Hospital cuts over neighbour debt

30 January 2013 Last updated at 20:33 ET

Protesters marching past Lewisham hospitalAt least 15,000 people marched in protest against proposals on Saturday

A decision is expected later on plans to close the Accident and Emergency department at Lewisham Hospital in south-east London and downgrade its maternity unit.

The proposal came after neighbouring South London Healthcare NHS Trust (SLHT) ran up debts of £150m.

Health Secretary Jeremy Hunt is expected to announce whether an “urgent care” ward will replace the A&E.

At least 15,000 people marched in protest on Saturday.

‘Dangerous precedent’

SLHT, which runs three hospitals, was placed in administration last year when it started losing about £1.3m a week.

Under the plans, the trust’s Queen Elizabeth Hospital site in Woolwich would come together with Lewisham Healthcare NHS Trust to create a new organisation.

Lewisham’s A&E unit would then be downgraded to an urgent care centre, meaning emergency cases would be seen at nearby hospitals. The maternity unit at Lewisham could also be slimmed down, with complex cases being dealt with elsewhere.

Shadow health secretary Andy Burnham said closing the A&E of a successful trust would set a “dangerous precedent”.

The closures are part of a radical overhaul proposed by special administrator, Matthew Kershaw, in response to SLHT going into administration.

The reorganisation proposed is intended to save around £42m from the payroll budget.

If implemented fully, Mr Kershaw said his recommendations would result in a radical overhaul of services in south London, and help deliver “safe, high-quality, affordable and sustainable services.”

The government has said “doing nothing is not an option”.


Visit the Source Site

Many A&Es 'not sharing crime data'

30 January 2013 Last updated at 23:59 ET

By Branwen Jeffreys Health correspondent, BBC News

Man in a hoodie holding a knifeSimilar schemes have seen a fall in incidents of violent crime

A coalition pledge to make hospitals share violent crime data with police is being carried out in only a third of areas in England, an audit shows.

The government has written to hospitals and chief constables for an explanation after the Department of Health audit.

Accident and emergency departments are meant to share information about where knife or gun attacks are happening with the police and local council.

This was part of the government’s programme for government in 2010.

‘Disappointed’

In 2010 the coalition promised in its programme for government to make hospitals share non-confidential information with the police so crime hotspots could be identified.

An audit carried out for the Department of Health has revealed that is happening effectively in only a third of community safety partnership areas, and not at all in one-fifth.

The charity Victim Support said it was very disappointing that the plan was not being implemented.

Susannah Hancock, its assistant chief executive, said: “The NHS is the second most likely public service after the police to come into contact with victims of violent crime, many of whom will not have reported such incidents to the police at all. “

It is thought that police are aware of fewer than a third of assaults that lead to the victim being treated in hospital.

Pioneering research carried out in Cardiff tested the idea of regularly sharing collated information about the type and location of attacks, with all confidential patient information removed.

As a result, the city saw a 35% fall in the numbers of assault victims turning up at A&E for treatment between 2000 and 2005.

Professor Jonathan Shepherd, from Cardiff University, said the research showed sharing information costs little, and saves money in the longer term for the NHS and the criminal justice system. He said the findings of the audit were surprising, giving the strong evidence, and the commitment from government.

“I feel disappointed that it hasn’t been taken up faster than this, and I would want to say to hospitals and local authorities this is straightforward, ethical information-sharing that makes for safer communities – just get on with it.”

‘Win-win’

Arrowe Park hospital, in the Wirral, has seen some impressive results from setting up systems to share information every month with the police and local council. Anyone arriving at A&E with an injury caused by a violent assault is taken through a standard set of questions about the location and circumstances of the attack.

The information has all patient data removed from it before it is shared. Between 2004 and 2010, the number of alcohol-related assault victims arriving for treatment fell by 30%.

Chris Oliver, from the Wirral University Hospital Trust, said the results had convinced busy staff in A&E to get involved: “It’s owned by everyone within the department. The reception staff are very proactive when going through the questions. It’s very rewarding for our staff to see the reduction in people coming into the department. It’s a win-win.”

The Department of Health said Health Minister Anna Soubry had written this week to all hospital chief executives and chief constables in England to remind them of the government’s commitment on sharing information.

The letter says there are no legal reasons for not sharing anonymous information, and asks for any “good reasons why it cannot be done” in areas which have failed to put systems in place.

Despite this slow progress in implementing the approach in England, the idea has attracted international interest and there are pilot schemes under way in other countries.

Visit the Source Site

Many A&Es ‘not sharing crime data’

30 January 2013 Last updated at 23:59 ET

By Branwen Jeffreys Health correspondent, BBC News

Man in a hoodie holding a knifeSimilar schemes have seen a fall in incidents of violent crime

A coalition pledge to make hospitals share violent crime data with police is being carried out in only a third of areas in England, an audit shows.

The government has written to hospitals and chief constables for an explanation after the Department of Health audit.

Accident and emergency departments are meant to share information about where knife or gun attacks are happening with the police and local council.

This was part of the government’s programme for government in 2010.

