Nearly One-Third Of Interns, Residents May Experience Depressive Symptoms During Their Training, Analysis Suggests

The Los Angeles Times (12/9, Kaplan) reports in “Science Now” that “nearly one-third of interns and residents experience depressive symptoms or full-blown depression at some point during their training,” an analysis published Dec. 8 in the Journal of the American Medical Association suggests. After analyzing “data from 54 earlier studies involving 17,560 physicians in training,” then pooling results, investigators found that “the prevalence of depression or depressive symptoms was 29%.”

        The Washington Post (12/9, Sun) points out in “To Your Health” that “researchers said the prevalence of depression was much higher among medical residents than the general population.” In comparison, “the National Institute of Mental Health has said that in 2013, about 6.7 percent of all US adults had at least one major depressive episode during the previous year.”

        TIME (12/9, Oaklander) reports that the reasons for higher rates of depression among new physicians “are complex, ranging from long hours and sleep deprivation to bullying by attending physicians to a stigmatized attitude against mental illness.” Not only are the physicians suffering, but their patients too, as evidenced by the fact that “medical literature links untreated mental health problems in this population of young doctors to more medical errors and worse patient care.”

        According to MedPage Today (12/9, Bender), an accompanying editorial observed that even though “the medical profession is obligated to provide the best medical and mental healthcare to its members, ‘best efforts fall short, mostly because of the high levels of stigma attached to seeking mental health care.’” The editorial suggested that “perhaps an overhaul of the graduate medical education training system is in order.” 

The summary of the study is given below

The study was done to provide a summary estimate of depression or depressive symptom prevalence among resident physicians.

Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. The estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression.

The data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17 560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ² = 0.39, I² = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ² = 0.04, I² = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ² = 0.09, I² = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents.

The study revealed  the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.

MCI not to upload the minutes of any ethics committee meeting held

The Medical Council of India (MCI), has revised its working methodology and has decided not to make public the minutes of any ethics committee meetings, where the medical negligence cases and cases relating to professional misconduct of doctors are heard. Since October 2013, the MCI has not uploaded the minutes of any ethics committee meeting held, that is, after the current administration took over.

MCI said that the decision taken in each case would be respective to that particular case. The council further added that no consolidated minutes of the meetings of the ethics committee are now being maintained/prepared. This is done as the ethics committee of the council considers the matter before it in a quasi-judicial capacity and makes judgement upon the appeal/complaint. The committee has to decide upon the matter that affects the rights and duties of the contesting parties in accordance with the principles of natural justice and disclosing the proceedings prior to conclusion of a matter would serve no public interest.

The minutes of ethics committee meetings were uploaded regularly from May 2011 to May 2013 on the MCI website. The minutes of each committee meeting started with confirmation of the minutes of the previous meeting and all proceedings were absolutely transparent till the current council took over in November 2013.

However, some medico-legal experts have expressed their displeasure at this new turn of events and believe that minutes of hearings need to be public. It have also pointed out that this decision by MCI seems more like an attempt to hide the irregularities in the MCI that are being frequently reported. Many appeals seeking the minutes of meetings were met with stony silence till the applicants approached the chief information commissioner who had to force the MCI to hand over the specific minutes sought and threaten the public information officer with penalty.

Chest Radiology - The Silhouette Sign

By Dr Deepu

Silhouette sign/loss of silhouette sign/ loss of outline sign.

I was always confused with the silhouette sign for its hidden meaning and failure to decode it by many medical students. So, I thought it would be apt to unravel it so that it could be handy for many medical students.

One of the most useful signs in chest radiology is the silhouette sign. This sign was described by Dr. Ben Felson. The silhouette sign is in nothing but  elimination of the silhouette or loss of lung/soft tissue interface caused by a mass or fluid in the normally air filled lung. For instance, if an intrathoracic opacity is in anatomic contact with, for example, the heart border, then the opacity will obscure that border. The sign is commonly applied to the heart, aorta, chest wall, and diaphragm. The location of this abnormality can help to determine the location anatomically. 

