Kate Johnson

Patients with systemic lupus erythematosus who are under the age of 50 have a high rate of fragility fractures, osteoporosis, and poor bone mineral density, according to new research.

And as expected, steroid use was significantly linked to reduced bone mineral density (BMD), reported C-S Yee of the University of Birmingham and colleagues (Ann. Rheum. Dis. 2005;64:111–113).

Although bisphosphonates are the only class of drugs that have shown efficacy in the treatment and prevention of corticosteroid-induced osteoporosis, their use in premenopausal women poses serious risks of birth defects in the event of an unplanned pregnancy, noted the authors.

The study included 242 patients with systemic lupus erythematosus (SLE), 231 of whom were female.

Study participants were asked to complete a questionnaire about risk factors for osteoporosis, including details about previous fractures and family history of fractures. There were also asked about drug use and in particular about the use of glucocorticoids, oral contraceptives, hormone therapy, calcium and vitamin D supplementation, and bisphosphonates.

Among the women, 126 (54%) were premenopausal, 39 (17%) had experienced premature menopause, and 64 (28%) had experienced normal menopause. The menopausal status of two patients was unknown because they did not fully complete the questionnaire.

A total of 123 patients (51%) had reduced BMD (T score less than −1.0), and 25 were in the osteoporotic range (T score less than −2.5).

Ten of the patients with reduced BMD and 3 in the osteoporotic range were taking bisphosphonates at the time of the scan.

There were 22 patients (9%) who had experienced fragility fractures since their diagnosis of SLE, all of whom were female. Of these, 2 (9%) had normal BMD, while the other 20 (91%) had reduced BMD, with 7 of these women were in the osteoporotic range. Most of the patients with fragility fractures (82%) were menopausal, and only 3 were taking bisphosphonates at the time of the scan.

Non-Afro-Caribbean race and exposure to prednisolone (more than 10mg/day) were associated with reduced BMD, while age and menopause were associated with osteoporosis, according to a regression analysis.

Only low BMD and advanced age predicted fractures. Steroid exposure did not predict fracture rates, noted the authors. However, “it is likely that the effect of steroids on fractures is mediated predominantly by reduction in bone density in susceptible individuals,” they reported.

Despite a high prevalence of fractures in this cohort, the authors noted a low prevalence among the premenopausal women (3%).

Patients with systemic lupus erythematosus who are under the age of 50 have a high rate of fragility fractures, osteoporosis, and poor bone mineral density, according to new research.

And as expected, steroid use was significantly linked to reduced bone mineral density (BMD), reported C-S Yee of the University of Birmingham and colleagues (Ann. Rheum. Dis. 2005;64:111–113).

Although bisphosphonates are the only class of drugs that have shown efficacy in the treatment and prevention of corticosteroid-induced osteoporosis, their use in premenopausal women poses serious risks of birth defects in the event of an unplanned pregnancy, noted the authors.

The study included 242 patients with systemic lupus erythematosus (SLE), 231 of whom were female.

Study participants were asked to complete a questionnaire about risk factors for osteoporosis, including details about previous fractures and family history of fractures. There were also asked about drug use and in particular about the use of glucocorticoids, oral contraceptives, hormone therapy, calcium and vitamin D supplementation, and bisphosphonates.

Among the women, 126 (54%) were premenopausal, 39 (17%) had experienced premature menopause, and 64 (28%) had experienced normal menopause. The menopausal status of two patients was unknown because they did not fully complete the questionnaire.

A total of 123 patients (51%) had reduced BMD (T score less than −1.0), and 25 were in the osteoporotic range (T score less than −2.5).

Ten of the patients with reduced BMD and 3 in the osteoporotic range were taking bisphosphonates at the time of the scan.

There were 22 patients (9%) who had experienced fragility fractures since their diagnosis of SLE, all of whom were female. Of these, 2 (9%) had normal BMD, while the other 20 (91%) had reduced BMD, with 7 of these women were in the osteoporotic range. Most of the patients with fragility fractures (82%) were menopausal, and only 3 were taking bisphosphonates at the time of the scan.

Non-Afro-Caribbean race and exposure to prednisolone (more than 10mg/day) were associated with reduced BMD, while age and menopause were associated with osteoporosis, according to a regression analysis.

Only low BMD and advanced age predicted fractures. Steroid exposure did not predict fracture rates, noted the authors. However, “it is likely that the effect of steroids on fractures is mediated predominantly by reduction in bone density in susceptible individuals,” they reported.

Despite a high prevalence of fractures in this cohort, the authors noted a low prevalence among the premenopausal women (3%).

Patients with systemic lupus erythematosus who are under the age of 50 have a high rate of fragility fractures, osteoporosis, and poor bone mineral density, according to new research.

And as expected, steroid use was significantly linked to reduced bone mineral density (BMD), reported C-S Yee of the University of Birmingham and colleagues (Ann. Rheum. Dis. 2005;64:111–113).

Although bisphosphonates are the only class of drugs that have shown efficacy in the treatment and prevention of corticosteroid-induced osteoporosis, their use in premenopausal women poses serious risks of birth defects in the event of an unplanned pregnancy, noted the authors.

The study included 242 patients with systemic lupus erythematosus (SLE), 231 of whom were female.

Study participants were asked to complete a questionnaire about risk factors for osteoporosis, including details about previous fractures and family history of fractures. There were also asked about drug use and in particular about the use of glucocorticoids, oral contraceptives, hormone therapy, calcium and vitamin D supplementation, and bisphosphonates.

Among the women, 126 (54%) were premenopausal, 39 (17%) had experienced premature menopause, and 64 (28%) had experienced normal menopause. The menopausal status of two patients was unknown because they did not fully complete the questionnaire.

A total of 123 patients (51%) had reduced BMD (T score less than −1.0), and 25 were in the osteoporotic range (T score less than −2.5).

Ten of the patients with reduced BMD and 3 in the osteoporotic range were taking bisphosphonates at the time of the scan.

There were 22 patients (9%) who had experienced fragility fractures since their diagnosis of SLE, all of whom were female. Of these, 2 (9%) had normal BMD, while the other 20 (91%) had reduced BMD, with 7 of these women were in the osteoporotic range. Most of the patients with fragility fractures (82%) were menopausal, and only 3 were taking bisphosphonates at the time of the scan.

Non-Afro-Caribbean race and exposure to prednisolone (more than 10mg/day) were associated with reduced BMD, while age and menopause were associated with osteoporosis, according to a regression analysis.

Only low BMD and advanced age predicted fractures. Steroid exposure did not predict fracture rates, noted the authors. However, “it is likely that the effect of steroids on fractures is mediated predominantly by reduction in bone density in susceptible individuals,” they reported.

Despite a high prevalence of fractures in this cohort, the authors noted a low prevalence among the premenopausal women (3%).

Adolescents with chronic fatigue syndrome show significant improvement with cognitive-behavioral therapy, according to the first randomized controlled trial involving this age group.

“These results endorse the findings of previous studies on the efficacy of CBT for adults with chronic fatigue syndrome [CFS],” reported Maja Stulemeijer and colleagues at University Medical Centre Nijmegen (the Netherlands).

Only one uncontrolled study in adolescents suggests that cognitive behavioral therapy can reduce chronic fatigue, according to the researchers (BMJ 2005;330:14).

The study followed 69 patients, aged 10–17 years, who met U.S. Centers for Disease Control and Prevention criteria for CFS and were randomized to either immediate therapy, or to remain on a waiting list for therapy. The intervention involved 10 individual sessions over 5 months, and therapy patients underwent one of two treatment protocols depending on whether they were considered active or passive patients.

Active patients were described as alternating between periods of activity and periods of rest; passive patients were described as spending most of their time lying down and going out infrequently. For active patients, treatment started with teaching them to recognize and accept their fatigue and reduce their activity level accordingly. This was followed by a gradual increase in activity.

Passive patients started immediately with a systematic program of activity building.

Measures of fatigue and functional impairment decreased more significantly in the therapy group, compared with the untreated group. School attendance improved significantly more in the therapy group, with 58% of these patients returning to school full time, compared with 29% of patients on the waiting list for therapy.

Participants in the therapy group also reported significantly less muscle pain, headache, unrefreshing sleep, and impaired concentration. They were also less likely to feel ill after exercise, compared with patients on the waiting list.

There were no significant differences in outcomes between patients in the active or passive treatment protocols. The authors noted that patients in all arms of the study continued to report symptoms.

