AAP Policy: Learn About School Nursing Services

Many children who take medications need them during the school day. In a revised policy statement, “Guidance for the Administration of Medication in School,” the AAP issues recommendations for school districts, pediatricians and other child health professionals. The AAP recommends that pediatricians prescribe medications for administration at school only when necessary.

Pediatricians should learn about local school nursing services and medication policies, and whether the school nurse is at the school all day, every day, or if medication administration is delegated to an unlicensed assistant. The AAP strongly endorses the presence of a full-time, licensed registered nurse in schools. Parents can help promote safe medication administration at their child’s school by informing their pediatrician about the school health services provided at the school.

American Academy of Pediatrics

College Nursery Closures Set To Spiral, Say Unions, UK

More than 50 further education colleges are set to make redundancies leading to the closure of a huge number of nurseries, according to UNISON, UCU and NUS.

The unions predict that the number of college crГЁche closures will hit record highs across the 433 colleges in the UK, with reports of cuts being received on a daily basis, including more than ten planned this week alone.

Hundreds of low paid women are being hit the hardest by the round of redundancies and service cuts, which are unjustified, as overall FE funding in England has increased this year.

Lunchtime protests over further education job cuts and training have been planned by both unions to take place on Friday 3 July.

Chris Fabby, Head of Further Education at UNISON, the UK’s largest public sector union, said:

“It is crazy to be making job cuts during a recession when colleges are needed so badly by their communities.

“And we believe that this is just the tip of the iceberg when it comes to nursery closures, as over the last week we have heard of at least 10 colleges announce closures.

“Those facing the biggest hit will be low paid women who may lose their livelihood or suffer a lack of childcare facilities.

“This is completely unjustified and we are concerned that the situation will worsen in 2010/11 when government cuts of over ВЈ340 million from the FE and skills sector kick in.”

UCU head of further education, Barry Lovejoy, said:

“At a time when vulnerable sections of the community are experiencing economic hardship closing nursery provision can only add salt to the wound.

“We urge employers to rethink these misguided plans. This is the last thing students need and will make it much harder to widen participation in deprived areas.”

Ama Uzowuru, NUS Vice President (Welfare) said:

“Being a student and a parent, whilst extremely rewarding, can be a real struggle.

“From ad hoc funding entitlements, to being excluded from student life, student parents are having their student experience short changed.

“These placements are vital to enable parents to up-skill and provide a better future for their children.

“In difficult financial times employers have made a decision that impacts on the underpaid and acerbates an already under-funded and overburdened service that is essential for supporting people and students to get through the recession.”


Comprehensive Treatment Of Extensively Drug-Resistant TB Works, Study Finds

The death sentence that too often accompanies a diagnosis of extensively drug-resistant tuberculosis (XDR-TB) can be commuted if an individualized outpatient therapy program is followed – even in countries with limited resources and a heavy burden of TB.

A study conducted in Peru between 1999 and 2002 shows that more than 60 percent of XDR-TB patients not co-infected with HIV were cured after receiving the bulk of their personalized treatment at home or in community-based settings. The paper appears in the August 7, 2008 issue of The New England Journal of Medicine.

“It’s essential that the world know that XDR-TB is not a death sentence,” says lead author Carole Mitnick, instructor in the Department of Global Health and Social Medicine at Harvard Medical School (HMS). “As or even more importantly, our study shows that effective treatment does not require hospitalization or indefinite confinement of patients.”

In some parts of the world, however, patients with XDR-TB and other drug-resistant forms of the disease are confined against their will in TB hospitals that resemble prisons, Mitnick adds.

Researchers from HMS, Brigham and Women’s Hospital, Partners In Health, Harvard School of Public Health, and the Massachusetts State Laboratory Institute, along with Lima, Peru-based organizations Socios en Salud, the Peruvian Ministry of Health, and Hospital Nacional Sergio E. Bernales, had already demonstrated that aggressive, outpatient treatment could cure multi-drug resistant tuberculosis (MDR-TB), which is resistant to two first-line anti-TB drugs. That pilot program has been adopted as a national endeavor by the Peruvian government.

A similar protocol was used for the recent study of XDR-TB, which is caused by TB bacteria that are resistant not only to the same first-line anti-TB drugs, but also to the two most important second-line drug classes.

