Student Anxiety

Study: Students who write about anxieties perform better on tests.
ABC World News (1/13, story 8, 0:20, Sawyer) reported, "And, what if you could cure your fears by writing them down? A new study found if students spend ten minutes listing their fears before a big exam, their scores increase 5% over time. Fearful students who do nothing saw their scores drop 12%. Doctors think writing down your fears makes them less mysterious, so your brain is less distracted."
The Los Angeles Times (1/14, Khan) reports University of Chicago researchers "performed a series of experiments to test their hypothesis." Initially, "they asked 20 college students to take a math test just to get a base-line score, and simply told them to do their best. Next, to raise the stakes, they told the students that they could receive a monetary award if they got a good grade." The Times says that "before beginning the main test, the researchers asked one group of students to spend 10 minutes writing down their feelings about the test, and the other group sat quietly for that time. Everyone then took the same exam." Notably, they "found that students who sat quietly did 12% worse than they had on the pre-test, and the ones who wrote about their anxieties improved their scores by 5%."
The Time (1/13, Park) "Healthland" blog reported the researchers speculate that "the benefits of writing" could be "related to the fact that when you worry, anxious thoughts occupy the working memory of the brain, thus crowding out other thoughts or knowledge relevant to the pressure-packed task at hand. Writing about the fear provides an outlet for these nerve-wracking thoughts, freeing up the working memory to concentrate on other things." The study was published in the journal Science. The Chicago Tribune (1/14, Malone) covers the story, as did the CNN (1/13, Landau) "The Chart" blog.

ER Crowd Tips

Physicians offer several tips meant to help patients better navigate EDs.
In a series dedicated to empowering patients, CNN (1/14, Rice) recounts the case of an infant whose worsening prognosis was attributed to -- by her parents -- the fact that she spent "nearly five hours...waiting in the emergency department." The case is surely not unique, considering that, "according to a 2009 report from the Government Accountability Office, emergency department wait times continue to increase." Comparing an ED to a restaurant in which some patrons stay longer than expected, ACEP President Dr. Sandra Schneider "says the backups occur as emergency departments struggle to find beds for admitted patients." With that in mind, ED physicians offered several tips to help patients "both before and after" they're arrival.
EDs trying new approaches to ease crowding. Kaiser Health News (1/14, Kenen) reports that Ochsner Medical Center "is one of a growing number of emergency departments trying new approaches to ease crowding. Those efforts "have ranged from high-tech options such as smart phone programs that let patients compare waiting times at local hospitals to something as mundane as staggering nursing shifts to better match patient traffic." But a number of hospitals like Ochsner "are looking at more fundamental routines, shaking up and re-engineering their procedures." For example, the center "created an emergency department protocol called 'QTrack'" in which the "sickest patients still go back immediately to the emergency department's traditional beds, but [some] patients...go quickly into separate treatment areas with a nice comfortable recliner or to a procedure room for stitches or a cast."
Emergency departments experience increase in patients, obstacles during snowstorms. CNN (1/13, Park) reported, "During snowstorms, people with chronic health issues such as end-stage renal disease have nowhere else to go for help, because their dialysis centers are closed." What's more, "'if you can't get to the pharmacy and it's a critical life-sustaining medication, the emergency department is your only bet,' said Dr. Leigh Vinocur, a spokeswoman for the American College of Emergency Physicians." Indeed, the "wait...may not be longer than usual, because people with less pressing health needs opt to stay home," but EDs "can face issues of crowding as discharged patients can't leave because they have no safe way of getting home" and "the homeless who are unable to find shelter come to hospitals with cold-related issues such as hypothermia." But "for emergency responders, the biggest obstacle is navigating through the maze of ice slicks and car accidents."

