Global medical news in review: October 28-November 3, 2012
medwireNews: A roundup of select stories of interest to US physicians from the MerckMedicus Medical News wire.
Exercise exonerated in sudden cardiac death of the young
Sudden cardiac death in young, seemingly fit people is largely caused by unrecognized heart disease, with most cases occurring at home when not doing exercise, report Andrew Krahn (University of British Columbia, Vancouver, Canada), speaking at the Canadian Cardiovascular Congress in Toronto, Ontario.
Krahn and colleagues reviewed coroners' reports for 174 cases of presumed sudden cardiac death that occurred in the state of Ontario in 2008 among people aged 2 to 40 years. Most of the victims were male (76%) and aged between 18 and 40 years (90%).
The team found that 126 (72%) of those who died had heart disease, which was previously undiagnosed in 78%.
Contrary to previous suggestions, only 33% of cases in children or adolescents and 9% in adults occurred while participating in moderate or vigorous exercise. The majority (72%) of events occurred at home.
Exercise therapy gives hip OA patients a leg up
Patients with hip osteoarthritis (OA) can achieve improvements in function and range of motion with the help of exercise therapy (ET), regardless of whether adjunctive manual therapy (MT) is used, say Helen French (Royal College of Surgeons, Dublin, UK) and colleagues.
In all, 131 patients with hip OA, aged an average of 62 years, were randomly assigned to receive ET (n=45), ET plus MT (n=43), or to a waiting list for 9 weeks (n=43), after which they were re-randomized to either the ET or ET plus MT group.
At a 9-week follow up, the patients receiving ET and ET plus MT showed significantly greater improvements in physical function, as measured using the Western Ontario and McMaster Universities Index (WOMAC), compared with controls, with an average 7.76-point difference in scores between those receiving interventions and those not.
A significant difference in favor of intervention was also seen for hip range of motion, at 15.85 degrees, and patients who received ET and ET plus MT were more likely to show an improvement on the Patient Global Assessment.
The findings are published in the Archives of Physical Medicine and Rehabilitation.
Many prostate cancer patients treated even at the end of life
Approximately one-third of men with castration-resistant prostate cancer (CRPC) receive some form of treatment in the last 3 months of life, but adverse effects from such treatment on quality of life may outweigh its impact on survival, the researchers suggest.
As they report in the American Journal of Hospice and Palliative Care, Hanna Zaghloul and colleagues from The Methodist Hospital in Houston, Texas, USA, looked at data for 88 men with CRPC who were treated, and died, at a 900-bed US institution between January 2003 and December 2010. The researchers quantified chemotherapy and treatment use in the 3 months prior to death.
Docetaxel was the most common treatment administered, at 19.4%, followed by paclitaxel, carboplatin, and doxorubin, at 15.1%, 10.8%, and 10.1%, respectively.
A total of 25% of the cohort studied experienced adverse events, with neutropenia affecting 18.3% of patients, nausea and/or vomiting 18.3%, and febrile neutropenia 13.6%.
The team suggests that hospice care, which is associated with improved quality of life and a reduced likelihood of aggressive care, should be given greater priority in this population, as recommended by the American Society of Clinical Oncology.
High-risk CVD not a barrier to cardiopulmonary exercise
US study results indicate that cardiopulmonary exercise (CPX) is well tolerated, even when performed by individuals with high-risk cardiovascular disease (CVD).
Only 0.16% of such individuals experienced an adverse event during CPX and none died, say Todd Miller (Mayo Clinic, Rochester, Minnesota, USA) and co-authors in Circulation.
The study, which examined outcomes of 4250 individuals with high-risk CVD, showed that sustained ventricular tachycardia was the most common adverse event associated with CPX.
The arrhythmia accounted for six of the eight adverse events seen among the group, which included patients with congestive heart failure (n=1289), hypertrophic cardiomyopathy (n=598), pulmonary hypertension (n=194), and aortic stenosis (n=212), as well as other less common forms of CVD.
Most (94.5%) patients completed their stress test, stopping only because of fatigue, chest pain, or shortness of breath.
The remaining 5.5% asked for their test to be terminated early or experienced electrocardiography changes, abnormal blood pressure, or a major adverse event, which led to test termination.
Aerobic activity may tame the child with ADHD
Writing in the Journal of Pediatrics , Matthew Pontifex (University of Illinois at Urbana-Champaign, USA) and colleagues report that a single 20-minute moderate aerobic exercise session resulted in significant improvements in attention and academic performance in children with and without attention deficit/hyperactivity disorder (ADHD), compared with a similar period spent sitting and reading.
Twenty children with ADHD and 20 controls without ADHD, all aged between 9 and 10 years, were asked to complete an attentional-control task after two 20-minute periods of sitting and reading, or exercise on a motorized treadmill at 65-75% of their maximal heart rate.
The overall response accuracy of the children with ADHD on the attentional-control task was lower than that of the control children, at 81.8% versus 88.8%. However, both groups had significantly improved response accuracy following exercise, compared with reading, at a combined group average of 87.1% versus 83.5%.
Electronic health records do not end drug errors
Relying on electronic health records (EHRs) is not enough to ensure accurate and complete documentation of patient medications, show study results, suggesting that efforts to minimize medication discrepancies are needed.
Amy Linsky (VA Boston Healthcare System, Massachusetts, USA) and colleagues report in BMJ Quality and Safety on a study comparing 104 patients' self-reported medications with their EHR records, noting: commissions ‑ medications listed as active in the EHR but the patient did not report using them; omissions ‑ medications that the patient reported using but were not recorded in the EHR; duplication ‑ more than one active listing for the same medication or drug class for a patient; and alteration in dose or frequency ‑ when a patient reported taking medication at a different dose or frequency to that stated in the EHR.
Overall, 60% of the cohort had a discrepancy that fitted at least one of these criteria, with a mean discrepancy rate of 3.7 per patient. Discrepancies broke down into 36% commissions, 27% omissions, 11% duplications, and 19% alterations in dose or frequency.
In multivariate analysis, an increasing number of medications was associated with a greater number of commissions and duplications, each with odds ratios (ORs) of 1.2 per medication. Conversely, increasing medications was associated with fewer omissions, with an OR of 0.9.
By Neil Osterweil, medwireNews Reporter