Adolescents with chronic fatigue syndrome show significant improvement with cognitive-behavioral therapy, according to the first randomized controlled trial involving this age group.

“These results endorse the findings of previous studies on the efficacy of CBT for adults with chronic fatigue syndrome [CFS],” reported Maja Stulemeijer and colleagues at University Medical Centre Nijmegen (the Netherlands).

Only one uncontrolled study in adolescents suggests that cognitive behavioral therapy can reduce chronic fatigue, according to the researchers (BMJ 2005;330:14).

The study followed 69 patients, aged 10–17 years, who met U.S. Centers for Disease Control and Prevention criteria for CFS and were randomized to either immediate therapy, or to remain on a waiting list for therapy. The intervention involved 10 individual sessions over 5 months, and therapy patients underwent one of two treatment protocols depending on whether they were considered active or passive patients.

Active patients were described as alternating between periods of activity and periods of rest; passive patients were described as spending most of their time lying down and going out infrequently. For active patients, treatment started with teaching them to recognize and accept their fatigue and reduce their activity level accordingly. This was followed by a gradual increase in activity.

Passive patients started immediately with a systematic program of activity building.

Measures of fatigue and functional impairment decreased more significantly in the therapy group, compared with the untreated group. School attendance improved significantly more in the therapy group, with 58% of these patients returning to school full time, compared with 29% of patients on the waiting list for therapy.

Participants in the therapy group also reported significantly less muscle pain, headache, unrefreshing sleep, and impaired concentration. They were also less likely to feel ill after exercise, compared with patients on the waiting list.

There were no significant differences in outcomes between patients in the active or passive treatment protocols. The authors noted that patients in all arms of the study continued to report symptoms.

Adolescents with chronic fatigue syndrome show significant improvement with cognitive-behavioral therapy, according to the first randomized controlled trial involving this age group.

“These results endorse the findings of previous studies on the efficacy of CBT for adults with chronic fatigue syndrome [CFS],” reported Maja Stulemeijer and colleagues at University Medical Centre Nijmegen (the Netherlands).

Only one uncontrolled study in adolescents suggests that cognitive behavioral therapy can reduce chronic fatigue, according to the researchers (BMJ 2005;330:14).

The study followed 69 patients, aged 10–17 years, who met U.S. Centers for Disease Control and Prevention criteria for CFS and were randomized to either immediate therapy, or to remain on a waiting list for therapy. The intervention involved 10 individual sessions over 5 months, and therapy patients underwent one of two treatment protocols depending on whether they were considered active or passive patients.

Active patients were described as alternating between periods of activity and periods of rest; passive patients were described as spending most of their time lying down and going out infrequently. For active patients, treatment started with teaching them to recognize and accept their fatigue and reduce their activity level accordingly. This was followed by a gradual increase in activity.

Passive patients started immediately with a systematic program of activity building.

Measures of fatigue and functional impairment decreased more significantly in the therapy group, compared with the untreated group. School attendance improved significantly more in the therapy group, with 58% of these patients returning to school full time, compared with 29% of patients on the waiting list for therapy.

Participants in the therapy group also reported significantly less muscle pain, headache, unrefreshing sleep, and impaired concentration. They were also less likely to feel ill after exercise, compared with patients on the waiting list.

There were no significant differences in outcomes between patients in the active or passive treatment protocols. The authors noted that patients in all arms of the study continued to report symptoms.

CHICAGO — Patients given radiopharmaceuticals for diagnostic or therapeutic nuclear medicine procedures can trigger radiation detectors up to 3 months after the procedure, Lionel S. Zuckier, M.D., said at the annual meeting of the Radiological Society of North America.

These patients should be given appropriate documentation, said Dr. Zuckier, director of nuclear medicine and positron emission tomography at the University Hospital, Newark, N.J.

“Many patients have been picked up and detained … and now we expect it to be a more common occurrence with the increasing number of extremely sensitive portable radiation detectors being distributed to local, state, and federal emergency responders,” he said.

Physicians should counsel patients about informed consent and advise them to carry letters of clarification to make any interactions with law enforcement personnel easier, he said.

Carrying such documentation is consistent with guidelines issued by both the Society of Nuclear Medicine and the U.S. Nuclear Regulatory Commission.

“This letter should include a contact name and number so that the information can be verified at any time. Our department has a 24-hour number that can be called,” said Dr. Zuckier, also a professor of radiology at the University of Medicine and Dentistry of New Jersey, Newark.

According to Dr. Zuckier, there were 18 million nuclear medicine procedures performed in 2002 in the United States.

With 10,000 portable Homeland Security radiation detectors in use, there is great potential for patients to be inconvenienced at airports or other security points.

His study, which he presented at the meeting, examined the strength of five radiation detection devices currently in use by the U.S. Homeland Security Department.

Therapeutic radiopharmaceuticals, such as iodine, used in the treatment of thyroid disorders, can be detected in the body and therefore have the potential to trigger radiation detectors up to 3 months after the procedure.

Patients who undergo cardiac exams with thallium can trigger alarms for up to 30 days, and patients who undergo bone and thyroid scans have detectable radiation levels for up to 3 days.

Patients undergoing PET scans with 18fluorodeoxyglucose are at risk for triggering radiation detectors for less than 24 hours post procedure, he said.

“These detectors are extremely sensitive and can pick up dose rates as small as 1 or 2 microrads per hour. Our study suggests guidelines as to how long [a patient's] documentation should be retained,” Dr. Zuckier said.

CHICAGO — Patients given radiopharmaceuticals for diagnostic or therapeutic nuclear medicine procedures can trigger radiation detectors up to 3 months after the procedure, Lionel S. Zuckier, M.D., said at the annual meeting of the Radiological Society of North America.

These patients should be given appropriate documentation, said Dr. Zuckier, director of nuclear medicine and positron emission tomography at the University Hospital, Newark, N.J.

“Many patients have been picked up and detained … and now we expect it to be a more common occurrence with the increasing number of extremely sensitive portable radiation detectors being distributed to local, state, and federal emergency responders,” he said.

Physicians should counsel patients about informed consent and advise them to carry letters of clarification to make any interactions with law enforcement personnel easier, he said.

Carrying such documentation is consistent with guidelines issued by both the Society of Nuclear Medicine and the U.S. Nuclear Regulatory Commission.

“This letter should include a contact name and number so that the information can be verified at any time. Our department has a 24-hour number that can be called,” said Dr. Zuckier, also a professor of radiology at the University of Medicine and Dentistry of New Jersey, Newark.

According to Dr. Zuckier, there were 18 million nuclear medicine procedures performed in 2002 in the United States.

With 10,000 portable Homeland Security radiation detectors in use, there is great potential for patients to be inconvenienced at airports or other security points.

His study, which he presented at the meeting, examined the strength of five radiation detection devices currently in use by the U.S. Homeland Security Department.

Therapeutic radiopharmaceuticals, such as iodine, used in the treatment of thyroid disorders, can be detected in the body and therefore have the potential to trigger radiation detectors up to 3 months after the procedure.

Patients who undergo cardiac exams with thallium can trigger alarms for up to 30 days, and patients who undergo bone and thyroid scans have detectable radiation levels for up to 3 days.

Patients undergoing PET scans with 18fluorodeoxyglucose are at risk for triggering radiation detectors for less than 24 hours post procedure, he said.

“These detectors are extremely sensitive and can pick up dose rates as small as 1 or 2 microrads per hour. Our study suggests guidelines as to how long [a patient's] documentation should be retained,” Dr. Zuckier said.

CHICAGO — Patients given radiopharmaceuticals for diagnostic or therapeutic nuclear medicine procedures can trigger radiation detectors up to 3 months after the procedure, Lionel S. Zuckier, M.D., said at the annual meeting of the Radiological Society of North America.

These patients should be given appropriate documentation, said Dr. Zuckier, director of nuclear medicine and positron emission tomography at the University Hospital, Newark, N.J.

“Many patients have been picked up and detained … and now we expect it to be a more common occurrence with the increasing number of extremely sensitive portable radiation detectors being distributed to local, state, and federal emergency responders,” he said.

Physicians should counsel patients about informed consent and advise them to carry letters of clarification to make any interactions with law enforcement personnel easier, he said.

Carrying such documentation is consistent with guidelines issued by both the Society of Nuclear Medicine and the U.S. Nuclear Regulatory Commission.

“This letter should include a contact name and number so that the information can be verified at any time. Our department has a 24-hour number that can be called,” said Dr. Zuckier, also a professor of radiology at the University of Medicine and Dentistry of New Jersey, Newark.

