A lawyer writing in the Michigan Law Review has assessed the outcomes of medical malpractice suits, with some interesting conclusions.

1. Contrary to popular opinion, the jury is more likely to sympathize with the physician than with the patient, other things being equal.
2. Juries can usually recognize a weak case, agreeing with the legal experts 80% to 90% of the time.
3. Plaintiffs win 10% to 20% of the cases that independent reviewers feel they should lose, and 20% to 30% of the cases rated as toss-ups.
4. Physicians win roughly half of the cases that independent expert reviewers believe they should lose, based on strong evidence of negligence.

It seems clear that defendants (and their hired experts) are more successful than plaintiffs (and their hired experts) in persuading juries to reach verdicts in their favor and against the opinions of independent reviewers. The moral: don’t sue unless you’re pretty sure you have a strong case.

Technorati : Doctor, Law, News
Del.icio.us : Doctor, Law, News
Ice Rocket : Doctor, Law, News
Flickr : Doctor, Law, News
Zooomr : Doctor, Law, News
Buzznet : Doctor, Law, News
Riya : Doctor, Law, News
43 Things : Doctor, Law, News

Putting It All Together

“You must do the thing you think you cannot do.”
Eleanor Roosevelt

Even positive lifestyle changes are challenging. But we see amazing people in our clinics every day, people of all ages and abilities, making astonishing strides toward fitness.

A Commitment to Exercise

Since making and keeping a lifelong commitment to an exercise program may be difficult, it’s important to look at the factors that may affect your success. One significant factor is self-efficacy, the amount of self-confidence you have in your ability to perform an activity. To determine your self-efficacy, take this quiz. Use the following scale to define how certain you are that you will fulfill your exercise commitment. If you are very uncertain, score 1 point; rather uncertain, score 2 points; rather certain, score 3 points; very certain, score 4 points.

I can exercise even when I am worried _______
I can exercise even when I feel depressed ______
I can exercise even when I feel tense ______
I can exercise even when I am tired ______
I can exercise even when I am busy ______

Your total score ______

If you scored above 10, you are ready to commit to an exercise program. If you received a score of 10 or below, starting an exercise program will be more difficult, but you can do it.

Encourage Yourself to Exercise

Starting and continuing a program requires effort. Take these hints seriously. Here are some ways to encourage yourself.

Breathe. Practice deep breathing if you feel stressed before you start exercising. Lie on your back with your feet on the floor, your knees bent, and your hands resting lightly on your lower abdomen. Take a deep breath in through your nose; feel your abdomen rise as air fills your lungs. Then exhale gently through pursed lips as the air leaves your abdomen. This technique will help you relax and focus.

Post reminders to yourself. Leave notes around the house to remind you to do certain exercises or to be aware of your posture.

Picture your goals. Choose a picture of someone you admire and would like to look like or a vacation spot you would love to visit. Put it in your wallet, on your office desk, or in a place where you will see it first thing in the morning. It will remind you why your exercises are so important. Copy exercises that are particularly important for you from this book and place them strategically around your home or office.

Be patient. Don’t measure or weigh yourself too often; your body will not always change in a consistent, steady fashion.

Look in the mirror. Installing mirrors in strategic places – where you exercise, eat, dress, or bathe – may help you see the changes occurring in your body as a result of consistent exercise.

Reward yourself. Do something special for yourself as a reward for maintaining your exercise program. Rewards don’t have to be expensive or fattening! Go to a movie with a friend. Allow yourself a Saturday of relaxation rather than doing chores. Treat yourself to fresh flowers at the market. Take a long, relaxing bath. Choose a special article of clothing as an incentive to help you reach your goal.

Use visualization. Picture yourself succeeding and looking a certain way; it can facilitate your exercise performance. The more vivid the visualization, the better.

Use repetition. Develop a mantra in which you constantly repeat – out loud or in your head – the benefits of exercise (“improved posture, strength, balance, flexibility, and endurance”) especially when you don’t feel like exercising or if you feel like stopping once you’ve started. Positive reinforcement can put you back on the road to exercise. Keep telling yourself that you will look and feel better.

