RedScrubs
The Resource for Medical Professionals

Much of my family lives on the Texas coast, where I joined them this past week, as Mother Nature’s fury visited us - not pleasant I assure you! Fortunately for us, we were able to stay for several days at a very dear friend’s house where we had the five basic 21st Century necessities: Running Water, Food, Electricity, Television, and…DSL.

So, between the endless drone of Hurricane Ike coverage, Wall Street woes, and November election speculation on TV, I found my solace in reading some good medical blog posts from MedReader. It’s always a little difficult to choose the top 5 for the week - but here they are for our faithful readers, this weeks Scrubby Awards: Enjoy!

Dr. Incognito

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.

Coumadin is most commonly used in patients with mechanical heart valves, post- cerebrovascular events and other indications as determined by the health care provider.

The Centers for Disease Control (CDC) released their 2008 breastfeeding report card recently and it was not impressive. The report suggested that standard procedures at many birthing facilities are not supporting a woman’s chances for a successful breastfeeding experience with their newborn infants.

The CDC survey, completed by over 2500 hospitals and birth centers in the U.S., examined such practices as labor and delivery, breastfeeding assistance, mother-newborn contact and breastfeeding support after discharge. The participating facilities were scored based on a 100 point score card system. The national average was 63, but there was a wide range of scores. For example Arkansas scored a mere 48 points.

The supplementation of omega-3 fatty acids in heart failure patients has shown improved morbidity and mortality whereas statins failed to show the same beneficial effect in the group of patients being studied. The long term administration of 1 g omega-3 fatty acids reduced all-cause mortality and admission to the hospital for cardiovascular reasons whereas there was no effect on these parameters with 10 mg rosuvastatin, a statin drug.

The study, called the GISSI-HF trial, showed a 9% reduction in all cause mortality with omega-3 fatty acids. Investigators reported “Although this moderate benefit was smaller than expected, it should be noted that these results were obtained in a population already treated with recommended therapies, was consistent across all of the predefined subgroups and was further supported by the findings of the per-protocol analysis.”

In a precedent offering, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) has compiled a Patient Nutrition Support Education Manual to assist with healthcare professionals’ verbal explanations concerning nutrition therapy options and procedures. This publication is a compilation of over 200 fact sheets from prestigious organizations and institutions.

The purpose of the 427 page manual is to provide clinicians (i.e. nurses, pharmacists, dietitians, pharmacists, health educators, etc.) with a compilation of some of the best patient education resources in the nutrition support arenas broadly encompassing enteral nutrition, parenteral nutrition, surgical procedures, medical conditions and pediatrics. Specific areas covered include parenteral and enteral access, complications of nutrition support, Medicare and Medicaid, enteral access devices and feeding methods, coping, care of feeding tubes, medication, surgery including gastrointestinal and transplant, medical conditions including gastrointestinal(G.I.) and diets to promote weight gain and maximize protein intake, nutrition considerations for patients with cancer, nutrition in the elderly, pediatric issues and Spanish materials that include parenteral and enteral nutrition, general nutrition and home nutrition support issues. A CD-ROM is included with the manual to assist with customization of the educational handouts.

New AHA obesity statement forces physicians to think about prevention
At last! The American Heart Association has fessed up! A recent statement on obesity has forced the AHA to think about its motives. It’s time we get past the prescription addiction and realized that exercise and diet can achieve the same benefits that many common prescription medications do.

Immunosuppressive drugs are drugs that inhibit or prevent activity of the immune system. They are used to prevent transplant rejection, to treat autoimmune disorders (i.e. rheumatoid arthritis) and to treat other conditions such as asthma.

Federal health authorities have asked the manufacturers of four widely used immunosuppressive drugs to bolster black box warnings on the risk of developing opportunistic fungal infections with the use of these drugs. The four drugs in question are Humira, Cimzia, Enbrel and Remicade.

A 321 page report issued by the U.S. Dept of Health and Human Services and the National Toxicology Program (NTP) has implicated Bisphenol-A (BPA) in adverse effects on the development of the prostate gland and brain and for behavioral effects in fetuses and infants. Bisphenol-A is found in many polycarbonate plastics and epoxy resins including the chemicals found in plastic bottles used for a variety of beverages.

The report, released September 4, 2008 provides the current opinion on BPA’s potential to cause harm to human reproduction or development. However, despite other reports linking BPA to metabolic syndrome and even impairments in learning and memory, FDA continues to take the stance that this substance does not pose any substantial risk to humans.

Well folks, the end of summer is drawing near; the Labor Day holiday this week is usually the signal for this year’s warm weather, family vacations. and fun in the sun to draw to a close. Historically, the blogs somewhat slow down during the summer months as well, so the future should be bright for great new posts pretty soon.

Still no shortage of great posts for this week, and here they are - this weeks Scrubby Awards!

-Dr. Incognito