According to Dr. Zuckier, there were 18 million nuclear medicine procedures performed in 2002 in the United States.

With 10,000 portable Homeland Security radiation detectors in use, there is great potential for patients to be inconvenienced at airports or other security points.

His study, which he presented at the meeting, examined the strength of five radiation detection devices currently in use by the U.S. Homeland Security Department.

Therapeutic radiopharmaceuticals, such as iodine, used in the treatment of thyroid disorders, can be detected in the body and therefore have the potential to trigger radiation detectors up to 3 months after the procedure.

Patients who undergo cardiac exams with thallium can trigger alarms for up to 30 days, and patients who undergo bone and thyroid scans have detectable radiation levels for up to 3 days.

Patients undergoing PET scans with 18fluorodeoxyglucose are at risk for triggering radiation detectors for less than 24 hours post procedure, he said.

“These detectors are extremely sensitive and can pick up dose rates as small as 1 or 2 microrads per hour. Our study suggests guidelines as to how long [a patient's] documentation should be retained,” Dr. Zuckier said.

QUEBEC CITY — Diabetes care is “on the path to automated glucose control,” with the promise of “intelligent” insulin pumps and devices in the near future, according to John Walsh, P.A.

Today's insulin pumps have an impressive capacity to improve currently suboptimal glycemic control in many patients with type 1 diabetes, he said at the annual meeting of the Canadian Diabetes Association and the Canadian Society of Endocrinology and Metabolism.

“Our current approach to diabetes does not work,” said Mr. Walsh, a certified diabetes educator and author of “Pumping Insulin” and other books on diabetes. “For most patients, the hemoglobin [Hb] A_1c goal of 6.5% or less is not being met.”

Patients with diabetes must make complex decisions about carbohydrate intake and insulin dosing several times every day. They often make poor decisions that may lead to imbalances in their blood glucose levels.

Insulin pumps can at least partially remedy this, but studies of patients who use pumps show only minimal improvements in their HbA_1c levels Mr. Walsh said.

“I don't think we've seen anywhere near the capacity that can be achieved with pumps,” he said. It is partly a matter of clinicians lacking experience with pumps and needing to become more familiar with the formulas for programming them. But it is also a matter of not using the data that is collected by pumps and glucose meters to look for patterns and correct problems, he said.

Establishing the correct total daily dose (TDD) of insulin is probably the most important part of programming a pump; all other dosing formulas are based on the TDD. An appropriate starting TDD can be calculated using the patient's weight in kilograms, divided by 1.8, to yield the number of insulin units, he said.

The basal dose can be calculated at 50% to 60% of the TDD, and carbohydrate boluses can be calculated using what he calls “the 500 rule”: Dividing 500 by the TDD gives the number of grams of carbohydrate that can be covered by 1 unit of bolus insulin. For example, if a patient's TDD is usually 50 units of insulin, applying “the 500 rule” would show that 10 g of carbohydrate requires 1 extra bolus unit of insulin, he said.

Once this basic pump formula is established for a patient, it can be fine-tuned. Advanced pumpers can calculate exact correction boluses needed to lower high glucose readings, and with modern pumps they can also make adjustments to account for any unused insulin that is still in their system (known as “bolus on board”).

As physicians become more familiar with pump formulas and programming, they should be able to access the pump's stored data to track a patient's dosing and blood glucose patterns and identify possible solutions to problems, Mr. Walsh said.

“Today's devices collect most of the necessary information about a patient's dosing schedule and carbohydrate intake, but it takes experience for a clinician to be able to quickly access that information and use it to make a treatment decision,” he said.

The workload involved in this kind of care is heavy and will remain that way until pumps become more intelligent and begin taking over more of the analysis involved, he said.

“Until there is a device that can give patients immediate advice and foresee potential problems, HbA_1c will not reach target levels for most patients, and health care involvement will remain heavy,” Mr. Walsh predicted.

QUEBEC CITY — Diabetes care is “on the path to automated glucose control,” with the promise of “intelligent” insulin pumps and devices in the near future, according to John Walsh, P.A.

Today's insulin pumps have an impressive capacity to improve currently suboptimal glycemic control in many patients with type 1 diabetes, he said at the annual meeting of the Canadian Diabetes Association and the Canadian Society of Endocrinology and Metabolism.

“Our current approach to diabetes does not work,” said Mr. Walsh, a certified diabetes educator and author of “Pumping Insulin” and other books on diabetes. “For most patients, the hemoglobin [Hb] A_1c goal of 6.5% or less is not being met.”

Patients with diabetes must make complex decisions about carbohydrate intake and insulin dosing several times every day. They often make poor decisions that may lead to imbalances in their blood glucose levels.

Insulin pumps can at least partially remedy this, but studies of patients who use pumps show only minimal improvements in their HbA_1c levels Mr. Walsh said.

“I don't think we've seen anywhere near the capacity that can be achieved with pumps,” he said. It is partly a matter of clinicians lacking experience with pumps and needing to become more familiar with the formulas for programming them. But it is also a matter of not using the data that is collected by pumps and glucose meters to look for patterns and correct problems, he said.

Establishing the correct total daily dose (TDD) of insulin is probably the most important part of programming a pump; all other dosing formulas are based on the TDD. An appropriate starting TDD can be calculated using the patient's weight in kilograms, divided by 1.8, to yield the number of insulin units, he said.

The basal dose can be calculated at 50% to 60% of the TDD, and carbohydrate boluses can be calculated using what he calls “the 500 rule”: Dividing 500 by the TDD gives the number of grams of carbohydrate that can be covered by 1 unit of bolus insulin. For example, if a patient's TDD is usually 50 units of insulin, applying “the 500 rule” would show that 10 g of carbohydrate requires 1 extra bolus unit of insulin, he said.

Once this basic pump formula is established for a patient, it can be fine-tuned. Advanced pumpers can calculate exact correction boluses needed to lower high glucose readings, and with modern pumps they can also make adjustments to account for any unused insulin that is still in their system (known as “bolus on board”).

As physicians become more familiar with pump formulas and programming, they should be able to access the pump's stored data to track a patient's dosing and blood glucose patterns and identify possible solutions to problems, Mr. Walsh said.

“Today's devices collect most of the necessary information about a patient's dosing schedule and carbohydrate intake, but it takes experience for a clinician to be able to quickly access that information and use it to make a treatment decision,” he said.

The workload involved in this kind of care is heavy and will remain that way until pumps become more intelligent and begin taking over more of the analysis involved, he said.

“Until there is a device that can give patients immediate advice and foresee potential problems, HbA_1c will not reach target levels for most patients, and health care involvement will remain heavy,” Mr. Walsh predicted.

QUEBEC CITY — Diabetes care is “on the path to automated glucose control,” with the promise of “intelligent” insulin pumps and devices in the near future, according to John Walsh, P.A.

Today's insulin pumps have an impressive capacity to improve currently suboptimal glycemic control in many patients with type 1 diabetes, he said at the annual meeting of the Canadian Diabetes Association and the Canadian Society of Endocrinology and Metabolism.

“Our current approach to diabetes does not work,” said Mr. Walsh, a certified diabetes educator and author of “Pumping Insulin” and other books on diabetes. “For most patients, the hemoglobin [Hb] A_1c goal of 6.5% or less is not being met.”

Patients with diabetes must make complex decisions about carbohydrate intake and insulin dosing several times every day. They often make poor decisions that may lead to imbalances in their blood glucose levels.

Insulin pumps can at least partially remedy this, but studies of patients who use pumps show only minimal improvements in their HbA_1c levels Mr. Walsh said.

“I don't think we've seen anywhere near the capacity that can be achieved with pumps,” he said. It is partly a matter of clinicians lacking experience with pumps and needing to become more familiar with the formulas for programming them. But it is also a matter of not using the data that is collected by pumps and glucose meters to look for patterns and correct problems, he said.

Establishing the correct total daily dose (TDD) of insulin is probably the most important part of programming a pump; all other dosing formulas are based on the TDD. An appropriate starting TDD can be calculated using the patient's weight in kilograms, divided by 1.8, to yield the number of insulin units, he said.

The basal dose can be calculated at 50% to 60% of the TDD, and carbohydrate boluses can be calculated using what he calls “the 500 rule”: Dividing 500 by the TDD gives the number of grams of carbohydrate that can be covered by 1 unit of bolus insulin. For example, if a patient's TDD is usually 50 units of insulin, applying “the 500 rule” would show that 10 g of carbohydrate requires 1 extra bolus unit of insulin, he said.

