As medicine changes during the past decades and even just in the past few years doctors have had to become more business-like. Drs.Hartzband, and Groopman write that rapidly rising health care costs over recent decades have prompted the application of business practices to medicine, with the goals of improving efficiency, restraining expenses, and increasing quality. Price tags are being applied to every aspect of a doctor's day, creating an acute awareness of costs and reimbursement. Physicians are now routinely provided with profit-and-loss reports reflecting their activity, and metrics are calculated to measure the cost-effectiveness of their work. Many business managers believe that clinicians will change their behavior to meet the imperatives of increased efficiency, cost containment, and improved quality only by increasing their focus on the flow of money in their work environment.
But are there unintended consequences of applying a business mindset to medicine?
Assigning a monetary value to every aspect of a physician's time and effort may actually reduce productivity, impair the quality of performance, and thereby even increase costs. Studies have shown that even the suggestion of money promotes behavior marked by selfishness and lack of collegiality.
In one experiment, a control group performed a series of tasks, such as unscrambling phrases, in a "neutral" environment, whereas another group was "primed" through the inclusion of the concept of money in the scrambled phrases and the placement of play money within their visual periphery during the exercise. In a series of such experiments, money-primed subjects were consistently less willing to extend themselves to those in need of assistance. The authors concluded, "People reminded of money reliably performed independent but socially insensitive actions."
Another recent experiment, involving 614 undergraduates, assessed the willingness of passersby to move a sofa onto a truck. The control group was asked to do it as a favor (without monetary compensation), whereas another group was offered 50 cents to help. The controls were significantly more willing to assist. When students were offered a piece of candy to help, there was no difference in willingness relative to the control group. But when the cost of the candy was mentioned ("a 50-cent candy"), willingness declined significantly, to the same low level as with the offer of 50 cents. Only by offering a substantially larger amount of money (10 times as much) did the cash group reach the same level of willingness to help as the control group. How could 50 cents be worth less as a motivator than no money at all?
The answer may lie in the difference between "social" or "communal" interactions and "market" or "exchange" interactions.
Researchers have described two types of relationships that involve giving a benefit to someone else.In a market relationship, when you provide goods or services, you expect to receive cash or bartered goods of similar value in return. In a communal relationship, you are expected to help when there is a need, irrespective of payment. In a communal relationship, an expectation and obligation to help when assistance is needed. Drs.Hartzband, and Groopman believe that in the current environment, the balance has tipped toward market exchanges at the expense of medicine's communal or social dimension. In the new business model there is no metric for the quality that derives from the communal dimension of medicine.
How can we restore the balance between communal and market exchange in medicine in the current economic environment, ask Drs.Hartzband, and Groopman, given the imperative to cut costs? One answer may lie in an experimental new paradigm in primary care termed the "patient-centered medical home." The term itself suggests an emphasis on the social exchange that exists in a family rather than the market exchange of a business. The medical home is envisioned as a "compassionate partnership" of primary care providers and patients, with coordinated care for patients' ongoing problems and increased attention to preventive measures.
The insurer would pay a set fee for each patient cared for in the medical home to cover what is now non-reimbursed time. Substantial cost savings are expected to result from coordination of care. As policymakers refine this model and extend it to include medical specialists, they should take into account the lessons of behavioral economics.
Caregivers should be appropriately reimbursed but should not be constantly primed by money. Success in such a model will require collegiality, cooperation, and teamwork — precisely the behaviors that are predictably eroded by a marketplace environment.
Dr. Hartzband is an endocrinologist at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School, and Dr. Groopman is a hematologist–oncologist at Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School — both in Boston.
References
Vohs KD, Mead NL, Goode MR. The psychological consequences of money. Science 2006;314:1154-1156. ;Heyman J, Ariely D. Effort for payment: a tale of two markets. Psychol Sci 2004;15:787-793. ;Ariely D. Predictably irrational: the hidden forces that shape our decisions. New York: Harper Collins, 2008.;Clark MS, Mills J. Interpersonal attraction in exchange and communal relationships. J Pers Soc Psychol 1979;37:12-24.
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 later for Five Groups as Priority Targets for H1N1 Vaccination .
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Tuesday, September 29, 2009
Sunday, September 27, 2009
Role of diet in the development of inflammatory bowel disease
Increasing incidence and prevalence figures for IBD both in the developed and developing world indicate that environmental factors are at least as significant in IBD as genetic susceptibility. Of these, diet and the host microbiota are likely to play important but as yet poorly defined roles. The major constituents of a standard Western diet may contribute to, or protect against, intestinal inflammation via several mechanisms. These include the effects of insulin resistance and short-chain fatty acids such as butyrate, modification of intestinal permeability, the antiinflammatory role of polyunsaturated fatty acids, and the effect of sulfur compounds from protein on host microbiota. This detailed review critically assesses the evidence for the role of diet in the development of IBD and examines the evidence for obesity as a contributing factor to IBD pathogenesis. Particular attention is focused on methodological issues including suitability of cases and controls, confounders such as smoking, and total energy expenditure. From Chapman-Kiddell et al. Role of diet in the development of inflammatory bowel disease Inflamm Bowel Dis 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.
*Tune in later for Unintended consequences of applying a business mindset to medicine.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
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 later for Unintended consequences of applying a business mindset to medicine.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Friday, September 25, 2009
Orthostatic Hypotension
Symptomatic falls in blood pressure after standing or eating are a frequent clinical problem. Symptoms are due to cerebral hypoperfusion and include generalized weakness, sensations described as dizziness or lightheadedness, visual blurring or darkening of the visual fields and, in severe cases, loss of consciousness. Less frequently, orthostatic hypotension leads to angina or stroke.
Symptoms of orthostatic hypotension vary in severity from mild to incapacitating; severely afflicted patients are unable to leave the supine position without experiencing presyncope or syncope.
Postural (orthostatic) hypotension is diagnosed when, within two to five minutes of quiet standing, one or more of the following is present: At least a 20 mmHg fall in systolic pressure At least a 10 mmHg fall in diastolic pressure Symptoms of cerebral hypoperfusion
Multiple epidemiologic surveys have found postural hypotension in as many as 20 percent of patients over age 65. Many patients with postural hypotension have systolic hypertension when seated or supine. In one study, for example, the prevalence of orthostatic hypotension was 18 percent in subjects age 65 years or older, although only 2 percent of the subjects were symptomatic (defined as dizziness with standing). There was a modest association (odds ratio 1.4 to 1.9) with systolic hypertension when supine, carotid stenosis greater than 50 percent, and the use of oral hypoglycemic agents. There was only a weak association with the use of beta blockers and no association with other antihypertensive drugs (including diuretics).In other reports, however, the use of antihypertensive medications (hydralazine, ACE inhibitors, ganglionic blockers) was, as expected, significantly related to postural hypotension in the elderly. Furthermore, discontinuing antihypertensive medications often led to an improvement of postural hypotension. Other drugs associated with postural hypotension, especially in the elderly, are vasodilators, including nitrates and calcium channel blockers; antidepressants (tricyclics and phenothiazines); opiates; and alcohol.
Orthostatic hypotension contributes a large proportion of hospitalizations; a report from the Nationwide Inpatient Sample estimated the orthostatic hypotension hospitalization rate to be 233 per 100,000 among patients over 75 years, with a median length of stay of three days and an overall inhospital mortality rate of 0.9 percent.
Other studies have also associated orthostatic hypotension in the elderly with mortality. Among 3522 Japanese American men, age 71 to 93 years, orthostatic hypotension was present in 6.9 percent and increased with age. The four-year age-adjusted mortality rates were 57 and 39 per 1000 patient-years.
Orthostatic hypotension can also occur in younger and middle-age subjects, who, in the absence of volume depletion (due to diuretics, hemorrhage or vomiting), usually have chronic autonomic failure.
Other associated diseases are diabetes, Parkinson's, dehydration, or drugs.
Check for meds that may precipitate BP drops such as alpha
blockers...diuretics...and many antiparkinson's drugs (levodopa, etc).
I suggest lowering the dose...or switching to another drug that's less likely to be a problem.
Nondrug therapies can help. I advise patients to get up slowly...increase fluid and sodium intake when possible...wear compression stockings...and avoid alcohol.
If nursing home patients have postprandial hypotension, I suggest walking to meals and taking a wheelchair ride back to their room.
When this isn't enough, consider therapies that increase BP.
Fludrocortisone raises BP by causing sodium and water retention but be careful using it in patients with heart failure.Fludrocortisone can also cause hypokalemia. One must check potassium levels and prescribe a supplement if potassium goes too low.
Midodrine raises blood pressure by causing vasoconstriction... so it must be cautiously in patients with heart disease.
Midodrine also decreases heart rate but care must be taken in using it with other meds that lower heart rate such as beta-blockers, digoxin, etc.
I tell patients not to be surprised if they get "goosebumps"...midodrine commonly causes hair to stand on end.
