Imaging Tests Up Among Advanced Cancer Patients

HealthDay – 1 hr 50 mins ago TUESDAY, July 31 (HealthDay News) -- A new U.S. study finds that the use of diagnostic imaging tests in Medicare patients with advanced cancer has risen faster than among patients with early-stage cancer.

The costs of diagnostic imaging have increased more than the overall costs of cancer care, making diagnostic imaging the fastest-growing part of Medicare-reimbursed services, the researchers noted. Medicare is the U.S. government-funded health insurance program for people over 65 and certain other patients.

They added that cancer care costs are highest during the last year of life, but little is known about the use of high-cost imaging tests in cancer patients during their final year.

In this study, the researchers examined data on the use of CT, MRI, PET and nuclear medicine scans for Medicare patients with late-stage (stage 4) breast, colon, lung or prostate cancer between 1995 and 2006. Stage 4 cancer means the cancer has spread throughout the body.

The analysis revealed that most of the patients underwent imaging procedures during the course of their care, and that the use of imaging in late-stage cancer patients increased between 1995 and 2006.

The study was published July 30 in the Journal of the National Cancer Institute.

The increasing use of imaging in late-stage cancer patients may be due to a lack of guidelines in this area or the use of imaging to help doctors manage symptoms, detect disease progression and assess the effects of treatment, said Dr. Yue-Yung Hu and colleagues at the Dana-Farber Cancer Institute, Brigham and Women's Hospital, and the University of Wisconsin.

While imaging often leads to appropriate measures to ease dying patients' suffering, it can also distract them from focusing on achievable end-of-life goals, cause them to spend more of their remaining time in medical care settings, and provoke anxiety, the researchers said.

Determining the most appropriate care for patients with late-stage cancer is complex, Drs. Robin Yabroff and Joan Warren, of the Health Services and Economics Branch at the U.S. National Cancer Institute, noted in an accompanying editorial.

"Physicians tend to overestimate survival for terminally ill cancer patients, which may influence their treatment and related imaging recommendations," they wrote in a journal news release. "Development of practice guidelines for advanced imaging in patients with stage IV disease, with explicit statements about the state of evidence will be critical, particularly for care outside of the window surrounding patient diagnosis."

More information

The American Cancer Society offers advice for cancer patients nearing the end of life.

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Exercise, meds both help depressed heart patients

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2 Patients HIV-Free After Transplants

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By LIZA McCLELLAN, M.D.

Researchers at Brigham and Women’s Hospital in Boston have discovered that, following bone marrow transplants, two men no longer have detectable HIV in their blood cells.

The finding is significant because it suggests that by giving these patients transplants while they were on anti-retroviral therapy, they may have been cured of the AIDS-causing virus.

“We expected HIV to vanish from the patients’ plasma, but it is surprising that we can’t find any traces of HIV in their cells,” said Dr. Timothy Henrich, one of the researchers studying the two men. “It suggests that under the cover of anti-retroviral therapy, the cells that repopulated the patient’s immune system appear to be protected from becoming re-infected with HIV.”

The findings were presented Thursday at the AIDS 2012 conference in Washington, D.C. The story shares similarities with that of Timothy Ray Brown, also known as “the Berlin patient,” but there are important differences. While the cells used in Brown’s transplant procedure were specifically chosen from a donor who had a genetic mutation that resisted HIV, these patients received transplants with normal cells. Also, the two patients whose cases were presented at the meeting are still taking anti-retroviral medications normally used to treat HIV-positive patients, while Brown is no longer taking these medications.

Further study will need to be done to prove that the two patients are truly cured.

“Studies over time including biopsies of lymphatic tissue would be required,” said Dr. Michael Saag, an infectious disease expert from University of Alabama at Birmingham. He said only time will tell if these patients remain HIV-free.

While it appears from these cases, as well as that of the Berlin patient, that altering a patient’s immune system may lead to a “cure” for HIV, bone marrow transplants are currently too costly and dangerous for all HIV patients to be able to undergo them.

Separately, scientists are trying to use gene therapy to alter patients’ immune systems to free them of HIV.  Most of the research in this field is very preliminary, but scientists at the Fred Hutchinson Cancer Research Center are trying to perform stem cell transplants with cells that have been genetically modified to be resistant to HIV, much like the cells that the Berlin patient received.