A total of 810 patients with unsuccessfully treated tuberculosis were referred for free individualized drug treatment and additional services as needed, including surgery, adverse-event management, and nutritional and psychological support. Sputum culture and drug-susceptibility testing results, performed at the Massachusetts State Laboratory Institute in Boston, were available for 651 patients. Based on susceptibility results for 12 anti-TB drugs, clinicians developed regimens that included five or more drugs to which the infecting strains were likely to respond. Forty-eight patients had XDR-TB; 603 had MDR-TB. None of the XDR-TB patients were co-infected with the HIV virus.

At the end of treatment, 60.4 percent in the XDR-TB group were cured; 66.3 percent with MDR-TB were cured. The outcomes among XDR-TB patients were better than most reported from hospital settings in Europe, the U.S., and Korea, Mitnick says.

Frequent contact with healthcare workers afforded many benefits and was an important element of success. Daily, supervised treatment was delivered in patient homes and at community health centers. The community health workers ensured a high level of treatment adherence and promptly detected circumstances requiring additional attention, including adverse events. Psycho-social needs were also assessed continuously and addressed through a range of interventions.

“It’s important for people to understand that this ambulatory form of treatment exists, is successful, and can be widely implemented in resource-poor settings,” Mitnick says.

Community-based interventions also protect hospital patients and staff from transmission of TB and allow TB patients to remain with their families during this protracted treatment. If hospitals have to accommodate only those with serious medical needs, this intervention can be implemented widely, and earlier in the disease course.

The benefits would be profound, Mitnick says. In addition to reduced morbidity and mortality among patients, an epidemiologic impact could be expected: a decrease in the incidence of resistant TB has been reported only in places where universal screening and treatment for DR-TB are offered at first TB diagnosis.

“DR-TB is everywhere in the world it’s been looked for and it’s not going away without additional resources,” Mitnick says. According to a notice issued by the World Health Organization this year, ever since it was first described in 2006, XDR-TB has been reported in 49 countries, including the United States. Approximately 1.5 million people are estimated to have MDR-TB, “but no one really knows how many have XDR-TB.” Expanded community-based delivery of improved treatment is essential to stem this epidemic.

This study was funded by The Bill & Melinda Gates Foundation. Additional collaborators in the delivery of care included the U.S. Centers for Disease Control & Prevention, the World Health Organization, and the U.S. Task Force for Child Survival and Development.

“Extensively Drug-resistant Tuberculosis: A Comprehensive Treatment”
Harvard Medical School: Carole D. Mitnick, Hamish S.F. Fraser, Mercedes C. Becerra; Brigham And Women’s Hospital: Sonya S. Shin, Sidney S. Atwood, Jennifer J. Furin, Garrett M. Fitzmaurice, Rocio M. Hurtado; Partners In Health: Kwonjune J. Seung, Michael L. Rich, Sharon Choi, Darius Jazayeri, Keith Joseph, Joia S. Mukherjee; Harvard School Of Public Health: Sasha C. Appleton, Molly F. Franke; Massachusetts State Laboratory Institute: Alexander Sloutsky; Socios En Salud: Felix A. Alcantara Viru, Katiuska Chalco, Dalia Guerra, Karim Llaro, Lorena Mestanza, Maribel Munoz, Eda Palacios, Jaime N. Bayona; Peruvian Ministry Of Health: Cesar A. Bonilla; Hospital Nacional Sergio E. Bernales: Epifanio Sanchez.
The New England Journal of Medicine, August 7, 2008

Harvard Medical School

Adults Who Eat Apples, Drink Apple Juice Have Lower Risk For Metabolic Syndrome

Not eating your apple a day? Perhaps you should be. Adults who eat apples, apple juice and applesauce have a significantly reduced risk of metabolic syndrome, a cluster of health problems that are linked to numerous chronic diseases such as diabetes and cardiovascular disease.

The study results, presented at the Experimental Biology 2008 meeting this week, were derived from an analysis of adult food consumption data collected in the 1999-2004 National Health and Nutrition Examination Survey (NHANES), the government’s largest food consumption and health database.

Dr. Victor Fulgoni analyzed the data, specifically looking at the association between consumption of apples and apple products, nutrient intake and various physiological parameters related to metabolic syndrome. When compared to non-consumers, adult apple product consumers had a 27% decreased likelihood of being diagnosed with metabolic syndrome.

