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    <recommendedItem id="20100101_19_445"
                     title="Physician Charged in Michael Jackson Death"
                     score="0.014"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18368?impressionId=1265818345328"
                     
      &lt;p&gt;Conrad Robert Murray, MD, the physician attending Michael Jackson when the pop singer died of cardiac arrest last June, has been charged with involuntary manslaughter in Los Angeles.&lt;/p&gt;
&lt;p&gt;Murray was to be arraigned this afternoon. If convicted, he could receive a maximum prison term of four years.&lt;/p&gt;
&lt;p&gt;According to the L.A. County District Attorney&apos;s office, Murray &quot;did unlawfully, and without malice, kill Michael Joseph Jackson . . . in the commission of an unlawful act, not amounting to a felony; and in the commission of a lawful act which might have produced death, in an unlawful manner, and without due caution and circumspection.&quot;&lt;/p&gt;
&lt;p&gt;Witnesses said Murray was with Jackson when the 50-year-old singer collapsed at his rented home in Beverly Hills. Murray tried to revive Jackson there with CPR, then accompanied him to a hospital. Jackson was pronounced dead at the hospital without regaining consciousness.&lt;/p&gt;
&lt;p&gt;Subsequent statements from investigators indicated that Murry had injected Jackson with the anesthetic agent propofol earlier that day, apparently to help Jackson sleep.&lt;/p&gt;
&lt;p&gt;The singer had long complained of insomnia, according to news reports.&lt;/p&gt;
&lt;p&gt;After an autopsy, the Los Angeles county coroner&apos;s office &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/15736&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/15736&quot; target=&quot;_blank&quot;&gt;ruled in August&lt;/a&gt; that Jackson died of an overdose involving multiple drugs, including propofol and lorazepam (Ativan). Other drugs found in his system included midazolam, diazepam, lidocaine, and ephedrine.&lt;/p&gt;
&lt;p&gt;News reports indicated that other physicians besides Murray had prescribed drugs for Jackson. In addition to insomnia, the singer was believed to suffer from chronic pain related to burns suffered during the filming of a television commercial years earlier.&lt;/p&gt;
&lt;p&gt;The Reuters news service reported that Murray had told investigators he was not the first physician to give propofol to Jackson.&lt;/p&gt;
&lt;p&gt;In numerous public statements, Murray has maintained his innocence of wrongdoing.&lt;/p&gt;
&lt;p&gt;When Jackson died, he was about two weeks from beginning a series of 50 concerts in London, his first major performance effort in a decade. The posthumous concert film &quot;This Is It&quot; was filmed during rehearsals for the series.&lt;/p&gt;
&lt;p&gt;Although paparazzi photographs released in the months prior to his death portrayed the singer looking frail and gaunt  --  one showed him in a wheelchair  --  he appeared healthy in the film.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_380"
                     title="AMA Opens Site for Physicians Looking to Help Haiti"
                     score="0.011"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18271?impressionId=1265818345328"
                     
      &lt;p&gt;The AMA has launched a &lt;a href=&quot;http://www.ama-assn.org/go/haiti-volunteer&quot; mce_href=&quot;http://www.ama-assn.org/go/haiti-volunteer&quot; target=&quot;_blank&quot; title=&quot;AMA&amp;#8200;Haiti&amp;#8200;volunteer&amp;#8200;site&quot;&gt;Web site &lt;/a&gt;to help coordinate healthcare professionals who want to volunteer for the medical relief effort in Haiti.&lt;/p&gt;
&lt;p&gt;The site hosts a registry where volunteers can enter their names and contact information, credentials, and other relevant language and disaster relief skills.&lt;/p&gt;
&lt;p&gt;The registry will be used for aid to Haiti and in future disasters that may require volunteer physician support, the AMA said in a statement.&lt;/p&gt;
&lt;p&gt;The AMA site also contains a free online training program that offers potential volunteers insight into the clinical and public healthcare skills necessary to aid in the relief effort.&lt;/p&gt;
&lt;p&gt;The page was created at a time when the number of hospitalizations and new patients has started to decline, AMA president J. James Rohack, MD, noted, but &quot;the need for continued medical assistance is still significant.&quot;&lt;/p&gt;
&lt;p&gt;&quot;I encourage physicians to consider how they can help with this effort,&quot; he declared.&lt;/p&gt;
&lt;p&gt;Some observers have criticized the large volume of doctors swarming to the disaster-stricken nation, claiming the additional burden placed on already limited food, water, and housing resources comes at a time when engineers have not yet rebuilt the necessary housing and plumbing outlets.&lt;/p&gt;