‘Disappointed’

In 2010 the coalition promised in its programme for government to make hospitals share non-confidential information with the police so crime hotspots could be identified.

An audit carried out for the Department of Health has revealed that is happening effectively in only a third of community safety partnership areas, and not at all in one-fifth.

The charity Victim Support said it was very disappointing that the plan was not being implemented.

Susannah Hancock, its assistant chief executive, said: “The NHS is the second most likely public service after the police to come into contact with victims of violent crime, many of whom will not have reported such incidents to the police at all. “

It is thought that police are aware of fewer than a third of assaults that lead to the victim being treated in hospital.

Pioneering research carried out in Cardiff tested the idea of regularly sharing collated information about the type and location of attacks, with all confidential patient information removed.

As a result, the city saw a 35% fall in the numbers of assault victims turning up at A&E for treatment between 2000 and 2005.

Professor Jonathan Shepherd, from Cardiff University, said the research showed sharing information costs little, and saves money in the longer term for the NHS and the criminal justice system. He said the findings of the audit were surprising, giving the strong evidence, and the commitment from government.

“I feel disappointed that it hasn’t been taken up faster than this, and I would want to say to hospitals and local authorities this is straightforward, ethical information-sharing that makes for safer communities – just get on with it.”

‘Win-win’

Arrowe Park hospital, in the Wirral, has seen some impressive results from setting up systems to share information every month with the police and local council. Anyone arriving at A&E with an injury caused by a violent assault is taken through a standard set of questions about the location and circumstances of the attack.

The information has all patient data removed from it before it is shared. Between 2004 and 2010, the number of alcohol-related assault victims arriving for treatment fell by 30%.

Chris Oliver, from the Wirral University Hospital Trust, said the results had convinced busy staff in A&E to get involved: “It’s owned by everyone within the department. The reception staff are very proactive when going through the questions. It’s very rewarding for our staff to see the reduction in people coming into the department. It’s a win-win.”

The Department of Health said Health Minister Anna Soubry had written this week to all hospital chief executives and chief constables in England to remind them of the government’s commitment on sharing information.

The letter says there are no legal reasons for not sharing anonymous information, and asks for any “good reasons why it cannot be done” in areas which have failed to put systems in place.

Despite this slow progress in implementing the approach in England, the idea has attracted international interest and there are pilot schemes under way in other countries.


Visit the Source Site

Could going veg lower your risk of heart disease?

A customer selects vegetables at a supermarket in Prague June 14, 2011. REUTERS/David W Cerny

A customer selects vegetables at a supermarket in Prague June 14, 2011.

Credit: Reuters/David W Cerny

By Genevra Pittman

NEW YORK | Thu Jan 31, 2013 3:36pm EST

NEW YORK (Reuters Health) – Vegetarians are one-third less likely to be hospitalized or die from heart disease than meat and fish eaters, according to a new UK study.

Earlier research has also suggested that non-meat eaters have fewer heart problems, researchers said, but it wasn’t clear if other lifestyle differences, including exercise and smoking habits, might also play into that.

Now, “we’re able to be slightly more certain that it is something that’s in the vegetarian diet that’s causing vegetarians to have a lower risk of heart disease,” said Francesca Crowe, who led the new study at the University of Oxford.

Still, she noted, the researchers couldn’t prove there were no unmeasured lifestyle differences between vegetarians and meat eaters that could help explain the disparity in heart risks.

Crowe and her colleagues tracked almost 45,000 people living in England and Scotland who initially reported on their diet, lifestyle and general health in the 1990s.

At the start of the study, about one-third of the participants said they ate a vegetarian diet, without meat or fish.

Over the next 11 to 12 years, 1,066 of all study subjects were hospitalized for heart disease, including heart attacks, and 169 died of those causes.

After taking into account participants’ ages, exercise habits and other health measures, the research team found vegetarians were 32 percent less likely to develop heart disease than carnivores. When weight was factored into the equation, the effect dropped slightly to 28 percent.

The lower heart risk was likely due to lower cholesterol and blood pressure among vegetarians in the study, the researchers reported this week in the American Journal of Clinical Nutrition.

Meat eaters had an average total cholesterol of 222 mg/dL and a systolic blood pressure – the top number in a blood pressure reading – of 134 mm Hg, compared to 203 mg/dL total cholesterol and 131 mm Hg systolic blood pressure among vegetarians.

Diastolic blood pressure – the bottom number – was similar between the two groups.

Crowe said the difference in cholesterol levels between meat eaters and vegetarians was equivalent to about half the benefit someone would see by taking a statin.

The effect is probably at least partly due to the lack of red meat – especially meat high in saturated fat – in vegetarians’ diets, she added. The extra fruits and vegetables and higher fiber in a non-meat diet could also play a role.

“If people want to reduce their risk of heart disease by changing their diet, one way of doing that is to follow a vegetarian diet,” Crowe told Reuters Health.

However, she added, you also don’t have to cut out meat altogether – just scaling back on saturated fat can make a difference, for example. Butter, ice cream, cheeses and meats all typically contain saturated fat.