I advise patients to avoid taking midodrine less than 4 hours before bedtime...to avoid HYPERTENSION when lying down.
Caffeine is worth a try to see if it reduces hypotension. I suggest 1 or 2 cups of coffee or black tea up to 3 times a day.
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 later for Role of diet in the development of inflammatory bowel disease.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Symptoms of orthostatic hypotension vary in severity from mild to incapacitating; severely afflicted patients are unable to leave the supine position without experiencing presyncope or syncope.
Postural (orthostatic) hypotension is diagnosed when, within two to five minutes of quiet standing, one or more of the following is present: At least a 20 mmHg fall in systolic pressure At least a 10 mmHg fall in diastolic pressure Symptoms of cerebral hypoperfusion
Multiple epidemiologic surveys have found postural hypotension in as many as 20 percent of patients over age 65. Many patients with postural hypotension have systolic hypertension when seated or supine. In one study, for example, the prevalence of orthostatic hypotension was 18 percent in subjects age 65 years or older, although only 2 percent of the subjects were symptomatic (defined as dizziness with standing). There was a modest association (odds ratio 1.4 to 1.9) with systolic hypertension when supine, carotid stenosis greater than 50 percent, and the use of oral hypoglycemic agents. There was only a weak association with the use of beta blockers and no association with other antihypertensive drugs (including diuretics).In other reports, however, the use of antihypertensive medications (hydralazine, ACE inhibitors, ganglionic blockers) was, as expected, significantly related to postural hypotension in the elderly. Furthermore, discontinuing antihypertensive medications often led to an improvement of postural hypotension. Other drugs associated with postural hypotension, especially in the elderly, are vasodilators, including nitrates and calcium channel blockers; antidepressants (tricyclics and phenothiazines); opiates; and alcohol.
Orthostatic hypotension contributes a large proportion of hospitalizations; a report from the Nationwide Inpatient Sample estimated the orthostatic hypotension hospitalization rate to be 233 per 100,000 among patients over 75 years, with a median length of stay of three days and an overall inhospital mortality rate of 0.9 percent.
Other studies have also associated orthostatic hypotension in the elderly with mortality. Among 3522 Japanese American men, age 71 to 93 years, orthostatic hypotension was present in 6.9 percent and increased with age. The four-year age-adjusted mortality rates were 57 and 39 per 1000 patient-years.
Orthostatic hypotension can also occur in younger and middle-age subjects, who, in the absence of volume depletion (due to diuretics, hemorrhage or vomiting), usually have chronic autonomic failure.
Other associated diseases are diabetes, Parkinson's, dehydration, or drugs.
Check for meds that may precipitate BP drops such as alpha
blockers...diuretics...and many antiparkinson's drugs (levodopa, etc).
I suggest lowering the dose...or switching to another drug that's less likely to be a problem.
Nondrug therapies can help. I advise patients to get up slowly...increase fluid and sodium intake when possible...wear compression stockings...and avoid alcohol.
If nursing home patients have postprandial hypotension, I suggest walking to meals and taking a wheelchair ride back to their room.
When this isn't enough, consider therapies that increase BP.
Fludrocortisone raises BP by causing sodium and water retention but be careful using it in patients with heart failure.Fludrocortisone can also cause hypokalemia. One must check potassium levels and prescribe a supplement if potassium goes too low.
Midodrine raises blood pressure by causing vasoconstriction... so it must be cautiously in patients with heart disease.
Midodrine also decreases heart rate but care must be taken in using it with other meds that lower heart rate such as beta-blockers, digoxin, etc.
I tell patients not to be surprised if they get "goosebumps"...midodrine commonly causes hair to stand on end.
I advise patients to avoid taking midodrine less than 4 hours before bedtime...to avoid HYPERTENSION when lying down.
Caffeine is worth a try to see if it reduces hypotension. I suggest 1 or 2 cups of coffee or black tea up to 3 times a day.
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 later for Role of diet in the development of inflammatory bowel disease.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Wednesday, September 23, 2009
OIG EXPECTS OVER $2.4 BILLION IN MEDICAL FRAUD RECOVERIES IN FIRST HALF OF FY 2009
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) expects to recover more than $2.4 billion in the first half of fiscal year (FY) 2009, the agency said in its Semi-Annual Report to Congress.According to the June 8 report, OIG’s expected recoveries include $274.8 million in audit-related receivables and $2.2 billion in investigative-related receivables, which includes nearly $552 million in non-HHS receivables resulting from OIG work.
Between October 2008 and March 2009, OIG reported exclusions of 1,415 individuals and organizations for fraud or abuse involving federal health care programs and/or their beneficiaries; 775 criminal actions against individuals or organizations that engaged in crimes against HHS programs; and 342 civil actions, which include False Claims Act and unjust enrichment suits, Civil Monetary Penalties Law settlements, and administrative recoveries related to provider self-disclosure matters.
The report also noted that OIG investigators and attorneys were instrumental in the government’s $1.4 billion settlement with Eli Lilly and Company. Lilly agreed to plead guilty to promoting its anti psychotic drug Zyprexa for uses not approved by the Food and Drug Administration and not covered by Medicaid or other federal programs.
Another OIG investigation resulted in an over $97.5 million settlement with Bayer HealthCare LLC, the report said. That settlement related to allegations that Bayer paid kickbacks to several durable medical equipment mail order suppliers and diabetic supply distributors, leading them to submit false claims to Medicare.
“These recoveries reflect our dedicated efforts to reduce fraud, waste, and abuse in HHS programs,” Inspector General Daniel R. Levinson said in a press release announcing the report. “We will continue to employ all of our audit, evaluation, investigation, and legal tools and also to collaborate with OIG’s government partners to accomplish this vital and expanding mission.”
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 later for Orthostatic Hypotension.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Between October 2008 and March 2009, OIG reported exclusions of 1,415 individuals and organizations for fraud or abuse involving federal health care programs and/or their beneficiaries; 775 criminal actions against individuals or organizations that engaged in crimes against HHS programs; and 342 civil actions, which include False Claims Act and unjust enrichment suits, Civil Monetary Penalties Law settlements, and administrative recoveries related to provider self-disclosure matters.
The report also noted that OIG investigators and attorneys were instrumental in the government’s $1.4 billion settlement with Eli Lilly and Company. Lilly agreed to plead guilty to promoting its anti psychotic drug Zyprexa for uses not approved by the Food and Drug Administration and not covered by Medicaid or other federal programs.
Another OIG investigation resulted in an over $97.5 million settlement with Bayer HealthCare LLC, the report said. That settlement related to allegations that Bayer paid kickbacks to several durable medical equipment mail order suppliers and diabetic supply distributors, leading them to submit false claims to Medicare.
“These recoveries reflect our dedicated efforts to reduce fraud, waste, and abuse in HHS programs,” Inspector General Daniel R. Levinson said in a press release announcing the report. “We will continue to employ all of our audit, evaluation, investigation, and legal tools and also to collaborate with OIG’s government partners to accomplish this vital and expanding mission.”
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 later for Orthostatic Hypotension.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Monday, September 21, 2009
STRIDES IN INCISION-LESS OPERATIONS NAMED “NOTES” USE MOUTH, OTHER ORIFICES, TO ACCESS PATIENTS' INTERNAL ORGANS
Accessing internal organs via the body's natural orifices is the newest trend in minimally invasive surgery. And surgeons around the world are developing innovative ways to use body openings in the hope surgical patients will have less pain, a faster recovery and no scars. At an international gastroenterology conference in Chicago, surgeons unveiled the newest no-scar surgical procedures, from incision-less weight-loss surgeries to vaginal appendectomies.
One of the experimental weight-loss surgeries, uses a stapling device that snakes down a patient's throat and into the stomach. A vacuum brings the sides of the stomach together, which the surgeon then staples together. The narrower stomach is supposed to make patients feel full faster, and help curb their appetite.
The vagina was the body opening of choice for a team from the University of California San Diego that is also investigating no-scar weight-loss surgery. For this procedure, with the help of two small abdominal incisions, surgeons remove 70 per cent of a patient's stomach through the vagina. The team has only tried the procedure on two patients, but the surgical team called it a "viable option" for morbidly obese patients."Compared to traditional laparoscopic techniques in which patients experience a high incidence of infections and hernias, the results so far indicate this procedure accelerates weight loss while minimizing adverse events," he said in a release.
But, most no-scar surgeries remain experimental because technology has not yet caught up with surgeons' ambitions.Surgeons, when they use these techniques, don't have the same level of precision as they would have in a standard laparoscopic or open surgery. And since less precision means more risks, most surgeons say the benefits currently don't outweigh the risks.
