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Health Care Information Committee Dr. Jeff Wilson, Dr. Lucille Vega, Dr. Gregory Steinmetz November 2008 Encouraging news for patients who take NSAIDs for chronic pain and who have had an episode of a bleeding ulcer - two separate studies suggest that recurrent bleeding episodes can be limited. Both studies, the first from Hong Kong and the second from Canada (reported in Gastroenterology and Lancet respectively), support the notion that patients taking celecoxib and a PPI did better over time than patients taking a non-selective NSAID alone, an NSAID with a PPI or a COX-2 alone. Family Practice News, Oct 15, 2008. Ginkgo biloba did not perform well in a randomized controlled trial to study effects on the development of dementia. The randomized, double blind, placebo controlled trial included 3,069 volunteers aged 75 and older. Mean follow up was 6.1 years, and participants were evaluated for dementia by an expert panel. Rates of diagnosed dementia were similar for both groups. JAMA, November 19, 2008 – Vol. 300, No. 19 pg. 2253-2262. Sports supplements are big business and are used by all levels of athletes. A recent review article from American Family Physician details the most common supplements and discusses reported benefits, adverse effects and the NCAA and IOC positions on the substances. Among those listed is caffeine, which is a banned substance - but only above the level of 12 mcg/ml for Olympic competition and 15 mcg/ml in collegiate athletic events. AFP, November 1, 2008. advising newly diagnosed type II diabetic patients NOT to check their sugars daily. A randomized-control trial of 184 patients with newly
diagnosed diabetes failed to show a significant improvement in A1C in
patients who checked their own finger stick glucose compared to those who
did not. The initially prescribed study medication was metformin, so
hypoglycemia was not a concern in the majority of patients; only 17 patients
in the study took a sulfonylurea. The patients who self-monitored were more
, on average, scoring 6% higher on a depression scale. The concern
is that depression and discouragement may lead to noncompliance. This study
does not include patients who take insulin, for whom monitoring is
recommended. Use clinical judgment when deciding whether or not to
recommend glucose self-monitoring. O’Kane MJ, et al. BMJ. 2008; 336:1174-1177. facts about smoking tobacco that you may want to discuss with your patients: a. On average, male smokers lose 13.2 years of life expectancy, and female b. Nearly one in 5 deaths is at least partially attributable to smoking, which c. Tobacco use has been associated with the following cancers: Lung and bronchus (87% of cases attributable to tobacco use), larynx, esophagus, stomach, pancreas, kidney and renal pelvis, urinary bladder, cervix, and AML. d. Tobacco use appears to have no effect on blood pressure. e. One study compared the quit rates at 52 weeks after initiation of a 3- month program including Chantix, Zyban, and placebo. At 52 weeks, the quit rates were 29% for Chantix, 23% for Zyban, and 15% for placebo. Source: NEJM 359:19, MMWR September 2008.


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