Just go through the X Ray to know the  various structures seen in the chest x ray.

Let me explain this with this image.

What do we see???

There is plastic bottle which is surrounded by air, the margins of the shadow is very  well demarcated from the surrounding air.

First scenario: There are two bottles, made of same material, placed apart from each other. The shadows appears separate from each other. Let us consider the right bottle to be the heart and the air surrounding the bottle as lung. The left bottle as a mass, since they are far from each other, the border of both  is visible clearly.

Second scenario: Here we see the bottles are touching each other at two points and there is no gap in between and if we look at the shadow, we cannot differentiate between the two shadows, they appear like a single opacity at the upper and lower ends.

For the heart, the silhouette sign can be caused by an opacity in the RML, lingula, anterior segment of the upper lobe, lower aspect of the oblique fissure, anterior mediastinum, and anterior portion of the pleural cavity.

This contrasts with an opacity in the posterior pleural cavity, posterior mediastinum, of lower lobes which cause an overlap and not an obliteration of the heart border. Therefore both the presence and absence of this sign is useful in the localization of pathology.

want to read more in chest radiology??? Have a look at the following pages
Chest Radiology
Signs in Chest Radiology

Chest Radiology _ A Case Of Azygous Lobe

By Dr Deepu
The lungs are normally divided into five lobes by three main fissures .
 Occasionally, invaginations of the visceral pleura create accessory fissures that separate individual bronchopulmonary segments into accessory lobes .
 An azygos lobe is found in approximately 0.4% of patients . In contrast to other accessory lobes, the azygos lobe does not correspond to a distinct anatomical bronchopulmonary segment .

It forms during embryogenesis when the precursor of the azygos vein fails to migrate to its medial position in the mediastinum, where it normally arches over the origin of the right upper lobe bronchus.
 This gives rise to the following characteristics, which are visible on a standard chest x-ray

: the laterally displaced azygos vein lies between folds of parietal pleura, also referred to as the mesoazygos, where it assumes a characteristic teardrop shape ; the mesoazygos indents the right upper lobe, thereby creating the accessory (azygos) fissure, which is similar in shape to an inverted comma; the fissure delineates the azygos lobe, located superomedially ; laterally, the pleural folds of the mesoazygos separate before reaching the chest wall, resulting in a radiopaque triangular area ; and medially, the tracheobronchial angle appears empty .

 An azygos lobe may be confused with a pathological air space such as a bulla or abscess . In addition, the abnormally located azygos vein may be mistaken for a pulmonary nodule, while a consolidated azygos lobe may be confused with a mass . An understanding of the pathogenesis and characteristic x-ray features of the azygos lobe will enable an accurate diagnosis in most cases .
 If the x-ray findings are equivocal, computed tomography will be diagnostic .

Sleep-Disordered Breathing In Kids May Be Linked To Academic Problems

By Dr Deepu

HealthDay (9/9) reports that research suggests that “when children have sleep troubles due to breathing problems – such as sleep apnea – they may struggle in school.” Investigators “reviewed the results of 16 studies dealing with sleep apnea or related disorders in children and academic achievement.” The data indicated that kids “with sleep-disordered breathing did worse in language arts, math and science tests compared to those without such conditions.” The findings were published online in Pediatrics.

The researchers reviewed the results of 16 studies dealing with sleep apnea or related disorders in children and academic achievement. The investigators found that children with sleep-disordered breathing did worse in language arts, math and science tests compared to those without such conditions.

Chest Medicine Made Easy -By Dr Deepu : BASICS OF CHEST X RAY- PART 2 , EASY WAY TO INTERP...

Chest Medicine Made Easy -By Dr Deepu : BASICS OF CHEST X RAY- PART 2 , EASY WAY TO INTERP...: Welcome to basics of CXR, this is part two of this series, read my previous post part 1, in the next post we will be exploring about the s...

