March 2014 Focus

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In this Issue:

News Update
FDA Reviewing Low-T Therapy After Second Study Shows CV Issues
Focus on COPD/Asthma
Obstructive Sleep Apnea Significantly Increases Risk of Severe Asthma

Bronchial Thermoplasty Brings Long-Term Relief to Severe Asthmatics

Pharmacy Update
VA Pharmacy Reengineering Project Plagued by Ongoing Problems
Multiple Sclerosis Clinical Consult
Dalfampridine ER Improves Walking in Veterans with MS
Breast Cancer Clinical Consult
How Prescribers Discuss Opioid Use/Abuse with Patients

U.S. MEDICINE NEWS UPDATE


FDA Reviewing Low-T Therapy After Second Study Shows CV Issues

WASHINGTON – With a second study showing increased risk of cardiovascular events among men using testosterone replacement therapy, the Food and Drug Administration announced that it is reassessing the safety of those products. The agency said it is investigating the risk of stroke, heart attack and death in men taking FDA-approved products for low testosterone. A recent study appearing in the online journal PLOS ONE, found that the risk of myocardial infarction following initiation of testosterone therapy is substantially increased in older men and in younger men with pre-existing diagnosed heart disease. A VA study late last year also found that testosterone replacement therapy increased risks of death, heart attack or ischemic stroke in veterans who had undergone coronary angiography and low serum testosterone levels.
More

http://www.usmedicine.com/2014-issues/fda-reviewing-low-t-therapy-after-second-study-shows-cv-issues/

FOCUS ON COPD/ASTHMA

Mihaela Teodorescu, MD

Obstructive Sleep Apnea Significantly Increases Risk of Severe Asthma

MADISON, WI – For older patients, obstructive sleep apnea appears to increase the risk of severe asthma sevenfold, which could be especially significant for veterans because of their high rates of sleep apnea. The study, led by researchers at William S. Middleton Memorial VA Hospital in Madison, WI, suggests that assessment of obstructive sleep apnea risk might provide important guidance for asthma treatment. Researchers suggest that asthma comes first and sleep apnea develops later, worsening the asthma symptoms.
More

http://www.usmedicine.com/agencies/department-of-defense-dod/obstructive-sleep-apnea-significantly-increases-risk-of-sever-asthma/

Col. Eric A. Crawley, MD

Bronchial Thermoplasty Brings Long-Term Relief to Severe Asthmatics

HONOLULU – Pulmonologists at Tripler Army Medical Center in Honolulu have pioneered a treatment that has brought relief to nearly a dozen military health system or VA patients with severe asthma during the past two years – and may have the potential to enable similar patients to remain on active duty in the future. The procedure, bronchial thermoplasty, uses radiofrequency energy (RFE) delivered through an expandable wire array passed through a standard bronchoscope into the lungs to heat and destroy some of the excess airway smooth muscle (ASM) that lines the bronchial tubes in severe asthma. By decreasing the volume of smooth muscle, thermosplasty reduces the force of the muscle spasms that cause breathing problems during an asthma attack.
More

http://www.usmedicine.com/agencies/department-of-defense-dod/bronchial-thermoplasty-brings-long-term-relief-to-severe-asthmatics/

PHARMACY UPDATE

VA Pharmacy Reengineering Project Plagued by Ongoing Problems

WASHINGTON – Originally launched in March 2003 and restarted in October 2009, the Pharmacy Reengineering (PRE) software development project continues to miss deadlines, stumble in deployment and suffer from project management failures. That’s according to a recent audit by the VA’s Office of the Inspector General which notes that these problems put delivery of critical patient safety functionality at risk of missing a 2019 deadline. Investigators point out that PRE isn’t just another software project that’s running a little behind schedule but is needed to address patient safety issues with adverse drug events.
More

http://www.usmedicine.com/agencies/department-of-veterans-affairs/va-pharmacy-reengineering-project-plagued-by-ongoing-problems/

MULTIPLE SCLEROSIS CLINICAL CONSULT

Dalfampridine ER Improves Walking in Veterans with MS
PORTLAND, OR – In a recent study, Portland VAMC researchers found that, in short-term trials, dalfampridine extended release (ER) improves walking in veterans with multiple sclerosis (MS). In the study, which was published recently in Multiple Sclerosis Journal, the authors noted that the tolerability and effects of dalfampridine-ER in clinical practice had not previously been reported. For the study, all MS patients at the Portland VAMC prescribed dalfampridine-ER over one year completed the Timed 25-Foot Walk (T25FW), Multiple Sclerosis Walking Scale-12 (MSWS-12), Two-Minute Timed Walk (2MTW) and Community Integration Questionnaire (CIQ) at baseline and follow-up clinic visits. Ongoing use and measures were then analyzed.
More

http://www.usmedicine.com/2014-issues/dalfampridine-er-improves-walking-in-veterans-with-ms/

BREAST CANCER CLINICAL CONSULT

In-House Breast-Conserving Surgery Lower in VHA Facilities

TAMPA, FL – Looking just at procedures performed in-house, rates of breast-conserving surgery (BCS) are much lower at the VHA than in the private sector, according to a new study led by researchers from the James A. Haley Veterans’ Hospital in Tampa. Rates were more similar, however, when procedures performed by an outside facility but purchased by the VHA were taken into account, according to the study. The authors, noting that previous non-state-adjusted research found a lower use of BCS for breast cancer at VHA facilities, called for further exploration and prospective analyses to examine their findings.
More

http://www.usmedicine.com/agencies/department-of-defense-dod/in-house-breast-conserving-surgery-lower-in-vha-facilities/

Brenda L. Mooney

Editorial Director, U.S. Medicine

mooney@usmedicine.com

39 York Street

Lambertville, NJ  08530

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