Articles Posted in Clinical guidelines

viagra-300x169This fall’s National Football League games will be markedly different in an unexpected way that also offers insight into the nation’s skyrocketing costs of medical care.

The makers of the erectile dysfunction drugs Viagra and Cialis are yanking $50 million in advertising from TV broadcasts of NFL games, their top contact point with male consumers.  Indeed,  the makers of both drugs are going dark with their costly ads across a variety of sports programs, including summer pro golf and tennis.

After billions of dollars in revenues reaped every year for their manufacturers, Viagra and Cialis both are Big Pharma hot shots no longer. They may have erased any remaining decorum on TV over the years with their advertising and marketing hype. But they cannot outrun a typical drug’s economic life cycle. Their patents are expiring, and their makers are trying to figure how best to exploit their profitable, branded drugs when generics—already regulator approved and ready to go—saturate markets and drive prices down, perhaps as early as next year.

anesthesia-300x153Some of the very medical specialists who are supposed to put patients to sleep experience big problems themselves staying awake, with more than half of anesthetic trainees reporting in a new national survey in Britain that they had crashed their cars or nearly done so while headed home after long night shifts.

American doctors’ social media responses to this new research indicate that work weariness and drowsy driving are perils for practitioners on this side of the Atlantic, too.

The doctors’ complaints also underscores the irrationality of recent decisions by American medical educators to reinstate long shifts for interns and residents, trainees who play important—and sleep-deprived— front-line roles in providing medical services to too many patients in academic medical centers and hospitals nationwide.

dna-208x300Pathologists are the medical specialists whom few patients ever meet, but they play increasingly important roles in treatment decisions. Some new reports raise concerns about systematic errors in the path lab.

The New York Times painted a surprisingly distanced picture of the work of pathologists in a recent report on these medical doctors who are trained to interpret an array of laboratory tests and often microscopic materials to determine the care for complex diseases.

The paper found that the specialists and their labs mislabeled and mixed up patient samples and results, as well as sometimes contaminating them—yes, rarely, but with potentially significant harms. Erroneous results could lead to misdiagnoses, resulting in patients getting wrong or ineffective treatment, especially for cancers, experts say.

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.

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