By Dr Deepu

Medical students with mental health problems do not feel adequately supported

Survey provides a snapshot of mental health problems among medical students in the UK

Over 80% of medical students with mental health issues feel they receive poor or only moderately adequate support from their medical schools, finds a small online survey published in Student BMJ today.

Of the 1,122 UK respondents, 30% (343) said they had experienced or received treatment for a mental health condition, and almost 15% (167) revealed that they had considered committing suicide while studying at medical school.

"The number of students reporting mental illness or considering suicide is shocking," says Twishaa Sheth, chair of the BMA’s student’s welfare committee, adding that "what is more concerning is the lack of independent support available for students."

Student BMJ invited its readers to take part in a survey on the health of medical students. The number of respondents represents around 2% of medical students.

The survey also asked questions about smoking, drinking and alcohol use. In total, 15.8% (177) of respondents claimed they smoked, one quarter reported binge drinking each week, and 10.9% (123) said they had taken illegal drugs more than once.

Furthermore, 8.3% (94) claimed to have tried a legal high, and the same number had used cognitive enhancing drugs to help with revision.

Reasons behind the high rates of mental health problems among medical students are "complex", writes Matthew Billingsley, Editor of the Student BMJ.

"Students often have a relentless timetable of exams as well as having to balance the emotional strain of seeing sick patients and uphold high professional standards," he says, adding that "the demands of the course can cause an over competitive environment that can have a detrimental effect on the health of students."

Deborah Cohen, senior medical research fellow at the University of Cardiff, describes Student BMJ’s results as "concerning," but that they are in line with previous research.

A study she carried out found that 15% of 557 respondents from two large UK medical schools had substantial levels of depression and 52% reported substantial levels of anxiety.

Earlier this year, Student BMJ reported that there was not a clear separation between medical school staff with pastoral roles and those who rule on fitness to practice disciplinary issues. This raised concerns about students being able to report a problem without it affecting their final result.

In July, the General Medical Council and the Medical Schools Council issued new guidelines to clarify that teaching and pastoral roles should be separate.

Iain Cameron, chair of the MSC, says "Medical schools take the mental wellbeing of their students seriously. The Student BMJ survey highlights key issues and similar concerns have been raised previously."

"It is crucial that students who have concerns about their health are able to make this known so that they can be provided with the necessary advice and support."

He adds that the MSC would like to work with Student BMJ and colleagues across the sector to promote the new guidelines and other initiatives on student mental health.

Link to research

Concern over inappropriate use of psychotropic drugs in people with intellectual disability

Over 70% of prescriptions are given to those without a record of mental illness

The proportion of people with intellectual disability in the UK who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness, finds a study published by The BMJ today.

This suggests that, in some cases, these drugs are being used to manage challenging behaviour rather than for mental illness, say the researchers. They call for changes in the prescribing of psychotropic drugs for people with intellectual disability as well as more evidence on their safety in this group.

People with intellectual disability develop severe mental illness at higher rates than do the general population and may show challenging behaviour.

Concern has existed for many years that psychotropic drugs in general - and antipsychotics in particular (mainly used to treat schizophrenia and bipolar disorder) - are overused in people with intellectual disability, but accurate estimates have been difficult to obtain.

So a team of researchers based at University College London set out to describe rates of recorded mental illness, challenging behaviour, and use of psychotropic drugs in people with intellectual disability in UK primary care.

They analysed data from 571 UK general practices using the The Health Improvement Network (THIN), a large database of electronic health records, and identified 33,016 people with a record of intellectual disability. Average age at study entry was 36 years and average follow-up was five and a half years.

Of 9,135 participants treated with antipsychotic drugs by the end of the study period, 6,503 (71%) did not have a record of severe mental illness.

Of the 11,915 with a record of challenging behaviour, 5,562 (47%) had received antipsychotic drugs, whereas only 1,421 (12%) had a record of severe mental illness.

And of those with a record of prescription of antipsychotics, 26% did not have a record of severe mental illness or challenging behaviour.

New prescriptions for antipsychotics were significantly more common in older people and in those with a record of challenging behaviour, severe mental illness, depression, anxiety, autism, dementia, and epilepsy.