“We have not yet transplanted any patient as part of our study,” said Dr. Hans-Peter Kiem of the Clinical Research Division at Fred Hutchinson Cancer Research Center and an attending transplant physician at Seattle Cancer Care Alliance. But Kiem and his research team have recently been awarded a research grant to further investigate stem cell transplantation as treatment as a means to find a cure for HIV.

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Half of heart patients don't stick to their meds

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Not All HIV Patients in U.S. Show Same Characteristics: Study

HealthDay – 1 hr 41 mins ago SUNDAY, July 22 (HealthDay News) -- Among people with HIV in the United States, those born outside the country are more likely than U.S.-born patients to be Hispanic or Asian and to have acquired HIV through heterosexual sex, a new study finds.

HIV is the virus that causes AIDS.

Language and cultural barriers can make it difficult for people born outside the United States to learn about HIV prevention, have access to HIV testing and to get timely medical care, the researchers noted.

They examined data from more than 191,000 people in 46 states and five U.S. territories who were diagnosed with HIV between 2007 and 2010. Of those people, 16.2 percent were born outside the United States.

The four states with the highest numbers of foreign-born people with HIV -- California, Florida, New York and Texas -- also had the highest number of HIV cases overall. Most of the newly diagnosed HIV patients were males -- 77.7 percent of U.S.-born patients and 73.5 percent of foreign-born patients.

Of the overall HIV diagnoses, foreign-born people accounted for: 3.3 percent of the more than 55,000 diagnoses in whites; 10 percent of the more than 86,000 diagnoses in blacks; 42.2 percent of the more than 42,000 diagnoses in Hispanics; and 64.3 percent of the nearly 2,000 diagnoses in Asians.

Heterosexual sex accounted for 39.4 percent of HIV diagnoses in foreign-born people and 27.2 percent of HIV diagnoses in U.S.-born people.

The most common regions of birth origin for foreign-born patients were Central America, including Mexico (41 percent); the Caribbean (21.5 percent); Africa (14.5 percent); Asia (7.9 percent); and South America (7.6 percent).

The data did not show whether foreign-born patients were infected with HIV before or after they arrived in the United States.

"These findings demonstrate the diversity of the HIV-infected population born outside the United States, presenting many clinical and public-health challenges," concluded H. Irene Hall, of the U.S. Centers for Disease Control and Prevention, and colleagues.

The study appears online in the Journal of the American Medical Association and was to be presented Sunday at the International AIDS Conference in Washington, D.C.

"This study and other studies suggest that

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All HIV Patients Should Take Meds Early On, Experts Now Say

HealthDay – 1 hr 41 mins ago MONDAY, July 23 (HealthDay News) -- A new report recommends that physicians begin treating all HIV-positive adults with antiretroviral drugs instead of waiting, at least in countries where the therapy is easily accessible.

All HIV-positive patients should take the drugs, even if blood tests reveal that their immune system is healthy, according to the revised guidelines, which were presented Sunday at the International AIDS Conference in Washington D.C., and published in the July 25 issue of the Journal of the American Medical Association.

Over the last 25 years, antiretroviral drugs have become stronger, easier to tolerate and simpler to take, the authors of the report explained. "New trial data and drug regimens that have become available in the last two years warrant an update to guidelines for antiretroviral therapy in HIV-infected adults in resource-rich settings," Dr. Melanie Thompson and her 2012 International Antiviral Society-USA Panel colleagues said in the report.

While medications don't rid the body of HIV -- the virus that causes AIDS -- they can prevent the virus from replicating and have allowed millions of people to live for years with a greatly reduced threat of developing AIDS, experts have noted.

However, not every person infected with HIV takes the medications. In some cases, doctors prefer to wait until a patient's immune system begins to show signs that the virus is becoming stronger.

The reasons why doctors sometimes wait to prescribe antiretroviral medications may be because the drugs can cause side effects, and there's also the challenge that patients must keep taking them or take the risk that the virus will rebound.

Commenting on the report, Rowena Johnston, director of research with the Foundation for AIDS Research in New York City, explained, "We can't lose sight of the fact that this is a big commitment. Once you start, you can't stop."

The report recommends that initial treatment include two nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine

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Not All HIV Patients in U.S. Show Same Characteristics: Study

HealthDay – 1 hr 41 mins ago SUNDAY, July 22 (HealthDay News) -- Among people with HIV in the United States, those born outside the country are more likely than U.S.-born patients to be Hispanic or Asian and to have acquired HIV through heterosexual sex, a new study finds.

