Articles Posted in Clinical guidelines

antidepressant-300x225Even as the nation enters an even scarier phase in its battle against the raging opioid abuse epidemic, new and sterner warnings are flying about antidepressants. The costs of these powerful drugs add up, as does the toll of depression and its care. Users say antidepressants are a nightmare to get off of. And medical experts cast growing doubt about whether their benefits outweigh their risks.

The New York Times deserves credit for detailing the worrisome plight of an estimated 15.5 million Americans who have been taking antidepressants — sold as brand drugs like Zoloft, Effexor, Paxil, Prozac, and Cymbalta — for at least five years. The rate of the psychiatric medications’ use “has almost doubled since 2010, and more than tripled since 2000,” the newspaper reported, adding that “nearly 25 million adults … have been on antidepressants for at least two years, a 60 percent increase since 2010.”

Users who try to wean themselves from the drugs find themselves, fast, in nasty situations with “dizziness, nausea, headache and paresthesia — electric-shock sensations in the brain that many people call brain zaps,” patients told the New York Times.

superbugs-300x118Hospitals may be providing us all with too many causes for high anxiety, with reports on increasing findings of “nightmare” bacteria stalking more health care facilities than had been known, more disclosures about how taxpayers may foot an even bigger bill to deal with a beleaguered public hospital in Washington, D.C.,  and a respected reform advocate’s detailing of just how traumatizing many hospital stays may be.

Let’s start with the new research by the federal Centers for Disease Control and Prevention, a study that tried to determine just how many cases there might already be of patients infected in hospitals, nursing homes, and other medical care facilities with so-called Superbugs, bacteria that resist treatment not only with most standard antibiotics but also drugs that are deemed therapies of last resort. These include three types of bacterial infections deemed especially urgent but difficult to control: Clostridium difficile (C. difficile), aka C-diff; carbapenem-resistant Enterobacteriaceae (CREs, as shown above); and Neisseria gonorrhoeae.

CDC officials weren’t sure how many of the Superbug cases — which leave doctors and hospitals little option but to provide only supportive care — they might detect by scrutinizing records from pathology labs nationwide.

coveredcalif-300x169Although Republicans have ripped at the health insurance offered under the Affordable Care Act, a less known but also important aspect of Obamacare may soon benefit Californians. This West Coast ACA-related move also may be worth watching by patients and medical safety advocates, as well as employers and insurers.

The Golden State, the San Francisco public radio station KQED reported, soon will tell hospitals that “time’s up” for them to improve their care, and, if they fail to hit new quality and safety targets that will be part of an impending three-year contract with Covered California, the ACA marketplace operator, they will get the boot from Obamacare coverage.

Because bluer-than-blue Democratic California has gone all-in in supporting and putting ACA coverages in place, the state’s Obamacare exchange is big (more than 1 million customers and 11 approved companies) and lucrative — so much so hospitals and insurers can’t ignore the quality demands. They’re neither extreme nor should they be surprising, because state officials emphasize they have consulted with key parties for several years now in the “Smart Care California” collaborative about the plans they intend to put in place.

Seroquel-25mg-300x195In a display of just how corruptive big money has gotten to be in modern medicine, Big Pharma keeps getting dubious doctors to write so-called off-label prescriptions for powerful anti-psychotic medications — no matter their proven harm to patients nor big settlements drug makers have been forced to pay.

The Washington Post deserves credit for its investigative dissection of AstraZeneca and its “blockbuster” product, Seroquel (generic name quetiapine). It’s a medication developed to treat severe cases of schizophrenia.

Instead, as has occurred with several other drugs of its kind, doctors — in response to major marketing and sales campaigns by AstraZeneca — have decided this wallop-packing drug can be given for uses for which there is less or little evidence. The Washington Post says doctors write abundant Seroquel scripts for patients with an “expansive array of ills, including insomnia, post-traumatic stress disorder and agitation in patients with dementia.”

FAST-infographic-2016-300x169It’s no April Fool joke: Emergency doctors across the country, according to the New York Times, have been defying widely accepted standards of care and withholding a drug that rigorous clinical trials and medical specialists long have recommended for stroke victims.

