A summary of the "must-read" articles from the journals in that pile on your desk.
Toxic Strain of C. Difficile Linked to Death
MMWR. 2005:54(47):1201-1205 [Dec. 2, 2005]
A new, more toxic strain of Clostridium difficile may be causing severe diarrhea and other GI symptoms in relatively young patients, and is linked to the death of a pregnant woman. Physicians should be alert to C. dif-associated disease (CDAD) in patients previously thought to be at low risk, according to the CDC.
Ann Intern Med. 2005;143:785-792 [Dec. 6, 2005]
The risk of stroke rises markedly after myocardial infarction, according to researchers at the Mayo Clinic who found that the rate of stroke was 22.6 per 1,000 person-months during the first 30 days after myocardial infarction, corresponding to a 44-fold increased risk for stroke. The risk remained two to three times higher than expected during the first three years after MI.
Botulinum Toxin May Relieve Tennis Elbow
Ann Intern Med. 2005;143:793-797 [Dec. 6, 2005]
In a study of 60 patients with lateral epicondylitis, Hong Kong researchers found that patients reported significantly less pain at four and 12 weeks following injections of 60 units of botulinum toxin type A. Four patients experienced mild finger paresis at four weeks.
Independent Practice Boosts Physician Job Satisfaction
Ann Fam Med. 2005;3:500-506 [Nov/Dec issue]
Physicians working in independent practices are happier than those working for large healthcare organizations, say researchers at the University of Wisconsin. Of 584 FPs they surveyed, those practicing independently put in more hours than those employed by healthcare organizations, but they reported better work relationships, greater family satisfaction, more sway over management decisions, and more job satisfaction. They also reported a better perception of the quality of care they delivered.
Febuxostat More Effective Than Allopurinol for Gout
N Engl J Med. 205;353:2450-61 [Dec. 8, 2005]
Researchers at the University of Chicago Pritzker School of Medicine found that serum urate concentrations were significantly lowered in patients receiving either 80 or 120 mg of febuxostat once a day. Levels were reduced from 8 or more mg per deciliter to less than 6 in 53% of patients receiving 80 mg febuxostat, and 62% of those receiving 120 mg. Only 21% of patients receiving 300 mg of allopurinol had levels that low. The reduction in gout flares and tophus area were similar in all groups.
Infliximab Effective in Treating Ulcerative Colitis
N Engl J Med. 2005;353:2462-76 [Dec. 8, 2005]
In two separate trials (ACT 1 and ACT 2), Belgian researchers gave 364 patients with moderate-to-severe active ulcerative colitis either a placebo, or infliximab (5 mg or 10 mg per kilogram of body weight) IV at weeks 0, 2, and 6, and then every eight weeks. Patients treated with infliximab-a monoclonal antibody against tumor necrosis factor-alpha-had a significant improvement at week eight. For ACT 1 patients, 69% of those on 5 mg infliximab and 61% on 10 mg responded, compared with 37% of those receiving a placebo. There were similar results in ACT 2.
Studies Show Few Side Effects from Smallpox Vaccines
JAMA. 2005;294:2734-2743 and JAMA. 2005;294:2744-2750 [Dec. 7, 2005]
Serious side effects from smallpox vaccines, including neurologic reactions, appear to be mild and limited, according to two studies done by researchers at the CDC. Adverse events occurred most often in older revaccinees.