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临床时讯 > 专家论坛


美国医学网站基层医生阅读率最高的十大新闻


  Medscape是美国专为临床医师和其他健康工作者提供医学信息的网站,2011年底其推出各种“十大(top10)”盘点,让我们看看美国初级保健医生(Primary Care Physicians)频道评出的点击率最高的10篇新闻。

  Top1:FDA一年内连续调整辛伐他汀的建议使用剂量

  2011年6月8日,美国食品与药物管理局(FDA)建议,辛伐他汀最大剂量不应超过80mg/d,且该剂量仅可用于已经连续使用辛伐他汀80mg/d超过12个月未出现肌肉损伤的患者;新启用辛伐他汀治疗和已经使用小剂量辛伐他汀治疗的患者最大安全剂量不应超过40mg/d。

  FDA还建议,同时服用胺碘酮、维拉帕米和地尔硫公式的患者,辛伐他汀剂量不应超过10mg/d;在同时服用氨氯地平和雷诺嗪的患者,辛伐他汀剂量不应超过20mg/d。但2011年12月15日,FDA宣布恢复辛伐他汀剂量限制,即在辛伐他汀与胺碘酮合联用时,其药物剂量限制由10mg改为20mg。

  FDA声明,目前尚无药代动力学或临床证据显示,辛伐他汀与胺碘酮联用时应减少药物剂量,故FDA纠正上述错误,将辛伐他汀与胺碘酮联用时的剂量重新调整至20mg,但辛伐他汀与维拉帕米和地尔硫公式联用时的剂量限制仍为10mg。

  Top4:美国CDC 2011~2012年流感疫苗接种建议

  美国疾病预防与控制中心(CDC)建议,6龄童以上人群都应当接种流感疫苗,以保护更多的人群免受流感侵袭。

  CDC建议每年都要接种流感疫苗,由于人体对于流感病毒的免疫力会随着时间而逐渐减弱,所以通过上一次接种获得的免疫力也许并不能够保证今年仍然有效。文章见美国CDC官方网站(CDC Expert Commentary,September 2011)。

  Top9:茶和咖啡可降低鼻腔MRSA携带量

  美国学者研究发现饮用热茶和热咖啡可能降低耐甲氧西林金黄色葡萄球菌(MRSA)鼻腔携带及感染。研究发表于《家庭医学年鉴》杂志上。

  研究者对2003年至2004年美国健康与营养调查数据进行二次分析。结果显示,全美预计有250万的MRSA鼻腔携带者,经过校正后的回归分析结果显示,饮用热茶人群的鼻腔MRSA携带率较不饮用热茶人群降低一半,饮用热咖啡的效果相似。研究者认为通过该研究可能发现安全、廉价和易于获得的降低鼻腔MRSA携带量的方法。

Ann Fam Med. 2011 Jul-Aug;9(4):299-304.

Tea and coffee consumption and MRSA nasal carriage.

Matheson EM, Mainous AG 3rd, Everett CJ, King DE.

Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.

PURPOSE: Hot tea and coffee have been found to have antimicrobial properties. The purpose of this study was to determine whether the consumption of tea, coffee, or both is associated with less frequent nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA).

METHODS: We performed a secondary analysis of data from the 2003-2004 National Health and Nutrition Examination Survey to investigate the relationship between the consumption of coffee, hot tea, cold tea, and soft drinks, and MRSA nasal carriage among the noninstitutionalized population of the United States.

RESULTS: An estimated 2.5 million persons (1.4% of the population) were MRSA nasal carriers. In an adjusted logistic regression analysis controlling for age, race, sex, poverty-income ratio, current health status, hospitalization in the past 12 months, and use of antibiotics in the past month, individuals who reported consuming hot tea were one-half as likely to have MRSA nasal carriage relative to individuals who drank no hot tea (odds ratio = 0.47; 95% confidence interval, 0.31-0.71). Similarly, individuals who reported consuming coffee had about a one-half reduction in the risk of MRSA nasal carriage relative to individuals who drank no coffee (odds ratio = 0.47; 95% confidence interval, 0.24-0.93).

CONCLUSIONS: Consumption of hot tea or coffee is associated with a lower likelihood of MRSA nasal carriage. Our findings raise the possibility of a promising new method to decrease MRSA nasal carriage that is safe, inexpensive, and easily accessible.

  其他

  Top2:医生的5大理财误区:按照同事的主意进行投资、未购买足够的保险、只关注延税储蓄、过于相信理财雇员、不能从债权人手中很好地保护不动产。

  Top3:2011年5月2日,美国食品与药品管理局(FDA)批准一种治疗2型糖尿病的口服新药利拉利汀(linagliptin)上市。

  Top5:许多刚从医学院校毕业的毕业生因巨额的助学贷款等原因,刚工作后年薪高达16万美元仍然生活艰难。

  Top6:包括肿瘤、糖尿病、慢性呼吸系统感染和心血管疾病在内的4种非传染性疾病(NCD)已成为全人类需要共同努力干预的疾病。这些疾病的共同点就是可以通过改变生活方式进行干预。目前,世界范围内非传染性疾病已成为造成死亡的首要原因,因其造成的死亡病例占所有死亡病例的2/3。

