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PrairiEDocs e-newsletter #26 Other archived PrairiEDocs e-newsletters Surveying
the land (and web) for news (and more)
First Ever Expert Consensus Guidelines Published For Treatment of Geriatric Depression Anti-Oxidant Drugs Quadruple Life Span of Small Mammals in a New Study New Lozenge More Effective in Helping Smokers Quit For the Public-New CDC Toll-Free Hotlines; For Professionals U.S. Postal Service Plan to Irradiate Mail; What Effect on Medication Shipments? Novel Approach Used to Kill Anthrax in Senate Office Building Recommendations for Post-Exposure Prophylaxis for AirBorne B. Anthracis in Florida Inhalation Cases Quotable Quotes Aspirin, Beta Blockers Improve Post MI Outcomes Without Regard to Renal Function Mortality rates in the coronary care unit among individuals with advanced renal disease who experience a myocardial infarction (MI) are high. Individuals withsignificant renal dysfunction are typically excluded from clinical trials. Investigators at the University of Missouri-Kansas City analyzed a prospectivecoronary care unit registry of 1,724 patients admitted over an eight year period to a single, tertiary care center for an acute MI to determine the cardioprotective advantage of aspirin and beta-blockers for patients with renal dysfunction. Findings were presented on November 5 at the annual meeting of the American College of Chest Physicians. Subjects were grouped based on their creatinine clearance rates, with cutpoints of 46.2, 63.1, and 81.5 ml/min/72 kg. Dialysis patients (n=47) fmade up a fifth comparison group. Overall, 902 patients were treated with combined aspirin andbeta-blockers. Use of this therapy was inversely proportional to the level of renal dysfunction; 64 percent of patients with normal renal function were treated with aspirin and beta blockers while treated in this manner compared to only 35 percent of those with the poorest creatinine clearance rates and 40 percent ofthose on dialysis. Despite increased reluctance to treat individuals with renal dysfunction with combined aspirin and beta-blockers, this therapy does appear to be helpful in all patient groups. A multivariate analysis that controlled for baseline differences in groups and for potential selection bias revealed that combined beta-blockerand aspirin therapy showed a cardioprotective effect across all degrees of renal dysfunction (ranging from 64 percent to 80 percent). Researchers noted that aspirin and beta-blockers are used less frequently in those with renal dysfunction or end stage renal disease on dialysis, but the benefit of aspirin and beta-blockers was conferred across all renal groups, with a relative risk reduction of greater than 50 percent for in-hospital death." First Ever Expert Consensus Guidelines Published For Treatment of Geriatric Depression The first-ever Expert Consensus Guidelines developed solely for the treatment of geriatric depression were published October 26 in the journal PostGraduate Medicine. The guidelines are based on a detailed survey of 50 of the country's leading experts specializing in geriatric depression, address the specific psychiatricneeds of at least 25% of adults over age 65 at serious risk for developing clinical depression. The report entitled, "Treatment of Depression in Older Persons"; contains 29 reatment guidelines and indicates that SSRIs are the most appropriate anti- depressants to use in the treatment of all types of geriatric depression.The guidelines also identify Celexa as the top-rated SSRI for the treatment of depression in older people. Ninety-six percent of the expert panel members said Celexa should be the first-line therapy for older depressed patients. Celexa was the only medication that received a first choice designation by the expertpanel when compared to others in the SSRI class. The guidelines address issues such as assessment of depression in older patients, acute treatment strategies, medication selection, dosing and duration of treatment, treatment resistance, strategies for continuation of maintenance treatment, and special treatment issues. Previously, clinicians treated geriatric depression by relying on guidelines developed for the treatment of depression in younger populations who do not present with as many coexisting medical conditions, multiple medications, systems changes and disabilities that may contribute to depression and complicate treatment in the elderly. The Expert Consensus Guidelines are based on a detailed survey of 50 of the country's leading experts specializing in geriatric depression. The survey study followed a modified methodology initially developed by the RAND Corporation and utilized senior investigators from the nation's three Intervention Research Centers devoted to geriatric mood disorders, which are funded by the National Institute for Mental Health. Anti-Oxidant Drugs Quadruple Life Span of Small Mammals in a New Study In a recent study publishedin the Journal of Neuroscience, researchers concluded that anti-oxidant drugs have quadrupled the life span of mice genetically engineered to live only aweek. This is the first evidence that anti- oxidant drugs work in making mammals live longer, interrupting some of the damage that arises in the aging process. The drugs used in the study focused on neutralizing the oxidative damage of free radicals. "What this paper shows is these drugs are very effective against preventing oxidative damage in the brain"; lead researcher Simon Melov, a molecular gerontologist at the private, nonprofit Buck Institute for Age