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    Friday, July 31, 2009

    STUDY INDICATES 47,000 OLDER AMERICANS ARE TREATED IN EDS EACH YEAR FOR FALLS ASSOCIATED WITH WALKING AIDS.

    A study in the Journal of the American Geriatrics Society "suggests that there is room for improvement in the use and design of walking aids," citing data that indicates "about 47,000 older Americans are treated in emergency" departments (EDs) "each year [for] falls associated with walkers and canes."

    The study "is based on six years of" ED "medical records," which showed that "such falls, mainly involving walkers, account for about three percent of all falls among people 65 and older." The study also shows that doctors should take more time to better fit patients with walking aids and teach how to use them safely."

    Women sustained 78 percent of walker-related injuries and 66 percent of cane-related injuries," and that "the risk of falling while using a walker or a cane increased with age, with the highest injury rate among those ages 85 and older." The researchers found that "fractures were the most common type of injury suffered while using canes (40 percent) and walkers (38 percent)."

    “It’s important to make sure people use these devices safely,” said an epidemiologist at the Centers for Disease Control and Prevention and the study’s lead author. “It gives them greater independence, but at the same time it can be a hazard if not used properly.” The study, found that 87 percent of fall injuries involved walkers and 12 percent involved canes. Researchers examined emergency-room medical records at 66 hospitals from Jan. 1, 2001, to Dec. 31, 2006. They focused on patients 65 and older who had been treated for 3,932 nonfatal, unintentional fall injuries in which a cane or a walker was involved. A statistical analysis estimates that there are 47,312 falls a year. The study found that fractures, bruises and abrasions were the most common injuries associated with the falls. Almost a third of all injuries were to the lower trunk, including the hips.

    Sixty percent of fall injuries associated with walkers and canes occurred at home, while 16 percent of falls involving a walker occurred at nursing homes, the study said.
    Authors of the study said that doctors might consider taking more time to show patients how to use walkers properly and that additional research could lead to design improvements for walking aids.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for FALLS IN THE ELDERLY.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Thursday, July 30, 2009

    WHO SAYS THE US DOES NOT RATION CARE?

    Nearly half of kidney transplant waitlist patients over age 60 are at risk to die before they receive a deceased-donor organ, researchers found. The risk of death before acquiring a kidney for senior citizens is high and even higher for patients age 70 and older, for African Americans, and for diabetics.

    These findings provide incentive for older patients to consider living donors as an alternative or to get on the list and navigate the deceased-donor process as quickly as possible.

    Kidney transplant can nearly double the life expectancy of end-stage renal disease patients over age 60. But an increasing gap between supply and demand has produced longer waiting times and increased mortality on the waiting list, the researchers said. Expanding waiting times clearly affect all portions of the transplant candidate populations.However, older and frailer patients may be the most directly affected because of rapid mortality rates before receiving a deceased-donor transplant.

    The number of newly listed kidney transplant candidates nearly tripled from 2,367 in 1995 to 6,982 in 2006, researchers found in an analysis of the Scientific Registry of Transplant Recipients database. The study included all 54,699 patients age 60 and older when placed on the U.S. waiting list for a single kidney transplant from 1995 to July 2007. Half of these older candidates were age 60 to 64 at the time of listing, and 79% were on dialysis at the time of listing.

    Overall, 61% of the older population received a transplant within five years of going on the list, but the proportion projected to receive a transplant within five years declined during the study period. For those waitlisted in 2006-2007, it was projected that 46% would die before receiving a deceased-donor transplant, up from a projected 22% in 1995.

    The waiting time for a deceased-donor transplant rose significantly from 1995 to 2007, but the gap between time to transplantation and average survival from waitlisting narrowed during the study period. However, the projections for the rate of death before receipt of a deceased-donor kidney varied widely within the older population:
    • 61% for those with diabetes
    • 52% for those older than 70
    • 62% for black patients
    • 60% for blood type O
    • 71% for blood type B
    • 68% for highly sensitized patients
    • 53% for those on dialysis at listing

    Where patients lived also made a big difference in projected rate of death before kidney transplantation. The mortality rate ranged from 81% for those in United Network for Organ Sharing region five (Arizona, California, Nevada, New Mexico, and Utah) to just 6% for those in region six (Alaska, Hawaii, Idaho, Montana, Oregon, and Washington).
    These factors may help clinicians and patients in decision-making, the researchers said. "As these results demonstrate, a white candidate with type AB blood in region one [Connecticut, Maine, Massachusetts, New Hampshire, and Rhode Island] is in a very different circumstance than a black candidate listed with type B blood in region five," they noted. They cautioned, though, that the study was limited by its retrospective, population-based design: its database did not include many factors that ultimately influence patients' prognoses and likelihood of receiving a transplant.

    "In this sense, these results provide a general framework that can be used to guide patients and illustrate the importance of various factors, but should not be used exclusively ignoring individual circumstances," they concluded. The practice of transplantation is rapidly changing, but not in favor of older patients, they noted. In particular, they cited a proposed policy for organ allocation that would give younger patients more rapid access to deceased-donor transplants than older candidates.

    Clinical Journal of the American Society of Nephrology 2009
    Schold J, et al "Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant"

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for STUDY INDICATES 47,000 OLDER AMERICANS ARE TREATED IN EDS EACH YEAR FOR FALLS ASSOCIATED WITH WALKING AIDS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Wednesday, July 29, 2009

    INCREASED RISK OF STROKE IN PATIENTS WITH PSORIASIS

    Psoriasis is a chronic Th-1 and Th-17 inflammatory disease. Chronic inflammation has also been associated with atherosclerosis and thrombosis. The authors conducted a population-based cohort study of patients seen by general practitioners participating in the General Practice Research Database in the United Kingdom, 1987–2002.

    Mild psoriasis was defined as any patient with a diagnostic code of psoriasis, but no history of systemic therapy. Severe psoriasis was defined as any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis.

    The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code.

    When adjusting for major risk factors for stroke, both mild (hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.0–1.1) and severe (1.43, 95% CI 1.1–1.9) psoriasis were independent risk factors for stroke. The excess risk of stroke attributable to psoriasis in patients with mild and severe disease was 1 in 4,115 per year and 1 in 530 per year, respectively.

    Patients with psoriasis, particularly if severe, have an increased risk of stroke that is not explained by major stroke risk factors identified in routine medical care.
    Joel M Gelfand et al.Investigative Dermatology advance online publication 21 May 2009; doi: 10.1038/jid.2009.112



    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for WHO SAYS THE US DOES NOT RATION CARE?.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Tuesday, July 28, 2009

    HOW DOES #TORT REFORM AND LIMITING #DEFENSIVE MEDICINE AFFECT TOTAL U.S. #HEALTHCARE EXPENDITURES?

    #EXPERTS SHOW THE NON SIGNIFICANT IMPACT ON TOTAL HEALTHCARE EXPENDITURES.

    Some special interests are calling for provisions to limit the legal liability of hospitals and medical care providers. You have likely heard the claim that the rising cost of medical malpractice insurance is driving doctors out of practice. Take away the threat of lawsuits, certain special interests claim and the country’s health care costs will drop. There is also a cry that defensive medicine as a byproduct of medical malpractice activities is further exacerbating the financial burden on healthcare in the U.S.

    But a new report paints a very different picture. True Risk: Medical Liability, Malpractice Insurance and Health Care,* concludes that limiting the liability of negligent hospitals and medical professionals would have virtually no impact on the cost of health care in this country. In fact, the study found that the cost of medical malpractice premiums are the lowest they have been in at least thirty years, the period for which data was studied. Medical malpractice premiums are less than ½ of 1% of all health care costs, and medical malpractice claims are a miniscule 1/5th of 1% of health care costs. Moreover, the states that have severely limited patients’ rights through so-called medical malpractice tort reform have similar malpractice insurance rates as states that have not so severely limited patients’ rights. Finally, the study found that medical malpractice insurers’ profits are generally higher than the rest of the property casualty industry.

    All told, the report concludes, limiting patients’ rights will not lead to affordable health care for all Americans. All so-called medical practice tort reform does is shield the negligent from the cost of their mistakes, putting the burden on the injured patient. Significantly, the study concludes that placing further limits on the liability of negligent doctors and unsafe hospitals would be unjustifiable, and would put almost no dent in our country’s health care costs.

    The study adds that “If Congress completely eliminated every single medical malpractice lawsuit,” it says, “including all legitimate cases, as part of health care reform, overall health care costs would hardly change, but the costs of medical error and hospital-induced injury would remain and someone else would have to pay.”

    All of this only confirms the position trial lawyers have been taking, which is that removing or further limiting medical liability would mean robbing patients of the only meaningful check and balance they have. Limiting liability is not a way to save the country money, and it’s not fair for patients who are wrongfully injured or who lose their lives due to negligence.

    "Our research makes clear that medical malpractice claims and premiums have almost no impact on the cost of health care “Our study also shows that states that have passed severe medical malpractice tort restrictions on victims of medical error have rate changes similar to those states that haven’t adopted these harsh measures.