HIV is the virus that causes AIDS.

Language and cultural barriers can make it difficult for people born outside the United States to learn about HIV prevention, have access to HIV testing and to get timely medical care, the researchers noted.

They examined data from more than 191,000 people in 46 states and five U.S. territories who were diagnosed with HIV between 2007 and 2010. Of those people, 16.2 percent were born outside the United States.

The four states with the highest numbers of foreign-born people with HIV -- California, Florida, New York and Texas -- also had the highest number of HIV cases overall. Most of the newly diagnosed HIV patients were males -- 77.7 percent of U.S.-born patients and 73.5 percent of foreign-born patients.

Of the overall HIV diagnoses, foreign-born people accounted for: 3.3 percent of the more than 55,000 diagnoses in whites; 10 percent of the more than 86,000 diagnoses in blacks; 42.2 percent of the more than 42,000 diagnoses in Hispanics; and 64.3 percent of the nearly 2,000 diagnoses in Asians.

Heterosexual sex accounted for 39.4 percent of HIV diagnoses in foreign-born people and 27.2 percent of HIV diagnoses in U.S.-born people.

The most common regions of birth origin for foreign-born patients were Central America, including Mexico (41 percent); the Caribbean (21.5 percent); Africa (14.5 percent); Asia (7.9 percent); and South America (7.6 percent).

The data did not show whether foreign-born patients were infected with HIV before or after they arrived in the United States.

"These findings demonstrate the diversity of the HIV-infected population born outside the United States, presenting many clinical and public-health challenges," concluded H. Irene Hall, of the U.S. Centers for Disease Control and Prevention, and colleagues.

The study appears online in the Journal of the American Medical Association and was to be presented Sunday at the International AIDS Conference in Washington, D.C.

"This study and other studies suggest that

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All HIV Patients Should Take Meds Early On, Experts Now Say

HealthDay – 1 hr 41 mins ago MONDAY, July 23 (HealthDay News) -- A new report recommends that physicians begin treating all HIV-positive adults with antiretroviral drugs instead of waiting, at least in countries where the therapy is easily accessible.

All HIV-positive patients should take the drugs, even if blood tests reveal that their immune system is healthy, according to the revised guidelines, which were presented Sunday at the International AIDS Conference in Washington D.C., and published in the July 25 issue of the Journal of the American Medical Association.

Over the last 25 years, antiretroviral drugs have become stronger, easier to tolerate and simpler to take, the authors of the report explained. "New trial data and drug regimens that have become available in the last two years warrant an update to guidelines for antiretroviral therapy in HIV-infected adults in resource-rich settings," Dr. Melanie Thompson and her 2012 International Antiviral Society-USA Panel colleagues said in the report.

While medications don't rid the body of HIV -- the virus that causes AIDS -- they can prevent the virus from replicating and have allowed millions of people to live for years with a greatly reduced threat of developing AIDS, experts have noted.

However, not every person infected with HIV takes the medications. In some cases, doctors prefer to wait until a patient's immune system begins to show signs that the virus is becoming stronger.

The reasons why doctors sometimes wait to prescribe antiretroviral medications may be because the drugs can cause side effects, and there's also the challenge that patients must keep taking them or take the risk that the virus will rebound.

Commenting on the report, Rowena Johnston, director of research with the Foundation for AIDS Research in New York City, explained, "We can't lose sight of the fact that this is a big commitment. Once you start, you can't stop."

The report recommends that initial treatment include two nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine

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Young Cancer Patients Often Lack Support: Study

HealthDay – 1 hr 40 mins ago MONDAY, July 23 (HealthDay News) -- Many teens and young adults diagnosed with cancer aren't receiving the social, psychological and informational support they require, new research suggests.

Cancer patients aged 14 to 39 have different needs and issues than younger and older patients, the researchers explained.

"When patients in this age group are diagnosed with cancer, they face issues -- premature confrontation with mortality, changes in physical appearance, disruptions in school or work, financial challenges and loss of reproductive capacity -- that can all be particularly distressing," study lead author Bradley Zebrack, associate professor of social work at the University of Michigan in Ann Arbor, said in a university news release.