SOURCE: American Journal of Clinical Nutrition, online January 30, 2013.

  • Link this
  • Share this
  • Digg this
  • Email
  • Reprints


Visit the Source Site

Analysis: Little to fear for Fresenius in U.S. health spending cuts

The headquarters of Fresenius is pictured in Bad Homburg near Frankfurt February 24, 2010. REUTERS/Johannes Eisele

The headquarters of Fresenius is pictured in Bad Homburg near Frankfurt February 24, 2010.

Credit: Reuters/Johannes Eisele

Thu Jan 31, 2013 8:45am EST

FRANKFURT (Reuters) – Fresenius Medical Care’s focus on a life-threatening illness and its buying power with suppliers mean the world’s biggest kidney dialysis provider may cope better with cuts in U.S. healthcare spending than many investors think.

FMC’s shares have slumped about 10 percent over the past three months on expectation the United States, battling to rein in its budget deficit, will reduce funds for state-run health schemes like Medicare that account for about 30 percent of the German company’s revenues.

A 2 percent cut to Medicare spending will come into effect in March, unless lawmakers agree to postpone it, while the federal agency in charge of Medicare is likely to announce a cut in reimbursements for dialysis providers for 2014 to reflect a drop in the use of an expensive drug to treat a side effect.

Congress has even set Medicare a non-binding target to slash spending on dialysis by $4.9 billion spread over ten years.

However, there are grounds for thinking the actual cutbacks, for dialysis providers at least, will not prove too severe.

Dialysis, where machines do the kidney’s vital job of cleaning blood of waste and excess fluids, accounts for only about $10 billion of Medicare’s $555 billion annual budget and is essential to patients’ survival.

Cutbacks are more likely to focus on less critical areas of healthcare, like joint replacements, some analysts think. What’s more, with longevity, obesity and diabetes on the rise across much of the world, demand for dialysis is growing.

“FMC has two years ahead of it that will be somewhat more difficult,” said Markus Manns, who manages a 200 million euro ($267 million) equity fund with a focus on healthcare at Union Investment in Frankfurt.

“But in the past, initial drafts have always been mitigated in such a way that both the government and dialysis providers were okay with in the end.”

WEAKER RIVALS

FMC, indirectly controlled by a German charitable trust, treats over 250,000 of the estimated 2.1 million people receiving kidney dialysis worldwide – a figure growing about 5-6 percent per year and expected to reach almost 4 million by 2020.

While about two-thirds of its 2011 net revenue of $12.8 billion came from North America, the company is seeing rapid growth in emerging markets as more sedentary lifestyles take hold and rising wealth drives an increase in insurance coverage.

For instance, it expects annual growth in patient numbers of 10 percent in Asia, compared with 4 percent in the United States, which will help to reduce its exposure to the latter.

In the meantime, FMC’s size – it operates more than a third of dialysis treatment centers in the United States – will be a big advantage in coping with spending cuts, analysts say.

More vulnerable will be the 100 or so smaller, less efficient firms that account for 25-30 percent of the market.

Indeed, shares in FMC’s closest rival in the United States, DaVita, have changed little in recent months, partly reflecting the view in that country that even if Medicare spending on dialysis is reduced, the larger players will be able to take a bigger share of the smaller pot.

The smaller firms often serve rural communities. As it could be politically difficult for Washington to drive these out of business, that may lead to lenient treatment for all dialysis providers when it comes to apportioning spending cuts.

“Many of the smaller dialysis chains and one-clinic operations continue to struggle to generate profits, something which we believe will continue to act as a buffer for the large dialysis organizations,” said Berenberg Bank analyst Tom Jones.

THE NEXT BIG THING

It’s undoubtedly going to be an uncertain few years.

“Visibility about (FMC’s) medium-term financial plans is fairly low,” said Credit Suisse analyst Christoph Gretler.

He described the stock’s valuation as “not overly attractive,” despite its slide to 1-1/2 year lows this month.

But some analysts believe that changes in the way Medicare operates could work in favors of bigger firms like FMC.

Rather than paying for the actual amount of drugs and services given to patients, Medicare is switching to a system of lump-sum reimbursements.

This will reward the industry for finding cheaper ways of providing dialysis, as long as it maintains the same quality of care. Medicare will eventually cut the reimbursement rate to claw back some of the efficiency gains, but only with a delay.

FMC’s size is expected to help it cut treatment costs, for instance by negotiating better drug buying terms with suppliers.

For now, the lump-sum reimbursement, or bundled rate, covers intravenous drugs but from 2016 oral drugs will be added and in the longer term, more sweeping reforms could be on the cards.

Under a plan dubbed accountable or comprehensive care, dialysis providers would have to pay for patients’ hospital stays due to dialysis-related conditions. In return, providers would receive an additional lump sum per patient, again rewarding them for more careful and less costly patient care.

“This would be the next mega-revolution in the healthcare industry,” said Union Investment’s Manns.

($1 = 0.7477 euros)

(Editing by Mark Potter)

  • Link this
  • Share this
  • Digg this
  • Email
  • Reprints


Visit the Source Site

Functional Issues Similar with Surgery, RT for Prostate Cancer

Register Today

Earn Free CME Credits by reading the latest medical news
in your specialty.

