It’s up to the U.S. Senate now whether tens of millions of Americans get stripped of the health insurance they obtained under the Affordable Care Act, aka Obamacare, or what kind of coverage they might have under some version of  the American Health Care Act aka Trumpcare.

News organizations have posted some good, factual summaries of Trumpcare vs. Obamacare, as passed by the House last week, including here and here and here. The Congressional Budget Office, the federal outfit that is supposed to provide lawmakers a nonpartisan, independent analysis of the costs and effects of legislation, will score the House bill sometime this week so Americans really know what the bill does and how much it costs.

sepsis-300x249Although public health officials have launched national campaigns against sepsis, it may be that new initiatives at the state and local levels will be more effective in battling the deadly scourge, particularly as it harms kids.

Sepsis, experts say, happens when the body is overwhelmed by infection and responds by shutting down key organs. It can lead to tissue damage, organ failure, and death. It’s difficult to predict, diagnose, and treat. As Stat, the online news service, reports:

Sepsis hospitalizes some 75,000 children and teens each year in the United States. Nearly 7,000 will die, according to one 2013 study. That’s more than three times as many annual deaths as are caused by pediatric cancers. And some of the children who survive sepsis may suffer long-term consequencesincluding organ damage and amputated limbs.

Knee-300x166Hip and knee replacements, especially among seniors, have become so prevalent that almost 7 million Americans by 2010 had undergone the surgeries. With the cost to Medicare of knee replacements running between $16,500 and $33,000, and with roughly half of the procedures’ expense occurring post-operatively, there’s some good news for patients on saving money—and staying safer too.

Patients may want to get themselves out of the hospital and stay out of in-patient rehab centers in favor of well-planned, careful recuperation at home, studies show. The research focused on single adults living alone, and whether they fared better over the short- and long-term by rehabbing from total knee and hip replacements at skilled nursing facilities or at home, particularly if their home care was well considered and followed through.

They did at least as well and were happier recuperating at home, researchers found, adding that they also may have been safer: That’s because a third of patients in rehab facilities suffered adverse events in their care, a rate comparable to unacceptably high hospital harms and those in skilled nursing facilities.

oregon-300x198For policy-makers and politicians who seek to offer robust, transparent information about the quality and safety of all too often troubled nursing homes, a newspaper investigation in Oregon underscores how poor execution guts good intentions.

The Oregonian deserves praise for discovering that a highly praised public health initiative in the Pacific Northwest foundered due to weak oversight and follow-up by regulators and others involved.

The project started with a great idea that many in health care discuss often: Taking public data about nursing homes and posting it online on a website targeted at families in desperate need for information to decide which care facilities are best for their ailing, infirm loved ones.

jobs-300x229Soaring medical costs are bad for our economic health, so why isn’t someone doing more about them?

There’s a reason, hiding in plain sight,  contends Chad Terhune, a seasoned health care journalist. He wrote a revealing Op-Ed in the New York Times, pointing out that 1 in 9 Americans now works in health care, up from 1 in 12 in 2000. Look around the country: Hospitals are throwing up fancy new buildings and putting to work tens of millions, many in some seriously high-paying jobs. As Terhune has noted:

Thirty-five percent of the nation’s job growth has come from health care since the recession hit in late 2007, the single biggest sector for job creation. Hiring rose even more as coverage expanded in 2014 under the health care law and new federal dollars flowed in. The law gave hospitals, universities and companies even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job pool. Cities welcomed the development — and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Mr. Trump last year.

cdc-school-265x300There may be more science and policy impact than many parents, teachers, and coaches realize when they joke that teen-agers can be so slow to mature now they’re almost like aliens. Young people, in fact, may need distinctive school schedules, courts, and reproductive awareness programs—all based on building research about adolescent brain and body development.

School start times and growing kids’ sleep needs

Let’s start with one of the common flashpoints in many households with teens: getting up and to school on time. The American Academy of Sleep Medicine has just joined with the American Medical Association, the American Academy of Pediatrics, and the federal Centers for Disease Control and Prevention in recommending that middle and high schools start the day no earlier than 8:30 a.m.

codeineWhen severe colds, flu, or other infections run down youngsters with bad aches or an unrelenting hack, worried parents and doctors may turn to potent painkillers and cough suppressants. But the federal Food and Drug Administration has issued its strongest warnings about key ingredients in some of these, saying kids should not receive medications containing codeine or tramadol.

Both are powerful opioid painkillers. Prescription cough syrups often contain codeine. Tramadol typically is a drug given only to adults, though the FDA says it is seeing it prescribed more often, off label, to kids. Both tramadol and codeine have been prescribed for post-surgery pain for youngsters who have had their tonsils or adenoids removed.

But children, especially those 12 and younger, can have severe reactions to codeine and tramadol. They can slow or labor their breathing.

mal200x267In the battles between lawyers and doctors over malpractice lawsuits filed by patients harmed while seeking medical services, it may be worth heeding economists’ prescription for caregivers: Physicians, heal thy selves.

Aaron Carroll, a pediatrician and health policy expert at Indiana University, has written in the “Upshot” column of the New York Times that research shows that so-called tort “reforms”—including current initiatives on medical malpractice by the Republican-controlled Congress—may be misguided.

That’s because advocates committed to greater patient safety and improved care may find more impressive results on the medical not the legal side of “reforms,” Carroll argues. He points to persuasive data from Florida and Texas hospitals and how they fare with lawsuits and their rankings with Patient Safety Indicators (PSIs).

D-vitaminsThe health care pendulum appears to have taken a bad swing to the extreme with vitamin D.  Too many Americans may be taking unnecessary tests to see if they’re deficient of this important nutrient. Too many of us are taking unneeded amounts of it.

Federal experts report that blood tests for vitamin D among Medicare beneficiaries, most 65 and older, increased 83-fold from 2000 to 2010. Testing rates rose 2.5-fold from 2009 to 2014 among those with commercial insurance.  Among a recent sample of 800,000 patients in Maine, nearly one in five had at least one test for blood levels of the vitamin over a three-year period. More than a third got two or more tests, often for vague complaints like malaise or fatigue. Labs and doctors are telling patients who have undergone tests and who have readings in the normal range of 20 to 30 nanograms of the vitamin per milliliter of blood that they suffer a deficiency.

This all is leading to what some experts are terming a “pandemic” of over-testing, faulty diagnosis, and excess consumption of a nutrient, based on sparse evidence and misplaced belief that, as the New York Times reports, “vitamin D can help turn back depression, fatigue, and muscle weakness, even heart disease or cancer. In fact, there has never been widely accepted evidence that vitamin D is helpful in preventing or treating any of those conditions.”

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