Once this basic pump formula is established for a patient, it can be fine-tuned. Advanced pumpers can calculate exact correction boluses needed to lower high glucose readings, and with modern pumps they can also make adjustments to account for any unused insulin that is still in their system (known as “bolus on board”).

As physicians become more familiar with pump formulas and programming, they should be able to access the pump's stored data to track a patient's dosing and blood glucose patterns and identify possible solutions to problems, Mr. Walsh said.

“Today's devices collect most of the necessary information about a patient's dosing schedule and carbohydrate intake, but it takes experience for a clinician to be able to quickly access that information and use it to make a treatment decision,” he said.

The workload involved in this kind of care is heavy and will remain that way until pumps become more intelligent and begin taking over more of the analysis involved, he said.

“Until there is a device that can give patients immediate advice and foresee potential problems, HbA_1c will not reach target levels for most patients, and health care involvement will remain heavy,” Mr. Walsh predicted.

QUEBEC CITY — Diabetes patients and their physicians are at high risk for burnout, but they can sidestep some of that risk by ruling out depression, William Polonsky, Ph.D., said at the joint annual meeting of the Canadian Diabetes Association and the Canadian Society of Endocrinology and Metabolism.

“Depression is much more common in these patients—they are 11/2 times more likely than average to have a major depressive disorder, and 37% of them have depressive symptoms,” Dr. Polonsky said, citing his own study on the topic (Pract. Diabetol. 2001:20;20–9).

Such mood disorders make it harder for patients to initiate healthy behavior change and are a powerful predictor of hospitalizations for diabetic complications, said Dr. Polonsky, a certified diabetes educator in San Diego and author of a book called “Diabetes Burnout: What to Do When You Can't Take It Anymore” (Alexandria, Va.: American Diabetes Association, 1992).

Dr. Polonsky's research has shown that fewer than 50% of diabetes patients follow physicians' guidelines on healthy meals, exercise, and blood glucose monitoring.

In a soon-to-be-published study of 700 patients, he found that 24% felt hopeless about avoiding the long-term complications of diabetes; 17% felt that diabetes controlled their life; 15% felt unmotivated to maintain healthy habits; 14% felt angry, scared, and depressed; and 13% felt overwhelmed.

These attitudes and behaviors from patients can put their physicians at risk for burnout. “You may get discouraged and depressed, and you may stop helping,” Dr. Polonsky said.

Patients may appear to lack motivation, but the problem is typically one of personal obstacles to good medical care. And mood disorders top the list of obstacles.

“Stay alert for undiagnosed depressive disorders and screen regularly. I am a big believer in once-a-year depression screening questionnaires,” Dr. Polonsky said.

If a yearly questionnaire does not fit well into a physician's routine, “tell patients they are at risk for depression and ask them two simple questions”:

▸ During the past month, have you felt down, depressed, or hopeless?

▸ During the past month, have you had little interest or pleasure in things that you used to enjoy, such as food, reading, or sex?

Once depression is ruled out or treated, other obstacles can be tackled.

A common problem is that of unrealistic patient goals. To lose weight, many patients will set such challenging weight-loss goals that they become discouraged and abandon their efforts.

There is a surprising level of miscommunication between health care professionals and patients when it comes to giving and receiving instructions. “Many of our patients don't speak our language,” he said. In one study that polled diabetes patients as they left their health care professionals' offices, patients and professionals disagreed on what issues were discussed almost 20% of the time, on decisions that were made almost 21% of the time, and on goals that were set 44% of the time (Diabet. Med. 2003;20:909–14).

Miscommunication may be partly due to patients' lack of “health literacy” and needs to be addressed. One study of 38 physicians and 74 diabetes patients found that physicians assessed patients' recall and comprehension in only 20% of 61 visits and for only 12% of 124 new concepts covered in the visits. But when an interactive educational approach was used, patients were 15 times more likely to have achieved glycemic control (Arch. Intern. Med. 2003;163:83–90).

Tackling a patient's diabetes burnout with such techniques is an effective strategy to avoid physician burnout as well, Dr. Polonsky said.

QUEBEC CITY — Diabetes patients and their physicians are at high risk for burnout, but they can sidestep some of that risk by ruling out depression, William Polonsky, Ph.D., said at the joint annual meeting of the Canadian Diabetes Association and the Canadian Society of Endocrinology and Metabolism.

“Depression is much more common in these patients—they are 11/2 times more likely than average to have a major depressive disorder, and 37% of them have depressive symptoms,” Dr. Polonsky said, citing his own study on the topic (Pract. Diabetol. 2001:20;20–9).

Such mood disorders make it harder for patients to initiate healthy behavior change and are a powerful predictor of hospitalizations for diabetic complications, said Dr. Polonsky, a certified diabetes educator in San Diego and author of a book called “Diabetes Burnout: What to Do When You Can't Take It Anymore” (Alexandria, Va.: American Diabetes Association, 1992).

Dr. Polonsky's research has shown that fewer than 50% of diabetes patients follow physicians' guidelines on healthy meals, exercise, and blood glucose monitoring.

In a soon-to-be-published study of 700 patients, he found that 24% felt hopeless about avoiding the long-term complications of diabetes; 17% felt that diabetes controlled their life; 15% felt unmotivated to maintain healthy habits; 14% felt angry, scared, and depressed; and 13% felt overwhelmed.

These attitudes and behaviors from patients can put their physicians at risk for burnout. “You may get discouraged and depressed, and you may stop helping,” Dr. Polonsky said.

Patients may appear to lack motivation, but the problem is typically one of personal obstacles to good medical care. And mood disorders top the list of obstacles.

“Stay alert for undiagnosed depressive disorders and screen regularly. I am a big believer in once-a-year depression screening questionnaires,” Dr. Polonsky said.

If a yearly questionnaire does not fit well into a physician's routine, “tell patients they are at risk for depression and ask them two simple questions”:

▸ During the past month, have you felt down, depressed, or hopeless?

▸ During the past month, have you had little interest or pleasure in things that you used to enjoy, such as food, reading, or sex?

Once depression is ruled out or treated, other obstacles can be tackled.

A common problem is that of unrealistic patient goals. To lose weight, many patients will set such challenging weight-loss goals that they become discouraged and abandon their efforts.

There is a surprising level of miscommunication between health care professionals and patients when it comes to giving and receiving instructions. “Many of our patients don't speak our language,” he said. In one study that polled diabetes patients as they left their health care professionals' offices, patients and professionals disagreed on what issues were discussed almost 20% of the time, on decisions that were made almost 21% of the time, and on goals that were set 44% of the time (Diabet. Med. 2003;20:909–14).

Miscommunication may be partly due to patients' lack of “health literacy” and needs to be addressed. One study of 38 physicians and 74 diabetes patients found that physicians assessed patients' recall and comprehension in only 20% of 61 visits and for only 12% of 124 new concepts covered in the visits. But when an interactive educational approach was used, patients were 15 times more likely to have achieved glycemic control (Arch. Intern. Med. 2003;163:83–90).

Tackling a patient's diabetes burnout with such techniques is an effective strategy to avoid physician burnout as well, Dr. Polonsky said.

QUEBEC CITY — Diabetes patients and their physicians are at high risk for burnout, but they can sidestep some of that risk by ruling out depression, William Polonsky, Ph.D., said at the joint annual meeting of the Canadian Diabetes Association and the Canadian Society of Endocrinology and Metabolism.

“Depression is much more common in these patients—they are 11/2 times more likely than average to have a major depressive disorder, and 37% of them have depressive symptoms,” Dr. Polonsky said, citing his own study on the topic (Pract. Diabetol. 2001:20;20–9).

Such mood disorders make it harder for patients to initiate healthy behavior change and are a powerful predictor of hospitalizations for diabetic complications, said Dr. Polonsky, a certified diabetes educator in San Diego and author of a book called “Diabetes Burnout: What to Do When You Can't Take It Anymore” (Alexandria, Va.: American Diabetes Association, 1992).

Dr. Polonsky's research has shown that fewer than 50% of diabetes patients follow physicians' guidelines on healthy meals, exercise, and blood glucose monitoring.

In a soon-to-be-published study of 700 patients, he found that 24% felt hopeless about avoiding the long-term complications of diabetes; 17% felt that diabetes controlled their life; 15% felt unmotivated to maintain healthy habits; 14% felt angry, scared, and depressed; and 13% felt overwhelmed.

