Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

Visit our website for more information about health information technology.

Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

Visit our website for more information about health information technology.

Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

Visit our website for more information about health information technology.

University of Minnesota hospitalist Karyn Baum, MD, MSEd, directs one of six regional training centers for Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based, multimedia curriculum, tool set, and system for healthcare organizations to improve their teamwork.

Using the TeamSTEPPS approach, Dr. Baum collaborated with hospitalist Albertine Beard, MD, and the charge nurse on a 28-bed medical unit at the Minneapolis VA Medical Center to present a half-day training session for all VA staff, including four hospitalists. The seminar mixed didactics, discussions, and simulations, similar to traditional role-playing techniques but using a high-fidelity manikin that talks and displays vital signs.

"Teamwork is a set of knowledge, skills, and attitudes that lead to the creation of a culture where it’s about us as a team, not about who is highest in the hierarchy," Dr. Baum says. Hospitalists want to be leaders, "but we have a responsibility to be intentional leaders, learning the skills and modeling them," she adds.

Improved teamwork benefits patients through more effective communication and reduction in medical errors, Dr. Baum says, "but it also helps to create a healthy environment in which to work, where we all have each other’s backs."

TeamSTEPPS, developed jointly by the federal Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense, has reached 25% to 30% of U.S. hospitals by annually training about 700 masters. The masters then go back to their institutions and share the techniques.

Read more about why improving teamwork is good for your patients.

University of Minnesota hospitalist Karyn Baum, MD, MSEd, directs one of six regional training centers for Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based, multimedia curriculum, tool set, and system for healthcare organizations to improve their teamwork.

Using the TeamSTEPPS approach, Dr. Baum collaborated with hospitalist Albertine Beard, MD, and the charge nurse on a 28-bed medical unit at the Minneapolis VA Medical Center to present a half-day training session for all VA staff, including four hospitalists. The seminar mixed didactics, discussions, and simulations, similar to traditional role-playing techniques but using a high-fidelity manikin that talks and displays vital signs.

"Teamwork is a set of knowledge, skills, and attitudes that lead to the creation of a culture where it’s about us as a team, not about who is highest in the hierarchy," Dr. Baum says. Hospitalists want to be leaders, "but we have a responsibility to be intentional leaders, learning the skills and modeling them," she adds.

Improved teamwork benefits patients through more effective communication and reduction in medical errors, Dr. Baum says, "but it also helps to create a healthy environment in which to work, where we all have each other’s backs."

TeamSTEPPS, developed jointly by the federal Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense, has reached 25% to 30% of U.S. hospitals by annually training about 700 masters. The masters then go back to their institutions and share the techniques.

Read more about why improving teamwork is good for your patients.

University of Minnesota hospitalist Karyn Baum, MD, MSEd, directs one of six regional training centers for Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based, multimedia curriculum, tool set, and system for healthcare organizations to improve their teamwork.

Using the TeamSTEPPS approach, Dr. Baum collaborated with hospitalist Albertine Beard, MD, and the charge nurse on a 28-bed medical unit at the Minneapolis VA Medical Center to present a half-day training session for all VA staff, including four hospitalists. The seminar mixed didactics, discussions, and simulations, similar to traditional role-playing techniques but using a high-fidelity manikin that talks and displays vital signs.

"Teamwork is a set of knowledge, skills, and attitudes that lead to the creation of a culture where it’s about us as a team, not about who is highest in the hierarchy," Dr. Baum says. Hospitalists want to be leaders, "but we have a responsibility to be intentional leaders, learning the skills and modeling them," she adds.

Improved teamwork benefits patients through more effective communication and reduction in medical errors, Dr. Baum says, "but it also helps to create a healthy environment in which to work, where we all have each other’s backs."

TeamSTEPPS, developed jointly by the federal Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense, has reached 25% to 30% of U.S. hospitals by annually training about 700 masters. The masters then go back to their institutions and share the techniques.

Read more about why improving teamwork is good for your patients.

The Food and Drug Administration on Dec. 21 approved teduglutide, to be marketed under the trade name Gattex, to treat adults with short bowel syndrome (SBS) who need parenteral nutrition.

Teduglutide, a recombinant analogue of human glucagon-like peptide-2 (GLP-2), was unanimously recommended for approval by an FDA advisory panel in October. It is a once-daily subcutaneous injection that helps improve intestinal absorption of fluids and nutrients, reducing the frequency and volume of parenteral nutrition.

"Considering Gattex has been shown to significantly reduce or in some cases even eliminate the requirement for parenteral support, it may become a cornerstone therapy in the management of short bowel syndrome." Dr. Ken Fujioka of the Nutrition and Metabolic Research Center, Scripps Clinic, Del Mar, Calif., said in a statement issued by Gattex’s maker, NPA Pharmaceuticals.

It is the third drug to be approved by the FDA for SBS patients who are dependent on parenteral nutrition. Somatropin (Zorbtive) was approved in 2003 and glutamine (Nutrestore) in 2004.

"Today’s approval expands the available treatment options for patients with this life-threatening condition," Dr. Victoria Kusiak, deputy director of the Office of Drug Evaluation III in the FDA Center for Drug Evaluation and Research, said in a statement. "Because Gattex may cause other serious health conditions, it is critical that patients and health care professionals understand the drug’s potential and known safety risks."

Teduglutide therapy increases the risk of developing cancer and polyps in the intestine, obstructions in the intestine, gallbladder disease, biliary tract disease, and pancreatic disease. The drug will have a Risk Evaluation and Mitigation Strategy, consisting of a communication plan and training for prescribers, according to the FDA.

Pivotal data on the drug were published in September in Gastroenterology (Gastroenterology 2012 Sept. 13 [doi:10.1053/j.gastro.2012.09.007]).

The Food and Drug Administration on Dec. 21 approved teduglutide, to be marketed under the trade name Gattex, to treat adults with short bowel syndrome (SBS) who need parenteral nutrition.

Teduglutide, a recombinant analogue of human glucagon-like peptide-2 (GLP-2), was unanimously recommended for approval by an FDA advisory panel in October. It is a once-daily subcutaneous injection that helps improve intestinal absorption of fluids and nutrients, reducing the frequency and volume of parenteral nutrition.

"Considering Gattex has been shown to significantly reduce or in some cases even eliminate the requirement for parenteral support, it may become a cornerstone therapy in the management of short bowel syndrome." Dr. Ken Fujioka of the Nutrition and Metabolic Research Center, Scripps Clinic, Del Mar, Calif., said in a statement issued by Gattex’s maker, NPA Pharmaceuticals.

It is the third drug to be approved by the FDA for SBS patients who are dependent on parenteral nutrition. Somatropin (Zorbtive) was approved in 2003 and glutamine (Nutrestore) in 2004.

"Today’s approval expands the available treatment options for patients with this life-threatening condition," Dr. Victoria Kusiak, deputy director of the Office of Drug Evaluation III in the FDA Center for Drug Evaluation and Research, said in a statement. "Because Gattex may cause other serious health conditions, it is critical that patients and health care professionals understand the drug’s potential and known safety risks."

Teduglutide therapy increases the risk of developing cancer and polyps in the intestine, obstructions in the intestine, gallbladder disease, biliary tract disease, and pancreatic disease. The drug will have a Risk Evaluation and Mitigation Strategy, consisting of a communication plan and training for prescribers, according to the FDA.

Pivotal data on the drug were published in September in Gastroenterology (Gastroenterology 2012 Sept. 13 [doi:10.1053/j.gastro.2012.09.007]).

The Food and Drug Administration on Dec. 21 approved teduglutide, to be marketed under the trade name Gattex, to treat adults with short bowel syndrome (SBS) who need parenteral nutrition.

Teduglutide, a recombinant analogue of human glucagon-like peptide-2 (GLP-2), was unanimously recommended for approval by an FDA advisory panel in October. It is a once-daily subcutaneous injection that helps improve intestinal absorption of fluids and nutrients, reducing the frequency and volume of parenteral nutrition.

