Blood donor concerns with Ross River virus
THE first case of Ross River virus (RRV) infection transmitted by blood transfusion has been reported in the MJA, raising questions about the identification of at-risk donors. The case report described the delayed notification received by the Australian Red Cross Blood Service in WA from a donor who had been diagnosed with acute RRV infection. The red blood cell component of the donation had already been transfused to a patient with myelodysplastic syndrome. After receiving the notification, the patient’s clinician requested serological testing, which indicated that patient had RRV infection. The Blood Service was “taking steps to strengthen its messaging to donors regarding development of post-donation illnesses”, the authors wrote. While the case highlighted that transfusion-transmission of RRV was not just a theoretical risk, it was still likely to remain a rare event, the authors wrote. As individual testing was not cost-effective and as most RRV infections were asymptomatic, excluding donors based on symptoms would not prevent all potentially infectious donations and could have a critical impact on blood supply. The authors wrote that pathogen reduction technology (PRT) was an alternative risk-management option that would not affect supply. The Blood Service was investigating the effectiveness of PRT for the prevention of arboviral transfusion-transmission, but further research was required, they wrote. While the Australian blood supply was one of the safest in the world, “it is important to remember that blood transfusion is not without risk and should only be undertaken when the efficacy of the transfusion and improved clinical outcome outweigh the risk”.
Medical assistants improve health goals
HEALTH coaching by medical assistants is effective for improving patients’ blood sugar control and low-density lipoprotein (LDL) cholesterol levels, but not blood pressure (BP) US research has found. The randomised controlled trial, published in Annals of Family Medicine, included 441 patients at two primary care clinics in California, whose clinical goals were assessed at 12 months for at least one of three uncontrolled conditions at baseline: diabetes, hypertension and hyperlipidaemia. Medical assistants trained as health coaches and met with patients before their visit to the clinic, remained in the examination room during the consultation, reviewed the care plan with the patient after the visit, and followed up with patients between visits in person and by telephone. Patients in the usual care group had access to any resources available at the clinic, such as visits with their clinician, diabetes educators, nutritionists, chronic care nurses, educational classes, and registry data to plan care. The authors found that participants in the health coaching group were more likely than those receiving usual care to achieve at least one of their clinical goals, or reach all of their clinical goals. Almost twice as many coached patients as those receiving standard care achieved the haemoglobin A1c goal for diabetes control. At the larger clinic, coached patients were also more likely to achieve the LDL cholesterol goal than patients receiving usual care, the authors said. However, the proportion of patients who met the systolic BP goal did not differ significantly between the groups. “This medical assistant health-coaching model may provide an important answer to the barriers of time, resources, and cultural concordance faced by many primary care practices seeking to implement self-management support”, the authors wrote. They said their study showed how medical assistants could successfully serve as health coaches to improve the glycaemic and cardiovascular health indicators of patients.
“Clear limits” from opioid reformulations to reduce misuse
US research into the effect of the 2010 reformulation of oxycodone hydrochloride (OxyContin) to reduce widescale misuse of prescription opioids has found that after an initial steep decline in misuse, the effect levelled off. The makers of OxyContin reformulated the drug to make crushing and solvent extraction difficult. The research, published in JAMA Psychiatry, was based on data from an ongoing US surveillance system that collects and analyses postmarketing data on misuse and diversion of prescription opioid analgesics and heroin. The 10 784 patients in the study had been diagnosed with opioid use disorder with the primary drug of misuse being a prescription opioid or heroin at entry to one of 150 drug treatment programs. The researchers found reduced misuse of the active drug — oxycodone — particularly in those who relied on tampering for injected or inhaled misuse. However, although survey responses indicated a time-related drop in the past-month abuse of OxyContin in the 12‒18 months after the reformulation was introduced, this steep decline levelled off “such that a relatively large percentage (25%-30%) of those entering treatment with a diagnosis of opioid dependence from 2012 through 2014 persisted in abusing the new formulation”, they wrote. The initial decline in misuse appeared to be related to a shift away from OxyContin to another opioid, particularly heroin. The researchers wrote that the reformulation appeared to have been effective in deterring at least some misuse. “Abuse-deterrent formulations have the intended purpose of curtailing abuse, but their effectiveness has clear limits, resulting in a significant level of residual abuse”, the researchers wrote, concluding that although drug misuse policy should focus on limiting supplies of prescription analgesics for misuse, efforts to reduce supply alone would not mitigate the opioid misuse problem in the US.
