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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_455"
                     title="Low Vitamin D Linked to Hip OA (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18379?impressionId=1265728369919"
                     
      &lt;p&gt;Elderly men with low serum levels of vitamin D are at increased risk for developing hip osteoarthritis, a prospective cohort study found.&lt;/p&gt;
&lt;p&gt;Men whose levels of 25-hydroxyvitamin (OH)D were between 15.1 to 30 ng/mL had twice the likelihood of prevalent radiographic hip osteoarthritis than those whose levels were normal (OR 2.19, 95% CI 1.21 to 3.97), according to R. Krishna Chaganti, MD, of the University of California at San Francisco, and colleagues.&lt;/p&gt;
&lt;p&gt;Conversely, after adjusting for age, season at blood draw, and clinic site, higher vitamin D levels were associated with a lower prevalence of hip osteoarthritis (OR 1.39 per 1 SD decrease in 25(OH)D level, 95% CI 1.11 to 1.74), the researchers reported in the February issue of &lt;em&gt;Arthritis &amp;amp; Rheumatism&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Because the role vitamin D may play in the pathogenesis and progression of osteoarthritis is unclear, Chaganti and colleagues analyzed data from the Osteoporotic Fractures in Men Study, which enrolled a large cohort of elderly men between 2000 and 2002 from six centers across the U.S.&lt;/p&gt;
&lt;p&gt;A total of 1,104 men whose mean age was 77.2 years had baseline measurements of serum vitamin D, and about 4.5 years later pelvic radiographs were obtained.&lt;/p&gt;
&lt;p&gt;Radiographs were scored to reflect joint space narrowing, osteophyte formation, cysts, subchondral sclerosis, and femoral head deformity.&lt;/p&gt;
&lt;p&gt;Vitamin D levels were categorized as deficiency (&amp;#8804;15 ng/mL), insufficiency (15.1 to 30 ng/mL), and sufficiency (&amp;gt;30 ng/mL).&lt;/p&gt;
&lt;p&gt;Mean vitamin D level was 23.38 ng/mL in men who had radiographic hip osteoarthritis, compared with 26.04 ng/mL in men without radiographic abnormalities (&lt;em&gt;P&lt;/em&gt;=0.0002).&lt;/p&gt;
&lt;p&gt;Men with hip osteoarthritis had a higher prevalence of both vitamin D insufficiency (77% versus 65%, &lt;em&gt;P&lt;/em&gt;=0.002) and deficiency (10.2% versus 7.5%, &lt;em&gt;P&lt;/em&gt;=0.012).&lt;/p&gt;
&lt;p&gt;Moreover, they had slower six-meter walking speed (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001) and reported more hip pain (&lt;em&gt;P&lt;/em&gt;=0.0001).&lt;/p&gt;
&lt;p&gt;Men who were vitamin D deficient also tended to have an increased likelihood of hip osteoarthritis (OR 1.99, 95% CI 0.83 to 4.74), but after adjustment in multivariate models, statistical significance was lost with this level of the vitamin.&lt;/p&gt;
&lt;p&gt;&quot;The association of low 25(OH)D levels with prevalent radiographic hip [osteoarthritis] underscores the potentially important role of vitamin D in the pathogenesis of [osteoarthritis]. Vitamin D metabolites have been found to be associated with the regulation of the Wnt pathway, products of which play important roles in the development and maintenance of bone and cartilage,&quot; the investigators explained.&lt;/p&gt;
&lt;p&gt;Furthermore, in vitro studies have suggested that serum levels of 25-hydroxyvitamin D&lt;sub&gt;3&lt;/sub&gt; can affect the ratio of RANKL to osteoprotegerin and thereby influence bone deterioration and repair.&lt;/p&gt;
&lt;p&gt;Previous investigations have yielded conflicting results. One study found that low levels of vitamin D were not associated with worsening of knee osteoarthritis, as reflected in loss of articular cartilage on MRI.&lt;/p&gt;
&lt;p&gt;Another study, however, linked knee osteoarthritis with low vitamin D levels, particularly in patients who also had decreased bone mineral density in the lumbar spine.&lt;/p&gt;
&lt;p&gt;&quot;Vitamin D influences the mineralization of bone matrix, and low serum levels of vitamin D may result in poorly mineralized bone that might alter forces across the joint and reduce joint deterioration,&quot; the authors suggested.&lt;/p&gt;
&lt;p&gt;On the other hand, low levels may interfere with chondrocyte metabolism and thereby increase degeneration.&lt;/p&gt;
&lt;p&gt;Further studies will be needed to more fully clarify the effects of the vitamin on the development and progression of osteoarthritis, the investigators cautioned.&lt;/p&gt;