Fulgoni notes, “We found that adults who eat apples and apple products have smaller waistlines that indicate less abdominal fat, lower blood pressure and a reduced risk for developing what is known as the metabolic syndrome.”

In addition to having a 30% decreased likelihood for elevated diastolic blood pressure and a 36% decreased likelihood for elevated systolic blood pressure, apple product consumers also had a 21% reduced risk of increased waist circumference – all predictors of cardiovascular disease and an increased likelihood of metabolic syndrome. Additionally, adult apple product consumers had significantly reduced C-reactive protein levels, another measurable marker related to cardiovascular risk.

Furthermore, apple product consumers’ diets were healthier than non-consumers – they had an overall greater intake of fruit and key nutrients, including dietary fiber, vitamins A and C, calcium and potassium. These consumers also ate less total fat, saturated fat, discretionary fat and added sugars.


Metabolic syndrome is believed to affect an estimated 36 million Americans. Metabolic syndrome, also known as Syndrome X and insulin resistance syndrome, is defined as having three or more of the associated symptoms, which include elevated blood pressure, increased waist size and abdominal fat, and elevated c-reactive protein levels.

Fulgoni, V., Fulgoni S., Haaga, S., Ebert, A. Apple consumption is associated with increased nutrient intakes and reduced risk of metabolic syndrome in adults from the National health and Nutrition Examination Survey (1999-2004). Experimental Biology 2008 Poster Presentation (unpublished).

Stacie Haaga
U.S. Apple Association

1994 Group Responds To Innovation, Universities, Science and Skills Committee ‘Students And Universities’ Report

Responding to the Innovation, Universities, Science and Skills Committee (IUSS) report on ‘Students and Universities’ Professor Paul Wellings, Chair of the 1994 Group of leading research intensive universities and Vice-Chancellor of Lancaster University said:

“We will examine with interest the recommendations made in this challenging and wide-ranging report. The 1994 Group supports flexible and diverse higher education provision which allows the sector to meet the wide range of differing needs of students, government, businesses and communities. However, we must ensure that throughout this diverse range of provision the very highest quality of academic experience is maintained.”

“1994 Group universities are strongly committed to improving access and are using variable bursaries to assist fair access and encourage students from lower socio-economic groups to attend world-class research-intensive universities. The system of universities offering individual bursary schemes is crucial to meet the specific needs of their students. 1994 Group universities are investing over ВЈ28.4m this year in student support and outreach activity. We offer an outstanding academic experience to talented students regardless of their background.”

“A national bursary scheme would be a big mistake; it would effectively be a tax, a forced pooling of tuition fee income, which would be distributed away from the institution to which a student pays his or her fee. It would seriously compromise the direct relationship between a student’s fees and their education.”

“1994 Group universities provide an excellent academic experience and a wide range of support for part-time and mature students and we would welcome the opportunity to work with the Government to examine how to continue to improve the student experience for all students across the sector.”

1994 Group

Congressional Democrats Say They Will Use Expanded Majority To Consider SCHIP Expansion, Other Issues, But First Will Address Economy

House Speaker Nancy Pelosi (D-Calif.) on Wednesday in a news conference said Congress would aim to pass measures related to health care that failed during the Bush administration, including an economic stimulus package with funding for state Medicaid programs, SCHIP expansion and federal funding for embryonic stem cell research, CongressDaily reports (McPike et al., CongressDaily, 11/5). In the Senate, Democrats and two independents who caucus with them will increase their majority from 51 seats to at least 56 seats, with four races still undecided as of Thursday morning. In the House, Democrats will increase their majority from 236 seats to at least 254 seats, with eight races still undecided (CNN, 11/6).

Pelosi suggested the current Senate take up the $61 billion economic stimulus package (HR 7110) approved by the House on Sept. 26. The bill includes money for state Medicaid programs, among other provisions, unlike the stimulus bill passed earlier this year. “If we can’t get the [Bush] administration interested in doing more, … the least we can do is the package that we have put forth,” Pelosi said, adding that the new Congress could move forward with a new stimulus bill early next year. She said, “Depending on what the first package is we may need another one,” and “it may be that we do one further down the road as we watch what is happening to our economy” (Clarke/Epstein, CQ Today, 11/5).