  Top7:受雇医生6大抱怨:缺乏工作安全感、薪资不稳定、随叫随到太累人、业务无法掌控、缺乏临床自主性、非竞争性霸王条款。

  Top8:2011年9月8日,联邦医疗保险对91人提起公诉,包括10名医生,称其通过虚报医疗费用收取回扣,非法开出止痛药处方,虚构心理治疗程序等手段骗取2.95亿美元医疗保险费用。

  Top10:侵袭性黑色素瘤(MM)早期识别的ABCDE方法,A即非对称(asymmetry),B即边缘不规则(border irregularity),C即颜色变化(color variability),D即直径大于6毫米(diameter greater than 6 mm),E即进展或变化(evolution or change)。

Counting Down 10 Through 1: Most-Read Medscape Articles by PCPs

10. The "Ugly Duckling" Sign: An Early Melanoma Recognition Tool For Clinicians and the Public

The key to preventing deaths due to invasive melanoma (MM) remains detecting the disease early, at a stage when surgical excision of the tumor is still curative. One clinical clue to diagnosis is the "ugly duckling" sign -- a useful indicator for MM screening with implications for healthcare workers and the lay public alike. Given certain limitations of the established ABCDE acronym for early melanoma recognition, this study suggests a new, broader way of thinking about the ugly duckling concept and its place in MM detection.

9. Tea and Coffee Consumption and MRSA Nasal Carriage

In this study, consumption of hot tea or coffee was associated with a lower likelihood of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage. The findings raise the possibility of a promising new method to decrease MRSA nasal carriage that is safe, inexpensive, and easily accessible.

8. 10 Physicians Charged in Fed Sweep of Medicare 'Fraudsters'

In September, a federal bust of Medicare fraud in 8 cities has yielded criminal charges against 91 individuals, including 10 physicians as well as nurses, physical therapists, and family counselors. The defendants allegedly billed Medicare for $295 million in false claims with the help of kickbacks, illegal pain medication prescriptions, imaginary psychotherapy sessions, and other ploys. The US Department of Justice called the bust "the highest amount of false Medicare billings in a single takedown in Strike Force history."

7. Six Biggest Gripes of Employed Doctors

The 6 biggest complaints according to this article were:

  • Lack of job security;

  • Changes in compensation;

  • Call schedule is too burdensome;

  • Lack of business control;

  • Lack of clinical autonomy; and

  • The tyranny of noncompete clauses.

    This article offers a discussion where you might want to share ideas on this volatile subject

    6. What's Killing Us? The 4 Deadliest Diseases

    This Medscape One-on-One between Eli Adashi, MD and Tea Collins, Executive Director of The Non-Communicable Diseases (NCD) Alliance, discussed the importance of the new global initiative against four major NCDs that are responsible for 60% of deaths worldwide: cancer, diabetes, cardiovascular disease, and pulmonary disease.

    5. I'm Struggling to Live on $160,000 a Year: MD Lament

    Whereas most Americans would consider a $160,000 income a fortune, many physicians find it a challenge to live on that amount. Why can some manage easily while others are struggling to pay the bills?

    4. Updated Influenza Vaccine Recommendations Issue

    New for the 2011-2012 season is a more-permissive influenza vaccination recommendation for persons with egg allergies. The CDC Advisory Committee on Immunization Practices now recommends that people who have experienced only hives from consuming eggs can receive the trivalent inactivated vaccine intramuscularly as long as they are treated by a healthcare provider who is familiar with the potential manifestations of egg allergies and can be observed by a healthcare professional for at least 30 minutes after receiving each dose. Live-attenuated influenza vaccine should not be used in these patients. Read the full CDC commentary.

    3. FDA Approves New Drug for Type 2 Diabetes

    In May, the US Food and Drug Administration approved linagliptin (Tradjenta™) for improving blood glucose control in adults with type 2 diabetes, either as a stand-alone or in combination with other therapies.

    2. Doctors' 5 Worst Financial Mistakes

    Physicians do their best to manage their money and investments wisely, but a few common mistakes keep cropping up. Are you guilty of any of these?

    1. FDA Restricts Use of Simvastatin 80 mg

    In early June 2011, the US Food and Drug Administration (FDA) issued a drug safety communication on the 80-mg dose of simvastatin because of an increased risk for muscle toxicity. "Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug," the agency stated.

    It advised physicians to limit using the 80-mg dose unless the patient had already been taking the drug for 12 months and there is no evidence of myopathy. In addition, the FDA requested that additional changes be made to the drug's label. The label changes include the new dosing recommendations as well as warnings not to use the drug with various medications, including itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), erythromycin, clarithromycin, telithromycin (Ketek), HIV protease inhibitors, nefazodone, gemfibrozil, cyclosporine, and danazol. In addition, the 10-mg dose should not be exceeded in patients taking amiodarone, verapamil, and diltiazem, and the 20-mg dose should not be exceeded with amlodipine (Norvasc) and ranolazine (Ranexa).

    As a result, there was concern that physicians would not be comfortable escalating to branded statins because of resistance from managed care and sometimes the necessity for prior authorization. In addition, it was thought that many patients would also be distressed by the added cost of a more expensive statin. The availability of generic atorvastatin in November should help address these issues for many patients.

    For commentary on this issue see Switching From Simvastatin 80 mg: How to Shop for Statins and Simvastatin 80 mg: If You Can't Go Lower, Go Elsewhere

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