&lt;p&gt;Strengths of the study include the large cohort of participants, careful classification of radiographic osteoarthritis, and reliance on the gold standard of vitamin D measurement, the 25(OH)D level.&lt;/p&gt;
&lt;p&gt;Limitations include the cross-sectional design, precluding the inference of causality, and the gap in time between measurement of serum vitamin D and radiography.&lt;/p&gt;
&lt;p&gt;The authors concluded that therapeutic interventions to increase vitamin D serum levels in the elderly &quot;are warranted,&quot; with the goal of improving skeletal health in this vulnerable age group.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, the National Center for Research Resources, and the NIH Roadmap for Medical Research.&lt;/p&gt;&lt;p&gt;The lead author was supported by a grant from the American College of Rheumatology Research and Education Foundation.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_454"
                     title="Glaucoma Meds Linked to Lower Mortality Risk (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Ophthalmology/Glaucoma/tb/18371?impressionId=1265728369919"
                     
      For patients diagnosed with glaucoma, taking medications for the condition appears to improve survival, researchers found.&lt;br&gt;
&lt;br&gt;Patients with suspected or confirmed glaucoma were 74% less likely to die during a five-year period if they were prescribed any glaucoma medication (HR 0.26, 95% CI 0.16 to 0.40), according to Joshua Stein, MD, of the University of Michigan Kellogg Eye Center in Ann Arbor, and colleagues.&lt;br&gt;
&lt;br&gt;However, in an analysis of patients with suspected glaucoma only, the association was no longer significant (HR 1.19, 95% CI 0.43 to 3.27), the researchers reported in the February issue of the &lt;em&gt;Archives of Ophthalmology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;Additional studies need to be done to try to sort out exactly why the patients who have diagnosed glaucoma tend to have reduced mortality relative to the other patients who are not being treated,&quot; Stein told &lt;em&gt;MedPage Today&lt;/em&gt;, adding that changes in clinical management should not be made until this is sorted out.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Previous studies of glaucoma and mortality have yielded conflicting results. Few have examined the effect of glaucoma medications, which can be absorbed systemically and affect the body in ways that may confound such analyses.&lt;/p&gt;
&lt;p&gt;So Stein and his colleagues looked at data from a large managed care network involving 21,506 patients 40 and older with suspected or confirmed glaucoma.&lt;/p&gt;
&lt;p&gt;About half (50.5%) had suspected glaucoma and the rest had received a definite diagnosis, most commonly open-angle glaucoma (21.5%).&lt;/p&gt;
&lt;p&gt;Comorbidities were common: 52.7% of the patients had hypertension and 41.3% had diabetes.&lt;/p&gt;
&lt;p&gt;From 2003 through 2007, 28.1% of the patients filled a prescription for a glaucoma medication. The most frequently prescribed drugs were prostaglandin analogues (20.8%) and beta-antagonists (12.8%).&lt;/p&gt;
&lt;p&gt;More than a quarter (28%) were also prescribed oral beta-blockers.&lt;/p&gt;
&lt;p&gt;During the study, 1.1% of the patients died.&lt;/p&gt;
&lt;p&gt;The overall reduction in risk of death during the study held for both single agents  --  topical beta-antagonists (HR 0.40, 95% CI 0.18 to 0.86) and prostaglandin analogues (HR 0.27, 95% CI 0.14 to 0.52),&lt;strong&gt; &lt;/strong&gt;as well as for combinations of glaucoma medications.&lt;/p&gt;
&lt;p&gt;The mortality risk declined as the number of prescribed medications increased (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). The hazard ratios for one, two, and three or more medications were 0.29, 0.19, and 0.12, respectively.&lt;/p&gt;
&lt;p&gt;Among those with the most common diagnosis, open-angle glaucoma, the risk of dying during the study was reduced by a relative 77% for those prescribed at least one medication (HR 0.23, 95% CI 0.14 to 0.37).&lt;/p&gt;
&lt;p&gt;It is unclear why glaucoma medication use is associated with a lower mortality risk, but it is possible that topical medications absorbed systemically could affect blood pressure, heart rate, breathing, and kidney function, Stein said.&lt;/p&gt;
&lt;p&gt;&quot;But the fact that multiple different medication classes are showing this protective effect suggests to me that it may not necessarily be the medications themselves, but perhaps it&apos;s the types of patients who are receiving the medications,&quot; he said.&lt;/p&gt;
