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Increasing ICS Compliance: The Voice May Be Recorded, But The Results Are Real
Automated phone calling may help physicians solve a perennial problem: patients who don"t take medicine prescribed for chronic health conditions.
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Drop In Access To Abortion Would Reward Antiabortion-Rights Violence, Opinion Piece Says
After the murder last month of Kansas abortion provider George Tiller, "there is a very real danger" that the availability of abortion later in pregnancy "will end in this country -- not after public deliberation, legislative debate and majority vote, but because antiabortion absolutists on the fringe have intimidated and blacklisted doctors and successfully threatened violence against them," Jim Buie, author of the blog The Buie Knife, writes in a Newsweek.com opinion piece. Buie writes that his parents in the early 1950s chose to institutionalize his three-year-old-brother, who was born with severe Down syndrome, after their attempts to care for him left them with "severe emotional distress" and unable "to meet the needs of their healthy children."Buie continues that he "cannot say that the option of a late-term abortion would have been the right one for my parents." However, "some of the arguments advanced by pro-life forces disturb me," he says, especially a "tendency to romanticize, sentimentalize and idealize life with a cute, forever-young Down-syndrome "angel child."" Buie adds, "It"s an argument I find off-putting, especially when it"s espoused by people who have never been through the wringer trying to care for a child whose disability level is on the most severe end of the scale." He continues, "At the same time, it is very disturbing that until recently, the majority of Down-syndrome fetuses were aborted without expectant mothers receiving proper information or support."Because of Tiller"s murder, it is "possible there won"t be any doctors in the country willing to perform" abortion later in pregnancy, "even if prenatal tests indicate severe retardation," according to Buie, who adds that this would mean that "domestic terrorism could win." He concludes, "It would mean that parents like my own would no longer have a choice, and would instead be forced to endure the same harsh realities that were present in the 1950s" (Buie, Newsweek.com, 6/17).
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New Pre-Clinical Data On OmniGuide's BeamPath NEURO(TM) Demonstrates Precise Cutting In Brain Tissue
OmniGuide, Inc., the developer of the first and only flexible CO2 laser fiber based on breakthrough photonic bandgap technology, announced the results of a pre-clinical study comparing the Company"s fiber scalpels to conventional incision methods in neurosurgery. In the study, surgeons from the Barrow Neurological Institute reported that careful studies of incisions produced in live brain tissue with fiber delivered CO2 laser radiation produced precise cuts while minimally effecting adjacent brain tissue when compared with a widely used reference technique. The study, led by Drs. Mark Preul, Robert W. Ryan, and Robert Spetzler of the Neurosurgery Research Laboratory, Barrow Neurological Institute, in Phoenix, Arizona, was presented at the annual conference of the American Academy of Neurological Surgeons in San Diego, California.
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Intervention Helps Reduce Pain And Depression

For patients who experience pain and depression, common co-existing conditions, an intervention that included individually tailored antidepressant therapy and a pain self-management program resulted in greater improvement in the symptoms of these conditions than patients who received usual care, according to a study in the May 27 issue of JAMA. Pain complaints account for more than 40 percent of all symptom-related outpatient visits, and depression is present in 10 percent to 15 percent of all patients who receive primary care. Pain and depression frequently co-exist (30 percent-50 percent co-occurrence), effect the treatment responsiveness of each, and have adverse effects on quality of life, disability, and health care costs, according to background information in the article. Kurt Kroenke, M.D., of Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, and colleagues conducted a study to determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and co-existing depression. The trial (Stepped Care for Affective Disorders and Musculoskeletal Pain [SCAMP]) included 250 patients who had low back, hip, or knee pain for 3 months or longer and at least moderate depression severity. Patients were randomly assigned to the intervention (n = 123) or to usual care (n = 127). Depression was assessed with the 20-item Hopkins Symptom Checklist, and pain primarily with the Brief Pain Inventory. The intervention consisted of 12 weeks of optimized antidepressant therapy (actively managed by a nurse care manager); followed by 6 sessions of a pain self-management program over 12 weeks (during each session, the nurse care manager introduces new strategies for patient self-management, assists the patient in choosing strategies, and supervises the patient as he/she practices the chosen strategy); and a 6-month continuation phase, in which symptoms were monitored and treatments reinforced, with a focus on preventing relapse. The researchers found that the intervention group had significantly better outcomes for depression. The intervention group was more than twice as likely to experience depression response (46 of 123 intervention patients [37.4 percent] vs. 21 of 127 usual care patients [16.5 percent]) and nearly 4 times as likely to experience complete remission (17.9 percent vs. 4.7 percent) at 12 months, corresponding to a much lower number of patients with major depression (40.7 percent vs. 68.5 percent). Intervention patients were also much more likely than usual care patients to report overall improvement in their pain at 12 months (47.2 percent vs. 12.6 percent). In terms of the trial"s primary outcome, the intervention group was significantly more likely to experience a composite response, defined as a reduction of 50 percent or greater in depression and a reduction of 30 percent or greater in pain. This difference in composite response rates was significant at both 6 months (23.6 percent for intervention patients vs. 7.9 percent for usual care patients) and 12 months (26.0 percent vs. 7.9 percent). "It is possible that pain improvement in our trial reflected a main effect of improved mood (i.e., an antidepressant effect on mood rather than an analgesic effect), and that as depression lifts, patients may experience pain as being less intense and less disabling. Conversely, it is also possible that the improvement in depression was mediated by an improvement in pain (i.e., as pain improves, patients feel less depressed) or that both depression and pain lessened as a result of treatment effects on a common pathway," the authors write. "Because pain and depression are among the leading causes of decreased work productivity, an intervention that is effective for both conditions may further strengthen a business model. Also, an intervention that allows a care manager to cover several conditions rather than a single disorder may enhance its implementation and cost-effectiveness. Given the prevalence, morbidity, disability, and costs of the pain-depression dyad, the SCAMP trial results have important implications." JAMA. 2009;301[20]:2099-2110. Journal of the American Medical Association


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