Spinal Corticosteroids Run Risk of Severe Neuro Effects

Epidural injections of corticosteroids to relieve pain — a widespread, off-label use — run the rare risk for blindness, stroke, paralysis, and death, the US Food and Drug Administration (FDA) announced today.

The FDA is requiring manufacturers of corticosteroids to revise drug labels to include this warning.

In today's announcement, directed at anesthesiologists and pain management physicians, the agency said it has not established the effectiveness and safety of epidural administration of corticosteroids such as hydrocortisone and methylprednisolone. As a consequence, "the FDA has not approved corticosteroids for such use."

>READ MORE for advising from the FDA at medscape.com

The Pitfalls of Friend Doctor's Advice

Everyone Wants Free Advice

There are some situations for which medical school simply doesn't prepare you. Consider Thanksgiving dinner, when Aunt Myrtle buttonholes you about a recurring rash that's been bothering her. Or the sideline consult that one of the parents at your kid's football game wants to have, right after her son lands awkwardly trying to catch a pass.

When you're a physician, informal requests for information are simply part of the conversational landscape. Sometimes those requests are a quick and easy way to help someone out with a bit of information, a simple clarification, or a reassuring affirmation. Other times they can escalate and become annoyances: A simple question can result in a follow-up phone call and more requests. And, in a worst-case scenario, they can present ethical landmines that may tempt physicians to cross professional boundaries.

How do you address or deflect such requests? Unfortunately, there are no easy answers. It depends a lot on you, your boundaries, and the situation.

READ FULL ARTICLE to find out more from medscape.com

Preeclampsia Pregnancies and benefits of Low-Dose Aspirin

Daily low-dose aspirin starting as early as the second trimester of pregnancy appears to prevent morbidity and mortality from preeclampsia among high-risk women, according to a systematic review published online April 8 in the Annals of Internal Medicine. However, potential rare or long-term harms could not be ruled out.

"Preeclampsia, which is characterized by hypertension and proteinuria during the second half of pregnancy, is a leading cause of maternal and perinatal death," write Jillian T. Henderson, PhD, MPH, from the Kaiser Permanente Center for Health Research in Portland, Oregon, and colleagues.

"Previous comprehensive systematic reviews have found antiplatelets (primarily low-dose aspirin) to be beneficial for the prevention of preeclampsia among women at heightened risk. We conducted this systematic review to support the US Preventive Services Task Force [USPSTF] in updating its 1996 recommendation, which is no longer active."

READ FULL ARTICLE to learn what to do from medscape.com

Wisely Choosing the Right Care

Hello and welcome. I am Dr. George Lundberg, at large for Medscape.

In about 1989, then-Secretary of Health and Human Services of the US government Dr. Louis Sullivan stated that between 30% and 40% of American medical care was unnecessary, wasted, or inappropriate. In 2013, Massachusetts health dignitaries stated that 30% of medical care in Massachusetts is unnecessary or inappropriate.

If they are correct, why have we in the American medical profession not fixed that in more than 20 years? Could it be that generation after generation of people who populate the system simply like it the way it is -- veritable pigs addicted to the money trough?

READ MORE from medscape.com

Medscape Reference

Medscape's clinical reference is the most authoritative and accessible point-of-care medical reference for physicians and healthcare professionals, available online and via all major mobile devices. All content is free.

The clinical information represents the expertise and practical knowledge of top physicians and pharmacists from leading academic medical centers in the United States and worldwide.

The topics provided are comprehensive and span more than 30 medical specialties.

READ MORE from medscape.com

Diseases and Conditions

More than 6000 evidence-based and physician-reviewed disease and condition articles are organized to rapidly and comprehensively answer clinical questions and to provide in-depth information in support of diagnosis, treatment, and other clinical decision-making. Topics are richly illustrated with more than 40,000 clinical photos, videos, diagrams, and radiographic images.

Procedures

More than 1000 clinical procedure articles provide clear, step-by-step instructions and include instructional videos and images to allow clinicians to master the newest techniques or to improve their skills in procedures they have performed previously.

Anatomy

More than 100 anatomy articles feature clinical images and diagrams of the human body's major systems and organs. The articles assist in the understanding of the anatomy involved in treating specific conditions and performing procedures. They can also facilitate physician-patient discussions.

Drug Monographs

More than 7100 monographs are provided for prescription and over-the-counter drugs, as well as for corresponding brand-name drugs, herbals, and supplements. Drug images are also included.

