In the News for the Week of 11-16-04
- CDC to distribute 10.3 million more flu vaccine doses
- FDA OKs FluMist storage in conventional freezers
Clinical news in the headlines
- Heart disease patients benefit from lower than normal blood pressure
- Highlights of Nov. 16 Annals of Internal Medicine
- Experimental treatment may curb Crohn's disease
- Tennessee likely to shut down TennCare program
- Need help recertifying? Turn to ACP resources
The CDC last week announced plans to distribute the remaining 10.3 million doses of flu vaccine to state health departments.
The vaccine, which will be delivered during December and January, will fulfill 100% of any orders originally placed under federal, state and multistate contracts, according to a Nov. 9 CDC news release. The distribution plan takes into account a state's high-priority needs, unmet needs and the number of doses each state has already received. The CDC plans to distribute another 1.2 million doses of pediatric vaccine over the next several weeks.
Since Oct. 11, the CDC has worked with manufacturer Aventis Pasteur to ship its remaining vaccine at a rate of about 3 million doses per week, totaling about 14 million doses to date, the CDC release said. Agency officials are also working to obtain several million vaccine doses from other countries, pending safety approvals by the FDA.
The CDC declined to say how many doses each state would receive and left it up to local health departments to decide how to allocate those doses equitably among high-risk populations, the Nov. 10 Washington Post reported. Some counties are planning to hold lotteries, while some states are trying to buy vaccine on their own outside the country, a practice the CDC discourages.
The CDC has established a 24-hour hotline to answer questions in both English and Spanish about the vaccine supply (1-800-CDC-INFO). Health care providers can also use the number to report cases of flu in their communities.
The CDC release is online.
The Washington Post is online.
Physicians can sign up for a one-hour CDC Internet/teleconference being held this week. The conference, which will take place Nov. 19 at noon ET, will provide an update on influenza with a focus on the use of antivirals. The interactive program will combine a telephone audio conference with visual content presented online.
More information about the conference is online.
The FDA is now allowing doses of FluMist, the intranasal live flu vaccine, to be stored in conventional frost-free freezers instead of in specially designed freezeboxes. The move is designed to encourage physicians to order the intranasal vaccine, which has been approved for healthy patients age 5-49.
The storage permission applies only to FluMist shipped between Nov. 2 and Feb. 8, 2005, according to a news release from MedImmune Inc., the vaccine's manufacturer. (Doses shipped before Nov. 2 should continue to be stored in freezeboxes.) Unused doses shipped after Nov. 2 should be returned or discarded on Feb. 8, 2005.
More information is online.
Clinical news in the headlines
A new study of heart disease patients found that reducing blood pressure to lower than normal levels resulted in a reduced risk of heart attack and other cardiovascular events.
In a 24-month trial involving 1,991 patients with coronary artery disease, researchers compared the effects of 10 mg of amlodipine or 20 mg of enalapril vs. placebo in heart disease patients whose blood pressure was considered within normal range, below 140/90 mm Hg. They found that patients receiving either of the two antihypertensives had significantly fewer cardiovascular events and were less likely to develop atherosclerosis. Results were published in the Nov. 10 Journal of the American Medical Association (JAMA).
According to study results, cardiovascular events occurred in 23.1% of those taking placebo, 16.6% of those taking amlodipine and 20.2% of those taking enalapril. A substudy of 274 patients showed a trend toward less progression of atherosclerosis, especially in those being treated with amlodipine.
Study participants had an average blood pressure of 129/78, normal by national guidelines. The Nov. 10 New York Times reported that the results indicate that lowering blood pressure below the normal range could have additional benefits for patients with heart disease. Most previous studies have focused on reducing high blood pressure to normal levels.
While some experts interviewed by the New York Times said the study was too small to be definitive, others said the findings suggest that national guidelines for normal blood pressure may need to be revised downward for patients at high risk for cardiovascular events.
The JAMA article is free online.
The New York Times is online.
The following articles appear in the Nov. 16 issue of the Annals of Internal Medicine. Full text is available to College members and subscribers online.
High-dose vitamin E supplements can increase all-cause mortality. A meta-analysis has found that several trials of high-dose vitamin E supplements show non-statistically significant total mortality increases. Researchers conclude that patients should avoid vitamin E doses of greater than or equal to 400 IU/d. More...
