Stopping statins may benefit terminally ill patients
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People in the late stages of cancer and other terminal illnesses are not only unharmed by discontinuing statins for cholesterol management, they may benefit, according to a study presented Friday by researchers at Duke Medicine representing a national research network.
The finding addresses a thorny question in treating people with life-limiting illnesses: When, if ever, is it appropriate to discontinue medications prescribed for other conditions that will likely not lead to their death?
In an analysis presented at the American Society of Clinical Oncology annual meeting in Chicago, the researchers reported that discontinuing statins in patients with advanced illnesses resulted in improved overall quality of life, lower costs and no increased deaths. In fact, the patients who stopped taking statins appeared to live slightly longer.
“When you look at the number of medications people take when they are dying, it doubles in the last year of life,” said lead author Amy Abernethy, M.D., Ph.D., director of the Center for Learning Health Care at the Duke Clinical Research Institute and a member of the Duke Cancer Institute. Abernethy represented the Palliative Care Research Cooperative Group, a national research network focused on improving care for people with serious illnesses.
Scientists discover potential new target for cancer immunotherapy
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Scientists have found a way to target elusive cells that suppress immune response, depleting them with peptides that spare other important cells and shrink tumors in preclinical experiments, according to a paper published online by Nature Medicine.
“We’ve known about these cells blocking immune response for a decade, but haven’t been able to shut them down for lack of an identified target,” said the paper’s senior author, Larry Kwak, M.D., Ph.D., chair of Lymphoma/Myeloma and director of the Center for Cancer Immunology Research at The University of Texas MD Anderson Cancer Center.
The cells, called myeloid-derived suppressor cells (MDSCs), are found abundantly in the microenvironment around tumors. Created with other blood cells in the bone marrow, they interfere with activation and proliferation of T cells, the immune system’s attack cells. MDSCs have been shown in mouse models to accelerate cancer progression and metastasis.
“This is the first demonstration of a molecule on these cells that allows us to make an antibody, in this case a peptide, to bind to them and get rid of them,” Kwak said. “It’s a brand new immunotherapy target.”
To curb hepatitis C, test and treat inmates
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Problematic as it is for society, the high incarceration rate in the United States presents an important public health opportunity, according to a new “Perspective” article in the New England Journal of Medicine. It could make staving off the worst of the oncoming hepatitis C epidemic considerably easier.
Nearly 4 million Americans may be infected with the hepatitis C virus (HCV). Many of them don’t know they carry HCV, which can take decades to make them ill with cirrhosis, cancer, or liver failure. About a million people could die because of HCV by 2060, the authors wrote, and many who are saved will have required critical and costly treatments, including liver transplants.
“We know this is going to come crashing down on us,” said lead author Dr. Josiah D. Rich, professor of medicine and epidemiology at Brown University and director of the Center for Prisoner Health and Human Rights at The Miriam Hospital. “It’s already starting to come crashing down. The next 10 to 20 years are going to be ugly.”
The single best setting for fighting the epidemic is U.S. prisons and jails, where more than 10 million people cycle through each year. In part because a major means of HCV transmission is through injection drug use, a large portion of the nation’s infected population passes through the criminal justice system. In the journal, for example, Rich and his coauthors estimate that one in six inmates is infected and one in three infected Americans ends up locked up for at least a little time in their lives.
Study finds hazardous flame retardants in preschools
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A new study of preschools and day care centers finds that flame retardants are prevalent indoors, potentially exposing young children to chemicals known to be hazardous.
The study, to appear online Thursday, May 15, in the journal Chemosphere, was led by researchers at the University of California, Berkeley, and funded by the California Air Resources Board. Although many infants and young children spend up to 50 hours per week in day care, the study authors noted that this paper represents the first systematic review of flame retardants in early child care settings.
The researchers covered 40 child care centers serving 1,764 children in Monterey and Alameda counties. The facilities were located in a mix of urban, rural and agricultural areas. The researchers collected air and floor dust samples when the children were present, and tested for 14 different PBDEs, or polybrominated diphenyl ethers, and four non-PBDE flame retardants, including tris phosphate compounds.
The study found both PBDEs and tris phosphate compounds in 100 percent of the dust samples collected. Median levels of PBDEs were somewhat lower than those found in homes in other studies, but median levels of chlorinated tris were similar to or higher than household levels found in other studies.
Access to electronic health records may influence care
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Unlike medical records kept in paper charts, electronic health records (EHR) provide numerous access points to clinicians to review a patient’s medical history. A new study has found access to electronic health records in acute care situations may influence the care given to that patient, and in some cases, failure to review the EHR could have adversely affected the medical management. The findings are reported in the May 2014 edition http://content.healthaffairs.org/content/33/5/800.abstract of Health Affairs. John L. Ulmer, M.D., professor of radiology and chief of neuroradiology at the Medical College of Wisconsin (MCW), is the corresponding author. Co-authors are Michael J. Franczak and Madeline Klein, former research assistants at MCW; Flavius Raslau, M.D., assistant professor of radiology at the University of Kentucky College of Medicine; Jo Bergholte, program manager at MCW; and Leighton P. Mark, professor of radiology at MCW.
In the study, three neuroradiologists at Froedtert & the Medical College Froedtert Hospital analyzed 2,000 head CT scans that had been ordered by emergency department physicians. For each exam, the neuroradiologists compared the medical information generated by the emergency department physicians to the additional information retrieved by interpreting radiologists who had access to EHR patient data.
The interpreting radiologists found that in many of the cases, the additional data in the EHR would have a significant impact on the interpretations of the head CT scans.