&lt;p&gt;The patients taking medication for glaucoma might be healthier than the untreated patients, he said.&lt;/p&gt;
&lt;p&gt;Those with more serious conditions might have to selectively choose which drugs they buy, and might purchase medications for more serious conditions than glaucoma.&lt;/p&gt;
&lt;p&gt;Also, physicians treating patients with more serious conditions might not focus on glaucoma, Stein said.&lt;/p&gt;
&lt;p&gt;A final possibility might be differences in the beneficiaries&apos; access to healthcare.&lt;/p&gt;
&lt;p&gt;The authors noted a number of limitations of the study: &lt;ul&gt; &lt;li&gt;The use of claims data, and not patient records, resulted in missing information on some important clinical variables&lt;strong&gt;,&lt;/strong&gt; such as smoking, body weight, blood pressure.&lt;/li&gt; &lt;li&gt;The results are not necessarily generalizable beyond the insured patients in this single, managed care network.&lt;/li&gt; &lt;li&gt;Death status could not be verified and cause of death could not be determined because of the use of de-identified data.&lt;/li&gt; &lt;li&gt;It is unclear whether patients actually took the prescribed medications.&lt;/li&gt; &lt;li&gt;The relationship between certain drug classes and mortality risk could not be determined because of low patient numbers.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_453"
                     title="BLOG: Linkfest Today"
                     score="0.01"
                     href="http://www.medpagetoday.com/Blogs/18383?impressionId=1265728369919"
                     
      &lt;div align=&quot;left&quot;&gt;One of the biggest problems with the growing hospitalist movement is the communication between the inpatient physician and primary care doctor.  Although it&apos;s getting better at some hospitals, there&apos;s clearly room for improvement.  The discharge summary, for instance, takes a few days before it gets transcribed and sent to a patient&apos;s regular doctor.  This is critical information needed for any follow-up visit.&lt;br&gt;
&lt;br&gt;
More concerning are cases where follow-up is needed on lab tests.  In a recent study, only 16% of &lt;a href=&quot;http://www.kevinmd.com/blog/2010/02/pending-lab-tests-hospitalist-discharge-summaries.html&quot; target=&quot;_blank&quot;&gt;pending lab tests&lt;/a&gt; were written in a discharge summary, which makes it difficult for a physician to know what to follow-up on.  &lt;br&gt;
&lt;br&gt;
Unified electronic records can be a solution, where both the inpatient and outpatient doctor can have access to the same medical chart, but we&apos;re clearly not there yet.  &lt;br&gt;
&lt;br&gt;
***&lt;br&gt;
&lt;br&gt;
What if our fragmented health system were applied to, say, the airline industry?  Well, it would look something like this:&lt;br&gt;
&lt;br&gt;

&lt;br&gt;
&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_452"
                     title="Study Backs Late Cardiotoxicity of Childhood Cancer Treatment (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18384?impressionId=1265728369919"
                     
      A childhood cancer survivor&apos;s risk of dying from cardiovascular causes rises with the dose of radiation his heart received during treatment, researchers in France and the United Kingdom affirmed.&lt;br&gt;
&lt;br&gt;Those whose hearts were exposed had a 60% higher risk of cardiovascular death than the general population, even at a dose of 1 Gy (95% CI 20% to 250%), according to Florent de Vathaire, PhD, of L&apos;Institut National de la Sant&amp;#233; et de la Recherche M&amp;#233;dicale in Paris, and colleagues.&lt;br&gt;
&lt;br&gt;The risk jumped to 12.5-fold for a cumulative radiation dose to the heart of 5 to 14.9 Gy, and to 14.9-fold for a dose of more than 15 Gy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 for trend), the researchers reported online in the &lt;em&gt;Journal of Clinical Oncology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The notion that exposing the heart to radiation increases the risk of cardiovascular disease and death is not surprising, according to an accompanying editorial.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;However, this study examined cardiovascular mortality effects of both the dose of radiation and the dose of anthracyclines given to childhood cancer victims in the same cohort.&lt;/p&gt;
