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Statins Don't Lower Risk Of Pneumonia In Elderly
Taking popular cholesterol-lowering statin drugs, such as Lipitor® (atorvastatin), does not lower the risk of pneumonia. That"s the new finding from a study of more than 3,000 Group Health patients published online on June 16 in advance of the British Medical Journal"s June 20 print issue.
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Lambda Legal Files Suit Against Assisted-Living Facility For Allegedly Discriminating Against HIV-Positive Resident
Lambda Legal, a group that represents HIV-positive people, on Tuesday filed a law suit against the Fox Ridge assisted-living facility in North Little Rock, Ark., for allegedly evicting a resident because he is HIV-positive, the Arkansas Democrat-Gazette reports.The Rev. Robert Franke, a retired biology and religion professor who was diagnosed with HIV in 1987, moved into Fox Ridge, which is operated by Parkstone Living Center, in February. The day after he moved into the facility, an unidentified administrator told his daughter, Sara Franke Bowling, that her "superiors" said Franke needed to be discharged from the facility "because of his HIV." Franke disclosed his HIV status on application materials before moving into the facility. The suit alleges that Parkstone violated the Fair Housing Act, the Americans with Disabilities Act and the Arkansas Civil Rights Act and requests a permanent injunction to prevent the facility from denying apartments or services to people living with HIV/AIDS. The suit also seeks compensatory and punitive damages and attorneys" fees and costs. The case was assigned to U.S. District Judge G. Thomas Eisele. The facility declined to comment on the suit. Julie Munsell, a spokesperson for the state Department of Human Services, said Arkansas law allows for people who have been discharged for assisted-living facilities to remain in the facility pending a hearing if the discharge is appealed. Munsell said the department"s Long-Term Care Division received notice that Franke was appealing the discharge but that the appeal was later dismissed without a hearing. According to Munsell, facilities are not permitted to discharge residents based on medical diagnoses but that some facilities have said they do not have the capacity to provide care for certain conditions. Munsell also said that Fox Ridge is "claiming that they did not admit this client so there is no need for a hearing." Scott Schoettes, staff attorney for Lambda"s HIV Project, said that Franke was not seeking medical care from Fox Ridge, although the facility does provide medical services. "He didn"t require any services beyond which they were licensed to provide," Schoettes said. Franke"s eviction is "particularly blatant and egregious, but unfortunately, not all that uncommon," Schoettes said, adding, "This happens all across the country. We want to send a message that this kind of discrimination is not going to be tolerated" (Satter, Arkansas Democrat-Gazette, 5/13).
News of the day
American Optometric Association Approves Optometric Board Certification At Annual Meeting
At the annual meeting of the American Optometric Association (AOA), members voted Friday 1,126 to 887 in favor of establishing the American Board of Optometry (ABO) as the entity to develop and implement the framework for board certification and maintenance of certification.
Mental Health

New Guideline For Low-Back Pain Interventions, Surgery Issued By The American Pain Society

The American Pain Society (APS) has issued a new clinical practice guideline for low back pain that emphasizes the use of noninvasive treatments over interventional procedures, as well as shared decision making between provider and patient. The findings are published in the current (May 1, 2009) issue of the journal Spine. The new APS guideline, based on an extensive review of existing research, provides clinicians with eight recommendations to help determine the best way to treat patients with low-back pain. It also expands its current and previously published guideline for initial evaluation and management of this chronic condition. "These recommendations are based on an even more complete body of evidence than was available just a few years ago. Consequently, we believe these recommendations will give physicians more confidence when treating patients with persistent back pain," said Roger Chou, M.D., lead author, director of the APS Clinical Practice Guideline Program, and associate professor of medicine (general internal medicine), Oregon Evidence-based Practice Center, Oregon Health & Science University. "Unfortunately, randomized trials for a number of commonly used interventional procedures are still too limited to generate evidence-based recommendations, and our review also highlights the need for more research," Chou added. Low-back pain is the fifth most common reason for doctor"s visits and accounts for more than $26 billion in direct health care costs nationwide each year. While a number of interventional diagnostic tests and therapies, and surgery are available, and their use is increasing, in some cases their usefulness remains uncertain. "We have advocated strongly in many of our recommendations for physicians to use shared decision making because of the relatively close trade-offs between potential benefits relative to harms, as well as costs and burdens of these various treatment options," Chou explained. Shared decision making involves a patient"s full participation in medical choices after receiving comprehensive information about the impact of all options on his or her particular life situation. To develop the guideline, a multidisciplinary APS panel, augmented by experts on interventional therapies, reviewed 3,348 abstracts and analyzed 161 relevant clinical trials. The panel found that the evidence for the use of these interventions was mixed, sparse or not available. Based on the data the panel gathered, the APS now recommends: * Against the use of provocative discography (injection of fluid into the disc in order to determine if it is the of back pain) for patients with chronic nonradicular low-back pain. * The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioral emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies. * Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies. * A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms. * Insufficient evidence to guide recommendations for vertebral disc replacement. * A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc. * A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients with persistent and disabling radiculopathy due to herniated lumbar disc or persistent and disabling leg pain. * Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root. Chou and his colleagues also reaffirm their previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. "In general, noninvasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," said Chou. Recommendations from the first APS Clinical Practice Guideline on Low-Back Pain are intended for primary care physicians and appeared in the Oct, 2, 2007, issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimize routine use of X-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders. Tamara Hargens-Bradley Oregon Health & Science University


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