Drug Interaction Checker

Our Drug Interaction Checker provides rapid access to tens of thousands of interactions between brand and generic drugs, over-the-counter drugs, and supplements. Check mild interactions to serious contraindications for up to 30 drugs, herbals, and supplements at a time.

Formulary Information

Access health plan drug formulary information when looking up a particular drug, and save time and effort for you and your patient. Choose from our complete list of over 1800 insurance plans across all 50 US states. Customize your Medscape account with the health plans you accept, so that the information you need is saved and ready every time you look up a drug on our site or in the Medscape app. Easily compare tier status for drugs in the same class when considering an alternative drug for your patient.

Medical Calculators

Medscape Reference features 129 medical calculators covering formulas, scales, and classifications. Plus, more than 600 drug monographs in our drug reference include integrated dosing calculators.

Image Collections

Hundreds of image-rich slideshow presentations visually engage and challenge readers while expanding their knowledge of both common and uncommon diseases, case presentations, and current controversies in medicine.

Are You Considering Complementary Medicine?

Millions of Americans use some form of complementary medicine. Like any decision concerning your health, decisions about whether to use complementary therapies are important. The National Center for Complementary and Alternative Medicine (NCCAM) has developed this fact sheet to assist you in your decisionmaking about complementary practices and products.

READ FULL ARTICLE from 

• Key Points
• What Do “Complementary,” “Integrative,” and “Alternative” Mean?
• How can I get reliable information about a complementary therapy?
• Are complementary therapies safe? How can I minimize risks in using these therapies?
• How can I determine whether statements made about the effectiveness of a complementary therapy are true?
• Are complementary therapies tested to see if they work?
• I am interested in a therapy that involves treatment from a complementary medicine practitioner. How do I go about selecting a practitioner?
• Can I receive treatment or a referral to a complementary medicine practitioner from NCCAM?
• Can I participate in a clinical trial of a complementary therapy?

Speaking Up About Your Medical Care

The Empowered Patient Coalition’s Preparing for Discharge Fact Sheet

The Joint Commission Speak Up about Medications Program

The Joint Commission Speak Up Program to Prevent Errors in Your Care

Five Steps to Safer Healthcare from AHRQ

Become More Involved in your Healthcare from AHRQ

Getting the Health Care You Need from The Health Consumer Alliance

Know Your Rights from the Joint Commission

Anesthesia & Me Checklist from the American Society of Anesthesiologists

via Speaking Up About Your Medical Care.

Lists of Things Physicians and Patients Should Question

Nine United States specialty societies representing 374,000 physicians developed lists of "Five Things Physicians and Patients Should Question" in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

What tests and procedures should patients and physicians talk about? Read the lists:

• American Academy of Allergy, Asthma & Immunology
• American Academy of Family Physicians
• American College of Cardiology
• American College of Physicians
• American College of Radiology
• American Gastroenterological Association
• American Society of Clinical Oncology
• American Society of Nephrology
• American Society of Nuclear Cardiology

Via Medical Lists

Talking About End-of-life Treatment Decisions

It's natural to avoid thinking—never mind talking—about dying. As a result, most people do not make their wishes clear to their loved ones or their health care providers. This includes many people who are nearing the end of life.

One way to communicate your wishes about future health care decisions is through "advance directives," which are legal documents that allow you to convey your decisions about your health care, especially end-of-life care. But fewer than half of severely or terminally ill patients have advance directives in their medical records, according to research sponsored by my agency, the Agency for Healthcare Research and Quality (AHRQ).

Even before you become old or ill, you need to think and talk about the kind of care you would want should a stroke, terminal illness, or life-threatening event occur. Ideally, these discussions should take place long before you need care. If such conversations don't take place, your family and physician must make decisions based on what they think you would want. As a physician, I know making decisions on behalf of a loved one is particularly difficult during an already stressful time.

End-of-life planning involves some thought and effort, such as completing advance directives. In addition to talking about your wishes with your family members, you should also talk with your doctor. Most doctors welcome the chance to discuss such issues but may be hesitant to raise the topic.

via Navigating the Health Care System: Talking About End-of-life Treatment Decisions.

Should More Patients Continue Aspirin Therapy Before Surgery?

By Megan Brooks

NEW YORK (Reuters Health) Apr 20 - The practice of empirically interrupting chronic aspirin therapy before surgery "should be abandoned," according to the authors of a contemporary literature review.

