Articles Posted in Clinical guidelines

bauchner-150x150dredlivingston-150x150While the federal Centers for Disease Control and Prevention has declared racism a serious threat to the nation’s health, establishment medicine finds itself mired in an angry scandal over doctors’ inability to recognize the term, much less its existence, or its considerable harms.

An uproar at a leading medical journal might seem a tempest in an ivy-covered tower. But patients will want to track even a little the professional furor falling on the leaders of the respected Journal of the American Medical Association.

Its website recently featured a podcast, for which doctors could get continuing professional education credit, in which host Ed Livingston (photo above left), JAMA’s deputy editor for clinical content and “a white editor and physician, questioned whether racism even exists in medicine,” Usha McFarling, a Pulitzer Prize-winning journalist reported for Stat, the medical-science news site.

covidmichmayo-300x203The campaign to conquer the coronavirus pandemic is having its cautious optimism tested by a stubborn and concerning surge of cases in the Midwest and Northeast, as well as frustrating vaccine supply problems — worsened by manufacturing bungles in a Baltimore plant.

Expert forecasters now see options for how the crucial next several months could go in the battle against the disease. These include an effective vaccination program outpacing the rise of variants (including the B117 strain that has become the most common in this country) and quashing the pandemic, to the viral mutations getting out of control and the nation limping into persistent and unchecked infections for a long time.

In Michigan, where one of the worst outbreak rages (see Mayo Clinic hot spot map, above), the governor and state officials have found themselves in a public policy quandary, uncertain whether stern health restrictions may have lost their public support to be effective now after showing results before. But in California, officials are waiting and watching to see if plunging infections, hospitalizations, and deaths will reverse as they have elsewhere.

waitingroom-2-300x202Patients packed in their doctors’ waiting rooms in pre-pandemic times may have looked around and wondered: Why are there so many seniors here receiving medical care?

It isn’t just age that gets older Americans in numbers to treatment for illness or injury or preventive care — it’s also, of course, their qualification at 65 for government-supported medical insurance, aka Medicare. That, perhaps, unsurprising conclusion has been affirmed by Stanford doctors and researchers in newly published research. The study also offers important insights on delayed treatment and the crucial role played by health insurance.

The work involved running down a hunch of Dr. Joseph Shrager, a cardiothoracic surgeon who wondered why so many older patients he saw were diagnosed with lung cancer at age 65 — and not, say, at 61, or 64? He discussed the observation with colleagues who concurred in their curiosity about Medicare eligibility and its role in disease diagnosis. As the university news service reported of the insurance hypothesis:

cte-300x157With coronavirus cases, hospitalizations, and deaths falling from scary winter highs, the easing of public health measures may see young athletes returning fast to what are supposed to be the fun and educational benefits of organized sports.

But will players, and more importantly grownups, ensure that appropriate practices are followed to ensure kids not only are safe from coronavirus infection but also don’t suffer serious and lasting head injuries?

The Washington Post has posted articles that could provide important reminders about the risks of chronic traumatic encephalopathy or CTE — the degenerative brain disease associated with the repeated blows to the head.

cookmizzoudmv-150x150It’s long been routine, if often controversial, for operating rooms to welcome medical device sales people and surgical trainees to watch the work of surgeons and nurses. But now the University of Missouri health system may have reset the bar with its $16.2 million settlement with almost two dozen patients over questionable knee surgeries.

The contested procedures were performed in part by a veterinarian.

That vet, James Cook, is listed on the university’s web site as the William & Kathryn Allen Distinguished Chair in Orthopaedic Surgery. The explanatory text online and a posted video has him describing how his chief role at the school focuses on research in people and animals in joint disorders. He says he is experimenting with techniques, notably in dogs, in which live materials can be used to replace problem joints.

cmsnursinghomecompare-300x139Federal regulators, by allowing owners and operators to self-report quality and safety data and failing to audit vital information with diligence, have “broken” the national nursing-home rating system — what was supposed to be an invaluable tool for consumers to make life-and-death decisions about where to place vulnerable loved ones needing round-the-clock care.

Instead, the New York Times reported, the popular and convenient star rankings have become little more than an inaccurate means for facilities to advertise and market themselves, even while keeping from the public their serious problems — including abuse, neglect, over medication, sexual assault, and killings of the aged, injured, and ailing.

The system’s glaring shortcomings were exposed even more by the coronavirus pandemic, the newspaper reported. It launched its deep dig into the ratings when it became clear that highly rated homes, when the pandemic struck, did not fare notably better, as might be expected.

bidenaddress-300x194The national vaccination campaign has picked up measurable momentum. Coronavirus cases, hospitalizations, and deaths continue to recede from scary winter highs. Even cautious state and local officials are easing public health restrictions.

Can it be that the pandemic will be enough in check that Americans can look forward to small family barbecues for the Fourth of July?

President Biden, in his first national broadcast address on the anniversary of the global declaration of a coronavirus pandemic, described that goal as he talked both about the national and personal sorrow of dealing with the worst public health catastrophe in a century while also seeing palpable progress in reining in the disaster.

churninnhomes-300x300Churn may be a wonderful word when discussing fresh milk, heavy cream, and butter. But it can be a nightmare term for the too-common, rapid, and lethal turnover that occurs in health staff at nursing homes and other long-term care facilities.

Personnel turnover left the aged, injured, and ailing residents at care centers, with an average annual health staff churn-rate of 128% and some facilities hitting as high as 300%, even more vulnerable during the coronavirus pandemic, a new study reported.

David Grabowski, a professor of health care policy at Harvard Medical School and one of the study’s authors, told the New York Times of the information he and his colleagues gathered:

drugoverdosedeathscdc-300x131Although the Biden Administration may be winning Americans’ approval for its battle against the coronavirus pandemic, drug abuse experts have expressed rising worry that federal efforts are lagging in the fight against a rising health menace: the resurgent opioid abuse and drug overdose crisis.

While overdoses for the first time might claim 100,000 U.S. lives in a single year, the national campaign to quell the opioid crisis, a top priority not that long ago, has become almost an “afterthought” for policy makers in Washington, D.C., the medical news site Stat reported:

“According to interviews with leading doctors, lobbyists, members of Congress, and multiple Biden Administration aides, proposed reforms include billions of new dollars for treatment and recovery services, a deregulation of addiction treatment medications, making many of 2020’s emergency telehealth allowances permanent, and scaling up harm-reduction offerings like needle exchanges, fentanyl test strips, and naloxone [an overdose antidote] distribution. But over a month into Biden’s presidency, it’s not clear when, or even if, a major push on addiction treatment will happen. Even if one does, it’s an open question whether it will lead to modest changes or the more radical approach some advocates say the crisis deserves.”

covidcasesnewcdcmarch21-300x157The nation has made significant progress, but the coronavirus pandemic is far from over, President Biden and top medical scientists say. That has not stopped a panoply of politicians from coast to coast from declaring a premature victory over the disease that has killed more than 520,000 Americans and infected  29 million people.

As infections, hospitalizations, and deaths have declined from scary peaks of recent months but still plateaued, governors in Texas and Mississippi rescinded coronavirus restrictions, abolishing mask requirements and allowing businesses to operate at 100% capacity.

Biden called the decisions “Neanderthal thinking.”

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