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 later for OIG EXPECTS OVER $2.4 BILLION IN MEDICAL FRAUD RECOVERIES IN FIRST HALF OF FY 2009.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
One of the experimental weight-loss surgeries, uses a stapling device that snakes down a patient's throat and into the stomach. A vacuum brings the sides of the stomach together, which the surgeon then staples together. The narrower stomach is supposed to make patients feel full faster, and help curb their appetite.
The vagina was the body opening of choice for a team from the University of California San Diego that is also investigating no-scar weight-loss surgery. For this procedure, with the help of two small abdominal incisions, surgeons remove 70 per cent of a patient's stomach through the vagina. The team has only tried the procedure on two patients, but the surgical team called it a "viable option" for morbidly obese patients."Compared to traditional laparoscopic techniques in which patients experience a high incidence of infections and hernias, the results so far indicate this procedure accelerates weight loss while minimizing adverse events," he said in a release.
But, most no-scar surgeries remain experimental because technology has not yet caught up with surgeons' ambitions.Surgeons, when they use these techniques, don't have the same level of precision as they would have in a standard laparoscopic or open surgery. And since less precision means more risks, most surgeons say the benefits currently don't outweigh the risks.
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 later for OIG EXPECTS OVER $2.4 BILLION IN MEDICAL FRAUD RECOVERIES IN FIRST HALF OF FY 2009.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Saturday, September 19, 2009
Low-Carb Diet Improves Symptoms & Quality of Life in Diarrhea predominant IBS
Data published in Clinical Gastroenterology and Hepatology suggest that a very low-carbohydrate diet (VLCD) provides adequate relief and improves abdominal pain, stool habits and quality of life in IBS-D.
Patients with IBS-D anecdotally report symptom improvement after initiating a VLCD; this study prospectively evaluated a VLCD in IBS-D. Participants with moderate to severe IBS-D were provided a two-week standard diet, then four weeks of a VLCD (20 g carbohydrates/d). A responder was defined as having adequate relief of gastrointestinal symptoms for two or more weeks during the VLCD. Changes in abdominal pain, stool habits and quality of life also were measured.
Of the 17 participants enrolled, 13 completed the study and all met the responder definition, with 10 reporting adequate relief for all four VLCD weeks. Stool frequency decreased and stool consistency improved from diarrheal to normal form. Pain scores and quality-of-life measures significantly improved (outcomes were independent of weight loss).
From Clinical Gastroenterology and Hepatology; 2009: 7(6): 706-708.e1
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 later for STRIDES IN INCISION-LESS OPERATIONS NAMED “NOTES” USE MOUTH, OTHER ORIFICES, TO ACCESS PATIENTS'INTERNAL ORGANS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Patients with IBS-D anecdotally report symptom improvement after initiating a VLCD; this study prospectively evaluated a VLCD in IBS-D. Participants with moderate to severe IBS-D were provided a two-week standard diet, then four weeks of a VLCD (20 g carbohydrates/d). A responder was defined as having adequate relief of gastrointestinal symptoms for two or more weeks during the VLCD. Changes in abdominal pain, stool habits and quality of life also were measured.
Of the 17 participants enrolled, 13 completed the study and all met the responder definition, with 10 reporting adequate relief for all four VLCD weeks. Stool frequency decreased and stool consistency improved from diarrheal to normal form. Pain scores and quality-of-life measures significantly improved (outcomes were independent of weight loss).
From Clinical Gastroenterology and Hepatology; 2009: 7(6): 706-708.e1
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 later for STRIDES IN INCISION-LESS OPERATIONS NAMED “NOTES” USE MOUTH, OTHER ORIFICES, TO ACCESS PATIENTS'INTERNAL ORGANS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Thursday, September 17, 2009
INFANT MORTALITY IS A MAJOR PUBLIC HEALTH PROBLEM, AND IT’S NOT IMPROVING.
Nicholas Bakalar writes that the United States had a higher infant mortality rate than 28 countries" in "2004, the latest year for which worldwide data are available." That figure is up from "only 11 countries" in 1960. Data also indicate that "there are large differences by race and ethnicity," with "non-Hispanic black, American Indian, Alaska Native, and Puerto Rican women" among those with "the highest rates of infant mortality." “It is thought that the increase in preterm birth and preterm-related causes of death are major factors inhibiting further declines in infant mortality,” said Marian F. MacDorman, the lead author of the report and a statistician at the C.D.C. “Infant mortality is a major public health problem, and it’s not improving.”
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 later for Low-Carb Diet Improves Symptoms & Quality of Life in Diarrhea predominant IBS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
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 later for Low-Carb Diet Improves Symptoms & Quality of Life in Diarrhea predominant IBS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Tuesday, September 15, 2009
AMDPatients are focusing on supplements to help prevent or slow age-related macular degeneration (AMD).
Age-related macular degeneration (AMD) is the leading cause of adult blindness. It is is a degenerative disease of the central portion of the retina (the macula) that results primarily in loss of central vision. Central vision is required for activities such as driving, reading, watching television, and performing activities of daily living. The Eye Diseases Prevalence Research Group (EDPRG) estimated that the prevalence AMD in adults age 40 and over in the United States was 1.47 percent, affecting 1.75 million people, in the year 2000, and projected that by 2020 AMD would affect almost three million people. A variety of potential risk factors have been suggested. Heavy alcohol use (more than three drinks per day) is associated with an increased risk for early AMD. AMD appears to be more prevalent in whites than in blacks with an intermediate prevalence in Hispanics and Chinese. Data are conflicting on the role of hypertension , higher body mass index, and sunlight.
AMDPatients are focusing on supplements to help prevent or slow age-related macular degeneration (AMD).
High doses of beta-carotene, vitamin C, vitamin E, and zinc in a specific product called PreserVision slows progression and loss of visual acuity in people who already have macular degeneration.But now there are concerns about whether these doses are safe. High doses of beta-carotene seem to increase the risk of lung cancer in smokers...and high doses of vitamin E might increase mortality. Now the NIH is testing a lutein and fish oil combo to see if it will slow progression of age-related macular degeneration.
Diets high in foods that contain lutein or fish oil seem to show a benefit...but this doesn't always translate to supplements.
DIETARY lutein seems to lower the risk of developing macular degeneration. Lutein is a yellow pigment that's concentrated in the macula and filters out harmful light. I encourage people to eat foods such as corn, spinach, broccoli, orange juice, grapes, etc.
Lutein SUPPLEMENTS are assumed to help...but so far there's no proof they prevent or slow the progression of macular degeneration.
I tell people not to count on Centrum Silver and other multivits with small amounts of lutein to prevent macular degeneration.
NIH is testing 10 mg/day of lutein, but it's too soon to recommend this high of a dose.
Dietary omega-3 fatty acids from fish or nuts seem to protect against early macular degeneration...but there's no proof that fish oil SUPPLEMENTS have the same benefit.
I tell patients their best bet for prevention is to wear sunglasses and avoid smoking and heavy alcohol drinking.
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 later for Infant Mortality.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
AMDPatients are focusing on supplements to help prevent or slow age-related macular degeneration (AMD).
High doses of beta-carotene, vitamin C, vitamin E, and zinc in a specific product called PreserVision slows progression and loss of visual acuity in people who already have macular degeneration.But now there are concerns about whether these doses are safe. High doses of beta-carotene seem to increase the risk of lung cancer in smokers...and high doses of vitamin E might increase mortality. Now the NIH is testing a lutein and fish oil combo to see if it will slow progression of age-related macular degeneration.
Diets high in foods that contain lutein or fish oil seem to show a benefit...but this doesn't always translate to supplements.
DIETARY lutein seems to lower the risk of developing macular degeneration. Lutein is a yellow pigment that's concentrated in the macula and filters out harmful light. I encourage people to eat foods such as corn, spinach, broccoli, orange juice, grapes, etc.
Lutein SUPPLEMENTS are assumed to help...but so far there's no proof they prevent or slow the progression of macular degeneration.
I tell people not to count on Centrum Silver and other multivits with small amounts of lutein to prevent macular degeneration.
NIH is testing 10 mg/day of lutein, but it's too soon to recommend this high of a dose.
Dietary omega-3 fatty acids from fish or nuts seem to protect against early macular degeneration...but there's no proof that fish oil SUPPLEMENTS have the same benefit.
I tell patients their best bet for prevention is to wear sunglasses and avoid smoking and heavy alcohol drinking.
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 later for Infant Mortality.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Sunday, September 13, 2009
Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.
Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.
On April 26, 2007, ABC World News, the American Broadcasting Corporation's flagship television news program, aired a “good news” story about a new test for prostate cancer. Against a background of a dramatic graphic showing that 1.6 million American men undergo prostate biopsy each year, the presenter announced: “Researchers at Johns Hopkins say they have developed a more accurate blood screening test.” The story was based on a new study examining the performance of early prostate cancer antigen-2 as a serum marker for prostate cancer. Unfortunately, ABC failed to disclose one crucial fact: the principal investigator of this study receives a share of the royalty sales of the test and is a paid consultant to the test's manufacturer. There was no discussion, for example, of the scientific evidence showing that the test was “more accurate” than existing screening tests or of the uncertain benefits and proven harms of prostate cancer screening
This failure was one of a litany of weaknesses in medical stories and poor health reporting.