They say the evidence they found in a PubMed and Medline literature search "strongly supports" continued perioperative use of aspirin in patients taking it for secondary prevention of coronary artery disease, cerebrovascular disease, and peripheral vascular disease.

"Many patients need to be on lifelong aspirin therapy for various cardiovascular indications and...other than for a select group of operative procedures, the risks of aspirin cessation exceed the benefit," Dr. Neal Stuart Gerstein from the Department of Anesthesiology and Critical Care Medicine, University of New Mexico in Albuquerque told Reuters Health by email.

via Should More Patients Continue Aspirin Therapy Before Surgery?.

Experimental treatment may help food allergies – - CNN.com Blogs

Food allergies are tricky business. Theyre on the rise in the United States and no one knows why.Some children are allergic to many foods, and its impossible to know based on preventive testing whether someone will have a mild or severe reaction. And so far theres no cure.Researchers at Johns Hopkins University and Duke University are working on a treatment that may one day allow kids with allergies to safely eat the foods that cause them life-threatening reactions. Its still in the early stages, but Dr. Robert Wood of Johns Hopkins, who has been on the forefront of food allergy research, estimates the treatment could be brought to the public within six to eight years.In his new study, researchers explored a treatment for children with cows milk allergies. The strategy is to desensitize the child by giving small amounts of the allergen milk. Oral immunotherapy, swallowing small amounts of the allergen, has shown to be more effective than sublingual therapy, which involves putting even tinier quantities of milk under the persons tongue.

via Experimental treatment may help food allergies – - CNN.com Blogs.

Topical NSAIDs May Be a Better Choice for Elderly With OA

September 18, 2012 — Topical diclofenac is about as effective as oral diclofenac in knee and hand osteoarthritis OA, is probably as effective as other oral NSAIDs, and might be a safer choice for elderly patients and others at risk for gastrointestinal adverse effects, according to an intervention review published online September 12 in the Cochrane Database of Systematic Reviews.Sheena Derry, PhD, and colleagues from the University of Oxford in the United Kingdom based their conclusions about topical NSAIDs on a review of randomized, double-blind studies with placebo or active comparators in which at least a single treatment was a topical NSAID used to treat chronic pain caused by OA, and in which treatment lasted at least 2 weeks. The analysis included data from 7688 participants in 34 studies, 23 of which compared a topical NSAID with placebo."Topical NSAIDs were significantly more effective than placebo for reducing pain due to chronic musculoskeletal conditions," the authors conclude. "Direct comparison of topical NSAID with an oral NSAID did not show any difference in efficacy." Topical NSAIDs were associated with more local adverse events, such as mild rash, but with fewer gastrointestinal adverse events than oral NSAIDs.

via Topical NSAIDs May Be a Better Choice for Elderly With OA.

Viruses attack the nose in winter, but you can ease the discomfort with fluids and sprays - The Washington Post

What to do. Drinking fluids helps thin mucus and unstuff your nose. Also, try a saline nose spray; it’s safe to use as often as you need it. Need stronger measures? Congestion is often caused by engorged blood vessels, so a decongestant is in order. Experts recommend spray decongestants over pills because they attack the problem locally rather than affect your entire system. Pick one with oxymetazoline, such as Afrin, Vicks Sinex or a generic. Be sure to use them as directed; the sprays can cause rebound swelling if used longer than three days. If you prefer pills, try pseudoephedrine (Sudafed or generic), which is nonprescription but is kept behind pharmacy counters. If you have hypertension or glaucoma, talk to your doctor before using it.

Sinusitis. This inflammation of the lining of the sinuses is caused by allergies, irritation or an infection. You’ll feel as if your head is stuffed up, not just your nose, and you might have tenderness in your cheeks, upper jaw or around your eyes.

What to do. Doctors usually encourage sufferers to try home or over-the-counter remedies — say, a painkiller and a decongestant. Most cases are viral, not bacterial, so antibiotics won’t help. Sinusitis usually clears up in about 10 days. If symptoms last longer, see your doctor.

via Viruses attack the nose in winter, but you can ease the discomfort with fluids and sprays - The Washington Post.

Preventing and Treating a Cold: What Works? | LiveScience

Washing hands and taking zinc may be the best ways to avoid getting the common cold, and over-the-counter pain relievers are the recommended treatments to alleviate the symptoms, according to a new review.

