RedScrubs
The Resource for Medical Professionals

New preventive recommendations appear in the August 5 issue of Annals of Internal Medicine regarding evidence summaries on the preventive recommendations for having the prostate specific antigen (PSA) test done. The new recommendations from the U.S. Preventive Task Forces state that men age 75 and older need not be screened for prostate cancer and younger men should discuss the benefits and harms of the PSA before being tested.

The science and art of feeding patients through their blood vessels has become a life saving part of critical care medicine. Many patients cannot eat but must be fed to get better, so total parenteral nutrition (TPN) emerged to meet that need and continues to be a refined science of feeding those who cannot use their alimentary tract.

What do the terms “Night Float”, “Budget”, “Compassionate Health Care”, “Tardiness”, and “NBC” have in common? Well…they happen to be the subjects of our weekly Redscrubs Wrap-Up for this week.

As always, many of these blogs that I love to read each week alternately keep me entertained, engrossed, and/or infuriated - kind of like an online healthcare version of Reader’s Digest, I suppose.

So, congrats to our Scrubby Winner this week, and the other honorees noted in the Wrap-Up. Don’t miss this compelling reading! - Dr. Incognito

The McLean County in the State of Illinois has about 9,500 people or 7% of its population with diabetes. Of those, about 120 die each year from the disease. Blue Cross and Blue Shield of Illinois collaborated with McLean County employers and health care providers to develop and implement a diabetes intervention program called Diabetes Checks and Balances.

The first program of its kind in Illinois, Diabetes Checks and Balances encouraged people with diabetes to contact their physician to obtain four tests – a HbA1c, a LDL, and eye exam and screening for kidney disease. More than 600 area participants met the criteria for the exam and 29% completed all four of the tests, twice as many people as in 2006 when it first started.

Pharmacogenomics is the study of how an individual’s genetic makeup (genotype) affects how the body responds to medication. Everyone is different. Pharmacogenomics looks at the ways these variations can be used to determine if a patient will or will not respond to a drug.

Considerable public interest has been shown in the use of pharmacogenomic testing to predict a patient’s response to warfarin, most commonly marketed as Coumadin and used as an anticoagulant. The anticoagulant effect of coumadin is measured by the use of prothrombin time (PT) and the International Normalized Ratio (INR). Using these methods the ratio of the patient’s PT to the mean PT for a group of normal individuals is calculated.

A new vaccine that is being used by the Roswell Park Cancer Institute in Buffalo, New York shows promise for those that have Ovarian cancer. This is still in Phase 1 trial and has been effective for 18 out of the 22 women who have received the vaccine. The vaccine was developed to find and kill cancer cells and has provided remarkable results.

C-Reactive Protein is a protein associated with inflammation and heart failure. In a study designed to look at the association with magnesium deficiency and elevated high sensitivity C – reactive protein (hsCRP), a community –based cross-sectional study involving 488 healthy children aged 10-13 from Durango, Mexico were randomly selected to participate in testing this hypothesis.

The results pointed to a relationship between magnesium deficiency and hsCRP. A total of 87.1% had both elevated hsCRP and low magnesium levels. Children with this profile tended to have the highest fasting glucose, the lowest HDL, highest insulin levels and highest triglyceride levels.

It is well known that diabetes is under-diagnosed. Approximately one-third of the individuals with diabetes do not know they have it and it generally takes about 7 years to determine the diagnosis. By that time, irreparable damage may already have occurred. This report offers a reconsideration of the diagnostic criteria for diabetes.

This study demonstrated that derangements of blood glucose control occur in patients with and without diabetes who undergo cardiac surgery. The study analyzed 8,727 adults placing them in a variety of blood glucose control categories (good= < 200 mg/dl), (moderate = 200-250 mg/dl)or (poor = >250 mg/dl). They determined that the percentage that fell in the inadequate blood glucose control categories were more likely to have heart failure, hypertension, renal dysfunction and ejection fraction < 50%. The study found that 52% of patients had poor control, 31% had moderate control and 8% with good control had diabetes as a diagnosis. Inadequate blood glucose control, but not diabetes, was associated with in-hospital mortality and morbidity. Inadequate control was also associated with post-operative heart attacks, and with pulmonary and renal complications in people without the diagnosis of diabetes.