According to CongressDaily, the “first dilemma” the new Congress will face on health care is whether to move legislation that would renew and expand SCHIP as its own bill or as part of “a larger overhaul effort.” Sources familiar with the matter say passing the expansion on its own could “give Democrats an early win by pointing to millions more children with health care coverage, a bonus if congressional stamina for an overhaul wears thin,” according to CongressDaily. An SCHIP expansion likely would be funded by an increase in the tobacco tax, but other reforms — such as expanding coverage to uninsured adults — “will vie with other priorities for dollars,” CongressDaily reports.

Other Aims
Pelosi also said that she would fight efforts “to destroy Social Security (and) unravel Medicare” and that Democrats would propose legislation to provide federal funding for embryonic stem cell research that was vetoed by President Bush. In addition, Congress could try to find a permanent fix for the Medicare physician reimbursement system next year, rather than providing a temporary delay of the planned cuts as it has done in recent years. Medicare Advantage payments likely would be cut to help fund a physician payment fix, as President-elect Barack Obama supports cutting MA rates.

CongressDaily reports that “some health overhauls might hitch a ride” on a Medicare payment fix bill, including comparative effectiveness research, pay-for-performance proposals and legislation addressing electronic health records — if health information technology is not taken up in its own bill.

Senate Finance Committee Chair Max Baucus (D-Mont.) plans to release details of his own health care overhaul plan over the next few weeks and convene a meeting of relevant committee leaders during the lame-duck session to discuss how best to move forward with the bill. Baucus spokesperson Carol Guthrie said the meeting likely will center on how to achieve health care reform in the current economic climate (CongressDaily, 11/5).

Health reform efforts could be limited by declining tax revenues and an increasing federal deficit related to the recent economic downturn, the San Francisco Chronicle reports. Pelosi said, “I think it’s important for the American people to know that many of our options have been diminished because of the downturn in the economy,” adding, “We have a lot less money to draw upon” (Coile, San Francisco Chronicle, 11/6). According to CQ Today, stabilizing the economy and withdrawing from Iraq — two priorities of Obama’s — could pull resources and attention away from other Democratic goals, including expanding health coverage.

In addition, even an increased Democratic majority in the Senate does not ensure easy passage of Democrats’ priorities, according to CQ Today. Republicans could begin “digging in their heels,” forcing Democrats to try to push their health care agenda, among other proposals, through the budget reconciliation process, which would allow passage by simple majority without the threat of filibuster. “The numbers can … convey an impression of command and domination that doesn’t stand scrutiny,” Ross Baker, a political science professor at Rutgers University, said, but he added, “When actual legislation is presented, a lot of those numbers can evaporate pretty quickly” (Jansen, CQ Today, 11/5).

According to CongressDaily, Obama has sought advice on health care from former Senate Majority Leader Tom Daschle, who “learned firsthand what went wrong when the Clinton administration failed to push through universal health care in 1993,” which was “seen as helping cause serious Democratic losses in the 1994 midterm elections” (CongressDaily, 11/5).

Additional Reaction
Former Democratic presidential candidate Sen. Hillary Rodham Clinton (D-N.Y.) said, “I hope that we’re going to really make progress on health care right off the bat with a new Congress. There are a lot of different ways of doing that” (Earle, New York Post, 11/6). George Mason University public policy professor Mark Rozell said Democrats must find a balance between pushing their priorities and not alienating Republicans. He said, “If the Democrats push hard on health care reform, … they’re going to miss a unique opportunity to come out during a honeymoon period and really make a very big difference.” Republican leaders “remained largely quiet Wednesday,” according to USA Today (Fritze, USA Today, 11/6).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.В  All rights reserved.

CMS, NCQA Seek Public Comment On Proposed Quality Measures For Medicare Special Needs Plans, USA

As part of its continuing efforts to improve the quality of care provided to people with Medicare, the Centers for Medicare & Medicaid Services (CMS), with the National Committee for Quality Assurance (NCQA), released for public comment a proposed set of structure and process measures for Medicare Special Needs Plans (SNPs).

The proposed measures are part of the initial implementation of a strategy to evaluate the structure, processes and performance of SNPs.

“This is a first step in evaluating the quality of care that is provided to Medicare beneficiaries who are receiving care from these new Medicare Advantage plans,” said CMS Acting Administrator Kerry Weems. “It’s important that we get the right measures in place to protect the vulnerable beneficiaries who are enrolled in or looking to enroll in Special Needs Plans.”

