Old Blood = Bad Blood?

Transfusions with blood that is 29+ days old are twice as likely to lead to nosocomial infections-- including pneumonia, upper respiratory infections and sepsis-- as transfusions with newer blood, a new CHEST 2008 study found.

Researchers studied 422 ICU patients from July 2003-Sept. 2006. In addition to finding that older blood carried higher risk, they found that the more "old" blood a patient got, the greater the risk of infection.

Current standards allow blood to be stored for up to 42 days, and the oldest blood is usually used first, to avoid waste ("sort of like milk in a supermarket", quipped one reporter.)

Given that the U.S. isn't exactly flush with blood supplies, it's unclear how best to use this new information. Tightening standards could cause a shortage.

Study director David Gerber, DO, noted in a press conference that "there is a national tendency to transfuse liberally, " and said providers need to work towards using blood more cautiously.

For tips on tightening up on transfusions, see this article in October ACP Hospitalist.

Labels: blood transfusions, CHEST 2008, Chest conference

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posted by Jessica Berthold at 11:57 AM   2 Comments

Nicotine dependence: It's worse than you think

It's the best of times and worst of times for ending tobacco dependence, according to David Sachs, ACP Member, of the Palo Alto Center for Pulmonary Disease Prevention.

The best, because there are more tools than ever to help patients quit.
The worst, because most physicians have no idea how to treat patients effectively.

In part, that's because doctors don't know that nearly 75% of people seeking tobacco-dependent treatment are categorized as "highly" dependent-- meaning standard, OTC therapies won't work on them, Dr. Sachs said during a Chest 2008 press conference about a new study he authored. In the study, he and his colleagues analyzed pretreatment dependence severity from 1989-2006 and found severity increased 12% during that time, with those classified as "highly dependent" increasing 32%.

Doctors should measure dependence in their patients trying to quit. For treatment, they may need to increase drug doses and duration of use, try different drug combinations, and put more stress on minimizing withdrawal symptoms.

Dr. Sachs didn't have a pat answer for why dependence has increased in the last 15 years, so moderator Mark Rosen, FACP, speculated: "Can we attribute any of this (increase in dependence) to the stress of having Bush in the White House for the last eight years?"

Labels: Chest conference, smoking cessation

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posted by Jessica Berthold at 11:36 AM   0 Comments

Conference News: Chest 2008

Hot off the presses from beautiful central Philly, where the Chest 2008 conference is underway:

• Statins may reduce VTE in patients with solid organ tumors. A new study of hospitalized cancer patients found that 8% of those who received statins developed VTE compared with 21% of patients who didn't. Study author Danai Khemasuwan, ACP Member, noted that a cause and effect relationship can't be inferred since the study was done by reviewing medical records, but hopes an RCT will confirm the results. Moderator David Gutterman, MD, said it makes sense that statins might improve the venous side of circulations, since it's already known they improve endothelial function. The author hopes to do an RCT next that will compare different kinds of statins, as well as different dosage levels.
• Biphosphonates may increase the risk for serious atrial fibrillation. A meta-analysis of 16,322 patients found that 1-2% of those who took alendronate or zoledronic acid for osteoporosis experienced serious AF (i.e. hospitalization or death)-- an approximately 66% greater risk than patients taking placebo, author Jennifer Miranda, MD, said. There were only 3 studies in the analysis, however, and none assessed whether the patients had other risks for CV disease. Dr. Miranda said it's her understanding that FDA wants to conduct more trials to look at the CV effects of biphosphonates.
• Most providers have scant knowledge of how to help smokers quit. A survey of 600 providers, including doctors, NPs, social workers and PAs, found less than 6% knew the AHRQ treatment guidelines for tobacco dependence. Only 16% of prescribers and 8% of nonprescribers knew which drugs were OTC vs. prescription, and the majority failed to recognize contraindications. Now that Medicare reimburses up to 8 visits/year for counseling people on quitting smoking, providers should take the opportunity to learn how to do this. One good first step, said the author: refer patients to 1-800-QUIT-NOW, a national quit line.

Labels: Chest conference

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posted by Jessica Berthold at 9:00 AM   0 Comments