Articles Posted in Clinical guidelines

coronamapjh-300x134As the Covid-19 pandemic slams the United States — with infections exceeding 100,000 and deaths spiking  beyond 2,000 — the battle with the viral outbreak underscores the axiom that a crisis brings out true character, good and bad.

Our highest praise continues to go out to first responders and medical personnel who have demonstrated huge courage and resolve in treating the sick and dying, despite too few resources still and at giant risk to themselves.

Institutions have stepped up to provide valuable information and services, including:

mammographyus-300x240As Americans live longer, clinicians may need to reconsider whether they need to subject older patients to routine screenings that may trigger even more costly, invasive, painful, and unnecessary medical testing and procedures. For women 70 and older, for example, yet more new evidence raises doubts about mammograms designed to detect breast cancers.

As the New York Times reported, researchers in Boston examined 2000-2008 Medicare claims “to follow more than one million women, ages 70 to 84, who had undergone a mammogram.” Quoting Dr. Xabier Garcia-Albéniz, an oncologist and epidemiologist at RTI Health Solutions and lead author of a new observational study of their women subjects:

“They had never had breast cancer and had a ‘high probability,’ based on their medical histories, of living at least 10 more years. ‘That’s the population who will reap the benefit of screening,’ Dr. Garcia-Albéniz said, because it takes 10 years for mammography to show reduced mortality. The researchers divided the subjects into two groups: one that stopped screening, and another that continued having mammograms at least every 15 months. They found that mammograms provided a survival benefit, if a modest one, for women ages 70 to 74. In line with previous research, the study found that annually screening 1,000 women in that age group would result, after 10 years, in one less death from breast cancer. But among the women who were 75 to 84, annual mammograms did not reduce deaths, although they did, predictably, detect more cancer than in the group that discontinued screening. ‘You’re diagnosing more cancer, but that’s not translating to a mortality benefit,’ Dr. Garcia-Albéniz said.”

drugpromotrump-300x178President Trump has stormed past accepted professional practices and triggered alarms about ethical decision making by caregivers, as he persists in his noisy advocacy for treating seriously ill patients with Covid-19 infections with an unproven pair of prescription drugs.

Promoting this drug regimen — on social media and in White House news conferences — has pitted the onetime real estate developer and reality show host with an undergraduate economics degree squarely against Dr. Anthony Fauci, one of the nation’s foremost infectious disease experts at the National Institutes of Health.

They have squared off publicly, with the leader of the free world talking about how he “feels good” about giving patients two, long-used antimalarial drugs — chloroquine and hydroxychloroquine (aka plaquenil) — while Fauci has insisted such prescribing has no basis now, and, at best, should be subjected to rigorous clinical trial to determine their effectiveness.

faucifacegrimace-300x210Even as Covid-19 wreaked unprecedented harms, there also have been actions that might lead even the most jaded observer to cry out:  What were these people thinking?

The pandemic’s global toll has risen to hundreds of thousands of infections and thousands of deaths. The U.S. toll at the end of the third week in March, the New York Times reported, exceeded 21,000 infections and nearly 300 deaths, with 1 in 5 Americans also now living under tough restrictions that have shut non-essential businesses, schools, colleges and universities, restaurants, gyms and health clubs, and sports and cultural events.

In the throes of such calamitous circumstances,  consider:

AAMedals-300x156Although federal experts estimate that alcohol abuse leads to 88,000 Americans’ deaths annually and economic costs of almost $250 billion, one of the nation’s oldest and best-known programs to deal with this problematic behavior has long been surrounded by doubts.

Critics have questioned its effectiveness, criticized its “irrationality,” and focused on its stepped regimen, desperate and self-enrolling participants, and core tenets, including its spiritual appeals to higher and external powers.

But after a deep dig into the building and rigorous evidence about it — including scrutiny of 27 studies, (some of them randomized clinical trials) with more than 10,000 participants — researchers from Harvard, Stanford, and Europe have concluded in a published, research review for the respected Cochrane Collaboration that Alcoholics Anonymous, indeed, can be beneficial for many but not all excessive alcohol users.

hhslogo2-150x150The Trump Administration, to its credit, has put out finalized new rules that aim to give patients greater access to and use of their all-important medical records, now mostly captured and contained in electronic form.