The SNPs are one of the fastest growing health plan options available as part of Medicare Advantage and were created by Congress as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). These Medicare managed care plans serve certain vulnerable groups of Medicare beneficiaries including those living in institutions such as nursing homes, beneficiaries with severe or disabling chronic conditions and beneficiaries eligible for both Medicare and Medicaid. SNPs provide special clinical programs to help people with distinct health care needs, reducing the need for them to be hospitalized or placed in an institution such as a nursing home. As of 2007, more than 470 SNPs are serving more than 1 million beneficiaries, and more than 760 SNPS will be available in 2008.

“Because they care for some of our most vulnerable citizens, Special Needs Plans must demonstrate that they are providing quality care and protecting the rights of Medicare and Medicaid beneficiaries,” said NCQA President Margaret E. O’Kane.

The measures released for comment today build upon existing NCQA standards and performance measures used to evaluate health plans serving more than 84 million Americans.

The measures examine how SNPs set up case management programs for members with complex needs and how they act to improve clinical care and patient experience. The CMS will also require SNPs to begin reporting on 13 Healthcare Effectiveness Data and Information Set (HEDIS®) measures that will assess clinical performance.

“We need to establish clear expectations that enable SNPs to use innovative approaches in serving vulnerable populations,” said Weems. “That is why we are looking for input and comment before we implement specific quality measurements for these plans.”

Interested parties are invited to comment on the proposed measures, posted on NCQA’s Web site at ncqa, through January 18, 2008. NCQA will summarize the comments and provide proposed final requirements to CMS for final approval in March. Final requirements and data collection tools will be available to SNPs in mid-April. SNPs will be required to submit HEDIS data by June 30, 2008.

More information about Medicare Special Needs Plans is available here.

Centers for Medicare & Medicaid Services

Center Of Excellence In Geriatric Medicine And Training At Browns

The Warren Alpert Medical School of Brown University has been named a Center of Excellence in Geriatric Medicine and Training by the John A. Hartford Foundation, the nation’s largest private foundation focused solely on aging and health.

Alpert Medical School was one of three medical schools chosen from a pool of 27 applicants to earn the Hartford Foundation designation. Rhode Island Hospital received the three-year, $450,000 grant award that accompanies the designation.

Grant funds will be used to train 13 geriatrics junior faculty and fellows – a tactic that will help ensure that Brown’s doctors-in-training can meet the needs of older patients. According to the U.S. Census Bureau, the number of Americans age 65 and older will double to 71 million by 2030. By that time, demographers predict a shortfall of 26,000 geriatricians across the country.

“We’re looking down the barrel of a loaded gun,” said Center of Excellence project leader Richard W. Besdine, M.D., professor of medicine at Brown, director of the Division of Geriatrics in the Department of Medicine, and head of the Center for Gerontology and Health Care Research. “We simply don’t have enough medical specialists to care for the coming ‘silver tsunami’ – a shortage that will only get worse over time. The Hartford Foundation award will help Alpert Medical School support the fellows and junior faculty who teach the next generation of doctors how to care for older adults and how to conduct research to improve that care.”

With the grant funding, Alpert Medical School and Rhode Island Hospital will:

* train advanced fellows and junior faculty to conduct aging-related research, including clinical, basic biology and health services research;

* train advanced fellows and junior faculty to be effective teachers, whether that is teaching medical students, residents or practicing physicians about geriatrics care;

* expand recruitment and training programs for advanced fellows and junior faculty.

There are now 27 Hartford Centers of Excellence in medicine across the United States, including at UCLA, Harvard, Yale, Johns Hopkins and Duke medical schools. These schools share several qualities, including strong leadership in geriatrics, a history of producing faculty in geriatrics, access to excellent clinical facilities for geriatrics, and a track record of attracting substantial research funding in geriatrics.

“To earn the grant award and be designated a Hartford Center of Excellence, Brown has shown that it has a very strong geriatrics program and is committed to taking that program to the next level,” said Gavin W. Hougham, a senior program officer at the Hartford Foundation who oversees the Centers of Excellence program. “The grant process was intensely competitive and Brown demonstrated that it will continue to develop the academic leaders in geriatric medicine our health care system needs.”

The Hartford Foundation grant comes on the heels of a $2-million, four-year award to Brown last year from the Donald W. Reynolds Foundation. That award is being used to provide aging-related content for every course for every year of medical school. The goal is to ensure that all Alpert Medical School students graduate with the knowledge and skills to treat the elderly.

