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Entries in Guidelines (10)

Monday
Aug272012

AAP Issues New Guidelines for Kids’ Snoring

Hemera/Thinkstock(NEW YORK) -- A new set of practice guidelines released Monday by the American Academy of Pediatrics (AAP) may help parents and pediatricians identify and diagnose kids who snore.

Pediatric sleep experts focused on children with a condition known as uncomplicated obstructive sleep apnea, which occurs when breathing is interrupted during sleep and is related to enlarged tonsils or obesity.  It is a condition the AAP says affects 1.2 to 5.7 percent of American children.  They reviewed evidence from 350 study articles between 1999 and 2010 to create the following recommendations:

  • Screening: All children and adolescents should be screened for snoring at their routine health visits.
  • Sleep testing: Any children who have symptoms of obstructive sleep apnea, such as habitual snoring, disturbed sleep from intermittent pauses, snorts or gasps, or daytime behavioral problems, should be referred for a sleep study.
  • Adenotonsillectomy: Any child with obstructive sleep apnea and enlarged tonsils should be referred to a surgeon to consider tonsil removal surgery.
  • High risk: A child undergoing tonsil surgery is considered “high-risk” if he or she is under age 3, has severe sleep apnea on sleep testing, is obese or currently has an infection.  These children should be closely monitored in the hospital after surgery for any complications.
  • Re-evaluation: After surgery, snoring children should be reassessed to see if their sleep apnea has improved or if they will need any further treatments.
  • CPAP: If symptoms do not improve after surgery or if a child is unable to get surgery for some reason, they should be considered for CPAP (continuous positive airway pressure), which is a breathing apparatus, often worn at night, that keeps airways open.
  • Weight loss: Weight loss is recommended for any overweight or obese patient in addition to any other treatments.
  • Intranasal steroids: Nasal sprays are recommended for patients with mild sleep apnea symptoms, whether in lieu of or after tonsil surgery.

The last set of guidelines for pediatric sleep apnea was released in 2002.  The changes reflected in these new guidelines were made in light of research over the past 10 years that has suggested that delayed diagnosis of childhood sleep apnea “can result in severe complications if left untreated,” according to the American Academy of Pediatrics report.  Examples include cognitive deficits, behavior problems, hypertension and heart problems, failure to thrive and inflammation throughout the body.

With these new guidelines, the AAP hopes that more cases of childhood sleep apnea will be diagnosed sooner and children will receive the proper treatments earlier to prevent these dangerous long-term effects.

Copyright 2012 ABC News Radio

Wednesday
Jul252012

New Guidelines Extend Women's Cancer Prevention Debate

Siri Stafford/Photodisc/Thinkstock(WASHINGTON) -- Everyone agrees that preventive care helps reduce the threat of cervical or breast cancer for women. But women often face conflicting recommendations by health care professionals when it comes to cancer prevention.
 
The government-run U.S. Preventive Services Task Force no longer recommends that women receive annual pap smears to screen for cervical cancer.

But the American College for Obstetricians and Gynecologists disagrees. It's issued new guidelines recommending annual well-woman exams for proper health maintenance beginning at age 21, and even sooner, if a woman has pelvic pain, a menstrual disorder or other worrisome symptoms. However, they say it's not necessary to have an exam before starting birth-control pills.
 
The college also believes that women between the ages of 20- and 39-years-old should have clinical breast exams every one to three years, and annual exams beginning at age 40.
 
That's where the doctors' group differs from the government task force. It recommends annual testing for breast cancer beginning at 50 years old.
 
The differing guidelines may be confusing, but it's best to consult with your own doctor to come up with the best preventive health care plan.

Copyright 2012 ABC News Radio

Monday
May212012

Govt. Panel Scuttles Prostate Cancer Testing Recommendations

iStockphoto/Thinkstock(WASHINGTON) -- The governmental advisory panel tasked with issuing cancer screening guidelines made a final recommendation on the most common form of prostate cancer screening, suggesting it's not needed, regardless of age.