The common cold strikes adults two to three times a year on average, while children under age 2 develop colds about six times a year, according to the study. There\'s no vaccine or cure for the cold, which usually takes only a few days to resolve on its own but can be bothersome and debilitating.

To identify the best ways to prevent getting a cold, or help alleviate its symptoms once it has struck, researchers reviewed more than 150 studies of both traditional and nontraditional approaches, ranging from gargling water to eating garlic.

via Preventing and Treating a Cold: What Works? | LiveScience.

Vicodin Not Superior to Tylenol #3 for Acute Pain

Hydrocodone/acetaminophen (Vicodin, AbbVie) was not superior to codeine/acetaminophen (Tylenol #3, McNeil) in acute pain relief reported by patients 24 hours after being discharged from the emergency department, according to a new study.

While Vicodin is the most popularly prescribed opioid in emergency departments, the drug and other hydrocodone combination formulations are under consideration by the US Food and Drug Administration (FDA) for rescheduling from a Schedule III drug to a more tightly regulated Schedule II drug. New York State has already made the change.

With Tylenol #3 representing a potentially ideal alternative, researchers sought to compare the 2 drugs — and found existing evidence was scant.

"The reason we conducted this study was because there was very little evidence supporting the superiority of Vicodin over Tylenol with codeine, despite its heavy preference in the emergency department setting," said lead author Andrew K. Chang, MD, MS, an associate professor of clinical emergency medicine at the Albert Einstein College of Medicine and attending physician at Montefiore Medical Center, Bronx, New York.

"There was no significant difference in side effects, [and] our results showed that Vicodin failed to provide superior pain relief compared to Tylenol with codeine."

via Vicodin Not Superior to Tylenol #3 for Acute Pain.

Migraines: Not Just Another Headache - YouTube

If you've never had a migraine, you might think it's just a really bad headache. But if you've ever had them, or you know someone who does, you know that they're much worse -- and much more complicated -- than that. Hank explains the biology behind this disorder of the central nervous system, and how it can be treated.

via Migraines: Not Just Another Headache - YouTube.

About Choosing Care Wisely | An Initiative of the ABIM Foundation

Choosing Wisely®

aims to promote conversations between physicians and patients by helping patients choose care that is:

Supported by evidence

Not duplicative of other tests or procedures already received

Free from harm

Truly necessary

In response to this challenge, national organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

This concept was originally conceived and piloted by the National Physicians Alliance, which, through an ABIM Foundation Putting the Charter into Practice grant, created a set of three lists of specific steps physicians in internal medicine, family medicine and pediatrics could take in their practices to promote the more effective use of health care resources. These lists were first published in Archives of Internal Medicine.

Recognizing that patients need better information about what care they truly need to have these conversations with their physicians, Consumer Reports is developing patient-friendly materials and is working with consumer groups to disseminate them widely.

via About Choosing Care Wisely | An Initiative of the ABIM Foundation.

When to Give Antiviral Drugs for the Flu

Evidence from past influenza seasons and the 2009 H1N1 pandemic has shown that treatment with antiviral medications can have clinical and public health benefit in reducing severe outcomes of influenza when initiated soon after illness onset. Clinical trials and observational data show that early antiviral treatment may:

• Shorten the duration of fever and illness symptoms;

• Reduce the risk for complications and death; and

• Shorten the duration of hospitalization.

Clinical benefit is greatest when antiviral treatment is initiated early. When indicated, antiviral treatment should be started as soon as possible after illness onset -- ideally, within 48 hours of symptom onset. However, observational studies show that antiviral treatment might still be beneficial in patients with severe, complicated, or progressive illness, and in hospitalized patients when started even later than 48 hours after illness onset.

In summary, antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who:

• Is hospitalized;

• Has severe, complicated, or progressive illness; or

• Is at higher risk for influenza complications.

Persons at higher risk for influenza complications in whom antiviral treatment is recommended include children younger than 2 years of age, adults aged 65 and older, persons with certain medical conditions, pregnant or postpartum women, American Indians and Alaskan Natives, and residents of nursing homes and other chronic-care facilities.

Decisions about starting antiviral treatment should not wait for test results or laboratory confirmation of influenza. When there is clinical suspicion of influenza and antiviral treatment is indicated, antiviral treatment should be started as soon as possible, along with use of appropriate infection control measures.

via When to Give Antiviral Drugs for the Flu.