"Considering Gattex has been shown to significantly reduce or in some cases even eliminate the requirement for parenteral support, it may become a cornerstone therapy in the management of short bowel syndrome." Dr. Ken Fujioka of the Nutrition and Metabolic Research Center, Scripps Clinic, Del Mar, Calif., said in a statement issued by Gattex’s maker, NPA Pharmaceuticals.

It is the third drug to be approved by the FDA for SBS patients who are dependent on parenteral nutrition. Somatropin (Zorbtive) was approved in 2003 and glutamine (Nutrestore) in 2004.

"Today’s approval expands the available treatment options for patients with this life-threatening condition," Dr. Victoria Kusiak, deputy director of the Office of Drug Evaluation III in the FDA Center for Drug Evaluation and Research, said in a statement. "Because Gattex may cause other serious health conditions, it is critical that patients and health care professionals understand the drug’s potential and known safety risks."

Teduglutide therapy increases the risk of developing cancer and polyps in the intestine, obstructions in the intestine, gallbladder disease, biliary tract disease, and pancreatic disease. The drug will have a Risk Evaluation and Mitigation Strategy, consisting of a communication plan and training for prescribers, according to the FDA.

Pivotal data on the drug were published in September in Gastroenterology (Gastroenterology 2012 Sept. 13 [doi:10.1053/j.gastro.2012.09.007]).

Linum usitatissimum, an annual plant native to the eastern Mediterranean and India and better known as flax (or linseed, several decades ago), was cultivated in ancient Egypt and Ethiopia and used for many purposes, including as an ingredient in medicine, soap, and hair products. The oil from the seeds of the plant is thought to possess significant health benefits. Flaxseed oil is one of the richest sources of omega-3 fatty acids, in particular, alpha-linolenic acid (ALA), which represents more than 50% of its total fatty acid content (Br. J. Nutr. 2009;101:440-5; Medical Herbalism: The science and practice of herbal medicine. Healing Arts Press: Rochester, Vt., 2003, p. 57). In addition, flaxseeds are rich in dietary fiber and lignans, which are phytoestrogens with antioxidant properties.

Sanjay Acharya/Wikimedia Creative Commons

Antioxidant, anti-inflammatory, and antiapoptotic properties have been associated with flaxseed oil and warrant medical consideration. The substantial anti-inflammatory activity of L. usitatissimum has been ascribed to its primary active constituent, ALA (57%), which suppresses arachidonic acid metabolism, thus inhibiting the synthesis of proinflammatory n-6 eicosanoids and reducing vascular permeability (Inflammopharmacology 2010;18:127-36).

In a randomized, double-blind, placebo-controlled application test in 2009, De Spirt et al. studied the cutaneous effects of supplementation with flaxseed or borage oil for 12 weeks in two groups of women (n = 45) aged 18-65 years with sensitive and dry skin. Fifteen women were included in each group, and 15 were randomized to a placebo control group. The placebo group received medium-chain fatty acids. The flaxseed oil included ALA and linoleic acid, and the borage oil contained linoleic and gamma-linolenic acids. ALA contributed to the significant rise in total fatty acids in plasma seen in the flaxseed oil group at weeks 6 and 12. An increase in gamma-linolenic acid was noted in the borage oil group. Erythema, roughness, and scaling were decreased in both treatment groups compared with baseline, while skin hydration was markedly elevated after 12 weeks. In addition, transepidermal water loss was diminished by 10% after 6 weeks in both oil treatment groups, with further reductions after 12 weeks in the flaxseed oil group. The investigators concluded that intervention with dietary lipids can manifest as skin improvements (Br. J. Nutr. 2009;101:440-5).

In 2010, Kaithwas and Majumdar evaluated the anti-inflammatory potential of flaxseed fixed oil against castor oil–induced diarrhea, turpentine oil–induced joint edema, and formaldehyde-induced and complete Freund’s adjuvant (CFA)-induced arthritis in Wistar albino rats. They found that flaxseed oil dose-dependently inhibited the adverse effects of castor oil and turpentine oil as well as CFA, and a significant inhibitory effect was also exerted by flaxseed oil against formaldehyde-induced proliferation of global edematous arthritis. Flaxseed oil also significantly diminished the secondary lesions engendered by CFA by dint of a delayed hypersensitivity reaction. The authors concluded that the significant anti-inflammatory activity imparted by L. usitatissimum fixed oil suggests its therapeutic viability for inflammatory conditions, such as rheumatoid arthritis (Inflammopharmacology 2010;18:127-36).

Recently, de Souza et al. studied the effects on skin wounds in rats of a semisolid formulation of flaxseed oil (1%, 5%, or 10%). The investigators assessed the contraction/re-epithelialization of the wound and resistance to mechanical traction in incisional and excisional models, respectively. They found that the groups treated with flaxseed oil concentrations of 1% or 5% largely started re-epithelialization earlier than the petroleum jelly control group, and achieved 100% re-epithelialization on the 14th day after injury, as compared to 33% of animals in the petroleum jelly group. The investigators concluded that flaxseed oil, at low concentrations, exhibits potential in a solid pharmaceutical preparation, for use in dermal repair (Evid. Based. Complement. Alternat. Med. 2012;2012:270752).

Early in 2012, Tülüce et al. set out to ascertain the antioxidant and antiapoptotic effects of flaxseed oil exerted against ultraviolet C–induced damage in rats. They divided animals into three groups: control, UVC alone, and UVC and flaxseed oil. UVC light exposure lasted for 1 hour twice daily for four weeks in the two exposure groups. In the flaxseed oil group, the oil was administered by gavage prior to each irradiation (4 mL/kg ). The investigators noted that malondialdehyde and protein carbonyl levels were higher in the UVC group than in the controls, but such levels were reduced in the flaxseed oil group compared with the UVC-only group, in skin, lens, and sera. Also, the activities of glutathione peroxidase and superoxide dismutase were found to be higher in the skin, lens, and sera of the flaxseed oil group as compared to the UVC-only group. In addition, retinal apoptosis was lower in the flaxseed group than in the UVC group. The researchers concluded that flaxseed oil may be useful in conferring a photoprotective effect against UVC-induced damage, as manifested in protein carbonylation and reactive oxygen species generation, in rats (Toxicol. Ind. Health. 2012;28:99-107).

Conclusion

Flaxseed oil has gained recent attention for its salutary effects as part of the diet. Rich in omega-3 essential fatty acids and lignans, flaxseed oil has been found to improve fatty acid profiles. Significantly, emerging evidence points to beneficial cutaneous effects derived from dietary use of flaxseed oil. However, more research is necessary to determine whether the beneficial constituents of flaxseed oil can be harnessed in topical products.

Dr. Baumann is in private practice in Miami Beach.

Linum usitatissimum, an annual plant native to the eastern Mediterranean and India and better known as flax (or linseed, several decades ago), was cultivated in ancient Egypt and Ethiopia and used for many purposes, including as an ingredient in medicine, soap, and hair products. The oil from the seeds of the plant is thought to possess significant health benefits. Flaxseed oil is one of the richest sources of omega-3 fatty acids, in particular, alpha-linolenic acid (ALA), which represents more than 50% of its total fatty acid content (Br. J. Nutr. 2009;101:440-5; Medical Herbalism: The science and practice of herbal medicine. Healing Arts Press: Rochester, Vt., 2003, p. 57). In addition, flaxseeds are rich in dietary fiber and lignans, which are phytoestrogens with antioxidant properties.

Sanjay Acharya/Wikimedia Creative Commons

Antioxidant, anti-inflammatory, and antiapoptotic properties have been associated with flaxseed oil and warrant medical consideration. The substantial anti-inflammatory activity of L. usitatissimum has been ascribed to its primary active constituent, ALA (57%), which suppresses arachidonic acid metabolism, thus inhibiting the synthesis of proinflammatory n-6 eicosanoids and reducing vascular permeability (Inflammopharmacology 2010;18:127-36).