I encourage all to check an online project called HealthNewsReview.org (http://HealthNewsReview.org/) that evaluates and grades media stories about new health interventions, notifying journalists of their grades. The project builds on other initiatives that monitor the quality of health reporting, such as the Australian Media Doctor Web site (http://www.mediadoctor.org.au/) and the United Kingdom's Behind the Headlines project (http://www.nhs.uk/News/Pages/NewsIndex.aspx ).
HealthNewsReview.org uses a 10-point grading scale. The rating criteria include whether a story adequately quantifies the benefits of an intervention, appraises the supporting evidence, and gives information on the sources of a story and the sources' competing interests. On this scale, the ABC story received a grade of just two. Based on the ratings of 500 stories from the highest circulation newspapers and news magazines, the most widely used wire service (Associated Press), and the three most popular US television networks, the report card from HealthNewsReview.org is grim.
Most stories (62%–77%) failed to adequately address costs, harms, benefits, the quality of evidence, and the existence of other treatment options. The trouble with distorted journalistic reports, is that they can generate false hopes and unwarranted fears. Accurate, balanced, and complete health reporting is crucial, so that “health care consumers are properly informed and ready to participate in decision making about their health care.”
When it comes to the quality of health reporting, why is the bar set so low?
One problem is that today's health reporters may have been covering crime last week and politics the week before. They have rarely been trained to understand the complexities of health research. For example, in her survey of 165 reporters in the US (response rate 69.6%), Melinda Voss found that 83% (96/115) had received no training in interpreting health statistics, and a third said that understanding key health issues was “often” or “nearly always” difficult.
While there are certainly studies in specialist medical journals that will be difficult for many people to grasp, nevertheless there may be some value in establishing a core set of scientific competencies for all health reporters. Indeed, the Association of Health Care Journalists' Statement of Principles states that health reporters should “understand the process of medical research in order to report accurately” (http://www.healthjournalism.org/secondarypage-details.php?id=56 ).
When a health story gets hyped, it is all too easy for medical journal editors to deny any responsibility. The reality, of course, is that journal editors themselves are the third party in the “complicit collaboration”—the journal's press release is the usual mechanism for linking the researcher to the journalist. Medical journals issue press releases about their upcoming studies partly because media publicity drives readers to the journal and builds brand recognition. A bland press release may be less likely to get your journal and the study noticed. Not surprisingly, a content analysis of journal press releases by Steven Woloshin and Lisa Schwartz found that these releases were themselves prone to exaggeration; press releases from research institutions and funding agencies may be equally as prone. Woloshin and Schwartz argue that all journal press releases should include:
(1) a section putting results into context,
(2) a section for the study's limitations,
(3) a statement of the study authors' competing interests, and
(4) a summary of the quantitative results expressed using absolute rather than just relative measures.
COMMENT: In this column or blog of my medical articles I assure all that I try to use all 4 criteria in the story. Wherever possible we attempt to gauge the evidence pro and con with these levels of evidence prior to writing the article.
LEVEL OF EVIDENCE for the medical articles we publish on this website.
Level Definition
A High-quality randomized controlled trial (RCT)
High-quality meta-analysis (quantitative systematic review)
B Nonrandomized clinical trial
Nonquantitative systematic review
Lower quality RCT
Clinical cohort study
Case-control study
Historical control
Epidemiologic study
C Consensus
Expert opinion
D Anecdotal evidence
In vitro or animal study
Adapted from Siwek J, et al. How to write an evidence-based clinical review article. Am Fam Physician 2002;65:251-8.
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 later for Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
On April 26, 2007, ABC World News, the American Broadcasting Corporation's flagship television news program, aired a “good news” story about a new test for prostate cancer. Against a background of a dramatic graphic showing that 1.6 million American men undergo prostate biopsy each year, the presenter announced: “Researchers at Johns Hopkins say they have developed a more accurate blood screening test.” The story was based on a new study examining the performance of early prostate cancer antigen-2 as a serum marker for prostate cancer. Unfortunately, ABC failed to disclose one crucial fact: the principal investigator of this study receives a share of the royalty sales of the test and is a paid consultant to the test's manufacturer. There was no discussion, for example, of the scientific evidence showing that the test was “more accurate” than existing screening tests or of the uncertain benefits and proven harms of prostate cancer screening
This failure was one of a litany of weaknesses in medical stories and poor health reporting.
I encourage all to check an online project called HealthNewsReview.org (http://HealthNewsReview.org/) that evaluates and grades media stories about new health interventions, notifying journalists of their grades. The project builds on other initiatives that monitor the quality of health reporting, such as the Australian Media Doctor Web site (http://www.mediadoctor.org.au/) and the United Kingdom's Behind the Headlines project (http://www.nhs.uk/News/Pages/NewsIndex.aspx ).
HealthNewsReview.org uses a 10-point grading scale. The rating criteria include whether a story adequately quantifies the benefits of an intervention, appraises the supporting evidence, and gives information on the sources of a story and the sources' competing interests. On this scale, the ABC story received a grade of just two. Based on the ratings of 500 stories from the highest circulation newspapers and news magazines, the most widely used wire service (Associated Press), and the three most popular US television networks, the report card from HealthNewsReview.org is grim.
Most stories (62%–77%) failed to adequately address costs, harms, benefits, the quality of evidence, and the existence of other treatment options. The trouble with distorted journalistic reports, is that they can generate false hopes and unwarranted fears. Accurate, balanced, and complete health reporting is crucial, so that “health care consumers are properly informed and ready to participate in decision making about their health care.”
When it comes to the quality of health reporting, why is the bar set so low?
One problem is that today's health reporters may have been covering crime last week and politics the week before. They have rarely been trained to understand the complexities of health research. For example, in her survey of 165 reporters in the US (response rate 69.6%), Melinda Voss found that 83% (96/115) had received no training in interpreting health statistics, and a third said that understanding key health issues was “often” or “nearly always” difficult.
While there are certainly studies in specialist medical journals that will be difficult for many people to grasp, nevertheless there may be some value in establishing a core set of scientific competencies for all health reporters. Indeed, the Association of Health Care Journalists' Statement of Principles states that health reporters should “understand the process of medical research in order to report accurately” (http://www.healthjournalism.org/secondarypage-details.php?id=56 ).
When a health story gets hyped, it is all too easy for medical journal editors to deny any responsibility. The reality, of course, is that journal editors themselves are the third party in the “complicit collaboration”—the journal's press release is the usual mechanism for linking the researcher to the journalist. Medical journals issue press releases about their upcoming studies partly because media publicity drives readers to the journal and builds brand recognition. A bland press release may be less likely to get your journal and the study noticed. Not surprisingly, a content analysis of journal press releases by Steven Woloshin and Lisa Schwartz found that these releases were themselves prone to exaggeration; press releases from research institutions and funding agencies may be equally as prone. Woloshin and Schwartz argue that all journal press releases should include:
(1) a section putting results into context,
(2) a section for the study's limitations,
(3) a statement of the study authors' competing interests, and
(4) a summary of the quantitative results expressed using absolute rather than just relative measures.
COMMENT: In this column or blog of my medical articles I assure all that I try to use all 4 criteria in the story. Wherever possible we attempt to gauge the evidence pro and con with these levels of evidence prior to writing the article.
LEVEL OF EVIDENCE for the medical articles we publish on this website.
Level Definition
A High-quality randomized controlled trial (RCT)
High-quality meta-analysis (quantitative systematic review)
B Nonrandomized clinical trial
Nonquantitative systematic review
Lower quality RCT
Clinical cohort study
Case-control study
Historical control
Epidemiologic study
C Consensus
Expert opinion
D Anecdotal evidence
In vitro or animal study
Adapted from Siwek J, et al. How to write an evidence-based clinical review article. Am Fam Physician 2002;65:251-8.
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 later for Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Friday, September 11, 2009
THE TREATMENT OF PINK EYE
Conjunctivitis, commonly known as "pink eye" can be allergic, viral, or bacterial in nature. Pathogens most frequently responsible for bacterial conjunctivitis are Streptococcus pneumoniae, Haemophilus influenza, and Staphylococcus aureus.
One way to differentiate bacterial from viral conjunctivitis is that bacterial conjunctivitis usually presents with a purulent discharge. A watery discharge is commonly seen with viral conjunctivitis. Symptoms of bacterial conjunctivis include red eyes, swelling, eyelids sticking together, itching, watering, and a white or yellow sticky discharge from the eyes.