"Whether it's mental health care, information for topics like infertility or other aspects of care like camps or retreat programs, this study shows that many of these patients aren't getting the care they need to address these unique challenges," he added.

Zebrack and colleagues surveyed 215 newly diagnosed teen and young adult cancer patients. Those in their 20s were much less likely than teens or patients in their 30s to use mental-health services and were more likely to report an unmet need for information about cancer, infertility and diet.

Young adults who were treated in adult, rather than pediatric, cancer facilities were more likely than teens who were treated in pediatric facilities to report an unmet need for age-appropriate websites, mental-health services, camp and retreat programs, transportation assistance and complementary and alternative health services.

The study was published online recently in the journal Cancer.

The lack of research involving teen and young adult cancer patients makes it difficult for health care providers to create age-appropriate services for them, Zebrack said. This study might help change that.

"Our research shows increasing patient referral to community-based social service agencies and reputable Internet resources can enhance the care and improve the quality of life for this group of patients," Zebrack said. "The more we know about their needs, the better support health care professionals will be able to provide."

More information

The U.S. National Cancer Institute has more about support for people with cancer.

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Doctors Tend to Share Patients With Similar Colleagues

HealthDay – Fri, Jul 20, 2012 FRIDAY, July 20 (HealthDay News) -- U.S. doctors tend to share patients with colleagues who have similar personal and practice styles, according to a new study.

The findings are from a Harvard Medical School study that looked at informal patient-sharing networks among doctors across the country. The researchers used 2006 data from nearly 4.6 million Medicare patients seen by more than 68,000 doctors in 51 urban and rural hospital referral regions.

The study was published in the July 18 issue of the Journal of the American Medical Association.

There was substantial variation between the doctors' informal sharing networks. The number of doctors included in a network ranged from 135 in Minot, N.D., to nearly 8,200 in Boston. The average number of other doctors each doctor was connected to per 100 Medicare patients was 27.3.

Doctors were far more likely to have connections with doctors based at the same hospital than those based at different hospitals. Connected doctors also were much more likely to be in close geographic proximity: The average distance for connected doctors was 13.1 miles, compared to 24 miles for unconnected doctors.

The researchers also found that patient characteristics such as race, age and health conditions were more similar among connected doctors than among unconnected doctors.

"It has long been known that physician behavior varies across geographic areas, yet our understanding of the factors that contribute to these geographic differences is incomplete," Dr. Bruce Landon, professor of health care policy at Harvard Medical School in Boston, said in a journal news release. "Our findings suggest that variation according to network attribute might help explain health-care variation across geographic areas, particularly given what is known about how networks function."

Strong connections among doctors -- as well as among doctors, nurses and administrators -- can create trust and shared values that improve health care for patients, Valerie Lewis and Dr. Elliott Fisher, both professors at Dartmouth University's Geisel School of Medicine in Hanover, N.H., wrote in an accompanying editorial.

More information

The American Academy of Family Physicians offers tips for choosing a family doctor.

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Many Medicaid Patients Skip Drugs That Could Prevent Heart Trouble

HealthDay – 1 hr 22 mins ago FRIDAY, July 20 (HealthDay News) -- Many Medicaid recipients with chronic health conditions that can lead to heart disease -- diabetes, high blood pressure and high cholesterol -- do not take their prescribed medications, a new study has found.

The researchers said failure to take medications leads to higher costs of care and an increased risk of hospitalization and even death.

They looked at 2008 and 2009 data from more than 150,000 Medicaid patients in New York City, aged 20 to 64, and found that only 63 percent of those with the three chronic conditions took their prescribed medications. Older patients and white and Asian patients were most likely to take their medications, while black and Hispanic patients were least likely.

"The outcome of this study is concerning, as it shows a large number of people with chronic conditions that lead to cardiovascular disease aren't taking prescribed medications, which could prevent a potential stroke or heart attack," lead author Dr. Kelly Kyanko, an instructor in the department of population health at the NYU Langone Medical Center, said in a center news release.

"We hope these findings will help local health authorities in the New York City area address this problem by creating programs to increase adherence rates, specifically in patient populations most at risk," Kyanko added.

The study was published online recently in the Journal of Urban Health.

"We believe that patients and their doctors can work to improve medication adherence through simple measures such as switching to once-a-day or combination pills, keeping a pill box and obtaining 90-day refills instead of 30-day refills for medications they take on a regular basis," Kyanko said.