Make it social. Use exercise as a way to spend time with your friends and loved ones. Go for a walk together or take a bicycling vacation. Having company can be fun, reinforcing, and encouraging. If you make a commitment to exercise with someone else, you may feel a new sense of responsibility.

Have a schedule. As much as possible, exercise at the same time each day – usually the earlier the better. If you can’t exercise early, head straight to the gym after work. If you miss a scheduled time, work it in at another time during the day or week.

Make it enjoyable. Listen to music or recorded books or watch TV while exercising. Or if much of your regular day is full of people and noise, take a quiet early morning walk.

Coping with Soreness

Aches and pains due to exercise are normal. When you’re stretching muscles or moving joints that you haven’t worked in a long time, you should expect a degree of discomfort. Rest assured, you will feel better.

Typical treatments for such soreness include protection, rest, ice, compression, elevation of the affected body part, and, if necessary, an elastic wrap. You can soothe sore muscles using ice cubes and cold water in double-sealed plastic bags, a large bag of frozen peas wrapped in a thin towel, or commercially available reusable ice packs.

While some soreness is normal with the start of an exercise program, joint pain may be a cause for concern. If your joint pain begins to ease by the end of a week, it was probably a combination of muscle soreness and a sign that you may have overworked your body. As the soreness subsides, return to the offending exercise, but only at half the weight or repetitions. Caution: If you experience severe pain that lasts several days or a more moderate pain that lasts more than 2 weeks, contact a physician or physical therapist. If you experience any chest pain or shortness of breath when performing endurance exercises, consult your physician or cardiologist immediately.

Tricking Yourself Into Fitness: Exercising on Days When Your Body Resists Some days you’re lucky if you get 15 minutes to yourself. When you don’t have time for a complete workout or you’re tempted to skip a day, try these tricks:
* Do a wall slide white you brush your teeth.
* If you live in an apartment building, walk 2 flights of stairs and then take the elevator the rest of the way.
* Use a speakerphone or headset when you talk on the phone, so that you can do arm or leg weight exercises at the same time.
* Hold a plank/push-up position for 1 minute.
* Set your watch and walk for 7 minutes, then turn around and walk back to your starting point in 7 minutes. Once you reach the 7-minute mark, you should try to extend your time.

This was the final extract from “Age-Defying Fitness” . You can buy the book from Amazon or from Peachtree Publishers.

Source
Age-Defying Fitness: Making the most of your body for the rest of your life. 1st edition. M. Moffat, CB. Lewis, Peachtree Publishers, Atlanta, 2006

Technorati : Fitness, Health Info
Del.icio.us : Fitness, Health Info
Ice Rocket : Fitness, Health Info
Flickr : Fitness, Health Info
Zooomr : Fitness, Health Info
Buzznet : Fitness, Health Info
Riya : Fitness, Health Info
43 Things : Fitness, Health Info

Summarized by Robert W. Griffith, MD

Summary
In a prospective randomized study, calcium-plus-vitamin D capsules significantly reduced the risk of cancers of different types in postmenopausal women.

Introduction
It’s been known for more than 50 years that exposure to the sun’s rays protects against some cancers – breast, rectum, ovary, prostate, stomach, bladder, esophagus, kidney, lung, pancreas, and uterus, as well as non-Hodgkin lymphoma and multiple myeloma. Researchers first proposed that vitamin D was responsible 25 years ago. Since then, associations have been found between colorectal and prostate cancer and low blood levels of vitamin D. All these findings are based on what are called “observational studies”. Now a double-blind, placebo-controlled trial of calcium and vitamin D supplementation has been done, in which the occurrence of cancer was an important outcome. Its findings have been published in the American Journal of Clinical Nutrition, and are summarized below.

What was done
Rural areas in eastern Nebraska, USA, supplied the participants for this study, who were women recruited by random telephone dialing. They had to be over 55, have no known cancers, and be healthy. The prime purpose of the study was to establish the benefits of supplemental vitamin D and calcium on the incidence of bone fractures, but the secondary focus was on the occurrence of cancer.

The subjects were randomly assigned to one of three treatments: placebo (vitamin D placebo and calcium placebo), calcium (either calcium citrate 1400 mg/day or calcium carbonate 1500 mg/day, plus vitamin D placebo), or calcium (as above) plus vitamin D (1100 IU cholecalciferol).