People with a record of challenging behaviour were more than twice as likely to receive a prescription for antipsychotics compared with those without a record of challenging behaviour, say the authors.

Prescription of antipsychotic drugs is disproportionate to the level of recorded severe mental illness and is associated with the presence of challenging behaviour, older age, and diagnoses of autism and dementia, they add.

"Inappropriate use of drug treatment has implications for the individual and for healthcare systems," they warn. "These findings highlight the need for an improved evidence base for use of drugs and optimisation of drug treatment in people with intellectual disability."

Link to article

SPOTTER: GIVE YOUR DIAGNOSIS

Give your Diagnosis?? and comment on X ray, microbiology  and Treatment.

GSK’s malaria candidate vaccine, Mosquirix™ (RTS,S), receives positive opinion from European regulators for the prevention of malaria in young children in sub-Saharan Africa

24 July 2015

Issued: London, UK

• WHO will now assess how the world’s first malaria candidate vaccine might be used alongside other tools to prevent malaria

GSK announced today that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has adopted a positive scientific opinion for its malaria candidate vaccine Mosquirix^TM, also known as RTS,S, in children aged 6 weeks to 17 months. Following this decision, the World Health Organization (WHO) will now formulate a policy recommendation on use of the vaccine in national immunisation programmes once approved by national regulatory authorities.

RTS,S, which was developed in partnership with the PATH Malaria Vaccine Initiative (MVI), is the first candidate vaccine for the prevention of malaria to reach this milestone. While other vaccines tackle viruses or bacteria, RTS,S has been designed to prevent malaria caused by the Plasmodium falciparum parasite, which is most prevalent in sub-Saharan Africa (SSA). In 2013, there were an estimated 584,000 deaths from malaria with around 90% of these occurring in SSA, and 83% in children under the age of five in SSA.¹

The CHMP scientific opinion is a key step in the regulatory process toward making RTS,S available alongside existing tools currently recommended for malaria prevention. The positive opinion for young children was based on the review of data assessing the candidate vaccine’s safety, efficacy and quality. Clinical data submitted for CHMP assessment were mainly from a phase III clinical trial programme involving more than 16,000 young children that was conducted by 13 African research centres in eight African countries (Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique, Nigeria, and Tanzania).

Data from this trial programme demonstrate that over the first 18 months following three doses of RTS,S, malaria cases were reduced by almost half in children aged 5-17 months at the time of first vaccination and by 27% in infants aged 6-12 weeks. At study end, four doses of RTS,S reduced malaria cases by 39% over four years of follow-up in children, and by 27% over three years of follow-up in infants.²  In areas of the highest malaria burden, more than 6,000 clinical malaria cases were prevented over the study period for every 1,000 children vaccinated.² The efficacy of RTS,S was evaluated in addition to existing malaria control measures, such as insecticide treated bed nets, which were used by approximately 80% of the children and infants in the trial.

Sir Andrew Witty, CEO of GSK said: “Today’s scientific opinion represents a further important step towards making available for young children the world's first malaria vaccine. While RTS,S on its own is not the complete answer to malaria, its use alongside those interventions currently available such as bed nets and insecticides, would provide a very meaningful contribution to controlling the impact of malaria on children in those African communities that need it the most. The work doesn’t stop here and GSK remains committed to investing in R&D for malaria vaccines and treatments to find more ways to tackle this devastating disease.”

Dr David C. Kaslow, Vice President of Product Development at PATH said: “Today marks a significant scientific milestone for the long-standing partnership to develop a vaccine, yet several more steps remain before a malaria vaccine might reach the young children in Africa who most need protection against this deadly human parasite. PATH will continue to work with GSK and other partners to ensure that the evidence is available, as soon as possible, to support informed decision-making on those remaining steps.”

GSK has committed to a not-for-profit price for RTS,S so that, if approved, the price of RTS,S would cover the cost of manufacturing the vaccine together with a small return of around five per cent that will be reinvested in research and development for second-generation malaria vaccines, or vaccines against other neglected tropical diseases.

