News in brief: Vitamin K prevents arterial calcium development in diabetes; Intersex report warns against early medical interventions; Patient communication suffers if physicians can’t mentally multitask

Tuesday, 19 Oct 2021

Vitamin K prevents arterial calcium development in diabetes patients

Oral vitamin K supplementation could help prevent arterial calcification in diabetes mellitus patients, Australian clinicians say.

A Western Australian study of 149 diabetes patients showed oral Vitamin K1 (10 mg/day for three months) “independently decreased the odds of developing new 18F-sodium fluoride positron emission tomography (18F-NaF PET) positive lesions in the coronary arteries (OR: 0.35, P = 0.010), aorta (OR: 0.27, P = 0.040) and in both aortic and coronary arteries (OR: 0.28, P = 0.002)”, versus placebo, the authors wrote in The American Journal of Clinical Nutrition.

The mechanism of the protective effect may relate to Vitamin K being a vital component for the activation of matrix Gla protein, a potent inhibitor of tissue calcification, with vitamin K deficiency in hemodialysis patients being associated with excessive calcification. Though the authors found these results promising, further studies are needed to confirm their findings.

Intersex report warns against early medical interventions

The Australian Human Rights Commission has recommended government legislation to prohibit medical interventions for young people born with variations in sex characteristics.

The only exceptions should be where the person including children under 18 years has provided consent or, where they do not have the ability to provide consent, only if intervention is considered a medical necessity as evaluated by an independent panel including members with relevant clinical expertise and lived experience.

It argues most interventions can be deferred until a child has capacity to provide consent or at least contribute to the decision making process.

The report, Ensuring health and bodily integrity: towards a human rights approach for people  born with variations in sex characteristics, was based on input from clinicians, including paediatricians, endocrinologists and psychiatrists, as well as from legal, human rights and government agencies. It recommended new national guidelines that should include requirements for obtaining informed consent, how to determine medical necessity, and best practice and treatment protocols.

It said psychosocial rationales, such as gender-conforming treatments, are not a permissible basis for intervention without personal consent.

“Legislation should prohibit medical interventions without authorisation, and there should be appropriate criminal penalties attached to breaching this prohibition.”

“The authorisation requirement may also have implications in terms of disciplinary action against health professionals and civil liability.”

Patient communication suffers if physicians can’t mentally multitask

Patient communication tends to be less satisfactory in specialties in which physicians must use diagnostic reasoning during patient encounters, an Australian study has found.

Physicians have more ‘cognitive busyness’ and must mentally multitask more than specialists such as surgeons whose encounters are more focused on procedures, according to according to Queensland researchers who analysed communication ratings for 67 doctors across various specialties.

They said their findings suggested that patient communication may be relegated to a secondary task and the news of an adverse finding may be less well accepted from physicians than from a procedural specialist who was not distracted by cognitive multitasking.

Possible solutions included having separate consultations for making and conveying a diagnosis or taking a break during a consultation before delivering the diagnosis, they suggested in Internal Medicine Journal.

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