Sign Up

37119

Prostate Cancer

Latest News| Videos

By Charles Bankhead, Staff Writer, MedPage Today

Published: January 30, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points

  • In this trial, men with localized prostate cancer had declines in sexual, urinary, and bowel function over time, whether they choose surgery or radiation therapy.
  • Note that the extent of functional decline did not differ significantly at 15 years, regardless of the initial radical therapy.

Men with localized prostate cancer have declines in sexual, urinary, and bowel function over time, whether they choose surgery or radiation therapy, data from a large cohort study showed.

Radical prostatectomy increased the odds of urinary incontinence and erectile dysfunction at 2 and 5 years compared with radiotherapy, which was associated with an increased likelihood of bowel dysfunction at 2 and 5 years.

However, the extent of functional decline did not differ significantly at 15 years, regardless of the initial radical therapy, as reported online in the New England Journal of Medicine.

“Considering the often long duration of survival after treatment for prostate cancer, these data may be used to counsel men considering treatment for localized disease,” David F. Penson, MD, of Vanderbilt University in Nashville, Tenn., and co-authors wrote in conclusion.

In particular, active surveillance might warrant more discussions between physicians and patients with clinically low-risk prostate cancer, Penson told MedPage Today.

In general, clinically localized prostate cancer has a favorable long-term prognosis, including overall and disease-specific survival. As a result, the effects of treatment on functional outcomes have emerged as a key issue in physician-patient discussions about treatment options.

Studies have revealed differences in functional-outcome profiles between prostatectomy and radiotherapy over the short- and intermediate-term. In contrast, little is known about long-term functional outcomes with the two most common treatment modalities for localized prostate cancer.

“Since the median life expectancy after treatment for prostate cancer is 13.8 years, a careful evaluation of long-term functional outcomes is critical to an understanding of the comprehensive experience of men living with a diagnosis of prostate cancer,” the authors noted in their introduction.

To inform on long-term outcomes after treatment for localized prostate cancer, Penson and colleagues analyzed data from the Prostate Cancer Outcomes Study (PCOS), a population-based cohort study involving men who had newly diagnosed prostate cancer during the mid-1990s and were followed prospectively for 15 years. The men were ages 55 to 74 at diagnosis.

The final analysis involved 1,655 men who underwent prostatectomy or definitive radiation therapy within 12 months of diagnosis and who had completed follow-up surveys after 2 or 5 years. The study group consisted of 1,164 men who had undergone prostatectomy and 491 who opted for radiation therapy.

During a baseline assessment, all PCOS participants provided information about prediagnostic urinary, sexual, and bowel function. The men were contacted at 1, 2, 5, and 15 years after diagnosis and asked to complete surveys related to disease-specific health-related quality of life.

At 15 years, 322 patients (27.7%) in the prostatectomy group had died, as had 247 men (50.3%) who underwent radiation therapy. Overall survey response rates were 87.5% at 2 years, 83.3% at 5 years, and 60.3% at 15 years.

At the 2-year mark, the prostatectomy group was more than six times as likely to have urinary incontinence as the radiotherapy group (OR 6.22, 95% CI 1.92 to 20.29). At 5 years, the odds for urinary incontinence remained five times higher in the prostatectomy group (OR 5.10, 95% CI 2.29 to 11.36).

The odds for sexual dysfunction also were significantly increased after prostatectomy compared with radiation therapy at 2 and 5 years (OR 3.46, OR 1.93, respectively). However, prostatectomy was associated with significantly lower odds of bowel urgency at 2 years (OR 0.39) and 5 years (OR 0.93) compared with radiation therapy.

At the 15-year follow-up, all of the significant differences had disappeared, although some absolute numbers continued to suggest between-group differences:

  • Urinary incontinence — 18.3% with prostatectomy versus 9.4% with radiotherapy (OR 2.34, 95% CI 0.88 to 6.23)
  • Erectile dysfunction — 87.0% versus 93.9% (OR 0.38, 95% CI 0.12 to 1.22)
  • Bowel urgency — 21.9% versus 35.8% (OR 0.98, 95% CI 0.45 to 2.14)

Advancing age almost certainly contributed to the high rates of functional problems at 15 years, Penson acknowledged. However, case-control studies by PCOS investigators showed that prostate cancer patients had worse functional outcomes at 5 years compared with age-matched men who had not had prostate cancer.

“While there’s definitely an aging effect, I think that we still have to say that some of this is also directly related to primary treatment, secondary treatment, or prostate cancer itself,” said Penson.

The research was supported by the National Cancer Institute and the Department of Veterans Affairs.

Penson had no relevant disclosures. Coauthors disclosed relationships with Ferring Pharmaceuticals, Dendreon, Johnson & Johnson, Informed Medical Decision Foundation, and Bayer Healthcare. One or more authors have provided expert testimony.

Primary source: New England Journal of Medicine
Source reference:
Resnick MJ, et al “Long-term functional outcomes after treatment for localized prostate cancer.” N Engl J Med 2013; DOI: 10.1056/NEJMoa1209978.