Out of 1180 women enrolled, just over 1000 completed the 4-year study. Serum samples taken at baseline and then annually measured 25(OH)D (25-hydroxy-vitamin D). Health status was assessed every 6 months.

What was found
Fifty women developed a non-skin cancer during the 4 years of the study. For all cancers combined, both the calcium-alone and the calcium-plus-vitamin D groups had rates less than those taking just the placebo; the likelihoods of developing cancer were 40% (calcium) and 53% (calcium-plus-vitamin D) of the rate for the placebo group, respectively.

The analysis was repeated for the occurrence of cancer between years 1 and 4 (the theory being that cancers diagnosed early in the study would have been present, though unrecognized, on enrollment). The likelihoods of developing cancer were 59% (calcium) and 23% (calcium-plus-vitamin D) of the rate for the placebo group, respectively.

The specific cancers that all showed a reduced incidence with calcium-plus-vitamin D over the 4 year period were cancer of the breast, colon, and lung, and lymphoma, leukemia, and myeloma.

The serum 25(OH)D levels were significant independent predictors of cancer risk. Calculations showed a 35% reduction in cancer risk for every 10 ng/mL increase in serum 25(OH)D levels.

What these findings mean
This study showed a decreased all-cancer risk with vitamin D supplementation, i.e. sufficient additional vitamin D to raise serum 25(OH)D levels more than 10 ng/mL – about 1000 IU of cholecalciferol. The findings are consistent with data from studies demonstrating roles for solar exposure, vitamin D status, or both.

The results for the calcium-only supplementation were marginal, and may have been a chance occurrence, according to the authors of the study. It’s known that calcium supplementation can reduce the number of colon polyps and prostate cancer; however, in this study only 3 of the 50 cancers were colon cancer.

This study was confined to women, because of the planned primary outcome, osteoporotic fractures. But it’s reasonable to assume that the findings would apply to men, as well.

The link between too much sun and skin cancer is well established. But the benefit of sunshine in promoting synthesis of vitamin D should not be overlooked; indeed, some scientists recommend that 15 minutes in the sun twice a week should be sufficient to ward off vitamin D deficiency. Just don’t overdo it.

Source
Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. JM. Lappe, D. Travers-Gustafson, M. Davies, et al., Am J Clin Nutr, 2007, vol. 85, pp. 1586–1591

Technorati : Calcium, Cancer, Health Info, Vitamin D
Del.icio.us : Calcium, Cancer, Health Info, Vitamin D
Ice Rocket : Calcium, Cancer, Health Info, Vitamin D
Flickr : Calcium, Cancer, Health Info, Vitamin D
Zooomr : Calcium, Cancer, Health Info, Vitamin D
Buzznet : Calcium, Cancer, Health Info, Vitamin D
Riya : Calcium, Cancer, Health Info, Vitamin D
43 Things : Calcium, Cancer, Health Info, Vitamin D

Summarized by Robert W. Griffith, MD

Summary

In the study summarized here, acupuncture given by experienced Chinese clinicians to patients with hypertension produces significant reductions in systolic and diastolic blood pressure. The beneficial effect does not persist after the 6-week treatment period, and conflicts with a recently reported study of similar design.

Introduction

There have been many reports that acupuncture can lower blood pressure in hypertensive patients, but these are rarely well-controlled, randomized, blinded studies, which represent the gold standard for demonstrating effectiveness of a treatment. One of the most recent controlled trials, reported in 2006, showed no benefit of acupuncture over a sham procedure, and the approach is not widely used in Western therapeutics.1 However, a new study, this time from Germany, has found a significant benefit of the procedure over a 6-week period in hypertensives. It’s reported in the journal Circulation , and we summarize it here.

What was done

This trial was the result of cooperation between the University of Nanjing, China, and the Ottobeuren Clinic and the Erlangen University Clinic, Germany. This collaboration allowed acupuncture to be administered by experts in Chinese medicine, an important consideration.

