GPs FEEL UNDER PRESSURE TO PRESCRIBE ANTIBIOTICS
From the FMS Global News Desk of Jeanne Hambleton PULSE 19 August 2014 | By Caroline Price
GPs feel pressure to prescribe antibiotics and sometimes prescribe them even when they do not feel it is necessary, a survey has revealed.
The survey of 1,000 GPs found 90% of respondents felt pressure from patients to prescribe them antibiotics, while over a quarter – 28% – said they prescribe them several times a week when they are unsure they are medically necessary.
The survey was commissioned by charity Nesta for the £10 million Longitude Prize – after the public voted for the prize to be focused on antibiotic use and the growing problem of antibiotic resistance.
Nearly half – 45% – of the GPs surveyed said they had prescribed antibiotics for a viral infection, knowing it would not be effective. But 70% of GPs also said they sometimes prescribed them because of doubts about whether an infection was viral or bacterial, with 24% citing a lack of easy-to-use diagnostic tools.
Dr Rosemary Leonard, a GP in London, said: ‘These results show the pressure GPs face to prescribe antibiotics when they are not necessary, something I understand very well.’
‘The more antibiotics taken, the more resistant bacteria come to them. Antibiotic resistance is a real issue and more needs to be done conserve antibiotics for the future. Diagnostics play a valuable role in making this happen. Not only can diagnostics help determine the type of infection someone has, they could gather valuable data and aid the global surveillance efforts.’
RESEARCHERS OBTAIN KEY INSIGHTS INTO HOW THE INTERNAL BODY CLOCK IS TUNED
From FMS Global News Desk of Jeanne Hambleton Released: 18-Aug-2014
Source : UT Southwestern Medical Center
Newswise — DALLAS – August 18, 2014 – Researchers at UT Southwestern Medical Center have found a new way that internal body clocks are regulated by a type of molecule known as long non-coding RNA.
The internal body clocks, called circadian clocks, regulate the daily “rhythms” of many bodily functions, from waking and sleeping to body temperature and hunger. They are largely “tuned” to a 24-hour cycle that is influenced by external cues such as light and temperature.
“Although we know that long non-coding RNAs are abundant in many organisms, what they do in the body, and how they do it, has not been clear so far,” said Dr. Yi Liu, Professor of Physiology.
“Our work establishes a role for long non-coding RNAs in ‘tuning’ the circadian clock, but also shows how they control gene expression.”
Determining how circadian clocks work is crucial to understanding several human diseases, including sleep disorders and depression in which the clock malfunctions. The influence of a functional clock is evident in the reduced performance of shift workers and the jet lag felt by long-distance travellers.
Dr. Liu and his team were able to learn more about the circadian rhythms by studying model systems involving the bread mold, Neurospora crassa. The researchers found that the expression of a clock gene named frequency (frq) is controlled by a long non-coding RNA named qrf (frq backwards) − an RNA molecule that is complementary, or antisense, to frq. Unlike normal RNA molecules, qrf does not encode a protein, but it can control whether and how much frq protein is produced.
Specifically, qrf RNA is produced in response to light, and can then interfere with the production of the frq protein. In this way, qrf can “re-set” the circadian clock in a light-dependent way. This regulation works both ways: frq can also block the production of qrf. This mutual inhibition ensures that the frq and qrf RNA molecules are present in opposite “phases” of the clock and allows each RNA to oscillate robustly. Without qrf, normal circadian rhythms are not sustained, indicating that the long non-coding RNA is required for clock functions.
The findings are published online in the journal Nature.
“We anticipate a similar mode of action may operate in other organisms because similar RNAs have been found for clock genes in mice. In addition, such RNAs may also function in other biological processes because of their wide presence in genomes,” said Dr. Liu, who is the Louise W. Kahn Scholar in Biomedical Research.