&lt;p&gt;The Web site itself cautioned would-be volunteers that Haiti is still in desperate condition. &quot;Physicians must be prepared to provide care in a physically challenging, austere, resource-constrained environment. It is imperative that those involved in the relief effort be self-sufficient and are able to work independently,&quot; the site warned.&lt;/p&gt;
&lt;p&gt;The AMA publishes the journal &lt;em&gt;Disaster Medicine and Public Health Preparedness&lt;/em&gt;, which it said would serve as a valuable resource to potential volunteers.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_474"
                     title="Denosumab Shows Promise in Rare Bone Tumor (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18407?impressionId=1265818345328"
                     
      &lt;p&gt;An investigational drug aimed at osteoporosis appears to be of benefit in treating a rare bone tumor, researchers said.&lt;/p&gt;
&lt;p&gt;In a small, single-arm, open-label study, 86% of patients with giant-cell tumor of bone had a response to denosumab, a fully human monoclonal antibody, according to David Thomas, MBBS, PhD, of the Peter MacCallum Cancer Centre in Melbourne, Australia, and colleagues.&lt;/p&gt;
&lt;p&gt;Currently, surgery is the definitive therapy, but the finding warrants more investigation of denosumab as a systemic treatment for the disease, Thomas and colleagues said online in &lt;em&gt;The Lancet Oncology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Indeed, the finding was described as a &quot;breakthrough&quot; by Maurice Balke, MD, of the University of Witten-Herdecke in Cologne, Germany, and Jendrik Hardes, MD, of University Hospital Muenster in Muenster, Germany.&lt;/p&gt;
&lt;p&gt;&quot;This is the first report that clearly shows a promising systemic treatment option for this rare type of tumor,&quot; they wrote in an accompanying editorial in the journal.&lt;/p&gt;
&lt;p&gt;More study is needed to tease out the mechanism involved, they said, as well as to see how long the effect lasts and whether the drug is effective in a broader population with the disease.&lt;/p&gt;
&lt;p&gt;But the study &quot;might change clinical practice&quot; in the treatment of the disease, they concluded.&lt;/p&gt;
&lt;p&gt;Giant-cell tumor of bone accounts for about 4% of primary bone tumors and about 18% of benign bone tumors. About 80% of patients with primary giant-cell tumors have disease that&apos;s amenable to resection, the researchers noted in the journal.&lt;/p&gt;
&lt;p&gt;The tumors consist of sheets of neoplastic ovoid mononuclear cells evenly interspersed with osteoclast-like giant cells. The giant cells and their precursors express the protein RANK, and some of the mononuclear cells express RANK ligand (or RANKL).&lt;/p&gt;
&lt;p&gt;Since denosumab inhibits RANKL, the researchers hypothesized, it might block bone destruction and eliminate the giant cells.&lt;/p&gt;
&lt;p&gt;To test the idea, they enrolled 37 patients with recurrent or unresectable disease and gave them subcutaneous denosumab (at 120 milligrams every 28 days, with loading doses on days eight and 15 of the first month).&lt;/p&gt;
&lt;p&gt;The primary endpoint was tumor response, defined as either elimination of at least 90% of the giant cells or no radiological progression of the target lesion up to week 25.&lt;/p&gt;
&lt;p&gt;After 25 weeks of treatment, two patients couldn&apos;t be evaluated because they lacked adequate histologic or radiologic data, the researchers said, but 30 of the remaining 35 had a response.&lt;/p&gt;
&lt;p&gt;Specifically, all of the 20 patients with histologic data showed at least a 90% reduction in giant cells from baseline. And 10 of the 15 patients assessed by radiology did not have progression of the lesion.&lt;/p&gt;
&lt;p&gt;The most common adverse event was pain in an extremity, followed by back pain and headache, Thomas and colleagues said.&lt;/p&gt;
&lt;p&gt;Five patients had grade three through five adverse events, but only one (a grade three increase in human chorionic gonadotropin concentration not related to pregnancy) was thought to be possibly associated with treatment.&lt;/p&gt;
&lt;p&gt;As well, there were five serious adverse events but none was deemed to be related to the drug.&lt;/p&gt;
&lt;p&gt;Thomas and colleagues said the study is limited by its small sample size (from a select population with recurrent or unresectable disease), the short study duration, and the single group study design.&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 Amgen Inc. Thomas reported financial links with Amgen, Pfizer, and Novartis, as well as a fellowship from the Victorian Cancer Agency. Several authors reported being employees of or holding equity in Amgen.&lt;/p&gt;&lt;p&gt;The editorial authors said they had no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_473"
