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New Data: Efficacy And Responder Analyses Of Divigel(R) (estradiol Gel) 0.1 Percent For The Treatment Of Menopause
Upsher-Smith Laboratories, Inc. presented the results of a secondary analysis to determine the response rates to three doses of transdermal Divigel(R) (estradiol gel) 0.1 percent at the recent 57th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG) in Chicago. The objectives of this secondary analysis of a phase III efficacy trial were to determine the percent of postmenopausal women who achieved a greater than 50 percent reduction in the frequency of moderate to severe vasomotor symptoms (MSVMS), or hot flashes, and to assess the change from baseline in a quality of life (Kupperman) index score that evaluated various menopausal symptoms. Divigel(R) doses studied included 1.0 mg, 0.5 mg and 0.25 mg of estradiol/day - the lowest effective approved dose of estradiol available for the treatment of MSVMS. The analysis showed a significantly greater percentage of women in all treatment groups versus placebo experienced > / = 50 percent reduction in the frequency of MSVMS at week 12. In the Divigel(R) 1.0 mg estradiol/day dosing group, 90 percent of women reported at least a 50 percent reduction in the frequency of MSVMS. Additionally, at 12 weeks, each of the doses of Divigel(R) significantly reduced the severity of menopausal symptoms identified by a quality of life index score compared to placebo.
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Health Affairs Study Finds No Link Between Cost, Quality Of Care
Quality of care is not linked to the cost of care, according to a study published last week on the Web site of the journal Health Affairs, CQ HealthBeat reports. For the study, researchers from Dartmouth College and Harvard University analyzed the health care bills of chronically ill Medicare beneficiaries in their last two years of life who received end-of-life care from 2,172 unidentified hospitals. The patients had one of three common conditions: heart attack, pneumonia or congestive heart failure. The study -- sponsored by the National Institute on Aging -- looked at common quality indicators at a hospital-by-hospital level instead of regional level (Norman, CQ HealthBeat, 5/22). Researchers compared the data with some of the quality measures reported on the HHS Hospital Compare Web site (Goldstein, "Health Blog," Wall Street Journal, 5/21). The study found that among the one-fifth of hospitals that spent the least, the cost of end-of-life care was $16,059 on average. In comparison, the cost of end-of-life care at the top 20% of highest-spending hospitals was $34,742 on average. The study also found no link -- or even evidence against a link -- between spending and the quality indicators. The researchers noted that the results might be skewed because the quality indicators they used might penalize hospitals that treat sicker patients. In addition, the study used process-of-care measures instead of patient outcomes. According to CQ HealthBeat, the findings of the study could have an effect on the debate over health care reform legislation because lawmakers and President Obama both have said that a reform plan must be able to control costs and expand access to high-quality, affordable health care (CQ HealthBeat, 5/22).
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Progress In Osteoporosis: Free Online Journal
No time to keep abreast of the most important osteoporosis-related research? Progress in Osteoporosis, the free online journal published by the International Osteoporosis Foundation (IOF) on http://www.iofbonehealth.org/pio provides concise summaries of new research published in the preceding three to four months. The journal is edited by leading osteoporosis researcher and author, Professor Ego Seeman of the University of Melbourne, Australia.
Mental Health

Care Management Reduces Depression And Suicidal Thoughts In Older Primary Care Patients

Depression in older adults too often goes unrecognized and untreated, resulting in untold misery, worsening of medical illness, and early death. A new study has identified one important remedy: Adding a trained depression care manager to primary care practices can increase the number of patients receiving treatment, lead to a higher remission rate of depression, and reduce suicidal thoughts. The two-year outcomes of the multicenter Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) study are published online in the American Journal of Psychiatry. Lead author of the study is Dr. George S. Alexopoulos, director of the Institute of Geriatric Psychiatry at NewYork-Presbyterian Hospital/Westchester Division and professor of psychiatry at Weill Cornell Medical College. "Almost one in 10 older adults in the United States has some form of depression, and one-fifth among them contemplates suicide. Two-thirds of these patients are treated by primary care physicians. Sadly, their depression is often inadequately treated due to the primary care physician"s time constraints and the patient"s reluctance to discuss their symptoms and adhere to treatment," says Dr. Alexopoulos. "The critical finding of the PROSPECT study is that adding a trained care manager to primary care practices increases the number of depressed older patients who receive treatment and improves their outcomes, not only in the short term, but over two years. "This is important because depression can either become chronic or relapse after an initial improvement," adds Dr. Alexopoulos. "Most diseases have worse outcomes when an old person becomes depressed. Depression almost doubles the risk for death. It follows that treating depression effectively can reduce sickness, disability and death." The study, conduced by NewYork Presbyterian/Weill Cornell, the University of Pittsburgh, and the University of Pennsylvania, followed 599 patients aged 60 years and older with depression at 20 primary care practices of varying sizes in New York and Pennsylvania. Participants were randomized to receive either the PROSPECT intervention or usual care. Those in the PROSPECT group were assigned a care manager -- a trained social worker, nurse or psychologist -- who helped the physician offer treatment according to accepted practice guidelines, monitored treatment response and provided follow-up over two years. Practice guidelines included the antidepressant citalopram (Celexa), with the option of other drugs or psychotherapy. After two years, nearly 90 percent of patients in the PROSPECT care management group had received treatment for depression, compared with 62 percent of those receiving usual care by their physicians. The decline in suicidal ideation (thinking about and/or planning suicide) was 2.2 times greater in the PROSPECT group. Remission of depression happened faster in the PROSPECT intervention group and remission rates continued to increase between months 18 and 24, while no appreciable increase occurred in the usual care group during the same period. The PROSPECT intervention worked especially well for a subgroup of patients with major depression, the more severe form of the disease, with a greater number achieving remission, or the near absence of symptoms. Patients with minor depression had favorable outcomes regardless of their study group. Various forms of care management are being used successfully for cardiovascular patients needing anticoagulation medication and for diabetes patients needing insulin monitoring, says Dr. Alexopoulos. "The PROSPECT study has demonstrated that care management is highly successful for older adults with major depression." "At this time, our nation is focused on disease prevention as a way to improve the health of Americans and to reduce health care cost. Reducing depression over long periods of time can be one of the ways to achieve this objective," continues Dr. Alexopoulos. "Care management, like that of the PROSPECT study, is relatively inexpensive. Finding ways to reimburse it can make it broadly available and have a major impact on the overall heath care." Dr. Alexopoulos serves as a paid member of the speaker"s bureau and a paid member of the Scientific Advisory Board for Forest Laboratories Inc., the maker of the antidepressant drug citalopram (Celexa). Forest offered free citalopram and a small stipend to support the study. Co-authors include Drs. Martha L. Bruce and Patrick J. Raue of NewYork-Presbyterian/Westchester and Weill Cornell Medical College; Dr. Charles F. Reynolds III of the University of Pittsburg; Drs. Ira R. Katz, David W. Oslin and Thomas Ten Have of the University of Pennsylvania; and Dr. Benoit H. Mulsant of the University of Toronto. NewYork-Presbyterian Hospital/Westchester Division NewYork-Presbyterian Hospital/Westchester Division, opened in 1894, is one of the world"s most advanced centers for psychiatric care. The Westchester Division serves children, adolescents, adults and the elderly with comprehensive outpatient, day treatment, partial hospitalization and inpatient services. In addition to clinical treatment, the Westchester Division is also a center for interdisciplinary medical research and education through its academic affiliate, Weill Cornell Medical College. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children"s Hospital and NewYork-Presbyterian Hospital/The Allen Pavilion. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. NewYork-Presbyterian Hospital


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