Administration of the drug, tPA or tissue plasminogen activator, helps to prevent brain injury after a stroke by dissolving the blood clot and opening up the blocked vessel. Neurologists and neurosurgeons as well as cardiologists, have campaigned for its aggressive use within hours after the onset of symptoms.  Indeed, hospitals nationwide have adopted speedy stroke care, including with tPA, under slogans like “Time is Brain.”

The drug’s fast use has become so accepted, the capacity to administer it is a keystone for hospitals to receive a much-sought designation as specialized stroke treatment centers. And though it has long been thought that tPA needed to be given within three or four hours from the start of stroke symptoms, new research funded by the National Institute of Neurological Disorders and Stroke has opened the strong possibility that many more patients could benefit from tPA and neurosurgery within 16 or even 24 hours after suffering a stroke.

smoke-300x148States may be rushing to legalize marijuana, but common sense, good research, and the law may be lagging. New reports confirm what should be inarguable: Marijuana may have health harms when smoked, and it poses safety risks when used while driving.

With the new and considerable attention paid to cigarette smoking, it’s plain to see that, like tobacco, a key health worry with marijuana rests in its burning and inhalation.

It hasn’t been easy to study due to grass’ legal classifications and, therefore, the restrictions imposed on researchers. But medical scientists at the University of California San Francisco have started to find that dope smoke, direct and second-hand, demonstrates similar or even slightly greater detrimental health effects than tobacco smoke.

Dumpster-300x251Although enthusiasts still wax on about  how technology will improve lives, patients may want to be wary about purported advances that may end up complicating and even compromising crucial parts of their medical care — including how their medical records are kept and how payers decide if they’re covered.

Let’s start with some kudos for dumpster-diving doctors in Canada who discovered flaws in hospitals’ disposal of supposedly confidential and legally protected patient health records. They went around unidentified facilities collecting from various bins a half ton of paper that doctors, nurses, and hospitals were ready to toss.

After examining the piles of paper, they found most private records had been properly handled. But thousands of documents also were not: They were improperly disposed of, and contained identifying or confidential patient treatment information, the researchers found. Though Canada’s patient privacy laws differ from those in the United States, they agree that patient health records must be guarded, and the researchers found violations of practice, policy, and potentially privacy laws.

maryland-flag-300x200Yes, Virginia (and Washington, D.C., and the rest of the U.S.): Ever-rising hospital costs can be constrained without the world coming to an end. Maryland’s four-year-old experiment — converting hospitals from a fee-for-service model to a global payment system with total revenues set at the outset of each year — is saving millions of dollars annually for patients, taxpayers, employers, and others who pay for medical services in the state.

The Baltimore Sun reported that Maryland’s Health Services Cost Review Commission and the Maryland Department of Health, found that the state’s unique test, already produced $586 million in hospital-related savings for Medicare in its first three years.

As the Sun said:

ivf-300x271Equipment failures in two clinics in Cleveland and San Francisco not only resulted in the loss of thousands of frozen human embryos and eggs, the incidents also have raised new concerns about safeguards and regulation of booming and costly fertility programs.

Experts said the mishaps were uncommon, and they were hard pressed to explain how advanced refrigeration systems, with rigorous checks and back-ups, could have malfunctioned at large, respected facilities, leading to a likely boom of lawsuits by women and couples against the University Hospitals Ahuja Medical Center’s Fertility Center in Cleveland and the  Pacific Fertility Center in San Francisco.

The centers serve different types of women and couples, with the San Francisco facility dealing with younger, career-driven, and international patients eager to freeze eggs and embryos in hopes of starting families later in life. It has attracted public notice, partly because high-tech firms in the nearby Silicon Valley offer financial assistance to women employees who want to freeze their eggs. The Cleveland center, meantime, seeks to assist women and couples in the city’s western suburbs with infertility issues, especially through in vitro fertilization.

cnnopioids-300x130Doctors already taking heat for selling out  their prescription pads for financial gain may want to brace themselves for new anger from patients, regulators, and lawmakers over two sets of data detailing unsavory links between MDs’ payments from Big Pharma and their opioid drug prescribing.

CNN, Harvard University, and CareDash.com — a site that says it seeks to serve low- to middle-income patients with reliable health care information — have examined national prescribing data, finding links between Big Pharma pay and doctors’ ordering of prescription painkillers central to a nationwide epidemic of abuse.

CNN, with Harvard, reported its findings:

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