    WHAT ABOUT THE ADDED EXPENSES OF DEFENSIVE MEDICINE?
    Defensive medicine is defined as "a deviation from sound medical practice, induced primarily by threat of liability."

    It is divided into two categories, assurance and avoidance behaviors. Assurance behavior, or positive defensive medicine, is practiced by most physicians and involves the supply of additional services of negligible medical value to reduce adverse outcomes, deter patients from filing malpractice claims, or persuade the legal system that the standard of care was met.

    Avoidance behavior, also known as negative defensive behavior, reflects physicians' efforts to distance themselves from potential legal risk. They do so by restricting their practice, refusing to perform high-risk procedures, and avoiding patients with complex problems or patients perceived as litigious. This type of behavior usually stems from a fear of uninsured non-monetary costs driving the physician out of business or the view that the downside of malpractice is greater than the upside of treatment.

    To demonstrate the prevalence of defensive medicine, the Harvard School of Public Health and Columbia Law School surveyed physicians practicing in Pennsylvania, a state once infamous for having the highest malpractice insurance premiums in the country. The study, conducted in 2005, received responses from over 800 physicians in six specialties, with approximately 93% of doctors responding affirmatively when asked whether they practiced medicine defensively.

    Defensive medicine is accompanied by an unexpectedly high overall cost, masked by the fact that these costs are split between doctors, patients, insurers, and the government. To gauge the burden of defensive medicine, Daniel P. Kessler and Mark B. McClellan compared healthcare costs in the 28 states with laws that limit punitive damages that can be paid out in malpractice lawsuits with states that do not. The effects of malpractice liability reforms were analyzed using data on Medicare beneficiaries treated for serious heart disease in 1984, 1987 and 1990. In contrast to the above study Kessler and McClellan found that liability reforms could reduce defensive medicine practices.

    The results of Kessler and McClellan's study applied to current health care expenditure to approximate the cost of defensive medicine and the nation's $1.4 trillion annual health care expenditure in 2005 (estimated to be over $2 trillion this fiscal year by President Obama), show that health care costs could have been reduced by $124 billion overall and government expenses by $50 billion per year. Adding the cost of defending malpractice cases, paying compensation, and covering additional administrative costs is a total of $29.4 billion. If these numbers are correct and one calculates the savings to the nations health care expenditures if defensive medicine was eliminated on my calculator [ph] the total cost of defensive medicine using Kessler and McClellan's numbers is $205 billion divided by the total cost of the nation’s healthcare expenditures of < $2 trillion equals > 1%.

    Overall, while defensive medicine, is a negative trend in medical care, the total costs associated with it appears to be nor more than <1% of the total U.S. healthcare expenditures. Healthcare in the United States is already a financial burden for many Americans, but placing caps on punitive fines for these lawsuits through tort reform and even completely eliminating all direct and indirect costs of defensive medicine will not significantly alleviate the financial burden of the American healthcare system.

    SUMMARY
    � Medical malpractice premiums, inflation-adjusted, are nearly the lowest they have been in over 30 years.

    � Medical malpractice claims, inflation-adjusted, are dropping significantly, down 45 percent since 2000.

    � Medical malpractice premiums are less than one-half of one percent of the country"s overall health care costs; medical malpractice claims are a mere one-fifth of one percent of health care costs. In over 30 years, premiums and claims have never been greater than 1% of our nation"s health care costs.

    � Medical malpractice insurer profits are higher than the rest of the property casualty industry, which has been remarkably profitable over the last five years.

    � The periodic premium spikes that doctors experience, as they did from 2002 until 2005, are not related to claims but to the economic cycle of insurers and to drops in investment income.

    � Many states that have resisted enacting severe restrictions on injured patients" legal rights experienced rate changes (i.e., premium increases or decreases for doctors) have similar costs to those states that enacted severe restrictions on patients" rights, i.e., there is no correlation between "tort reform" and insurance rates for doctors.

    The total costs of defensive medicine are a mere 1% of the total U.S.healthcare expenditures and eliminating these costs would have virtually no impact on the cost of health care in this country. Indeed medical practice tort reform to prevent defensive medicine would instead shield the negligent from the cost of their mistakes, and put the burden on the patient who is wrongfully injured.

    *The study was co-authored by Gillian Cassell-Stiga and Joanne Doroshow of the Center for Justice & Democracy and J. Robert Hunter, an actuary who serves as Director for the Consumer Federation of America. Hunter is also the former Commissioner of Insurance for the State of Texas and served as Federal Insurance Administrator under the Ford and Carter Administrations.

    Articles Referenced:
    Hellinger, FJ, WE Encinosa. "The Impact of State Laws Limiting Malpractice Damage Awards on Health Care Expenditures." American Journal of Public Health 96(8)(2006): 1375-81.
    • Kessler, DP, N Summerton, JR Graham. "Effects of the Medical Liability System in Australia, the UK and the USA." Lancet 368(9531)(2006): 240-6.
    • Manner, Paul A.. "Practicing defensive medicine--Not good for patients or physicians." AAOS Now (2007).
    • Studdert, DM, MM Mello, WM Sage, CM DesRoches, J Peugh, K Zapert, TA Brennan. "Defensive Medicine among High-Risk Specialist Physicians in a Volatile Malpractice Environment." The Journal of the American Medical Association 293(21)(2005): 2660-2.
    • Weinstein, Stuart L.. "The Cost of Defensive Medicine." AAOS Now (2008).


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for INCREASED RISK OF STROKE IN PATIENTS WITH PSORIASIS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Monday, July 27, 2009

    MORE PATIENTS WITH STROKES DIE ON WEEKEND HOSPITAL ADMISSION

    R. Webster Crowley MD et al. reports that there is expanding literature to show that certain patients admitted during the weekend have worse outcomes than similar patients admitted during the week. Although many clinicians have hypothesized the presence of this "weekend effect" with patients with intracerebral hemorrhage, there is a paucity of studies validating this conjecture.

    The authors performed a retrospective cohort study of patients with intracerebral hemorrhage (International Classification of Diseases, 9th Revision, Clinical Modification=431) extracted from the 2004 Nationwide Inpatient Sample. Multivariable logistic regression analyses and Cox proportional hazards regression were conducted to calculate the odds of death (within 7, 14, and 30 days) and the hazard ratio of death for patients with weekend intracerebral hemorrhage admissions compared with weekday intracerebral hemorrhage admissions. All analyses were adjusted for concurrent differences in length of stay, patient demographics, and comorbid disease.

    The authors found that weekend hospital admissions accounted for 26.8% of the 13 821 patients with a diagnosis of intracerebral hemorrhage in the National Inpatient Sample. Admission during the weekend was a statistically significant independent predictor of death within 7 days (OR, 1.14; 95% CI, 1.05 to 1.25), within 14 days (OR, 1.15; 95% CI, 1.05 to 1.25), and within 30 days (OR, 1.15; 95% CI, 1.05 to 1.25).

    The adjusted hazard of in-hospital death (hazard ratio, 1.12; CI, 1.05 to 1.20) indicates that the overall risk of in-hospital death with intracerebral hemorrhage is 12% higher with weekend admission, leading the authors to conclude that weekend admission for intracerebral hemorrhage was associated with increased risk-adjusted mortality when compared with admission during the remainder of the week.

    COMMENT.
    Is this one more instance of poor turnover problems with housestaff and nurses. We’ve seen a lot of problems with turnovers of patients with increasing frequency of shifts between hospitalists and nurses especially during a weekend. We’ve seen this same higher mortality with heart attacks admitted on weekends too. This study needs the highest priority to “fix the system.”


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for HOW DOES #TORT REFORM AND LIMITING #DEFENSIVE MEDICINE AFFECT TOTAL U.S. #HEALTHCARE EXPENDITURES?.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Sunday, July 26, 2009

    THE CRUX OF THE HEALTH CARE DEBATE SUMMARIZED IN THE JULY 24 NEWS HOUR INTERVIEW WITH DAVID BROOKS

    David Brooks : Five out of six people in the country have health coverage. Three out of four of them, according to most polls and pollsters I talk to, are satisfied. They're not thrilled with it, but they're satisfied with it. And that's where the president and the case has to be made in the country, that, look, this is in the national interest.

    But then the president has got a substantive problem, which is, for the majority who have health care and are basically satisfied with it, their main concern is the increasing costs. And so people have a legitimate question: How is it we're going to cut my costs by creating a new trillion-dollar entitlement? That's a legitimate question which the president didn't really answer. How are we going to control costs without anybody sacrificing anything?

    It's something that's bigger than me personally. But at the same time, I'm not going to be punished and I'm not going to come out of this worse. But, you know, I think that's where the job remains to be done.

    JIM LEHRER: Do they buy the case that he also makes, is that it's essential to the economy, as well as to health care and all the other things, per se? There's a bigger picture that has to do with the economy?

    DAVID BROOKS
    : I was struck over the past couple of years that people really feel their wages are being squeezed. Now, why are wages being squeezed? It's not because total compensation is being squeezed. It's because compensation is going to pay for health care instead of salary.