Tylenol in Drugs

FDA to limit amount of acetaminophen in prescription painkillers.
ABC World News (1/13, story 4, 1:50, Sawyer) reported, "The FDA launched a major crackdown [on Thursday] against the overuse of one of the most popular painkillers on the market, acetaminophen."
Bloomberg News (1/14, Larkin) reports, "Prescription pain pills may contain no more than 325 milligrams of acetaminophen as of Jan. 14, 2014, the Food and Drug Administration said." The medicines "also will carry a boxed warning on liver risks." The FDA said the "most common acetaminophen dose for prescription and over-the-counter drugs is 500 milligrams."
The AP (1/14, Perronne) reports that FDA officials said "the labeling on prescription drugs often does not make it clear that they contain acetaminophen, instead using abbreviations for the ingredient like 'APAP.'"
The New York Times (1/14, Harris) reports that Federal drug regulators "have tried for decades to cut down on acetaminophen's toll, but little changed until June 2009, when the FDA's panel of experts voted by a bare majority to call for a ban on drugs that combine acetaminophen with narcotics."
The Washington Post (1/14, Stein) reports the FDA's Sandra Kweder said, "The FDA is taking this action to make prescription combination pain medications containing acetaminophen safer for patients to use. ... Overdose from prescription combination products containing acetaminophen account for nearly half of all cases of acetaminophen-related liver failure in the United States, many of which result in liver transplant or death."

Ear Infection Update

Antibiotics may help ease children's ear infections.
The Los Angeles Times (1/13, Maugh) reports, "The medical consensus on whether to give antibiotics to young children with ear infections has been swinging from one extreme to the other as conflicting clinical trials have pushed pediatricians first toward widespread use of the drugs, then toward a 'watch and wait' approach in which most infections seem to clear up on their own." Now, however, "two new trials reported Wednesday in the New England Journal of Medicine are nudging the pendulum back toward treatment of the infections, especially for the youngest children." They indicate that "the use of antibiotics in infants and toddlers under the age of two is only modestly effective and reduces the duration of symptoms by only a small amount, but it prevents relapses and progression of the disease."
Bloomberg News (1/13, Ostrow) emphasizes the importance of the new research, since "three of four children will have at least one ear infection by the time they turn three years old, according to the US National Institutes of Health." NIH defines "an ear infection [as] an inflammation of the middle ear, which occurs when fluid builds up behind the eardrum," and "is usually caused by bacteria."
The Washington Post (1/12, Huget) "The Checkup" blog reported that both studies "show that antibiotics are more effective than placebos in relieving ear-infection symptoms such as fever, poor appetite, decreased activity and irritability, and suggested that their benefits warrant their being administered early on, regardless of the seeming severity of a child's symptoms." The studies also noted, however, that "the use of antibiotics must be weighed against the risk of antimicrobial resistance, to which prescriptions for childhood maladies, such as ear infections, are thought to contribute mightily, and against antibiotics' side effects, which can include diarrhea and eczema."
The NPR (1/13, Knox) "Shots" blog reported that both studies "come down firmly on the side of early antibiotic therapy for kids under age two or three," finding that these children "get over painful ear infections faster, and have less severe symptoms, if they get prompt treatment with Augmentin [amoxicillin clavulanate], an inexpensive antibiotic often used to treat respiratory infections." Nevertheless, the "study authors and other experts say doctors should be sure the child really is suffering from an ear infection before writing that prescription."
HealthDay (1/12, Salamon) reported that in the first study, "291 children between the ages of six months and 23 months old with certain ear infections -- as defined by the presence of a bulging eardrum and parental observations, among other symptoms -- were split into groups receiving antibiotics or placebos for 10 days." Researchers found that "among those who received amoxicillin-clavulanate, 35 percent had initial resolution of symptoms by day two; 61 percent by day four; and 80 percent by day seven. In contrast, of those on placebo, 28 percent had initial resolution of symptoms by day two, 54 percent by day four and 74 percent by day seven," investigators found.
According to WebMD (1/12, DeNoon), in the second study, researchers followed "319 children aged six to 35 months with acute otitis media," half of whom were randomized to placebos and the other "half were treated with a seven-day course of Augmentin." The investigators discovered that "only 18.6% of the children treated with antibiotics got worse or failed to improve, compared with 44.9% of the children in the placebo group."
MedPage Today (1/12, Bankhead) reported, "Collectively, the two studies provided a clear answer to an unresolved clinical question, Jerome Klein, MD, of Boston University Medical Center, wrote in an accompanying editorial." Klein wrote, "More young children with a certain diagnosis of acute otitis media recover more quickly when they are treated with an appropriate antimicrobial agent." Medscape (1/12, Barclay, subscription required) also covered the story.

