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In Elderly Lung Cancer Patients, All-Biologic Regimen Found To Be Efficacious And Well-Tolerated
Previously untreated non-small cell lung cancer (NSCLC) patients over the age of 70 respond well to a combination of bevacizumab and erlotinib, Fox Chase Cancer Center researchers reported at the annual meeting of the International Association for the Study of Lung Cancer.

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Boston Launches Safer-Sex Campaign Targeting Teenagers Using Social Networking Sites, Other Outlets
The Boston Public Health Commission has allocated $100,000 to a new campaign that uses social networking sites and other media outlets to raise sexual health awareness among teenagers, the Boston Globe reports. The city is facing increasing rates of sexually transmitted diseases among those age 15 to 19, according to the Globe. The new campaign will include educational videos featuring teenagers that will air on the MTV, FX and BET television networks; radio and mass transit advertisements; and theater performances. Facebook, YouTube and other social networking sites also will be used to reach teenagers with safer sex messages. Officials hope to address teenagers" "casual attitudes" toward sexually transmitted diseases, the Globe reports. Lydia Shrier, an adolescent medicine specialist at Children"s Hospital Boston, said teenagers might say ""Hey, I may get HIV, but it"s treatable and I"m going to live." It"s not a death sentence to them" (Smith, 8/4).
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Evidence Challenges Effectiveness Of Embryo Screening For Older Women
There is growing evidence that a procedure for identifying chromosomal abnormalities in embryos prior to in vitro fertilization is ineffective at helping older women become pregnant, the Wall Street Journal reports. The procedure -- known as pre-implantation genetic screening, or PGS -- is performed in dozen of U.S. fertility clinics and sometimes marketed to older women as a way to increase the odds of a healthy live birth. PGS involves extracting a single cell from a six-cell embryo and inspecting it for chromosomal abnormalities known as aneuploidies; unaffected embryos can then be implanted through IVF. Women older than age 35 have a higher risk of aneuploidies, in which embryos have fewer or more than the usual number of 23 pairs of chromosomes. Aneuploidies can trigger early miscarriage or certain genetics conditions, such as Down syndrome. Most medical experts agree that embryo screening is capable of significantly reducing the risk of Down syndrome and other serious chromosome-related illnesses. However, evidence from several studies increasingly suggests that the procedure does not increase older women"s chances of healthy live births. The American Society for Reproductive Medicine released an initial opinion about PGS in 2007, saying that available evidence does not support the use of embryo screening to increase live birth rates in older women. Andrew La Barbera, scientific director of the society, said, "Since that time, there have been several more trials that have reached the same conclusion." Another shortcoming is that most clinics can only test for fewer than half of the 23 chromosomes, meaning that many defects can go undetected. However, medical experts say that the use of PGS has increased in the two years since ASRM issued its recommendations. According to the Journal, PGS can add more than $2,000 to the roughly $10,000 cost of one IVF cycle. Very few health insurers cover PGS, though some pay for IVF. Some experts contend that studies showing a lack of clinical benefit from PGS do not use more efficient biopsy techniques that can prevent damage to the embryo. Santiago Munne, scientific director for Reprogenetics, said that the treatment is "effective." In a 2007 study, Munne and colleagues used PGS to reduce the rate at which patients miscarried. However, the chances of a woman getting pregnant largely were unchanged, which the authors said could be attributed to the small number of study participants (Naik, Wall Street Journal, 6/1).
Diagnostics

Focus On Patient Safety In Ambulatory Care System: UCSF Team

Health care experts at the University of California, San Francisco highlight in a new report the hidden risks and complexities that compromise patient safety for ambulatory patients with chronic disease. While most prior research in patient safety has focused on preventing medical errors during hospital stays, the UCSF team emphasizes that more attention should be paid to chronic disease patients who receive care on an outpatient basis. The team"s analysis appears in the July 2009 edition of the Joint Commission Journal on Quality and Patient Safety in an article titled "Refocusing the Lens: Patient Safety in Ambulatory Chronic Disease Care." The article describes how gaps in the current health care system undermine safety in the outpatient setting, leading to preventable death and disability as well as unnecessary costs. Unlike acute care settings, where patients receive care from trained teams of clinicians guided by protocols, the outpatient setting involves patients performing the day-to-day self-management of their chronic conditions, often in the absence of clear protocols, said lead author Urmimala Sarkar, MD, MPH, assistant professor of medicine in the UCSF Division of General Internal Medicine and the Center for Vulnerable Populations at San Francisco General Hospital Medical Center. The authors assert that ambulatory settings present unique challenges, such as lack of communication between health systems, communities with inadequate res, and patients struggling to manage multiple medications and complicated treatment regimens. They aim to refocus attention on the issue of ambulatory patient safety, because they have seen the adverse effects of medical errors in their own outpatient practices. "As a resident, I saw one of my patients who had just been discharged from the hospital," said Sarkar, "and I found that she was taking literally four times the maximum dose of her blood pressure medication. The medication overdose gave her kidney failure, and I had to send her right back to the hospital." The article, which appears in the journal"s "Forum" section, is the first to present a conceptual framework for advancing the field of ambulatory patient safety in chronic disease management. It uses actual clinical cases to illustrate the interrelated ways that communities and health systems, patient-provider interactions, and health behaviors all impact patient safety. To improve safety for chronic disease populations, the authors advocate first to improve patients" and caregivers" capacity for self-management. This includes targeting safety promotion efforts to those most at risk, including individuals with limited English proficiency, limited health literacy, and those with other social vulnerabilities, such as poverty and food insecurity. The team notes that patients with limited health literacy and language barriers report greater problems across a range of communications issues, including informed consent, shared decision making, and addressing health concerns with their providers. The authors also recommend that clinicians in ambulatory health systems develop more robust health information technology systems, especially for safety surveillance; improve communication among providers and patients, especially for transitions in care; and develop and implement interventions to better prepare and support patients to safely manage their chronic disease at home. Moreover, clinicians should weigh the risk of intensifying treatment regimens with potential risks and adverse events that could arise in the ambulatory setting, according to the authors. Co-authors of the article are Robert M. Wachter, MD, Lynne and Marc Benioff endowed chair in hospital medicine, chief of the Division of Hospital Medicine, and chief of the Medical Service, UCSF Medical Center; Steven A. Schroeder, MD, distinguished professor of health and health care, UCSF Department of Medicine; and Dean Schillinger, MD, professor of medicine at UCSF, director of the Center for Vulnerable Populations at SFGH, and program chief of the California Diabetes Program. Sarkar"s work is supported by a grant from the Agency for Healthcare Research and Quality. Schillinger"s work is supported by a grant from the Agency for Healthcare Research and Quality and a National Institutes of Health Clinical and Translational Science Award. The UCSF Center for Vulnerable Populations is part of the Department of Medicine at SFGH. Founded in 2006, its mission is to carry out innovative research to prevent and treat chronic disease in populations for whom social conditions often conspire to both promote chronic disease and make its management more challenging.CVP is nationally and internationally known for its research in health communication and health policy to reduce health disparities. UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care Karin Rush-Monroe University of California - San Francisco


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