Knee and Hip Replacements May Be Bad for the Heart

Contrary to recent reports, researchers found that osteoarthritis patients who had total knee or hip joint replacement surgery, known as arthroplasty, were at increased risk of heart attack (myocardial infarction) in the early post-operative period. However, findings indicate that long-term risk of heart attack did not persist, while the risk for venous thromboembolism — blood clot in veins and lungs — remained years after the procedure.
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Adverse effects of common prostate enlargement and hair growth drugs

Twenty-five percent of men currently taking Finasteride or Dutasteride, popularly known as Proscar and Avodart, for the treatment of benign prostate enlargement, appear not to benefit from taking these medications. Those prescribed Propecia or Avodart for male pattern hair loss (known as alopecia) are also at risk for adverse events elicited by these drugs.
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Newborn care inspection announced

Newborn care in England under inspection

  • 20 August 2015
  • From the section Health
Neonatal care involves the care of babies born early and those needing treatment at the start of life

Neonatal services within and outside hospitals will be examined

A review of the care available to newborns and young babies with severe health problems has been announced by the Care Quality Commission.

It will draw on the case of Elizabeth Dixon, from Surrey, who died 14 years ago after a breathing tube was not dealt with correctly.

The CQC says it wants to identify what barriers can stop hospitals from providing good or outstanding care.

The report, expected to be published in March 2016, may lead to new guidelines.

The inspection will involve around 20 neonatal services in England. These services, both inside and outside hospitals, involve the care of babies born early and those needing treatment in hospital after birth.

Care failure

Inspectors will look at how well staff spot problems that develop during pregnancy and how these are dealt with.

And in particular the commission will examine the care of babies who need breathing tubes.

This follows the experiences of the Dixon family.

Elizabeth Dixon died in 2001 as a result of failures in the tracheostomy care she received at home, while under the care of a newly qualified agency nurse.

Prof Edward Baker, deputy chief inspector of hospitals at the CQC, said: “Everyone has the right to care which is safe and effective but we know from our inspections of maternity services there is a marked difference in the quality of the care provided.

“We want to highlight good practice so that it can be shared, but also to identify what is stopping hospitals from providing good or outstanding care.”

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Stroke 'more likely' with long hours

Stroke ‘more likely’ with long hours

By James Gallagher
Health editor, BBC News website
  • 20 August 2015
  • From the section Health
Woman working

People working long hours are more likely to have a stroke, according to analysis of more than half a million people.

The data, published in the Lancet medical journal, showed the chance of a stroke increased beyond the traditional 9am to 5pm.

The link is uncertain, but theories include a stressful job and the damaging impact on lifestyle.

Experts said people working long hours should monitor their blood pressure

The study showed that in comparison to a 35-40 hour week, doing up to 48 hours increased the risk by 10%, up to 54 hours by 27% and over 55 hours by 33%.

Dr Mika Kivimaki, from University College London, said that in the 35-40 hour group there were fewer than five strokes per 1,000 employees per decade.

And that increased to six strokes per 1,000 employees per decade in those working 55 hours or more.

Dr Kivimaki admitted researchers were still at the “early stages” of understanding what was going on.

Ideas include the extra stress of working long hours or that sitting down for long periods is bad for health and may increase the risk of a stroke.

However, it could just be a marker for poor health with those chained to the office not having enough time to prepare healthy meals or exercise.

Dr Kivimaki told the BBC News website: “People need to be extra careful that they still maintain a healthy lifestyle and ensure their blood pressure does not increase.”

The Stroke Association’s Dr Shamim Quadir commented: “Working long hours can involve sitting for long periods of time, experiencing stress and leads to less time available to look after yourself.

“We advise that you have regular blood pressure checks, if you’re at all concerned about your stroke risk you should make an appointment with your GP or health professional.”

Dr Tim Chico, a consultant cardiologist based at the University of Sheffield, said: “Most of us could reduce the amount of time we spend sitting down, increase our physical activity and improve our diet while working and this might be more important the more time we spend at work.”

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Extra virgin olive oil linked to lower blood sugar and cholesterol

(Reuters Health) – Compared to other kinds of fat, extra virgin olive oil may have healthier effects on levels of blood sugar and bad cholesterol after meals, according to an Italian study.

That may explain why a traditional Mediterranean diet rich in olive oil is linked to lower risk of cardiovascular disease, researchers say.

“Lowering (post-meal) blood glucose and cholesterol may be useful to reduce the negative effects of glucose and cholesterol on the cardiovascular system,” lead study author Francesco Violi, a researcher at Sapienza University in Rome, said by email.

