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Skyrocketing prescription prices force patients to skip meds
This article is adapted from the AAFP Leader Voices Blog. Image credit: Shutterstock.com Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 10, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/michael-munger" rel="tag" > Michael Munger, MD < /a > Tags: Meds Medications Source Type: blogs

Welcome to My World: Med Wreck
By HANS DEUVEFELT, MD Part of a series on primary care challenges and their solutions. Medication reconciliation is something we do every day, in the clinic and in the hospital. It shouldn’t be as hard as it is. A patient with multiple medical problems returns for a fifteen minute quarterly visit. He saw his cardiologist three weeks ago and was told to double his metoprolol. There are two ways to catch this change: when the cardiologist’s office note comes in, or as we check the patient in for his visit. The cardiologist’s office note, generated by one of the leading EMRs, runs seven pages and contains entries a...
Source: The Health Care Blog - August 10, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Sulodexide
Brief Review Abstract: Sulodexide is a glycosaminoglycan with antithrombotic properties. The future role of sulodexide is possibly as an agent to prevent recurrent venous thromboembolism in those at higher risk of bleeding with warfarin and novel oral anticoagulants (NOACS). Sulodexide is a glycosaminoglycan with antithrombotic properties. It corresponds to a mixture of heparin and dermatan sulfate having profibrinolytic properties and anti-inflammatory activity demonstrated in vitro [1]. Sulodexide has anti oxidant and anti glucotoxic effects which make it potentially beneficial in the treatment of diabetic kidney di...
Source: Cardiophile MD - November 17, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology antithrombotic glycosaminoglycan SURVET Study Source Type: blogs

Test your medicine knowledge: 58-year-old man with type 2 diabetes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated during a routine appointment. He is asymptomatic. He was diagnosed with type 2 diabetes mellitus 4 years ago and has hypertension, dyslipidemia, and obesity. His medications are enteric-coated low-dose aspirin, lisinopril, fluvastatin (20 mg/d), and metformin. His calculated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohort Equations is 10%. On physical examination, blood pressure is 126/78 mm Hg and pulse rate is 72/min. The remainder of the ex...
Source: Kevin, M.D. - Medical Weblog - October 3, 2015 Category: Journals (General) Authors: Tags: Conditions Diabetes Heart Source Type: blogs

Medications After a Heart Attack
From: www.secondscount.orgYour heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.Medications you are likely to be prescribed after a heart attack fall int...
Source: Dr Portnay - January 23, 2015 Category: Cardiology Authors: Dr Portnay Source Type: blogs

MKSAP: 64-year-old man with knee osteoarthritis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated for a 2-year history of knee osteoarthritis. He has bilateral knee pain that worsens with walking. He has tried topical therapies, physical therapy, and acetaminophen, none of which has provided relief. The patient also has peripheral vascular disease, hyperlipidemia, and hypertension. Medications are hydrochlorothiazide, pravastatin, and a daily aspirin. On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 116/76 mm Hg, pulse rate is 60/min, and respirati...
Source: Kevin, M.D. - Medical Weblog - July 12, 2014 Category: Journals (General) Authors: Tags: Meds Rheumatology Source Type: blogs

Statin Therapy Does Not Improve Cardiovascular Risk for Patients With HIV and Low HDL
The main lipid abnormality of people living with HIV is low high density lipoprotein (HDL).  There are 5 subfractions of HDL: 2a, 2b, 3a, 3b, and 3c, from largest (and most effective in cholesterol removal) to smallest (and least effective). Neither pravastatin nor rosuvastatin changes the distribution of high-density lipoprotein (HDL) subfractions in patients who are HIV-seropositive with (Source: Nelson Vergel's HIV Blog)
Source: Nelson Vergel's HIV Blog - June 5, 2014 Category: HIV AIDS Authors: Nelson Vergel Source Type: blogs

A clear-eyed look at treating the elderly with medicine
A recent case taught me a lot about how people perceive their medicines. I was trying to help a 92-year-old man get off some of his medicine. I can’t go into the details, but suffice to say, there was much opportunity to trim a long list of drugs, many of which were threatening his existence and impairing his quality of life. As I was discussing stopping many of the meds, the patient said (with a quite sincere tone): “You doctors these days just want us old people to go off and die.” That was a zinger, a real punch in the gut. I was trying to do the opposite–allow him to live a longer and better lif...
Source: Dr John M - March 7, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

A clear example of how values matter in judging statins for primary prevention
The new JAMA has an article and an editorial that favor using statins for primary prevention. The clinical evidence and the editorial focus on the relative risk improvement with statins. However, the clinical evidence reports on a number needed to treat for 5 years of 138 to prevent 1 death. So 5 years of statin therapy for 138 patients to prevent 1 death. Is this a reasonable trade off? The lipidologists obviously see this as a victory for their hypothesis. They quote data that patients tolerate statin therapy as well as they tolerate placebo. They now have the evidence. We should give many more patients statins! Many cri...
Source: DB's Medical Rants - December 11, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs

How Manipulated Clinical Evidence Could Distort Guidelines - the Case of Statins for Primary Prevention
This study excluded many patient for whom the statins were not contraindicated or warned against: uncontrolled hypertension; type 1 or type 2 diabetes mellitus on insulin or with a HgBA1C at least 10%; and body weight more than 50% "desirable limit for height."  (Based on the official contraindications and warnings for commonly used statins, e.g., see contraindications for Lipitor here, active liver disease, pregnancy for likely to become pregnant, nursing mothers, hypersensitivity to the medicine; and warnings: use of cyclosprine or strong CYP3A4 inhibitors, uncontrolled hypothyroidism, renal impairment.)  Thus ...
Source: Health Care Renewal - December 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: American College of Cardiology American Heart Association clinical trials conflicts of interest evidence-based medicine guidelines manipulating clinical research review articles Source Type: blogs

Greatly improved new statin guidelines – with one exception
The Twitterverse blew up yesterday when they released the new lipid guidelines. I read many articles and finally think I am understanding the big progress these guidelines achieve. My favorite review is on Medscape (free registration required) – New Cholesterol Guidelines Abandon LDL Targets. I titled this post the statin guidelines, because these guidelines no longer focus on LDL levels, but rather the use of statins. We are no longer asked to treat to goal, rather to put appropriate patients on a statin. The four major primary- and secondary-prevention patient groups who should be treated with statins were identifi...
Source: DB's Medical Rants - November 13, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs

Low Rate Of Problems With Statins In Study Of Quarter Million Patients
A very large analysis of previously published studies finds that statins are generally safe and well tolerated, but helps confirm previous links to a small increased risk for diabetes and elevation of liver enzymes. Some statins were better tolerated than other statins and lower-dose statins were better tolerated than high dose statins. In a paper published in Circulation: Cardiovascular Quality and Outcomes, Huseyin Naci and colleagues report their findings from a systematic review of clinical trials with statins for both primary and secondary prevention. The data from 55 placebo controlled trials and 80 trials inclu...
Source: CardioBrief - July 9, 2013 Category: Cardiology Authors: Larry Husten Tags: Prevention, Epidemiology & Outcomes atorvastatin Pravastatin primary prevention Rosuvastatin secondary prevention Simvastatin Source Type: blogs

May Diabetes-Related News Snippets
Conclusion: "Compared with pravastatin, treatment with higher potency statins, especially atorvastatin and simvastatin, might be associated with an increased risk of new onset diabetes."22% higher risk with Lipitor (atorvastatin) and 18 percent higher with Crestor (rosuvastatin).In mainstream press coverage, Drug company shills,, a.k.a. well known cardiologists, bend over backward to ignore this latest confirmation of a phenomenon that has been public knowledge for more than a year. The reason that statins cause diabetes may have to do with the fact that they impair the operation mitochondria--the part of the cel...
Source: Diabetes Update - June 3, 2013 Category: Diabetes Authors: Jenny Source Type: blogs

Drug News in Brief
Short takes on matters various. Taking Aim at Pot—Researchers have recently made clinical efforts to test three drugs that might help during marijuana withdrawal to keep pot abstainers on the straight and narrow. Researchers at Columbia University, led by Margaret Haney, have been testing a synthetic THC compound called nabilone. The drug is designed to address sleep and appetite problems during withdrawal.  Whether it is any better tolerated by users than Marinol, Uncle Sam’s widely unpopular version of synthetic THC, remains to be seen. This approach can be viewed rather like methadone or buprenorphine substitu...
Source: Addiction Inbox - March 20, 2013 Category: Addiction Authors: Dirk Hanson Source Type: blogs

Unreported Drug Side Effects Discovered by Analysis of Google Big Data
Discussion about Big Data; Relevance for Healthcare). The key aspect of such Google research is understanding how to interpret search engine queries. Here's a graph of the search term gonorrhea from Google Trends with volume peaking in October, 2010. A correlation with relevant news headlines is also provided. (Source: Lab Soft News)
Source: Lab Soft News - March 14, 2013 Category: Pathologists Authors: Bruce Friedman Tags: Electronic Medical Record Healthcare Information Technology Medical Consumerism Medical Research Pharmaceutical Industry Source Type: blogs

Bad Pharma And The Statin Wars - Forbes
It’s been amusing to watch former Pfizer executive John LaMattina try to pick apart Ben Goldacre’s new book, Bad Pharma,  a powerful indictment of the industry in which LaMattina used to work. This is not the occasion to get into the details of this battle, but as an aside let me just say that I would advise any representatives of the pharmaceutical industry to think very carefully before choosing to take on Goldacre. John LaMattina What I want to focus on here is an assertion, accepted by both Goldacre and LaMattina, that is simply mistaken. LaMattina’s latest post is a respon...
Source: PharmaGossip - March 2, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs

Yes, Statins do everything – even lower BP
What could be crazy enough to end a 4 month hibernation of CTE? Archives Int Med 4/08 – The UCSD Statin study yielded further evidence that statin treatment reduces blood pressure (although not by much) The RCT enrolled over 900 subjects without known CVD or diabetes. The idea was to independently assess the effect on BP. There was no inclusion / exclusion criteria regarding baseline BP. Subjects were randomized to pravastatin, simvastatin, or placebo. Treatment with a statin resulted in about a 2-2.5 point drop in SBP and DBP. The treatment was stopped at 6 months, and the blood pressures returned to baseline by mon...
Source: Consider The Evidence: Med/Peds Journal Roundup - April 18, 2008 Category: Internists and Doctors of Medicine Authors: medblog Tags: archives of internal medicine hypertension Source Type: blogs