High-risk patients may require more intensive interventions, such as working with a nurse or pharmacist to ensure they take their prescribed medications, she added.

Cardiovascular disease is the leading cause of death both in New York and in the United States, according to the release.

More information

The U.S. Centers for Disease Control and Prevention outlines ways to prevent heart disease.

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Colo. Dental Patients Advised to Get HIV Testing

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Sodium Buildup in Brain Linked to Disability in MS Patients

HealthDay – 2 hrs 1 min ago TUESDAY, July 17 (HealthDay News) -- Sodium buildup in the brain seems to be linked to disability in people with multiple sclerosis, researchers have found.

This accumulation of sodium could be an indicator of the degeneration of nerve cells that results from the disease, according to a team of European researchers. Although multiple sclerosis, or MS, symptoms vary from patient to patient, the study authors suggested that their findings may help predict the severity of disease progression and disability.

"A major challenge with multiple sclerosis is providing patients with a prognosis of disease progression. It's very hard to predict the course of the disease," Patrick Cozzone, director emeritus of the Center for Magnetic Resonance in Biology and Medicine, a joint unit of National Center for Scientific Research and Aix-Marseille University in Marseille, France, said in a news release from the Radiological Society of North America.

In conducting the study, the researchers used a specific type of imaging technology that provides information on the sodium content of cells in the body, known as 3 Tesla sodium MRI. The test was performed on 26 patients with relapsing-remitting MS, the most common form of the disease, in which flare-ups of symptoms are followed by periods of recovery.

Of the study's participants, 14 had early stage relapsing-remitting MS and 12 had advanced forms of the disease. The researchers also examined 15 healthy participants without MS that they matched for the patients' ages and genders.

"We collaborated for two years with chemists and physicists to develop techniques to perform

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Colo. Dental Patients Advised to Get HIV Testing

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Scientists Pinpoint Antibody That May Be Specific to MS Patients

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New Guidelines Issued for Biopsy Use in Melanoma Patients

HealthDay – 4 hrs ago MONDAY, July 9 (HealthDay News) -- Sentinel lymph node biopsy -- a minimally invasive surgical technique that lets doctors see whether cancer has spread -- should be performed on patients with melanoma tumors of intermediate thickness and may also be appropriate for thick melanoma tumors, according to new guidelines released Monday.

The American Society of Clinical Oncology (ASCO) and the Society for Surgical Oncology issued the evidence-based recommendations to clarify the use of this type of biopsy, which they said has been inconsistent.

A sentinel lymph node is the first lymph node to which cancer cells are most likely to spread from the original tumor, according to the U.S. National Cancer Institute. There can be more than one sentinel lymph node. During a biopsy, the node is identified, removed and examined for cancer cells.

"When used for the right patients at the right time, sentinel lymph node biopsy is one of our best tools for personalizing melanoma treatment, and for sparing patients from unnecessary procedures or therapies," study lead author Dr. Sandra Wong, co-chair of the guideline panel and an assistant professor of surgery at the University of Michigan, said in an ASCO news release.

The panel of 14 clinical and methodological experts from various disciplines reviewed 73 studies, involving 25,000 patients, that were published over the past two decades. After examining this evidence, the panel made the following recommendations:

The procedure is recommended for all patients with melanoma tumors between 1 millimeter (mm) and 4 mm (intermediate thickness). Sentinel lymph node biopsy detects cancer in the sentinel node in about 18 percent to 26 percent of these patients, the panel noted. Sentinel lymph node biopsy may be beneficial to patients with melanoma tumors greater than 4 mm ("thick"). The panel noted, however, that few studies focus on the use of the biopsy in patients with thick melanomas. The panel found there is not enough evidence to recommend routine sentinel lymph node biopsy for patients with melanoma tumors less than 1 mm ("thin"). The experts added that thin melanomas can usually be cured through surgical removal of the primary tumor. However, the biopsy could be considered in patients with thin melanoma who have certain high-risk factors, such as rapidly dividing cancer cells.

Patients with a positive sentinel lymph node biopsy should undergo complete removal of the remaining lymph nodes, the experts added. This procedure has been shown to prevent the spread of cancer.

The panel also advised doctors to discuss sentinel lymph node biopsy, particularly the procedure's potential risks and benefits, with their patients as part of the treatment-planning process.