In a randomized, double-blind, placebo-controlled application test in 2009, De Spirt et al. studied the cutaneous effects of supplementation with flaxseed or borage oil for 12 weeks in two groups of women (n = 45) aged 18-65 years with sensitive and dry skin. Fifteen women were included in each group, and 15 were randomized to a placebo control group. The placebo group received medium-chain fatty acids. The flaxseed oil included ALA and linoleic acid, and the borage oil contained linoleic and gamma-linolenic acids. ALA contributed to the significant rise in total fatty acids in plasma seen in the flaxseed oil group at weeks 6 and 12. An increase in gamma-linolenic acid was noted in the borage oil group. Erythema, roughness, and scaling were decreased in both treatment groups compared with baseline, while skin hydration was markedly elevated after 12 weeks. In addition, transepidermal water loss was diminished by 10% after 6 weeks in both oil treatment groups, with further reductions after 12 weeks in the flaxseed oil group. The investigators concluded that intervention with dietary lipids can manifest as skin improvements (Br. J. Nutr. 2009;101:440-5).

In 2010, Kaithwas and Majumdar evaluated the anti-inflammatory potential of flaxseed fixed oil against castor oil–induced diarrhea, turpentine oil–induced joint edema, and formaldehyde-induced and complete Freund’s adjuvant (CFA)-induced arthritis in Wistar albino rats. They found that flaxseed oil dose-dependently inhibited the adverse effects of castor oil and turpentine oil as well as CFA, and a significant inhibitory effect was also exerted by flaxseed oil against formaldehyde-induced proliferation of global edematous arthritis. Flaxseed oil also significantly diminished the secondary lesions engendered by CFA by dint of a delayed hypersensitivity reaction. The authors concluded that the significant anti-inflammatory activity imparted by L. usitatissimum fixed oil suggests its therapeutic viability for inflammatory conditions, such as rheumatoid arthritis (Inflammopharmacology 2010;18:127-36).

Recently, de Souza et al. studied the effects on skin wounds in rats of a semisolid formulation of flaxseed oil (1%, 5%, or 10%). The investigators assessed the contraction/re-epithelialization of the wound and resistance to mechanical traction in incisional and excisional models, respectively. They found that the groups treated with flaxseed oil concentrations of 1% or 5% largely started re-epithelialization earlier than the petroleum jelly control group, and achieved 100% re-epithelialization on the 14th day after injury, as compared to 33% of animals in the petroleum jelly group. The investigators concluded that flaxseed oil, at low concentrations, exhibits potential in a solid pharmaceutical preparation, for use in dermal repair (Evid. Based. Complement. Alternat. Med. 2012;2012:270752).

Early in 2012, Tülüce et al. set out to ascertain the antioxidant and antiapoptotic effects of flaxseed oil exerted against ultraviolet C–induced damage in rats. They divided animals into three groups: control, UVC alone, and UVC and flaxseed oil. UVC light exposure lasted for 1 hour twice daily for four weeks in the two exposure groups. In the flaxseed oil group, the oil was administered by gavage prior to each irradiation (4 mL/kg ). The investigators noted that malondialdehyde and protein carbonyl levels were higher in the UVC group than in the controls, but such levels were reduced in the flaxseed oil group compared with the UVC-only group, in skin, lens, and sera. Also, the activities of glutathione peroxidase and superoxide dismutase were found to be higher in the skin, lens, and sera of the flaxseed oil group as compared to the UVC-only group. In addition, retinal apoptosis was lower in the flaxseed group than in the UVC group. The researchers concluded that flaxseed oil may be useful in conferring a photoprotective effect against UVC-induced damage, as manifested in protein carbonylation and reactive oxygen species generation, in rats (Toxicol. Ind. Health. 2012;28:99-107).

Conclusion

Flaxseed oil has gained recent attention for its salutary effects as part of the diet. Rich in omega-3 essential fatty acids and lignans, flaxseed oil has been found to improve fatty acid profiles. Significantly, emerging evidence points to beneficial cutaneous effects derived from dietary use of flaxseed oil. However, more research is necessary to determine whether the beneficial constituents of flaxseed oil can be harnessed in topical products.

Dr. Baumann is in private practice in Miami Beach.

Linum usitatissimum, an annual plant native to the eastern Mediterranean and India and better known as flax (or linseed, several decades ago), was cultivated in ancient Egypt and Ethiopia and used for many purposes, including as an ingredient in medicine, soap, and hair products. The oil from the seeds of the plant is thought to possess significant health benefits. Flaxseed oil is one of the richest sources of omega-3 fatty acids, in particular, alpha-linolenic acid (ALA), which represents more than 50% of its total fatty acid content (Br. J. Nutr. 2009;101:440-5; Medical Herbalism: The science and practice of herbal medicine. Healing Arts Press: Rochester, Vt., 2003, p. 57). In addition, flaxseeds are rich in dietary fiber and lignans, which are phytoestrogens with antioxidant properties.

Sanjay Acharya/Wikimedia Creative Commons

Antioxidant, anti-inflammatory, and antiapoptotic properties have been associated with flaxseed oil and warrant medical consideration. The substantial anti-inflammatory activity of L. usitatissimum has been ascribed to its primary active constituent, ALA (57%), which suppresses arachidonic acid metabolism, thus inhibiting the synthesis of proinflammatory n-6 eicosanoids and reducing vascular permeability (Inflammopharmacology 2010;18:127-36).

In a randomized, double-blind, placebo-controlled application test in 2009, De Spirt et al. studied the cutaneous effects of supplementation with flaxseed or borage oil for 12 weeks in two groups of women (n = 45) aged 18-65 years with sensitive and dry skin. Fifteen women were included in each group, and 15 were randomized to a placebo control group. The placebo group received medium-chain fatty acids. The flaxseed oil included ALA and linoleic acid, and the borage oil contained linoleic and gamma-linolenic acids. ALA contributed to the significant rise in total fatty acids in plasma seen in the flaxseed oil group at weeks 6 and 12. An increase in gamma-linolenic acid was noted in the borage oil group. Erythema, roughness, and scaling were decreased in both treatment groups compared with baseline, while skin hydration was markedly elevated after 12 weeks. In addition, transepidermal water loss was diminished by 10% after 6 weeks in both oil treatment groups, with further reductions after 12 weeks in the flaxseed oil group. The investigators concluded that intervention with dietary lipids can manifest as skin improvements (Br. J. Nutr. 2009;101:440-5).

In 2010, Kaithwas and Majumdar evaluated the anti-inflammatory potential of flaxseed fixed oil against castor oil–induced diarrhea, turpentine oil–induced joint edema, and formaldehyde-induced and complete Freund’s adjuvant (CFA)-induced arthritis in Wistar albino rats. They found that flaxseed oil dose-dependently inhibited the adverse effects of castor oil and turpentine oil as well as CFA, and a significant inhibitory effect was also exerted by flaxseed oil against formaldehyde-induced proliferation of global edematous arthritis. Flaxseed oil also significantly diminished the secondary lesions engendered by CFA by dint of a delayed hypersensitivity reaction. The authors concluded that the significant anti-inflammatory activity imparted by L. usitatissimum fixed oil suggests its therapeutic viability for inflammatory conditions, such as rheumatoid arthritis (Inflammopharmacology 2010;18:127-36).

Recently, de Souza et al. studied the effects on skin wounds in rats of a semisolid formulation of flaxseed oil (1%, 5%, or 10%). The investigators assessed the contraction/re-epithelialization of the wound and resistance to mechanical traction in incisional and excisional models, respectively. They found that the groups treated with flaxseed oil concentrations of 1% or 5% largely started re-epithelialization earlier than the petroleum jelly control group, and achieved 100% re-epithelialization on the 14th day after injury, as compared to 33% of animals in the petroleum jelly group. The investigators concluded that flaxseed oil, at low concentrations, exhibits potential in a solid pharmaceutical preparation, for use in dermal repair (Evid. Based. Complement. Alternat. Med. 2012;2012:270752).