&lt;p&gt;That&apos;s something previous studies haven&apos;t done, according to editorialists Steven E. Lipshultz, MD, of the University of Miami and Holtz Children&apos;s Hospital in Miami, and M. Jacob Adams, MD, MPH, of the University of Rochester, N.Y.&lt;/p&gt;
&lt;p&gt;&quot;These are pretty profound findings,&quot; Lipshultz told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;These are the exact concerns we&apos;ve had based on careful subclinical assessments of how the heart in these survivors has been working.&quot;&lt;/p&gt;
&lt;p&gt;His group was one of the first to report that survivors of childhood cancer faced not only acute cardiotoxicity from treatment, but also late cardiac effects.&lt;/p&gt;
&lt;p&gt;As more effective treatment for childhood cancers came into play, the dramatic jump in survival rates  --  from less than 50% in the mid-1970s to 80% today  --  yielded a large enough population of survivors to make chronic issues from treatment apparent, Lipshultz noted.&lt;/p&gt;
&lt;p&gt;&quot;It appears that for some of these survivors we have substituted one fatal disease of childhood  --  cancer  --  for another fatal disease of early adult life,&quot; he said.&lt;/p&gt;
&lt;p&gt;de Vathaire&apos;s group studied a cohort of 4,122 French and British children diagnosed with childhood solid cancer between 1942 and 1986 and who survived at least five years.&lt;/p&gt;
&lt;p&gt;Over an average of 27 years of follow-up, they were at 8.3-fold higher risk of dying from any cause compared with the general populations in France and the United Kingdom (95% CI 7.6 to 9.0).&lt;/p&gt;
&lt;p&gt;The majority of these excess deaths occurred early after diagnosis, five to nine years afterward in this analysis  --  in which all patients survived to five years.&lt;/p&gt;
&lt;p&gt;Based on just 32 deaths from cardiovascular diseases in the cohort, the childhood cancer survivors experienced five times the cardiovascular mortality (95% CI 3.3 to 6.7) expected from the general population (1.7% cumulative at 35 years versus 0.3%).&lt;/p&gt;
&lt;p&gt;This elevation in risk was similar to that seen in large studies from the United States and Nordic countries, suggesting generalizability of the results, Lipshultz said.&lt;/p&gt;
&lt;p&gt;Radiation therapy also conferred a 5.0-fold elevation in risk of cardiovascular disease-related death (95% CI 1.2 to 21.4).&lt;/p&gt;
&lt;p&gt;Like radiation, a higher cumulative dose of anthracycline chemotherapy also increased risk of dying from cardiac diseases, compared with the general population (RR 4.4 for a dose over 360 mg/m&lt;sup&gt;2&lt;/sup&gt;, 95% CI 1.3 to 15.3).&lt;/p&gt;
&lt;p&gt;However, radiotherapy and chemotherapy did not appear to interact for cardiovascular mortality (&lt;em&gt;P&lt;/em&gt;=0.4).&lt;/p&gt;
&lt;p&gt;Notably, the vinca alkaloids were also significantly linked to cardiovascular disease-related death risk among childhood cancer survivors, even after adjustment for sex, treatment period, age at diagnosis, follow-up, and all other treatment modalities (RR 3.6, 95% CI 1.0 to 12.9).&lt;/p&gt;
&lt;p&gt;Currently, guidelines support regular long-term cardiovascular screening for childhood cancer survivors who received anthracycline-based chemotherapy but provide little to no direction for those treated with non-anthracycline chemotherapy or radiation, Lipshultz noted.&lt;/p&gt;
&lt;p&gt;These results suggested all three groups should be getting cardiac follow-up, he told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;However, because other research has suggested that these individual treatments affect the heart in different ways, such as diastolic rather than systolic dysfunction with radiotherapy, screening modalities may need to account for this as well, he said.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that cardiovascular disease was probably under-reported as a cause of death in the cohort.&lt;/p&gt;
&lt;p&gt;&quot;Indeed, 15 of the deaths classified as results of cancer as the principal cause had cardiovascular diseases as the immediate cause,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Ligue Nationale Contre le Cancer; the Programme Hospitalier de Recherche Clinique; the Agence Fran&amp;#231;aise de S&amp;#233;curit&amp;#233; Sanitaire et Produit de Sant&amp;#233;; Electricit&amp;#233; de France; the Wyeth Foundation for childhood and adolescent health; and a grant from the Foundation of France.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;The editorialists reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_451"
