iForumRx.org

“Slip! Slop! Slap! And Wrap!®”, the slogan created by the American Cancer Society is a catchphrase intended to attract the public’s attention, raise awareness of the dangers of ultraviolet (UV) radiation, and promote prevention against skin cancer. Despite public awareness campaigns, the incident of non-melanoma skin cancer (NMSC), including both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), continues to climb — quite rapidly. They are the most common cancers in the United States. Given the significant and growing morbidity, mortality, and economic burden ofNMSC, finding effective preventative measures are of great interest.

After cardiovascular (CV) safety concerns emerged with rosiglitazone use, the Food and Drug Administration (FDA) now requires outcome studies to be performed for all new diabetes medications.   The first CV safety study (ELIXA) for a drug in the glucagon-like peptide 1-receptor agonist (GLP-1 RA) class – lixisenatide - was published in December 2015.  Lixisenatide is a once-daily injectable GLP-1 RA approved for use in Europe and awaits FDA approval in the United States.

Managing behavioral health in persons withdementia is an enormous and growing problem. Most patients with Alzheimer's disease (AD) have challengingneuropsychiatric symptoms such as agitation. These symptoms are distressing andoften overwhelming for caregivers often resulting in institutionalization andincreased healthcare utilization. Several medications are used off-labelto treat these symptoms including antidepressants, antipsychotics,anticonvulsants, anxiolytics and cholinesterase inhibitors.   But manyregulatory bodies, professional associations, and patient advocacy groups havepromoted initiatives to decrease the inappropriate use of medications andencourage the use of alternatives, particularly behavioral interventions. The combination of dextromethorphan hydrobromideand quinidine sulfate (Nuedexta) has been recently studied for the off-labeltreatment of agitation in Alzheimer’s disease.  A patient-centered, systematic, andevidence-based approach should be considered when addressing the behavioral and psychological symptoms of dementia.

For over two decades LMWHs have been routinely used to provide therapeutic coverage in patients who must temporarily stop warfarin. Current guidelines suggest using injectable anticoagulants during warfarin interruption (aka bridging) in patients with atrial fibrillation based on patients’ risk of arterial thrombosis. Using the CHADS2 score to assess risk, the guidelines recommend (grade 2C) bridge therapy if the CHADS2 score is 5 or higher and not bridging if the CHADS2 score is 2 or lower. But what about patients with a CHADS2 score of 3 or 4?

Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25,

50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for

patients with diabetes requiring insulin continues to expand. Current

guidelines for glycemic management of patients with type 2 diabetes provide

specific recommendations for the initiation of insulin therapy, but not insulin intensification. The recently published LanScape study provides a foundation for making evidence-based

clinical decisions.

With over 75% of people using mobile phones worldwide, text messaging might be a simple, cost-effective platform to encourage lifestyle changes. Several healthcare-related applications and mobile phone text messaging systems have already been designed; yet, very few have undergone rigorous testing to confirm clinical benefit.  The investigators of the Tobacco, Exercise, and Diet Messages (TEXT ME) trial designed a text message-based intervention to encourage lifestyle modifications and evaluated its impact on cardiovascular risk in patients with established CHD. The TEXT ME study provides robust findings to support a simple, inexpensive intervention to modify cardiovascular risk … at least over the short term.

The debate over the intensity of blood pressure

(BP) lowering for patients with hypertension has been going on for decades.  Additional fuel to the fire was recently added

with the early halt and publication of the Systolic Blood Pressure Intervention

Trial (SPRINT).  So “how low should

you go” for patients with high BP? Do lower BP goals reduce CV outcomes and

death, particularly in patients at high risk? 

Do they cause greater adverse effects? Or perhaps even worsen CV outcomes?

These questions were examined in SPRINT.

Televised medical talk shows have become a daily

viewing ritual for millions around the world. The Dr Oz Show is so popular that it earned him the title

“America’s Doctor”, attracting massive numbers of followers as did the show The Doctors.   To what extent are the recommendations and claims

made by medical shows supported by evidence?

With increased emphasis on disease

prevention, gestational diabetes (GDM) is worthy of more attention. The

incidence is on the rise not only in the United States (U.S.) but worldwide. Complications of GDM such as preeclampsia, cesarean delivery, neonatal

hypoglycemia, macrosomia, and birth trauma negatively impact maternal and fetal

health. Is a readily available,

non-prescription dietary supplement the answer? Recent investigations have examined

the use of myo-inositol for GDM

prevention, with positive results.

Several studies have evaluated the correlation

between low-dose aspirin and NSAID use and the development of colorectal

cancer. In 2007, the U.S. Preventive Services Task Force (USPSTF) recommended against the use aspirin for the

prevention of colorectal cancer in most adults. However, there is

mounting evidence that daily, long-term aspirin use may prevent colorectal

cancer in patients aged 50-69. Could something as simple as an

aspirin a day prevent colon CA?