On Monday, the United States Preventive Services Task Force, or USPSTF, put forth this guideline on prostate-specific antigen (PSA) blood tests, which more than 20 million American men get each year. The formal recommendation follows draft guidance the task force issued in October 2011. These guidelines drive the screening decisions of doctors throughout the country.

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The PSA blood test is the traditional way to detect evidence of prostate cancer, which is the most common cancer diagnosed in American men. The National Cancer Institute estimates that in 2012, almost 250,000 new cases and more than 28,000 prostate cancer-related deaths will occur.

The task force maintains that PSA tests do more harm than good. Dr. Michael LeFevre, co-vice chairman of the task force, said the medical procedures arising from the tests could have serious downsides, including blood clots, heart attacks, strokes and possibly death. Other complications include impotence and urinary incontinence.

"Of 1,000 men who are screened, at most one man will avoid a prostate cancer death," LeFevre said. "Two to three will have blood clot, heart attack, stroke or even death from treatment of the prostate cancer. One in 3,000 men screened will die of surgical complications from the treatment."

However, the medical community is split on Monday's recommendation. And most urologists -- the doctors who arguably treat the most cases of prostate disease -- do not agree with the task force's guidelines.

"PSA screening is the only test we have," says Dr. William Catalona, a professor of urology at Northwestern University. "The great majority of doctors who deal with prostate cancer patients believe that the task force underestimated the benefits and overestimated the harm. Perhaps it is because none of the Task Force members were urologists."

"There is no mention of the dramatic decline in the number of men with advanced prostate cancer," says Dr. Patrick Walsh, professor of urology at Johns Hopkins University. "In 1990, 21 percent of men at diagnosis had metastatic prostate cancer to bone. Today it is 4 percent. This is clearly a dramatic effect of PSA testing."

"[The new recommendations] fail to recognize that in the absence of PSA testing, a man will not know that he has the disease until he has symptoms, at which time the cancer is too far advanced to cure," Walsh said.

And Dr. Gerald Andriole, chief of urology at Washington University School of Medicine, called the task force's recommendations "too draconian on categorically dismissing PSA."

"In some respects we have not been using PSA as well as we could," Andriole said. "However, to post a headline that says 'No More PSA Testing' is throwing the baby out with the bathwater."

Primary care physicians differed on whether the recommendations are a good idea. Some, like Dr. Jacques Carter, assistant professor of medicine at Harvard Medical School, insisted that "screening for prostate cancer saves lives." Others, like Dr. Jim Jirjis, director of adult primary care at Vanderbilt University, said they had already begun to recommend against the tests. Still, others said that the decision needed to be made on a case-by-case basis.

"I agree that screening for prostate cancer in men in general is a bad idea," said Dr. John Messmer, associate professor of family and community medicine at Penn State Hershey College of Medicine. "That being said, the possibility of obtaining a PSA on a man with particular circumstances should still be an option."

As for the millions of middle-aged and older men who find themselves in the middle of this debate, the consensus among the physicians is for them to communicate openly with their doctors.

"This does not preclude a patient from asking for the test and the physician offering the test," says LeFevre. "There should be an open and honest discussion with significant known harms."

And while the USPSTF's recommendations may drastically reduce the number of men who undergo a PSA blood test, those considered to have a strong family history of prostate cancer -- in other words, more than one first degree relative with prostate cancer before the age of 69 -- may still want to consider getting it.

Copyright 2012 ABC News Radio

Wednesday
Apr252012

US Men Ignoring 2008 Prostate Screening Guidelines 

Hemera/Thinkstock(CHICAGO) -- Warren Buffett’s decision to undergo prostate cancer screening reflects the reality that nearly half of American men 75 and older continue being tested despite official recommendations against doing so, researchers reported Tuesday.

“PSA screening for more than 40 percent of men 75 or older is inappropriate,” said Dr. Scott G. Eggener, an assistant professor of surgery at University of Chicago Medical Center, whose research confirms that older men aren’t heeding 2008 guidance from the U.S. Preventive Services Task Force.

“Selective screening is reasonable to consider for the healthiest men over age 75, but for the large majority of men in this age group, early detection can lead to treatment of a disease that will probably never cause a problem,” he said.

