Comparison of Amlodipine vs Enalapril to Limit Occurrences of Thrombosis (CAMELOT)

We did not focus exclusively on the blood pressure question. CAMELOT was more about what therapeutic strategy should be used with CAD patients.[1] We knew that some people advocated the use of angiotensin-converting enzyme (ACE) inhibitors, and although the results of the Heart Outcomes Prevention Evaluation (HOPE)[2] were not yet available when CAMELOT was set up, there was a lot of support for the potential benefits. In addition, a pilot study, the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT),[3] coordinated at the University of Michigan Medical Center (Ann Arbor), showed that amlodipine could reduce major cardiovascular events in patients who were not particularly hypertensive.

Stop U Be 4 Errors

"A recent error occurred when a nurse who was taking a patient's history recorded his insulin dose using the letter 'u' instead of the word 'unit' (Figure 1). The physician misread the 'u' as a '4' and wrote orders for doses dramatically different from what the patient had been taking (Figure 2). Although the physician also used the abbreviation 'u,' thankfully it was not misread as yet another 4. The patient received a single overdose of insulin, but fortunately was not harmed. The only safe way to express units is to write it out completely. Incidentally, another safe practice, telling patients the names and doses of drugs being administered, also played a role in helping to prevent additional errors. Further overdoses were averted when the nurse said to the patient, 'Here's your insulin, 44 units.' The patient responded, '44 units? I take 4 units!'"

Errors while writing orders

"An order was written for '1.25 mg of Toradol x 1,' or so it seemed (Figure 1). Despite a spelling error (Tordol), that's the way a pharmacist initially read the transcribed telephone order (see below). Since the dose didn't make sense, the pharmacist checked with the transcribing nurse, who responded by saying she'd numbered the order for 25 mg of TORADOL (ketorolac) IV using the number 1 followed by a period. Errors are possible whenever numbers or extraneous marks precede drug orders. Avoid the temptation to number orders, even on preprinted order forms. We see no reason for it, but if orders must be numbered, each digit should be circled. In the past we've published cases where initials, letters, checkmarks, and other incidental marks used during ordering or transcription of handwritten orders can obscure or change how a medication order appears."

Celecoxib Linked to Increased Cardiovascular Risk

The cyclooxygenase (COX)-2 inhibitor celecoxib (Celebrex) more than doubled the risk of cardiovascular events in subjects enrolled in the Adenoma Prevention with Celecoxib (APC) study, Celebrex maker Pfizer Inc said today. The large randomized, double-blind, placebo-controlled, multicenter study was designed to investigate whether celecoxib could prevent colon cancer in people who had previously had colon polyps. Subjects who took celecoxib had 2.5 times as many fatal and nonfatal heart attacks as those who did not take the drug.

Exercising Before Mealtime May Improve Postprandial...

Exercising before a meal improves postprandial endothelial function, according to the results of a study published in the Dec. 21 issue of the Journal of the American College of Cardiology. 'Free-living humans spend the majority of their lives in the postprandial state, and the changes to metabolism seen during the hours after meal ingestion are likely to play an important role in the atherosclerotic disease process,' write Jason M.R. Gill, PhD, from the University of Glasgow and Glasgow Royal Infirmary in the U.K., and colleagues. 'There is now a large body of evidence indicating that a single session of moderate exercise can reduce subsequent postprandial lipemia by ~20% to 25%.'

AHA Updates Recommendations for BP Measurements

The American Heart Association has updated its 1993 recommendations for blood pressure measurements. The new guidelines that are published in the February issue of Hypertension emphasize out-of-office blood pressure readings, proper cuff size, and more. 'Since the last statement, there have been huge changes in the technology used to measure blood pressure and in our knowledge about the significance of different measurements,' lead author Thomas G. Pickering, MD, DPhil, from Columbia University Medical Center in New York, NY, says in a news release. 'We've found that blood pressure measurements taken by doctors in their offices may actually be unreliable in many patients. For that reason, there is wider acceptance of blood pressure readings taken by patients in their homes, and of 24-hour ambulatory blood pressure monitoring.

Mobile Phone Radiation Harms DNA, New Study Finds

Radio waves from mobile phones harm body cells and damage DNA in laboratory conditions, according to a new study majority-funded by the European Union, researchers said on Monday. The so-called Reflex study, conducted by 12 research groups in seven European countries, did not prove that mobile phones are a risk to health but concluded that more research is needed to see if effects can also be found outside a lab.