Violi and his colleagues tested the effect of adding extra virgin olive oil (EVOO) to a Mediterranean diet based on fruits, vegetables, grains and fish, with only limited consumption of dairy or red meat.

On two separate occasions, researchers gave 25 healthy people a typical Mediterranean lunch. For one meal, they added 10 grams (about 2 teaspoons) of extra virgin olive oil, and for the other, they added 10 g of corn oil.

Blood tests done before and two hours after the meals found that blood sugar rose after eating in all the participants, which is normal. But blood sugar rose much less after a meal with olive oil compared to one with corn oil.

That’s in line with previous research linking EVOO to elevated levels of insulin, a hormone that helps convert glucose into energy, Violi said.

It’s unclear, though, why the blood tests after meals with olive oil also showed lower levels of low-density lipoprotein (LDL), the bad kind of cholesterol that builds up in blood vessels and can lead to atherosclerosis, blood clots and heart attacks.

“Lowering (post-meal) blood glucose and cholesterol may be useful to reduce the negative effects of glucose and cholesterol on the cardiovascular system,” Violi said.

Worldwide, more people die of cardiovascular diseases than any other cause. These conditions killed an estimated 17.5 million people in 2012, most often from heart disease or stroke, according to the World Health Organization (WHO).

Violi’s team also found that after meals with corn oil, people had significantly higher levels of two kinds of LDL than they did after meals supplemented with extra virgin olive oil.

The study is quite small, and didn’t explore whether adding corn oil to meals might be better than including no oil at all, the researchers acknowledge in the journal Nutrition and Diabetes.

Even so, they argue, theirs is among the first studies to link a Mediterranean diet containing extra virgin olive oil to lower blood sugar and LDL cholesterol after meals.

People who want to get any potential health benefits from extra virgin olive oil shouldn’t take this experiment as permission to pour it on top of every meal, noted Arrigo Cicero, a scientist at Alma Mater Studiorum University of Bologna who wasn’t involved in the study.

“Use extra virgin olive oil instead of other fats,” Cicero said by email. “The assumption is it has to be included as a source of energy in the context of a balanced diet.”

SOURCE: Nutrition and Diabetes, online July 20, 2015.

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Lilly, Boehringer diabetes drug cuts heart attack, stroke risk in trial

A new diabetes pill from Eli Lilly and Co and Boehringer Ingelheim cut risk of heart attack, stroke and death in a closely watched study, the first glucose-lowering drug to show such protective results in a large cardiovascular trial, the drugmakers said on Thursday.

Besides burnishing the image of the year-old drug, Jardiance, the results could raise the profile of rival new drugs in the same class of medicines called SGLT2 inhibitors, such as Johnson & Johnson’s Invokana and AstraZeneca Plc’s Farxiga.

Lilly shares rose 2.8 percent in morning trading, amid a decline of 0.7 percent for the Arca Pharmaceutical Index of large drugmakers.

Jardiance (empagliflozin) was approved by U.S. regulators last August. By blocking the protein SGLT2, it inhibits reabsorption of glucose in the kidney, thereby lowering overall blood sugar.

Lilly and privately held German drugmaker Boehringer said the favorable results for Jardiance were seen in a 7,000-patient study of patients with type 2 diabetes considered at high risk of heart attacks and stroke. That is the most common form of diabetes, which is closely linked to obesity.

Significantly fewer cardiac deaths, non-fatal heart attacks or non-fatal strokes were seen in patients who took Jaridance in combination with standard treatments, compared with patients who took standard treatments alone, meeting the trial’s primary goal.

Standard treatments included statins and blood pressure drugs. Patients were followed an average of 3.1 years.

Lilly and Boehringer said about half of deaths in people with type 2 diabetes are caused by cardiovascular disease, and that reducing cardiovascular risk is therefore an essential component of diabetes care.

“This is a positive, and a first for the field of diabetes,” Sanford Bernstein analyst Tim Anderson said in a research note. “(This) could give the drug – and the broader SGLT2 class in which it competes – a competitive leg up.”

Anderson noted that besides lowering blood sugar levels, SGLT2 inhibitors also modestly lower body weight and blood pressure, and that those effects could have helped Jardiance in the cardiovascular “outcomes” trial.

The drugmakers said they plan to release full results of the trial on Sept. 17 at the annual meeting of the European Association for the Study of Diabetes in Stockholm.

Safety of Jardiance was consistent with results of previous trials. Its side effects have included dehydration, dizziness and low brood sugar.

(Reporting by Ransdell Pierson Editing by W Simon)

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Morning Break: Pelvic Mesh Scandal, Off-Label No-Nos

“In the little known world of medical lending, financiers invest in operations to remove pelvic implants from women suing device makers – and reap an inflated share of the payouts when cases settle,” Reuters reports in an eye-opening story.