"Our rapidly growing understanding of the biology of melanoma is driving development of more effective treatments with fewer side effects for patients," panel co-chair Dr. Gary Lyman, a professor of medicine and director of comparative effectiveness and outcomes research at Duke University School of Medicine and the Duke Cancer Institute, said in the news release.

"But to take advantage of this progress, we need to know the true extent of the disease from the start. This guideline will help ensure that sentinel lymph node biopsy is used appropriately whenever it can provide that vital information while avoiding unnecessary procedures in patients who are unlikely to benefit."

Information on the guidelines was published online by ASCO.

More information

The U.S. National Cancer Institute has more about melanoma.

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Stroke Patients Hospitalized on Weekends Don't Seem to Do As Well

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Parkinson's Patients Experience Declines Years Before Diagnosis

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Obesity, larger waist size associated with better outcomes in heart failure patients

ScienceDaily (July 3, 2012) — A slim waist and normal weight are usually associated with better health outcomes, but that's not always the case with heart failure patients, according to a new UCLA study.

See Also:Health & MedicineObesityHeart DiseaseCholesterolStroke PreventionDiseases and ConditionsDiet and Weight LossReferenceArtificial heartIschaemic heart diseaseRheumatic feverHypertension

Researchers found that in both men and women with advanced heart failure, obesity -- as indicated by a high body mass index (BMI) -- and a higher waist circumference were factors that put them at significantly less risk for adverse outcomes.

The study findings are published in the July 1 online issue of the American Journal of Cardiology.

Heart failure affects 5.8 million people, including 2.5 million women. Approximately one-half to two-thirds of heart failure patients are overweight or obese.

Women and men are known to have differences in body composition and body-fat distribution, and this study is one of the first to specifically assess the impact of BMI and waist circumference on women and compare it with men.

The findings also offer further insight into an observed phenomenon in chronic heart failure known as the "obesity paradox": Obesity is a known risk factor for developing heart disease and heart failure, but once heart failure has manifested, being overweight may provide some protective benefits.

"The study provides us with more insight about how both genders of heart failure patients may be impacted by the obesity paradox," said senior author Dr. Tamara Horwich, an assistant professor of cardiology at the David Geffen School of Medicine at UCLA. "Heart failure may prove to be one of the few health conditions where extra weight may prove to be protective."

For the study, researchers analyzed data on advanced heart failure patients treated at UCLA Medical Center from 1983 to 2011. The team assessed 2,718 patients who had their BMI measured at the beginning of heart failure treatment and 469 patients who had their waist circumference measured at the beginning of treatment.

Using standardized measures, the researchers identified men or women as having a high BMI if they were greater or equal to 25 kg/m² -- this included both overweight patients (25 to 29.9 kg/m²) and obese patients (30 kg/m² or greater).

For men, a high waist circumference was considered 40 inches (102 cm) or greater, and for women, 37 inches (88 cm) or greater. This assessment also included patients who were either overweight or obese.

At the two-year follow-up, researchers used statistical analysis and found that in men, a high waist circumference and high BMI were associated with event-free survival from adverse outcomes like death, the need for a heart transplant, or the need for ventricular assist device placement.

Women with a higher BMI also had better outcomes than their normal-weight counterparts, and women with a high waist circumference also trended toward improved outcomes.

Both men and women with a normal BMI and waist circumference were at a substantially higher risk for these adverse outcomes. In fact, a normal BMI was associated with significantly worse outcomes -- a 34 percent higher risk in men and a 38 percent higher risk in women -- than a high BMI.

Normal waist circumference was also associated with an increased risk of adverse outcomes in both genders, with men's risk doubling and women's risk tripling.

"We knew that obesity might provide a protective benefit for heart failure patients, but we didn't know whether this obesity paradox applied specifically to women with heart failure, as well as men -- and it does," Horwich said.

BMI measurement has been used for years as a surrogate measure of body fat. Since it measures all mass -- including lean muscle, which weighs more than fat -- the measurement may not be specific for total body fat. Waist circumference is a newer addition that may provide a more direct connection to body fat, since it measures the fat accumulated around the belly.

"The study also demonstrates how BMI and waist circumference can be used together to provide a more accurate measure of fat in the body to help determine obesity and assess risk," said the study's first author, Adrienne L. Clark, a resident in the department of medicine at the Geffen School of Medicine.