                     title="AAN: High Intake of Vitamin D Linked to Lower MS Risk (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAN/tb/18406?impressionId=1265818345328"
                     
      &lt;p&gt;TORONTO  --  Women whose mothers consumed high levels of vitamin D during pregnancy have a lower risk of developing multiple sclerosis, a large, observational study confirmed.&lt;/p&gt;
&lt;p&gt;Mothers who reported the highest intake during pregnancy were 45% less likely to have a daughter who subsequently developed the disease than those who consumed the least vitamin D (RR 0.55, 95% CI 0.35 to 0.88), according to Fariba Mirzaei, MD, MPH, a doctoral student at the Harvard School of Public Health.&lt;/p&gt;
&lt;p&gt;Mirzaei is scheduled to report the findings at the American Academy of Neurology (AAN) meeting in April.&lt;/p&gt;
&lt;p&gt;Lily Jung, MD, a neurologist at Swedish Medical Center in Seattle, said in an interview that the study &quot;adds more fuel to the fire that low vitamin D is important in the genesis of MS,&quot; which has been demonstrated in previous studies. (See &lt;a href=&quot;http://www.medpagetoday.com/Neurology/MultipleSclerosis/4738&quot; mce_href=&quot;http://www.medpagetoday.com/Neurology/MultipleSclerosis/4738&quot; target=&quot;_blank&quot;&gt;High Blood Levels of Vitamin D May Lower MS Risk&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;She said it&apos;s unclear why vitamin D is associated with risk of multiple sclerosis.&lt;/p&gt;
&lt;p&gt;&quot;There&apos;s an idea that perhaps there might be receptors that are turned on by vitamin D levels that give some form of protection, but that is very preliminary information and we&apos;re still learning a lot about that,&quot; said Jung, who is also a spokeswoman for the AAN.&lt;/p&gt;
&lt;p&gt;Although the link between vitamin D and risk of multiple sclerosis has been demonstrated before, gestational exposure to the vitamin has not been studied.&lt;/p&gt;
&lt;p&gt;To fill that gap, Mirzaei analyzed data from the Nurses&apos; Mothers&apos; Study, which includes a subcohort of the two Nurses&apos; Health Studies that was restricted to nurses whose biological mothers completed a questionnaire in 2001 about their diet during pregnancy.&lt;/p&gt;
&lt;p&gt;The current analysis included 35,794 nurse-mother pairs.&lt;/p&gt;
&lt;p&gt;During the 16-year study period, 199 of the nurses were diagnosed with multiple sclerosis.&lt;/p&gt;
&lt;p&gt;In addition to a lower risk of disease among those whose mothers consumed the largest amounts of vitamin D, those whose mothers had the highest predicted serum 25-hydroxyvitamin D levels also had a reduced risk of having a daughter with the disease (RR 0.58, 95% CI 0.37 to 0.90).&lt;/p&gt;
&lt;p&gt;In an analysis of milk drinking alone, mothers who drank at least four glasses a day had a nonsignificant reduced risk of having a daughter who would develop multiple sclerosis compared with those who drank less than three glasses a month (RR 0.44, 95% CI 0.16 to 1.23).&lt;/p&gt;
&lt;p&gt;However, there was a significant trend for lower risk of multiple sclerosis with increasing milk consumption (&lt;em&gt;P&lt;/em&gt;=0.001).&lt;/p&gt;
&lt;p&gt;Jung noted that the study was limited by the use of questionnaires decades after a pregnancy to determine dietary intake of vitamin D.&lt;/p&gt;
&lt;p&gt;Nevertheless, she said, &quot;this is very consistent with what we&apos;re seeing elsewhere in terms of vitamin D in moms and the risk of MS in kids.&quot;&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;Mirzaei 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_472"
                     title="Test Allows LMW Heparin Monitoring in Cath Lab (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Cardiology/PCI/tb/18403?impressionId=1265818345328"
                     
      &lt;p&gt;A novel point-of-care anticoagulation test not yet available in the U.S. allowed more accurate dosing of enoxaparin (Lovenox) prior to cardiac catheterization in a clinical trial, researchers said.&lt;/p&gt;
&lt;p&gt;Patients in whom anticoagulation was insufficient with standard enoxaparin doses were identified with the Hemochron Jr. Hemonox test at a sensitivity of 94.9% (95% CI 91.1% to 97.4%) and specificity of 73.3% (95% CI 67.6% to 78.5%), allowing for needed dosage adjustments before undergoing catheterization and coronary revascularization, reported Johanne Silvain, MD, of Piti&amp;#233;-Salp&amp;#234;tri&amp;#232;re Hospital in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;&quot;In daily practice, the Hemonox test may be used in the catheterization laboratory to assess the appropriate level of anticoagulation therapy in patients undergoing percutaneous coronary intervention and to avoid the use of unfractionated heparin in addition to enoxaparin, as is still done by some interventionists,&quot; the researchers wrote in the Feb. 16 &lt;em&gt;Journal of the American College of Cardiology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Normally, anticoagulant therapy is started in patients scheduled for catheterization to minimize the risk that the procedure will trigger a thrombotic event.&lt;/p&gt;
