News Briefs: Clinical Practice Updates

This roundup includes the following brief clinical practice updates:

The Agency for Healthcare Research and Quality and the Veterans Administration have produced fact sheets for physicians related to screening for abdominal aortic aneurysm, coronary heart disease and vascular disease, as well as the use of aspirin to prevent cardiovascular disease.

The agencies also are offering brochures for patients with information on high blood pressure, high cholesterol, screening for abdominal aortic aneurysm, and the use of aspirin to prevent heart attacks in men and strokes in women.

The literature can be downloaded from AHRQ's Web site.

Physicians should be aware of a multistate outbreak of Escherichia coli O157:H7 infections linked to eating raw, prepackaged cookie dough produced by Nestle Toll House.

The CDC said that as of June 25, there were 69 people infected with a strain of E. coli O157:H7 with the same genetic fingerprint in 29 states. Forty-six cases have been laboratory-confirmed; other results are pending. There have been 34 hospitalizations linked to the outbreak, and nine people have developed kidney failure. No deaths have been reported.

The CDC said patients with the illness range in age from 2-65 years, but 64 percent are younger than 19 years old. Seventy-three percent of people infected are female.

Clinical features of E. coli infection include diarrhea and abdominal cramps two to eight days after ingestion. Hemolytic uremic syndrome, a type of kidney failure, is most common in children younger than age 5 years and the elderly.

Individuals who have eaten prepackaged, refrigerated Nestle Toll House cookie dough and have experienced these symptoms should contact their physician immediately, and physicians should report cases to state or local health authorities.

Consumers should not eat prepackaged Toll House refrigerated cookie dough because of the risk of contamination and are advised to throw away the product if they have it in their home. Consumers also should be reminded not to eat raw food products that are intended to be cooked or baked.

More than 47,000 Americans ages 65 and older are treated in emergency departments each year for injuries from falls involving walkers and canes, according to a CDC study (6-page PDF; About PDFs) published in the June issue of the Journal of the American Geriatrics Society.

The study, which examined six years of medical records, found that people were seven times more likely to be injured in a fall that involved a walker than in those involving a cane, and nearly 90 percent of injuries involved walkers.

Older women sustained more than 75 percent of walker-related injuries and 66 percent of cane-related injuries. The highest injury rates were among those ages 85 and older.

The study encourages health professionals to spend more time fitting walking aids to patients and educating patients on how to use the products safely. To reduce the risk of falls, the CDC also recommends that adults 65 and older have a regular exercise program, have their physicians review their medications, have their vision checked and make their home as safe as possible. More than half of the injuries reported in the study occurred at home.

The study was limited to injuries treated in emergency departments, excluding those treated in physician's offices and other outpatient settings.

The CDC has Web pages devoted to preventing falls among the elderly and children.

The FDA said in the July 1 Federal Register (2-page PDF; About PDFs) that it is seeking public input on the implementation of its oversight of U.S. tobacco products. The agency said it is requesting comments that will help it develop strategies to protect public health.

President Obama signed the Family Smoking Prevention and Tobacco Control Act into law June 22. The legislation gives the FDA authority to regulate the manufacturing, marketing and distribution of tobacco products.

Comments can be submitted for as long as 90 days after the June 30 notice. They may be submitted online or mailed to the Division of Dockets Management (HFA305), Food and Drug Administration, 5630 Fishers Lane, Ste. 1061, Rockville, MD 20852.

The FDA is requiring manufacturers to put a boxed warning on the prescribing information for the smoking cessation drugs varenicline and bupropion, which are marketed as Chantix and Zyban, respectively, because of a risk of serious mental health events associated with their use. The agency said changes in behavior, depression, hostility and suicidal thoughts have been linked to the drugs.

In addition, the FDA said similar warnings will be required for bupropion marketed as the antidepressant Wellbutrin, as well as for all generic versions of that product. The antidepressants already carry a boxed warning for suicidal behavior in treating psychiatric disorders.

The agency advised physicians prescribing Chantix and Zyban to monitor patients for unusual changes in mood or behavior, and patients should be instructed to contact their physician if they experience such changes.