Contrary to popular thought, regular exercise before and during pregnancy could have beneficial effects for women that develop high blood pressure during gestation, human physiology professor Jeff Gilbert said, summarising a new study by his research team.
Gilbert

Mini-courses designed to increase creative stimulation and variety in physicians’ daily routines can sharpen critical thinking skills, improve job satisfaction and encourage innovative thinking, according to Penn State College of Medicine researchers who piloted a series of such courses.
‘For decades, career development theory has identified a stage that occurs at midlife, characterised by a desire to escape the status quo and pursue new ventures,’ said Kimberly Myers, Ph.D., associate professor of humanities. ‘It is increasingly clear that these mid-career professionals are yearning to explore ways of thinking that are outside of their usual responsibilities.’
The courses are an outgrowth of a pilot initiative called the Penn State Hershey Physician Writers Group, which Myers founded and facilitated. The group met every other week for three months and explored how medically related topics are featured in different literary genres. Participants wrote original pieces, which they discussed and edited with each other and Myers.
‘The process of literary analysis, which is both methodical and intuitive, helps to sharpen the cognitive processes inherent in medical diagnosis and treatment that are so vital in medical practice,’ said Myers. ‘Group discussions also provide a refreshing opportunity for collaboration, which help to form new alliances among colleagues.’
Many physicians’ writings were published in professional journals, and the physicians reported overwhelming satisfaction with the experience. As a result of the pilot program’s success, the researchers and their colleagues in the Department of Humanities developed and conducted eight mini-courses on different topics throughout 2010-2011.
Although each course had its own objectives, the overarching goal of the series was to provide humanities-related, clinically relevant learning opportunities for health care practitioners.
‘The topics covered fell into four general categories: reading, reflection, and discussion; creative expression; technology; and ethics,’ said Daniel George, Ph.D., assistant professor of humanities.
To accommodate busy schedules, the researchers scheduled these courses across an eight-month period and met three to five times total. Each hour of participation earned one Continuing Medical Education credit. Participants included physicians, nurses, administrative and support staff, medical and nursing students and health researchers and scientists.
Post-course surveys proved as favourable as the feedback from the Writers Group. Participants reported a high degree of satisfaction with learning new disciplines outside of biomedicine, using their training in uncustomary ways, forming new camaraderie with their colleagues, and enjoying a respite from the stressful flow of the workday.
‘These courses offer an opportunity for intellectual and social ‘play’ to those who participate, which fosters workplace satisfaction and creative, innovative thinking,’ said George. ‘Efforts that implement programs like these in other medical settings could potentially contribute to reviving the health care system, which would ultimately benefit both practitioners and their patients.’ EurekAlert

Included in the 2012 International Antiviral Society-USA panel recommendations for human immunodeficiency virus (HIV) patient care is that all adult patients, regardless of CD4 cell count, should be offered antiretroviral therapy (ART), according to an article. Other new recommendations include changes in therapeutic options and modifications in the timing and choice of ART for patients with an opportunistic illness such as tuberculosis.
Melanie A. Thompson, M.D., of the AIDS Research Consortium of Atlanta, presented the findings of the article at a JAMA media briefing at the International AIDS Conference.
‘Since the first antiretroviral drug was approved 25 years ago, improvements in the potency, tolerability, simplicity, and availability of ART have resulted in dramatically reduced numbers of opportunistic diseases and deaths where ART is accessible,’ according to background information in the article. ‘New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for ART in HIV-infected adults in resource-rich settings.’
Dr. Thompson and colleagues with the International Antiviral Society-USA panel conducted a review of the medical literature to identify relevant evidence published since the last report (2010), as well as data that had been published or presented in abstract form at scientific conferences in the past 2 years. The revised guidelines reflect new data regarding recommendations of when to initiate ART, new options for initial and subsequent therapy, ART management in the setting of special conditions, new approaches to monitoring treatment success and quality, and managing antiretroviral failure.
Among the primary recommendations of the panel are that treatment is recommended for all adults with HIV infection. The researchers found that there is no CD4 cell count threshold at which starting therapy is contraindicated, but the strength of the recommendation and the quality of the evidence supporting initiation of therapy increase as the CD4 cell count decreases and when certain concurrent conditions are present. Patients should be monitored for their CD4 cell count, and also HIV-1 RNA levels, ART adherence, HIV drug resistance, and quality-of-care indicators.
Initial regimens that are recommended include 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a non-nucleoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). ‘The aim of therapy continues to be maximal, lifelong, and continuous suppression of HIV replication to prevent emergence of resistance, facilitate optimal immune recovery, and improve health’ the authors write. Alternatives in each class are recommended for patients with or at risk of certain concurrent conditions, including cardiovascular disease, reduced kidney function, or tuberculosis.
The primary reasons for switching regimens include virologic, immunologic, or clinical failure and drug toxicity or intolerance. Switching regimens in virologically suppressed patients to reduce toxicity, improve adherence and tolerability, and avoid drug interactions can be done by switching 1 or more agents in the regimen. ‘Confirmed treatment failure should be addressed promptly and multiple factors considered,’ the researchers write.
‘Although it is crucial to intensify efforts to find a cure for persons who are already infected and an effective vaccine for those who are not, many of the tools needed to control the HIV/AIDS pandemic are already at hand. Critical components of the tool kit to eradicate AIDS include expanded HIV testing, increased focus on engagement in HIV care, early and persistent access to ART, and attention to improving ART adherence. These must occur in the context of strategies to address social determinants of health, including the elimination of stigma and discrimination,’ the authors conclude. EurekAlert

A Rhode Island Hospital radiation oncologist says in a new editorial that research exploring the impact of radiotherapy in older women with low risk of breast cancer recurrence has little effect on actual clinical decisions. The editorial written by David E. Wazer, MD, chief of the department of radiation oncology, is published in the currently being published.
Breast-conserving therapy (BCT) has shown to have comparable outcomes to mastectomy, allowing women to preserve their breast without compromising their chance of being cured of cancer. BCT also has been associated with improved quality of life, as compared to mastectomy. Radiation therapy is an integral part of BCT, and its benefit is clearly dependent on the baseline risk of ipsilateral breast tumor recurrence (IBTR) after surgical excision alone, and is small in patients at low risk of recurrence. Multiple trials have shown that the IBTR risk decreases with age, and has prompted analysis of the benefit of radiotherapy for older patients with breast cancer.
‘If an older patient has been treated for breast cancer, and has a low risk of recurrence, there may be no clinical reason to subject them to radiation therapy,’ Wazer said. ‘It