News News News
STAPHYLOCOCCUS BECOMES MORE DANGEROUS
Methicillin resistant staphylococcus aureus (MRSA) has become more invasive, infecting the muscles, joints, and internal organs of otherwise healthy children, according to two reports at the 2008 annual meeting of the Pediatric Orthopaedic Society of North America.
Aggressive treatment with long-term antibiotics as well as surgical drainage is necessary to treat these patients, who acquired the infections in the community and not within a hospital.
Already dangerously resistant to many antibiotics, this new invasive form is potentially even more deadly. Physicians will need to begin considering this potentially fatal infection whenever a child develops muscle or joint pain with other signs of a bacterial infection. (Family Practice News June 1, 2008, page 1)
ACUPUNCTURE & HEADACHE
In a randomized, controlled trial, 74 patients with chronic daily headache were assigned to receive either medical management alone (headache medication) or medical management plus acupuncture (10 treatments over six weeks).
The patients receiving acupuncture reported 3.7 times less suffering due to headaches at six weeks, and showed improvements in the Headache Impact Test and mental state, along with reduced limitation of daily activities and social functioning. The “medication only” group showed no improvement in any of the measures studied. (Headache 2005;45:1113-1123)
ACUPUNCTURE & MIGRAINE
Acupuncture (up to 15 sessions over 12 weeks) was compared with metoprolol (a standard migraine prophylaxis medication) for effectiveness and tolerability in 113 patients randomized to one of two groups.
The number of days with migraine decreased by 2.5 days in the acupuncture group compared to 2.2 in the medication group and those experiencing 50% or greater reduction in attacks was 61% for acupuncture and 49% for medication. Severe adverse effects occurred only in the medication group. (12th Annual Symposium on Complementary Health Care, 19-21 September 2005, Exeter, UK)
ACUPUNCTURE & LOWER BACK PAIN
An analysis of Canadian patients who had self-referred to acupuncturists for treatment for low back pain (LBP), found that they made significantly fewer visits to their physician for LBP care in the year following treatment (1.55 versus 4.45 in 1999, 1.41 versus 7.17 in 2000 and .86 versus 4.04 in 2001) compared to LBP sufferers who had not received acupuncture.
They consequently required significantly less physician expenditure (around 25% of the cost of LBP care in the general population). (12th Annual Symposium on Complementary Health Care, 19-21 September 2005, Exeter, UK)
ACUPUNCTURE & THE GASTRIC SPHINCTER
Inappropriate relaxation of the muscular lower esophageal sphincter (LES) is associated with gastric reflux and heartburn.
Now a study has shown that electrical non-needle stimulation of Neiguan P-6 can reduce the rate of LES relaxation by 40%. Fourteen healthy (no heartburn) volunteers were treated either at Neiguan P-6 or a sham point on the hip.
A separate study ruled out endorphins or enkephalins as the mechanism of action of the point stimulation by giving the volunteers naloxone, which blocks the effect of these chemicals. (Am J Physiol Gastrointest Liver Physiol, 2005; 289: G197-G201)
SOIL BACTERIA CAN GROW ON A DIET OF ANTIBIOTICS
While hunting for soil bacteria that can turn plant waste to biofuels, a team of microbiologists from Harvard University, Boston, Massachusetts, decided to grow soil samples in pure antibiotics as a control.
Surprisingly, they found that all the soil samples contained bacteria that can survive on antibiotics, and many subsisted on multiple drugs. Although these strains are not normally pathogens, the soil bacteria could pass the genes for antibiotic resistance and metabolism into bacteria that do cause human disease. (Science (DOI: 10.1126/science.1155157)
CAUTION WITH PROBIOTICS
In a study of 298 patients with increased future risk of pancreatitis, a mixture of six probiotic bacteria was administered to the treatment group to see if it would reduce this risk. The probiotics showed no benefit and increased the risk of death by 2 ½ times.
The probiotic group also developed 9 cases of bowel ischemia which were 89% fatal, whereas there was no ischemia in the placebo group. Widely considered to be beneficial, administration of probiotic bacteria may require further study. In pediatric studies, increased levels of asthma, allergic symptoms and bronchitis were found in groups given probiotics when compared with placebo. (Family Practice News, June 15, 2008, p. 25)
EMERGENCY ASTHMA TREATMENT DAMAGES HEART
Inhaled Albuterol is often used to treat acute asthma in children, but nearly half of 50 children who received this treatment at Children’s Hospital of Pittsburgh had signs of heart muscle damage as a result, and two thirds developed low blood pressure, which may also indicate cardiovascular dysfunction.