Early in 2012, Tülüce et al. set out to ascertain the antioxidant and antiapoptotic effects of flaxseed oil exerted against ultraviolet C–induced damage in rats. They divided animals into three groups: control, UVC alone, and UVC and flaxseed oil. UVC light exposure lasted for 1 hour twice daily for four weeks in the two exposure groups. In the flaxseed oil group, the oil was administered by gavage prior to each irradiation (4 mL/kg ). The investigators noted that malondialdehyde and protein carbonyl levels were higher in the UVC group than in the controls, but such levels were reduced in the flaxseed oil group compared with the UVC-only group, in skin, lens, and sera. Also, the activities of glutathione peroxidase and superoxide dismutase were found to be higher in the skin, lens, and sera of the flaxseed oil group as compared to the UVC-only group. In addition, retinal apoptosis was lower in the flaxseed group than in the UVC group. The researchers concluded that flaxseed oil may be useful in conferring a photoprotective effect against UVC-induced damage, as manifested in protein carbonylation and reactive oxygen species generation, in rats (Toxicol. Ind. Health. 2012;28:99-107).

Conclusion

Flaxseed oil has gained recent attention for its salutary effects as part of the diet. Rich in omega-3 essential fatty acids and lignans, flaxseed oil has been found to improve fatty acid profiles. Significantly, emerging evidence points to beneficial cutaneous effects derived from dietary use of flaxseed oil. However, more research is necessary to determine whether the beneficial constituents of flaxseed oil can be harnessed in topical products.

Dr. Baumann is in private practice in Miami Beach.

Each month, more than 4 billion hours of video are watched on YouTube. It’s not all for Justin Bieber (though much of it is). People across the globe are flocking to YouTube for medical information and advice. Why not take advantage of this interested audience and free service?

Videos can be made simply, using tools you already have, or they can be done professionally in a studio. Although there are some advantages to professionally produced videos, the beauty of YouTube and the user-generated content movement is that these frills are unnecessary. The most important factor is not the quality of the video, but rather, the quality of the content. Videos that capture your true personality and that deliver useful content to viewers will be successful, regardless of how they are produced.

Videos are powerful on many levels: They’re a platform to educate your patients and prospective patients and market your practice. They showcase you both as a person and a physician. And video content is 50 times more likely to appear on the first page of search engine results than text-only content.

Though you could go to your local camera or electronics store and spend a small fortune on video equipment, I suggest you start off with what you have on hand, such as your smart phone or webcam. Choose a well-lighted, quiet area in your office or at home, such as in front of a bookcase. Outline a script, read through it a few times so that it sounds natural, then videotape yourself and see how it looks.

You won’t be perfect on the first take, but that’s OK. The beauty of short 1- to 2-minute videos is that they’re easy to reshoot.

For your first video, I suggest doing an introduction. Your goal is to appear approachable, friendly, and trustworthy. Introduce yourself and share some personal information, such as where you grew up, where you went to school, your favorite sports teams, your hobbies – anything that provides an opportunity for viewers to connect with you on a personal level. Look straight at the camera, smile often, and speak clearly. Keep it under 90 seconds.

Then do another 90-second video welcoming patients to your practice. Mention your expertise, clinical interests, and anything else that makes your practice stand out.

You’ll find that generating content for videos isn’t difficult. Make videos of procedures that you’re expert in, post-op instructions that you repeat frequently, or cosmetic procedures that patients often inquire about.

Create a channel on a video-sharing site such as YouTube or Vimeo, and upload your videos one at a time. You can then embed those videos on your practice website or blog (see last month’s column on blogging).

Here are some of my best practices for making videos:

• Before you start, ask yourself, "Why would someone want to watch this video?"

• Make a single point in each video and stay focused.

• Choose a well-lighted, quiet area for recording. Place the light source in front of you. Back lighting can create shadows.

• Consider composition. You don’t have to be in the center of the frame. You can be off to one side, especially if you’re including something behind you in the shot, or if you are using props. But always look into the camera.

• Use props when relevant.

• Keep videos under 2 minutes.

• Have a script or an outline, but never read from it.

• Tell stories. Patients will remember them better than statistics.

• Rehearse, rehearse, rehearse.

• Be conversational and smile.

• Watch each take so you can make appropriate changes.

• Don’t waste time trying to make a video "go viral."

• Share your videos on Twitter, Facebook, or other social sharing sites.

When you’re done, have someone from your office view the video critically. Are you looking into the camera or over the heads of the viewers? Are you smiling enough? Do you have too many vocal fillers like "um" and "pretty much?" Are you easily seen and heard? It is interesting and worthy of an audience?

Finally, share your video with me @dermdoc on Twitter. You can count on a retweet.

Dr. Benabio is in private practice in San Diego. Visit his consumer health blog; connect with him on Twitter @Dermdoc, and on Facebook.

Each month, more than 4 billion hours of video are watched on YouTube. It’s not all for Justin Bieber (though much of it is). People across the globe are flocking to YouTube for medical information and advice. Why not take advantage of this interested audience and free service?

Videos can be made simply, using tools you already have, or they can be done professionally in a studio. Although there are some advantages to professionally produced videos, the beauty of YouTube and the user-generated content movement is that these frills are unnecessary. The most important factor is not the quality of the video, but rather, the quality of the content. Videos that capture your true personality and that deliver useful content to viewers will be successful, regardless of how they are produced.

Videos are powerful on many levels: They’re a platform to educate your patients and prospective patients and market your practice. They showcase you both as a person and a physician. And video content is 50 times more likely to appear on the first page of search engine results than text-only content.

Though you could go to your local camera or electronics store and spend a small fortune on video equipment, I suggest you start off with what you have on hand, such as your smart phone or webcam. Choose a well-lighted, quiet area in your office or at home, such as in front of a bookcase. Outline a script, read through it a few times so that it sounds natural, then videotape yourself and see how it looks.

You won’t be perfect on the first take, but that’s OK. The beauty of short 1- to 2-minute videos is that they’re easy to reshoot.

For your first video, I suggest doing an introduction. Your goal is to appear approachable, friendly, and trustworthy. Introduce yourself and share some personal information, such as where you grew up, where you went to school, your favorite sports teams, your hobbies – anything that provides an opportunity for viewers to connect with you on a personal level. Look straight at the camera, smile often, and speak clearly. Keep it under 90 seconds.

Then do another 90-second video welcoming patients to your practice. Mention your expertise, clinical interests, and anything else that makes your practice stand out.

You’ll find that generating content for videos isn’t difficult. Make videos of procedures that you’re expert in, post-op instructions that you repeat frequently, or cosmetic procedures that patients often inquire about.

Create a channel on a video-sharing site such as YouTube or Vimeo, and upload your videos one at a time. You can then embed those videos on your practice website or blog (see last month’s column on blogging).

Here are some of my best practices for making videos:

• Before you start, ask yourself, "Why would someone want to watch this video?"

• Make a single point in each video and stay focused.

• Choose a well-lighted, quiet area for recording. Place the light source in front of you. Back lighting can create shadows.

• Consider composition. You don’t have to be in the center of the frame. You can be off to one side, especially if you’re including something behind you in the shot, or if you are using props. But always look into the camera.

• Use props when relevant.

• Keep videos under 2 minutes.

• Have a script or an outline, but never read from it.

• Tell stories. Patients will remember them better than statistics.

• Rehearse, rehearse, rehearse.

• Be conversational and smile.

• Watch each take so you can make appropriate changes.

• Don’t waste time trying to make a video "go viral."

• Share your videos on Twitter, Facebook, or other social sharing sites.

When you’re done, have someone from your office view the video critically. Are you looking into the camera or over the heads of the viewers? Are you smiling enough? Do you have too many vocal fillers like "um" and "pretty much?" Are you easily seen and heard? It is interesting and worthy of an audience?

Finally, share your video with me @dermdoc on Twitter. You can count on a retweet.

Dr. Benabio is in private practice in San Diego. Visit his consumer health blog; connect with him on Twitter @Dermdoc, and on Facebook.

Each month, more than 4 billion hours of video are watched on YouTube. It’s not all for Justin Bieber (though much of it is). People across the globe are flocking to YouTube for medical information and advice. Why not take advantage of this interested audience and free service?

Videos can be made simply, using tools you already have, or they can be done professionally in a studio. Although there are some advantages to professionally produced videos, the beauty of YouTube and the user-generated content movement is that these frills are unnecessary. The most important factor is not the quality of the video, but rather, the quality of the content. Videos that capture your true personality and that deliver useful content to viewers will be successful, regardless of how they are produced.