Studies document health disparities, but don't identify efforts to reduce them. Researchers identified articles on health care disparities published in 10 leading health journals in 2002 and 2003. Those studies documented the existence of disparities at the patient, physician and health care system level. However, researchers found no good evidence for interventions that actually reduce inequities. More...
High-dose steroid use associated with increased heart disease risk. Patients who received high doses of glucocorticoids were more than 2.5 times as likely as patients not taking the drugs to have cardiovascular complications, a new study found. High steroid use was defined as more than 7.5 mg of oral, inhaled, topical, rectal and nasal steroids daily. While the study did not determine whether steroids caused the heart disease, researchers said the association was strong enough to alert physicians and patients. More...
An NIH-sponsored trial found that up to 75% of patients in a Crohn's disease trial responded to an experimental treatment using anti-interleukin-12, leading to long-term symptom remission.
The trial involved 79 patients with active Crohn's disease who were randomly assigned to receive weekly injections of either 1 mg or 3 mg of anti-interleukin-12 per kilogram of body weight, or of placebo. Participants received either an uninterrupted seven-week injection schedule or had a four-week interval between the first and second treatments. Results were published in the Nov. 11 New England Journal of Medicine (NEJM).
Researchers found that patients with an uninterrupted schedule of 3 mg of anti-interleukin-12 had the highest response rate, according to a news release from the National Institute of Allergy and Infectious Diseases (NIAID). In the group with the interrupted injection schedule, patients who received 3 mg had a higher response than those receiving the lower dose. Among those responding, 50% had long-term symptom remission.
Data suggest that an antibody targeted to interleukin-12 p40 is effective against the inflammation of Crohn's disease, the authors noted. The NIAID release said that more studies are needed to determine the most effective dosage and treatment schedule.
The NEJM abstract is online.
The NIAID release is online.
The governor of Tennessee last week announced that he will likely shut down TennCare, the state's coverage program, and shift most of its 1.3 million enrollees to Medicaid, unless his administration and TennCare advocates can agree to limit program benefits.
If TennCare dissolves and the state returns to Medicaid coverage, about 430,000 TennCare enrollees who are not Medicaid-eligible would lose their benefits, according to the Nov. 11 HealthLeaders News. The $7.8 billion TennCare program was launched in 1994 to bring managed care to the uninsured and chronically ill in the state, alleviating the burden of care on private insurers and hospitals.
The troubled program's likely shutdown was spurred by the federal government's plan to cut $100 million in TennCare funding over the next fiscal year, HealthLeaders reported. The program also suffered from escalating drug costs, with the state spending more than $2 billion a year on drugs for TennCare recipients—more than the state's higher education spending.
Earlier this year, TennCare advocates opposed the governor's plan to reform the program by imposing benefit limits, prior authorizations for prescriptions and greater use of disease management programs. While the governor said negotiations would continue this week, he said the program would not survive if proposed reform measures continue to be challenged in court.
HealthLeaders is online.
The College is offering several courses designed to help busy internists complete ABIM SEP modules and prepare for the secure recertification exam in internal medicine.
ACP's "Preparation for Recertification" course presents a targeted review of the developments of the past 10 years in internal medicine, with an emphasis on exam-related material. The course uses state-of-the-art audience response systems to maximize interaction between faculty and attendees, with mini-lectures summarizing advances in key areas of each discipline. It is an excellent refresher course for any internist and preparation for those who plan to take the recertification exam.
ACP also offers courses designed to help physicians complete an ABIM self-evaluation process (SEP) module in one day. Using an automated audience response system, faculty members guide attendees through the module question-by-question and encourage group discussion of different responses.
At the end of each session, attendees complete the module's answer card and return it to ABIM for grading. For physicians who want to complete multiple modules, ACP is offering a two-day/two-module series of SEP courses immediately prior to Annual Session 2005 and a three-day/three-module series in June.
Courses are offered in Orlando (February), Washington (March), San Francisco (April) and Boston (June).
More information and registration are online.
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A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has severe COPD, previously with minimal exertional symptoms, but now notes activity-limiting shortness of breath when walking short distances. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical history is otherwise unremarkable. Medications are a twice-daily fluticasone/salmeterol inhaler and an as-needed albuterol/ipratropium metered-dose inhaler. He has a 55-pack-year smoking history but quit when COPD was diagnosed. Following a physical exam, chest radiograph, and transthoracic echocardiogram, what is the most appropriate diagnostic test to perform next?
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