I had the pleasure of listening to a talk on utilizing online resources and social media such as blogs, wikis, Facebook and Twitter for educating medical students and residents yesterday by Dr. Kenar Jhaveri, the founder of Nephron Power.
Online resources are indeed playing an increasing role in educating future doctors in the US and abroad. However, it is imperative that physicans take appropriate precautions while utlizing these resources to maintain confidentiality, honesty, and trust in the medical profession. Drs. Arash Mostaghimi, MD, MPA and Bradley H. Crotty, MD, recently published an excellent article in Annals of Internal Medicine which puts forth guideline for maintaining professionalism in the digital age. among other things they recommend a "dual citizenship" approach of separating the personal and professional persona and taking a pro-active approach to managing one's online presence. I highly recommend reading this article.
Ref: Arash Mostaghimi, MD, MPA, and Bradley H. Crotty, MD.Professionalism in the Digital Age. Ann Intern Med. 2011;154:560-562.
Tuesday, April 26, 2011
Tuesday, April 12, 2011
Diuretic Strategies in Patients with Acute Decompensated Heart Failure.
In a prospective, double-blind, randomized trial, 308 patients with acute decompensated heart failure were assigned to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2.5 times the previous oral dose). The protocol allowed specified dose adjustmen
ts after 48 hours. The coprimary end points were patients' global assessment of symptoms, quantified as the area under the curve (AUC) of the score on a visual-analogue scale over the course of 72 hours, and the change in the serum creatinine level from baseline to 72 hours.
In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms (mean AUC, 4236±1440 and 4373±1404, respectively; P=0.47) or in the mean change in the creatinine level (0.05±0.3 mg per deciliter [4.4±26.5 μmol per liter] and 0.07±0.3 mg per deciliter [6.2±26.5 μmol per liter], respectively; P=0.45). In the comparison of the high-dose strategy with the low-dose strategy, there was a nonsignificant trend toward greater improvement in patients' global assessment of symptoms in the high-dose group (mean AUC, 4430±1401 vs. 4171±1436; P=0.06). There was no significant difference between these groups in the mean change in the creatinine level (0.08±0.3 mg per deciliter [7.1±26.5 μmol per liter] with the high-dose strategy and 0.04±0.3 mg per deciliter [3.5±26.5 μmol per liter] with the low-dose strategy, P=0.21). The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function.
Reference: Felker Gm at al. N Engl J Med. 2011 Mar 3;364(9):797-805.
ts after 48 hours. The coprimary end points were patients' global assessment of symptoms, quantified as the area under the curve (AUC) of the score on a visual-analogue scale over the course of 72 hours, and the change in the serum creatinine level from baseline to 72 hours.
In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms (mean AUC, 4236±1440 and 4373±1404, respectively; P=0.47) or in the mean change in the creatinine level (0.05±0.3 mg per deciliter [4.4±26.5 μmol per liter] and 0.07±0.3 mg per deciliter [6.2±26.5 μmol per liter], respectively; P=0.45). In the comparison of the high-dose strategy with the low-dose strategy, there was a nonsignificant trend toward greater improvement in patients' global assessment of symptoms in the high-dose group (mean AUC, 4430±1401 vs. 4171±1436; P=0.06). There was no significant difference between these groups in the mean change in the creatinine level (0.08±0.3 mg per deciliter [7.1±26.5 μmol per liter] with the high-dose strategy and 0.04±0.3 mg per deciliter [3.5±26.5 μmol per liter] with the low-dose strategy, P=0.21). The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function.
Reference: Felker Gm at al. N Engl J Med. 2011 Mar 3;364(9):797-805.
Friday, April 1, 2011
Rituxan in ANCA-associated vasculitis
Wegener’s granulomatosis and microscopic polyangiitis are classified as antineutrophil cytoplasmic antibody (ANCA)−associated vasculitides as most patients have antibodies against proteinase 3 or myeloperoxidase.The ANCA-associated vasculitides affect small-to-medium-size blood vessels, with a predilection for the respiratory tract and kidneys. Without treatment mortality is very high and mostly the norm.
Cyclophosphamide and glucocorticoids have been the standard therapy for remission induction for decades. While this treatment is effective in controlling the disease and inducing temporary remission in a majority of the patients, the side effects of cyclophosphamide (leucopenia, infertility, bladder cancer) are very severe and limiting. And, a search for a suitable alternative to cyclophosphamide for inducing disease remission in these patients with fewer side effects is ongoing.
In the following slides I have summarized two landmark studies that evaluated Rituxan in ANCA associated vasculitis as an alternative to cyclophosphamide:
Cyclophosphamide and glucocorticoids have been the standard therapy for remission induction for decades. While this treatment is effective in controlling the disease and inducing temporary remission in a majority of the patients, the side effects of cyclophosphamide (leucopenia, infertility, bladder cancer) are very severe and limiting. And, a search for a suitable alternative to cyclophosphamide for inducing disease remission in these patients with fewer side effects is ongoing.
In the following slides I have summarized two landmark studies that evaluated Rituxan in ANCA associated vasculitis as an alternative to cyclophosphamide:
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