    And it's not unanimous, but most of them say this does not fundamentally alter the fee-for-service incentives that you need to reduce, to bend that curve, and they haven't done that yet. "There's a reason why almost every employer and small business group is opposed to the Democrats' government takeover of health care, and that's because it would impose new job-killing taxes during a recession," House Minority Leader John Boehner, R-Ohio, said. "No report can change that."

    And in the weekly GOP address, Rep. Cathy McMorris of Washington state, vice chair of the House Republican Conference, said, "America's small businesses will pay a high price." Citing a study by the National Federation of Independent Business, she said Democratic-written proposals would destroy a million more jobs than the economy has already lost.

    She called the Democratic efforts "a prescription for disaster – one that will put Washington bureaucrats in charge of your family's personal medical decision."


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for MORE PATIENTS WITH STROKES DIE ON WEEKEND HOSPITAL ADMISSION .

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Saturday, July 25, 2009

    WHAT DIET IS EFFECTIVE IN REDUCING PROSTATE CANCER RISK?

    In a the article A systematic review of the effect of diet in prostate cancer prevention and treatment Journal of Human Nutrition and Dietetics, May 2009 the authors suggest that the dietary recommendations for patients diagnosed with prostate cancer [ PC] are similar to those aiming to reduce their risk of PC.

    Bottom Line
    • Although conclusive evidence is limited, the current data are indicative that a diet low in fat, high in vegetables and fruits, and avoiding high energy intake, excessive meat, excessive dairy products and calcium intake, is possibly effective in preventing PC.

    • Caution must be taken to ensure that men do not take excessive amounts of dietary supplements because there may be adverse affects associated with their over consumption, say the authors.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for MORE PATIENTS WITH STROKES DIE ON WEEKEND HOSPITAL ADMISSION .

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Friday, July 24, 2009

    How to Find a Good Hospital

    The reality is, says S.Balauf of US News, that not all hospitals—or doctors or nurses, for that matter—deliver high-quality care. The United States has a "very inconsistent, uneven quality of healthcare," says Anne Weiss, who leads the quality/equality healthcare team at the Robert Wood Johnson Foundation, a healthcare philanthropy based in Princeton, N.J. Even the type of treatment that similar patients get can vary from hospital to hospital and region to region. In some parts of the country, for example, heart patients are more likely to receive angioplasty than coronary bypass surgery, while in many places the opposite is true. (U.S. NEWS wrote about this phenomenon and the fact that some heart patients may get the less appropriate procedure because they may not be fully informed about their options.)

    The time to find a good hospital is long before you need one. By tapping a few readily available resources, however, patients can make informed decisions about a good local hospital for the treatment they need. According to the National Committee for Quality Assurance, a healthcare nonprofit based in Washington, D.C., patients who make informed choices and get engaged in their care early ultimately reap better health outcomes.

    Your primary-care physician. Consult this trusted source if a specialist ever tells you that surgery or treatment is necessary, and ask your primary-care doc where he recommends you have it done. Primary-care physicians have a good working knowledge of the hospitals in their area, including each institution's overall reputation and how it stacks up against its local peers for specific procedures and treatments. Ideally, their reasoning will be based on other patients' outcomes

    Your insurance company. Inquire about the quality data they've collected on each facility where they would cover your treatment. That info can typically be found on the plan's website or by phone. The data might be limited to the pool of patients your plan covers and the doctors and hospitals in the plan's network, but it's nevertheless a source of details that can inform your choice.

    That friend of a friend who is a nurse. Your extended social network may include more hospital employees than you realize. "Most people know someone in the local healthcare system. But realize they provide a narrow view, seeing perhaps only one slice of all the variables that make up a hospital's level of care.

    A trusted family member or friend. Bringing someone you trust to an important appointment, or simply going through the hospital-selection process with another person, can be quite powerful. "Never go alone" and "Never stay alone."If nothing else, your companion is likely to be more clear-headed than you are when you're faced with daunting new information about your health. He or she need not be a medical professional.

    • I would not trust highway billboards touting a hospital's latest award. They're hard to miss—and plentiful in many regions of the country. But beware the source. The prize may or may not have any real bearing on the real quality of care a patient could expect at that hospital. As an example Hospital Compare, hosted by the federal Centers for Medicare and Medicaid Services, focuses on how often hospitals give heart attack patients aspirin within 30 minutes of their arrival at the ED, give surgery patients the correct antibiotic at the right time prior to the procedure, and otherwise do the right thing in 23 "process measures." Some-I believe most of these criteria-- are relative lightweights. Most hospitals show great success, for example, at giving smoking-cessation advice to heart patients who smoke. (Nurse: "I see you're a smoker, Mr. Smith. You know it doesn't help your heart condition, don't you?" Mr. Smith: "Yes, I do." Nurse marks box on discharge form.)

    • Hospital Compare also indicates whether a hospital's death rates in heart attack, heart failure, and pneumonia patients is better, no different, or worse than the U.S. average. That might seem useful, but the average is so broadly defined that only about 2 percent of hospitals are "better" or "worse." Clicking on the graph or table view of the page will reveal the actual death rates, as well as average state and national rates. Last year, the site began offering patient satisfaction data gleaned from surveys, such as the percentages of patients who reported their nurses always communicated well and of those who said they would definitely recommend the hospital. Look, but take with a grain of salt. Studies show that individuals whose medical care was successful tend to be more satisfied with a hospital in other ways.

    • Some websites [www.hookman.com] have links to other sites that also rank or rate good hospitals across the country, and such sites have potential value to people who are seeking a good hospital in their area.

    Is there a correlation between hospitals’ “quality”scores?

    Unfortunately no! A study reported in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION found no correlation between how well hospitals scored on a 13-item set of Leapfrog quality and safety measures and death rates, adjusted for severity, of patients admitted to the hospitals. The study didn't look at rates of complications.The Leapfrog Group is a nonprofit business coalition that allows consumers to compare hospital safety and quality ratings based on results of a voluntary survey. Hospitals are rated on their ability to satisfy two sets of safety standards. One set, such as appropriate ICU staffing and a program to reduce bedsores, applies to the entire hospital. The other set reflects quality of care and cost for 10 specific procedures and conditions, including repairing an abdominal aortic aneurism and treating pneumonia. Hospitals can be compared directly. You may not be able to find yours, however. Roughly 1,300 hospitals out of more than 5,000 in the nation—two out of 16 in Baltimore, for example—responded to the most recent Leapfrog survey.

    COMMENT:
    In the end after you do all your research it then really comes down to luck and faith. Faith that you have a fine doctors who will make good decisions for you. Trust—but verify.
    African medical facilities always have relatives in with patients. That’s a good thing.
    Always have someone with you in the hospital—a friend or loved one who will stay with you and watch out for you.




    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for WHAT DIET IS EFFECTIVE IN REDUCING PROSTATE CANCER RISK?.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Thursday, July 23, 2009

    Cancer Care too Expensive

    NEWLY INAUGURATED PRESIDENT SARAH PALIN DISCLOSES HER WINNING ELECTION STRATEGY WITH LADIES HOME JOURNAL WHITE HOUSE CORRESPONDENT AND EX-CBS NEWS ANCHOR KATIE COURIC

    “I’ve always maintained, that if you give the Democrats enough rope they’ll hang themselves” said the triumphant new President of the U.S. Sarah Palin. The last straw was denying cancer treatment to her former running mate John McCain when his melanoma returned to the left side of his face. The treatment was denied because of his age by the head Washington D.C. agency established for Equitable Health Distribution (EHD) under the Obama Health reform acts. They did because of his advanced age of being past 70 years old and on the basis of these four developments which in retrospect dynamically converted many pro-lifers into pro-choice.
    The inevitable shift in public opinion tipped the balance to Palin’s pro-life winning election theme. Unfortunately it was too late for the former war hero and presidential candidate McCain.


    1. First “IOM released top 100 comparative effectiveness priorities”
    The stimulus bill "earmarked $400 million for 'comparativeness effectiveness research,'" HHS "asked the Institute of Medicine (IOM), created by Congress to provide advice to policymakers, health professionals, the private sector, and the public, to identify the top priorities on which [healthcare services] to spend the money." In a report , the IOM "listed the top 100 areas of medicine in which research is needed to determine which treatments or preventive measures work best. One of the major areas was cancer treatment. The IOM's research priorities include "remedies for back pain, obesity, and preventing falls in the eldery, as well as studies about how to disseminate the findings to doctors and patients." The 100 recommendations "were selected from some 2,600 suggestions submitted to the committee from professional groups, policy makers and the public

    The NYT praised the IOM's "report as one of the first concrete steps in a broad effort by administration officials and health experts to shift the focus of medical practice toward scientific evidence -- rather than a physician's personal views or treatments promoted by medical product companies.". Insurers, unions, consumer groups, and "many medical researchers" are cited as proponents of comparative effectiveness research, who "say such studies are essential to curbing the widespread use of ineffective treatments."