Videos are powerful on many levels: They’re a platform to educate your patients and prospective patients and market your practice. They showcase you both as a person and a physician. And video content is 50 times more likely to appear on the first page of search engine results than text-only content.

Though you could go to your local camera or electronics store and spend a small fortune on video equipment, I suggest you start off with what you have on hand, such as your smart phone or webcam. Choose a well-lighted, quiet area in your office or at home, such as in front of a bookcase. Outline a script, read through it a few times so that it sounds natural, then videotape yourself and see how it looks.

You won’t be perfect on the first take, but that’s OK. The beauty of short 1- to 2-minute videos is that they’re easy to reshoot.

For your first video, I suggest doing an introduction. Your goal is to appear approachable, friendly, and trustworthy. Introduce yourself and share some personal information, such as where you grew up, where you went to school, your favorite sports teams, your hobbies – anything that provides an opportunity for viewers to connect with you on a personal level. Look straight at the camera, smile often, and speak clearly. Keep it under 90 seconds.

Then do another 90-second video welcoming patients to your practice. Mention your expertise, clinical interests, and anything else that makes your practice stand out.

You’ll find that generating content for videos isn’t difficult. Make videos of procedures that you’re expert in, post-op instructions that you repeat frequently, or cosmetic procedures that patients often inquire about.

Create a channel on a video-sharing site such as YouTube or Vimeo, and upload your videos one at a time. You can then embed those videos on your practice website or blog (see last month’s column on blogging).

Here are some of my best practices for making videos:

• Before you start, ask yourself, "Why would someone want to watch this video?"

• Make a single point in each video and stay focused.

• Choose a well-lighted, quiet area for recording. Place the light source in front of you. Back lighting can create shadows.

• Consider composition. You don’t have to be in the center of the frame. You can be off to one side, especially if you’re including something behind you in the shot, or if you are using props. But always look into the camera.

• Use props when relevant.

• Keep videos under 2 minutes.

• Have a script or an outline, but never read from it.

• Tell stories. Patients will remember them better than statistics.

• Rehearse, rehearse, rehearse.

• Be conversational and smile.

• Watch each take so you can make appropriate changes.

• Don’t waste time trying to make a video "go viral."

• Share your videos on Twitter, Facebook, or other social sharing sites.

When you’re done, have someone from your office view the video critically. Are you looking into the camera or over the heads of the viewers? Are you smiling enough? Do you have too many vocal fillers like "um" and "pretty much?" Are you easily seen and heard? It is interesting and worthy of an audience?

Finally, share your video with me @dermdoc on Twitter. You can count on a retweet.

Dr. Benabio is in private practice in San Diego. Visit his consumer health blog; connect with him on Twitter @Dermdoc, and on Facebook.

The holiday season has come and gone with alarming speed; and now, ’tis the season for resolutions, turning over a new leaf, promising – yet again – to break all those bad habits once and for all.

I can’t presume to know what your professional bad habits are, but I do know the ones I get asked about the most. The following "top ten list" might provide some inspiration for assembling a list of your own:

1. Start on time. So many doctors complain of running behind. Guess what? Your patients complain about that too. Waiting is the most common patient complaint, and you can’t hope to run on time if you don’t start on time. No single change will improve your efficiency more than this.

2. Organize your Internet time. I confess, this one is on my own list most years. E-mail needs to be answered, and your office’s Twitter feed and Facebook page need updating; but do it before or after office hours. It’s just too easy to start clicking that mouse, and suddenly you’re half an hour behind.

3. Permit fewer interruptions. Phone calls and pharmaceutical reps seem to be the big interrupters in most offices. Make some rules, and stick to them. I’ll stop to take an emergency call, or one from an immediate family member; all others get routed to the nurses or are returned at lunch or after hours. Reps make appointments, like everybody else – and only if they have something new to talk about.

4. Organize samples. See my column on this subject. We strip all the space-wasting packaging off our samples and store them, alphabetically, in cardboard "parts" bins, available in many industrial catalogs. Besides always knowing what you have, you’ll always know what you’re out of; and your staff will waste far less time tracking samples down. Also, a bin system makes logging samples in and out much easier, should that become a requirement – as the FDA keeps promising.

5. Clear your "horizontal file cabinet." That’s the mess on your desk, all the paperwork you never seem to get to (probably because you’re tweeting or answering e-mail). Set aside an hour or two and get it all done. You’ll find some interesting stuff in there. Then, for every piece of paper that arrives on your desk from now on, follow the DDD Rule: Do it, Delegate it, or Destroy it. Don’t start a new mess.

6. Keep a closer eye on your office finances. Most physicians delegate the bookkeeping, and that’s fine. But ignoring the financial side creates an atmosphere that facilitates embezzlement. Set aside a couple of hours each month to review the books personally. And make sure your employees know you’re doing it.

7. Make sure your long-range financial planning is on track. This is another task physicians tend to "set and forget," but the Great Recession was an eye-opener for many of us. Once a year, sit down with your accountant and planner, and make sure your investments are well diversified and all other aspects of your finances – budgets, credit ratings, insurance coverage, tax situations, college savings, estate plans, and retirement accounts – are in the best shape possible. Now would be a good time.

8. Pay down your debt. Debt can destroy the best-laid retirement plans; many learned this the hard way when the "bubble" burst. If you carry significant debt, set up a plan to pay it off as soon as you can.

9. Take more vacations. Remember Eastern’s First Law: Your last words will NOT be, "I wish I had spent more time in the office." This is the year to start spending more time enjoying your life, your friends and family, and the world. As John Lennon said, "Life is what happens to you while you’re busy making other plans."

10. Look at yourself. A private practice lives or dies on the personalities of its physicians, and your staff copies your personality and style. Take a hard, honest look at yourself. Identify your negative personality traits and work to eliminate them. If you have any difficulty finding the things that need changing . . . ask your spouse. He or she will be happy to outline them for you, in great detail.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. T

The holiday season has come and gone with alarming speed; and now, ’tis the season for resolutions, turning over a new leaf, promising – yet again – to break all those bad habits once and for all.

I can’t presume to know what your professional bad habits are, but I do know the ones I get asked about the most. The following "top ten list" might provide some inspiration for assembling a list of your own:

1. Start on time. So many doctors complain of running behind. Guess what? Your patients complain about that too. Waiting is the most common patient complaint, and you can’t hope to run on time if you don’t start on time. No single change will improve your efficiency more than this.

2. Organize your Internet time. I confess, this one is on my own list most years. E-mail needs to be answered, and your office’s Twitter feed and Facebook page need updating; but do it before or after office hours. It’s just too easy to start clicking that mouse, and suddenly you’re half an hour behind.

3. Permit fewer interruptions. Phone calls and pharmaceutical reps seem to be the big interrupters in most offices. Make some rules, and stick to them. I’ll stop to take an emergency call, or one from an immediate family member; all others get routed to the nurses or are returned at lunch or after hours. Reps make appointments, like everybody else – and only if they have something new to talk about.

4. Organize samples. See my column on this subject. We strip all the space-wasting packaging off our samples and store them, alphabetically, in cardboard "parts" bins, available in many industrial catalogs. Besides always knowing what you have, you’ll always know what you’re out of; and your staff will waste far less time tracking samples down. Also, a bin system makes logging samples in and out much easier, should that become a requirement – as the FDA keeps promising.

5. Clear your "horizontal file cabinet." That’s the mess on your desk, all the paperwork you never seem to get to (probably because you’re tweeting or answering e-mail). Set aside an hour or two and get it all done. You’ll find some interesting stuff in there. Then, for every piece of paper that arrives on your desk from now on, follow the DDD Rule: Do it, Delegate it, or Destroy it. Don’t start a new mess.

6. Keep a closer eye on your office finances. Most physicians delegate the bookkeeping, and that’s fine. But ignoring the financial side creates an atmosphere that facilitates embezzlement. Set aside a couple of hours each month to review the books personally. And make sure your employees know you’re doing it.