StemExpress, the firm that worked with Planned Parenthood patients to facilitate medical uses of fetal tissue, has ended its relationship with the women’s health organization to escape the political firestorm. (Los Angeles Times)

GOP lawmakers are asking the Justice Department to provide information on laws banning for-profit sale of fetal tissue, and to report on their “history of enforcement” of those laws, according to CBS News.

Emergency! A bedbug infestation at Pittsburgh’s 911 dispatch center has forced workers into temporary quarters.

Four Scottish Boy Scouts have come down with bacterial meningitis after a trip to Japan, the BBC reports.

Did you think all big drugmakers make big profits? Think again.

Illinois has a tough new vaccination law, tightening religious exemptions, but the Chicago Tribune reports that it won’t take effect this school year.

Drug-maker Amgen will pay out $71 million for making unsupported claims to promote off-label use of anemia drug Aranesp, and severe plaque psoriasis drug Enbrel, Time reports.

A CDC survey finds many Hispanics believe antibiotics will treat a cold. (Reuters)

Generic drug maker Mylan, which has criticized India-based rivals, has been cited for quality violations at three of its own plants in India, Bloomberg reports.

Columbia University’s program to teach nutrition to its staff, a program they say is the only one of its kind, is embarking on its fourth year. MedPage Today asked other hospitals and found Be Fit at Mass General and Core Nutrition at Vanderbilt.

Another Yosemite National Park visitor has come down with the plague.

Morning Break is a daily guide to what’s new and interesting on the Web for healthcare professionals, powered by the MedPage Today community. Got a tip? Send it to us:

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Hospira announces TGA approval of Inflectra (infliximab) for treatment of eight inflammatory conditions

Hospira today announced that InflectraTM (infliximab), the first monoclonal antibody (mAb) biosimilar therapy, has been registered in Australia. This registration paves the way for the Federal Government to reduce the cost of some of the most expensive medicines on the Pharmaceutical Benefits Scheme (PBS).

Inflectra has been registered in Australia for the treatment of eight inflammatory conditions: rheumatoid arthritis (RA); psoriatic arthritis; ankylosing spondylitis (AS); adult and paediatric Crohn’s disease; refractory fistulising Crohn’s disease; adult and paediatric ulcerative colitis; and plaque psoriasis.

Inflectra is a biosimilar medicine formulated to deliver comparable efficacy, safety and quality as the originator biologic, Remicade® (infliximab) – a mAb therapy that cost the PBS more than $100 million last year.

A biosimilar is a biologic medicine that has been researched and developed in line with the high quality standards of biologic manufacturing to treat the same diseases as the originator product. A biosimilar has the potential to deliver a 20-30 per cent reduction in the price paid for the therapy.

Related Stories

The TGA approval of Inflectra is based on extensive data, including the results of pivotal trials in patients with RA and AS which concluded that the biosimilar was therapeutically comparable to Remicade®.

“Inflectra offers comparable efficacy, safety and quality as the reference product, with the potential for sizeable cost savings,” said Wayne Lee, Associate Director, Medical Affairs, Hospira.

“Registration of Inflectra by the TGA shows that they support the fundamental principles of data extrapolation which allows patients and healthcare professionals to access the full suite of indications. This is an important development for patients, prescribers and payers,” he said.

With a number of originator biologic medicines (primarily mAb therapies) set to come off patent, the Federal Government in Australia estimates that increased use of biosimilar medicines will deliver $880 million in PBS savings over the next five years.3

“Biosimilars increase access to medicines and we look forward to working with the Government and prescribers to ensure the full benefits of biosimilars are realised in Australia,” Mr Lee added.

Hospira has one of the largest biosimilar pipelines in the industry and has already delivered more than 10 million doses of biosimilar medicines to patients worldwide, including many cancer patients in Australia who receive treatment with Nivestim™, a filgrastim biosimilar, for neutropaenia.


Hospira, Inc.

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NHS 'could prescribe E-cigarettes'

E-cigarettes could be prescribed by the NHS to help smokers quit, report says

By Adam Brimelow
Health correspondent, BBC News
  • 19 August 2015
  • From the section Health
  • comments
Woman smoking an electronic cigarette

E-cigarettes are 95% less harmful than tobacco and could be prescribed on the NHS in future to help smokers quit, a review of their use has concluded.

Experts who have compiled a report for Public Health England say “vaping” could be a “game changer” for persuading people to quit cigarettes.

They also say there is no evidence they give children a “gateway” into smoking.

Some health campaigners have welcomed the findings, but the British Medical Association has expressed caution.

