Unintentional Discontinuation of Medications

Patients who are discharged from hospitals may be at risk for unintentional discontinuation of medications prescribed for chronic diseases. Treatment in the intensive care unit may place patients at an elevated risk since the focus is on acute care and there is the danger of incomplete communication as responsibility shifts from one physician to another.

The downstream effect of unintentional discontinuation of medications varies in severity according to the medication group. Discontinuing gastric acid suppressors may result in heartburn, but stopping an anticoagulant such as warfarin could increase the risk of stroke. Prescription errors may occur as medications for chronic diseases are not restarted when the acute episode resolves; patients may be without their medications for the remainder of their hospital stay and after discharge.

There are several important steps that physicians can take to improve patient safety and to minimize gaps in patient care. Hospitals are ‘graded’ on these efforts.  Discharge planning starts at hospital admission, but errors of omission are difficult to spot. It is important for patients (and their families) to play an active role in the transition between the hospital and the community. After hospitalization the list of medications should look very much like the list before hospitalization – if not, find out why a change was made. This is especially important in the case of elective surgery.

JAMA, 2011;306(8):840-847

Medical News from My Brother-In-Law

The Japanese eat very little fat and suffer fewer heart attacks than Americans.

The Mexicans eat a lot of fat and suffer fewer heart attacks than Americans.

The Chinese drink very little red wine and suffer fewer heart attacks than Americans.

The Italians drink a lot of red wine and suffer fewer heart attacks than Americans.

The Germans drink a lot of beer and eat lots of sausages and fats and suffer fewer heart attacks than Americans.

CONCLUSION:

 Eat and drink what you like. Speaking English is apparently what kills you.

Constipation and Heart Disease

In a large study of post-menopausal women, constipation was associated with all the major risk factors for cardiovascular events. However, constipation was not an independent risk factor nor was there a causal relationship with constipation and cardiovascular disease. The study, published in the American Journal of Medicine, was derived from a survey of more than 70,000 women in the Women’s Health Initiative.

Constipation was associated with increased age, African American and Hispanic descent, smoking, diabetes, high cholesterol, family history of myocardial infarction, hypertension, obesity, lower physical activity levels, lower fiber intake, and depression. Women with moderate and severe constipation experienced more cardiovascular events (14.2 and 19.1 events/1000 person-years, respectively) compared with women with no constipation (9.6/1000 person-years). After adjustment for demographics, risk factors, dietary factors, medications, frailty, and other psychological variables, constipation was no longer associated with an increased risk of cardiovascular events except for the severe constipation group, which had a 23% higher risk of cardiovascular events.

It is difficult to interpret this study. The degree of constipation was self-reported and limited to the previous four weeks. Was severe constipation a marker for poor health (or health habits) in general? Does severe constipation trigger some inflammatory event, leading to cardiovascular disease? Could there be intestinal bacterial overgrowth (there have been studies associating infections and coronary heart disease)? Because of the particular population studied, women who are postmenopausal, mostly white, and educated beyond high school, these results may not be generalizable to younger age groups and less educated women and men.

Amer J Medicine, 124:8; 714-723, August 2011

Colonoscopy for Dummies

It’s the life-saving procedure that is the butt (sorry) of every joke. Not only doctors, but truckdrivers, teachers and the corner bartender know the importance of colonoscopy in detecting cancer early enough to cure. Still, everyone seems to be dragging their feet and find way too many excuses to schedule one. There is an easy to read guide that will answer many questions, including the ones that patients think are too dumb to ask. Colonoscopy for Dummies is a FREE download.

Colon cancer is the second leading cause of cancer death in the United States, behind smoking-related lung cancer. Guidelines strongly recommend that people begin receiving colon cancer screenings upon reaching age 50, or earlier if they have a family history of the disease. The preparation for the test is the part that most worries patients: anticipation is far worse than the actual event. This and many other topics are covered in easy to understand language.

Colonoscopy for Dummies is available through collaboration between Salix Pharmaceuticals and the Colon Cancer Alliance.

The Latest Research

Low fat chocolate milk may do a better job of improving athletic performance than sports drinks, according to a study from the University of Texas, Austin. Sports drinks provide electrolyte-rich fluids and carbohydrates; low fat chocolate milk adds easily absorbed protein. In the study, athletes who drank low-fat chocolate milk after a difficult workout cycled faster and displayed more power than those who consumed beverages that were similar to typical sports drinks. This might be an important finding for athletes who train twice per day, but it is difficult to make a global recommendation. Lactose intolerance is wide spread, especially among people of color.

·      J Strength Cond Res 2011;25:1210-1224

Patients who take their statin (cholesterol-lowering) medications regularly have reduced out of pocket health care expenses and are less likely to be hospitalized for cardiovascular-related reasons. Patients on statins have higher drug costs but lower medical costs, resulting in lower total healthcare costs. The average cost saving over 18 months was $944; it can be inferred that the patient’s out of pocket savings was nearly $200.

·      Am J Cardiol 2011;107:1662-1666

Bone loss associated with breast cancer chemotherapy can be lessened by increasing Vitamin D levels and the magnitude of the bone-loss prevention correlates with the blood vitamin D levels. 

·      Poster presentation, American Society of Clinical Oncology Annual Meeting 2011