Patients with mild or moderate hypertension were enrolled at the Ottobeuren Clinic; they had blood pressures ranging from 140/90 to 179/109 mm Hg, or they were on antihypertensive medication for the previous 2 months. They were excluded if they had renal problems, diabetes, atrial fibrillation, or a history of cardiovascular events such as heart attack or stroke. On enrollment, they were randomly allocated to receive acupuncture or sham treatment for 6 weeks. Patients returned for follow-up exams within 3 days after finishing treatment, and then after 3 months and 6 months.

Blood pressures were measured by the usual cuff method at the patients’ visits, and by an ambulatory device (measuring every 15 minutes by day and every 30 minutes by night) worn for 24 hours at the three follow-up intervals. Exercise blood pressure was measured before treatment and at the follow-up intervals.

Acupuncture was administered by 7 University of Nanjing physicians with at least 5 years’ training in traditional Chinese medicine followed by several years of practice using acupuncture. Active or sham treatment was administered by one of the 7 experts, using 22 sessions spread over 6 weeks; each sessions lasted 30 minutes. At each session, 3 acupuncture points were needled on both sides for 20 minutes. In the active group the points were chosen according to the Chinese type of hypertension – one of 4 types based on traditional Chinese medicine. Sham treatment was identical, except that needling points were chosen without relevance for blood pressure lowering, according to traditional Chinese medicine concepts.

What was found

A total of 160 patients were randomized to treatments – 83 to active and 77 to sham acupuncture. Their average age was 58, and 49% of them were men. Most of them (78%) were receiving antihypertensive medication, which was kept unchanged during the study. 140 of the subjects finished the treatment course – 72 active and 68 sham acupuncture patients.

The 24-hour ambulant blood pressures for the two groups, measured at the end of the 6 weeks, showed an average difference in favor of the active acupuncture treatment of 6.4 mm Hg systolic and 3.7 mm Hg diastolic. The most pronounced difference was seen for the day-time systolic blood pressure, which was reduced in the active group by 7.3 mm Hg. In the sham treatment group all blood pressure measurements had increased by about 2 mm Hg.

At 3 and 6 months after the end of the course of treatment average systolic and diastolic blood pressures in the active acupuncture group had returned to pretreatment levels. No patient developed any adverse effects, and no patient died.

Conclusions

This study shows that acupuncture given by experienced Chinese clinicians to patients with hypertension produces significant reductions in systolic and diastolic blood pressure. This beneficial effect, however, does not persist beyond the treatment period. Sham acupuncture (given at non-hypertension needle points) was without any beneficial effect on blood pressure.

There are two main questions. How do these findings reconcile with the controlled study1 reported last year? And do they have any practical consequences for treating high blood pressure?

The SHARP study protocol appears very similar to that of the present study, although it is not clear if only Chinese specialist acupuncturists administered the treatment. And only 12 sessions (or less), spread over 6 to 8 weeks, were used. However, there was no significant difference between the active and sham-treated patients in reductions in blood pressure.

The present study, however, produced beneficial effects in the actively-treated patients but none in the sham group; the magnitude of change was equivalent to that reported from controlled studies of lifestyle measures (such as weight reduction, salt limitation, and vigorous exercise), or indeed, from many well-controlled drug studies.

The authors of the present study suggest that acupuncture may offer an alternative therapeutic option for hypertension, especially in those patients who want to avoid drug therapy. Many antihypertensive drugs have unpleasant side effects, while acupuncture has few, if any; the only complaint is of occasional very slight pain associated with the insertion of the needles. It seems unlikely, however, that acupuncture will make a major contribution to the therapy of hypertension; multiple weekly sessions lasting 30 minutes and the need to use traditional Chinese experts will prove inconvenient and, perhaps, more costly than medication. The conflicting results from the two trials discussed here do not lend much encouragement, either. Nevertheless, the positive findings in this study may conceivably give some insight into the mechanism of hypertension to researchers prepared to seek a link between the technique and physiologic responses.

