A meta-analysis of 17 randomised controlled trials has shown that pre-procedural treatment with sodium bicarbonate based hydration is the optimal treatment strategy to prevent contrast-induced nephropathy (CIN). The research, published in the open access journal BMC Medicine, shows that although the benefit may have been overestimated by previous studies, sodium bicarbonate is clearly superior to normal saline.

Hitinder Gurm from the University of Michigan worked with a team of international researchers to study the results of trials featuring a total of 2633 people to assess the effectiveness of saline versus sodium bicarbonate for the prevention of CIN. According to Gurm, “Contrast agents are administered in millions of procedures annually worldwide. In the USA and Europe, contrast-induced nephropathy (CIN) is the third leading cause of acute renal failure in hospitalized patients, accounting for about 10% of hospital-acquired renal failure. Although CIN is generally limited to a transient decline of renal function, it cannot be regarded as a benign complication - as many as 30% of cases result in lasting kidney damage”.

The authors found that CIN occurred in 109 of the 1327 patients treated with sodium bicarbonate and in 175 of the 1306 patients who received normal saline. The number needed to prevent one case of CIN was 16. The exact mechanism of CIN is still unknown, but sodium bicarbonate is thought to prevent it by increasing the alkalinity of tubular fluid and thereby limiting free radical production. Gurm said, “Six studies monitored the degree of alkalinization and all but one found a significant increase. Interestingly this one study did not find a benefit of sodium bicarbonate. Therefore, it could be hypothesized that the bicarbonate should be dosed to achieve urinary alkalinization”.

Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis
Pascal Meier, Dennis T Ko, Akira Tamura, Umesh Tamhane and Hitinder S Gurm
BMC Medicine (in press) http://www.biomedcentral.com/bmcmed/

Source:
Graeme Baldwin

BioMed Central

The National Prescribing Service Ltd (NPS) has welcomed a funding enhancement from the Federal Government to expand on our quality use of medicines work. NPS will receive additional funds over the next four years to continue programs that improve medicines use among Australians. “This announcement acknowledges NPS’ role in providing accurate, independent information to health professionals and consumers. It also reflects the Government’s commitment to integrative and preventative health measures that benefit all Australians,” NPS CEO, Dr Lynn Weekes said.

“This was not an easy Budget for the nation, but through our continued work promoting the safe and effective use of medicines, NPS will contribute to long term savings.”

It was also announced in the Budget that NPS will receive funding to run a national diagnostic requesting service to promote best clinical practice for efficient use of diagnostic imaging and pathology tests.

“We are yet to determine the details with the Department of Health and Ageing but it is likely to reflect our successful quality use of medicines program model,” Dr Weekes said.

This includes decision support tools, implementation of evidence-based guidelines, peer feedback and educational programs designed to assist health professionals and consumers make the best health decisions.

“Diagnostic imaging and pathology programs are a logical expansion of our current work with health professionals. Ultimately we hope to run synergistic programs that link diagnostics with medicines, ensuring tests are used efficiently and result in the best outcomes for patients.”

“We look forward to working closely with industry stakeholders in this new and interesting area for NPS,” Dr Weekes said.

The additional funding includes an additional $21 million over four years to enhance its existing work and $9.4 million over four years for the new diagnostics work.

Further detail about the work NPS will be doing over the next four years is expected to be announced in coming weeks.

The National Prescribing Service Limited (NPS) is an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing.

Source
National Prescribing Service Ltd

According to the American Cancer Society, pancreatic cancer is the fourth leading cancer killer in the country, with more than 42,000 new cases expected to be diagnosed this year and more than 35,000 deaths. In New Jersey alone, 1,000 deaths are estimated from the disease, which only has a five-year, five-percent survival rate. That is why researchers at The Cancer Institute of New Jersey (CINJ) have launched a new clinical trial, which aims to determine the effectiveness of an advanced radiation therapy technique on those with pancreatic cancer. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

Radiation therapy involves using a beam of high-energy particles or waves such as x-rays to destroy or damage cancer cells. In this study, researchers through the Department of Radiation Oncology at CINJ and Robert Wood Johnson University Hospital will use a treatment called Intensity Modulated Radiation Therapy (IMRT), which is considered a more sophisticated delivery technique that can increase the amount of radiation to the pancreatic tumor while keeping the dose to normal organs at a safe level. This is done through multiple computer-controlled radiation beams. In this trial, the amount of radiation to the tumor site will be gradually increased throughout the treatment period to determine the maximum safe dosage.

Salma Jabbour, MD, who is a radiation oncologist at CINJ and an assistant professor of radiation oncology at UMDNJ-Robert Wood Johnson Medical School, is the lead investigator of the study. She notes IMRT can afford a patient an improved quality of life, “By being able to provide a specified amount of radiation to a targeted area, we will be able to preserve more healthy tissue and reduce side effects that may cause interruptions in the treatment cycle.”

Selected patients will undergo various testing before and during treatment, including x-rays, blood work and physical exams. For most of the six-month treatment period, participants will receive a combination of both IMRT and chemotherapy. Regular follow-up visits would be required for at least the first two years.

Patients at or above age 18 with the diagnosis of locally advanced pancreatic cancer (pancreatic cancer that has not spread to the lungs or liver) that cannot be operated on are eligible to take part in the trial, although other criteria must be met. The study is part of the CINJ Oncology Group (CINJOG), which is comprised of physicians throughout New Jersey from the CINJ Network of hospitals.

Clinical trials, often called cancer research studies, test new treatments and new ways of using existing treatments for cancer. At CINJ, researchers use these studies to answer questions about how a treatment affects the human body and to make sure it is safe and effective. There are several types of clinical trials that are currently underway at CINJ, including those that diagnose, treat, prevent, and manage symptoms of cancer. Many treatments used today — whether it is drugs or vaccines; ways to do surgery or give radiation therapy; or combinations of treatments — are the results of past clinical trials.

As New Jersey’s only National Cancer Institute-designated Comprehensive Cancer Center, CINJ provides patients with access to treatment options not available at other institutions within the state. CINJ currently enrolls more than 1,000 patients on clinical trials, including approximately 15 percent of all new adult cancer patients and approximately 70 percent of all pediatric cancer patients. Enrollment in clinical trials nationwide is fewer than five percent of all adult cancer patients.

About The Cancer Institute of New Jersey

The Cancer Institute of New Jersey is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center, and is dedicated to improving the prevention, detection, treatment and care of patients with cancer. CINJ’s physician-scientists engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. The Cancer Institute of New Jersey is a center of excellence of UMDNJ-Robert Wood Johnson Medical School.

The Cancer Institute of New Jersey Network is comprised of hospitals throughout the state and provides a mechanism to rapidly disseminate important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. Major Clinical Research Affiliate Hospitals: Carol G. Simon Cancer Center at Morristown Memorial Hospital, Carol G. Simon Cancer Center at Overlook Hospital, Jersey Shore University Medical Center. Affiliate Hospitals: Bayshore Community Hospital, CentraState Healthcare System, Cooper University Hospital*, JFK Medical Center, Raritan Bay Medical Center, Robert Wood Johnson University Hospital at Hamilton (CINJ at Hamilton), Saint Peter’s University Hospital, Somerset Medical Center, Southern Ocean County Hospital, The University Hospital/UMDNJ-New Jersey Medical School*, and University Medical Center at Princeton.

Source: Cancer Institute of New Jersey