Moderate-Fat Diet Better Than Low-Fat at Improving CVD Risks

"A moderate-fat diet is better than a low-fat diet at improving cardiovascular disease risk factors, according to the results of a study published in the February issue of the American Journal of Clinical Nutrition."

Long-Term NSAIDs May Not Be Useful for Osteoarthritis

Nonsteroidal anti-inflammatory drugs (NSAIDs) offer only a small, short-term benefit that may not be clinically significant for people with knee osteoarthritis (OA), according to the results of a meta-analysis published in the Nov. 30 Online First issue of the BMJ. Due to the long-term harm and lack of demonstrated benefit, the investigators recommend against long-term use of NSAIDs for OA."

Elevated Alanine Aminotransferase Predicts Type 2 Diabetes

"Elevated Alanine Aminotransferase Predicts New-Onset Type 2 Diabetes Independently of Classical Risk Factors, Metabolic Syndrome, and C-Reactive Protein in the West of Scotland Coronary Prevention Study"

Moderate Alcohol Consumption Inversely Related to Coronary Calcification

"Drinking one or two alcoholic beverages per day is inversely associated with extensive coronary calcification in individuals without coronary heart disease, according to the results of a study published in the November 22nd issue of the Archives of Internal Medicine."

Diabetes in Midlife Linked to Dementia Three Decades Later

"People with diabetes mellitus in midlife are nearly three times more likely to develop dementia in old age than their counterparts without diabetes, according to a report in the November 23rd issue of Neurology."

Topiramate vs Placebo in Painful Diabetic Neuropathy: Analgesic and Metabolic Effects

Other anticonvulsants that are being used for the treatment of painful diabetic neuropathy -- valproic acid, carbamazepine, gabapentin, and vigabatrin, for example -- have been associated with weight gain and/or impaired glycemic control. This is in contrast to the topiramate experience in this study in which a large number of subjects experienced weight loss. Of note, however, approximately 1 of 4 patients in the topiramate group discontinued treatment because of an adverse event. This may, in part, reflect the target of 400 mg daily, a relatively high dose. As the study authors suggest, a lower target dose may provide comparable efficacy, may be better tolerated, and may thus improve the study-completion rate. They propose that titrating to a dose that provides adequate analgesia may be a better approach.

Unlike Rofecoxib, Celecoxib Not Linked to Increased Risk of MI

"Unlike rofecoxib, celecoxib does not appear to increase risk of myocardial infarction (MI), according to the results of a case-control study posted online Dec. 7 and published in the Feb. 1, 2005, print issue of the Annals of Internal Medicine."

Getting Sufficient Sleep May Help Reduce Weight Gain

"Sleep deprivation alters hormones and increases appetite, according to the results of a brief randomized study published in the Dec. 7 issue of the Annals of Internal Medicine. The editorialists suggest that getting enough sleep may help reduce weight gain."

Now I understand why I feel bloated after night duties!

Breast MRI Highly Sensitive, But Not Specific, for Breast Cancer

"Breast magnetic resonance imaging (MRI) has high sensitivity but not specificity for breast cancer, according to the results of a prospective trial published in the Dec. 8 issue of JAMA. The authors conclude that this test does not obviate the need for biopsy."

Premature Birth May Predispose to Insulin Resistance ...

"Premature birth, even with normal size for gestational age, may be a risk factor for insulin resistance developing in childhood, according to the results of a study published in the Nov. 18 issue of the New England Journal of Medicine."

Improved Outcome of Antihypertensive Therapy Associated With ...

Analysis of the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) study and substudy published in the Nov. 17 issue of JAMA showed that improved outcome of antihypertensive therapy was associated with reduction in left ventricular hypertrophy (LVH) either by electrical criteria or echocardiography. The editorialist suggests that while we are awaiting the definitive study, it may be appropriate to evaluate LVH during antihypertensive therapy."

High Selenium Linked to Lower Colorectal Adenoma Risk

"Higher blood levels of selenium are associated with lower rates of colorectal neoplasia, the results of a study in the November 17th issue of the Journal of the National Cancer Institute suggest."

High Selenium Linked to Lower Colorectal Adenoma Risk

"Higher blood levels of selenium are associated with lower rates of colorectal neoplasia, the results of a study in the November 17th issue of the Journal of the National Cancer Institute suggest."