In 2008, the USPSTF issued a recommendation that found limited benefit for screening men ages 75 and older for prostate cancer. Last year, the task force drafted guidelines that said prostate screening was of limited benefit for helping men of any age live longer, and that harms of unnecessary treatments often outweigh benefits.

Eggener and his colleagues set out to determine whether men were paying attention to the guidelines. They found that in 2005, two years before issuance of the guidelines, 43 percent of men 75 and older underwent prostate-specific antigen (PSA) testing, which measures levels of a protein in the blood.

In 2010, when the guidelines had been out for two years, the screening rate among those men rose slightly to 43.9 percent, according to results appearing in this week’s issue of JAMA.

Last week, Buffett, the 81-year-old CEO of Berkshire Hathaway, announced that he would undergo radiation treatment beginning in mid-July for Stage 1 prostate cancer, and that a CT scan, bone scan and MRI found no evidence it had spread.

At the time, top U.S. urologists and prostate surgeons reacted to the announcement by saying that most men with newly diagnosed prostate cancer are likely to die from something else.

However, there are exceptions, as world-renowned prostate cancer expert Dr. Patrick Walsh, a urology professor at Johns Hopkins Medical Institutions in Baltimore, pointed out to ABC News, citing a University of Rochester study appearing last year in the journal Cancer that found half of the deaths from prostate cancer “occur in men who are diagnosed after the age of 75.”

“The fact is that older men who are diagnosed with prostate cancer oftentimes have more advanced disease than younger men -- the opposite of what we used to believe,” Walsh said.

Some older men can have aggressive Stage 1 tumors, which despite being confined to the prostate gland, contain highly abnormal cells capable of spreading quickly, Walsh said.

Dr. William J. Catalona, director of the Clinical Prostate Cancer Program at Northwestern University in Chicago, told ABC News that Buffett’s case “shows how valuable the PSA test is, especially in view of a rumor I heard that the USPSTF will probably release its final recommendation against PSA screening in the next few weeks.”

Catalona described PSA testing as “the most effective way to detect prostate cancer in its curable stages and if used intelligently it reduces the chances of dying from prostate cancer by nearly 50 percent. Warren Buffett is no dummie.”

Eggener and his colleagues reviewed cancer data from the National Health Interview Survey, which follows a representative group of 87,500 Americans. They focused on men aged 40 and older who said they underwent prostate cancer screening as part of a routine exam. Screening rates were unchanged between 2005 and 2010 in all age groups, Eggener and his colleagues reported. They found PSA screening more common among men 75 and older than those 40 to 49 and 50 to 59.

The study authors said their data likely underestimated the rate of men not undergoing PSA testing enough, because self-reports are lower than rates found when researchers review actual medical records.

They recommended monitoring of the effect of the 2011 USPSTF recommendations.

Copyright 2012 ABC News Radio

Tuesday
Sep202011

Concerns over New Organ Donor Guidelines Overblown

Stockbyte/Thinkstock(RICHMOND, Va.) -- A recent Washington Post article on the guidelines governing organ donation may have stirred unnecessary alarm, according to medical experts.

The article, published Monday in the Post, says new guidelines from the United Network for Organ Sharing (UNOS) will do away with a suggested two-minute wait time after the donor’s heart has stopped beating to assure death before donation begins.  UNOS has always left the determination of these wait times up to the judgment of individual hospitals, however, and these guidelines won’t change that fact, according to UNOS spokesman Joel Newman.

“UNOS offers guidance on the different elements that hospitals should cover in their own organ donation policies, but the one thing we shouldn’t be weighing in on is how a hospital should be determining when death occurs,” says Charles Alexander, the immediate past president of UNOS and current president and CEO of the Living Legacy Foundation.

“We are there to facilitate donation only after the medical care team has independently determined that death is inevitable,” he says, adding that the article’s wording could produce confusion that in the worst-case scenario may discourage patients from wanting to become donors.

“This article is a hysterical and inappropriate reaction to a very minor change in some standards.  There is zero threat to the public well-being in this document,” says Dr. Jeffrey Punch, chief of the section of transplantation at the University of Michigan’s Department of Surgery.