Sponsored Resources

ADVERTISEMENT

Resources (from Industry)

Video Library

Medical Education (Non-CME)

Most Read Stories

  • Clinical Notes: New Norovirus Strain Appears
  • Ground Beef Blamed for Salmonella Cases
  • Alogliptin Wins FDA Go-Ahead for Type 2 Diabetes
  • Smoking Deaths Now Equal in Women and Men
  • FDA Panel Votes for Tighter Controls on Vicodin
  • FDA Warns of Liver Injury Risk with Tolvaptan
  • Flu Activity Up and Down, Still Epidemic
  • Bladder Control Drug Gets FDA OTC Go-Ahead
  • Early Breast Ca Survival Better with Lumpectomy
  • Folic Acid-Cancer Debate Continues

ADVERTISEMENT


Visit the Source Site

ACE Inhibitors Linked to Hallucinations

Register Today

Earn Free CME Credits by reading the latest medical news
in your specialty.

Sign Up

37113

By Chris Kaiser, Cardiology Editor, MedPage Today

Published: January 30, 2013

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania

Action Points

  • Note that this small case-series demonstrated a potential association between lisinopril usage and visual hallucinations.
  • Clinicians should be aware of this potential side effect, but data remain too preliminary to confirm a direct ACE inhibitor-hallucination relationship.

Elderly patients with memory problems who suddenly have visual hallucinations may need to stop taking ACE inhibitors, researchers suggested.

In four case studies, the hallucinations experienced by patients with various memory deficits disappeared after they discontinued lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, reported John Doane, MD, and Barry Stults, MD, from the University of Utah Health Sciences Center in Salt Lake City.

Although hallucinations are “a generally unrecognized side effect” of ACE inhibitors, this is the first published account showing an association between lisinopril and hallucinations, they wrote online in the Journal of Clinical Hypertension.

“Commonly reported adverse effects of ACE inhibitors include cough, rash, angioedema, hypotension, hyperkalemia, and renal insufficiency,” researchers noted. “Visual hallucinations as an adverse effect of ACE inhibitors are not listed in recent reviews of this drug class but have been reported, primarily in elderly persons.”

Patients in these four cases ranged in age from 92 to 101, were being treated with lisinopril for hypertension or heart failure, and had some form of memory impairment: mild cognitive impairment (two), Alzheimer’s disease (one), and dementia (one).

In these four cases, stopping lisinopril resulted in the cessation of hallucinations within 48 hours for two patients, and within 7 and 30 days for the third and fourth patients.

The onset of symptoms after starting the drug and cessation of hallucinations following drug stoppage varied:

  • 5 months until hallucinations occurred and 7 days after medication discontinuation until they stopped
  • 2 months and 2 days
  • 1 year and 2 days
  • 6 years and 30 days

One patient who stopped taking hydrochlorothiazide first and then lisinopril experienced recurrent hypertension 12 weeks post-ACE inhibitor discontinuation. She was again given lisinopril, but the hallucinations came back within a week, after which the lisinopril was stopped.

Researchers noted the “contrasting reports from observational and small randomized clinical trials” trying to determine whether or not ACE inhibitors protect patients from cognitive decline.

Doane and Stults also conducted a search of the literature and found seven previously published case reports of visual hallucinations associated with other ACE inhibitors: cilazapril, enalapril, captopril, and quinapril.

The age range in these cases spanned 49 to 92, and the dates of publication ranged from 1988 to 2001.

The investigators reported that two patients went back on the ACE inhibitor and again had hallucinations, which resolved when they stopped the medication.

Doane and Stults also searched the database of the Medicines and Healthcare Products Regulatory Agency (MHRA), a government entity in the U.K, for cases of adverse drug reactions. These unpublished reports have a number of limitations, however, including the lack of a necessity for causal evidence related to the drug and the adverse reaction.

Nevertheless, researchers found another 14 cases of ACE inhibitor-related hallucinations when they searched through MHRA category II data, which is more comprehensive than category I. Four of these cases involved lisinopril. Other ACE inhibitors involved were ramipril, enalapril, captopril, and perindopril.

When they examined category I data, they found another 35 cases of hallucinations related to ACE inhibitors. Symptoms resolved for 25 of these patients after stopping the drug, continued in two, and no further data were available for the remaining eight cases.

This evidence doesn’t prove causality but its strength is that when some patients were rechallenged with lisinopril, the symptoms returned, and when they were taken off the drug, the symptoms ceased, the investigators noted.

As far as a mechanism of action for hallucinations to be associated with ACE inhibitors, researchers suggested it could related to the observation that these drugs raise the level of opioid peptides.

It’s important to recognize this complication associated with ACE inhibitors, particularly as the aging population increases, the researchers said.

The study was limited because it had only four cases and there was missing information in the database search.

The authors reported no specific funding in relation to this research and no conflicts of interest to disclose.

