MedGenMed : Medscape general medicine 

About: MedGenMed : Medscape general medicine is an academic journal. The journal publishes majorly in the area(s): Population & MEDLINE. It has an ISSN identifier of 1531-0132. Over the lifetime, 878 publications have been published receiving 15496 citations.

Medscape's response to the Institute of Medicine Report: Crossing the quality chasm: a new health system for the 21st century.

Abstract: he U.S. health care delivery system does not provide consistent, highquality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge--yet there is strong evidence that this frequently is not the case. Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm. A number of factors have combined to create this chasm. Medical science and technology have advanced at an unprecedented rate during the past half-century. In tandem has come growing complexity of health care, which today is characterized by more to know, more to do, more to manage, more to watch, and more people involved than ever before. Faced with such rapid changes, the nation’s health care delivery system has fallen far short in its ability to translate knowledge into practice and to apply new technology safely and appropriately. And if the system cannot consistently deliver today’s science and technology, it is even less prepared to respond to the extraordinary advances that surely will emerge during the coming decades. The public’s health care needs have changed as well. Americans are living longer, due at least in part to advances in medical science and technology, and with this aging population comes an increase in the incidence and prevalence of chronic conditions. Such conditions, including heart disease, diabetes, and asthma, are now the leading cause of illness, disability, and death. But today’s health system remains overly devoted to dealing with acute, episodic care needs. There is a dearth of clinical programs with the multidisciplinary infrastructure required to provide the full complement of services needed by people with common chronic conditions. The health care delivery system also is poorly organized to meet the challenges at hand. The delivery of care often is overly complex and uncoordinated, requiring steps and patient “handoffs” that slow down care and decrease rather than improve safety. These cumbersome processes waste resources; leave unaccountable voids in coverage; lead to loss of information; T March 2001

Medical tourism: globalization of the healthcare marketplace

Abstract: The citizens of many countries have long traveled to the United States and to the developed countries of Europe to seek the expertise and advanced technology available in leading medical centers. In the recent past, a trend known as medical tourism has emerged wherein citizens of highly developed countries choose to bypass care offered in their own communities and travel to less developed areas of the world to receive a wide variety of medical services. Medical tourism is becoming increasingly popular, and it is projected that as many as 750,000 Americans will seek offshore medical care in 2007. This phenomenon is driven by marketplace forces and occurs outside of the view and control of the organized healthcare system. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have increasing impact on the healthcare landscape in industrialized and developing countries around the world.

Associations Between Body Mass Index and the Prevalence of Low Micronutrient Levels Among US Adults

Abstract: BACKGROUND Low micronutrient levels observed with increasing adiposity may result from inadequate nutrient intake and/or alterations in nutrient metabolism. OBJECTIVE To examine the association between body mass index (BMI) and micronutrient levels among a nationally representative sample of US adults aged > or = 19 years. DESIGN Using nationally representative cross-sectional data from the National Health and Nutrition Examination Survey III (NHANES III), we examined odds ratios of low micronutrient levels using logistic regression adjusting for covariates. MEASUREMENTS Nutritional biomarker levels (as indicated by serum levels of total carotenoids, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, vitamin E, vitamin C, selenium, vitamin A, vitamin D, folate, vitamin B12, and red blood cell folate) among men and nonpregnant women, by BMI category. RESULTS Overweight and obese adults had higher odds of low levels for a number of nutrients compared with normal-weight adults. Odds of being low in multiple micronutrients was most common among overweight and obese premenopausal women. CONCLUSION These findings underscore the need for further assessment of specific micronutrient inadequacies among persons who are overweight or obese. Specifically, research is needed to determine whether these inadequacies are due to insufficient dietary intake, altered metabolic processes, or both.

TNF-alpha modulation for treatment of Alzheimer's disease: a 6-month pilot study.

Abstract: Context: Current pharmacologic treatments for Alzheimer's disease (AD) do not prevent long-term clinical deterioration. Tumor necrosis factor (TNF)-alpha, a proinflammatory cytokine, has been implicated in the pathogenesis of AD. Objective: To investigate the use of a biologic TNF-alpha inhibitor, etanercept was given by perispinal extrathecal administration for the treatment of AD. Methods: This was a prospective, single-center, open-label, pilot (proof-of-concept) study, in which 15 patients with mild-to-severe AD were treated for 6 months. We administered etanercept, 25-50 mg, once weekly by perispinal administration. Main outcome measures included the Mini-Mental State Examination (MMSE), the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog), and the Severe Impairment Battery (SIB). Results: The average age of our patient population was 76.7. The mean baseline MMSE was 18.2 (n = 15); the mean baseline ADAS-Cog was 20.8 (n = 11); and the mean baseline SIB was 62.5 (n = 5). There was significant improvement with treatment, as measured by all of the primary efficacy variables, through 6 months: MMSE increased by 2.13 ± 2.23, ADAS-Cog improved (decreased) by 5.48 ± 5.08, and SIB increased by 16.6 ± 14.52. Conclusion: An increasing amount of basic science and clinical evidence implicates inflammatory processes and resulting glial activation in the pathogenesis of AD. This small, open-label pilot study suggests that inhibition of the inflammatory cytokine TNF-alpha may hold promise as a potential approach to AD treatment. Further study in randomized, placebo-controlled clinical trials is merited.

Comparing the efficacy of medications for ADHD using meta-analysis.

Abstract: Objective Medications used to treat attention-deficit/hyperactivity disorder (ADHD) have been well researched, but comparisons among drugs are hindered by the absence of direct comparative trials.