The new UNOS guidelines concern how hospitals and organ procurement organizations should regulate donation after cardiac death (DCD), a less common form of donation that occurs when a patient is not technically brain dead (the most commonly used determinant of death) but has no heartbeat on their own. This kind of donation accounts for about seven percent to 10 percent of all donations in the United States, according to Alexander.  Each hospital has its own protocol for DCD, but the wait time usually varies from two to five minutes after a true heartbeat is lost.

The confusion over the guidelines’ change to the “two-minute rule” may have arisen because of a change to the reference section of the new UNOS guidelines.  When the guidelines were first made in 2007, the UNOS committee included a reference section that cited past medical literature that suggested two minutes as wait time. This reference section was never part of UNOS’s actual recommendations, however, and was removed from the new guidelines to avoid confusion. As Alexander says, it is for medical professionals to decide, not organ donation facilitators.

What the guidelines do change is the language concerning DCD -- they recommend that cardiac death be changed to circulatory death, a change that UNOS feels better represents the medical definition of death defined according to the Uniform Determination of Death Act: an “irreversible cessation of circulatory and respiratory functions.”

Basically, circulation death means that the heart may have some weak activity, but the circulation of blood would never be sufficient to sustain life.

The guidelines also recommend that the organizations that facilitate donation and individual hospitals should determine whether donation would even be a viable option before it is discussed with the donor’s family. Past protocol recommends that donation discussions should begin only after the family decides to withdraw life support.

Some people might fear that this change cuts families out of the donation decision, but the change in protocol is intended to "to avoid getting the family worked up about organ donation if it really isn’t possible, and to make sure it goes through if it is possible,” Punch says.

Many families “push extremely hard to have their loved one donate organs,” he says.  “They desperately want their loved one’s last function on earth to be saving other’s lives.”

Waiting until the decision to withdraw life support has been made to even begin discussing donation means that “sometimes [it] is not logistically possible for donation to occur,” Punch says. "This is tragic for that family, as well as to the recipients that do not benefit.”

Even if it makes it more likely that organ donation would be possible, discussing the idea before the patient has died remains a touchy topic that may scare some donors away, says Dr. Michael Grodin, a professor of health law, bioethics and human rights at Boston University who also commented in the Post article. He worries that any loosening of regulation surrounding donation could break down the “absolute trust” that must exist between donor families and doctors.

“Better to have fewer transplants and absolute trust in the system or not only will there be individual problems but this could actually lead to fewer families willing to donate,” he says.

Alexander was more concerned that the possible alarm and misunderstanding spurred by the Post article could threaten public trust.

“If people misunderstand the message sent in the Post article, we end up losing public trust,” he says. “When we don’t have public trust, there are families that may not opt to pursue organ donation and when that happens, people die.”

Copyright 2011 ABC News Radio

Monday
Mar282011

Doctors Warn 'Facebook Depression' Could Affect Teens

NICHOLAS KAMM/AFP/Getty Images(ELK GROVE VILLAGE, Ill.) -- Troubled teens who obsess over social media networks may be affected by "Facebook depression," according to a group of influential doctors.

Authors of the American Academy of Pediatrics' new social media guidelines find that kids with poor self-esteem could feel even worse while scanning through status updates and pictures on Facebook.  Seeing others post happy messages and appearing to be having a great time in photos could make teens believe that they can't compare to their happiness, leading to them feeling depressed.

Dr. Gwenn O'Keeffe, the lead author of the guidelines, which were published online Monday in Pediatrics, said the depression brought on by Facebook could be worse than other real-life situations teens face that could bring them down, like sitting alone in a crowded school cafeteria.

Copyright 2011 ABC News Radio

Monday
Mar212011

New Guidelines Recommend All Women Should Be Screened for Cystic Fibrosis 

Comstock/Thinkstock(WASHINGTON) -- The American College of Obstetricians and Gynecologists (ACOG) has expanded guidelines for preconception and prenatal cystic fibrosis screening. 