Primary source: Journal of Clinical Hypertension
Source reference:
Doane J, et al “Visual hallucinations related to angiotensin-converting enzyme inhibitor use: case reports and review” J Clin Hypertens 2013; DOI: 10.1111/jch.12063

Sponsored Resources

ADVERTISEMENT

Resources (from Industry)

Video Library

Medical Education (Non-CME)

Most Read Stories

  • Clinical Notes: New Norovirus Strain Appears
  • Ground Beef Blamed for Salmonella Cases
  • Alogliptin Wins FDA Go-Ahead for Type 2 Diabetes
  • Smoking Deaths Now Equal in Women and Men
  • FDA Panel Votes for Tighter Controls on Vicodin
  • FDA Warns of Liver Injury Risk with Tolvaptan
  • Flu Activity Up and Down, Still Epidemic
  • Bladder Control Drug Gets FDA OTC Go-Ahead
  • Early Breast Ca Survival Better with Lumpectomy
  • Folic Acid-Cancer Debate Continues

ADVERTISEMENT


Visit the Source Site

Prostate cancer study tracks long-term urinary, sexual and bowel function side effects

Jan. 30, 2013 — A new study comparing outcomes among prostate cancer patients treated with surgery versus radiotherapy found differences in urinary, bowel and sexual function after short-term follow-up, but those differences were no longer significant 15 years after initial treatment.

The study, led by first author Matthew Resnick, M.D., instructor in Urologic Surgery, Vanderbilt University Medical Center, was published in the Jan. 31 issue of the New England Journal of Medicine.

From Oct. 1, 1994, through Oct. 31, 1995, investigators enrolled men who had been diagnosed with localized prostate cancer in the Prostate Cancer Outcomes Study (PCOS).

For the current study, investigators followed 1,655 men between the ages of 55 and 74 from the PCOS group, of whom 1,164 (70.3 percent) had undergone prostatectomy, while 491 (29.7 percent) had undergone radiotherapy. At the time of enrollment, the patients were asked to complete a survey about clinical and demographic issues and health-related quality of life. The men were contacted again at set times following treatment and were asked about clinical outcomes and disease-specific quality of life issues.

Men whose prostates had been surgically removed were significantly more likely than those who received radiation therapy to report urinary leakage at two years and five years. However, at 15 years, the investigators found no significant difference in the adjusted odds of urinary incontinence. Nonetheless, patients in the surgery group were more likely to wear incontinence pads throughout the 15-year follow-up period.

Men in the prostatectomy group were also significantly more likely than those in the radiotherapy group to report having problems with erectile dysfunction two years and five years after surgery.

“At the two- and five-year time points, men who underwent prostatectomy were more likely to suffer from urinary incontinence and erectile dysfunction than men who received radiation therapy,” said Resnick. “While treatment-related differences were significant in the early years following treatment, those differences became far less pronounced over time.”

Despite early and intermediate-term data revealing treatment-dependent differences in patterns of sexual dysfunction, after five years both groups had a gradual decline in sexual function. At 15 years, erectile dysfunction was nearly universal with 87 percent in the prostatectomy group and 93.9 percent in the radiotherapy group reporting sexual difficulties.

The authors noted that age may have played a role in the patients’ waning sexual function, as shown in unrelated studies.

Some patients also experienced problems with bowel function in the years following treatment. Those who were treated with radiotherapy had more problems in the short term. Men in the radiotherapy group reported significantly higher rates of bowel urgency than those in the prostatectomy group at two years and five years.

However, at 15 years, despite absolute differences in the prevalence of bowel urgency between the two groups, the researchers found no significant difference in the odds of bowel urgency. Men who had been treated with radiotherapy were significantly more likely to report being bothered by bowel symptoms at both the two-year and 15-year points.

“This study of 15-year outcomes represents a mature portrait of quality of life issues following prostate cancer treatment,” said David Penson, M.D., MPH, Ingram Professor of Cancer Research, professor of Urologic Surgery and Medicine, and director of the Vanderbilt Center for Surgical Quality and Outcomes Research, the senior study author.

“Regardless of the form of initial treatment, patients in this study had significant declines in sexual and urinary function over the duration of the study. The causes of these declines probably include advancing age and additional cancer therapies, in addition to the original therapy,” Penson said.

“Patients need to be aware that all aggressive therapies for prostate cancer have significant side effects and perhaps these data make an argument for active surveillance (avoiding aggressive treatment and closely following the cancer) in certain cases.”

Since the median life expectancy after treatment for prostate cancer is 13.8 years, the authors suggested that these data may be used by physicians to counsel men who are considering treatment for localized disease.

Other authors for this study include Tatsuki Koyama, Ph.D., Kang-Hsien Fan, M.S., R. Lawrence Van Horn, Ph.D., Vanderbilt; Peter Albertsen, M.D., University of Connecticut, Farmington; Michael Goodman, M.D., MPH, Emory University, Atlanta; Ann Hamilton, Ph.D., University of Southern California, Los Angeles; Richard Hoffman, M.D., MPH, University of New Mexico and New Mexico VA Healthcare System, Albuquerque; Arnold Potosky, Ph.D., Georgetown University Medical Center, Washington, D.C.; Janet Stanford, Ph.D., Fred Hutchinson Cancer Research Center, Seattle; and Antoinette Stroup, Ph.D., University of Utah, Salt Lake City.

