Medical News You May Have Missed - Week of March 4th

"Choosing Wisely" Campaign Releases New Lists of Questionable Procedures, Meds

Seventeen medical societies recently released lists of close to 90 frequently ordered but often unnecessary tests and procedures, as part of the American Board of Internal Medicine Foundatio's (ABIM) "Choosing Wisely" campaign.

The lists, developed by a growing number of professional societies, present “Things Physicians and Patients Should Question” in a concerted effort to encourage discussion between patient and clinician about medical tests and procedures that may be appropriate to forgo. The campaign now includes lists from 35 specialty societies, including the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).

The ACP’s No. 1 recommendation, out of 5 things to question, was the need for  screening exercise electrocardiogram testing in asymptomatic, low-risk patients.

The AAFP released a list of 10 tests and procedures. The top item was to avoid imaging for low back pain within the first 6 weeks after symptoms appear, an item that also appeared in the ACP’s top five.

“Choosing Wisely” was launched in April 2012 with 9 medical specialties participating.  New to the initiative this year, among other groups, are: American Academy of Ophthalmology, American College of Obstetricians and Gynecologists, American Society for Clinical Pathology, and the American Society of Echocardiography.  

For a complete list of participating professional societies and “Top Things…” lists, click here.

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Colonoscopy Reduced Risk of Late-Stage Colorectal Cancer by 70%

Adults of average risk for colorectal cancer can reduce the likelihood of being diagnosed with late-stage disease by 70% by undergoing screening colonoscopy, according to the results of a case-control study published in Annals of Internal Medicine.

This decrease in risk was also seen for right colon cancer (OR=0.36; 95% CI, 0.16-0.80), where evidence of the effectiveness of colonoscopy has been limited. 

A second studied published in Annals found that patients who received electronic health record-linked automated reminders to undergo colorectal cancer screening were twice as likely to be up to date on screening than patients who were given usual care (56.8% vs. 26.3%; P<.001). In this study, automated reminders included letters, pamphlets, and fecal occult blood tests mailed to participants. 

Additional support, such as a follow-up phone call or nurse navigation, increased the number of patients up-to-date on screening compared with automated methods alone.

An abstract of the colorectal screening study can be found here and an abstract for the electronic health record study can be found here.

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HIV-Positive Status Increased Risk for Acute MI by Almost 50%

Veterans infected with HIV had a 48% increased risk for acute myocardial infarction (AMI) compared with uninfected veterans, even after adjustment for Framingham risk factors, comorbidities, and substance use. This increase persisted even among those veterans with an HIV-1 RNA level of less than 500 copies/mL (HR=1.39; 95% CI, 1.17-1.66). The findings were reported in a new study published online March 4 in JAMA: Internal Medicine.

Researchers examined the link between HIV and risk for AMI among 82,459 participants (97.2% men) in the Veterans Aging Cohort Study Virtual Cohort from April 1, 2003 to December 31, 2009. During that time, 871 AMIs were reported with the mean number of events per 1,000 person-years statistically greater among male veterans with HIV across three age groups:

• 40 to 49 years: 2.0 vs. 1.5 (P<.05).
• 50 to 59 years: 2.9 vs. 2.2 (P<.05).
• 60 to 69 years: 5.0 vs. 3.3 (P<.05).

The study authors note that while their findings are consistent with prior results in this area, their analyses are more definitive. This study included adjudicated AMI events within the VA, transfers to the VA, and events not treated at the VA (Medicare and Medicaid), and fatal and nonfatal AMI events. Also considered in this study were confounders such as smoking and rates of AMI among infected participants compared with uninfected participants matched for demographic and behavioral similarities.

An accompanying editorialist commented that this increased risk found in men underscored “the need for further research in women, research into the underlying mechanisms of the increased risk, and the development of specific interventions to reduce the risk of AMI in HIV-positive populations.”

The article can be accessed for free, here.

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Anemia Drug Recalled; Hypersensitivity Reported

Takeda Pharmaceuticals issued a voluntary nationwide recall of all lots of peginesatide (Omontys) injection, according to an FDA alert issued on February 24. The drug, an erythropoiesis-stimulating agent, has been associated with serious and fatal hypersensitivity reactions, including anaphylaxis, in some patients receiving a first dose.

The reactions, reported to the FDA by 19 US dialysis centers, have occurred within 30 minutes of injection. No reports of reactions have been reported in patients receiving subsequent doses or in patients who have completed their dialysis session.

According to the FDA, health care providers should stop using peginesatide and return the product to the manufacturer.

The FDA is asking health care professionals to report any adverse reactions to the FDA’s MedWatch program online, by fax, or by regular mail: 

• Complete and submit the report online at www.fda.gov/medwatch/report.htm, or
• Download and complete the form, then submit it via fax at 1-800-FDA-0178, or
• Print and complete postage-paid, pre-addressed Form FDA 3500 available at:
https://www.accessdata.fda.gov/scripts/medwatch/. Mail to address on the pre-addressed form.

The FDA recall notice can be read here.

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Artificial Pancreas Reduced Nocturnal Hypoglycemia in Type 1 Diabetes

Patients aged 1 to 18 years with type 1 diabetes at a diabetes camp experienced less than half as many episodes of nocturnal hypoglycemia and were able to maintain tighter glucose control when using an artificial pancreas system than when they used a sensor-augmented insulin pump, according to a study reported on February 28 in The New England Journal of Medicine.

When using the insulin pump, patients reported 22 hypoglycemia events, defined as glucose less than 63 mg/dL, compared with only 7 events when using the artificial pancreas system. The mean overnight glucose level was also significantly lower with the artificial pancreas (126.4 mg/dL) compared with 140.4 mg/dL when using the insulin pump.

The 56 patients were randomly assigned to use either the artificial pancreas or the insulin pump during two overnight sleep sessions. The multinational crossover study was conducted in the camp setting as a test of the feasibility of implementing the artificial pancreas system outside the hospital.

The full study is available here.

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