These attitudes and behaviors from patients can put their physicians at risk for burnout. “You may get discouraged and depressed, and you may stop helping,” Dr. Polonsky said.

Patients may appear to lack motivation, but the problem is typically one of personal obstacles to good medical care. And mood disorders top the list of obstacles.

“Stay alert for undiagnosed depressive disorders and screen regularly. I am a big believer in once-a-year depression screening questionnaires,” Dr. Polonsky said.

If a yearly questionnaire does not fit well into a physician's routine, “tell patients they are at risk for depression and ask them two simple questions”:

▸ During the past month, have you felt down, depressed, or hopeless?

▸ During the past month, have you had little interest or pleasure in things that you used to enjoy, such as food, reading, or sex?

Once depression is ruled out or treated, other obstacles can be tackled.

A common problem is that of unrealistic patient goals. To lose weight, many patients will set such challenging weight-loss goals that they become discouraged and abandon their efforts.

There is a surprising level of miscommunication between health care professionals and patients when it comes to giving and receiving instructions. “Many of our patients don't speak our language,” he said. In one study that polled diabetes patients as they left their health care professionals' offices, patients and professionals disagreed on what issues were discussed almost 20% of the time, on decisions that were made almost 21% of the time, and on goals that were set 44% of the time (Diabet. Med. 2003;20:909–14).

Miscommunication may be partly due to patients' lack of “health literacy” and needs to be addressed. One study of 38 physicians and 74 diabetes patients found that physicians assessed patients' recall and comprehension in only 20% of 61 visits and for only 12% of 124 new concepts covered in the visits. But when an interactive educational approach was used, patients were 15 times more likely to have achieved glycemic control (Arch. Intern. Med. 2003;163:83–90).

Tackling a patient's diabetes burnout with such techniques is an effective strategy to avoid physician burnout as well, Dr. Polonsky said.

CHICAGO – Functional magnetic resonance imaging can identify activation in specific regions of the brain when people lie and one day could be used to augment or replace polygraph testing, Scott H. Faro, M.D., said at the annual meeting of the Radiological Society of North America.

“We have just begun to understand the potential of fMRI [functional magnetic resonance imaging] in studying deceptive behavior,” said Dr. Faro, professor and vice chair of radiology and director of the functional brain imaging center and clinical MRI at Temple University, Philadelphia.

“We plan to investigate the potential of fMRI both as a standalone test and as a supplement to polygraph, with the goal of creating the most accurate test for deception,” he said.

His research involved the examination of 11 volunteers with simultaneous fMRI and polygraph testing. Six of the subjects had been asked to shoot a toy gun and then lie about their participation, whereas the nonshooters were asked to tell the truth. In addition to being asked about the shooting, all subjects were asked unrelated control questions.

In all cases, fMRI and polygraph accurately identified the deceptive responses.

The fMRI showed activation in different areas of the brain, depending on whether a subject was being deceptive or truthful. The use of a real-life stimulus was a very important part of this study because this scenario can elicit strong activation of emotional and cognitive centers in the brain, which can be seen with fMRI, Dr. Faro said.

The investigators found that, during deception, activation was seen in the left medial, left inferior, and right precentral regions of the frontal lobe; the right hippocampus and right middle regions of the temporal lobe; and the anterior and posterior cingulate regions of the limbic lobe.

During truthful responses, activated areas included the left inferior and right medial regions of the frontal lobe, the left inferior region of the temporal lobe, and the posterior cingulate gyrus in the limbic lobe.

Some areas of the brain were activated during both lying and truth-telling, but there were five activated areas unique to lying: two in the frontal lobe (the right precentral gyrus and the left medial frontal gyrus), two in the temporal lobe (the right hippocampus and the right middle temporal lobe), and the anterior cingulate of the limbic lobe.

Investigation into other means of lie detection is important because polygraph testing is considered only 90% accurate, he said.

The polygraph test only measures peripheral physiologic responses, including galvanic skin conductance, which increases during perspiration, blood pressure, and respiration. These physiologic responses can vary among individuals, however, and can be self-regulated. “The deception response begins in the brain and controls all aspects of behavior. That is why the brain is the focus of our research,” Dr. Faro said.

It is too early to tell whether fMRI results can be self-regulated, but the results suggest that the consistencies in brain activation patterns seen on fMRI may be beyond conscious control.

Dr. Faro's research is the first to use polygraph correlation and a modified version of control questioning techniques with fMRI. In addition, his research is the first to use a real-life stimulus, which is critical if the technique is to be developed into a practical test, he said.

These fMRI images show areas found to be active in the group analysis data of the subjects when they were asked to be deceptive. The cross hair in each image represents the hippocampus, one of the areas showing activity. Courtesy Feroze B. Mohamed, Ph. D.

CHICAGO – Functional magnetic resonance imaging can identify activation in specific regions of the brain when people lie and one day could be used to augment or replace polygraph testing, Scott H. Faro, M.D., said at the annual meeting of the Radiological Society of North America.

“We have just begun to understand the potential of fMRI [functional magnetic resonance imaging] in studying deceptive behavior,” said Dr. Faro, professor and vice chair of radiology and director of the functional brain imaging center and clinical MRI at Temple University, Philadelphia.

“We plan to investigate the potential of fMRI both as a standalone test and as a supplement to polygraph, with the goal of creating the most accurate test for deception,” he said.

His research involved the examination of 11 volunteers with simultaneous fMRI and polygraph testing. Six of the subjects had been asked to shoot a toy gun and then lie about their participation, whereas the nonshooters were asked to tell the truth. In addition to being asked about the shooting, all subjects were asked unrelated control questions.

In all cases, fMRI and polygraph accurately identified the deceptive responses.

The fMRI showed activation in different areas of the brain, depending on whether a subject was being deceptive or truthful. The use of a real-life stimulus was a very important part of this study because this scenario can elicit strong activation of emotional and cognitive centers in the brain, which can be seen with fMRI, Dr. Faro said.

The investigators found that, during deception, activation was seen in the left medial, left inferior, and right precentral regions of the frontal lobe; the right hippocampus and right middle regions of the temporal lobe; and the anterior and posterior cingulate regions of the limbic lobe.

During truthful responses, activated areas included the left inferior and right medial regions of the frontal lobe, the left inferior region of the temporal lobe, and the posterior cingulate gyrus in the limbic lobe.

Some areas of the brain were activated during both lying and truth-telling, but there were five activated areas unique to lying: two in the frontal lobe (the right precentral gyrus and the left medial frontal gyrus), two in the temporal lobe (the right hippocampus and the right middle temporal lobe), and the anterior cingulate of the limbic lobe.

Investigation into other means of lie detection is important because polygraph testing is considered only 90% accurate, he said.

The polygraph test only measures peripheral physiologic responses, including galvanic skin conductance, which increases during perspiration, blood pressure, and respiration. These physiologic responses can vary among individuals, however, and can be self-regulated. “The deception response begins in the brain and controls all aspects of behavior. That is why the brain is the focus of our research,” Dr. Faro said.

It is too early to tell whether fMRI results can be self-regulated, but the results suggest that the consistencies in brain activation patterns seen on fMRI may be beyond conscious control.

Dr. Faro's research is the first to use polygraph correlation and a modified version of control questioning techniques with fMRI. In addition, his research is the first to use a real-life stimulus, which is critical if the technique is to be developed into a practical test, he said.

These fMRI images show areas found to be active in the group analysis data of the subjects when they were asked to be deceptive. The cross hair in each image represents the hippocampus, one of the areas showing activity. Courtesy Feroze B. Mohamed, Ph. D.

CHICAGO – Functional magnetic resonance imaging can identify activation in specific regions of the brain when people lie and one day could be used to augment or replace polygraph testing, Scott H. Faro, M.D., said at the annual meeting of the Radiological Society of North America.

“We have just begun to understand the potential of fMRI [functional magnetic resonance imaging] in studying deceptive behavior,” said Dr. Faro, professor and vice chair of radiology and director of the functional brain imaging center and clinical MRI at Temple University, Philadelphia.

“We plan to investigate the potential of fMRI both as a standalone test and as a supplement to polygraph, with the goal of creating the most accurate test for deception,” he said.

His research involved the examination of 11 volunteers with simultaneous fMRI and polygraph testing. Six of the subjects had been asked to shoot a toy gun and then lie about their participation, whereas the nonshooters were asked to tell the truth. In addition to being asked about the shooting, all subjects were asked unrelated control questions.