                     title="Sentinel Nodes Predict Spread in Oral Cancer (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18367?impressionId=1265728369919"
                     
      &lt;p&gt;In early oral squamous cell carcinoma, a sentinel node biopsy correctly predicted an absence of lymphatic metastasis in all but 4% of patients, researchers said.&lt;/p&gt;
&lt;p&gt;For T1 and T2 lesions that were clinically node-negative, the procedure  --  combined with additional sectioning and immunohistochemistry  --  yielded a negative predictive value of 96%, according to Francisco Civantos Jr., MD, of the University of Miami, and colleagues.&lt;/p&gt;
&lt;p&gt;For T1 lesions, the value was 100%, while for T2 cancers it was 94%, the researchers reported online in the &lt;em&gt;Journal of Clinical Oncology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The finding may position the procedure as an intermediate option between watchful waiting and selective neck dissection, the researchers said, asserting that it&apos;s now &quot;reasonable&quot; to conduct a head-to-head trial of sentinel node biopsy and neck dissection.&lt;/p&gt;
&lt;p&gt;The procedure has significantly increased the sensitivity for detecting lymphatic metastasis in melanoma and breast cancer patients, Civantos and colleagues noted.&lt;/p&gt;
&lt;p&gt;But in oral cancer, many surgeons prefer a completion neck dissection, they added, despite the &quot;measurable morbidity&quot; that&apos;s associated with the procedure. On the other hand, because of that morbidity, other specialists prefer watchful waiting and elective neck irradiation.&lt;/p&gt;
&lt;p&gt;To investigate the issue, Civantos and colleagues conducted a multicenter trial in which patients with early invasive oral cancers were treated with both procedures  --  a sentinel node biopsy, followed by completion selective neck dissection.&lt;/p&gt;
&lt;p&gt;The primary goal was to see if a negative hematoxylin and eosin finding on the sentinel node biopsy accurately predicted the negativity of the other cervical lymph nodes removed in the neck dissection.&lt;/p&gt;
&lt;p&gt;All told, 140 patients qualified and had the dual procedures, the researchers reported.&lt;/p&gt;
&lt;p&gt;The sentinel nodes were identified using a radioactive gamma probe. The primary tumor was removed transorally, followed by the sentinel node biopsy through a small incision within the area of the planned incision for the neck dissection.&lt;/p&gt;
&lt;p&gt;Staining of the sentinel nodes at the various trial sites resulted in 106 that were negative. Of those, 100 were also negative by hematoxylin and eosin staining of the neck dissection specimens.&lt;/p&gt;
&lt;p&gt;That yielded a negative predictive value of 94%, the researchers said.&lt;/p&gt;
&lt;p&gt;Additional step sectioning and immunohistochemistry at a central pathology lab increased the negative predictive value to 96%, they said.&lt;/p&gt;
&lt;p&gt;Both findings were significant, they reported, with a one-sided &lt;em&gt;P&lt;/em&gt;-value of &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001.&lt;/p&gt;
&lt;p&gt;One limitation of the study, the researchers noted, is that the dual procedures may have interfered with each other, in that sentinel lymph biopsy might have changed the way the neck dissection was performed or the other way around.&lt;/p&gt;
&lt;p&gt;But that &quot;may actually lead to underestimation of the accuracy of this technique,&quot; they said, since the neck dissections were guided by information gleaned from nuclear imaging and the gamma probe used in the sentinel node procedure.&lt;/p&gt;
&lt;p&gt;The study was also limited, the researchers said, because many surgeons involved were only moderately experienced and none was experienced &quot;at levels currently considered appropriate for surgeons caring for breast cancer or melanoma.&quot;&lt;/p&gt;
&lt;p&gt;Nonetheless, they said, the negative predictive value found in the study was &quot;higher than anticipated for a multi-institutional setting with relatively inexperienced surgeons.&quot;&lt;/p&gt;
&lt;p&gt;They added that only a clinical trial in which outcomes after a negative sentinel node biopsy are simply observed for several years would yield a true negative predictive value for the procedure.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Cancer Institute.&lt;/p&gt;&lt;p&gt;Civantos reported no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>