Next steps

Following the CHMP positive scientific opinion, two of the WHO’s independent advisory groups, the Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Committee (MPAC) will now jointly review the evidence base for RTS,S and make a joint policy recommendation for how it might be used alongside other tools to prevent malaria in the event the vaccine candidate is approved by national regulatory authorities in SSA. The WHO has indicated that such a policy recommendation may be possible by end of this year.

Following the WHO policy recommendation, GSK will also submit an application to the WHO for pre-qualification of RTS,S. WHO pre-qualification involves a scientific assessment of the quality, safety and efficacy of any new vaccine proposed for introduction in WHO Expanded Programme on Immunization. A pre-qualification decision is used by the United Nations agencies and other large scale public procurement agencies to help inform vaccine purchasing decisions.

Once a WHO pre-qualification is granted, GSK would then apply for marketing authorisation in countries in sub-Saharan Africa on a country-by-country basis. These regulatory and policy decisions would, if positive, enable countries to begin implementation of RTS,S through their universal immunisation programmes.

Both a WHO policy recommendation and WHO pre-qualification are requirements for Gavi, the Vaccine Alliance, to support eligible African countries introducing RTS,S into local immunisation programmes supported by UNICEF.

Notes to Editors

• Mosquirix is the brand name given to this malaria candidate vaccine. Its scientific name, RTS,S, reflects the composition. RTS,S also contains the AS01 adjuvant system.[i]
• RTS,S aims to trigger the body’s immune system to defend against the Plasmodium falciparum malaria parasite when it first enters the human host’s bloodstream and/or when the parasite infects liver cells. It is designed to prevent the parasite from infecting, maturing and multiplying in the liver, after which time the parasite would re-enter the bloodstream and infect red blood cells, leading to disease symptoms.
• The safety and efficacy of RTS,S has been evaluated in a large-scale phase III trial, in which it was administered in three doses, one month apart, with an additional fourth dose given 18 months later. Results from this trial have consistently demonstrated that RTS,S can help to protect children against malaria in endemic countries, when used in addition to other malaria control measures such as bed nets.
• RTS,S is the most advanced malaria vaccine candidate in development globally. It was created in 1987 by scientists working at GSK laboratories. Early clinical development was done in collaboration with the Walter Reed Army Institute for Research. In January 2001, GSK and PATH, with grant monies from the Bill & Melinda Gates Foundation to PATH, entered into a public-private partnership to develop an RTS,S-based vaccine for infants and young children living in malaria-endemic regions in sub-Saharan Africa.
• GSK has invested more than $365 million to date and expects to invest a further $200 to $250 million until development is completed. Between 2001 and the end of 2014, the MVI, supported by grants from Bill & Melinda Gates Foundation, invested more than $200 million to advance the RTS,S project.
• The EMA’s CHMP opinion is a final stage in the Article 58 procedure initiated in July 2014, by which the CHMP gives a scientific opinion, in co-operation with the World Health Organization (WHO), on a medicinal product for human use that is intended exclusively for markets outside of the European Union (EU). This assessment requires medicinal products to meet the same standards as those intended for use in the EU.

References

1.      http://www.who.int/malaria/media/world_malaria_report_2014/en/

2.      RTS,S Clinical Trials Partnership, The Lancet. 2015; 386 (9988): 31–45.

BMJ comes out with review article on Febrile seizures

This clinical review summarises how to recognise a febrile seizure and rule out other underlying causes. How to manage febrile seizures and how to deal with common questions posed by parents in this situation.

Comparative effectiveness and tolerance of treatments for H pylori

This network meta-analysis compares different eradication treatments forHelicobacter pylori.This showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, levofloxacin based triple treatment, hybrid treatment and sequential treatment might be most effective for eradicating H pylori.

Nagging people is a futile exercise

  

Columnist Margaret McCartney argues that nagging people about the need to do exercise to achieve health won’t work. Exercise should be for the people, by the people, she says.