In all cases, fMRI and polygraph accurately identified the deceptive responses.

The fMRI showed activation in different areas of the brain, depending on whether a subject was being deceptive or truthful. The use of a real-life stimulus was a very important part of this study because this scenario can elicit strong activation of emotional and cognitive centers in the brain, which can be seen with fMRI, Dr. Faro said.

The investigators found that, during deception, activation was seen in the left medial, left inferior, and right precentral regions of the frontal lobe; the right hippocampus and right middle regions of the temporal lobe; and the anterior and posterior cingulate regions of the limbic lobe.

During truthful responses, activated areas included the left inferior and right medial regions of the frontal lobe, the left inferior region of the temporal lobe, and the posterior cingulate gyrus in the limbic lobe.

Some areas of the brain were activated during both lying and truth-telling, but there were five activated areas unique to lying: two in the frontal lobe (the right precentral gyrus and the left medial frontal gyrus), two in the temporal lobe (the right hippocampus and the right middle temporal lobe), and the anterior cingulate of the limbic lobe.

Investigation into other means of lie detection is important because polygraph testing is considered only 90% accurate, he said.

The polygraph test only measures peripheral physiologic responses, including galvanic skin conductance, which increases during perspiration, blood pressure, and respiration. These physiologic responses can vary among individuals, however, and can be self-regulated. “The deception response begins in the brain and controls all aspects of behavior. That is why the brain is the focus of our research,” Dr. Faro said.

It is too early to tell whether fMRI results can be self-regulated, but the results suggest that the consistencies in brain activation patterns seen on fMRI may be beyond conscious control.

Dr. Faro's research is the first to use polygraph correlation and a modified version of control questioning techniques with fMRI. In addition, his research is the first to use a real-life stimulus, which is critical if the technique is to be developed into a practical test, he said.

These fMRI images show areas found to be active in the group analysis data of the subjects when they were asked to be deceptive. The cross hair in each image represents the hippocampus, one of the areas showing activity. Courtesy Feroze B. Mohamed, Ph. D.

Skin testing for penicillin allergy has ground to a halt because the most important antigen that is used in the test has been pulled off the market, creating costly problems that have far-reaching impact, according to Steven Grabiec, M.D.

“We are left with a situation where we can't skin test for penicillin adequately because we don't have one of the major antigens we need. If you can't prove a patient is not allergic, you are either obligated to give them a nonpenicillin drug, or you must go through the process of desensitizing them—both options being more costly than simply giving them penicillin,” said Dr. Grabiec, who is a clinical associate professor of pediatrics at the State University of New York at Buffalo.

About 10% of the U.S. population reports a history of penicillin allergy, but if they could be tested with a complete panel of penicillin skin test reagents, more than 90% of them could be declared nonallergic, according to the American Academy of Allergy, Asthma, and Immunology.

The main antigen that is used in penicillin skin testing, benzylpenicilloyl polylysine (commonly known as Pre-Pen) is being phased out by the manufacturer. The orphan drug application for another antigen, penicillin minor determinant mixture (MDM), has been on file with the Food and Drug Administration since 1987, Eric Macy, M.D., chair of the AAAAI Committee on Adverse Reactions to Drugs and Biologicals, explained in a written statement (www.aaaai.org/members/academynews/2004/07/penicillin.stm

The supply of Pre-Pen worldwide ran out in August 2004 when the most recent batch expired. As a result, “the AAAAI has become involved because the free market system in the United States has not worked to fill this critical need,” the statement said.

The AAAAI is working to find a manufacturer for the complete set of penicillin skin-testing reagents. “Ideally both materials would be sold together as a single penicillin allergy skin test reagent set,” according to the statement.

“Penicillin as an antibiotic has a lot of indications, and removing that from consideration increases the cost of medicine. This is a serious situation, not just for allergists, but for the medical community in general,” Dr. Grabiec said in an interview.

“If a complete set of commercial, FDA-approved, penicillin skin test materials were available, allergist-immunologists would be able to safely skin test a much higher fraction of the 10% of the population that carries a history of penicillin allergy,'” Dr. Macy said.

“This would help promote the more appropriate use of antibiotics and avoid some of the development of antibiotic resistance driven by inappropriate avoidance of penicillins,” he added in the statement.

Skin testing for penicillin allergy has ground to a halt because the most important antigen that is used in the test has been pulled off the market, creating costly problems that have far-reaching impact, according to Steven Grabiec, M.D.

“We are left with a situation where we can't skin test for penicillin adequately because we don't have one of the major antigens we need. If you can't prove a patient is not allergic, you are either obligated to give them a nonpenicillin drug, or you must go through the process of desensitizing them—both options being more costly than simply giving them penicillin,” said Dr. Grabiec, who is a clinical associate professor of pediatrics at the State University of New York at Buffalo.

About 10% of the U.S. population reports a history of penicillin allergy, but if they could be tested with a complete panel of penicillin skin test reagents, more than 90% of them could be declared nonallergic, according to the American Academy of Allergy, Asthma, and Immunology.

The main antigen that is used in penicillin skin testing, benzylpenicilloyl polylysine (commonly known as Pre-Pen) is being phased out by the manufacturer. The orphan drug application for another antigen, penicillin minor determinant mixture (MDM), has been on file with the Food and Drug Administration since 1987, Eric Macy, M.D., chair of the AAAAI Committee on Adverse Reactions to Drugs and Biologicals, explained in a written statement (www.aaaai.org/members/academynews/2004/07/penicillin.stm

The supply of Pre-Pen worldwide ran out in August 2004 when the most recent batch expired. As a result, “the AAAAI has become involved because the free market system in the United States has not worked to fill this critical need,” the statement said.

The AAAAI is working to find a manufacturer for the complete set of penicillin skin-testing reagents. “Ideally both materials would be sold together as a single penicillin allergy skin test reagent set,” according to the statement.

“Penicillin as an antibiotic has a lot of indications, and removing that from consideration increases the cost of medicine. This is a serious situation, not just for allergists, but for the medical community in general,” Dr. Grabiec said in an interview.

“If a complete set of commercial, FDA-approved, penicillin skin test materials were available, allergist-immunologists would be able to safely skin test a much higher fraction of the 10% of the population that carries a history of penicillin allergy,'” Dr. Macy said.

“This would help promote the more appropriate use of antibiotics and avoid some of the development of antibiotic resistance driven by inappropriate avoidance of penicillins,” he added in the statement.

Skin testing for penicillin allergy has ground to a halt because the most important antigen that is used in the test has been pulled off the market, creating costly problems that have far-reaching impact, according to Steven Grabiec, M.D.

“We are left with a situation where we can't skin test for penicillin adequately because we don't have one of the major antigens we need. If you can't prove a patient is not allergic, you are either obligated to give them a nonpenicillin drug, or you must go through the process of desensitizing them—both options being more costly than simply giving them penicillin,” said Dr. Grabiec, who is a clinical associate professor of pediatrics at the State University of New York at Buffalo.

About 10% of the U.S. population reports a history of penicillin allergy, but if they could be tested with a complete panel of penicillin skin test reagents, more than 90% of them could be declared nonallergic, according to the American Academy of Allergy, Asthma, and Immunology.

The main antigen that is used in penicillin skin testing, benzylpenicilloyl polylysine (commonly known as Pre-Pen) is being phased out by the manufacturer. The orphan drug application for another antigen, penicillin minor determinant mixture (MDM), has been on file with the Food and Drug Administration since 1987, Eric Macy, M.D., chair of the AAAAI Committee on Adverse Reactions to Drugs and Biologicals, explained in a written statement (www.aaaai.org/members/academynews/2004/07/penicillin.stm

The supply of Pre-Pen worldwide ran out in August 2004 when the most recent batch expired. As a result, “the AAAAI has become involved because the free market system in the United States has not worked to fill this critical need,” the statement said.

The AAAAI is working to find a manufacturer for the complete set of penicillin skin-testing reagents. “Ideally both materials would be sold together as a single penicillin allergy skin test reagent set,” according to the statement.

“Penicillin as an antibiotic has a lot of indications, and removing that from consideration increases the cost of medicine. This is a serious situation, not just for allergists, but for the medical community in general,” Dr. Grabiec said in an interview.

“If a complete set of commercial, FDA-approved, penicillin skin test materials were available, allergist-immunologists would be able to safely skin test a much higher fraction of the 10% of the population that carries a history of penicillin allergy,'” Dr. Macy said.