    2. This was followed by the NEJM.1056/NEJMp0904133) published on June 30, 2009, which stated “This unique opportunity to invest in a major component of the scientific infrastructure for improving health care delivery will be indispensable for achieving a health care system that delivers affordable, high-quality care for all Americans. Physicians and patients deserve the best patient-centered evidence regarding what works, so that Americans can receive care of the highest quality and the best possible outcomes can be achieved.” Also the NEJM explained (10.1056/NEJMp0905631) that the American Recovery and Reinvestment Act of 2009 (ARRA). “which was the $787 billion economic stimulus package that President Barack Obama signed into law on February 17, 2009, included $1.1 billion for Comparative Effectiveness Research [CER]. The research priorities developed by the IOM committee — delivered as Congress requested only 19 weeks after Obama signed the measure — must be taken into account by the DHHS as it allocates $400 million in support of CER projects over the next 2 years. (A Federal Coordinating Council for Comparative Effectiveness Research, a new advisory group created by the ARRA, is also providing input to the DHHS [http://hhs.gov/recovery/programs/cer/cerannualrpt.pdf].)

    3. The third article was a successful trial balloon from the NIH -- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute (TF), and Department of Bioethics, The Clinical Center (CG), National Institutes of Health, Bethesda, MD. Tito Fojo of the National Cancer Institute and Christine Grady at the National Institutes of Health. wrote [Fojo.T.et al How Much Is Life Worth: Cetuximab, Non–Small Cell Lung Cancer, and the $440 Billion Question] that “The high price of some of the newest cancer medicines are coming under scrutiny as part of an effort by lawmakers and health officials to rein in overall medical costs.”. Fojo is calling into question the widespread use of expensive cancer drugs to prolong patients' lives by just weeks or months. Fojo states that a study showed that "treating a lung-cancer patient with Erbitux [cetuximab], a drug that costs $80,000 for an 18-week regimen, only prolongs survival by 1.2 months." The authors noted that "based on that estimate, extending the lives of the 550,000 Americans who die of cancer annually by one year would cost $440 billion." The authors argued that "health professionals and researchers cannot ignore costs in setting treatment standards.These authors also "questioned the cost-benefit calculus for other big cancer drugs " calling "for changes in the testing and practice of medicine—despite the fact drugmakers say this article exaggerated the overall costs of their treatments because few patients are on them for extended periods of time."

    4. Going even further the NIH authors stated that “Studies of cancer drugs that are expected to find survival advantages of two months or less should be undertaken only if the treatment costs less than $20,000.” Otherwise, they say the research community will waste valuable resources pursuing therapies that the healthcare system can't afford to provide. "We naturally avoid confronting the tension between not wanting to put a value on a life and having limited resources. But the spiraling cost of cancer care in particular makes this dilemma inescapable."They continued, "We must stop deluding ourselves into thinking that prescribing expensive chemotherapies and tests is an aberration, a temporary deviation from an otherwise reasonable cost trajectory."More than 90% of all new anticancer drugs receiving FDA approval in the past four years cost more than $20,000 for a 12-week course of treatment, they said.Drs. Fojo and Grady even rejected the argument that cost-benefit ratios will improve through identification of patient subgroups who are more or less likely than average to respond to a given drug.

    5. Drs. Fojo and Grady recommended a series of policies that were immediately implemented with the new health reform acts.:

    • Anticipated treatment costs should be coupled to trial designs, such that the endpoint benefit should cost no more for a quality-adjusted life-year than renal dialysis -- currently $129,000.

    • Drugs that work for a particular patient subset "should be advocated, approved, and prescribed for that subset only."

    • Clinicians should not prescribe beyond FDA-approved indications -- such as giving treatment-resistant or refractory patients a drug approved only as first-line therapy.

    • "The all too common practice of administering a new, marginally beneficial drug to a patient with advanced cancer should be strongly discouraged. In cases where there are no further treatment options, emphasis should be first on quality of life and then cost."

    • Toxicities should receive extra scrutiny for drugs with marginal benefits.
    Fojo T, et al "How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question" J NATL CANCER INST 2009; DOI: 10.1093/jnci/djp177.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for How to Find a Good Hospital.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Wednesday, July 22, 2009

    Don't spend your life trying to impress others

    Because even if you convince others that you're great, have you convinced yourself?

    I’ve heard a great sermon. It’s this.

    Next time you're in a conversation, see how long it takes the other person (and yourself!) to start mentioning personal accomplishments. A movie star who believes his fan mail is in trouble. Because he's built a house of cards. And when he falls, he'll fall hard. Chasing after honor is a sign that you don't sufficiently respect yourself. It's like saying, "I might not amount to much, but if I can make others think I do, then I'm worth something."

    One of the most destructive ways of trying to impress others is by role-playing. We act out characters that we think others will like. Did you ever notice how your personality can change in the presence of different people? We may go through 10 or 20 roles per day!

    But it's not true. It's chasing "fool's gold" -- yellow and glittery, but worthless. Deep down you feel like a fraud. People who are satisfied with themselves don't need public recognition to reassure their worth. If you depend upon the opinions of others to determine how good you are, then you become like a leaf in the wind, fluttering in whichever direction the fads of the time blow you. If you have confidence in your own worth, you'll be better able to follow opinions that are your own and not society's.

    Always ask yourself: "What is my real motive?"
    Advice.
    • Don't get trapped in the obsessive need for recognition.
    • Seeking the approval of others harms you, because it keeps you from the real work of becoming great.
    • If you need others to verify your significance, it's time to examine your self-esteem.
    • When you act to impress others, you feel the emptiness inside.
    • When you get the urge to toot your own horn, ask yourself: Who am I trying to impress?
    • Even if you convince people that you're the greatest person in the world, have you convinced yourself?

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for Cancer Care too Expensive.

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    Tuesday, July 21, 2009

    Pressure Stockings 'Should Not Be Used' to Prevent DVT

    Deep vein thrombosis (DVT) and pulmonary embolism are common after stroke. In small trials of patients undergoing surgery, graduated compression stockings (GCS) appear to reduce the risk of DVT.

    National stroke guidelines in several countries extrapolating from these trials recommend their use in patients with stroke. Researchers assessed the effectiveness of thigh-length GCS to reduce DVT after stroke.

    In an international trial, researchers randomized some 2500 immobile patients hospitalized within 1 week of an acute stroke to either use of, or avoidance of, thigh-length stockings. Ultrasound studies done at roughly 30 days found no significant difference between the groups with regard to the occurrence of DVT in the popliteal or femoral vessels.

    However, the risk for adverse effects (skin breaks, ulcers, blisters, and necrosis) was much higher in stocking users than nonusers (5% vs. 1%).
    Graduated compression stockings don't reduce the risk for deep venous thrombosis after stroke, according to this large trial. Commentators say flatly that the stockings "should not be used after stroke and current guidelines will need to be amended."

    The Lancet, Online Publication, 2009 doi:10.1016/S0140-6736(09)60941-7

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for Don't spend your life trying to impress others.

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    Monday, July 20, 2009

    Avoidable Post Hospital Discharge Errors Are Common

    Adverse events after discharge from the hospital are common. Many of these adverse events are avoidable or ameliorable.

    400 consecutive patients discharged home from the general medical service of a tertiary care academic hospital were followed in one study. After discharge, 76 patients (19%) had adverse events, defined as injuries occurring as a result of poor medical management. Of these, 23 patients had preventable adverse events, defined as adverse events judged to have been caused by an error, and 24 patients had ameliorable adverse events, defined as adverse events in which the severity could have been decreased.

    Adverse drug events accounted for 66% of adverse events, and procedure-related injuries for 17%. Of the 25 adverse events that caused a transient or permanent disability, 12 events were preventable and six events were ameliorable.
    Adverse drug events [ADEs] are almost as common among outpatients and they have important litigation consequences.

    A summary analysis of more than 1500 published case reports of ADEs yielded information on possible risk factors for drug-related deaths, disabilities, and life threats and on which events may have been preventable.

    The study showed that the drug categories most commonly involved in ADEs were central-nervous-system agents, antimicrobials, antineoplastics, and cardiovascular agents.

    CAUSES OF ADES

    Faulty prescribing was the most common reason for medication error, and
    Wrong dosage was the most common type of error.
    Overall, 52% of the cases were judged to have been preventable;
    Of these, 50% could have been prevented by a pharmacist.

    Litigation was reported for 13% of the cases; Settlements and judgments averaged $3.1 million.


    Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. Am J Health Syst Pharm. 2001;58:1399-1405.

    Ann Intern Med. 2003;138:161-167
    Comment: “In theory, there is no difference between theory and practice. In practice there is.”- Yogi Berra

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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    Sunday, July 19, 2009

    How to Find a Good Hospital

    The reality is, says S.Balauf of US News, that not all hospitals—or doctors or nurses, for that matter—deliver high-quality care. The United States has a "very inconsistent, uneven quality of healthcare," says Anne Weiss, who leads the quality/equality healthcare team at the Robert Wood Johnson Foundation, a healthcare philanthropy based in Princeton, N.J. Even the type of treatment that similar patients get can vary from hospital to hospital and region to region. In some parts of the country, for example, heart patients are more likely to receive angioplasty than coronary bypass surgery, while in many places the opposite is true. (U.S. NEWS wrote about this phenomenon and the fact that some heart patients may get the less appropriate procedure because they may not be fully informed about their options.)