Longer Work Hours Tied To Increased Risk For Stroke

The Los Angeles Times (8/20, Kaplan) reports in “Science Now” that people “who put in long hours at the office were 33% more likely to suffer a stroke than their colleagues who clocked out earlier,” according to study findings published online yesterday in The Lancet. The study also found that even people “who worked just over 40 hours per week saw a significant increase in stroke risk.”

        The New York Times (8/20, Saint Louis) “Well” blog points out that the “new analysis includes data on more than 600,000 individuals in Europe, the United States and Australia, and is the largest study thus far of the relationship between working hours and cardiovascular health.” Included in the analysis were 17 “studies of stroke” that “included 528,908 men and women who were tracked on average 7.2 years,” as well as 25 studies of “coronary heart disease among workers” that involved some “603,838 people.”

        TIME (8/20, Basu) reports that the study authors are not sure why longer work hours appear to be linked to an increased risk for stroke, but posited that “working long hours tends to be correlated with risky health behaviors, like drinking more alcohol or sitting for hours at a time.” Such behaviors, in combination “with the stress associated with working overtime, could be a perfect recipe for a stroke or cardiovascular strain.” The Telegraph (UK) (8/20, Knapton) also covers the study.

CPAP Alternatives For Traveling With Obstructive Sleep Apnea

By Dr Deepu

The Sleep Review (8/20, Wolski) reports on “easy to use, effective, and unobtrusive” alternatives to CPAP for patients with OSA while traveling. Dr. Glenn Adams, medical director and sleep medicine specialist at Sarasota Memorial Health Care System, said one of the most effective options is “Provent, which goes over the nose and creates back pressure to treat OSA,” but is not covered by insurance. The piece also discusses the option of oral appliances.

FDA grants “fast track” designation to pneumonia drug

By Dr Deepu

FDA grants “fast track” designation to pneumonia drug

The Triangle (NC) Business Journal (8/19, deBruyn, Subscription Publication) reports that Chapel Hill-based drug developer Cempra Inc. received “Fast Track” designation from the FDA to expedite the review process for “Cempra’s experimental drug solithromycin, a treatment for community acquired bacterial pneumonia (CABP).” The drug is “currently in Phase 3 development for the treatment of CABP and Cempra plans a New Drug Application submission in 2016.”

Combined use of antidepressants and painkillers linked to bleeding risk

Extra vigilance needed when using both types of drugs together

Taking a combination of antidepressants and common painkillers is associated with an increased risk of bleeding soon after starting treatment, finds a study published in The BMJ this week.

The researchers say their results may have been affected by other unmeasured or unknown factors and should be interpreted with caution. However, they suggest special attention is needed when patients use both these classes of drugs together.

Depression produces the greatest decrement in health of all common chronic conditions and depression in older people is an important public health problem.

But concern exists that antidepressants may interact with common painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) to increase the risk of bleeding inside the skull (intracranial haemorrhage).

So a team of researchers based in Korea compared the risk of bleeding among patients treated with antidepressants with and without NSAIDs.

Using the Korean nationwide health insurance database, their study involved over four million people who were prescribed antidepressants for the first time between 2009 and 2013.

NSAID prescriptions were obtained and hospital records were used to identify time to first admission with intracranial haemorrhage within 30 days of a new prescription. Factors that could affect the results, such as age, sex, and use of other medications, were taken into account.

Compared with use of antidepressants alone, the team found that combined use of antidepressants and NSAIDs was associated with a substantially increased bleeding risk.

They found no statistically meaningful differences in risk of bleeding between different types of antidepressant drugs, or with age. Being male was the most common factor for a higher risk of bleeding with combined use of antidepressants and NSAIDs.

"The addition of NSAIDs to antidepressant treatment increased the risk of intracranial haemorrhage within 30 days of the combination starting, especially in men," conclude the authors. "This result adds to evidence confirming the increase of risk with combination use of antidepressants and NSAIDs."

In an accompanying editorial, Dr Stewart Mercer at the University of Glasgow and colleagues at the University of Cambridge, say the results give some cause for concern.

