Popular Articles

Inflammation-Regulating Protein May Prove Relevant To Controlling Sepsis
Scientists at Singapore"s Institute of Molecular and Cell Biology (IMCB), under the Agency for Science, Technology and Research (A*STAR), have identified the protein, WIP1, as the molecular "brake" that curbs severe inflammation in the body.

Appeals Court Panel Says Pharmacists Must Distribute Emergency Contraception Under Washington State Regulation
A three-judge panel of the U.S. Circuit Court of Appeals for the 9th Circuit on Wednesday unanimously ruled to lift an injunction blocking Washington state officials from penalizing pharmacists who refused to dispense the emergency contraception pill Plan B, the Los Angeles Times reports (Williams, Los Angeles Times, 7/9). The panel said the district court judge who issued the injunction refused to consider women"s need for EC (Egelko, San Francisco Chronicle, 7/9). The panel"s ruling is part of a larger case before the district court involving the constitutionality of a 2007 state regulation requiring pharmacies to stock and dispense EC. Joyce Roper, an assistant attorney general for Washington state, said the appeals court ruling means that the 2007 regulation will take immediate effect.The plaintiffs in the case, Stromans -- a supermarket pharmacy owner -- and two pharmacists employed elsewhere, argued that the state regulation requiring pharmacists to stock and dispense EC violated their First Amendment right to freedom of religion (Los Angeles Times, 7/9). The regulation said that pharmacies must stock and fill legally prescribed prescriptions but allowed individual pharmacists to object on moral or religious grounds if another pharmacist was available, in person or by telephone, to fill the order (San Francisco Chronicle, 7/9). The plaintiffs argued that the regulation would force them to choose between following their religious beliefs and keeping their jobs. They contended that EC prevents implantation of a fertilized egg, which they equated with abortion. The U.S. District Court in Seattle awarded the plaintiffs the temporary injunction in November 2007, pending trial on the constitutionality of the regulation (Los Angeles Times, 7/9). Plan B contains a high dose of a drug found in most birth control pills that generally prevents ovulation or the fertilization of an egg. Recent research suggests that it does not prevent a fertilized egg from implanting in the uterus (Woodward, AP/Seattle Post-Intelligencer, 7/8). FDA in April lowered the age limit for nonprescription purchase of Plan B from 18 to 17 (San Francisco Chronicle, 7/9). Appeals Panel Returns Case to District CourtThe appeals court panel ruled that the freedom to exercise one"s religion "does not relieve an individual of the obligation to comply with a valid and neutral law of general applicability." The panel added, "Any refusal to dispense -- regardless of whether it is motivated by religion, morals, conscience, ethics, discriminatory prejudices or personal distaste for a patient -- violates the rules" (Los Angeles Times, 7/9). The panel ordered the district judge to reconsider the 2007 regulation under Supreme Court standards that allow states to pass neutral laws that may affect religious practices. According to the panel, the regulation does not aim to interfere with religious practices or beliefs and is intended to promote patients" health. In addition, the panel said the district court judge did not consider how the injunction would affect "sexually active women of childbearing age who will be denied reasonable access to Plan B" (San Francisco Chronicle, 7/9). According to the Times, the panel"s ruling could foretell future judgments in the case, including that a patient"s right to timely medication surpasses a pharmacist"s personal beliefs (Los Angeles Times, 7/9).
News of the day
Allergan Receives FDA Approval For ACUVAIL(TM) Ophthalmic Solution For The Treatment Of Pain And Inflammation Following Cataract Surgery
Allergan, Inc. (NYSE: AGN) announced that the United States Food and Drug Administration (FDA) has approved ACUVAIL(TM) (ketorolac tromethamine ophthalmic solution) 0.45%, an advanced, preservative-free formulation of ketorolac, a nonsteroidal anti-inflammatory drug (NSAID) indicated for the treatment of pain and inflammation following cataract surgery. Cataracts are a leading cause of blindness among older adults and cataract surgery is the most frequently performed surgical procedure in the United States, with more than 3 million procedures performed each year.1
Oncology

Success In Hospitalist-Run Short-Stay Units Driven By Availability Of Diagnostic Tests

The most important factors for a successful stay in hospital short-stay units (SSUs) are the types of diagnostic tests performed and whether or not specialty consultations are needed. When hospitalists staff these units, they can ensure that only patients who need readily accessible services are admitted. These are the findings of a study published in the Journal of Hospital Medicine. SSUs provide an alternative to traditional inpatient services for patients and exist in one-third of hospitals in the United States. These units deliver efficient and high-quality care to patients requiring short anticipated hospital stays for medical conditions like low risk chest pain, but little is known about what factors predict SSU success. As demand for inpatient services have grown, SSUs have expanded beyond "observation medicine" to provide more complex inpatient services (such as management of heart failure, diabetes out-of-control, and transient ischemic attacks) in locations commonly adjacent to emergency departments. To inform the future direction of the rapidly expanding SSUs, the researchers collected data on consecutive patients admitted to a SSU over a four month period. 738 patients were eligible to the study, and the majority (85%) were admitted with either a provisional diagnosis of possible acute coronary syndrome or heart failure. As SSUs were designed to care for patients during brief stays, visits were considered successful when the length-of-stay was less than 72 hours and eventual admission to traditional inpatient services was not required. Of the 738 patients, 71% (582) had successful SSU stays. Patients who received inaccessible tests or specialty consultations were much more likely to have an unsuccessful stay than patients who did not. For example, patients who received a consultation had a 52% chance of having an unsuccessful stay. "We found that less accessible diagnostic tests and the need for consultations had the greatest association with unsuccessful stays," said lead researcher Dr. Brian Lucas, of Stroger Hospital of Cook County and Rush University Medical Center, Illinois, USA. "From this we concluded that hosptialists who staff SSUs should focus administratively toward gaining access to services that their patients will need. Also, hospitalists can help emergency department physicians make admission-location decisions by discussing the potential needs of the patient prior to SSU admission." "Among very-low or low-risk patients - the types of patients who are typically admitted to SSUs - considering what services patients will need is more important than further refining their clinical risk," added Lucas. This study is published in the Journal of Hospital Medicine. Full citation: Lucas BP, Kumapley R, Mba B, Nisar I, Lee K, Ofori-Ntow S, Borkowsky S, Asmar A, Lewis T, Bienias JL; A hospitalist-run short stay unit: features that predict length-of-stay and eventual admission to traditional inpatient services; J Hosp Med 2009; 4(1): 13-15; DOI: 10.1002/jhm.386 About the Author: Brian P Lucas MD MS, is based at Stroger Hospital of Cook County and Rush University Medical Center. As well as a practicing hospitalist, Dr. Lucas is also an Assistant Professor at Rush University and Chief, Division of Hospital Medicine. Jennifer Beal Wiley-Blackwell


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