Bacterial conjunctivitis is frequently self-limiting, resolving spontaneously within seven to 14 days in 60% to 70% of the cases. However, treatment with antibacterial agents provide marginal benefit by leading to a faster clinical and microbiological cure and reducing the rate of disease transmission and the chance of rare complications. In addition, some daycares and schools require children with conjunctivitis to be treated with an ophthalmic antibacterial for at least 24 to 48 hours before they can return.
To help manage symptoms of bacterial conjunctivitis, recommend cold or warm compresses, lubricants, ocular decongestants, etc. Bacterial conjunctivitis can be considered contagious until antibiotics have been on board for 24 to 48 hours or until symptoms clear. I emphasize proper hygiene (e.g., hand washing, not touching the eyes with hands, use clean washcloths, etc) and avoiding close contact with others to prevent spreading the infection. I tell patients who use contact lenses to wear their prescription eyeglasses instead, until the infection is cleared.
The goals when treating bacterial conjunctivitis are to improve patient comfort, reduce the course of infection/inflammation, and prevent the spread of infection. Topical therapy is usually sufficient. Eyedrops have the advantage of not interfering with vision and are generally the preferred form for adults. On the other hand, ointments have the advantage of prolonged contact with the ocular surface and are usually preferable in young children. Improvement is generally seen within three to four days of treatment initiation. Patients should be referred to an ophthalmologist if there is no improvement within the first 24 hours after initiation of therapy or if the condition worsens.
Topical corticosteroids should be avoided since some conditions that present as a red eye with watery discharge, such as herpetic keratitis, can worsen with corticosteroid use.
Treatment options for bacterial conjunctivitis include sulfacetamide (Bleph-10, etc), erythromycin, bacitracin (AK-Tracin), bacitracin-polymyxin B (Polysporin), polymyxin B-neomycin-gramicidin (Neosporin), trimethoprim-polymyxin B (Polytrim), aminoglycosides (e.g., gentamicin, tobromycin, etc), quinolones (ciprofloxacin [Ciloxan], levofloxacin [Quixin], gatifloxacin [Zymar], etc), and azithromycin (AzaSite).
There are no significant differences between the clinical effects of various ophthalmic antibacterial agents used in patients with suspected acute bacterial conjunctivitis. The choice of treatment is based on ease of use, side-effects, bacterial susceptibility, and cost. In general, fewer daily doses yields better compliance to treatment.
Azithromycin ophthalmic solution (AzaSite) is dosed less frequently than other ophthalmic antibacterial agents (one drop twice daily for two days, then one drop daily for five days), but it is considerably more expensive and difficult to use. Fluoroquinolones are highly effective and well-tolerated; however, they are generally not used first-line for routine cases of bacterial conjunctivitis due to concerns of emerging resistance and cost. In general, agents that are less expensive with broad-spectrum coverage are used first-line for acute bacterial conjunctivitis (e.g., Polytrim, Polysporin, etc).
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 later for Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
One way to differentiate bacterial from viral conjunctivitis is that bacterial conjunctivitis usually presents with a purulent discharge. A watery discharge is commonly seen with viral conjunctivitis. Symptoms of bacterial conjunctivis include red eyes, swelling, eyelids sticking together, itching, watering, and a white or yellow sticky discharge from the eyes.
Bacterial conjunctivitis is frequently self-limiting, resolving spontaneously within seven to 14 days in 60% to 70% of the cases. However, treatment with antibacterial agents provide marginal benefit by leading to a faster clinical and microbiological cure and reducing the rate of disease transmission and the chance of rare complications. In addition, some daycares and schools require children with conjunctivitis to be treated with an ophthalmic antibacterial for at least 24 to 48 hours before they can return.
To help manage symptoms of bacterial conjunctivitis, recommend cold or warm compresses, lubricants, ocular decongestants, etc. Bacterial conjunctivitis can be considered contagious until antibiotics have been on board for 24 to 48 hours or until symptoms clear. I emphasize proper hygiene (e.g., hand washing, not touching the eyes with hands, use clean washcloths, etc) and avoiding close contact with others to prevent spreading the infection. I tell patients who use contact lenses to wear their prescription eyeglasses instead, until the infection is cleared.
The goals when treating bacterial conjunctivitis are to improve patient comfort, reduce the course of infection/inflammation, and prevent the spread of infection. Topical therapy is usually sufficient. Eyedrops have the advantage of not interfering with vision and are generally the preferred form for adults. On the other hand, ointments have the advantage of prolonged contact with the ocular surface and are usually preferable in young children. Improvement is generally seen within three to four days of treatment initiation. Patients should be referred to an ophthalmologist if there is no improvement within the first 24 hours after initiation of therapy or if the condition worsens.
Topical corticosteroids should be avoided since some conditions that present as a red eye with watery discharge, such as herpetic keratitis, can worsen with corticosteroid use.
Treatment options for bacterial conjunctivitis include sulfacetamide (Bleph-10, etc), erythromycin, bacitracin (AK-Tracin), bacitracin-polymyxin B (Polysporin), polymyxin B-neomycin-gramicidin (Neosporin), trimethoprim-polymyxin B (Polytrim), aminoglycosides (e.g., gentamicin, tobromycin, etc), quinolones (ciprofloxacin [Ciloxan], levofloxacin [Quixin], gatifloxacin [Zymar], etc), and azithromycin (AzaSite).
There are no significant differences between the clinical effects of various ophthalmic antibacterial agents used in patients with suspected acute bacterial conjunctivitis. The choice of treatment is based on ease of use, side-effects, bacterial susceptibility, and cost. In general, fewer daily doses yields better compliance to treatment.
Azithromycin ophthalmic solution (AzaSite) is dosed less frequently than other ophthalmic antibacterial agents (one drop twice daily for two days, then one drop daily for five days), but it is considerably more expensive and difficult to use. Fluoroquinolones are highly effective and well-tolerated; however, they are generally not used first-line for routine cases of bacterial conjunctivitis due to concerns of emerging resistance and cost. In general, agents that are less expensive with broad-spectrum coverage are used first-line for acute bacterial conjunctivitis (e.g., Polytrim, Polysporin, etc).
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 later for Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Wednesday, September 9, 2009
THE PROBLEM OF ABUSIVE HEAD TRAUMA (AHT) AND CHILD ABUSE
A child comes into the ER for a possible fracture. A skeletal survey is performed that reveals a healing right radial neck fracture. The medical record from the urgent care center is obtained. This includes a clinical note dated 4 months prior to patient's presentation to the ED, which described a visit for repeated emesis and irritability. A bruise on the chin was noted on that visit, and the explanation given was a fall inside the patient's crib that occurred 4 days prior to that visit. A report to the Department of Children and Families was found to have been made for missed well-child visits
The level of suspicion for suspected abusive head trauma (AHT) and child abuse should be high. AHT in babies less than 1 year old represents a significant fraction of young children admitted for head injury. Approximately 30% of children aged 0-3 years admitted to pediatric hospitals for intracranial injury have been found to meet the criteria for abuse. Crying is thought to be a trigger for many cases of AHT and prevention efforts are directed toward caregiver response to colicky babies and crying infants.
Approximately 30% of children with AHT may be missed on the initial presentation. Common misdiagnoses include viral gastroenteritis, sepsis, and accidental head injury. Common symptoms at presentation are often the result of acute brain injury (ie, lethargy, decreased level of consciousness, vomiting, apnea, hypotonia, and seizures).
The physical examination findings may include evidence of soft tissue injury, particularly swelling or bruising; however, the absence of bruising or other evidence of trauma neither excludes injury nor abuse.
Funduscopic examination should be performed in any child suspected to have abusive head injury, preferably by an ophthalmologist with sufficient pediatric experience to determine the significance of any identified injury.Retinal hemorrhages are a hallmark finding in abusive head injury, and they are present in a majority of children who carry the diagnosis. They may be unilateral or bilateral and involve 1 or more layers. The mechanism of retinal hemorrhages is unclear, but the leading theory is that they are caused by vitreous traction on the retina during acceleration/deceleration. Lasting visual impairment in those children who survive AHT is common.CT scanning is an essential part of the initial workup of suspected head trauma. CT scanning can also be helpful as a screening neuroimaging study in children with suspected abuse. Even without clinical examination findings of brain injury, a significant number of abused infants will have important findings on neuroimaging.
Unilateral, bilateral, or parafalcine subdural hemorrhages are the most common radiologic finding in infants with AHT. Subdural hemorrhages of mixed attenuation have previously been considered as evidence for repeated head injury, with hyperdense components of the hemorrhage associated with injury occurring in the past 48-72 hours and hypodense components representing older injury occurring more than 3 weeks prior to the scan. Hyperacute bleeding or the mixing of blood and cerebrospinal fluid (CSF), however, can produce mixed-density lesions from a single injury. While the presence of subdural hemorrhage lends supporting evidence to the diagnosis of head trauma, inferences about the timing and mechanism of injury cannot be drawn with certainty from a single noncontrast CT scan.Magnetic resonance imaging (MRI) can be a useful study for demonstrating parenchymal contusion, axonal shearing, extra-axial hemorrhages, and posterior fossa injuries. Diffusion-weighted imaging and apparent diffusion coefficient mapping are particularly useful. Additional supportive evidence for child abuse is obtained through a skeletal survey. The presence of previously healed fractures in infants is strongly suggestive of chronic abuse.