They point out that both types of drug are widely used, and that co-morbidity of the conditions for which these drugs are used is very high - 65% of those with major depression also have chronic pain.

They urge family doctors to be extra vigilant in terms of prescribing behaviour and discussing the risks with patients, especially in deprived areas where "the combination of mental and physical problems (including chronic pain) is very common." And they say further research is required to extend the findings over longer time periods and in differing populations.

Link to full

High-Flow Nasal Therapy Effective As NIV In Preterm Infants

Medscape (8/18) reports that an analysis published in the journal Pediatrics found that high-flow nasal cannula therapy “is as safe and efficacious as conventional modes of noninvasive ventilation (NIV) in preterm infants.” The study, which compared high-flow therapy with nasal continuous positive airway pressure, found “no significant differences between groups with respect to a variety of secondary outcomes,” such as the duration of time in the neonatal unit or respiratory support.

COPD Patients With Comorbid Mental Issue Have Higher Readmission Risk

According to Lung Disease News (8/18, Semedo), a recent study in the journal CHEST found that psychological conditions such as depression anxiety, or psychosis were associated with a higher risk of hospital readmission for COPD complications. “These psychological disorders are more likely to predict early readmission than other significant factors,” said Gurinder Singh of the University of Texas Medical Branch at Galveston. “This is likely related to the limited ability of these patients to handle the COPD, poor social support or community resources and non-adherence with treatment,” Singh added.

E-Cigarettes Not Gateway Drug Among British Youth, Survey Says

The Guardian (UK) (8/17, Meikle) reports that an online survey by the British anti-tobacco group Action On Smoking and Health found that “experimentation with e-cigarettes is rising among 11- to 18-year-olds in Britain but is most common among those who already smoke or who have done in the past.” The group suggests that the results show it is “unlikely” that e-cigarettes are being used as a gateway drug to tobacco. Also covering the story are the Daily Mail (UK) (8/17, Duell) and the Independent (UK). (8/17, Connor)

Helicobacter Pylori May Be Common In Patients With COPD

The Daily Mail (UK) (8/16) reported that “the bacteria helicobacter pylori” may “be common in patients with chronic obstructive pulmonary disease (COPD).” Research has “found that levels of the bacteria are up to three times higher in people with COPD, and one theory is that infection in childhood may affect the growth of the lungs, making them more vulnerable to disease.”

Researcher Identify Factors That May Put COPD Patients At Higher Risk For Falls

Reuters (8/15, Rapaport) reported that research suggests that older individuals with COPD may have a higher likelihood of experiencing falls if they have additional medical conditions, prior falls, or a lengthier smoking history. The findings were published in Respirology.

Regular consumption of sugary drinks associated with type 2 diabetes

Sugar sweetened drinks may give rise to nearly 2 million diabetes cases over 10 years in the US and 80,000 in the UK

Regular consumption of sugar sweetened drinks is positively associated with type 2 diabetes independent of obesity status, finds a study published in The BMJ this week.

Artificially sweetened drinks and fruit juice also showed a positive association with type 2 diabetes, but the quality of evidence was limited. None the less, the authors warn that neither artificially sweetened drinks nor fruit juice are suitable alternatives to sugar sweetened drinks for the prevention of type 2 diabetes.

Artificially sweetened beverages have been seen as possible alternatives to sugar sweetened beverages to reduce intake of sugars and energy, and fruit juice has been considered a healthier alternative. However, evidence was not available to clarify whether or not consumption of each of sugar sweetened beverages, artificially sweetened beverages, and fruit juice is associated with risk of diabetes after taking account of obesity status.

To address this question, an international team of researchers led by the MRC Epidemiology Unit at Cambridge University set out to assess whether or not habitual consumption of sugar sweetened drinks, artificially sweetened drinks, or fruit juice was associated with the incidence of type 2 diabetes, and to estimate the 10-year risk attributable to sugar sweetened drinks in the USA and UK.