7. Make sure your long-range financial planning is on track. This is another task physicians tend to "set and forget," but the Great Recession was an eye-opener for many of us. Once a year, sit down with your accountant and planner, and make sure your investments are well diversified and all other aspects of your finances – budgets, credit ratings, insurance coverage, tax situations, college savings, estate plans, and retirement accounts – are in the best shape possible. Now would be a good time.

8. Pay down your debt. Debt can destroy the best-laid retirement plans; many learned this the hard way when the "bubble" burst. If you carry significant debt, set up a plan to pay it off as soon as you can.

9. Take more vacations. Remember Eastern’s First Law: Your last words will NOT be, "I wish I had spent more time in the office." This is the year to start spending more time enjoying your life, your friends and family, and the world. As John Lennon said, "Life is what happens to you while you’re busy making other plans."

10. Look at yourself. A private practice lives or dies on the personalities of its physicians, and your staff copies your personality and style. Take a hard, honest look at yourself. Identify your negative personality traits and work to eliminate them. If you have any difficulty finding the things that need changing . . . ask your spouse. He or she will be happy to outline them for you, in great detail.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. T

The holiday season has come and gone with alarming speed; and now, ’tis the season for resolutions, turning over a new leaf, promising – yet again – to break all those bad habits once and for all.

I can’t presume to know what your professional bad habits are, but I do know the ones I get asked about the most. The following "top ten list" might provide some inspiration for assembling a list of your own:

1. Start on time. So many doctors complain of running behind. Guess what? Your patients complain about that too. Waiting is the most common patient complaint, and you can’t hope to run on time if you don’t start on time. No single change will improve your efficiency more than this.

2. Organize your Internet time. I confess, this one is on my own list most years. E-mail needs to be answered, and your office’s Twitter feed and Facebook page need updating; but do it before or after office hours. It’s just too easy to start clicking that mouse, and suddenly you’re half an hour behind.

3. Permit fewer interruptions. Phone calls and pharmaceutical reps seem to be the big interrupters in most offices. Make some rules, and stick to them. I’ll stop to take an emergency call, or one from an immediate family member; all others get routed to the nurses or are returned at lunch or after hours. Reps make appointments, like everybody else – and only if they have something new to talk about.

4. Organize samples. See my column on this subject. We strip all the space-wasting packaging off our samples and store them, alphabetically, in cardboard "parts" bins, available in many industrial catalogs. Besides always knowing what you have, you’ll always know what you’re out of; and your staff will waste far less time tracking samples down. Also, a bin system makes logging samples in and out much easier, should that become a requirement – as the FDA keeps promising.

5. Clear your "horizontal file cabinet." That’s the mess on your desk, all the paperwork you never seem to get to (probably because you’re tweeting or answering e-mail). Set aside an hour or two and get it all done. You’ll find some interesting stuff in there. Then, for every piece of paper that arrives on your desk from now on, follow the DDD Rule: Do it, Delegate it, or Destroy it. Don’t start a new mess.

6. Keep a closer eye on your office finances. Most physicians delegate the bookkeeping, and that’s fine. But ignoring the financial side creates an atmosphere that facilitates embezzlement. Set aside a couple of hours each month to review the books personally. And make sure your employees know you’re doing it.

7. Make sure your long-range financial planning is on track. This is another task physicians tend to "set and forget," but the Great Recession was an eye-opener for many of us. Once a year, sit down with your accountant and planner, and make sure your investments are well diversified and all other aspects of your finances – budgets, credit ratings, insurance coverage, tax situations, college savings, estate plans, and retirement accounts – are in the best shape possible. Now would be a good time.

8. Pay down your debt. Debt can destroy the best-laid retirement plans; many learned this the hard way when the "bubble" burst. If you carry significant debt, set up a plan to pay it off as soon as you can.

9. Take more vacations. Remember Eastern’s First Law: Your last words will NOT be, "I wish I had spent more time in the office." This is the year to start spending more time enjoying your life, your friends and family, and the world. As John Lennon said, "Life is what happens to you while you’re busy making other plans."

10. Look at yourself. A private practice lives or dies on the personalities of its physicians, and your staff copies your personality and style. Take a hard, honest look at yourself. Identify your negative personality traits and work to eliminate them. If you have any difficulty finding the things that need changing . . . ask your spouse. He or she will be happy to outline them for you, in great detail.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. T

WASHINGTON  – Marijuana remains popular with U.S. teenagers, with steady and even rising rates of use, according to a key federal survey.

This year’s data from the annual Monitoring the Future survey found that marijuana was the No. 1 drug used by students in the 8th, 10th, and 12th grades. About 35% of high school seniors said they smoked pot in the past year, consistent with 2011 usage. Daily use among seniors also stayed flat, at around 7%.

Alicia Ault/IMNG Medical Media

Of concern is the declining number of seniors who view marijuana use as risky. Only 20% of seniors said occasional use was harmful, the lowest rate recorded since 1983. Higher numbers of 8th and 10th graders consider pot smoking to be risky, but those figures declined as well.

Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said that teen perception of harm might be decreasing in part because of the ongoing debate over legalized medical marijuana and recent state efforts that decriminalized recreational use.

Previous NIDA studies have shown that teens believe that anything used for medicinal purposes – such as prescription painkillers – are inherently less dangerous. Also, many teens will not use drugs because they are illegal. Without laws prohibiting use, "that deterrent is not present," Dr. Volkow said at a press conference called by NIDA.

But marijuana is not harmless, Dr. Volkow noted. A study published earlier this year found that heavy marijuana use in the teen years contributed to lower IQs and impaired mental abilities (Proc. Natl. Acad. Sci. USA 2012;109:E2657-64 [doi:10.1073/pnas.1206820109]).

"We are increasingly concerned that regular or daily use of marijuana is robbing many young people of their potential to achieve and excel in school or other aspects of life," she said.

Alicia Ault/IMNG Medical Media

Synthetic marijuana, also known as spice or K-2, was the second most popular drug among high school seniors, with 11% reporting they had used it in the past year. A little more than 4% of 8th graders said they’d used the substance.

Dr. Volkow cautioned that synthetic cannabinoids were just as dangerous as is the plant form, and possibly more so, given that the active drug could be concentrated. Many ingredients that can be found in synthetic marijuana have been banned by the Drug Enforcement Administration.

Prescription drug abuse continues to be of concern. Among seniors, Adderall was the third most used drug. About 8% said they had used the prescription stimulant in the previous year, often for a nonmedical use. Vicodin was close behind, with 7.5% of seniors having used it within the past year. The majority of 12th graders (68%) said they were given the prescription medications by friends or relatives; 38% said they had bought the drug from friends or relatives, about a third said they had gotten it by prescription, and 22% said they took it from friends or relatives.

So called "bath salts" were included in the Monitoring the Future survey this year for the first time. "Bath salts" is the street name for a group of designer amphetamine-like stimulants that are sold over the counter. Only 1.3% of seniors reported using the products, a relatively low rate that may reflect heavy publicity about their dangers, Gil Kerlikowske, director of the White House Office of National Drug Control Policy, said at the briefing.

The survey also showed that both tobacco and alcohol use have declined significantly over the years. Alcohol use is at its lowest since the survey began in 1975. About 70% of high school seniors said they’d ever used alcohol, down from a peak of 90%.

For tobacco, there were significant declines in lifetime use among 8th graders: 16% in 2012 compared with a peak of 50% in 1996. For 10th graders, 28% said they had ever smoked tobacco, down from a peak of 61% in 1996. Rates of use of smokeless tobacco and other tobacco products continued to stay steady.

"So as we look at these numbers and we look again in trying to determine what they tell us, I think they identify the areas where we need to pay attention and don’t become complacent," Dr. Volkow said.

More than 45,000 students from 395 public and private schools took part in the Monitoring the Future survey this year. Since 1975, the survey has measured the drug, alcohol, and cigarette use and related attitudes of U.S. high school seniors; 8th and 10th graders were added to the survey in 1991. The survey is funded by NIDA and conducted by University of Michigan investigators led by  Lloyd Johnston, Ph.D.