“This would help promote the more appropriate use of antibiotics and avoid some of the development of antibiotic resistance driven by inappropriate avoidance of penicillins,” he added in the statement.

MONT TREMBLANT, QUE. — Objective improvement of atrophic facial acne scars can be achieved with the 1,064-nm Q-switched neodymium:YAG laser, according to recently published study.

"This is one of the few papers that [exist] actually showing objective criteria for a problem that's difficult, sometimes, to visually assess in terms of degree of improvement," Roy Geronemus, M.D., told this newspaper. Dr. Geronemus coauthored the study, which is in press, with Paul Friedman, M.D., who is in private practice in Houston, and Greg Skover, Ph.D., of Johnson & Johnson.

Speaking at a symposium on cutaneous laser surgery sponsored by SkinCare Physicians of Chestnut Hill, Dr. Geronemus outlined the study, which used the Primos 3-D optical imaging system to assess skin topography in 11 patients at baseline, and at 1, 3, and 6 months after their fifth and last laser treatment.

"One of the problems we face in dermatology, and specifically in the area of laser medicine, is that there is a tremendous lack of objective evidence to substantiate the benefits, or lack thereof, of a particular treatment," Dr. Geronemus said.

At midtreatment (1 month after the third treatment), an 8.9% improvement in patients' Ra scores was seen. The Ra score is a measurement of skin smoothness and is calculated by averaging the height of all points of the topographic profile (Arch. Dermatol. 2004;140:1337–41).

This improvement in Ra score increased to 23% at 1 month after the last treatment and to 32% and then 39% at 3 months and 6 months after the last treatment, said Dr. Geronemus, who is in private practice in New York.

"The continued incremental improvements were an indication of ongoing dermal collagen remodeling long after the last treatment session," he explained at the meeting.

He has no associations with any company involved in these treatments.

MONT TREMBLANT, QUE. — Objective improvement of atrophic facial acne scars can be achieved with the 1,064-nm Q-switched neodymium:YAG laser, according to recently published study.

"This is one of the few papers that [exist] actually showing objective criteria for a problem that's difficult, sometimes, to visually assess in terms of degree of improvement," Roy Geronemus, M.D., told this newspaper. Dr. Geronemus coauthored the study, which is in press, with Paul Friedman, M.D., who is in private practice in Houston, and Greg Skover, Ph.D., of Johnson & Johnson.

Speaking at a symposium on cutaneous laser surgery sponsored by SkinCare Physicians of Chestnut Hill, Dr. Geronemus outlined the study, which used the Primos 3-D optical imaging system to assess skin topography in 11 patients at baseline, and at 1, 3, and 6 months after their fifth and last laser treatment.

"One of the problems we face in dermatology, and specifically in the area of laser medicine, is that there is a tremendous lack of objective evidence to substantiate the benefits, or lack thereof, of a particular treatment," Dr. Geronemus said.

At midtreatment (1 month after the third treatment), an 8.9% improvement in patients' Ra scores was seen. The Ra score is a measurement of skin smoothness and is calculated by averaging the height of all points of the topographic profile (Arch. Dermatol. 2004;140:1337–41).

This improvement in Ra score increased to 23% at 1 month after the last treatment and to 32% and then 39% at 3 months and 6 months after the last treatment, said Dr. Geronemus, who is in private practice in New York.

"The continued incremental improvements were an indication of ongoing dermal collagen remodeling long after the last treatment session," he explained at the meeting.

He has no associations with any company involved in these treatments.

MONT TREMBLANT, QUE. — Objective improvement of atrophic facial acne scars can be achieved with the 1,064-nm Q-switched neodymium:YAG laser, according to recently published study.

"This is one of the few papers that [exist] actually showing objective criteria for a problem that's difficult, sometimes, to visually assess in terms of degree of improvement," Roy Geronemus, M.D., told this newspaper. Dr. Geronemus coauthored the study, which is in press, with Paul Friedman, M.D., who is in private practice in Houston, and Greg Skover, Ph.D., of Johnson & Johnson.

Speaking at a symposium on cutaneous laser surgery sponsored by SkinCare Physicians of Chestnut Hill, Dr. Geronemus outlined the study, which used the Primos 3-D optical imaging system to assess skin topography in 11 patients at baseline, and at 1, 3, and 6 months after their fifth and last laser treatment.

"One of the problems we face in dermatology, and specifically in the area of laser medicine, is that there is a tremendous lack of objective evidence to substantiate the benefits, or lack thereof, of a particular treatment," Dr. Geronemus said.

At midtreatment (1 month after the third treatment), an 8.9% improvement in patients' Ra scores was seen. The Ra score is a measurement of skin smoothness and is calculated by averaging the height of all points of the topographic profile (Arch. Dermatol. 2004;140:1337–41).

This improvement in Ra score increased to 23% at 1 month after the last treatment and to 32% and then 39% at 3 months and 6 months after the last treatment, said Dr. Geronemus, who is in private practice in New York.

"The continued incremental improvements were an indication of ongoing dermal collagen remodeling long after the last treatment session," he explained at the meeting.

He has no associations with any company involved in these treatments.

One of the largest studies to examine the long-term health effects of cosmetic breast implants has found little evidence to advance the debate about whether implants are linked to connective tissue disease.

The retrospective cohort study by the National Cancer Institute was primarily designed to assess cancer occurrence and overall mortality patterns among implant recipients.

Several published reports on that cohort showed no association between implants and subsequent risk of breast cancer or most other cancers.

However, a two- to threefold increase in the rates of respiratory and brain cancers and a four- to fivefold increase in suicide rates were found among women with implants, compared with control patients. (For references, see the NCI's fact sheet at www.nci.nih.gov/newscenter/siliconefactsheet

Findings linking implants with connective tissue disorders (CTDs), however, are far less conclusive.

"Given the diagnostic complexities of these diseases, excess risks, if they exist, may be beyond detection even in a study of this size," wrote principal author Louise A. Brinton, Ph.D., of the National Cancer Institute, Rockville, Md. (Am. J. Epidemiol. 2004;160:619–27).

"The design of the study did not enable us to derive any firm conclusions, but we were able to rule out very large increased risks," she told this newspaper.

Roughly half the 7,234 breast augmentation recipients (49.7%) had received silicone implants, while about 34% received double lumen implants, about 12% received saline implants, and about 4% received other or unspecified implant types.

The 2,138 control patients were of similar age and had had other types of plastic surgery not involving silicone, such as abdominoplasty or liposuction; blepharoplasty or rhytidectomy; and rhinoplasty, otoplasty, mentoplasty, or genioplasty.

Surgeries in both groups had taken place between 1983 and 1984.

Study subjects were mailed questionnaires about demographic information, subsequent plastic surgeries, current health status, and lifestyle factors that could affect their health. They were asked whether they had a physician's diagnosis of a CTD—including rheumatoid arthritis (RA), arthritis of another type, scleroderma, systemic lupus erythematosus (SLE), Sjögren's syndrome, Raynaud's phenomenon, fibrositis/fibromyalgia, vasculitis, chronic fatigue syndrome, or multiple sclerosis.

The study found that 4.8% of implant patients reported a diagnosis of one of four major CTDs (RA, scleroderma, SLE, or Sjögren's syndrome), compared with 2.9% of controls, representing a relative risk of 2.0. This risk elevation was statistically significant, but after controlling for various confounding factors, the investigators concluded that the risks were not significant.

One limitation is that risk estimates were based on patient reports of their CTD diagnosis, rather than on a physician's report.

Two rheumatologists blinded to the implant status of the patients reviewed medical records to determine if each participant's history, physical examination, and radiographic and laboratory findings supported the CTD diagnosis. They then rated each CTD diagnosis as "likely," "unlikely," or "unable to assess."

Although the reviewers were able to access the medical records of only 30%–40% of study participants, they concluded that "most diagnoses were insufficiently supported, either because the records were incomplete or because clinical criteria were not met."

When relative risks were recalculated using only the "likely" diagnoses, the revised estimated relative risk for RA, scleroderma, and Sjögren's syndrome combined was still 2.0, and for RA alone it was 1.3, both of which were not statistically significant, given the smaller sample size.

"We were relying on self-reports of these conditions that even rheumatologists have a hard time diagnosing, and …many of these conditions are extremely rare. So we ended up with very small numbers, and it was really not possible to either confirm or refute whether there is an association," said Dr. Brinton.