Research in Novato, California "That may have utility in diseases like Alzheimer's diseaseand Parkinson's disease." He said the next step in the research will be to use the anti-oxidants in normal mice. "If the evidence continues to accumulate in relation to the effectiveness of these drugs against free radical damage related to aging, then I don't think its an improbable prediction that they will be effective inprolonging life span in mammals,"; Melov said. New Lozenge More Effective in Helping Smokers Quit A new lozenge can triple as moker's chance of quitting and is more effective than other forms of nicotine replacement therapy, according to results of a study released Monday. A large clinical trial (1800 smokers in US and Great Britain) suggests that NiQuitin CQ (GlaxoSmithKline) worked better than nicotine patches, gum, inhalers or nasal sprays to help smokers kick the habit. The study showed that smokers randomly selected to receive the lozenges were three times more likely to stop than people who took a placebo. Other nicotine replacement therapy products have been shown to be twice or less than twice as effective as a placebo in helping smokers give up the habit. The lozenges, available in two and four milligram doses (projected cost of $25/week), were designed to reduce cravings and withdrawal symptoms and were taken in gradually reduced amounts for 12 weeks. Although the dosage of the lozenges is the same as nicotine gum, researchers stated that the lozenges were more probably effective because they release 25 percent to 27 percent more nicotine from each dose. According to the results ofthe trial (to be formally published in Archives of Internal Medicine next year), cigarette cravings for those using the lozenges were reduced by 23percent during the first week. Researchers believe the cravings encountered during the first two weeks of smoking cessation are key determinants in successor failure of attempts to quit smoking. For the Public-New CDC Toll-Free Hotlines 32,000 people have been prescribed antibiotics in the anthrax crisis, with 5,000 of them asked to remain on the antibiotics for a full sixty days. The FDA plans to contact all 32,000 people to better gauge the extent of side effects. Headlines and conversation continue to focus on this health crisis. Such concern for health and safety after the events of September 11 has prompted many people to call the Centers for Disease Control. These callers were referred to (404) 639-2897, but now a toll-free CDC Public Response Hotline has been established. All public callers should be referred to the following numbers: English
(888) 246-2675 For the Professional In Iowa (courtesy of the Iowa Department of Public Health-IDPH): General phone number (available to public also) 800.362.2736 Professionals only (medical, fire, law enforcement)- hotline number-866.834.9671 Looking for resource documents, recommended procedures, new information available, or clarifications and corrections that have been discovered, go to "credible sites" recommended by the IDPH- http://>www.idph.state.ia.us/ or www.bt.cdc.gov If you would like to receive the IDPH's weekly e-mail update regarding bioterrorism, please send your request to mrexroat@idph.state.ia.us A Reminder---ACUTE CARE, INC. has put together an impressive list of resources, links, etc. re: medical responses to nuclear, biological and chemical terrorism; just visit http://www.acutecare.com/whatnew.htm to see the latest or to research an area of concern. Links to the CDC and military medical resources are included, also. U.S. Postal Service Plan to Irradiate Mail; What Effect on Medication Shipments? Mail-order prescription drug companies are raising concerns that the U.S. Postal Service's proposal to irradiate the mail to eliminate the threat of anthrax exposure could pose dangers to medication shipments. Industry officials are concernedbecause of the very limited scientific study conducted on the effectsof irradiation on medications. CongressDaily reports that mail-order drug companies such as AdvancePCS, Merck-Medco and Express Scripts account for nearly one-sixth of the country's prescription drug sales, a percentage that has been growing in recent years. (CongressDaily, 11/5). The following web site contains some useful information on how USDA is responding to the concerns of possible bioterrorism involving food supplies. Informational materials and links are located at: http://www.usda.gov/special/biosecurity/safeguard.htm Novel Approach Used to Kill Anthrax in Senate Office Building The Environmental Protection Agency finished sealing the doors and windows of the Hart Senate Office Building on November 2 with sheets of plastic and duct tape to make it airtight in preparation for a novel decontamination. This week, chlorine dioxide will be generated and spread throughout the anthrax-infected nine-story building using the ventilation system. Special strips with harmless bacteria are being placed throughout the building connected to computers so scientists outside will be able to monitor when the building is safe. If everything works as planned, all the B. anthracis spores will be destroyed, and in a couple of weeks, the 50 senators who have offices in the building will be able to move back in, all their possessions intact. Last week, scientists tested the technique in a big trailer in the parking lot of the Brentwood Post Office. The chlorine dioxide killed the bacteria in the trailer without harming a computer, paper documents, pictures, ink signatures, carpet or wood. Other contaminated buildings on