“Aging is a clear strength at Brown, whether it’s the latest discovery about the biological causes of aging or the latest thinking in nursing home policy,” said Eli Y. Adashi, M.D., dean of medicine and biological sciences at Brown. “This designation from the Hartford Foundation is proof positive that Alpert Medical School, and its Rhode Island Hospital partner, are national leaders in aging research, clinical care and medical training.”

“With the aging of the baby boom population, the field of geriatrics is poised to become one of the most critical areas of medicine in the next few decades,” said Edward Wing, M.D., chairman of the Department of Medicine at Rhode Island Hospital and the Joukowsky Family Professor of Medicine and chairman of the Department of Medicine at Alpert Medical School. “We thank the Hartford Foundation for recognizing that Rhode Island Hospital and Alpert Medical School have the expertise and commitment to train the next generation of geriatric clinicians and researchers.”


Source: Wendy Lawton

Brown University

Cardiovascular Research Foundation Announces Late Breaking Trials And First Report Investigations To Be Presented At TCT 2010

The Cardiovascular Research Foundation has announced the late breaking trials and first report investigations that will be presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2010 scientific symposium. Findings from these clinical trials are expected to significantly impact interventional cardiology practices and patient care. TCT 2010 will take place September 21 – 25 in Washington, DC.

The studies selected will shed new light on the effectiveness of minimally invasive techniques, pharmaceuticals, technologies and devices that show potential to treat or prevent heart disease, one of the leading causes of death globally.

Late-breaking clinical trials and first report investigations will be highlighted during press conferences scheduled for Thursday, September 23, Friday, September 24, and Saturday, September 25.

Late Breaking Trials
PARTNER: A Prospective Randomized Trial of Transcatheter Aortic Valve Implantation Compared to Standard Therapy in Patients with Inoperable Aortic Stenosis
SPIRIT IV: Two-Year Results from a Prospective Randomized Trial of Everolimus-Eluting Stents Compared to Paclitaxel-Eluting Stents in Patients with Coronary Artery Disease
COMPARE: Two-Year Results from a Prospective Randomized Trial of Everolimus-Eluting Stents Compared to Paclitaxel-Eluting Stents in Patients with Coronary Artery Disease

First Report Investigations
LANCELOT ACS: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial of a Reversible PAR-1 Thrombin Receptor Antagonist in Patients with Acute Coronary Syndromes
LEVANT I: A Prospective Randomized Trial of a Paclitaxel-Eluting Balloon Compared to a Non-Drug-Eluting Balloon With and Without Stenting in Patients with Diseased Femoropopliteal Arteries
PERfECT STENT: A Prospective Randomized Trial Evaluating a Paclitaxel-Eluting Balloon in Patients Treated with Endothelial Progenitor Cell Capturing Stents for De Novo Coronary Artery Disease

Late Breaking Trials
ZILVER PTX: A Prospective Randomized Trial of a Paclitaxel-Eluting Stent Compared to Balloon Angioplasty with Provisional Bare Metal Stenting in Patients with Superficial Femoral Artery Disease
SORT OUT 4: A Prospective Randomized Trial of Everolimus-Eluting and Sirolimus-Eluting Stents in Patients with Coronary Artery Disease
ISAR-TEST-4: Two-Year Clinical and Angiographic Outcomes from a Prospective Randomized Trial of Everolimus-Eluting and Sirolimus-Eluting Stents in Patients with Coronary Artery Disease

First Report Investigations
DES-BTK: A Prospective, Double-Blind, Randomized Trial of Polymer-Free Sirolimus-Eluting Stents Compared to Bare Metal Stents in Patients with Infrapopliteal Disease
TORPEDO: A Prospective Randomized Trial of Percutaneous Endovenous Intervention Compared to Anticoagulation Alone in Patients with Deep Venous Thrombosis
BLAST: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial of a Monocyte-Depleting Agent After Bare Metal Stents in Patients with Coronary Artery Disease

Late Breaking Trials
ISAR-TEST-5: A Prospective Randomized Trial of Polymer-Free Sirolimus-/Probucol-Eluting Stents Compared to Zotarolimus-Eluting Stents in Patients with Coronary Artery Disease
HORIZONS-AMI: Three-Year Follow-up from a Prospective Randomized Trial of Antithrombin Strategies and Drug-Eluting Stents in Patients with Acute Myocardial Infarction Undergoing Primary Angioplasty
CRISTAL: A Prospective Randomized Trial of Sirolimus-Eluting Stents Compared to Balloon Angioplasty for Restenosis of Drug-Eluting Coronary Stents