    The time to find a good hospital is ling before you need one. By tapping a few readily available resources, however, patients can make informed decisions about a good local hospital for the treatment they need. According to the National Committee for Quality Assurance, a healthcare nonprofit based in Washington, D.C., patients who make informed choices and get engaged in their care early ultimately reap better health outcomes.

    • Your primary-care physician. Consult this trusted source if a specialist ever tells you that surgery or treatment is necessary, and ask your primary-care doc where he recommends you have it done. Primary-care physicians have a good working knowledge of the hospitals in their area, including each institution's overall reputation and how it stacks up against its local peers for specific procedures and treatments. Ideally, their reasoning will be based on other patients' outcomes

    • Your insurance company. Inquire about the quality data they've collected on each facility where they would cover your treatment. That info can typically be found on the plan's website or by phone. The data might be limited to the pool of patients your plan covers and the doctors and hospitals in the plan's network, but it's nevertheless a source of details that can inform your choice.

    • That friend of a friend who is a nurse. Your extended social network may include more hospital employees than you realize. "Most people know someone in the local healthcare system. But realize they provide a narrow view, seeing perhaps only one slice of all the variables that make up a hospital's level of care.

    • A trusted family member or friend. Bringing someone you trust to an important appointment, or simply going through the hospital-selection process with another person, can be quite powerful. "Never go alone" and "Never stay alone."If nothing else, your companion is likely to be more clear-headed than you are when you're faced with daunting new information about your health. He or she need not be a medical professional.

    • I would not trust highway billboards touting a hospital's latest award. They're hard to miss—and plentiful in many regions of the country. But beware the source. The prize may or may not have any real bearing on the real quality of care a patient could expect at that hospital. As an example Hospital Compare, hosted by the federal Centers for Medicare and Medicaid Services, focuses on how often hospitals give heart attack patients aspirin within 30 minutes of their arrival at the ED, give surgery patients the correct antibiotic at the right time prior to the procedure, and otherwise do the right thing in 23 "process measures." Some-I believe most of these criteria-- are relative lightweights. Most hospitals show great success, for example, at giving smoking-cessation advice to heart patients who smoke. (Nurse: "I see you're a smoker, Mr. Smith. You know it doesn't help your heart condition, don't you?" Mr. Smith: "Yes, I do." Nurse marks box on discharge form.)

    • Hospital Compare also indicates whether a hospital's death rates in heart attack, heart failure, and pneumonia patients is better, no different, or worse than the U.S. average. That might seem useful, but the average is so broadly defined that only about 2 percent of hospitals are "better" or "worse." Clicking on the graph or table view of the page will reveal the actual death rates, as well as average state and national rates. Last year, the site began offering patient satisfaction data gleaned from surveys, such as the percentages of patients who reported their nurses always communicated well and of those who said they would definitely recommend the hospital. Look, but take with a grain of salt. Studies show that individuals whose medical care was successful tend to be more satisfied with a hospital in other ways.

    • Some websites [www.hookman.com] have links to other sites that also rank or rate good hospitals across the country, and such sites have potential value to people who are seeking a good hospital in their area.

    Is there a correlation between hospitals’ “quality”scores?

    Unfortunately no! A study reported in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION found no correlation between how well hospitals scored on a 13-item set of Leapfrog quality and safety measures and death rates, adjusted for severity, of patients admitted to the hospitals. The study didn't look at rates of complications.The Leapfrog Group is a nonprofit business coalition that allows consumers to compare hospital safety and quality ratings based on results of a voluntary survey. Hospitals are rated on their ability to satisfy two sets of safety standards. One set, such as appropriate ICU staffing and a program to reduce bedsores, applies to the entire hospital. The other set reflects quality of care and cost for 10 specific procedures and conditions, including repairing an abdominal aortic aneurism and treating pneumonia. Hospitals can be compared directly. You may not be able to find yours, however. Roughly 1,300 hospitals out of more than 5,000 in the nation—two out of 16 in Baltimore, for example—responded to the most recent Leapfrog survey.

    COMMENT:
    In the end after you do all your research it then really comes down to luck and faith. Faith that you have a fine doctors who will make good decisions for you. Trust—but verify.

    African medical facilities always have relatives in with patients. That’s a good thing.
    Always have someone with you in the hospital—a friend or loved one who will stay with you and watch out for you.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for Avoidable Post Hospital Discharge Errors Are Common

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    Saturday, July 18, 2009

    ARE THE PPI’S SAFE IN PREGNANCY?

    Heartburn and acid reflux are common medical disorders in pregnancy and can result in serious discomfort and complications. Furthermore, some pregnant women also experience more severe gastrointestinal conditions, such as helicobacter pylori infections, peptic ulcers, and zollinger-ellison syndrome. To allow the use of proton pump inhibitors (ppis) in pregnancy, the fetal safety of this drug class must be established. The aim of this study is to determine the fetal safety of ppis during early pregnancy through systematic literature review.methods. All original research assessing the safety of ppis in pregnancy was sought from inception to july 2008. Two independent reviewers identified articles, compared results, and settled differences through consensus. The downs-black scale was used to assess quality. Data assessed included congenital malformations, spontaneous abortions, and preterm delivery.

    A random effects meta-analysis combined the results from included studies.

    Results:of the 60 articles identified, 7 met inclusion criteria. Using data from 134,940 patients, including 1,530 exposed and 133,410 not exposed to ppis, the overall odds ratio (or) for major malformations was 1.12 (95% confidence interval, ci: 0.86-1.45).

    Further analysis revealed no increased risk for spontaneous abortions (or=1.29, 95% ci: 0.84-1.97); similarly, there was no increased risk for preterm delivery (or=1.13, 95% ci: 0.96-1.33).

    In the secondary analysis of 1,341 exposed and 120,137 not exposed to omeprazole alone, the or and 95% ci for major malformations were 1.17 and 0.90-1.53, respectively.

    Conclusions:on the basis of these results, ppis are not associated with an increased risk for major congenital birth defects, spontaneous abortions, or preterm delivery. The narrow range of 95% cis is further reassuring, suggesting that ppis can be safely used in pregnancy.

    am j gastroenterol 2009; 104:1541-1545; doi:10.1038/ajg.2009.122; published online 2009.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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    Friday, July 17, 2009

    Women Still Drinking During Pregnancy

    Despite the Surgeon General's warning that alcohol can affect unborn children, pregnant women haven't changed their drinking habits much over the past two decades, the CDC saidAbout 40% of women realize they're pregnant at four weeks' gestation, a critical period for fetal organ development,

    The U.S. Surgeon General has consistently advised women against drinking alcohol during pregnancy. National prevalence of fetal alcohol syndrome is about 0.5 to 2.0 cases per 1,000 births, but the other fetal alcohol spectrum disorders occur about three times as often, the researchers said.

    Women with the highest rates of drinking during pregnancy were older, college graduates, employed, and unmarried.

    Between 2001 and 2005, 17.7% of pregnant women ages 35 to 44 reported having at least one drink in the past 30 days, compared with 8.6% of women ages 18 to 24.

    While it's not well understood why drinking habits differ across certain aspects of social status, the researchers had a few possible explanations. It could be that older women may be more alcohol dependent and have more difficulty abstaining from alcohol while pregnant, they speculated. Also, they said, more-educated women and employed women might have more discretionary money to spend on alcohol. And unmarried women might attend more social occasions where alcohol is served, the researchers said. They emphasized that healthcare providers should routinely ask women of childbearing age about their alcohol use and inform them of the risks of drinking during pregnancy.

    Alcohol use levels before pregnancy are a strong predictor of alcohol use during pregnancy, the researchers said. Many women who use alcohol continue to do so during the early weeks of gestation because they don't realize they're pregnant, as about half of all births are unplanned.

    Denny CH, et al "Alcohol use among pregnant and nonpregnant women of childbearing age -- U.S., 1991 -- 2005 MMWR 2009; 58(19): 529-32

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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    Thursday, July 16, 2009

    WHICH ORAL ANTIBIOTICS ARE SAFE DURING PREGNANCY AND BREASTFEEDING?

    Many are okay...and LESS risky than an untreated infection. But some have special precautions...and several should be avoided.
    Penicillins and cephalosporins are usually safe.
    Consider using a higher or more frequent dose during the 2nd and 3rd trimesters...to compensate for the increased volume of distribution and clearance.
    Erythromycin and azithromycin are also generally safe in pregnancy. Don't use clarithromycin...due to concerns about birth defects in animal studies.
    Nitrofurantoin is usually okay during pregnancy and breastfeeding. Don't use it close to delivery due to a small chance of hemolytic anemia in the newborn.
    TMP/SMX should usually be avoided. Trimethoprim may cause birth defects during the 1st trimester...and sulfonamides may cause high bilirubin and jaundice in the baby if given near term.