WASHINGTON  – Marijuana remains popular with U.S. teenagers, with steady and even rising rates of use, according to a key federal survey.

This year’s data from the annual Monitoring the Future survey found that marijuana was the No. 1 drug used by students in the 8th, 10th, and 12th grades. About 35% of high school seniors said they smoked pot in the past year, consistent with 2011 usage. Daily use among seniors also stayed flat, at around 7%.

Alicia Ault/IMNG Medical Media

Of concern is the declining number of seniors who view marijuana use as risky. Only 20% of seniors said occasional use was harmful, the lowest rate recorded since 1983. Higher numbers of 8th and 10th graders consider pot smoking to be risky, but those figures declined as well.

Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said that teen perception of harm might be decreasing in part because of the ongoing debate over legalized medical marijuana and recent state efforts that decriminalized recreational use.

Previous NIDA studies have shown that teens believe that anything used for medicinal purposes – such as prescription painkillers – are inherently less dangerous. Also, many teens will not use drugs because they are illegal. Without laws prohibiting use, "that deterrent is not present," Dr. Volkow said at a press conference called by NIDA.

But marijuana is not harmless, Dr. Volkow noted. A study published earlier this year found that heavy marijuana use in the teen years contributed to lower IQs and impaired mental abilities (Proc. Natl. Acad. Sci. USA 2012;109:E2657-64 [doi:10.1073/pnas.1206820109]).

"We are increasingly concerned that regular or daily use of marijuana is robbing many young people of their potential to achieve and excel in school or other aspects of life," she said.

Alicia Ault/IMNG Medical Media

Synthetic marijuana, also known as spice or K-2, was the second most popular drug among high school seniors, with 11% reporting they had used it in the past year. A little more than 4% of 8th graders said they’d used the substance.

Dr. Volkow cautioned that synthetic cannabinoids were just as dangerous as is the plant form, and possibly more so, given that the active drug could be concentrated. Many ingredients that can be found in synthetic marijuana have been banned by the Drug Enforcement Administration.

Prescription drug abuse continues to be of concern. Among seniors, Adderall was the third most used drug. About 8% said they had used the prescription stimulant in the previous year, often for a nonmedical use. Vicodin was close behind, with 7.5% of seniors having used it within the past year. The majority of 12th graders (68%) said they were given the prescription medications by friends or relatives; 38% said they had bought the drug from friends or relatives, about a third said they had gotten it by prescription, and 22% said they took it from friends or relatives.

So called "bath salts" were included in the Monitoring the Future survey this year for the first time. "Bath salts" is the street name for a group of designer amphetamine-like stimulants that are sold over the counter. Only 1.3% of seniors reported using the products, a relatively low rate that may reflect heavy publicity about their dangers, Gil Kerlikowske, director of the White House Office of National Drug Control Policy, said at the briefing.

The survey also showed that both tobacco and alcohol use have declined significantly over the years. Alcohol use is at its lowest since the survey began in 1975. About 70% of high school seniors said they’d ever used alcohol, down from a peak of 90%.

For tobacco, there were significant declines in lifetime use among 8th graders: 16% in 2012 compared with a peak of 50% in 1996. For 10th graders, 28% said they had ever smoked tobacco, down from a peak of 61% in 1996. Rates of use of smokeless tobacco and other tobacco products continued to stay steady.

"So as we look at these numbers and we look again in trying to determine what they tell us, I think they identify the areas where we need to pay attention and don’t become complacent," Dr. Volkow said.

More than 45,000 students from 395 public and private schools took part in the Monitoring the Future survey this year. Since 1975, the survey has measured the drug, alcohol, and cigarette use and related attitudes of U.S. high school seniors; 8th and 10th graders were added to the survey in 1991. The survey is funded by NIDA and conducted by University of Michigan investigators led by  Lloyd Johnston, Ph.D.

WASHINGTON  – Marijuana remains popular with U.S. teenagers, with steady and even rising rates of use, according to a key federal survey.

This year’s data from the annual Monitoring the Future survey found that marijuana was the No. 1 drug used by students in the 8th, 10th, and 12th grades. About 35% of high school seniors said they smoked pot in the past year, consistent with 2011 usage. Daily use among seniors also stayed flat, at around 7%.

Alicia Ault/IMNG Medical Media

Of concern is the declining number of seniors who view marijuana use as risky. Only 20% of seniors said occasional use was harmful, the lowest rate recorded since 1983. Higher numbers of 8th and 10th graders consider pot smoking to be risky, but those figures declined as well.

Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said that teen perception of harm might be decreasing in part because of the ongoing debate over legalized medical marijuana and recent state efforts that decriminalized recreational use.

Previous NIDA studies have shown that teens believe that anything used for medicinal purposes – such as prescription painkillers – are inherently less dangerous. Also, many teens will not use drugs because they are illegal. Without laws prohibiting use, "that deterrent is not present," Dr. Volkow said at a press conference called by NIDA.

But marijuana is not harmless, Dr. Volkow noted. A study published earlier this year found that heavy marijuana use in the teen years contributed to lower IQs and impaired mental abilities (Proc. Natl. Acad. Sci. USA 2012;109:E2657-64 [doi:10.1073/pnas.1206820109]).

"We are increasingly concerned that regular or daily use of marijuana is robbing many young people of their potential to achieve and excel in school or other aspects of life," she said.

Alicia Ault/IMNG Medical Media

Synthetic marijuana, also known as spice or K-2, was the second most popular drug among high school seniors, with 11% reporting they had used it in the past year. A little more than 4% of 8th graders said they’d used the substance.

Dr. Volkow cautioned that synthetic cannabinoids were just as dangerous as is the plant form, and possibly more so, given that the active drug could be concentrated. Many ingredients that can be found in synthetic marijuana have been banned by the Drug Enforcement Administration.

Prescription drug abuse continues to be of concern. Among seniors, Adderall was the third most used drug. About 8% said they had used the prescription stimulant in the previous year, often for a nonmedical use. Vicodin was close behind, with 7.5% of seniors having used it within the past year. The majority of 12th graders (68%) said they were given the prescription medications by friends or relatives; 38% said they had bought the drug from friends or relatives, about a third said they had gotten it by prescription, and 22% said they took it from friends or relatives.

So called "bath salts" were included in the Monitoring the Future survey this year for the first time. "Bath salts" is the street name for a group of designer amphetamine-like stimulants that are sold over the counter. Only 1.3% of seniors reported using the products, a relatively low rate that may reflect heavy publicity about their dangers, Gil Kerlikowske, director of the White House Office of National Drug Control Policy, said at the briefing.

The survey also showed that both tobacco and alcohol use have declined significantly over the years. Alcohol use is at its lowest since the survey began in 1975. About 70% of high school seniors said they’d ever used alcohol, down from a peak of 90%.

For tobacco, there were significant declines in lifetime use among 8th graders: 16% in 2012 compared with a peak of 50% in 1996. For 10th graders, 28% said they had ever smoked tobacco, down from a peak of 61% in 1996. Rates of use of smokeless tobacco and other tobacco products continued to stay steady.

"So as we look at these numbers and we look again in trying to determine what they tell us, I think they identify the areas where we need to pay attention and don’t become complacent," Dr. Volkow said.

More than 45,000 students from 395 public and private schools took part in the Monitoring the Future survey this year. Since 1975, the survey has measured the drug, alcohol, and cigarette use and related attitudes of U.S. high school seniors; 8th and 10th graders were added to the survey in 1991. The survey is funded by NIDA and conducted by University of Michigan investigators led by  Lloyd Johnston, Ph.D.

While the debate about whether pediatric hospitalists should obtain certification is alive and well, the majority of hospitalists favor further education through fellowships, or a recognition of focused practice for the subspecialty.

When asked in a recent poll by The Hospitalist which certification options pediatric hospital medicine should pursue, 40% of respondents preferred having a recognition of focused practice for pediatric hospitalists, similar to that of adult hospitalists; 25% thought a one-year fellowship should be in place; and 9% would keep the status quo. Currently, there is no specific certification option for pediatric hospitalists. Still, the topic has raised some strong opinions and remains popular fodder for debate among hospitalists.

