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Featured Resource: HealthPathNC

Public health–related documents are well represented within the State Library of North Carolina's digital collections. To provide a convenient access point to this information, and in preparation for future digitization efforts, they are introducing a new portal: HealthPathNC. Through this portal, you can access materials available in popular current collections like those on eugenics in North Carolina and the influenza epidemic of 1918– 1919. You can also more easily find groups of topically related public health documents. HealthPathNC includes multiple methods for accessing the public health collection, including keyword searching, browsing, and selecting from a variety of popular health topics. There is also a list of general resources including books, original manuscripts, digital collections, and online exhibits that will provide you with more in–depth information about some of the topics you’ll see in HealthPathNC.

Check out the new site at http://statelibrary.ncdcr.gov/digital/healthpath/index.html

Proton-Pump Inhibitors and Clopidogrel: Important Interaction?

Coronary heart disease patients who received both drugs experienced fewer hospitalizations for gastrointestinal bleeding than did those who received clopidogrel alone.

Researchers have suggested that concomitant use of clopidogrel and proton-pump inhibitors (PPIs) is associated with elevated risk for cardiovascular disease (CVD) events. In this retrospective cohort study, investigators reviewed Tennessee Medicaid data for 20,596 patients who received clopidogrel after hospitalization for myocardial infarctions (MIs), coronary artery revascularization, or unstable angina during a 7-year period; 37% received concomitant PPI therapy.

PPI recipients experienced fewer hospitalizations for gastrointestinal bleeding than did nonrecipients (8.2 vs. 12.2 per 1000 person-years). Results remained significant (hazard ratio, 0.50) in analyses adjusted for demographics, other medication use, diagnosis and procedures, and a propensity score (a variable constructed from the data that makes the analysis more like that of a randomized trial). CVD hospitalizations (for acute MI, sudden death, stroke, or other CVD-related death) were similar for PPI recipients and nonrecipients (63.8 and 64.5 per 1000 person-years). In adjusted analyses, the hazard ratio was 0.99 (not significant).

Comment: PPIs could inhibit the transformation of clopidogrel to its active metabolite, thus reducing clopidogrel's beneficial antiplatelet effects. This large study, as well as several other recent studies (Journal Watch, Gen Med Feb 23 2010 and Journal Watch, Gen Med Oct 8 2009), suggest no adverse effects on cardiovascular outcomes with concomitant use of clopidogrel and PPIs. However, the authors point out that the confidence intervals around their best estimates of risk for adverse clinical outcomes mean that risks associated with PPIs could exceed benefits when risk for a CVD-related event is high and risk for gastrointestinal bleeding is low.

Source:
Ray WA. Outcomes with consurrent use of clopidogrel and proton-pump inhibitors: a cohort study. Ann Intern Med 2010 Mar 16;152(6):337-45. PMID:20231564.

Cancer Surgery, Diabetes & Mortality

In a systematic review and meta-analysis appearing in the April 2010 edition of Diabetes Care, researchers conclude that "cancer patients with preexisting diabetes are about 50% more likely to die after surgery than their nondiabetic counterparts".

The abstract of this article, Postoperative Mortality in Cancer Patients With Preexisting Diabetes, can be found online at: http://care.diabetesjournals.org/content/33/4/931

Health Care Reform News and Views

The Washington Post has created a special section on the health care reform bill and associated news. View the full suite of stories and features online at http://voices.washingtonpost.com/health-care-reform/.

The Great Prostate Mistake

The inventor of the PSA test for prostate cancer screening Prof Richard Ablin, in a very recent op-ed in the NY Times, today regrets his invention and rues how it has led to a multi-billion dollar profit driven public health disaster in the USA . He writes - I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.

You can read the entire editorial at the following Web-link:
http://www.nytimes.com/2010/03/10/opinion/10Ablin.html

The Wireless Future of Medicine

Check out this TED talk on using mobile devices in health care. See some of the technology that can "take individualized medicine to a new height."

Eric Topol says we'll soon use our smartphones to monitor our vital signs and chronic conditions. At TEDMED, he highlights several of the most important wireless devices in medicine's future -- all helping to keep more of us out of hospital beds.

Eric Topol: The wireless future of medicine (17 min video)