Share this story on Facebook, Twitter, and Google:

Other social bookmarking and sharing tools:


Story Source:

The above story is reprinted from materials provided by Vanderbilt University Medical Center. The original article was written by Dagny Stuart.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Matthew J. Resnick, Tatsuki Koyama, Kang-Hsien Fan, Peter C. Albertsen, Michael Goodman, Ann S. Hamilton, Richard M. Hoffman, Arnold L. Potosky, Janet L. Stanford, Antoinette M. Stroup, R. Lawrence Van Horn, David F. Penson. Long-Term Functional Outcomes after Treatment for Localized Prostate Cancer. New England Journal of Medicine, 2013; 368 (5): 436 DOI: 10.1056/NEJMoa1209978

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.


Visit the Source Site

Erectile dysfunction drug also helps men ejaculate and orgasm

Jan. 30, 2013 — New data suggests the erectile dysfunction (ED) drug Cialis may also be beneficial in helping men who have problems with ejaculation and orgasm, report researchers from NewYork-Presbyterian Hospital/Weill Cornell Medical Center in the February issue of the British Journal of Urology International. Cialis is currently approved for the treatment of ED, benign prostate hypertrophy (BPH) and for treatment of men with both conditions.

Their study, a meta-analysis of 17 double-blind, placebo-controlled clinical trials of men with ED, is the first to analyze the benefit an agent like Cialis offers for common issues of sexual dysfunction that may have little to do with ED. Their study concluded that approximately 70 percent of men who used Cialis during sexual activity for 12 weeks were able to ejaculate most of the time and to reach orgasm, compared to 30 percent in the placebo group. Also, these benefits from the drug were seen despite the level of a man’s ED severity.

“There are many men who have, at most, very mild problems achieving an erection but who cannot easily ejaculate,” says the study’s lead author, Dr. Darius Paduch, a urologist and male sexual medicine specialist at NewYork-Presbyterian/Weill Cornell and director of Sexual Health and Medicine at Weill Cornell Medical College. “Our study shows Cialis works very well for these men with problems ejaculating.”

Dr. Paduch says up to 18 percent of men have a normal erection but don’t ejaculate, or take a long time to do so. He adds that while the issue may be more prevalent in the elderly, it affects men of all ages.

“Many of my patients are young men who want to have children and so they want to solve their issues with ejaculation,” says Dr. Paduch, who is also an associate professor of urology and reproductive medicine at Weill Cornell. “We don’t know why this occurs. Every internist faces this problem in his male patients and has no options to offer. Our study shows Cialis may help.”

Men with No ED Can Have Sexual Dysfunction

Dr. Paduch and his colleagues have long researched issues of sexual dysfunction that extend beyond ED. “Erectile dysfunction isn’t the whole story, by any means,” he says.

A 2011 study led by Dr. Paduch helped clarify the issue. The largest analysis to date of orgasmic and ejaculatory dysfunction, also published in the British Journal of Urology International, followed nearly 12,130 men with mild to severe ED and found that 65 percent of the participants were unable to have an orgasm and 58 percent had problems with ejaculation. Even men with no or very minimal ED reported poor ejaculatory function (17 percent) and poor ability to have an orgasm (22 percent). At the time, Dr. Paduch pointed out that approximately 30 million American men — half of all men aged 40 to 70 — have trouble achieving or sustaining an erection. “While medications like Viagra and Cialis have been successful in helping many of these men, our research suggests there are other common sexual issues that remain largely unaddressed,” he said in 2011.

Non-erectile sexual dysfunction is underreported and undertreated due to social stigma and, in particular, misunderstandings about the physiology of male sexual response and orgasmic dysfunction, Dr. Paduch says. “For decades it was believed that only women had problems with orgasm, but our research shows that orgasmic dysfunction could be as prevalent among men as it is among women.”

In this new study, Dr. Paduch and his colleagues examined data from 17 placebo-controlled 12-week trials of Cialis, given at different doses. These studies included 3,581 participants with a mean age of 54.9, including 1,512 men with severe ejaculatory dysfunction (EJD) and 1,812 with severe orgasmic dysfunction (OD). In some cases, patients with one or both of these conditions reported only mild or moderate ED.

The researchers examined the study participants’ responses on questionnaires about the effect Cialis had on ED, EJD, and OD, among other measures of sexual satisfaction. The original questionnaire was primarily focused on the effects of Cialis on ED, but provided valuable additional information.

They found that treatment with Cialis (10 or 20 milligrams taken as needed) was associated with significant increase in ejaculatory and orgasmic function across all levels of severity of ED, EJD and OD, compared to use of a placebo agent.

For example, 66 percent of men with severe EJD and 66 percent with severe OD who used Cialis reported improved ejaculatory function, compared with 36 percent and 35 percent, respectively, in the placebo group. Also, patients with moderate dysfunction also experienced significant improvements with Cialis, Dr. Paduch reports.