According to Horwich, no one knows exactly why the obesity paradox exists for heart failure patients, but there are several possible explanations.

Being underweight is traditionally associated with a poorer prognosis in heart failure patients. Obesity may be at the other end of the spectrum, and patients may thereby benefit from increased muscle mass, as well as metabolic reserves in the form of fatty tissue. In addition, increased levels of serum lipoproteins that are associated with increased body fat may play an anti-inflammatory role, neutralizing circulating toxins and inflammation-related proteins.

Obese patients also present at an earlier stage of heart failure due to increased symptoms and functional impairment caused by excess body weight, so they may be getting help sooner, which also could improve outcomes, the researchers said.

The next steps in research will include larger studies with longer follow-up times, as well as a closer look at the physiology behind the obesity paradox.

The study was funded by the National Heart, Lung and Blood Institute, part of the National Institutes of Health (grant 1K23HL085097).

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Half of all heart patients make medication errors

Reuters – 11 hrs ago NEW YORK (Reuters Health) - Half of all heart patients made at least one medication-related mistake after leaving the hospital, and guidance from a pharmacist didn't seem to reduce those errors, in a new study.

Consequences of mistakes - such as forgetting to take certain drugs or taking the wrong dose - can range from side effects like constipation to more serious drops in blood pressure. Two percent of errors were life-threatening.

Hospitals involved in the study were already taking steps to prevent medication mistakes in addition to the extra pharmacist intervention, said Dr. Sunil Kripalani, the study's lead author from the Vanderbilt University Medical Center in Nashville, Tennessee.

"We were surprised to see that in spite of these efforts that 50 percent (of patients) were still having these medication errors," he told Reuters Health.

Although the pharmacist visits didn't help the average patient, he added, certain ones seemed to benefit - such as patients who were on multiple drugs or had trouble understanding health information.

As for traditionally lower-risk patients, he said other strategies to prevent errors may be needed.

ONE-ON-ONE MEETINGS

For their study, Kripalani and his fellow researchers followed patients who had been hospitalized for heart conditions at Vanderbilt University Hospital and Brigham and Women's Hospital in Boston.

Half of the patients were randomly assigned to attend two visits with a pharmacist, who looked at which medications patients were taking and instructed them on what to do once they left the hospital to manage their prescriptions and reduce side effects.

The patients also received tools, such as a medication chart and pillbox, to use at home.

After leaving the hospital, the patients received a phone call within a few days from one of the study's coordinators who was able to identify medication-related problems over the phone. If any were found, a pharmacist made a follow-up call.

The other heart patients did not receive any special treatment outside of normal hospital procedure, which is for a nurse or doctor to spend a few minutes with patients before they leave the hospital to discuss their medications.

One month later, 432 out of the 851 patients had made at least one harmful or potentially-harmful medication error, including missing doses, taking the incorrect dose, stopping a drug too early or continuing it for too long.

Just under one-quarter of those errors were judged to be serious and about two percent were life-threatening. And there was no difference in the number of errors made by patients who did or didn't get extra pharmacist advice.

One limitation, the researchers note in their Annals of Internal Medicine report, is that not all patients in the intervention group had two pharmacist visits or a follow-up call as intended. It's also unclear whether the findings would apply to patients being treated for other, non-heart conditions.

KEEP A LIST

Kevin Boesen, director of the Medication Management Center at the University of Arizona College of Pharmacy in Tucson, told Reuters Health he's not surprised that many people are confused after leaving the hospital.

"To me, I think (the finding) highlights the challenge for the transition from hospital to home," he said.

Boesen added that it's important for patients to meet with their regular pharmacist and primary care doctor after they get out of the hospital or fill a prescription somewhere else.

"I think there is the assumption that when a patient goes to a pharmacy the pharmacist will have a list of all the medication they're on," he said. But that's not always the case.

A key safety step patients can take, Boesen and Kripalani agreed, is to keep track of all of the drugs they're taking and carry a list.

"The single most important thing patients and families can do to promote safety with their medications is to always keep a medication list with them," Kripalani said. That list should include drug doses and patients' reason for taking each medication, he added.

"If a patient simply carries that medication list, so everyone is working off of one list, that definitely helps," said Boesen.

SOURCE: http://bit.ly/P65Kp7 Annals of Internal Medicine, online July 2, 2012.

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