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Annals of Internal Medicine tip sheet for June 19, 2012, online issue

1. Hospitalization Often Catastrophic for Alzheimer Patients

Hospitalization of patients with Alzheimer disease (AD) often leads to complications such as delirium, loss of independence, institutionalization, and death. Researchers theorized that AD patients who suffer an episode of delirium during hospitalization are at increased risk for adverse outcomes. In a prospective study, researchers reviewed 15 years of medical records for a cohort of 771 patients aged 65 or older with a clinical diagnosis of AD to determine which patients, and under what circumstances, had hospitalization, delirium, death, and/or institutionalization. The records showed that 48 percent of the study patients were hospitalized and 25 percent developed delirium during their stay. While hospitalized patients without delirium had a substantially increased risk for death and institutionalization, those with delirium had an even higher risk. Further research is needed to understand whether delirium is only a signal that precedes decline for patients with AD or if preventing it can reduce adverse outcomes.

2. Osteoarthritis Treatment, Flavocoxid, Linked to Significant Liver Injury

Osteoarthritis is a common and potentially debilitating joint disorder caused by aging and regular wear and tear. Painkillers prescribed for osteoarthritis offer limited pain relief and are associated with adverse events. Flavocoxid is a proprietary medical food that is marketed to treat osteoarthritis. A medical food is a specially formulated supplement used to manage diseases with specific nutritional requirements that cannot be met through normal diet. Unlike drug treatments, medical foods can be marketed without clinical trials proving safety and efficacy. In this case series, the authors describe characteristics of patients with acute liver injury that is suspected to have been caused by flavocoxid. Among 877 patients enrolled in the Drug-Induced Liver Injury Network Prospective Study, four developed symptoms and signs of liver injury within three months after initiating flavocoxid. The four patients all females between the ages of 57 and 68 were evaluated to determine the likely cause of their liver injury. The researchers concluded that flavocoxid was very likely to be the cause in three patients and was possibly the cause in one patient. For all four patients, the liver injury resolved within weeks of cessation. According to the authors of an accompanying editorial, patients often consider medical foods and food supplements to be "natural", so they may not disclose use of medical foods with their physician. The editorialists caution that physicians should discourage their patients from using any kind of medical food or supplement until policies related to marketing are changed to include safety and efficacy trials.

3. Patients with Alcoholic Cirrhosis Probably Won't Die from Liver Cancer

Screening These Patients for Liver Cancer Not Likely to Save Lives, Unlikely to be Cost-effective

Patients with alcoholic cirrhosis have an increased risk for liver cancer. It has been suggested that screening for liver cancer in this population may save lives, yet no randomized trials have examined the effect of liver cancer screening on total mortality or liver cancer-related mortality in patients with alcoholic cirrhosis. Researchers in Denmark studied a nationwide registry of patients hospitalized with a first-time diagnosis of alcoholic cirrhosis from 1993 to 2005. Among 8,482 patients, 169 developed liver cancer, and 5,734 died, 151 of whom had liver cancer. The incidence and mortality of liver cancer was no greater in the alcoholic cirrhosis patients than those in the nationwide cohort. The researchers conclude that screening for liver cancer in alcoholic cirrhosis patients would not decrease the high mortality in this population, nor would it be cost-effective.


Contact: Abbey Anderson
American College of Physicians

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