Articles Posted in Clinical guidelines

legionnaires-232x300Hospitals and nursing homes, by failing to properly maintain their water systems, may be putting older patients at high risk of an unusual form of pneumonia, with federal officials tracking 1 in 5 suspected or confirmed  cases of life-threatening Legionnaire’s Disease to health care facilities.

Anne Suchat, acting director of the Centers for Disease Control and Prevention, has urged caregivers to redouble their efforts to stamp out Legionella bacteria contamination in areas where poor maintenance may allow infections to flourish, including in water storage tanks, pipes, cooling systems, showers, sinks, and bathtubs. She said Legionnaire’s cases were too widespread, “deadly … and preventable.”

CDC researchers analyzed 2,809 of 6,079 Legionnaire’s cases nationwide in 2015 alone. They found 553 cases in 21 different and targeted jurisdictions, including Virginia, definitely or possibly occurring in a nursing home or hospital. The infections caused 66 deaths.

softball-300x197Although fans may fret when pros like the Nationals’ Bryce Harper get hit by a pitcher—and brawls ensue—some amateur athletes are the most likely to be struck and hurt: Ball-contact injuries are highest among female softball players, followed by women who play field hockey.

That’s according to new research on thousands of college athletes that found that less than half of the female athletes’ injuries when hit by balls caused them to lose playing time. Most suffered bruises (30.5 percent) and sprains (23.1 percent). But concussions were among the most commonly recorded serious injuries, occurring in 16.1 percent of cases, with finger fractures an issue, too.

When injuries were compared between men and women in baseball-softball, basketball, and soccer, female athletes had a larger proportion of ball-contact injuries diagnosed as concussions than did men, researchers found.

Diverse_doctors_3-300x201Some new research studies suggest ways to find a good doctor by focusing on demographics. Older doctors who have reduced their caseloads may not be an optimal choice, one study suggests, while another finds that, for seniors sick enough to be hospitalized, women MDs excel. And doctors who are immigrants can be solid patient choices, a third study reports.

Let’s be clear: These studies are observational, and they focus on select measures of care. But they are based on big data, analyses of hundreds of thousands and even millions of cases. Your own individual experience with a clinician counts a ton, and must never be ignored. A doctor with a brilliant resume, golden accomplishments, and a sterling reputation can still treat you badly, even blunder with your care.

Still, after examining three years of data on more than 700,000 admissions and the outcomes of 19,000 doctors, researchers from Harvard Medical School and prominent Boston-area hospitals found that as MDs aged, mortality rates of their hospitalized patients climbed. For doctors younger than 40, the rate was 10.8 percent, while for those older than 60, it hit 12 percent.

thyroid-300x222Check the neck? If you’re doing so routinely, especially if you lack worrisome symptoms or haven’t had past problems, please reconsider: Regular thyroid cancer screenings received a “D” grade from a blue-ribbon panel of experts. The exams can cause more harm than good, says the U.S. Preventive Services Task Force, which does periodic, evidence-based reviews of common medical screens.

Its most recent review finds cause for concern that doctors and hospitals, pushed by a prominent patient advocacy group that Big Pharma’s helping to underwrite, keep recommending and subjecting patients to unneeded thyroid cancer screens. The screens, with ultrasound and physician exams, too often lead to more tests, and then to painful, invasive, and costly procedures.

Doctors worldwide are detecting thyroid cancer at increasing rates, with the found incidences going up by 5 percent annually in this country. But at the same time, the relatively small numbers of thyroid cancer deaths haven’t budged. They’re neither rising nor falling. (See the diagram).

maternal-300x170new investigation of one of the great shames of American medical care raises big questions about why labor and delivery is more dangerous to new mothers in the U.S. than just about anywhere else in the civilized world.

To their considerable credit, National Public Radio and Pro Publica, a Pulitzer Prize-winning investigative news site, have joined forces to examine why 700 to 900 American women die each year from pregnancy related causes, and 65,000 nearly die.

The news organizations say Americans are “three times more likely to die in childbirth than women in Canada, and six times more likely than Scandinavian women.” And while U.S. maternal deaths are rising, their numbers were plunging in developed countries from England to South Korea.

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.

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.”

Prostate-e1492269148971-483x1024A burst of bad headlines and not so great news reports may have confused some men. But to put it in lay terms:  The use of the common test for routine prostate cancer screening got a dim grade of C for many men, up from a dismal D, in a re-evaluation by independent experts who assess the nation’s preventive medical services.

That blunt review of regular prostate-specific antigen (PSA) tests, despite some reports to the contrary, keeps with how the influential U.S. Preventive Services Task Force (USPTF) looked at annual  screening for this most common form of cancer for men when it issued its first guidelines in 2012, notes healthnewsreview.org.

The health information site says the USPTF earlier had surprised many, downgrading routine prostate cancer screening to a D, and noting, “There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” It now says it rates a C for many men younger than 70, meaning physicians should “Offer or provide this service for selected patients depending on individual circumstances,” and that “There is at least moderate certainty that the net benefit is small.”

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