&lt;p&gt;Silvain and colleagues explained that low molecular weight heparins such as enoxaparin appear to be safer and at least as effective as unfractionated heparin, but are not widely used.&lt;/p&gt;
&lt;p&gt;&quot;The inability to rapidly monitor the anticoagulant effect of enoxaparin in a similar fashion as the activated clotting time with unfractionated heparin has limited the use of enoxaparin in interventional cardiac procedures,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Past clinical studies have found that most but not all patients achieve target levels of anticoagulation using standard doses of enoxaparin, Silvain and colleagues noted. Excessive anticoagulation increases risk of bleeding, whereas shortfalls raise the likelihood of periprocedural&lt;strong&gt; &lt;/strong&gt;myocardial infarction, pulmonary embolism, and stroke.&lt;/p&gt;
&lt;p&gt;According to Silvain and colleagues, there are currently no good ways to measure the adequacy of enoxaparin dosing at bedside. Activated clotting time is too imprecise with enoxaparin, and chromogenic anti-factor Xa activity requires a laboratory-performed assay, they wrote.&lt;/p&gt;
&lt;p&gt;They evaluated the Hemonox test in 296 unselected patients undergoing catheterization because of cardiac symptoms, of whom 169 went on to percutaneous revascularization or bypass graft surgery.&lt;/p&gt;
&lt;p&gt;The Hemonox test delivers results as a clotting time.&lt;/p&gt;
&lt;p&gt;Enoxaparin was given intravenously in 211 patients, in combination with subcutaneous enoxaparin in 21, only subcutaneously to 64 patients, and the route was unrecorded in the remaining 14.&lt;/p&gt;
&lt;p&gt;Blood samples were drawn immediately after sheath insertion and again 10 minutes later. Samples were tested with Hemonox, a standard assay for activated partial thromboplastin time, and the lab assay for anti-factor Xa activity. The latter served as the &quot;gold standard&quot; reference in the study.&lt;/p&gt;
&lt;p&gt;Insufficient anticoagulation  --  defined as an anti-factor Xa level of less than 0.5 IU/mL  --  was found in 14 patients at the second blood draw. Excessive anticoagulation occurred in only three patients, all of whom had anti-factor Xa levels of 1.9 IU/mL (upper level cutoff 1.8 IU/mL).&lt;/p&gt;
&lt;p&gt;Silvain and colleagues found that the area below the receiver operating characteristic curve for the Hemonox test, for discriminating those individuals with inadequate anticoagulation, was 0.95 relative to the anti-factor Xa assay (95% CI 0.93 to 0.97).&lt;/p&gt;
&lt;p&gt;Using a cutoff of 120 seconds for the Hemonox clotting time to identify inadequate anticoagulation, which maximizes the sensitivity, the results produced a positive predictive value of 73.9% (95% CI 68.7% to 79.0%) and a negative predictive value of 94.8% (95% CI 91.8% to 97.8%).&lt;/p&gt;
&lt;p&gt;A cutoff of 80 seconds reversed the Hemonox test&apos;s performance almost exactly  --  it produced a sensitivity for detecting inadequate anticoagulation of 74.5% and a specificity of 98.5%. Silvain and colleagues explained that, in patients undergoing interventional procedures, &quot;the sensitivity of the bedside test is critical.&quot;&lt;/p&gt;
&lt;p&gt;Activated partial thromboplastin time correlated much more poorly with anti-factor Xa results, the researchers said.&lt;/p&gt;
&lt;p&gt;The Hemonox results paralleled those of the anti-factor Xa assay in important subgroups, including obese patients and the elderly, the researchers reported.&lt;/p&gt;
&lt;p&gt;Two major bleeding events were observed in the study, both in patients with anti-factor Xa levels well within the target range.&lt;/p&gt;
&lt;p&gt;Silvain and colleagues noted that the lack of clinical outcomes as a study endpoint was a limitation, as was the lack of sufficient data to assess the Hemonox test&apos;s effectiveness in measuring excessive anticoagulation.&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 funded by International Technidyne Corp., which developed the anticoagulation test.&lt;/p&gt;&lt;p&gt;Study authors reported relationships other than research funding with Pfizer, sanofi-aventis, Astellas, Eli Lilly, Bristol-Myers Squibb, The Medicines Company, Schering-Plough, Merck Sharpe &amp;amp; Dohme, Cordis, and GlaxoSmithKline. They also reported research funding from Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, sanofi-aventis, Eli Lilly, Guerbet Medical, Medtronic, Boston Scientific, Cordis, Stago, and Centocor.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>