First Report Investigations
BIOFREEDOM: A Prospective Randomized Trial of Polymer-Free Biolimus A9-Eluting Stents and Paclitaxel-Eluting Stents in Patients with Coronary Artery Disease
AVIO: A Prospective Randomized Trial of Intravascular Ultrasound-Guided Compared to Angiography-Guided Stent Implantation in Complex Coronary Lesions
EXCELLENT: A Prospective Randomized Trial of Everolimus-Eluting and Sirolimus-Eluting Stents in Patients with Coronary Artery Disease

To view the program update, click here.

Judy Romero
Cardiovascular Research Foundation

Bone Mineral Content Continues To Increase In Obese Adolescents During Weight Loss

Obese teenagers who
succeeded in losing weight in a year-long medically supervised weight
control program also saw their bone mineral content increase over that
period, say researchers from The Children’s Hospital of Philadelphia. The
finding was reassuring, because adolescence is a critical period for bone
health in later life.

A study in the current issue of the journal Obesity studied 62
adolescents between the ages of nine and 17 years who participated in a
trial looking at the effectiveness of a comprehensive, family-based,
behavioral weight control program in conjunction with a weight loss drug,
sibutramine. The researchers previously reported the combination of
behavioral changes and medication helped very obese teenagers lose weight.

In adults, obesity is associated with increased bone mineral density
and voluntary weight loss is associated with a decrease in bone mineral
density. The findings in this study show that bone mineral content
continues to increase in this adolescent population despite weight loss.

“The growing pediatric obesity epidemic raises important clinical and
public health questions about the effects on lifelong bone health of early
onset obesity and its treatment,” said Nicolas Stettler, M.D., M.S.C.E.,
pediatric nutrition specialist at The Children’s Hospital of Philadelphia
and lead author of this study. “Although fractures due to low bone mineral
content are mainly a problem for the elderly, the amount of bone mass
acquired during puberty is the key determinant of lifetime fracture risk.”

Using a dual energy X-ray absorptiometry scanner (DXA), researchers
looked at specific body areas including legs, arms and lumbar spine as well
as the bone mineral content of the whole body. The data was compared with a
reference group of 66 adolescents. Bone mineral content of the obese
subjects was higher than that of the reference group at the beginning and
end of the study.

When looking at each subject’s bone mineral content, adjusted for their
height, the researchers noticed that bone mineral content in the arms and
legs increased less than would be expected with growth while the lumbar
spine content increased more than expected. These changes in bone mineral
content were largely explained by changes in the amount of fat and muscle
in the body during the intensive weight loss program.

“As obesity treatment during adolescence becomes more frequent, it is
important to understand the role of weight loss on bone health during this
critical period,” Dr. Stettler added.

This study was supported by the National Institutes of Health, the
General Clinical Research Center at Children’s Hospital, Knoll
Pharmaceutical and Abbott Laboratories.

Dr. Stettler’s coauthors were: Robert I. Berkowitz, M.D., chief of
child and adolescent psychiatry at Children’s Hospital; Joanna Cronquist of
Children’s Hospital; Justine Shults of the Center for Clinical Epidemiology
and Biostatistics, University of Pennsylvania School of Medicine; Thomas A.
Wadden, of the Weight and Eating Disorders Program at the University of
Pennsylvania School of Medicine; and Babette S. Zemel, Ph.D.; and Mary B.
Leonard, M.D. both of Children’s Hospital.

About The Children’s Hospital of Philadelphia: The Children’s Hospital
of Philadelphia was founded in 1855 as the nation’s first pediatric
hospital. Through its long-standing commitment to providing exceptional
patient care, training new generations of pediatric healthcare
professionals and pioneering major research initiatives, Children’s
Hospital has fostered many discoveries that have benefited children
worldwide. Its pediatric research program is among the largest in the
country, ranking third in National Institutes of Health funding. In
addition, its unique family-centered care and public service programs have
brought the 430-bed hospital recognition as a leading advocate for children
and adolescents. For more information, visit chop.edu.

The Children’s Hospital of Philadelphia