MI size and mortality linked to circadian rhythm
MYOCARDIAL infarct (MI) size and inhospital mortality follow a circadian rhythm depending upon the time of symptom onset, according to the results of a Swiss retrospective, registry-based study. The research, published in PLOS One, was based on 6223 patients who had an ST-elevation MI (STEMI) between 1999 and 2013, and were admitted to 82 acute-care hospitals and treated with primary angioplasty within 6 hours of symptom onset. Peak creatine kinase (CK) was used as a proxy measure for MI size. The researchers found the maximum average peak CK value (2315 U/L) was for patients with symptom onset at 11 pm, whereas the minimum average (2017 U/L) was for onset at 11 am. They also found no correlation was observed between ischaemic time and circadian peak CK variation. There were 223 (3.58%) patient deaths during index hospitalisation. “Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality”, the researchers wrote. “The risk of death from STEMI was highest for patients with symptom onset at 00:00 and lowest for those with onset at 12:00.” The authors said their findings supported the notion that the myocardium’s vulnerability to ischaemia was subject to a significant circadian pattern. “These results suggest that symptom onset time should be considered as a prognostic parameter in STEMI patients undergoing primary [percutaneous coronary intervention] less than 6 hours after known symptom onset”, they wrote.
Vegetarian diet lowers colorectal cancer risk
VEGETARIAN diets are associated with an overall lower risk of colorectal cancers compared with non-vegetarian diets, according to a study published in JAMA Internal Medicine. The study included 77 659 men and women recruited from Seventh-day Adventist churches in North America between 2002 and 2007. The researchers examined the relationship between dietary patterns and colorectal cancer incidence using a food frequency questionnaire, and categorised diet into four vegetarian patterns (vegan, lacto-ovo vegetarian, pescovegetarian and semivegetarian) and a non-vegetarian pattern. Cancer incidence was determined primarily using state cancer registry linkages. The authors found that during a mean follow-up of 7.3 years, there were 380 documented cases of colon cancer and 110 cases of rectal cancer. The adjusted hazard ratios (HRs) in all vegetarians combined compared with non-vegetarians were 0.78 for all colorectal cancers, 0.81 for colon cancer and 0.71 for rectal cancer. Compared with non-vegetarians, the adjusted HR for colorectal cancer was 0.84 among vegans, 0.82 in lacto-ovo vegetarians, 0.57 in pescovegetarians and 0.92 in semivegetarians, the authors wrote. “The evidence that vegetarian diets similar to those of our study participants may be associated with a reduced risk of colorectal cancer, along with prior evidence of the potential reduced risk of obesity, hypertension, diabetes and mortality, should be considered carefully in making dietary choices and in giving dietary guidance”, the authors wrote.
No reliable evidence for homeopathy: NHMRC statement
THE NHMRC has released its final report of its review of evidence on the effectiveness of homeopathy for treating health conditions. The review, described as “comprehensive”, included evidence from systematic reviews, evidence submitted to the NHMRC, public consultation and consideration of published guidelines. In a statement based on the review outcomes the NHMRC concluded that hat there were no health conditions for which there was reliable evidence that homeopathy was effective. “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious”, the statement said. “People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.” The statement advised people considering whether to use homeopathy to first get advice from a registered health practitioner, and said those who did use it should tell their health practitioner and should keep taking any prescribed treatments.