    Metronidazole is sometimes avoided in the 1st trimester due to concerns about possible malformations. But it can be used during pregnancy if there are no good alternatives.
    For a single dose while breastfeeding, suggest stopping breastfeeding for 12 to 24 hours to allow the drug to be eliminated.
    Clindamycin is an alternative to metronidazole for anaerobic coverage and is considered safe in pregnancy and lactation.
    Fluoroquinolones (ciprofloxacin, etc) are associated with cartilage damage in animals. Even though this isn't confirmed in humans, try to avoid fluoroquinolones during pregnancy.
    Tetracyclines should be avoided in pregnancy...especially in the 2nd and 3rd trimesters. They're associated with adverse effects on fetal teeth and bones, other defects, and maternal liver toxicity.
    Tell moms that tetracycline can be used during breastfeeding...it only shows up in very low concentrations in breast milk.

    On-line resources:
    Motherisk. http://www.motherisk.org/index.jsp. Offers consumers answers to questions about morning sickness and the risk or safety of medications, disease, chemical exposure, and more. Provides teratogen information for healthcare professionals and updates on Motherisk's continuing reproductive research.
    Perinatology.com. http://www.perinatology.com/. Provides teratogen information for healthcare professionals and links to clinical guidelines and more.
    Organization of Teratology Information Specialists (OTIS). http://www.otispregnancy.org/. Provides medical consultation on prenatal exposures for consumers and healthcare professionals.
    OBfocus. http://www.obfocus.com/. Provides information for healthcare professionals and consumers on pregnancy related issues, including drug exposure. Provides a list of resources on high risk pregnancy



    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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    Wednesday, July 15, 2009

    IMPORTANCE OF CHLAMYDIA SCREENING

    "One of the biggest frustrations in public-health circles today involves a tiny bacterium called Chlamydia trachomatis." some CDC experts "estimate that twice that many cases go undetected." Thus far, "efforts to screen for chlamydia have run into a number of obstacles," with one issue being "simple awareness." And, "many primary-care doctors may be too time-pressed to bring up chlamydia screening during office visits," or do not think it is an issue affecting their patient demographics. Therefore, the "CDC, along with the National Chlamydia Coalition, an umbrella group of nearly 40 medical associations, are working to spread the word about the importance of screening for chlamydia."

    Chlamydia infection is the most common sexually transmitted disease, responsible for a record 1.1 million cases reported to the Centers for Disease Control and Prevention in 2007, and experts there estimate that twice that many cases go undetected. Left untreated, chlamydia can cause infertility or potentially fatal ectopic pregnancies. But many women aren’t even aware that they were exposed to it—possibly years ago—until they try to have a baby and can’t.

    Chlamydia can be detected with a simple urine test. It can be treated with a single dose of antibiotics, and the CDC has been urging all sexually active women under 26 years old to be tested for it annually, as well as older women who have had a change of sexual partner. Yet fewer than 40 % of women in those categories are being screened. “You’d think this would be a no-brainer,” says John Douglas, director of the CDC’s division of STD prevention. “That’s why we’re trying to get the message out.”
    The CDC, along with the National Chlamydia Coalition, an umbrella group of nearly 40 medical associations, are working to spread the word about the importance of screening for chlamydia.

    Chlamydia is especially prevalent among women ages 15 to 19 and African-Americans, but sample studies have found the infection in nearly 10% of all female Army recruits, 10% of female college freshmen and 14% of women in managed-care plans. Experts say it’s about three times as prevalent in women than men, but it may be that men eliminate it from their bodies more readily, while it goes on to cause far more damage in women.

    Many girls in the prime chlamydia age group are under the care of pediatricians, who may be uncomfortable bringing up sex with patients they’ve treated since infancy. Even when pediatricians discuss the human papilloma virus (HPV) vaccine with adolescents and parents, it’s often in the context of preventing cancer in the future, not current sexual activity.“But to pretend that teenagers aren’t having sex is very dangerous.”

    Even when women are treated for chlamydia, about 25% become reinfected within six months—probably due to a partner who wasn’t treated. So the CDC recommends that doctors give women a second course of antibiotics for their partners, even without being seen by a doctor themselves. It can be treated either with a weekly dose of doxycycline or a single dose of azithromycin, which goes by the brand name Zithromax, made by Pfizer Inc., in many countries.

    Chlamydia can be spread by oral or anal sex, as well as vaginal sex; condoms greatly reduce the transmission rate. No one knows for sure how long an infected person remains contagious. But experts advise caution. More insidiously, even when a woman no longer tests positive for an active infection, the chlamydia bacteria may have moved into her upper genital tract and set off pelvic inflammatory disease. PID can cause pelvic pain—or it can be asymptomatic—but it often leaves inflammation and scar tissue that blocks a woman’s fallopian tubes, preventing fertilization. PID is also the most common cause of ectopic pregnancy, which can be fatal. “It’s not the infection itself but the body’s response to get rid of the bacteria that causes the scarring,” There is also evidence of old chlamydia infections in women with endometriosis—a condition in which bits of uterine lining tissue grow outside the uterus, which can also cause pain and infertility. Chlamydia infecting the uterine wall can cause miscarriages, and that it can invade ovaries and lead to early ovarian decline and early menopause. Such scarring can sometimes be seen with a hysterosalpingogram. Severe scar tissue may need to be removed surgically before a woman can get pregnant or to resolve pelvic pain.

    The CDC recommends that all pregnant women be tested for chlamydia at the first prenatal visit, although if you are planning to become pregnant, it’s a good idea to be tested for all STDs well in advance. Older women who are experiencing pelvic pain, intermittent bleeding, unusual vaginal discharge or signs of early menopause should ask their doctor if chlamydia could be involved

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for WHICH ORAL ANTIBIOTICS ARE SAFE DURING PREGNANCY AND BREASTFEEDING?

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    Tuesday, July 14, 2009

    Stronger warnings on drugs containing acetaminophen

    In May, 2009 an FDA report recommended stronger warnings and dose limits on drugs containing the painkiller acetaminophen," which is "the active ingredient in Tylenol and a host of other pain relievers." The report "cites an increased risk of liver damage." The FDA working group that issued the report, "made up of 12 top officials in the FDA's Center for Drug Evaluation and Research, recommended lowering immediate-release tablet strength to no more than 325 milligrams from the current 500 milligrams and reducing the single adult dose to 650 milligrams, from 1,000 milligrams.

    The FDA also warned that acetaminophen "overdose was linked to 458 deaths and 26,000 hospitalizations annually from 1990 to 2001," and the drug "is a leading cause of acute liver failure in the US."

    These recommendations cover "both prescription doses and over-the-counter medication" and "include enhanced public information efforts, stronger labels warning of liver side effects, and dose limitations."

    On June 30 the FDA panel recommended that prescription Vicodin [hydrocodone bitartrate and acetaminophen] and Percocet [oxycodone and acetaminophen] be banned, and that over-the-counter Tylenol, Excedrin, Nyquil, and Theraflu contain stronger warning labels...The problem, according to FDA advisors, is that they all contain acetaminophen, which can cause liver damage."

    The FDA Drug Safety Advisory Committee also "recommended lowering the maximum daily nonprescription dose of acetaminophen," Current doses are "at four grams a day or eight extra strength Tylenol a day. The committee...said the maximum single adult dose, should be 650 milligrams. And while extra strength Tylenol recommends two, 500-milligram pills at once, the panel recommends that dose would require a prescription."

    The FDA "panel noted that patients who take Percocet and Vicodin for long periods often need higher and higher doses to achieve the same effect." "The two drugs combine a narcotic with acetaminophen," and the panel's vote to "recommend a ban on the combination drugs was one of 11 it took" at the meeting. The experts also recommended "that the FDA reduce the highest allowed dose of acetaminophen in over-the-counter pills...to 325 milligrams, from 500," and "to reduce the maximum daily dosage to less than 4,000 milligrams."

    The panel "of 37 doctors, pharmacists, and researchers voted on the recommendations after spending two days discussing steps the FDA should take to reduce the number of acetaminophen overdoses."


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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    Monday, July 13, 2009

    ILLEGAL USE OF OPIOIDS

    Data from the National Survey on Drug Use and Health in 2007 suggested that 33 million people over the age of 12 used an opioid for a nonmedical purpose at some point.

    Most obtained the drug for free from a friend or relative or in the case of Michael Jackson as an alias..

    The FDA's Center for Drug Evaluation and Research is drafting a Risk Evaluation and Mitigation Strategy (REMS) aimed at reducing adverse events caused by opioids.

    Physicians who prescribe opioids must register with the Drug Enforcement Agency (DEA), but the drugs might be less likely to be misused if more regulations were imposed on physicians who prescribe opioids. According to the DEA, a clinician who prescribes controlled substances has an obligation to take "reasonable measures" to prevent the drug from being diverted to those who use it for a nonmedical purpose.

    Schedule II agents include morphine, oxycodone, pure hydrocodone, and methadone. A handful of hydrocodone and morphine combination products are listed in Schedule III, but the analgesic options in this class are relatively scarce.