Source
Randomized trial of acupuncture to lower blood pressure. FA. Fleischkampf, J. Gallasch, O. Gefeller , et al., Circulation, 2007, vol. 115, pp. 3121–3129

Technorati : Acupuncture, Health Info, Hypertension
Del.icio.us : Acupuncture, Health Info, Hypertension
Ice Rocket : Acupuncture, Health Info, Hypertension
Flickr : Acupuncture, Health Info, Hypertension
Zooomr : Acupuncture, Health Info, Hypertension
Buzznet : Acupuncture, Health Info, Hypertension
Riya : Acupuncture, Health Info, Hypertension
43 Things : Acupuncture, Health Info, Hypertension

Robert W. Griffith, MD

Here’s another ‘re-discovery’. In 1996 Honolulu scientists reported that, in a population of 8000 men, those with above average serum uric acid levels had a 40% reduction in their likelihood of later contracting Parkinson’s disease. This was reported in the American Journal of Epidemiology . The scientists suggested that the antioxidant properties of uric acid might protect against oxidative damage and nerve cell death in Parkinson ‘s. And they advised further research.

Eleven years later (last June, in fact) the same journal reported data from the Health Professionals Follow-up Study, which comprised 18,000 men screened in1993-1995 and followed until 2000. 84 cases of Parkinson’s disease were matched with two controls by age, race, and time of blood collection. Then the participants were divided into quarters (quartiles) based on their serum uric acid. After corrections for age, smoking, and caffeine, those in the highest quartile were found to have a 55% lower likelihood of developing the disease than those in the lowest quartile. The principal investigator stated “”the data are very compelling, and if they are confirmed, urate could become the first biomarker of Parkinson’s disease”. Do we really need another study (in ten years’ time!) to re-discover this relationship?

Source
HealthandAge Blog

Technorati : health news, parkinson
Del.icio.us : health news, parkinson
Ice Rocket : health news, parkinson
Flickr : health news, parkinson
Zooomr : health news, parkinson
Buzznet : health news, parkinson
Riya : health news, parkinson
43 Things : health news, parkinson

The US Food and Drug Administration (FDA) said yesterday that a preliminary review of new data on the safety of two stomach drugs made by AstraZeneca, Prilosec (generic name omeprazole) and Nexium (generic name esomeprazole) suggests that long term use of these medications does not lead to heart attacks and other heart related events. The agency said for the time being, until a final decision and recommendation is made in three months’s time, health professionals and patients should not change their current practice in the use of these drugs.

Prilosec and Nexium are proton pump inhibitors (PPIs) used to control stomach acid. They are taken by patients with a range of gastrointestinal conditions such as ulcers and gastroesophageal reflux disease (GERD). Some GERD conditions erode the lining of the food pipe (esophagus) and PPIs help to heal the erosions or stop them getting worse. Prilosec and Nexium are available in the US by prescription, although Prilosec is also dispensed over the counter for heartburn.

AstraZeneca submitted preliminary reports on two small long term studies on Prilosec and Nexium to the FDA and other regulators throughout the world in May this year.

The two studies involved patients with severe GERD who were randomly assigned to receive surgery or drug treatment.

The results from the 14 year Prilosec (omeprazole) study showed there were more heart attacks, heart failure and heart related sudden deaths among the drug patients compared with the surgery patients. This difference was noticed in the first year of the study and continued thereafter.

The other study on Nexium (esomeprazole), has now gathered 5 years of follow up on patients but is not yet completed. The initial results also showed a difference between the drug treatment and the surgery group, similar to the Prilosec study, but a more recent update has since shown that the incidence of cardiovascular events is largely similar between the two groups.

Also, since May, as well as receiving more information on the not yet completed Nexium (esomeprazole) study, the FDA has received analyses from 14 other studies on Prilosec (omeprazole). Four of these other studies were placebo controlled trials. These additional studies showed fewer heart related events in the drug groups compared to the placebo groups.

The FDA said there is a lot of data to go through, and it is proving difficult to conduct a thorough review in a short time, hence the announcement of these preliminary findings. The agency said it will complete the full review and give a final decision and recommend any changes to drug usage within the next three months.

In the meantime the agency advises health professionals and patients not to change their medication practices regarding either of the two drugs.

One of the reasons the agency gave for the difficulty it was experiencing in reviewing the data was that “the study protocols did not specify how heart problems, such as heart attacks, were to be defined or documented. As a result, evaluating the information that has been gathered about the safety of either drug in these studies is difficult.”