The Welsh government has previously announced that it plans to ban the use of e-cigarettes in enclosed spaces. Now opposition parties have criticised the plans.

E-cigarettes are increasingly popular and are now used by 2.6 million adults in Britain.

But public health experts have been divided over whether they should be seen as a much safer alternative to smoking, or a pathway to a deadly addiction.

Public Health England asked a team of experts to examine the emerging evidence.

Their findings are unequivocal. On the question of safety, they conclude – as a broad estimate – that e-cigarettes are “around 95% less harmful” than smoking.

One of the report authors, Prof Ann McNeill from King’s College London, said e-cigarettes could be a “game-changer” in public health.

1. On some e-cigarettes, inhalation activates the battery-powered atomiser. Other types are manually switched on

2. A heating coil inside the atomiser heats liquid nicotine contained in a cartridge

3. The mixture becomes vapour and is inhaled. Many e-cigarettes have an LED light as a cosmetic feature to simulate traditional cigarette glow.

Different brands of e-cigarettes contain different chemical concentrations.

“At the moment, 80,000 people [in England] die every year as a result of cigarette smoking. If everybody who was smoking switched to e-cigarettes that would reduce to about 4,000 deaths a year. That’s the best estimate at the moment. It may well be much, much lower than that.”

The report says that although GPs and stop-smoking services are currently not able to prescribe e-cigarettes as none of the products on the market are licensed for medicinal purposes, they hope that hurdle will be removed in the future.

Potential cost

By Hugh Pym, BBC health editor

From nowhere to more than 2.5 million British users in under a decade – the e-cigarette story has moved at a dramatic pace

But what about the cost of prescribing?

In England in 2013-14, there were nearly 1.8 million prescription items to help patients stop smoking.

More than half were for Nicotine Replacement Therapy, including patches, gum and sprays.

The cost to the NHS in that year was just under £49m, down on the figure three years earlier.

If approved, e-cigarettes would add to that total, with the kit costing £20 or more and replacement fluid about £10-a-week for the average smoker trying to kick the habit.

Health campaigners will argue that the cost is justified by long-term savings on the treatment of smoking related diseases.

Public Health England says it is “committed to ensure that smokers have a range of evidence-based, effective tools to help them to quit.

“We encourage smokers who want to use e-cigarettes as an aid to quit smoking to seek the support of local stop-smoking services, given the potential benefits as quitting aids,” it adds.

“PHE looks forward to the arrival on the market of a choice of medicinally regulated products that can be made available to smokers by the NHS on prescription.”

In the meantime, Prof McNeill said she would urge health professionals to discuss the use of e-cigarettes with people who want to quit smoking.

“If I was running a stop-smoking service, I would encourage people who are interested in trying e-cigarettes to have a go. I would also be recommending all the other evidence-based medications that people can use.”

The review also highlights evidence that growing numbers of people have doubts over the safety of the devices. It says nearly half the population (44.8%) do not realise e-cigarettes are much less harmful than smoking.

Prof Kevin Fenton, director of health and wellbeing at Public Health England, said it was important to tackle what he called “harmful myths”.

“E-cigarettes are not completely risk-free but when compared to smoking, evidence shows they carry just a fraction of the harm. The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting.”

Strong regulation

The report concludes there is no evidence, so far, that e-cigarettes are acting as a route into smoking for children or non-smokers. It says regular use is found “almost exclusively” among those who have already smoked, and that e-cigarettes have rapidly become the most widely used quitting aid in England.

The findings have been welcomed by Action on Smoking and Health (Ash). The charity’s chief executive, Deborah Arnott, said: “This timely statement from Public Health England should reassure health professionals, the media, and the public, particularly smokers, that the evidence is clear: electronic cigarettes are very much less harmful than smoking.”

The British Medical Association, which has backed curbs on the use of e-cigarettes, was more guarded. Spokesman Dr Ram Moorthy said the review would help ensure an informed debate, but he insisted the public needed protection.

“We need to see a stronger regulatory framework that realises any public health benefit they may have, but addresses significant concerns from medical professionals around the inconsistent quality of e-cigarettes, the way they are marketed, and whether they are completely safe and efficient as a way to reduce tobacco harm.”

A spokesman for the Welsh Government, which aims to restrict e-cigs in line with cigarettes, said: “We are concerned the use of e-cigarettes may renormalise smoking, especially for a generation who have grown up in a largely smoke-free society.

“We are not alone in our concerns – the World Health Organisation and other international bodies have called for greater regulation of e-cigarettes and 40 other countries have already taken similar steps.

“Our Bill does not aim to prevent the use of e-cigarettes for those seeking to give up conventional smoking.”

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