The investigators note that their observations of selection and reporting biases underscore the complexities of evaluating the relationship of implants and CTDs.

"Thus, future studies designed to resolve the question of a possible association between breast implants and rheumatoid arthritis or other CTDs would need to be very large and include well-validated and documented cases and unbiased assessments of exposure," they said.

"There were a lot of methodological problems with this study, and the authors did a good job of outlining them," commented Diana Zuckerman, Ph.D., president of the National Center for Policy Research for Women & Families, a Washington-based nonprofit group. "This is the latest of several red flags warning women that the risks of breast implants have not been adequately studied," she said in an interview.

One of the largest studies to examine the long-term health effects of cosmetic breast implants has found little evidence to advance the debate about whether implants are linked to connective tissue disease.

The retrospective cohort study by the National Cancer Institute was primarily designed to assess cancer occurrence and overall mortality patterns among implant recipients.

Several published reports on that cohort showed no association between implants and subsequent risk of breast cancer or most other cancers.

However, a two- to threefold increase in the rates of respiratory and brain cancers and a four- to fivefold increase in suicide rates were found among women with implants, compared with control patients. (For references, see the NCI's fact sheet at www.nci.nih.gov/newscenter/siliconefactsheet

Findings linking implants with connective tissue disorders (CTDs), however, are far less conclusive.

"Given the diagnostic complexities of these diseases, excess risks, if they exist, may be beyond detection even in a study of this size," wrote principal author Louise A. Brinton, Ph.D., of the National Cancer Institute, Rockville, Md. (Am. J. Epidemiol. 2004;160:619–27).

"The design of the study did not enable us to derive any firm conclusions, but we were able to rule out very large increased risks," she told this newspaper.

Roughly half the 7,234 breast augmentation recipients (49.7%) had received silicone implants, while about 34% received double lumen implants, about 12% received saline implants, and about 4% received other or unspecified implant types.

The 2,138 control patients were of similar age and had had other types of plastic surgery not involving silicone, such as abdominoplasty or liposuction; blepharoplasty or rhytidectomy; and rhinoplasty, otoplasty, mentoplasty, or genioplasty.

Surgeries in both groups had taken place between 1983 and 1984.

Study subjects were mailed questionnaires about demographic information, subsequent plastic surgeries, current health status, and lifestyle factors that could affect their health. They were asked whether they had a physician's diagnosis of a CTD—including rheumatoid arthritis (RA), arthritis of another type, scleroderma, systemic lupus erythematosus (SLE), Sjögren's syndrome, Raynaud's phenomenon, fibrositis/fibromyalgia, vasculitis, chronic fatigue syndrome, or multiple sclerosis.

The study found that 4.8% of implant patients reported a diagnosis of one of four major CTDs (RA, scleroderma, SLE, or Sjögren's syndrome), compared with 2.9% of controls, representing a relative risk of 2.0. This risk elevation was statistically significant, but after controlling for various confounding factors, the investigators concluded that the risks were not significant.

One limitation is that risk estimates were based on patient reports of their CTD diagnosis, rather than on a physician's report.

Two rheumatologists blinded to the implant status of the patients reviewed medical records to determine if each participant's history, physical examination, and radiographic and laboratory findings supported the CTD diagnosis. They then rated each CTD diagnosis as "likely," "unlikely," or "unable to assess."

Although the reviewers were able to access the medical records of only 30%–40% of study participants, they concluded that "most diagnoses were insufficiently supported, either because the records were incomplete or because clinical criteria were not met."

When relative risks were recalculated using only the "likely" diagnoses, the revised estimated relative risk for RA, scleroderma, and Sjögren's syndrome combined was still 2.0, and for RA alone it was 1.3, both of which were not statistically significant, given the smaller sample size.

"We were relying on self-reports of these conditions that even rheumatologists have a hard time diagnosing, and …many of these conditions are extremely rare. So we ended up with very small numbers, and it was really not possible to either confirm or refute whether there is an association," said Dr. Brinton.

The investigators note that their observations of selection and reporting biases underscore the complexities of evaluating the relationship of implants and CTDs.

"Thus, future studies designed to resolve the question of a possible association between breast implants and rheumatoid arthritis or other CTDs would need to be very large and include well-validated and documented cases and unbiased assessments of exposure," they said.

"There were a lot of methodological problems with this study, and the authors did a good job of outlining them," commented Diana Zuckerman, Ph.D., president of the National Center for Policy Research for Women & Families, a Washington-based nonprofit group. "This is the latest of several red flags warning women that the risks of breast implants have not been adequately studied," she said in an interview.

One of the largest studies to examine the long-term health effects of cosmetic breast implants has found little evidence to advance the debate about whether implants are linked to connective tissue disease.

The retrospective cohort study by the National Cancer Institute was primarily designed to assess cancer occurrence and overall mortality patterns among implant recipients.

Several published reports on that cohort showed no association between implants and subsequent risk of breast cancer or most other cancers.

However, a two- to threefold increase in the rates of respiratory and brain cancers and a four- to fivefold increase in suicide rates were found among women with implants, compared with control patients. (For references, see the NCI's fact sheet at www.nci.nih.gov/newscenter/siliconefactsheet

Findings linking implants with connective tissue disorders (CTDs), however, are far less conclusive.

"Given the diagnostic complexities of these diseases, excess risks, if they exist, may be beyond detection even in a study of this size," wrote principal author Louise A. Brinton, Ph.D., of the National Cancer Institute, Rockville, Md. (Am. J. Epidemiol. 2004;160:619–27).

"The design of the study did not enable us to derive any firm conclusions, but we were able to rule out very large increased risks," she told this newspaper.

Roughly half the 7,234 breast augmentation recipients (49.7%) had received silicone implants, while about 34% received double lumen implants, about 12% received saline implants, and about 4% received other or unspecified implant types.

The 2,138 control patients were of similar age and had had other types of plastic surgery not involving silicone, such as abdominoplasty or liposuction; blepharoplasty or rhytidectomy; and rhinoplasty, otoplasty, mentoplasty, or genioplasty.

Surgeries in both groups had taken place between 1983 and 1984.

Study subjects were mailed questionnaires about demographic information, subsequent plastic surgeries, current health status, and lifestyle factors that could affect their health. They were asked whether they had a physician's diagnosis of a CTD—including rheumatoid arthritis (RA), arthritis of another type, scleroderma, systemic lupus erythematosus (SLE), Sjögren's syndrome, Raynaud's phenomenon, fibrositis/fibromyalgia, vasculitis, chronic fatigue syndrome, or multiple sclerosis.

The study found that 4.8% of implant patients reported a diagnosis of one of four major CTDs (RA, scleroderma, SLE, or Sjögren's syndrome), compared with 2.9% of controls, representing a relative risk of 2.0. This risk elevation was statistically significant, but after controlling for various confounding factors, the investigators concluded that the risks were not significant.

One limitation is that risk estimates were based on patient reports of their CTD diagnosis, rather than on a physician's report.

Two rheumatologists blinded to the implant status of the patients reviewed medical records to determine if each participant's history, physical examination, and radiographic and laboratory findings supported the CTD diagnosis. They then rated each CTD diagnosis as "likely," "unlikely," or "unable to assess."

Although the reviewers were able to access the medical records of only 30%–40% of study participants, they concluded that "most diagnoses were insufficiently supported, either because the records were incomplete or because clinical criteria were not met."

When relative risks were recalculated using only the "likely" diagnoses, the revised estimated relative risk for RA, scleroderma, and Sjögren's syndrome combined was still 2.0, and for RA alone it was 1.3, both of which were not statistically significant, given the smaller sample size.

"We were relying on self-reports of these conditions that even rheumatologists have a hard time diagnosing, and …many of these conditions are extremely rare. So we ended up with very small numbers, and it was really not possible to either confirm or refute whether there is an association," said Dr. Brinton.

The investigators note that their observations of selection and reporting biases underscore the complexities of evaluating the relationship of implants and CTDs.

"Thus, future studies designed to resolve the question of a possible association between breast implants and rheumatoid arthritis or other CTDs would need to be very large and include well-validated and documented cases and unbiased assessments of exposure," they said.

"There were a lot of methodological problems with this study, and the authors did a good job of outlining them," commented Diana Zuckerman, Ph.D., president of the National Center for Policy Research for Women & Families, a Washington-based nonprofit group. "This is the latest of several red flags warning women that the risks of breast implants have not been adequately studied," she said in an interview.