None of these children had a history of cardiac disease. Extra caution is necessary to monitor children who receive this treatment, suggested Dr. Daniel Fagbuyi, a fellow in pediatric emergency medicine, who reported these results. (Family Practice News June 1, 2008, page 6)
ACUPUNCTURE PROMISING FOR GALLBLADDER DYSKINESIA
Biliary dyskinesia presents with biliary pain, absence of gallstones and delayed emptying of the gallbladder and is usually treated by cholecystectomy (surgical removal of the gallbladder).
In a small study, ten children (mean age 16 years) with dyskinesia were treated with acupuncture (mean five treatments), mostly at points Taichong LIV-3 and Yanglingquan GB-34 (for Liver qi stagnation), Sanyinjiao SP-6, Zusanli ST-36, Gongsun SP-4, Taibai SP-3 and Zhongwan REN-12 (for Stomach and Spleen deficiency), Zhongwan REN-12, Liangmen ST-21 and Yinlingquan SP-9 (for stagnation of qi, damp and food), and Neiguan P-6, Zusanli ST-36, Xiawan REN-10 and Shangwan REN-13 (for rebellion of Stomach qi).
All ten patients improved significantly after two treatments and were symptom-free within 4-7 treatments. At two years follow-up, eight were symptom free and none required surgery. (Medical Acupuncture 2005; 16(3)
EAR ACUPUNCTURE & HIP PAIN
A study which compared auricular press needles inserted at specific points for hip pain (hip joint, lung, Shenmen, thalamus) with similar needles inserted in auricular non-points, in 61 patients one day before and for three days after total hip arthroplasty surgery, found that the true points group used 32% less analgesics than the non-point group. (Pain 2005; 114: 320-7)
NEW GUIDELINES FOR INFERTILITY IN THOSE OVER 35
The American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility have revised their guidelines to suggest that a workup is recommended for women over 35 who have not become pregnant after 6 months of trying. The past recommendation was that evaluation should only be done after 12 months. The earlier evaluations may result in more findings of no abnormalities, “but at least women will be reassured that they aren’t wasting their time if they are told to spend another 6 months trying to conceive”, states Dr. Surrey, medical director of the Colorado Center for Reproductive Medicine. (Family Practice News June 1, 2008, page 22)
Ed. note: Another consequence will be the increased number of tests ordered, some of which may involve risk. Presumably, more women will also be encouraged to pursue hormonal and surgical “fertility” treatments. These procedures have the potential to increase a woman’s reproductive age by exhausting the supply of eggs. This should be discussed with patients before “fertility” treatments begin.
ACUPRESSURE COUNTERS SLEEPINESS
In this interesting study, students were taught to apply acupressure (tapping and massaging) to either five stimulating points or five relaxing points (without knowing the intended effects of the different points).
The students were randomly assigned to one of two groups. The first were taught to apply acupressure to the stimulation points on day one, and to the relaxing points on days two and three, and the second group followed a relaxing, stimulation, stimulation pattern.
Levels of sleepiness were assessed each afternoon. After accounting for other factors such as caffeine consumption and amount of sleep the previous night, it was found that the stimulation points had a significantly greater effect on reducing sleepiness than the relaxing points. (J Altern & Complem Medicine 2005, 11 (4): 673-679)
ACUPRESSURE ALLEVIATES PARENTAL ANXIETY
Parents understandably suffer anxiety before their children’s surgery, and a new study has determined that acupressure can alleviate it. Sixty-one parents were randomly assigned to receive acupressure at either Yintang (M-HN-3) or a sham point in the preoperative holding area before their children's surgery. The parents treated at Yintang reported significantly less anxiety at 20 minutes post-intervention as compared with parents in the sham group. (Anesth Analg. 2005; 101(3) :666-9)
ACUPRESSURE & DYSMENORRHEA
In a study which compared acupressure at Sanyinjiao SP-6 with simple resting for female technical college students in Taiwan suffering from dysmenorrhea, the acupressure – whether in the form of treatment or self-treatment – was found to significantly reduce pain. (J Adv Nurs. 2004 Nov; 48(4):380-7)
SHIATSU HELPS POST-TERM LABOR
Pregnant post-term women who were taught shiatsu techniques by a midwife were significantly more likely to go into labor spontaneously compared to women who did not learn the technique. (Complement Ther Med 2005; 13: 11-15).
CHINESE MEDICINE FOR TEMPEROMANDIBULAR JOINT PROBLEMS
Chinese medicine (TCM) was demonstrated to be significantly more effective for temperomandibular joint disorders than specialty care (SC) in a study of 110 women randomized to receive one or the other.