UT Southwestern investigators are leaders in unraveling the gene networks underlying circadian clocks and have shown that most body organs, such as the pancreas and liver, have their own internal clocks, and that virtually every cell in the human body contains a clock. It now appears that the clocks and clock-related genes – some 20 such genes have been identified – affect virtually all of the cells’ metabolic pathways, from blood sugar regulation to cholesterol production.
Other UT Southwestern researchers involved in the latest findings include Dr. Zhihong Xue, Qiaohong Ye, Dr. Juchen Yang and Dr. Guanghua Xiao. Support for this research included grants from the National Institutes of Health, the Welch Foundation, the Cancer Prevention Research Institute of Texas, and the Biotechnology and Biological Sciences Research Council.
“This study adds to an important body of work that has shown the ubiquity of a circadian clock across species, including humans, and its role in metabolic regulation in cells, organs, and organisms,” said Dr. Michael Sesma, Program Director in the Division of Genetics and Developmental Biology at the of the National Institutes of Health’s National Institute of General Medical Sciences, which partially funded the research.
“These new results from Dr. Liu and his colleagues also extend beyond understanding the function of an anti-sense RNA in the fine tuning of a cell’s daily rhythm; they provide an example of the means by which anti-sense transcription likely regulates other key molecular and physiological processes in cells and organisms.”
About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985.
Numbering more than 2,700, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 91,000 hospitalized patients and oversee more than 2 million outpatient visits a year.
OPIOID USERS BREATHE EASIER WITH NOVEL DRUG TO TREAT RESPIRATORY DEPRESSION
From the FMS Global News Desk of Jeanne Hambleton Embargoed: 19-Aug-2014 Source : American Society of Anesthesiologists (ASA) Citations Anesthesiology
Newswise — Chicago – August 19, 2014 – People taking prescription opioids to treat moderate to severe pain may be able to breathe a little easier, literally. A study published in the September issue of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®), found that a new therapeutic drug, GAL-021, may reverse or prevent respiratory depression, or inadequate breathing, in patients taking opioid medication without compromising pain relief or increasing sedation.
“Although opioids such as oxycodone, methadone and fentanyl are commonly used to manage perioperative and postoperative pain, opioids are associated with an increased risk of adverse effects, the most serious being respiratory depression,” said Albert Dahan, M.D., lead author and professor of anesthesiology at Leiden University Medical Center in the Netherlands. “Opioid-induced respiratory depression can lead to brain damage, cardiac arrest or death.”
Current drug treatments for opioid-induced respiratory depression (OIRD) include administering a drug such as naloxone that counteracts the effect of the opioid and/or decreasing opioid doses; however, both compromise pain relief. Conversely, GAL-021 is an intravenous respiratory stimulant that works by blocking certain potassium channels in the brain that regulate breathing. It has been previously reported that GAL-021 reverses respiratory depression in animals without diminishing opioid-related pain relief.
In the study, GAL-021 stimulated breathing in 12 healthy male volunteers who underwent opioid-induced respiratory depression, at which time their breathing capacity was decreased by 25 to 30 percent. All patients experienced an increase in respiratory rate and tidal volume, which is the amount of air that is expelled during a normal breath. Researchers also found that GAL-021 had no adverse affect on non-respiratory variables such as sedation, pain relief, blood flow or safety parameters.
“The development of potent painkillers that do not increase the risk of respiratory depression seems still far away,” said Dr. Dahan. “Using an add-on drug that reverses or prevents respiratory depression caused by opioid use, without affecting pain relief, is currently our best option to treat this condition. While our data suggest that GAL-021 is an attractive alternative to other respiratory stimulants, additional studies are needed to further confirm these findings.”
The Leiden University Medical Center respiratory laboratory is currently funded by some other parties involved in opioid-induced respiratory depression and reversal of respiratory depression: Mundipharma (Cambridge, United Kingdom) and Revive Therapeutics (Vaughan, Ontario, Canada).
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring that physician anesthesiologists evaluate and supervise the medical care of patients before, during, and after surgery to provide the highest quality and safest care that every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount.
Back tomorrow. Jeanne