Bioterrorism research and planning put on front burner
A $5 billion initiative has been launched by the Agency for Healthcare Research and Quality to assess and improve the capacity of the nation's health care system to respond to attempts at bioterrorism. The effort is part of a broader effort by the U.S. Dept. of Health and Human Services and other federal agencies.
The initiative will focus on improving the clinical preparedness of physicians and health care systems by examining the clinical training and ability of front-line medical staff.
It will also focus on the use of information and decision support systems to enhance clinical preparedness in the event of a bioterrorist threat and on improving linkages between the health system, local and state public health departments and emergency preparedness units.
Funded projects include:
- Research on a prototype database and Web site to give clinicians the opportunity to report suspicious trends suggesting a bioterrorist event. It will also develop four prototypes for decision support systems to give clinicians "just-in-time" information and advice on appropriate response.
- A project evaluating the ability of existing data systems and information technology to support earlier detection of and response to a bioterrorist event.
- Research on developing innovative approaches to training clinicians for bioterrorist attacks and creative methods for evaluating the effectiveness of those approaches.
- A national network established by the American Academy of Family Physicians, which includes 110 clinicians from practices in 34 states and four Canadian provinces. It will explore the adequacy of linkages of doctors' offices with public health and emergency preparedness agencies.
Over-the-counter drug linked to strokes in younger patients
An ingredient in a variety of over-the-counter cold medicines and diet drugs may be at the root of some strokes suffered by people younger than age 50. A Food and Drug Administration advisory panel voted last month that phenylpropanolamine, known as PPA, cannot be classified as safe, a step critical to a manufacturer's ability to sell the drug without a prescription. The FDA has been weighing the nonprescription sale of PPA, and the advisory committee's recommendation will play a role in this decision.
Six billion doses of PPA are sold annually, yet hemorrhagic strokes in young people are rare. Overall, FDA records show 44 such cases among PPA users in the past 30 years. The victims were predominantly women and the median age was 35.
In the 1980s, researchers began to uncover patterns between PPA and stroke sufferers in a series of cases in which young women suddenly had strokes within days of taking appetite suppressants. Manufacturers have maintained that these concerns are out of proportion.
And the Consumer Healthcare Products Assn. funded a five-year study at Yale University in New Haven, Conn., to determine if PPA use was more common among those who suffer strokes than among the general population. The study concluded that PPA increased the risk for stroke among young women in two narrow circumstances. The organization said the study was flawed because it involved too few people and did not take into account cases in which stroke victims died or suffered speech loss because their use of PPA could not be determined.
However, the FDA panel found that the study's findings, in addition to the agency's own records, offered significant support for the link between the drug and the incidence of hemorrhagic stroke.
Sometimes allergic patients may tolerate penicillin, study says
Penicillin may still be an option for treatment even for those who have had previous adverse reactions to the antibiotic because people lose their sensitivity to the drug over time, according to a study published in the October issue of Chest.
Researchers used a skin test to assess penicillin-reaction risk in patients who had previously reported allergic reactions to the drug. They found that at least half were able to take penicillin without an allergic reaction, leading to speculation that physicians may be able to use the drug more often.
It also may be a way of tackling increasing antibiotic resistance.
"A person with a history of penicillin allergy and a negative reaction to a skin test may be able to use a penicillin compound that could reduce the use of certain alternative antibiotics and cut down on the increasing emergence of resistant micro-organisms," said Alejandro C. Arroliga, MD, one of the researchers and the head of critical care medicine at the Cleveland Clinic.
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