Federal officials had to battle a handful of wealthy, powerful corporations that own and install proprietary software and computing systems to try to help patients.

They also instantly created major new concerns with their “interoperability” regulations for doctors and hospitals:

curveflatten-300x175Across the nation, and throughout the DC region, Americans — finally — have started to come to grips with the gravity of a fast-spreading, new respiratory virus’ infections. The novel coronavirus has infected almost 150,000 internationally, killing thousands as part of what now is officially a global pandemic and a national emergency.

Cases of Covid-19 have been detected in Washington, D.C., Virginia, and Maryland, as public health officials have urged the public to increase safeguards against contracting the disease, notably by staying home and practicing not only hygienic measures (washing their hands, covering their coughs and sneezes, and foregoing handshakes and hugs) but also keeping their distance from others.

Businesses have urged their people to work from home. Schools have shut their doors. Concerts, plays, museums, and cultural events and institutions have closed and canceled. Professional and amateur sports have suspended play. Travel, domestic and international, has screeched to a halt. Panic buying has broken out at groceries and big box warehouse stores.

cdcHepCopioidabuse-300x150The opioid-overdose crisis has not disappeared, not by a long shot, and there’s a new warning about its toll: A blue-ribbon expert panel has urged doctors to expand testing for hepatitis C to all adults, ages 18 to 79, and no longer limiting the screening to those born between 1945 and 1965. That’s because the risky conduct that goes with abusing opioids also bumps up the risk of this potentially deadly but treatable liver infection.

Hepatitis C is growing as a significant health concern, the New York Times reported:

“Despite substantial advances in treatment over the past five years, infections are on the rise. Roughly 44,700 new hepatitis C infections were reported in the United States in 2017, according to federal data. A major challenge for health officials is that a significant number of people have the virus but do not know they are infected … Hepatitis C leads to chronic liver disease in most people who contract it, and some eventually develop cirrhosis and liver cancer. It is spread primarily through the sharing of needles among people who use illicit drugs.”

calguardvirusaid-300x169The coronavirus outbreak spreading across the globe may be providing Americans with an unhappy view of the dirty downsides of the too-often dysfunctional U.S. health care system as it grapples with spiking Covid-19 infections.

Congress has appropriated more than $8 billion, so the federal government can provide the nation the support it needs in battling the respiratory illness that exploded out of central China a few weeks ago. Almost 100,000 people globally have been infected with the virus, which has killed thousands. The deaths in this country are rising into the dozens, while infections are increasing into the hundreds. In Italy, the government took a drastic step in dealing with steeply rising infections and ordered a virus-related quarantine of much of the northern part of the country — a tough lock down because the Lombardy area is the largest economic powerhouse of the nation.

In the U.S., federal efforts to stockpile needed medical supplies, notably masks, gloves, and gowns — personal protective equipment or PPEs — continue to lag. The administration is under fire for its slow and ineffectual roll-out of virus testing kits. Vice President Pence promised that big numbers of screening supplies would be available quickly — at least 1 million, asap — but he since has been forced to walk back that pledge. Even as he talked about 75,000 test kits becoming available soon, the Atlantic magazine reported that as few as 1,895 Americans have been tested so far for the virus.

GovMikePence-300x200The viral outbreak that exploded out of central China suddenly has captured the rapt attention of Wall Street, the White House, and Americans from coast to coast. The rising pitch and politicization of the important conversation about Covid-19 — a respiratory virus that already has posed a growing global health threat — can only be described as worrying.

For ordinary folks, the guidance emerging from all this: It may be time for smart preparation — definitely not panic.

The Trump Administration apparently has gotten the message that viral concerns are high, and the president and his men have conducted two news conferences in almost as many days, including announcing the first coronavirus death of an American in the continental U.S. and travel restrictions affecting Iran, Italy, and South Korea.

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