Don't Sit!

Taking small breaks from sitting may help heart, metabolic health.
Bloomberg News (1/12, von Schaper) reports that "taking small breaks from sitting down such as standing for phone calls or walking to see colleagues may trim office workers' waistlines and help their heart and metabolic health," according to a study published in the European Heart Journal. Investigators "drew on data from almost 4,800 volunteers outfitted with devices that tracked their activity for seven days as part of the U.S. National Health and Nutrition Examination Survey." The researchers found that "the more breaks people took, the smaller their waists and the lower the levels of a blood marker linked to inflammation."

Shingles Vaccine Update

Shingles vaccine may reduce risk of outbreaks by 55%.
The Los Angeles Times (1/12, Maugh) reports that a study published Jan. 12 in the Journal of the American Medical Association involving "more than 300,000 elderly patients showed that the underutilized herpes zoster vaccine reduced the incidence of painful shingles outbreaks by 55%, even in the oldest populations." Shingles, "a painful rash brought on by the varicella zoster virus," may precipitate painful post-herpetic neuralgia and may also "cause vision loss if it spreads to the eyes." There is no cure for the condition, which is precipitated by the same virus that causes chickenpox.
USA Today (1/12, Lloyd) reports, "Everyone over 60 should be vaccinated against shingles, the Centers for Disease Control and Prevention recommends." The study, which was co-written by researchers from the CDC and Kaiser Permanente, pointed out that "nearly one out of three people in the USA will develop shingles, a painful and potentially serious condition also known as herpes zoster." Despite that fact, "only 10% of those 60 and older -- the group most at risk for shingles -- got the vaccine (Zostavax) in 2009." USA Today explains that some insurance and Medicare plans do not cover the cost of the vaccine, which ranges in price from $150 to $300. This might be one reason why the vaccine is underutilized.
Bloomberg News (1/12, Ostrow) reports that after comparing "75,761 members of Kaiser Permanente who received Zostavax with 227,283 unvaccinated members," researchers "found that one episode of shingles would be averted for every 71 people who receive the vaccine." Based on the study's findings and the fact that the incidence of shingles will increase as baby boomers age, family-practice physician Juanita Watts, of Kaiser Permanente's office in Glendale, CA, "said anyone 60 and older, including people who've had shingles before, can get the vaccine as long as they don't suffer from an illness that affects their immune system."
WebMD (1/11, Doheny), HealthDay (1/11, Gardner), MedPage Today (1/11, Phend), and Medscape (1/11, Jeffrey, subscription required) all covered the story.

NSAID Safety Update

Certain NSAID painkillers associated with increased risk for heart attack and stroke.
Bloomberg News (1/12, Hallam) reports, "Commonly prescribed medicines that ease pain by fighting inflammation have been linked to increased risk heart attack and stroke," according to an analysis published online Jan. 11 in the British Medical Journal.
The CNN (1/11, Landau) "The Chart" blog reported, "Supporting previous research on the subject, a large meta-analysis of 31 studies has found significant risks of cardiovascular events in people who take prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs)." The blog entry noted, "The analysis spanned studies including a total of more than 116,000 patients. Scientists looked at trials that had compared NSAIDs with other NSAIDs or placebo."
According to HealthDay (1/11, Reinberg), "Compared with patients taking placebo, those taking rofecoxib and lumiracoxib had twice the risk of heart attack, and those taking ibuprofen had more than three times the risk of stroke." Interestingly, "the highest risks for cardiac death were associated with etoricoxib and diclofenac, where the risk was around four times greater than for placebo, the researchers found." The least harmful medicine appeared to be naproxen, the study found.