Articles Posted in Research Studies

doc-sleep-300x225Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

rheumatoid-arthritis-hands-2-300x200More than 50 million Americans struggle with arthritis: Three in 10 of them find that stooping, bending, or kneeling can be “very difficult.” One in five can’t or find it tough to walk three blocks, or to push or pull large objects. Grown-ups with arthritis are more than twice as likely to report fall injuries.  Arthritics have lower employment rates, and a third of them 45 and older experience anxiety or depression. So what to do about this leading cause of disability, a painful condition whose woes will only grow as the nation ages and already is responsible for $81 billion in direct annual medical costs?

Experts from the Centers for Disease Control and Prevention recommend that those with the most common arthritis forms—osteoarthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia—avoid a reflexive reach for pain-killing pills. Instead, they must keep moving. “Physical activity,” CDC experts said in a new study, “is a proven strategy for managing arthritis. …” It also “has known benefits for the management of many other chronic conditions” that also afflict those with arthritis—including heart disease, diabetes, and obesity.

Although arthritis commonly is associated with seniors, the majority of adults with the condition, more than 32.2 million Americans, are younger than 65. Arthritis is much more common among women than men, and much less so among Hispanics and those of Asian descent that among whites. It afflicts those with a high school or less education more than those who completed college or higher.

hospital-bed-300x144Although hospitals continue to try to shrug it off, the damning evidence is building that far more Americans die of preventable causes in their care than previously thought, and “approximately 200,000” such deaths each year in the United States is “not unreasonable” as an estimate.

Those are the top-line findings from a team of doctors and public health experts who have published new research in the Journal of Patient Safety. Theirs was the fourth study in recent times to try to quantify what one of the research groups has described as potentially the “third leading cause of death in the United States,” those from medical error, especially occurring in hospitals.

A year ago, the Heartland Health Research Institute looked at Iowa and six surrounding states to assess what experts call preventable adverse events, and examining the existing studies that might offer national insights on the issue. These researchers found that it was reasonable to conclude that “250,000 patients [die] annually in U.S. hospitals due to preventable mistakes.”

hospital-300x209When a giant institution like MedStar Georgetown University Hospital announces it will spend more than a half-billion dollars to improve, rebuild, and expand its facilities, few of us blink.

That’s because we know that hospitals, in general, are “among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes,” observes Druv Khullar, an M.D. and M.P.P. at Massachusetts General and Harvard Medical School.

Khullar, however, goes on to write in a trenchant Op-Ed column in the New York Times that, “evidence suggests we’ve been building [hospitals] all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us.”

PrecisionHealth-300x108It’s a $50-million business with a roster of blue-chip consultants who would be an envied faculty at most any major university. But look closely at the activities of Precision Health Economics because this firm’s esteemed academic economists, for big bucks, are boosting Big Pharma’s efforts to justify some of its sky-high prices for its products to policy-makers, regulators, and lawmakers.

Pro Publica, the Pulitzer Prize-winning online investigative site, deserves credit for raising questions about yet another area in which ordinary Americans may be outgunned by special-interest money. Big Pharma already has earned notoriety for seeking to advance its causes by paying physicians, underwriting patient advocacy groups—and now retaining high-powered economists.

Economists play a key role in providing expert views on drugs, their prices, and markets, all of which are increasingly controversial issues as Americans struggle to afford medications that can cost $1,000 a day or tens of thousands of dollars for treatment regimens lasting for a few months.

Back-Pain-300x188Back pain is one of Americans’ leading debilitating complaints, prompting us to spend billions of dollars annually for relief and costing more than $100 billion, especially in lost work and wages. But an influential physicians’ group, joining a growing number of other experts, now recommends that we buck up, exercise, keep moving—and stay away from a reflexive reach for drugs, especially powerful painkillers, to deal with aching backs.

The American College of Physicians, with guidelines published in the Annals of Internal Medicine, concedes it is breaking with longstanding medical views on treating low back pain. But the group’s experts said they conducted a “systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain.”

They found that many patients with low back pain recovered over time “regardless of treatment,” and these individuals might benefit most from heat, rest, exercise, and over the counter, non-steroidal medications. Another group of back pain sufferers might need physical therapy, stress reduction, acupuncture, yoga, or ta-chi. Only after patients have not found relief with “non-pharmacological therapy,” should doctors consider giving non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. If these don’t work, tramadol (Cymbalta) or duloxetine (Ultram) might be considered.

prescription-bottles-1-300x170Some diligent, grown-up sons and daughters may want to check in on mom, dad, and grandma, grandpa, all the aunties and uncles, too. That’s because there’s yet another warning that too many doctors are whipping out their prescription pads all too readily and writing scripts for retirement-age Americans, who now take on average three psychiatric drugs without any mental health history.

Research published in the JAMA Internal Medicine shows that over-prescribing of powerful psychotropic drugs, including sleeping pills, painkillers, and anti-depressants may be more common than believed. The study was based on an analysis of data from a big number of doctors’ office visits, with researchers finding the number of “polypharmacy” incidents (cases in which seniors received scripts for multiple drugs) increased between 2004 and 2013 from 1.5 million to 3.68 million.

This doubling resulted from seniors’ greater openness in talking with their doctors about mental health issues, and, in instances where visits were related to “anxiety, insomnia, or depression,” the researchers write. But, in disturbing fashion, a high number of women and rural patients were involved in cases where multiple psychotropics were prescribed, and many of the prescriptions were for painkillers.

HouseGregoryHouse-276x300Doctors, nurses, and hospitals should stop ignoring colleagues who act like jerks because obnoxious physicians—think of  Dr. Gregory House, the TV internist—may hurt patients, especially in surgery.

Researchers, who published a study in the JAMA Surgery, looked at two years of quality care data from seven medical centers, involving 800 surgeons and 32,000 adult patients. They also had information on physicians with “unsolicited patient observations,” meaning complaints from those undergoing care and their friends and families.

Stat, the online health information site, summarizes what the researchers found:

ryanMembers of Congress are home in their districts for a week-long break, and many lawmakers are expected to get an earful from voters upset over many issues at the start of the Trump Administration, especially this: What the heck’s going on with health care?

Republicans have insisted for years now—counter-factually, as the evidence has amply demonstrated—that they had a cheaper, better, more inclusive alternative to the Affordable Care Act, aka Obamacare. The promised to repeal the ACA on the day they gained control of Congress and the White House. That hasn’t happened. Nor has the GOP proffered its vaunted replacement. Instead, the party had talked in recent days about an ACA repair.

But under fire from their most conservative party members, Republican leaders have thrown up what they call an outline of Trumpcare. The GOP has moved from lots of R’s—repeal, replace, and repair—to some C’s and D’s: Costly, callous, divisive, and cruel. Those are some ways their retread plan elements (dubbed “déjà vu all over again” in one report) could be described. The outline still faces major challenges, not the least of which is whether a chaotic White House and a lumpen Congress can conduct the nation’s business and enact public policy.

ear-187x300Traffic, rock concerts, leaf blowers, and blaring head phones — these are among the many noise sources that have played a part in 40 million American adults suffering from hearing losses not caused by their work conditions, Uncle Sam says.

The federal Centers for Disease Control and Prevention, based on a study of more than 3,500 people who underwent tests and questioning, estimates that a quarter of Americans ages 20 to 69 suffer hearing impairment that constitutes “a significant, often unrecognized health problem.”

This diminished capacity, especially if untreated, can lead to “decreased social, psychological, and cognitive functioning,” the CDC says. Its study also reported that:

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