While the cause of subdural hematoma in association with retinal hemorrhage will most commonly be abusive head injury, a differential diagnosis for these findings must be considered. It is important for clinicians to be mindful of the diagnosis of AHT, but first rule out other rare causes that can mimic abuse.
• Coagulopathies have been associated with retinal and intracranial hemorrhage in infants, including hemophilia, vitamin-K deficiency, and disseminated intravascular coagulopathy. Retinal hemorrhages in these disorders are typically confined to the posterior pole, and the nature of the bleeding problem can be detected by laboratory tests. It is recommended to perform a prothrombin time, activated partial-thromboplastin time, and a platelet count as minimum screening tests.
• Glutaric aciduria type I, a rare metabolic disease, is associated with developmental delay and subdural hemorrhages. Performing an assay for organic acids in the urine can test for this disease.
• Other causes of intracerebral hemorrhage include cerebral malaria, intracranial aneurysms, galactosemia, and meningitis.
• Osteogenesis imperfecta is an uncommon connective tissue disorder that frequently results in fractures. Subdural hemorrhage has rarely been described as a complication of this disease.
• Because these disorders can closely mimic abusive head trauma, it is important to maintain a nonaccusatory and open-minded posture during the initial evaluation, as parents are understandably sensitive to the possibility that they are being accused of harming their children. Some helpful statements include "I'm concerned that someone may have harmed your child" and "several diseases can explain this pattern of injury, including trauma. We need to check for other signs of these illnesses to make sure your child is safe."
Notwithstanding the latest negative publicity about CT scans, clinicians should have a low threshold for performing CT scans of the head on infants coming in with nonspecific findings that could be explained by head injury, when appropriate.
While reporting a reasonable suspicion for abuse is mandatory, it is not the job of the healthcare provider to determine the social or legal management of any case.
A child protection team, if available, should be consulted with any concerns of abusive injury. AHT is likely underdiagnosed and underreported, which contributes to the dismal outcomes for children eventually diagnosed with abuse. In multiple series, the mortality is approximately 20%.
The neurologic outcome is also poor, with many survivors having persistent neurologic and behavioral deficits.
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 later for THE TREATMENT OF PINK EYE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
The level of suspicion for suspected abusive head trauma (AHT) and child abuse should be high. AHT in babies less than 1 year old represents a significant fraction of young children admitted for head injury. Approximately 30% of children aged 0-3 years admitted to pediatric hospitals for intracranial injury have been found to meet the criteria for abuse. Crying is thought to be a trigger for many cases of AHT and prevention efforts are directed toward caregiver response to colicky babies and crying infants.
Approximately 30% of children with AHT may be missed on the initial presentation. Common misdiagnoses include viral gastroenteritis, sepsis, and accidental head injury. Common symptoms at presentation are often the result of acute brain injury (ie, lethargy, decreased level of consciousness, vomiting, apnea, hypotonia, and seizures).
The physical examination findings may include evidence of soft tissue injury, particularly swelling or bruising; however, the absence of bruising or other evidence of trauma neither excludes injury nor abuse.
Funduscopic examination should be performed in any child suspected to have abusive head injury, preferably by an ophthalmologist with sufficient pediatric experience to determine the significance of any identified injury.Retinal hemorrhages are a hallmark finding in abusive head injury, and they are present in a majority of children who carry the diagnosis. They may be unilateral or bilateral and involve 1 or more layers. The mechanism of retinal hemorrhages is unclear, but the leading theory is that they are caused by vitreous traction on the retina during acceleration/deceleration. Lasting visual impairment in those children who survive AHT is common.CT scanning is an essential part of the initial workup of suspected head trauma. CT scanning can also be helpful as a screening neuroimaging study in children with suspected abuse. Even without clinical examination findings of brain injury, a significant number of abused infants will have important findings on neuroimaging.
Unilateral, bilateral, or parafalcine subdural hemorrhages are the most common radiologic finding in infants with AHT. Subdural hemorrhages of mixed attenuation have previously been considered as evidence for repeated head injury, with hyperdense components of the hemorrhage associated with injury occurring in the past 48-72 hours and hypodense components representing older injury occurring more than 3 weeks prior to the scan. Hyperacute bleeding or the mixing of blood and cerebrospinal fluid (CSF), however, can produce mixed-density lesions from a single injury. While the presence of subdural hemorrhage lends supporting evidence to the diagnosis of head trauma, inferences about the timing and mechanism of injury cannot be drawn with certainty from a single noncontrast CT scan.Magnetic resonance imaging (MRI) can be a useful study for demonstrating parenchymal contusion, axonal shearing, extra-axial hemorrhages, and posterior fossa injuries. Diffusion-weighted imaging and apparent diffusion coefficient mapping are particularly useful. Additional supportive evidence for child abuse is obtained through a skeletal survey. The presence of previously healed fractures in infants is strongly suggestive of chronic abuse.
While the cause of subdural hematoma in association with retinal hemorrhage will most commonly be abusive head injury, a differential diagnosis for these findings must be considered. It is important for clinicians to be mindful of the diagnosis of AHT, but first rule out other rare causes that can mimic abuse.
• Coagulopathies have been associated with retinal and intracranial hemorrhage in infants, including hemophilia, vitamin-K deficiency, and disseminated intravascular coagulopathy. Retinal hemorrhages in these disorders are typically confined to the posterior pole, and the nature of the bleeding problem can be detected by laboratory tests. It is recommended to perform a prothrombin time, activated partial-thromboplastin time, and a platelet count as minimum screening tests.
• Glutaric aciduria type I, a rare metabolic disease, is associated with developmental delay and subdural hemorrhages. Performing an assay for organic acids in the urine can test for this disease.
• Other causes of intracerebral hemorrhage include cerebral malaria, intracranial aneurysms, galactosemia, and meningitis.
• Osteogenesis imperfecta is an uncommon connective tissue disorder that frequently results in fractures. Subdural hemorrhage has rarely been described as a complication of this disease.
• Because these disorders can closely mimic abusive head trauma, it is important to maintain a nonaccusatory and open-minded posture during the initial evaluation, as parents are understandably sensitive to the possibility that they are being accused of harming their children. Some helpful statements include "I'm concerned that someone may have harmed your child" and "several diseases can explain this pattern of injury, including trauma. We need to check for other signs of these illnesses to make sure your child is safe."
Notwithstanding the latest negative publicity about CT scans, clinicians should have a low threshold for performing CT scans of the head on infants coming in with nonspecific findings that could be explained by head injury, when appropriate.
While reporting a reasonable suspicion for abuse is mandatory, it is not the job of the healthcare provider to determine the social or legal management of any case.
A child protection team, if available, should be consulted with any concerns of abusive injury. AHT is likely underdiagnosed and underreported, which contributes to the dismal outcomes for children eventually diagnosed with abuse. In multiple series, the mortality is approximately 20%.
The neurologic outcome is also poor, with many survivors having persistent neurologic and behavioral deficits.
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 later for THE TREATMENT OF PINK EYE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Monday, September 7, 2009
THE DANGERS OF ACID REDUCING MEDICATIONS LIKE NEXIUM AND OTHER PPIs
Increased risks of C.dificile infection, pneumonia, bone fractures.
Though initially "recommended for intensive-care patients to prevent stress ulcers," some 40 to 70 percent of inpatients now receive acid-suppressive drugs" like Nexium [esomeprazole], Prilosec [omeprazole], and Prevacid [lansoprazole], "with about half receiving them for the first time." This increased their risk of contracting pneumonia by 30 percent.
We now know that PPIs also increase the chances of getting C.difficile disease, especially those patients receiving PPIs in the hospital or long term care facility..
Gulmez et al writing in the Arch Intern Med. 2007;167(9):950-955 --Use of Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia --A Population-Based Case-Control Study conclude that the use of PPIs, especially when recently begun, is associated with an increased risk of community-acquired pneumonia. The authors conducted a population-based case-control study using data of all patients with a first-discharge diagnosis of community-acquired pneumonia from a hospital during 2000 through 2004. The adjusted odds ratio (OR) associating current use of PPIs with community-acquired pneumonia was 1.5 (95% confidence interval [CI], 1.3-1.7). N
It is of interest that no association was found with the older histamine2-receptor antagonists like Tagamet, Pepcid and others. (OR, 1.10; 95% CI, 0.8-1.3) or with past use of PPIs (OR, 1.2; 95% CI, 0.9-1.6). Only recent initiation of treatment with PPIs (0-7 days before index date) showed a particularly strong association with community-acquired pneumonia (OR, 5.0; 95% 2.1-11.7), while the risk decreased with treatment that was started a long time ago.