Capitol Hill -- the Dirksen Senate building and the Longworth and Ford House office buildings -- have been disinfected with bleach and foam because evidence of anthrax was found in only small amounts and limited to a few specific sites rather than the ventilation system. The CDC is very concerned about helping clinicians and the general public tell the difference between seasonal aches and coughs, such as the flu, and the very rare but headline-grabbing anthrax cases. To date, the following should be considered: --the first symptoms of inhaled anthrax are the same as the flu and other wintertime viruses - fever, ache, cough, weakness/lethargy. Panicky patients and nervous clinicians may be quick to prescribe anthrax-killing antibiotics overprescription of these is already a concern. --one noticeable difference is that symptoms of nasal congestion or runny nose have not been reported in the inhaled anthrax cases so far. Those symptoms, of course, are common in many other virus-borne wintertime respiratory ills; --the importance of the clinical history of the occupation and the environment (postal workers and those handling the mail) has been the most significant red flags in considering and identifying anthrax as the disease-causing entity; --white cell counts also may be elevated in anthrax cases, while they are more likely to be normal or below with viral infections; --unfortunately, no single sign or symptom can reveal whether someone has early-stage inhaled anthrax. Antibody levels will eventually rise, but late in the infection, after treatment should have already begun; --many are using anthrax as motivator to get people to get vaccinated against the flu---to reduce confusion caused by this similarity in symptomology with anthrax. The flaw in this reasoning is that, by some estimates, perhaps 90 percent of wintertime flu-like illnesses are cause by neither the flu or anthrax. So even those who get flu shots may still come down with flu-like symptoms. As more is learned about anthrax, revisions in current guidelines will follow. Clinicians are encouraged to monitor the CDC's website on a frequent basis. Recommendations for Post-Exposure Prophylaxis for Air Borne B.Anthracis in Florida Inhalation Cases Example of recommendations from the CDC obtained by the International Society for Infectious Diseases, http://www.isid.org These recommendations are based on the susceptibility pattern of the B. Anthracis isolate from the Florida inhalational anthrax case. Adult patients Adult
males & non-pregnant females (ages 18-65 yrs) Pregnant adult females Adults age 65 yrs & over Children Antibiotics for children are listed in order of preference: Children 9 yrs & over Children less than 9 yrs Amoxicillin is preferred for children. If allergic to amoxicillin or penicillin, consultation with a physician is required, as ciprofloxacin or doxycycline may be indicated. This information is for general reference only. Individual allergies, medical histories, etc. need to be considered. Contact the CDC for specific, updated information and the most recent recommendations. First Person Account: ED Physicians
at Ground Zero on 9-11-01 Poison Updates The
Completely Different Pediatric Emergency Medicine Journal
Nonverbal Language
Great Puzzle Web Site Too Much Time on Your Hands?
Internet News A New Hoax Circulating There is an e-mail message circulating around the Net informing you that if you create a fake contact in your e-mail address book you can prevent your computer from spreading Internet viruses (actually, worms) to all of your friends and colleagues. This strategy does NOT work. Read all the reasons why at: http://antivirus.about.com/library/weekly/aa082801b.htm Another very useful resource to visit frequently regarding urban legends and e-mail hoaxes is: http://www.netsquirrel.com/combatkit/ Dick Gregory, comedian, author, political activist: When I lost my rifle, the Army charged me 85 dollars. That is why in the Navy the Captain goes down with the ship. [A politician is] a person skilled in the art of compromise. Usually an elected official who has compromised to get nominated, compromised to get elected, and compromised repeatedly to stay in office. Will Durant-(1885-1981)historian, author, Pulitzer Prize winner: Our knowledge is a receding mirage in an expanding desert of ignorance. The trouble with most people is that they think with their hopes and fears rather than with their minds. Every vice was once a virtue, and may become respectable again, just as hatred becomes respectable in time of war. In
my youth I stressed freedom, and in my old age I stress
order. I have made the great discovery that liberty is a
product of order. ERDOCS e-mail group (listserv) As a Clinician
providing acute and emergency medical care, you are invited
to visit and participate in our new ERDOCS group at eGroups,
a free, easy-to-use email group service! You have plenty
of experiences to share, questions to ask, concerns and
opinions to voice, suggestions, news to post, tips to offer,
etc. and can do so within this framework. This is a versatile
system for posting things to be sent to a group to peruse,
respond to, or simply be aware of. It eliminates conventional
mail delays and allows you to review and post at your leisure.
(We still have the more open-ended [any visitor can observe/post]
discussion group at the ACUTE CARE, INC. web site). Our goal is to give you a variety of
feedback and communication tools. This e-newsletter is available through the generous unrestricted
support of
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