The global burden of hypertension: good news and bad news

Hypertension is a common disorder and a powerful risk factor for death and disability from heart disease and kidney failure. Worldwide, it affects an estimated 690 million persons and it is the major risk factor for stroke. The good news is that safe and effective treatments are available and in the majority of patients, hypertension can be diagnosed easily and blood pressure can be controlled. Unfortunately, most hypertensive patients have uncontrolled blood pressure. To effectively address this situation, a renewed commitment to refine strategies for controlling blood pressure is necessary. Additional emphasis is also warranted for the prevention of hypertension in the first place.     

The good news about giving bad news to patients

BACKGROUND: There are few data available on how physicians inform patients about bad news. We surveyed internists about how they convey this information. METHODS: We surveyed internists about their activities in giving bad news to patients. One set of questions was about activities for the emotional support of the patient (11 items), and the other was about activities for creating a supportive environment for delivering bad news (9 items). The impact of demographic factors on the performance of emotionally supportive items, environmentally supportive items, and on the number of minutes reportedly spent delivering news was analyzed by analysis of variance and multiple regression analysis. RESULTS: More than half of the internists reported that they always or frequently performed 10 of the 11 emotionally supportive items and 6 of the 9 environmentally supportive items while giving bad news to patients. The average time reportedly spent in giving bad news was 27 minutes. Although training in giving bad news had a significant impact on the number of emotionally supportive items reported (P <.05), only 25% of respondents had any previous training in this area. Being older, a woman, unmarried, and having a history of major illness were also associated with reporting a greater number of emotionally supportive activities. CONCLUSIONS: Internists report that they inform patients of bad news appropriately. Some deficiencies exist, specifically in discussing prognosis and referral of patients to support groups. Physician educational efforts should include discussion of prognosis with patients as well as the availability of support groups.     

The anthracyclines: When good things go bad

In the era of targeted therapy the anthracyclines, which were discovered almost half-century ago, may appear to be too old to be good. While it is certainly true that the prototypic anthracyclines have been around for many years, there are robust clinical facts to confute that their time is over. These drugs continue to play an undisputed role in the treatment of many forms of cancer, including hematological malignancies and solid tumors. Unfortunately, however, their main side-effect remains: a life-threatening cardiotoxicity which became apparent at the beginning of anthracyclines' clinical use. In addition to this long-standing problem, we are now discovering that new combination therapies often cause a higher than expected incidence of cardiotoxicity, as if the newly designed drugs make the heart more vulnerable to the old one. Altogether, however, an overwhelming amount of clinical evidence suggests that anthracyclines are too good to be old. Yet, they would look much better if they caused less harm to the heart when administered as either single agents or in combination with otherwise promising new drugs.     

No news is good news: opportunistic infections

The 38th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) was notable for not having any oral sessions on opportunistic infections. This is an indication of the enormous success of combination antiretroviral therapy, which has greatly reduced the occurrences of opportunistic infections. Hepatitis C was discussed at the conference, but it was treated as a co-morbid condition rather than an opportunistic infection. Two studies addressed the question of stopping pneumocystis prophylaxis in patients responding to antiretroviral therapy. Other issues discussed included mycobacterium avium complex (MAC), cytomegalovirus (CMV), and pyogenic bacterial infections.     

关于全基因组相关分析的研究--你首先想要什么：好消息,坏消息,或者好消息？

很久以来都认为遗传成分参与2型糖尿病（T2DM）的发病，但是有关遗传学上的发现一直进展缓慢，这是由于遗传成分的复杂性。有关糖尿病相关的各种表型的研究的大量资料提示，所谓的“T2DM”可能是许多疾病的统称，由于它们具有通常相互重叠的多种基本发病机制。因此，对曾抱有期望的T2DM的遗传学基础的寻求已经证明是很艰难的。