27-03-2010 CT ANGIO – Not yet please (Areas of agreement and controversy: There is broad consensus that coronary CT angiography is indicated in patients with an intermediate pre-test probability of coronary artery disease (CAD) when other non-invasive tests have been equivocal. In this context, CT can reliably exclude significant CAD. Cardiac CT also has an established role in the evaluation of bypass grafts and suspected coronary anomalies. Radiation exposure from CT procedures remains a concern, although techniques are now available to reduce the X-ray dosage without significantly compromising the image quality. However, with the current level of knowledge, the cardiac CT examinations are not justified to screen for CAD in asymptomatic individuals. Neither is it considered appropriate in patients with a high pre-test probability of CAD, for whom invasive catheter coronary angiography is usually of more benefit.)
27-03-2010 CLOPIDOGREL & PPI – Maybe not that bad (Results showed no difference in event rates between those prescribed a PPI and those not given a PPI.)
26-03-2010 COX2 v COX1 Metanalysis – As safe as COX1s according to pharma funded studies (A pinch of salt?)
27-03-2010 MIGRAINE & YOUR HEART – How did they approve this negative study in the first place? (Migraine Intervention with Starflex Trial (MIST) results, showing no difference in headache cure between patients who underwent patent foramen ovale (PFO) closure and sham-treated migraineurs.)
26-03-2010 Obesity a psychological disorder – proposal by Prof Volkow for DSM V bec it resembles addiction to drugs: ‘Obesity is characterized by compulsive consumption of food and the inability to restrain from eating despite the desire to do so. These symptoms are remarkably parallel to those described in DSM-IV for substance abuse and drug dependence (Table 1), which has led some to suggest that obesity may be considered a “food addiction” (Cota 2006).’
27-03-2010 NPH to Lantus conversion: Same units if NPH once daily. If bd its 80% of the DAILY (i.e. Total) NPH dose (work out the amount of NPH if 70/30 mix)
26-03-2010 Orthorexia – Coined 1997 not in DSM IV or V (due 2013) – a focus on healthy foods – when extreme can lead morbidity or mortality.
27-03-2010 Aspirin Primary Prevention in DM (More CVAs ?less CVDs) – Diabetes Care study (Patients receiving aspirin lowered their cumulative incidence of coronary heart disease events by 3.91%, reducing the rate of deaths from coronary heart disease by 4.65%. However, subjects’ cumulative incidence of stroke increased by 0.51%, elevating the stroke mortality rate by 0.28%.) BUT (The use of aspirin to ward off CVD is still controversial and merits further study, according to the investigators. In 2 large, randomized trials recently published in the Journal of the American Medical Association and the British Medical Journal, respectively — namely, the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes trial and the Prevention of Progression of Arterial Disease and Diabetes trial — low-dose aspirin use in this population did not prevent cardiovascular events.)
27-03-2010 ASPIRIN/CLOPIDOGREL & BREASTFEEDING – Not proven to be unsafe. Minimise exposure, don’t give if infant has fever because of Reye’s. (There have been no adverse reports described in infants exposed to low dose aspirin, clopidogrel or dipyridamole via breast milk, however, they should be used with caution in breastfeeding mothers. Infant monitoring of adverse effects described with therapeutic doses should be undertaken especially signs of bruising and bleeding, which may be prolonged in the case of aspirin and clopidogrel. Due to the short half-life of clopidogrel and once daily dosing, the risk of adverse effects in infants may be minimized by timing the dose in relation to the feed immediately before the infant’s longest sleep period and expressing and discarding the milk before the next feed is due.)
27-03-2010 DIET – Reducing saturated fats not enough need to replace with polyunsaturated fats (“This is pretty important on a policy level,” said Mozaffarian. “It’s naturally assumed that lowering saturated fat is good for the heart, but that’s not what the evidence shows.” Simply reducing saturated fat without regard to what is substituted for it might not derive any benefit, he said.  The results of the study are published online March 23, 2010 in PLoS Medicine.)