Harvard researchers are also saying that "patients who take proton pump inhibitors (PPIs) are at higher risk for pneumonia than those who do not," a finding that is of note, considering that a "growing number of hospital patients are routinely given drugs to prevent acid reflux."
In a Harvard study all patients included in the study were hospitalized for at least three days, and none were in intensive care units." Slightly "over half -- 52 percent -- received some sort of acid-suppressing medication to help prevent stress ulcers."
Another large retrospective study reported on 6/4/09 has found a strong link between use of proton pump inhibitors (PPIs) and hip fracture risk Those at highest risk were those patients who had at least one other standard risk factor for hip fracture, such as renal impairment, diabetes, or glucocorticoid, estrogen, and bisphosphonates use An analysis of a healthcare company's massive database found that the rate of hip fractures was increased by about 30% in patients using PPIs for two years or more prior to fracture.
The study focused on 33,752 Kaiser members who had suffered a hip or femur fracture along with more than 130,000 controls matched for age, sex, race, and length of Kaiser membership.
In men, the odds ratio for hip fracture with at least two years' PPI use was 1.34 (95% CI 1.18 to 1.51). The odds ratio for women was 1.28 (95% CI 1.17 to 1.39).
The analysis showed no associations with drugs such as ACE inhibitors, calcium channel blockers, or non-narcotic painkillers.
When the researchers looked at the effects of age, they found the greatest increase in risk among those 50 to 59 years old (OR 2.31, 95% CI 1.67 to 3.18).
Another database study published last year indicated that PPI use for at least seven years led to a nearly doubled risk of osteoporotic fracture
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 later for THE PROBLEM OF ABUSIVE HEAD TRAUMA.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Though initially "recommended for intensive-care patients to prevent stress ulcers," some 40 to 70 percent of inpatients now receive acid-suppressive drugs" like Nexium [esomeprazole], Prilosec [omeprazole], and Prevacid [lansoprazole], "with about half receiving them for the first time." This increased their risk of contracting pneumonia by 30 percent.
We now know that PPIs also increase the chances of getting C.difficile disease, especially those patients receiving PPIs in the hospital or long term care facility..
Gulmez et al writing in the Arch Intern Med. 2007;167(9):950-955 --Use of Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia --A Population-Based Case-Control Study conclude that the use of PPIs, especially when recently begun, is associated with an increased risk of community-acquired pneumonia. The authors conducted a population-based case-control study using data of all patients with a first-discharge diagnosis of community-acquired pneumonia from a hospital during 2000 through 2004. The adjusted odds ratio (OR) associating current use of PPIs with community-acquired pneumonia was 1.5 (95% confidence interval [CI], 1.3-1.7). N
It is of interest that no association was found with the older histamine2-receptor antagonists like Tagamet, Pepcid and others. (OR, 1.10; 95% CI, 0.8-1.3) or with past use of PPIs (OR, 1.2; 95% CI, 0.9-1.6). Only recent initiation of treatment with PPIs (0-7 days before index date) showed a particularly strong association with community-acquired pneumonia (OR, 5.0; 95% 2.1-11.7), while the risk decreased with treatment that was started a long time ago.
Harvard researchers are also saying that "patients who take proton pump inhibitors (PPIs) are at higher risk for pneumonia than those who do not," a finding that is of note, considering that a "growing number of hospital patients are routinely given drugs to prevent acid reflux."
In a Harvard study all patients included in the study were hospitalized for at least three days, and none were in intensive care units." Slightly "over half -- 52 percent -- received some sort of acid-suppressing medication to help prevent stress ulcers."
Another large retrospective study reported on 6/4/09 has found a strong link between use of proton pump inhibitors (PPIs) and hip fracture risk Those at highest risk were those patients who had at least one other standard risk factor for hip fracture, such as renal impairment, diabetes, or glucocorticoid, estrogen, and bisphosphonates use An analysis of a healthcare company's massive database found that the rate of hip fractures was increased by about 30% in patients using PPIs for two years or more prior to fracture.
The study focused on 33,752 Kaiser members who had suffered a hip or femur fracture along with more than 130,000 controls matched for age, sex, race, and length of Kaiser membership.
In men, the odds ratio for hip fracture with at least two years' PPI use was 1.34 (95% CI 1.18 to 1.51). The odds ratio for women was 1.28 (95% CI 1.17 to 1.39).
The analysis showed no associations with drugs such as ACE inhibitors, calcium channel blockers, or non-narcotic painkillers.
When the researchers looked at the effects of age, they found the greatest increase in risk among those 50 to 59 years old (OR 2.31, 95% CI 1.67 to 3.18).
Another database study published last year indicated that PPI use for at least seven years led to a nearly doubled risk of osteoporotic fracture
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 later for THE PROBLEM OF ABUSIVE HEAD TRAUMA.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Saturday, September 5, 2009
LONGER-TERM HORMONE THERAPY APPEARS TO BE THE STANDARD OF CARE IN ADVANCED PROSTATE CANCER
Research suggests prolonged chemical castration may be needed to suppress prostate tumor-fueling hormones.
There is, however, much debate regarding the appropriate treatment for tumors that have metastasized to both prostate lobes. While androgen-deprivation therapy has increased patients' survival odds, those subjected to the treatment for extended periods of time often experienced hot flashes, a sluggish libido, and other unwanted side effects. But this much appears certain at this time.
Prostate cancer patients need three years of treatment known as chemical castration to suppress the production of tumor-fueling hormones and improve their chance of survival," according to researchers in France who had hoped that "cutting back on the drugs would provide the same benefit as longer-term treatment." What they found instead was that "patients treated for six months were more likely to die than those on the drugs for several years."
So, the French team decided to see "if six months of androgen suppression could provide the same benefit as three years of treatment, but with fewer adverse effects. Study participants "had confirmed but nonmetastatic prostate cancer in either T1c to T2a-b clinical stage with pathological nodal stage N1 or N2 or stages T2c to T4 with clinical nodal stages N0 to N2." Following "external beam radiation, all of the men received six months of androgen blockade with a luteinizing hormone-releasing hormone analogue -- started on the first day of radiation -- and a daily antiandrogen agent started a week earlier." Six months later, "patients whose disease had not progressed were randomly assigned to no further treatment (and formed the short-term therapy group) or to another 2.5 years of androgen blockade with the luteinizing hormone-releasing hormone analogue but without the antiandrogen agent." Altogether, "970 men were randomized -- 483 to short-term suppression and 487 to long-term suppression."
By study end, investigators noted that "the five-year death rate of men in the longer-treatment group was 15.2 percent, compared with 19 percent for those in the shorter-term treatment group,"
COMMENT:
These results pretty much mirror those of a similar American trial according to Dr. Eric M. Horwitz, of the Fox Chase Cancer Center in Philadelphia, who led the group that did the US study of 1,554 men who were followed for 10 years. That work revealed that the disease-free survival rate for the short-term group was 13.2 percent, compared with 22.5 percent for those treated longer." "We have long believed that longer-term hormone therapy is the standard of care, and "these studies support that belief.
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 later for THE DANGERS OF ACID REDUCING MEDICATIONS LIKE NEXIUM AND OTHER PPIs-.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
There is, however, much debate regarding the appropriate treatment for tumors that have metastasized to both prostate lobes. While androgen-deprivation therapy has increased patients' survival odds, those subjected to the treatment for extended periods of time often experienced hot flashes, a sluggish libido, and other unwanted side effects. But this much appears certain at this time.
Prostate cancer patients need three years of treatment known as chemical castration to suppress the production of tumor-fueling hormones and improve their chance of survival," according to researchers in France who had hoped that "cutting back on the drugs would provide the same benefit as longer-term treatment." What they found instead was that "patients treated for six months were more likely to die than those on the drugs for several years."
So, the French team decided to see "if six months of androgen suppression could provide the same benefit as three years of treatment, but with fewer adverse effects. Study participants "had confirmed but nonmetastatic prostate cancer in either T1c to T2a-b clinical stage with pathological nodal stage N1 or N2 or stages T2c to T4 with clinical nodal stages N0 to N2." Following "external beam radiation, all of the men received six months of androgen blockade with a luteinizing hormone-releasing hormone analogue -- started on the first day of radiation -- and a daily antiandrogen agent started a week earlier." Six months later, "patients whose disease had not progressed were randomly assigned to no further treatment (and formed the short-term therapy group) or to another 2.5 years of androgen blockade with the luteinizing hormone-releasing hormone analogue but without the antiandrogen agent." Altogether, "970 men were randomized -- 483 to short-term suppression and 487 to long-term suppression."