Another reason was that many of the patients who were in the surgery group in one of the trials pulled out of the study without undergoing surgery. They were on the younger side and less likely to have a history of cardiovascular events or risks compared to the drug group. These group differences could have biassed the results.

The official statement from the FDA regarding its current view on these results is:

“Based on everything we know now, FDA’s preliminary conclusion is that the observed difference in risk of heart attacks and other heart related problems seen in early analyses of the two small long-term studies is not a true effect.”

Technorati : News, health, stomach
Del.icio.us : News, health, stomach
Ice Rocket : News, health, stomach
Flickr : News, health, stomach
Zooomr : News, health, stomach
Buzznet : News, health, stomach
Riya : News, health, stomach
43 Things : News, health, stomach

A new US study suggests that women who have migraines with aura (seeing spots and flashing lights), particularly those who smoke or use oral contraceptives, are at increased risk of having a stroke compared with women who do not have migraines.

The study is published in Stroke, a journal of the American Heart Association, and was carried out by researchers from the University of Maryland School of Medicine, Baltimore, Maryland, the VA Maryland Health Care System, also in Baltimore, and the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

According to the World Health Organization (WHO), migraine is a “primary headache disorder”, and most likely has hereditary factors. It happens when chemicals are released deep inside the brain that cause painful inflammations of the nerves and blood vessels in the head. Nobody knows what starts the process off and what decides how long a migraine episode lasts. The attacks appear and end spontaneously: for some people this is about once a year and for others it could be once a week.

As well as the painful headache, nausea is also a common symptom of migraine in adults, as is sensitivity to lights and sounds and occasionally vomiting. In children the most common symptom is abdominal pain.

Migraines usually start in puberty and mostly affect people between 35 and 45 years of age. Studies carried out in Europe and America show that up to 8 per cent of men and 18 per cent of women have a migraine each year. The prevalence in South and Central America is said to be similar, but lower in Asia, according to the WHO.

According to the British Association for the Study of Headache (BASH), around one third of migraine sufferers also experience migraine with “aura”, where they see flashing lights, spots or lines either just before or during the migraine episode.

The authors of the present study said that previous research has already linked migraine with aura with ischemic stroke, but few of them have looked into the clinical and physiological features of the link.

Dr Steven J. Kittner of of the University of Maryland School of Medicine and colleagues assessed the link between probable migraine with visual aura and probable migraine without visual aura (PMVA) with ischemic stroke among groups of women according to various factors including headache characteristics and various clinical features.

The case controlled study enrolled 386 women aged between 15 and 49 who had suffered a stroke for the first time, and matched them to 614 controls by age and ethnic status. The women completed questionnaires about their headache symptoms and were put in three groups: no migraine, probable migraine without visual aura, and probable migraine with visual aura (PMVA).

The results showed that:
* Women with PMVA had a 50 per cent greater risk of ischemic stroke compared to the no migraine group.
The risk was highest among those with no history of high blood pressure (hypertension), diabetes or heart attack (myocardial infarction).
* Women with PMVA who smoked and used oral contraceptives had a 7-fold increase in ischemic stroke risk compared to women with PMVA who did not smoke or use oral contraceptives.
* Also, women who had their first PMVA attack in the preceding year had a 6.9 fold increase in ischemic stroke risk compared to women with no history of migraine.
* Kittner and colleagues concluded that:

“PMVA was associated with an increased risk of stroke, particularly among women without other medical conditions associated with stroke. Behavioral risk factors, specifically smoking and oral contraceptive use, markedly increased the risk of PMVA, as did recent onset of PMVA.”

“Probable Migraine With Visual Aura and Risk of Ischemic Stroke. The Stroke Prevention in Young Women Study.”
Leah R. MacClellan, Wayne Giles, John Cole, Marcella Wozniak, Barney Stern, Braxton D. Mitchell, and Steven J. Kittner.
Stroke, Published online before print, Aug 9, 2007.
doi:10.1161/STROKEAHA.107.488395

Technorati : Health, Migraine
Del.icio.us : Health, Migraine
Ice Rocket : Health, Migraine
Flickr : Health, Migraine
Zooomr : Health, Migraine
Buzznet : Health, Migraine
Riya : Health, Migraine
43 Things : Health, Migraine