26-03-2010 Xray can give fNEG, if pain persists consider MRI (UK Dr v US Dr :  Use clinical accumen before MRI v Use MRI if ANY doubt)
27-03-2010 HEART FAILURE & BNP – Treat to keep the BNP low gives beter results (Outpatients with chronic, primarily systolic heart failure lived longer if their medical management was guided by natriuretic-peptide-assay results, compared with med adjustments based on “usual clinical care,” in a meta-analysis that had to rely on a limited number of randomized, controlled trials [1])
27-03-2010 TKR Satisfaction – 95% at one year in the US
27-03-2010 VACCINE ROTARIX – Porcine DNA in vaccine FDA warning
27-03-2010 CT ANGIO – Not yet please (Areas of agreement and controversy: There is broad consensus that coronary CT angiography is indicated in patients with an intermediate pre-test probability of coronary artery disease (CAD) when other non-invasive tests have been equivocal. In this context, CT can reliably exclude significant CAD. Cardiac CT also has an established role in the evaluation of bypass grafts and suspected coronary anomalies. Radiation exposure from CT procedures remains a concern, although techniques are now available to reduce the X-ray dosage without significantly compromising the image quality. However, with the current level of knowledge, the cardiac CT examinations are not justified to screen for CAD in asymptomatic individuals. Neither is it considered appropriate in patients with a high pre-test probability of CAD, for whom invasive catheter coronary angiography is usually of more benefit.)
27-03-2010 CLOPIDOGREL & PPI – Maybe not that bad (Results showed no difference in event rates between those prescribed a PPI and those not given a PPI.)
26-03-2010 COX2 v COX1 Metanalysis – As safe as COX1s according to pharma funded studies (A pinch of salt?)
27-03-2010 MIGRAINE & YOUR HEART – How did they approve this negative study in the first place? (Migraine Intervention with Starflex Trial (MIST) results, showing no difference in headache cure between patients who underwent patent foramen ovale (PFO) closure and sham-treated migraineurs.)
26-03-2010 Obesity a psychological disorder – proposal by Prof Volkow for DSM V bec it resembles addiction to drugs: ‘Obesity is characterized by compulsive consumption of food and the inability to restrain from eating despite the desire to do so. These symptoms are remarkably parallel to those described in DSM-IV for substance abuse and drug dependence (Table 1), which has led some to suggest that obesity may be considered a “food addiction” (Cota 2006).’
27-03-2010 NPH to Lantus conversion: Same units if NPH once daily. If bd its 80% of the DAILY (i.e. Total) NPH dose (work out the amount of NPH if 70/30 mix)
26-03-2010 Orthorexia – Coined 1997 not in DSM IV or V (due 2013) – a focus on healthy foods – when extreme can lead morbidity or mortality.
27-03-2010 Aspirin Primary Prevention in DM (More CVAs ?less CVDs) – Diabetes Care study (Patients receiving aspirin lowered their cumulative incidence of coronary heart disease events by 3.91%, reducing the rate of deaths from coronary heart disease by 4.65%. However, subjects’ cumulative incidence of stroke increased by 0.51%, elevating the stroke mortality rate by 0.28%.) BUT (The use of aspirin to ward off CVD is still controversial and merits further study, according to the investigators. In 2 large, randomized trials recently published in the Journal of the American Medical Association and the British Medical Journal, respectively — namely, the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes trial and the Prevention of Progression of Arterial Disease and Diabetes trial — low-dose aspirin use in this population did not prevent cardiovascular events.)
27-03-2010 ASPIRIN/CLOPIDOGREL & BREASTFEEDING – Not proven to be unsafe. Minimise exposure, don’t give if infant has fever because of Reye’s. (There have been no adverse reports described in infants exposed to low dose aspirin, clopidogrel or dipyridamole via breast milk, however, they should be used with caution in breastfeeding mothers. Infant monitoring of adverse effects described with therapeutic doses should be undertaken especially signs of bruising and bleeding, which may be prolonged in the case of aspirin and clopidogrel. Due to the short half-life of clopidogrel and once daily dosing, the risk of adverse effects in infants may be minimized by timing the dose in relation to the feed immediately before the infant’s longest sleep period and expressing and discarding the milk before the next feed is due.)
27-03-2010 DIET – Reducing saturated fats not enough need to replace with polyunsaturated fats (“This is pretty important on a policy level,” said Mozaffarian. “It’s naturally assumed that lowering saturated fat is good for the heart, but that’s not what the evidence shows.” Simply reducing saturated fat without regard to what is substituted for it might not derive any benefit, he said.  The results of the study are published online March 23, 2010 in PLoS Medicine.)
26-03-2010 Xray can give fNEG, if pain persists consider MRI (UK Dr v US Dr :  Use clinical accumen before MRI v Use MRI if ANY doubt)
27-03-2010 HEART FAILURE & BNP – Treat to keep the BNP low gives beter results (Outpatients with chronic, primarily systolic heart failure lived longer if their medical management was guided by natriuretic-peptide-assay results, compared with med adjustments based on “usual clinical care,” in a meta-analysis that had to rely on a limited number of randomized, controlled trials [1])
27-03-2010 TKR Satisfaction – 95% at one year in the US
27-03-2010 VACCINE ROTARIX – Porcine DNA in vaccine FDA warning
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