By study end, investigators noted that "the five-year death rate of men in the longer-treatment group was 15.2 percent, compared with 19 percent for those in the shorter-term treatment group,"
COMMENT:
These results pretty much mirror those of a similar American trial according to Dr. Eric M. Horwitz, of the Fox Chase Cancer Center in Philadelphia, who led the group that did the US study of 1,554 men who were followed for 10 years. That work revealed that the disease-free survival rate for the short-term group was 13.2 percent, compared with 22.5 percent for those treated longer." "We have long believed that longer-term hormone therapy is the standard of care, and "these studies support that belief.
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 later for THE DANGERS OF ACID REDUCING MEDICATIONS LIKE NEXIUM AND OTHER PPIs-.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Thursday, September 3, 2009
MORE MEDICAL SCHOOLS BEEF UP CONFLICTS POLICIES
But report says many medical schools have inadequate conflict-of-interest, medical-device policies.
Wall Street Journal Health Blogger, Shirley S. Wang points out that although "more medical schools are improving their conflict-of-interest policies to police their ties with drug and medical-device makers," more than half of the schools "still have inadequate policies or no policies at all," according to data from the American Medical Student Association and the Pew Prescription Project. In the report, "45, or a third, of medical schools rated earned a 'A' or 'B' grade on the latest AMSA PharmFree Scorecard, which means the school made 'a serious attempt to think and address the appropriate relationship of medical faculty to the pharmaceutical and medical-device industry.'" Last year, "just 21 schools were awarded one of these top grades.
More medical schools are improving their conflict-of-interest policies to police their ties with drug and medical-device makers.
But more than half the schools still have inadequate policies or no policies at all.
Forty-five, or a third, of medical schools rated earned a “A” or “B” grade on the latest AMSA PharmFree Scorecard, which means the school made “a serious attempt to think and address the appropriate relationship of medical faculty to the pharmaceutical and medical-device industry,” Last year, just 21 schools were awarded one of these top grades.
The groups’ goal isn’t to sever relationships between the academic medical community and the private sector, which are needed to advance new technology.Rather, “company marketing should become less of a driver of prescribing. Gifts, free meals and paying doctors to be on speaker’s bureaus are undesirable in the groups’ eyes.
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 later for LONGER-TERM HORMONE THERAPY APPEARS TO BE THE STANDARD OF CARE IN ADVANCED PROSTATE CANCER.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Wall Street Journal Health Blogger, Shirley S. Wang points out that although "more medical schools are improving their conflict-of-interest policies to police their ties with drug and medical-device makers," more than half of the schools "still have inadequate policies or no policies at all," according to data from the American Medical Student Association and the Pew Prescription Project. In the report, "45, or a third, of medical schools rated earned a 'A' or 'B' grade on the latest AMSA PharmFree Scorecard, which means the school made 'a serious attempt to think and address the appropriate relationship of medical faculty to the pharmaceutical and medical-device industry.'" Last year, "just 21 schools were awarded one of these top grades.
More medical schools are improving their conflict-of-interest policies to police their ties with drug and medical-device makers.
But more than half the schools still have inadequate policies or no policies at all.
Forty-five, or a third, of medical schools rated earned a “A” or “B” grade on the latest AMSA PharmFree Scorecard, which means the school made “a serious attempt to think and address the appropriate relationship of medical faculty to the pharmaceutical and medical-device industry,” Last year, just 21 schools were awarded one of these top grades.
The groups’ goal isn’t to sever relationships between the academic medical community and the private sector, which are needed to advance new technology.Rather, “company marketing should become less of a driver of prescribing. Gifts, free meals and paying doctors to be on speaker’s bureaus are undesirable in the groups’ eyes.
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 later for LONGER-TERM HORMONE THERAPY APPEARS TO BE THE STANDARD OF CARE IN ADVANCED PROSTATE CANCER.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Tuesday, September 1, 2009
INVESTING HEAVILY IN PREVENTION MEASURES MAY NOT REDUCE HEALTHCARE COSTS, RESEARCH SUGGESTS.
Even though past efforts have yielded "little success," lawmakers on both sides of the aisle are fixated on "one idea" when it comes to reigning in the healthcare system's spiraling costs: "A bigger government role in disease prevention." This is the conventional Washington wisdom. “The health-care system is tilted toward a disease system rather than a wellness system," said Health and Human Services Secretary Kathleen Sebelius in an interview.
But what if they built this big edifice of preventive care and no one came?
Many previous government prevention efforts aimed at costly chronic diseases have had little success in reducing illness or costs. Medicare has conducted seven pilot programs in the past decade testing the theory on some of the most costly chronic diseases. Each showed little if any cost savings or measurable improvement in patients' health.
The largest experiment, the Medicare Health Support program, started in 2005 and eventually included about 200,000 patients. Groups were assigned to companies that specialize in helping people with chronic health conditions lower their medical costs and keep from getting sicker. Most of the patients had diabetes or congestive heart failure.
Nurses contacted the patients to make sure they were following doctors' instructions to take medication and reduce sodium intake. They also mailed patients packets about their diseases and directed them toward community health classes.
Overall, the program didn't reduce the group's rate of acute-care hospitalizations, hospital readmissions, emergency-room visits or death. It also didn't meet its goal of lowering patients' Medicare payments in an amount equal to the cost of the prevention services. The company that achieved the highest cost savings recouped only 26% of the fees spent on the program through lower Medicare spending.
There are studies which corroborate the "benefits of a healthy lifestyle." But the "problem is that when testing becomes too widespread, or heavy investments are made in monitoring people with chronic diseases, the rewards often fail to match the costs." This was exemplified in a 2008 NEJM report "which examined 279 spending ratios in published studies of health-oriented prevention measures, and another 1,221 on treatments for people who were already sick and "concluded that most preventive measures reviewed didn't save money. For instance, screening all 65-year-olds for diabetes would cost an extra $590,000 for every healthy year of life it adds over just screening people that age with high blood pressure."
To cap it all off the Congressional Budget Office, in its report, concluded that greater use of preventive care would at best generate modest reductions in costs over 10 years, and might even result in increases.
One reason cost savings are hard to achieve, is that much of the money spent on disease prevention goes for people who aren't going to get sick anyway. Also, people have trouble making difficult lifestyle changes, such as taking up regular exercise or eating healthier food.
CQ Today reports that preventive care's financial benefits is a "myth.” Although such initiatives would, in many cases, result in better health, it is less clear that they would reduce total spending for healthcare. ... Many other studies that have examined the impact of such initiatives do not indicate net savings."
So much for the conventional wisdom and saving money for Health care reform by increasing preventive care.
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 later for MORE MEDICAL SCHOOLS BEEF UP CONFLICTS POLICIES.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
But what if they built this big edifice of preventive care and no one came?
Many previous government prevention efforts aimed at costly chronic diseases have had little success in reducing illness or costs. Medicare has conducted seven pilot programs in the past decade testing the theory on some of the most costly chronic diseases. Each showed little if any cost savings or measurable improvement in patients' health.
The largest experiment, the Medicare Health Support program, started in 2005 and eventually included about 200,000 patients. Groups were assigned to companies that specialize in helping people with chronic health conditions lower their medical costs and keep from getting sicker. Most of the patients had diabetes or congestive heart failure.
Nurses contacted the patients to make sure they were following doctors' instructions to take medication and reduce sodium intake. They also mailed patients packets about their diseases and directed them toward community health classes.
Overall, the program didn't reduce the group's rate of acute-care hospitalizations, hospital readmissions, emergency-room visits or death. It also didn't meet its goal of lowering patients' Medicare payments in an amount equal to the cost of the prevention services. The company that achieved the highest cost savings recouped only 26% of the fees spent on the program through lower Medicare spending.
There are studies which corroborate the "benefits of a healthy lifestyle." But the "problem is that when testing becomes too widespread, or heavy investments are made in monitoring people with chronic diseases, the rewards often fail to match the costs." This was exemplified in a 2008 NEJM report "which examined 279 spending ratios in published studies of health-oriented prevention measures, and another 1,221 on treatments for people who were already sick and "concluded that most preventive measures reviewed didn't save money. For instance, screening all 65-year-olds for diabetes would cost an extra $590,000 for every healthy year of life it adds over just screening people that age with high blood pressure."
To cap it all off the Congressional Budget Office, in its report, concluded that greater use of preventive care would at best generate modest reductions in costs over 10 years, and might even result in increases.
One reason cost savings are hard to achieve, is that much of the money spent on disease prevention goes for people who aren't going to get sick anyway. Also, people have trouble making difficult lifestyle changes, such as taking up regular exercise or eating healthier food.
CQ Today reports that preventive care's financial benefits is a "myth.” Although such initiatives would, in many cases, result in better health, it is less clear that they would reduce total spending for healthcare. ... Many other studies that have examined the impact of such initiatives do not indicate net savings."
So much for the conventional wisdom and saving money for Health care reform by increasing preventive care.
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 later for MORE MEDICAL SCHOOLS BEEF UP CONFLICTS POLICIES.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
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