Articles Posted in Clinical guidelines

influenza-virus-fulltext-300x203As the flu epidemic rages across the country, it also may be testing the oft-tenuous public respect for preventive medicine, especially as patients get hit with surprise medical bills and experts struggle to explain the complexities and limits of protections afforded by vaccinations.

Are flu shots useful or not?, many Americans may be asking, as this season’s infections hit marks not seen for at least a decade. (Spoiler alert: Yes, get that shot!) Flu kills many more patients than many realize, and this year, the virus is on track to claim as many as 4,000 lives a week.

The toll among children has been scary, with the deaths of 84 youngsters blamed on flu. Three out of four of the youngsters who died from flu had not been immunized, officials say.

banyan-300x173Federal officials offer a glimmer of hope in caring for head injuries, especially the sharp, repeated, and often damaging blows that  afflict athletes and which millions worldwide are witnessing, yes, as part of the Winter Olympic Games.

The federal Food and Drug Administration has announced that it has approved a long-awaited blood test that can help doctors determine the severity of traumatic brain injuries. This test will provide a cheaper, easier, more convenient, and likely faster way to handle the rising health bane of concussions, rather than relying on computed tomography or CT scans using big machines and a form of X-rays.

As the New York Times reported:

srabuse-300x150Imagine if Uncle Sam permitted everyone who lives in Newport News, Va., or maybe Fort Lauderdale, Fla., to be chemically restrained, drugged with powerful medications so they fell, day and night, into a speechless stupor. Now, further envision the furor if these 180,000 souls and their families each were forced to pay as much as $100,000 annually  to be reduced to a near vegetative state.

This real situation with over-medicated Americans, in this case seniors in nursing homes, is just one more cruelty happening against the aged. It’s also hard to see federal officials issuing faint praise on how regulations slowly — too painfully so — are reducing abuse of potent anti-psychotics in the nation’s care for the old, especially those with dementia.

The Centers for Medicare and Medicaid Services, aka CMS, has issued new data on its seven-year campaign to slash elder care facilities administering antipsychotics sold under brand names like Abilify, Risperdal, and Zyprexa. Questions also have been raised about a newer drug, the little red pill branded as Nudexta.

dexter-300x282All critters great and small may be adorable and adored, but some extreme and unsupported claims for the mental health benefits that pets bring may be launching a needed correction in how so-called emotional support animals get accommodated in public spaces.

It would be tough to make up this story, much less explain why a recent United Airlines passenger, a performance artist, thought it appropriate to try to fly with her pet peacock (he’s shown in a photo taken by his owner and posted on his public Instagram account). She claimed it was an emotional support animal, protected under disability law, and she said she had purchased a separate seat for the hefty bird.

United, which hasn’t endeared itself to the public with its customer service, said it thrice had told this passenger in advance that her peacock wasn’t getting on its jet.

wheartatttack-238x300As cardiologists and oncologists swap cross-fire about the conditions they treat and how they do so, here’s hoping that, above all, their female patients end up helped and not harmed, getting vital information about risks and benefits of therapies for two of the leading killers of women: heart disease and breast cancer.

What’s behind the medical specialists’ cross currents? Cardiologists and the American Heart Association are pointing to a major therapeutic statement published in the medical journal Circulation.

On the one hand, it provides what many see as an important, needed call to doctors of all kinds to recognize that heart disease among women goes “dangerously under-diagnosed and under-treated,” due in no small part because practitioners still fail to see that women suffer heart attacks in different ways than do many men. They do not, for example, suffer stabbing chest pain, radiating into the arm. Instead, as they experience clogs in tiny veins and arteries, they may feel a constant exhaustion and a discomfort as if they were having their chest squeezed or crushed.

immodium-300x169The opioid epidemic has become so pernicious that it can be exhausting to even try to see its expansive harms. But it’s crucial to keep confronting the many ways this lethal scourge affects Americans and their lives, if only to hope that politicians, policy-makers, doctors, hospitals, and many others get off their duffs and do something about it.

This crisis — which includes more than 64,000 overdose deaths in 2017 alone — has reached in a surprising new way into many households’ medicine cabinets. It’s not due to potential abuses of potent pain-killers that many may have stashed there. Nope, now federal officials are fretting about the current dosages of the key ingredient in common, over-the-counter anti-diarrhea medications like Imodium.

It turns out that the substance known generically as loperamide, useful in stopping the runs, happens to be part of the opioid family, an addictive drug class that includes morphine and oxycodone. Drug users have turned now to abusing anti-diarrhea meds, which are sold in high-count packages and at dosages that authorities want reduced.

stroke2-300x169Although medicine has made advances in treating strokes, more than 795,000 Americans suffer them annually, they kill 140,000 of us each year, and they’re a leading cause of disability. But medical experts, revising their care guidelines, say that patients with the most common kind of stroke —  a clot blocking blood flow to the brain — may be better treated in an expanded window of still urgent time.

This higher but still guarded optimism does not apply to all stroke cases and not to all ischemic strokes (the kind that come from blood vessel blockages). Doctors have known for awhile now that it is vital to bust the damaging clot — and they had thought their time to do so with drugs like tPA and surgeries was constrained to six or so hours. This led specialists to their axiom, “Time is brain,” and to crash responses.

But for many patients, the tight treatment time frame was unhelpful. They might not be discovered quickly after suffering a stroke and being incapacitated. They might have had their stroke while sleeping, and doctors had decided the timing of their care based on when they could last recall being well — often putting them outside the six-hour limit. Some patients also live far from hospitals that could provide clot-busting drugs, or, even more key, surgeries to implant stents or a thrombectomy, a procedure in which doctors use a small tool to grab the clot and remove it.

As the science keeps getting deeper, the news keeps getting worse about the harms that can be inflicted by repeated blows to the head in sports — and in life.

The path-breaking medical scientists at Boston University and elsewhere, who have helped to establish how concussions, notably in football, may lead to the onset of the neurodegenerative disease chronic traumatic encephalopathy or CTE, have told the Washington Post that their latest study may show that, “It’s really the hit that counts.”

danger-194x300jeanne_lenzerJeanne Lenzer, a seasoned medical investigative reporter, points out that 32 million Americans — about one in 10 of us — have at least one medical device implanted in our bodies. These include artificial joints, cardiac stents, surgical mesh, pacemakers, defibrillators, nerve stimulators, replacement lenses in eyes, heart valves and birth control devices.

Most patients — indeed most of the public — may think federal regulators subject all this hardware to rigorous quality and safety testing.

That’s a wrong assumption. And though medical devices may be helping change and save many lives, Lenzer also warns they are harming and even killing too many patients. In a new book (The Danger Within Us), interviews, and in a recent Op-Ed in the New York Times (“Can Your Hip Replacement Kill You?”), she has argued that:

medtest-300x169Medical over-screening and over-testing not only adds hundreds of billions of dollars in unnecessary costs to U.S. health care, it also may be skewing researchers’ understanding of what causes disease and imposing harsh burdens on older Americans.

Stat, an online health and medical news service, has highlighted an intriguing study from the Dartmouth Institute for Health Policy and Clinical Practice, whose researchers are well-respected for their work on their Atlas Project, which “documents glaring variations in how medical resources are distributed and used in the United States.”

Dartmouth researchers recently examined screening, especially for breast, prostate, and thyroid cancers, and found that over-testing, as Stat reported, may be “misleading doctors and the public about what increases people’s risk of developing cancers,” especially “the types of cancer that matter.”

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