    State medical licensing boards, health insurance plans, and law enforcement officials must play a big role in enforcing the REMS.

    FDA officials acknowledged the interplay of the FDA and the DEA on the issue of opioids. While the FDA normally focuses on the safety of drugs for medical purposes, it can't ignore the fact that millions of people use the drugs to get high.

    One suggestion is that the FDA require opioid manufacturers to put serial numbers or microchips in opioid tablets, linked to the prescription that released them to a patient. That way, if law enforcement officials seize pills, the prescriber and patient can be easily traced. Other ways are creating opioid medications that are "less abusable" such as crush-proof pills.

    The FDA is already considering serial numbers on some classes of medication for a different reason -- to confirm the integrity of the supply chain.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    * Tune in tomorrow for Stronger warnings on drugs containing acetaminophen.

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    Sunday, July 12, 2009

    Part II of II: SHOULD EVERYONE TAKE ASA?

    PART II OF II DETRIMENTAL EFFECTS OF ASPIRIN

    SHOULD EVERYONE TAKE ASA?

    Aspirin and other platelet aggregation inhibitors may increase the likelihood of asymptomatic cerebral microbleeds among older adults. Microbleeding has gained recognition over the past decade as a marker of small-vessel disease in the brain.

    The analysis involved 1,062 participants in the longitudinal, population-based Rotterdam Scan Study, all age 60 or older and free of dementia. They underwent MRI over a period of roughly one year to assess the presence and location of microbleeds. Pharmacy records showed that 34.2% had used an antithrombotic drug as an outpatient in the years before their MRI. The study determined that these antithrombotic drug users were more likely to have cerebral microbleeds than nonusers after adjustment for age and sex (odds ratio 1.55, 95% confidence interval 1.14 to 2.09).The association remained after additional adjustment for cardiovascular risk (OR 1.56, 95% CI 1.15 to 2.12).

    Antithrombotics were also linked to presence of brain infarcts and high white matter lesion volume, but exclusion of participants with a known history of cerebrovascular disease attenuated these associations.

    Location appears to be important: strictly lobular microbleeding suggests cerebral amyloid angiopathy, in which accumulation of amyloid protein leads to degeneration of smooth muscle cells and increases risk of ruptures and hemorrhages. Aspirin users in the population-based study were also more likely to show microbleeding limited to lobular areas of the brain, the researchers reported.

    Past microbleeding -- indicated by small deposits of the iron-storing protein hemosiderin on brain scans -- was 71% more common with use of platelet aggregation inhibitors than without antithrombotic drugs.

    Exclusive use of platelet aggregation inhibitors accounted for most of the antithrombotics (23.1% of the cohort). Another 5.9% exclusively used anticoagulants. These were overwhelmingly warfarin (Coumadin) and other vitamin K antagonists rather than heparin.
    Although not significant, anticoagulants displayed a magnitude of microbleeding risk (OR 1.49, 95% CI 0.81 to 2.67) similar to platelet aggregation inhibitors (OR 1.71, 95% CI 1.21 to 2.41) in the fully adjusted model.

    One researcher speculated that "It may be that microbleed formation is more dependent on the sealing of small-vessel-wall defects by platelet aggregation than it is on clot stabilization."

    Source reference:
    Vernooij MW, et al "Use of antithrombotic drugs and the presence of cerebral microbleeds: The Rotterdam scan study" ARCH NEUROL 2009; 66: DOI: 10.1001/archneurol.2009.42.

    COMMENT:
    This brings up the question as to the indications for everyone—healthy with minimal cardio-vascular risks and those with greater risks taking small doses of aspirin as prophylaxis for heart attacks and stroke, as well as the advanced elderly.

    Aspirin is enormously useful as a prophylactic for cardiovascular events including myocardial infarction and ischaemic stroke. There has been concern, however, that aspirin can also increase hemorrhagic strokes and cause gastrointestinal bleeding. This study investigated the balance of positive and negative effects, and the results indicate no overwhelming difference. For individual patients, therefore, it depends on whether it is better to risk an MI or a gastrointestinal bleed says findings in the Lancet, Volume 373, Issue 9678, Pages 1849 - 1860, 30 May 2009 doi:10.1016/S0140-6736(09)60503-1

    These findings "challenge guidelines that endorse the use of aspirin for primary prevention as a general public health policy and reinforce the need to take each patient's preferences and goals.

    Researchers undertook an analysis of six primary prevention trials encompassing some 95,000 individuals at low-average risk assigned to take aspirin or no aspirin. Aspirin was associated with a significant reduction in risk for serious vascular events (0.51% vs. 0.57% per year), but the net effect on stroke was not significant. Aspirin increased risks for major gastrointestinal and extracranial bleeding. Therefore everyone using aspirin in the primary prevention of cardiovascular disease is "of uncertain net value," reports this Lancet meta-analysis.

    Why?

    This major study shows that although regular use can cut the rate of non-fatal heart attacks, it can also increase the risk of internal bleeding by a third.

    Healthy adults who take daily aspirin to prevent heart attacks could be doing more harm than good, warn researchers. The researchers "found that healthy people who take aspirin reduced their already small risk of heart attack or stroke by 12 percent, while the small risk of internal bleeding is increased by a third." This means there were five fewer non-fatal heart attacks for every 10,000 people treated. This pro was was offset by the con of a comparable increase in bleeding -- one extra stroke and three cases of stomach bleeding per 10,000 people treated."

    Meanwhile, the secondary prevention studies showed that where patients were taking aspirin to prevent a repeat attack -- aspirin reduced the chances of serious vascular events by about one-fifth and this benefit clearly outweighed the small risk of bleeding.

    Older age, male sex, diabetes, and high blood pressure were associated with significantly elevated absolute ischemic stroke and major coronary event risk, but also with significantly increased risk of major extracranial bleeding and at least a trend for hemorrhagic stroke as well.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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    Saturday, July 11, 2009

    Part I of II: IS IT SAFE TO TAKE ENTERIC COATED ASPIRIN?

    Even low-dose aspirin (acetylsalicylic acid [ASA]) produces intestinal damage.

    The small bowel was shown to be damaged by low-dose ASA even on a short-term basis in twenty healthy volunteers (age range, 19-64 years) who underwent video capsule endoscopy (VCE), fecal calprotectin, and permeability tests (sucrose and lactulose/mannitol [lac/man] ratio) before and after ingestion of 100 mg of enteric-coated ASA daily for 14 days.

    Video capsule images were assessed by 2 independent expert endoscopists, fully blinded to the treatment group, by using an endoscopic scale.

    Post-ASA VCE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers). The median baseline lac/man ratio (0.021; range, 0.011-0.045) increased after ASA use (0.036; range, 0.007-0.258; P = .08), and the post-ASA lac/man ratio was above the upper end of normal (>0.025) in 10 of 20 volunteers (vs baseline, P < .02). The median baseline fecal calprotectin concentration (6.05 microg/g; range, 1.9-79.2) also increased significantly after ASA use (23.9 microg/g; range, 3.1-75.3; P < .0005), with 3 patients having values above the cutoff (>50 microg/g). Five of 10 subjects with abnormal findings at VCE also had lac/man ratios above the cutoff. Median baseline sucrose urinary excretion (70.0 mg; range, 11.8-151.3) increased significantly after ASA administration (107.0 mg; range, 22.9-411.3; P < .05).

    CONCLUSIONS: The short-term administration of low-dose ASA is associated with mucosal abnormalities of the small bowel mucosa, which might have implications in clinical practice.

    E. Smecuol Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment. Clin Gastroenterol Hepatol 7(5):524-9 (2009)

    COMMENT:

    The efforts to generate safer NSAIDS and aspirins includes enteric coated and slow release formulations. But these “safer” formulations simply shift the damage of these agents to a more distal site in the intestinal tract.

    This study documents that even in the short term and in healthy controls a short course of enteric coated ASA can damage the small intestinal mucosa.

    Half of the healthy study population showed mucosal damage.
    This study must be taken into consideration by patients and their providers.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for PART II of II SHOULD EVERYONE TAKE ASA?

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    Friday, July 10, 2009

    COMMONLY USED DRUGS THAT INCREASE PHOTOSENSITIVITY

    You surely know that this is summer the great season of the year of cook-outs, the beach and lots of sun. But you should also be aware of the following medicaltions that you may be taking that increases photosensitivity—and take extra precautions if you fit in this picture.