"I think it is clear the vast majority of pediatric hospitalists believe there are skills necessary to function at a high level in pediatric hospitalist medicine that are not gained during just three years of pediatric residency," says Douglas W. Carlson, MD, SFHM, SHM's representative to the Joint Council of Pediatric Hospital Medicine.

Dr. Carlson says he considers two-year fellowships the best option. However, he does see the possible negative consequences to further education. "If we go to a fellowship, I am worried we will turn off that pipeline [of bright young physicians] … particularly when so many medical students in residency are coming out with such huge debt," he adds.

Rather than debating which result is best, Mark Shen, MD, SFHM, medical director of hospital medicine at Dell Children's Medical Center in Austin, Texas, is more interested in the "why"of the matter."Whatever result comes out will be well thought through," he says. "In my mind, I would be more interested in what the underlying thought process is in the decision more than anything else."

Currently, no medical society, including SHM, has released an official statement on pediatric hospitalist certification.

Visit our website for more information about pediatric hospitalist certification.

While the debate about whether pediatric hospitalists should obtain certification is alive and well, the majority of hospitalists favor further education through fellowships, or a recognition of focused practice for the subspecialty.

When asked in a recent poll by The Hospitalist which certification options pediatric hospital medicine should pursue, 40% of respondents preferred having a recognition of focused practice for pediatric hospitalists, similar to that of adult hospitalists; 25% thought a one-year fellowship should be in place; and 9% would keep the status quo. Currently, there is no specific certification option for pediatric hospitalists. Still, the topic has raised some strong opinions and remains popular fodder for debate among hospitalists.

"I think it is clear the vast majority of pediatric hospitalists believe there are skills necessary to function at a high level in pediatric hospitalist medicine that are not gained during just three years of pediatric residency," says Douglas W. Carlson, MD, SFHM, SHM's representative to the Joint Council of Pediatric Hospital Medicine.

Dr. Carlson says he considers two-year fellowships the best option. However, he does see the possible negative consequences to further education. "If we go to a fellowship, I am worried we will turn off that pipeline [of bright young physicians] … particularly when so many medical students in residency are coming out with such huge debt," he adds.

Rather than debating which result is best, Mark Shen, MD, SFHM, medical director of hospital medicine at Dell Children's Medical Center in Austin, Texas, is more interested in the "why"of the matter."Whatever result comes out will be well thought through," he says. "In my mind, I would be more interested in what the underlying thought process is in the decision more than anything else."

Currently, no medical society, including SHM, has released an official statement on pediatric hospitalist certification.

Visit our website for more information about pediatric hospitalist certification.

While the debate about whether pediatric hospitalists should obtain certification is alive and well, the majority of hospitalists favor further education through fellowships, or a recognition of focused practice for the subspecialty.

When asked in a recent poll by The Hospitalist which certification options pediatric hospital medicine should pursue, 40% of respondents preferred having a recognition of focused practice for pediatric hospitalists, similar to that of adult hospitalists; 25% thought a one-year fellowship should be in place; and 9% would keep the status quo. Currently, there is no specific certification option for pediatric hospitalists. Still, the topic has raised some strong opinions and remains popular fodder for debate among hospitalists.

"I think it is clear the vast majority of pediatric hospitalists believe there are skills necessary to function at a high level in pediatric hospitalist medicine that are not gained during just three years of pediatric residency," says Douglas W. Carlson, MD, SFHM, SHM's representative to the Joint Council of Pediatric Hospital Medicine.

Dr. Carlson says he considers two-year fellowships the best option. However, he does see the possible negative consequences to further education. "If we go to a fellowship, I am worried we will turn off that pipeline [of bright young physicians] … particularly when so many medical students in residency are coming out with such huge debt," he adds.

Rather than debating which result is best, Mark Shen, MD, SFHM, medical director of hospital medicine at Dell Children's Medical Center in Austin, Texas, is more interested in the "why"of the matter."Whatever result comes out will be well thought through," he says. "In my mind, I would be more interested in what the underlying thought process is in the decision more than anything else."

Currently, no medical society, including SHM, has released an official statement on pediatric hospitalist certification.

Visit our website for more information about pediatric hospitalist certification.

Clinical question: What are the relative predictive values of the HEMORR2HAGES, ATRIA, and HAS-BLED risk-prediction schemes?

Background: The tools predict bleeding risk in patients anticoagulated for atrial fibrillation (afib), but it is unknown which is the best for predicting clinically relevant bleeding.

Study design: Post-hoc analysis.

Setting: Data previously collected for the AMADEUS trial (2,293 patients taking warfarin; 251 had at least one clinically relevant bleeding event) were used to test each of the three bleeding-risk-prediction schemes on the same data set.

Synopsis: Using three analysis methods (net reclassification improvement, receiver-operating characteristic [ROC], and decision-curve analysis), the researchers compared the three schemes’ performance. HAS-BLED performed best in all three of the analysis methods.

The HAS-BLED score calculation requires the following patient information: history of hypertension, renal disease, liver disease, stroke, prior major bleeding event, and labile INR; age >65; and use of antiplatelet agents, aspirin, and alcohol.

Bottom line: HAS-BLED was the best of the three schemes, although all three had only modest ability to predict clinically relevant bleeding.

Citation: Apostolakis S, Lane DA, Guo Y, et al. Performance of the HEMORR2HAGES, ATRIA and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation. J Am Coll Cardiol. 2012;60(9):861-867.

Visit our website for more physician reviews of recent HM-relevant literature.

Clinical question: What are the relative predictive values of the HEMORR2HAGES, ATRIA, and HAS-BLED risk-prediction schemes?

Background: The tools predict bleeding risk in patients anticoagulated for atrial fibrillation (afib), but it is unknown which is the best for predicting clinically relevant bleeding.

Study design: Post-hoc analysis.

Setting: Data previously collected for the AMADEUS trial (2,293 patients taking warfarin; 251 had at least one clinically relevant bleeding event) were used to test each of the three bleeding-risk-prediction schemes on the same data set.

Synopsis: Using three analysis methods (net reclassification improvement, receiver-operating characteristic [ROC], and decision-curve analysis), the researchers compared the three schemes’ performance. HAS-BLED performed best in all three of the analysis methods.

The HAS-BLED score calculation requires the following patient information: history of hypertension, renal disease, liver disease, stroke, prior major bleeding event, and labile INR; age >65; and use of antiplatelet agents, aspirin, and alcohol.

Bottom line: HAS-BLED was the best of the three schemes, although all three had only modest ability to predict clinically relevant bleeding.

Citation: Apostolakis S, Lane DA, Guo Y, et al. Performance of the HEMORR2HAGES, ATRIA and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation. J Am Coll Cardiol. 2012;60(9):861-867.

Visit our website for more physician reviews of recent HM-relevant literature.

Clinical question: What are the relative predictive values of the HEMORR2HAGES, ATRIA, and HAS-BLED risk-prediction schemes?

Background: The tools predict bleeding risk in patients anticoagulated for atrial fibrillation (afib), but it is unknown which is the best for predicting clinically relevant bleeding.

Study design: Post-hoc analysis.

Setting: Data previously collected for the AMADEUS trial (2,293 patients taking warfarin; 251 had at least one clinically relevant bleeding event) were used to test each of the three bleeding-risk-prediction schemes on the same data set.

Synopsis: Using three analysis methods (net reclassification improvement, receiver-operating characteristic [ROC], and decision-curve analysis), the researchers compared the three schemes’ performance. HAS-BLED performed best in all three of the analysis methods.

The HAS-BLED score calculation requires the following patient information: history of hypertension, renal disease, liver disease, stroke, prior major bleeding event, and labile INR; age >65; and use of antiplatelet agents, aspirin, and alcohol.

Bottom line: HAS-BLED was the best of the three schemes, although all three had only modest ability to predict clinically relevant bleeding.

Citation: Apostolakis S, Lane DA, Guo Y, et al. Performance of the HEMORR2HAGES, ATRIA and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation. J Am Coll Cardiol. 2012;60(9):861-867.

Visit our website for more physician reviews of recent HM-relevant literature.