“More study is needed, but we are hopeful our findings may lead to a treatment for many men who cannot now achieve sexual satisfaction,” Dr. Paduch says.

Other study co-authors include Alexander Bolyakov, a research associate in the Department of Urology at Weill Cornell, and Paula K. Polzer and Steven Watts, the study’s senior investigator, both of Lilly Research Laboratories of Eli Lilly.

This research study was funded by Eli Lilly and Company, the manufacturer of Cialis.

Study authors Dr. Paduch and Bolyakov are funded study investigators and consultants for Eli Lilly. In addition, Polzer and Watts are employees of, and minor shareholders in, Eli Lilly.

Share this story on Facebook, Twitter, and Google:

Other social bookmarking and sharing tools:


Story Source:

The above story is reprinted from materials provided by Weill Cornell Medical College.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Darius A. Paduch, Alexander Bolyakov, Paula K. Polzer, Steven D. Watts. Effects of 12 weeks of tadalafil treatment on ejaculatory and orgasmic dysfunction and sexual satisfaction in patients with mild to severe erectile dysfunction: integrated analysis of 17 placebo-controlled studies. BJU International, 2013; 111 (2): 334 DOI: 10.1111/j.1464-410X.2012.11656.x

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.


Visit the Source Site

Warning For Men: Erection Problems May Signal ‘Silent’ Heart Disease And Early Death

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Heart Disease;  Men’s Health
Article Date: 31 Jan 2013 – 0:00 PST

Current ratings for:
Warning For Men: Erection Problems May Signal ‘Silent’ Heart Disease And Early Death

Patient / Public: not yet rated
Healthcare Prof: not yet rated

Men with erection problems now have an extra reason to see their doctor: even relatively minor erectile difficulties could signal ‘silent’ heart disease and may indicate an increased risk of dying early from any cause, a major new study shows.

An Australian study – the world’s largest to investigate the link between erectile dysfunction and heart disease – has found that men with erectile dysfunction have a higher risk of hospital admission for heart disease, even if they have no history of heart problems. They are also at greater risk of premature death from any cause.

The research, from the Sax Institute’s 45 and Up Study and published in international journal PLOS Medicine, is the first to show a direct link between how severe a man’s erection problem is and his risk of dying early or being treated in hospital for heart disease.

“The risks of future heart disease and premature death increased steadily with severity of erectile dysfunction, both in men with and without a history of cardiovascular disease,” lead author and 45 and Up Study Scientific Director Professor Emily Banks said.

“Rather than causing heart disease, erectile dysfunction is more likely to be a symptom or signal of underlying ‘silent’ heart disease and could in future become a useful marker to help doctors predict the risk of a cardiovascular problem. This is a sensitive topic but men shouldn’t suffer in silence; there are many effective treatments, both for erectile dysfunction and for cardiovascular disease.”

Erection problems are very common: around one in five men aged 40 and over report moderate or severe erectile dysfunction.

While previous studies have shown that men with severe erectile dysfunction are more likely than men with no erectile difficulties to have cardiovascular events such as heart disease or stroke, this study (funded by the Heart Foundation and the NSW Office for Health and Medical Research) is the first to review gradients of erectile dysfunction from none, to mild, moderate and severe forms.

Heart Foundation Cardiovascular Health Director Dr Rob Grenfell said the results were nationally significant and demonstrated why governments should invest in large health studies such as the 45 and Up Study.

“These results tell us that every man who is suffering from any degree of erectile dysfunction should be seeking medical assistance as early as possible and also insisting on a heart health check by their GP at the same time,” Dr Grenfell said.

The researchers, from the Sax Institute, Australian National University, The University of Sydney, Victor Chang Cardiac Research Institute and The George Institute for Global Health examined hospital and death records for 95,000 men from the 45 and Up Study – the largest ongoing study of healthy ageing in the Southern Hemisphere, with more than 250,000 people taking part.

The men gave information about health and lifestyle factors and were followed for a two to three-year period, recording 7855 hospital admissions related to cardiovascular disease and 2304 deaths.

“The large number of men in the study meant we could also look at the risks in relation to different types of cardiovascular disease,” Professor Banks said. “We found men with erectile dysfunction were at higher risk of heart attack, heart failure, peripheral vascular disease and heart conduction problems.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our erectile dysfunction / premature ejaculation section for the latest news on this subject.
45 and Up Study partners:
Cancer Council NSW; Heart Foundation; NSW Government; beyondblue; Australian Red Cross Blood Service; UnitingCare Ageing
Sax Institute
Please use one of the following formats to cite this article in your essay, paper or report:

MLA

n.p. “Warning For Men: Erection Problems May Signal ‘Silent’ Heart Disease And Early Death.” Medical News Today. MediLexicon, Intl., 31 Jan. 2013. Web.
31 Jan. 2013. <http://www.medicalnewstoday.com/releases/255589.php>


APA

n.p. (2013, January 31). “Warning For Men: Erection Problems May Signal ‘Silent’ Heart Disease And Early Death.” Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/255589.php.

Please note: If no author information is provided, the source is cited instead.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.


Visit the Source Site