Cystic fibrosis is a progressive disease that primarily affects the lungs, pancreas and digestive tract.  Median survival is around 37 years as the disease shortens patient lifespan significantly, according to the ACOG.

Previously, screening to determine whether a person carried the cystic fibrosis causing gene was only recommended for people who had a family history of the disease or were of Ashkenazi Jewish or Caucasian decent, where the prevalence of the disease is highest and the sensitivity of the test is over 90 percent.  The test is less than 50 percent effective in detecting the carrier gene in Asians. 

Since it is very hard to say that people belonging to a particular ethnicity are more likely to be affected with cystic fibrosis, the ACOG is now recommending testing all women of reproductive age for the cystic fibrosis gene as part of routine obstetric care.

Copyright 2011 ABC News Radio 

Wednesday
Mar162011

New Guidelines Proposed for Assessing and Resuscitating Children

Ryan McVay/Thinkstock(OXFORD, England) -- After a review of 69 studies including 143,000 children, researchers say the guidelines for pediatric heart and breathing rate reference ranges should be updated.

Dr. Matthew Thompson of the UK's Oxford University and colleagues suggested new reference ranges that are used for assessing and resuscitating children.

The new reference ranges show that a child's respiratory rate from birth to early adolescence decreases, with the sharpest decline occurring under the age of two.  Median breaths per minute fell from 44 at birth to 26 breaths per minute at age two.

The median heart rate in children also climbs from 127 beats per minute at birth to a maximal 145 beats per minute at one month.  By age two, the median heart rate decreases to 113 beats per minute, according to the researchers.

The researchers concluded that the guidelines should be changed due to the differences between the existing published guidelines and the findings of their recent review.

"Our centile charts of respiratory rate and heart rate in children provide new evidence-based reference ranges for these vital signs," they wrote in the report published in the March 15 online edition of The Lancet. "We have shown that there is substantial disagreement between these reference ranges, and those currently cited in international pediatric guidelines."

They add that the current reference ranges should be "updated with new thresholds on the basis of our proposed centile charts," particularly in cases where the differences between their charts and the current ranges are so large that many children are not likely classified correctly.

Copyright 2011 ABC News Radio 

Thursday
Jan202011

New Osteoporosis Screening Guidelines Suggested

Photo Courtesy - Getty Images(WASHINGTON) -- The U.S Preventive Services Task Force has updated screening recommendations for osteoporosis, a disease that reduces the mineral density in bones.  Osteoporosis is most common in women after menopause. 

After a review of medical studies in the last eight years, the new standards say that, as before, all women 65 and older should be routinely screened for osteoporosis. Women under 65 should also be screened if their risk of bone fracture is as high or greater than 65-year-old white women who have higher rates of the disease than other ethnic groups. 

The task force made no recommendation for the frequency of screenings, citing a lack of evidence.  And for the same reason,  no guidelines  were set for osteoporosis screening  in men. 

Copyright 2011 ABC News Radio

Thursday
Jan132011

USDA to Announce Healthier New School Lunch Guidelines

Photo Courtesy - Getty Images(WASHINGTON) -- The U.S. Department of Agriculture will announce Thursday the first new school lunch guidelines in 15 years.

Throughout that time span, childhood obesity rates in the country have continued to rise.

"The more we can reinforce the right set of choices and encourage the right set of choices, the greater the chances are that we will get a handle on obesity," U.S. Secretary of Agriculture Tom Vilsack told ABC News.

The new guidelines, which are based on an Institute of Medicine study, will call for a reduction in saturated fat, sugar and sodium.  Schools will be required to serve more whole grains, as well as serving both fruits and vegetables daily.  And, for the first time, schools will have to set maximum calorie counts in addition to minimum ones.

Here's an example of a current school lunch:

-- Breaded beef patty on a roll
-- Fruit popsicle
-- Low-fat milk

And here's what a meal might look like under the new rules:

-- Baked fish nuggets
-- Whole wheat roll
-- Mashed potatoes
-- Broccoli
-- Peaches
-- Skim milk

Copyright 2011 ABC News Radio







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