TCM consisted of individualized acupuncture, herbs, tuina and relaxation (20 visits over four months). SC consisted of bite splint, education, massage and pharmacotherapy. Patients improved in both groups, with the TCM group showing more rapid improvement and significantly greater improvement in worst pain at six months, as well as greater improvements in general health. (12th Annual Symposium on Complementary Health Care, 19-21 September 2005, Exeter, UK).
"What Were They Thinking?" Department
CALL ME....DOCTOR NURSE
The National Board of Medical Examiners has validated a new certification for a Doctor of Nursing Practice, or “DNP”. The first exam will be offered in the Fall of 2008. According to a report in the June 16th, 2008 American Medical News, nursing educators who award the DNP degree propose that graduates are “comparable with primary care physicians in their diagnostic and disease management skills.”
Predictably, physician organizations are intimidated. The AMA house of delegates is considering a resolution to “endorse policy that the title ‘doctor’ be used only by licensed physicians, dentists and podiatrists in a medical setting”.
Ignoring the issue for the moment of how doctors of nursing and medical doctors compare in practice: The cultural climate has changed in America, and it is clear that the medical system has a place in mind for the 2000 DNPs graduating each year. And we know that when the fat cats of the medical system decide what they want, they usually get it.
What is really more interesting to consider is why the profession of medicine has allowed itself to become so out of touch with reality that so many alternative training models and practitioners have become equally palatable to the fat-cat palate, as well as to the public at large.
Clinical pharmacists, nurse anesthetists, nurse practitioners, nurse midwives, optometrists, chiropractors, naturopaths, acupuncturists, psychologists, clinical social workers and others have all successfully moved into the territories once exclusively claimed by physicians. Performing surgery and prescribing drugs, and even practicing primary and secondary care is well established by fact and by statute for many of these professionals.
Could it be that modern physicians have squandered all of the good will generated by their predecessors in providing personalized medical care, creating lasting relationships in the days before employers or insurance companies forced patients to change physicians every few years?
Is it possible that all the propaganda that high technology medical centers and drug companies create to flood the airwaves and print media have convinced everyone that given the most expensive and advanced technology and drugs, that doctors are pretty much a commodity item and one is just the same as another?
Another possible factor is that the antiquated and irrelevant training methods and subjects that remain central to medical education have led doctors to lose touch with the important clinical skills required in 21st century practice. In contrast, nursing and some alternative systems emphasize teaching problem-solving skills and hands-on practical attitudes that patients need and appreciate.
For example, the premedical requirements that all medical schools require, are, in practice, only obtainable at expensive colleges and universities. Who would take these courses if they weren’t required? Do future doctors really need to go into debt to pay the exorbitant tuition charged at most universities to prepare for medical school?
More importantly, much of this course material is only distantly related to what is useful to medical students and physicians, and yet pre-medical requirements have not changed significantly since I applied to medical school more than thirty years ago.
Two semesters of calculus were required for me at Brown.
There is no doubt that competence with algebra is of great importance to physicians. Every physician should be able to calculate drug dosages for both intravenous and intramuscular administration as well as understand how to solve clinically relevant equations. However, throughout medical school and 27 years of practicing medicine, I have never found it necessary to understand or utilize the skills from that year of calculus.
I'm quite certain that out of a hundred clinically oriented physicians who have actually practiced medicine for 10 years or more, to find even one who needed to know any more calculus that could be taught in an hour would be remarkable.
So it is also with the 2 years of inorganic and organic chemistry that I studied. A year of physics was also a waste of time, as were the usual biology courses that undergraduates “need” for their pre medical requirements. All of these requirements could be effectively condensed into two semesters of a “medical science” curriculum where the emphasis would be exclusively on clinically relevant principles and exercises.
This would free up a lot of teaching time to investigate subjects of real value to would-be physicians. Courses in cooking, trans cultural medical practices, foreign languages, basic accounting or business skills, meditational practice, ethics, or communication skills would all be much more useful to undergraduates than the present fossilized curriculum.
At a time when “evidence based” standards for medical practice are all the rage, it is interesting that our system of medical education has never been subjected to any results-based tests of effectiveness. The arbitrary and elitist requirements established for students of medicine, as well as the high financial cost, are barriers to study, dissuading many excellent candidates from pursuing a medical degree.
Others have perceived this void and have jumped in to establish themselves as viable alternatives to physicians, with a resulting division of health care into dozens of different degree and certification programs.
But, don’t expect a revolution in thinking from medical educators. They are much more interested in teaching outdated theories and creating a passive workforce of technicians than providing students with healthy habits of independent thinking and problem solving skills.
Presently, even physicians in different specialties cannot coordinate care effectively with each other: Introducing new hierarchies and territorial rivalries are unlikely to improve our presently dysfunctional system.