They analysed the results of 17 observational studies. Design and quality were taken into account to minimise bias. None of these was funded by industry.

They found that habitual consumption of sugar sweetened drinks was positively associated with incidence of type 2 diabetes, independently of obesity status.

The association between artificially sweetened drinks or fruit juice and incident type 2 diabetes was less evident. Yet, the researchers found little evidence for benefits of these beverages, and therefore concluded these drinks are unlikely to be healthy alternatives to sugar sweetened drinks for preventing type 2 diabetes.

They point out that the studies analysed were observational, so no definitive conclusions can be drawn about cause and effect.

However, assuming a causal association, they estimate that two million new-onset type 2 diabetes events in the USA and 80,000 in the UK from 2010 to 2020 would be related to consumption of sugar sweetened beverages.

“Although more research on cause and effect needs to be carried out, this study indicates the potential health gains that may be achieved by reducing the consumption of sugar sweetened drinks,” they conclude.

Link to article

Miscellaneous Mnemonics

Miscellaneous Mnemonics

Resistor colour codes "Bad Boys Rape 
Our Young Girls But Violet Gives Willingly
- Get Some Now":
· In ascending resistor value order:
Black: 0
Brown: 1
Red: 2
Orange: 3
Yellow: 4
Green: 5
Blue: 6
Violet: 7
Grey: 8
White: 9
Gold: 5%
Silver: 10%
None: 20%

Visible spectrum colors in order ROY G. BIV
· In order from low end of spectrum:
Red
Orange
Yellow
Green
Blue
Indigo
Violet
Alternatively: "Richard Of York Gained Battles
In Vain" (Richard III was an English king defeated in 1485).

Ohm's Law "Virgins Are Rare":
Volts = Amps x Resistance
· Note: can then rearrange to more common form Resistance = Volts / Amps.

Ideal gas law "Pure Virgins Never Really
Tire":
PV=nRT

Electric units "Vaulting John Says: 'Ann
Can Sing OVA'. What Just Sing? And
Vault.":
Volts = Joules/Sec
Amps = Coulombs/Sec
Ohms = Volts/Amp
Watts = Joules/Sec=Amps x Volts

Ideal gas law [for All My Children fans] "Pine Valley
is Not Real Time"
PV=nRt

Work: formula "Lots of Work gets me Mad!":
Work = Mad:
M=Mass
a=acceleration
d=distance

Syncope (fainting) treatment If the face is red,
raise the head.
If the face is pale, raise the tail.

Hospice facets HOSPICE:
Home
Outpatient
Support groups
Pain medication/ Physical needs
Inpatient
Counseling
End-stage (terminal) illness/ Emotional needs

Healthy lifestyle modification DRAINS:
Diet
Reduce weight
Alcohol reduced
Improve circulation (exercise)
No other disease
Smoking stopped

Clinical essay plan "During Exams Please
Say Silently I Must Prepare F***ing 
Well":
Definition
Epidemiology
Pathology
Signs and Symptoms
Investigations
Management
Prognosis
Further Work

Safety factors SETUP:
Stop
Environment
Traffic
Unknown hazards
Protect yourself, patient, bystanders

Admission orders: general ADA VAN DISSEL:
· In order of writing on the hospital admission form:
Admit (to which ward)
Diagnosis
Allergies
Vital signs
Activities
Nursing orders (wind, wound, and water)
Diet
Intravenous
Sedation
Sleep
Elimination
Lab work

Quality of life measurement in patients FIDOH:
Functional status
Impairment
Death/ Duration of life
Opportunity
Health perception
· Functional status: Social function (limitations in usual roles, degree of
social interaction, sexual function); psychological function (affective and
cognitive); physical function.
· Impairment: Symptoms, signs, self reported disease, physiological changes.
· Death/ Duration of life: Mortality, life expectancy, disease adjusted years of
life lost
· Opportunity: How the disease has influenced the patient's ability to
participate in society as well as their psychological resilience
· Health perception: Satisfaction with health; general feeling on a day to day
basis.