    Analgesic Agents
    NSAIDs: celecoxib (Celebrex), diclofenac (Voltaren, Cataflam), diflunisal (Dolobid), etodolac (Lodine), ibuprofen (Motrin), indomethacin, ketoprofen (Orudis), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Anaprox), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril)
    Other: cyclobenzaprine (Flexeril), dantrolene (Dantrium), sumatriptan (Imitrex)

    Antibiotics
    Fluoroquinolones: ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin) Tetracyclines: demeclocycline (Declomycin), doxycycline (Vibramycin), minocycline (Minocin), oxytetracycline (Terramycin), tetracycline (Achromycin), tigecycline (Tygacil) Other: azithromycin (Zithromax), capreomycin (Capastat), ceftazidime (Fortaz), cefazolin (Ancef), cycloserine (Seromycin), dapsone, gentamicin, griseofulvin, ethionamide (Trecator), isoniazid (Nydrazid), metronidazole (Flagyl), nalidixic acid (NegGram), pyrazinamide, sulfamethoxazole/trimethoprim (Bactrim), sulfasalazine (Azulfidine), sulfisoxazole (Gantrisin)

    Antidepressants
    Tricyclic Antidepressants: amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), maprotiline (Ludiomil), nortriptyline (Pamelor), protriptyline (Vivactil), trimipramine (Surmontil)
    Selective serotonin reuptake inhibitors: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft)
    Antidepressant, Other: bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), venlafaxine (Effexor)

    Antidiabetic Agents

    Sulfonylureas: acetohexamide (Dymelor), chlorpropamide (Diabinese), glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Micronase), tolazamide (Tolinase), tolbutamide (Orinase)

    Antihistamines
    cetirizine (Zyrtec), cyproheptadine (Periactin), diphenhydramine (Benadryl), loratadine (Claritin), promethazine (Phenergan)

    Antiplatelet
    clopidogrel (Plavix)

    Cardiovascular
    Thiazide diuretics: bendroflumethiazide (Corzide), chlorthalidone (Thalitone), hydrochlorothiazide (Microzide), hydroflumethiazide (Diucardin), indapamide (Lozol), methyclothiazide (Enduron), metolazone (Zaroxolyn) Diuretics, Other: bumetanide (Bumex), furosemide (Lasix), triamterene (Dyrenium)
    Antihypertensives: amlodipine (Norvasc), captopril (Capoten), diltiazem (Cardizem, Tiazac), enalapril (Vasotec), hydralazine, labetalol, minoxidil, nifedipine (Procardia), sotalol (Betapace) Statins: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor)
    Other: acetazolamide, amiodarone (Cordarone, Pacerone), fenofibrate (Tricor), methyldopa, quinidine

    Vitamins
    pyridoxine (vitamin B6), vitamin A

    REFERENCES:
    Dukes MNG, Aronson JK. Meyler's side effects of drugs. 14th ed. Amsterdam: Elsevier; 2000.
    Moore DE. Drug-induced cutaneous photosensitivity. Drug Saf 2002;25:345-72.
    Allen JE. Drug-induced photosensitivity. Clin Pharm 1993;12:580-7
    Pharmacist's Letter/Prescriber's Letter 2009;25(6):250606.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for PART I of II DETRIMENTAL EFFECTS OF ASPIRIN

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    Thursday, July 9, 2009

    CAUTION YOUR FAMILIES ABOUT SWIMMING POOL DISEASES

    Reports of gastrointestinal illness from use of public pools and water parks have risen sharply in recent years, according to the Centers for Disease Control and Prevention. The leading culprit is a microscopic organism that lives in human feces.

    The CDC is increasingly documenting cases of "gastrointestinal illness from use of public pools and water parks," noting that a "microscopic organism that lives in human feces" appears to be at the center of the trend. "Called cryptosporidium, it is a parasite transmitted in an egg-like shell that can survive as long as 10 days even in chlorinated water." And "in 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people...up from seven outbreaks and 567 people in 2004." Although officials are not clear as to why this rise is taking place, CDC epidemiologists have pointed out that "detection and reporting had probably improved since a treatment for the diarrheal illness -- called cryptosporidiosis, or crypto for short -- became available in 2002." Furthermore, "the recent large outbreaks, she said, have raised awareness and led to better reporting."

    Called cryptosporidium, it is a parasite transmitted in an egglike shell that can survive as long as 10 days even in chlorinated water. In 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people, according to the disease centers — up from 7 outbreaks and 567 people in 2004. One of the largest recent crypto outbreaks occurred in Utah in 2007. There were 2,000 confirmed cases, but that number vastly underestimates the illness’s total impact.

    COMMENT:
    People should not swim or allow their children to swim when they have diarrhea. The water you swim in is shared with everyone, so what one swimmer does has consequences for all the swimmers.

    The symptoms of crypto resemble those of food poisoning. Though most cases clear up on their own, the illness can require hospitalization, particularly in small children and people with weakened immune systems.

    In addition to not swimming while ill with diarrhea, health experts say people should shower before swimming and never use the pool as a toilet. Parents should wash young children before they enter the pool and take them on frequent bathroom breaks. Children in diapers require vigilant attention.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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    Wednesday, July 8, 2009

    HEATSTROKE

    Everyone is at risk for Heatstroke in times of extreme heat, those who are exerting themselves, but also those sitting quietly in the sun. Heat stroke is defined as a core body temperature in excess of 40.5ºC (105ºF) with associated central nervous system dysfunction in the setting of a large environmental heat load that cannot be dissipated

    The truth is, you can develop heat stroke while sitting perfectly still, if you have certain risk factors like chronic medical conditions or use certain medications.
    Hyperthermia is defined as elevation of core body temperature above the normal range of body temperature. Body temperature is maintained within a narrow range by balancing heat load with heat dissipation. The body's heat load results from both metabolic processes and absorption of heat from the environment. As core temperature rises, the the autonomic nervous system is stimulated to produce sweating and cutaneous vasodilation.

    Evaporation is the principal mechanism of heat loss in a hot environment, but this becomes ineffective above a relative humidity of 75 percent. The other major methods of heat dissipation — radiation (emission of infrared electromagnetic energy), conduction (direct transfer of heat to an adjacent, cooler object), and convection (direct transfer of heat to convective air currents) — cannot efficiently transfer heat when environmental temperature exceeds skin temperature.

    In other words when it gets hot and needs to pump faster, hearts weakened by heart disease may be unable to get the body cooled fast enough. People with high blood pressure or hypertension also experience greater stress on the heart, and hypertension sufferers often follow low-salt diets. Not having enough salt in your system can lower the threshold for heat stroke. People with diabetes can also easily become dehydrated, which keeps the body from sweating normally, and obesity not only puts extra pressure on the heart, but it also must work even harder to cool down a larger person.

    Medications like diuretics (water pills) reduce the amount of fluid in the body and lead to easier dehydration. Beta blockers, often used to treat heart problems, can also prevent the heart from beating faster, thus inhibiting the body's cooling system. Older people are especially at risk for these factors affecting how your body reacts to the heat. Untreated heat exhaustion can lead to heat stroke, which is signified by a rapid heartbeat, confusion or even delirium, a fever of greater than 104 degrees, severe headaches and seizures or muscle twitching. The skin of a heat stroke victim will be warm and dry, because the body is no longer able to perspire.

    The reason is --Your body must maintain its normal temperature to work well. When it gets hot, your body begins to cool itself by sweating. Your body cools as the perspiration evaporates. In order to get more blood to the skin's surface and aid sweating, the heart will beat faster. This occurs even if you're sitting still in the sun.If your body is unable to rid itself of excess heat, your organs can begin to overheat and stop working. This is called heat stroke, and can result in confusion, seizures, permanent disabilities, multiorgan system failure, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation, renal, hepatic failure, hypoglycemia, rhabdomyolysis, seizures and death.

    Physical findings in heat stroke may include cutaneous vasodilation, tachypnea, rales due to noncardiogenic pulmonary edema, excessive bleeding due to disseminated intravascular coagulation, and evidence of neurologic dysfunction such as altered mentation or seizures. The skin may be moist or dry, depending upon underlying medical conditions, the speed with which the heat stroke developed, and hydration status. Not all victims of heat stroke should be assumed to be volume-depleted. Laboratory studies may reveal coagulopathy, acute renal failure, acute hepatic necrosis, respiratory alkalosis, and a leukocytosis as high as 30,000 to 40,000/mm3.

    Warning signs for heat stroke or exhaustion are dizziness or fainting, excessive sweating, muscle cramps, cold or clammy skin, headaches, rapid heartbeat or nausea. If you experience any of these, get out of the heat right away, drink water, juice or sports drinks and seek medical attention.

    PRECAUTIONS
    The risk of serious consequences can be reduced with a few simple precautions. If you have A chronic medical conditions discussed, try to get out of the sun sooner than others, and avoid outdoor activities during the hottest times of day. Wear loose fitting clothes and unless otherwise directed, get plenty of extra fluids (like water, but avoid alcoholic or caffeinated beverages).

    TREATMENT
    Cooling measures — Augmentation of evaporative cooling is considered the treatment modality of choice because it is effective, noninvasive, and easily performed. The naked patient is sprayed with a mist of lukewarm water while air is circulated with large fans. Shivering may be suppressed with intravenous benzodiazepines such as diazepam (5 mg IV) or lorazepam (1-2 mg IV) or, if NMS is not suspected, with chlorpromazine (25 to 50 mg IV).

    Other effective cooling methods are less commonly utilized. Immersing the patient in ice water is the most effective method of rapid cooling. Immersing the patient in ice water results in rapid cooling but complicates monitoring and access. Applying ice packs to the axillae, neck, and groin is effective, but is poorly tolerated in the awake patient.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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