They also looked at the in vitro effects of triclosan on heart and skeletal muscle cell lines.

As reported in the Proceedings of the National Academies of Sciences, mice injected with intraperitoneal triclosan (≥12.50 mg/kg) had a reduction in heart function measures as great as 25% following 20 minutes exposure. They also had an 18% reduction in grip strength (total force produced by limbs) for up to 60 minutes after being injected.

The in vitro experiments showed that triclosan exposure prevented heart and skeletal muscle fibers from contracting properly by impairing calcium channel function and ultimately resulting in muscle failure.

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HRT linked to ulcerative colitis

Postmenopausal hormone replacement therapy (HRT) increases the risk for ulcerative colitis (UC), but not Crohn's disease (CD), a study shows.

Andrew Chan (Harvard Medical School, Boston, Massachusetts, USA) and colleagues used data from the Nurses' Health Study for 22,044 women who were postmenopausal at baseline and a further 86,800 who became postmenopausal during the course of the study. In all, 138 women developed UC, and 138 developed CD during the 32 years of the study.

Compared with those who had never used HRT, past and current users had a significantly increased risk for developing UC, the authors report in Gastroenterology. Those who currently used hormones had a 71% increased risk, and those who had previously taken hormones had a 65% increased risk. Risk also seemed to increase with the duration of hormone use.

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Prenatal alcohol effects linger

Women who expose their unborn child to high levels of alcohol risk restricting the child's growth until the age of 9 years, researchers say.

Robert Carter (Children's Hospital Boston, Massachusetts) and team found that the average weight of children born to mothers who were heavy drinkers, defined as having two or more drinks a day, was 0.6 standard deviations (SDs) lower than that of children born to light drinkers (<1 drink a day, no binging) or abstainers, from 6.5 months to 9 years of age.

The average height of babies born to heavy drinkers was 0.5 SD lower than those born to light drinkers or abstainers, while head circumference was 0.9 SD lower from 6.5 months to 9 years, they report in Alcoholism: Clinical and Experimental Research.

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By Neil Osterweil, medwireNews Reporter