Briefly this week, there is no less risk of blood clots associated with central venous catheters with the prophylatic use of warfarin, a new drug is tested in mice that might be useful in chemoprevention, and disparities between blacks and whites are found in post-surgical deaths in teaching hospitals.
Pet owners may be persuaded to stop smoking if they realize their pets are in danger, the Commonwealth Fund proposes comprehensive change in the US health care system, and Deadly in Pink reveals new tobacco marketing strategies that are focusing on young women.
Brief Research Reports
Using warfarin (Coumadin®) to prevent clots in central venous catheters (CVC) doesn’t help. After their CVCs were inplanted, 1590 patients in 68 centers in the United Kingdom were randomly assigned to get no warfarin, a fixed daily dose of warfarin, or an adjusted daily dose based on their international normalised ratio (INR). Compared to no warfarin, neither fixed or adjusted dose warfarin showed lower rates of catheter-related blood clots. Such clots were experienced by 6 percent of patients in both groups. While bleeding episodes were rare, they occurred more often when patients were getting warfarin. Adjusted dose warfarin reduced bleeding instances. There was no impact on survival, no matter what approach was taken. Annie M. Young in The Lancet, February 14 2009.
Enzastaurin, a drug that targets a specific protein kinese in cells that can lead to abnormal cell division and growth, reduces colon cancer in mice. Protein kineses change the chemical structure of other proteins and the signals that they send within cells. Enzastaurin blocks protein kinese C-beta II, reducing changes to expression of three genes critical to the growth and development of colon cancer. The researchers believe that enzastaurin may be effective in preventing colon cancer in people at high risk for the disease. It is also being studied as a treatment for several cancers. Alan P. Fields in Cancer Research, February 15 2009.
White patients who have surgery in a teaching hospital are less likely to die from complications after surgery than if they had their operations in a hospital without residents in training. However, this difference doesn’t occur for black patients. They are as likely to die in a larger teaching hospital as in a smaller, non-teaching setting. Most of the improvement in death rates for whites comes from complications being recognized and treated successfully in teaching hospitals. Failure to rescue black patients with complications may account for the fact that they don’t do better in teaching hospitals, despite the presence of residents, higher nurse to patient ratios, and more technology. Jeffrey H. Silber, M.D. in Archives of Surgery, February 2009.
Pet owners who smoke might be motivated to quit to protect their animals. A web-based survey of 3,300 pet owners found that about 1 in 5 smoked and 1 in 4 lived with someone who smoked. If they had information that secondhand smoke hurt their pets, about a third of the smokers said they would try to quit. Some also agreed to ask others not to smoke or to smoke outside. Among people living with smokers, 1 in 4 would ask people to smoke outside away from pets. About half of smokers wanted to get information about how secondhand smoke affected their animals. Sharon Milberger in Tobacco Control, online February 10, 2009.
The Commonwealth Fund proposes changes in the US health care system to cover the uninsured and reduce growth in health care costs. If enacted now, it would ensure universal coverage by 2012 and reduce expected costs in 2020 by $3 billion. Everyone would be required to choose either a private or public health insurance plan through a national insurance exchange with premiums based on income, not health status. Payment policies would move from “fee-for-service” to bundled reimbursements, rewarding evidence-based outcomes and coordination of care. Full proposal from the Commonwealth Fund: The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way, February 19, 2009.
Deadly in Pink, a new report from a collaboration of health advocates including the American Cancer Society, reveals how tobacco advertising is targeting women and girls. Purse packs resembling cosmetics, feminine colors and designs in ads and cigarette packaging, and ads in women’s magazines focus on slimness and fashion while terms like “low-tar” untrue health messages. Deadly in Pink website has links to the full report, a video, and other information.