Articles Posted in Clinical guidelines

measlesnhs-300x200The 44th President implored the members of his staff that a key aspect of their collective success could be summarized by a simple notion: Don’t do stupid stuff. If only many more parents nationwide would concur — and shun the anti-scientific nonsense peddled by anti-vaxxers.  As the new year advances, public health officials across the country are battling measles outbreaks, dozens of reported cases in the Pacific Northwest (Washington and Oregon) and in New York City.

The concern is rising because disease carriers are increasing in their number and mobility in areas where populations may be especially vulnerable due to low vaccination rates. Public health officials have likened the situation to “tossing a match into a can of gasoline,” or a disease spread “like a wildfire.”

As the New York Times reported of the risks this childhood infection poses: “Measles can cause permanent neurological damage, deafness and in relatively rare cases, death.”

With the nation fast graying, a long-term care crisis looms, and too many Americans may not realize that not only will nursing home care be tough to find and afford, it also may be less than ideal. But what happens if seniors themselves — especially the frail old — are asked how care-giving services might best serve them, so they not only can stay in their homes but also enjoy their lives more?

That’s the experimental approach taken by a health care team in Denver, working in the long-titled program, “Community Aging in Place — Advancing Better Living for Elders.” CAPABLE staff intervene with the aged, asking them how, even with disability and debilitation, to improve their lives. The program offers them six visits by an occupational therapist, four visits by a registered nurse, and home repair and modification services worth up to $1,300.

headmri-300x300When patients experience bad headaches, severe chest pain, back or neck aches, or even when kids come in with gut pain that likely is appendicitis, doctors too readily push them into and through what may be hospitals’ over-sized cash-generating machines. It’s past time to end wasteful use of high-powered imaging systems, experts from the Mayo Clinic and Stanford University say.

Drs. Ohad Oren, Electron Kebebew, and John Ioannidis have called out their medical colleagues in an opinion piece published in the medical journal JAMA over excess computed tomography (CT) and magnetic resonance imaging (MRI), saying conditions can’t justify why Americans undergo these costly scans at many times the rate, for example, that Finns do.

Research shows diagnoses don’t improve with many more MRIs and CTs. Instead, they may lead to yet more costly, invasive, and unnecessary tests and procedures, some of which can harm patients.

abraarkaranmdWell, just because.

That isn’t a great answer for cranky toddlers with too many questions. It’s also an unacceptable but real reason why too many hospitalized patients get woken up in the middle of the night and subjected 24/7 to expensive, invasive, and often unnecessary tests and procedures.

Abraar Karan (right), an internal medicine resident at the Brigham and Women’s Hospital/ Harvard Medical School, has blogged with welcome candor about doctors’ casual acceptance of medical routines that not only discomfit but also can harm patients. As he wrote online for BMJ (aka the British Medical Journal): “The reality of medicine is that there are many things we as doctors do for absolutely no reason. That is to say, there is no evidence (randomized controlled trial or otherwise) for doing them, other than ‘that’s the way we’ve always done it.’”

diabetesteststrips-300x200Doctors, hospitals, health officials, and disease advocacy groups race to warn about diabetes’ risks, harms, and increasing prevalence. But why, then, doesn’t modern medicine also do much more to help diabetics with the skyrocketing costs of their care, whether with insulin at excessive prices or with  expensive medical aids?

Ted Alcorn of the New York Times drilled down on one slice of diabetes care to capture how medical profiteering distorts what ought to be a more direct, simple, and less pricey treatment for a disease that afflicts as many as 100 million Americans in varying degree.

He reported on the “strange marketplace” for the chemical-imbued plastic strips diabetics use to test their blood sugar, inserting them into specialized meters for glucose readings. Before diabetics adjust their diet or take insulin, they may test themselves with strips and meters as many as 10 times a day. The costs add up. Diabetics can pay thousands of dollars annually to get test strips over the counter.

cancerdeathrates2018-271x300Cancer hasn’t gotten knocked out of its spot as Americans’ No. 2 killer, but health officials have delivered some good news about the disease that once was considered irreversible in its lethal course: Cancer deaths rates have fallen now for a quarter of a century.

The American Cancer Society, pointing to 1991 as a peak year, says that death rates from the disease declined by 27 percent, “meaning more than 2.6 million deaths [were] avoided between 1991 and 2016.”

Still, 1.7 million Americans likely will be diagnosed with cancer this year, and the disease will kill more than 600,000 patients — meaning 1,666 people per day in this country will die of cancer.

hospital-unit-300x150As the new year gets under way, regulators and lawmakers need to look hard at a nightmare in New Jersey involving a free-standing surgical center and to a nationwide harms occurring in psychiatric hospitals to ensure that these and other institutions improve the safety and quality of their patient care.

USA Today and the Wall Street Journal, in separate stories, reported about shoddy practices and lax oversight that contributed to significant problems in the medical facilities.

The Journal investigated hospitals for the mentally ill and found that, “More than 100 psychiatric hospitals have remained fully accredited by a major hospital watchdog despite serious safety violations that include lapses linked to the death, abuse or sexual assault of patients.”

davincirobot-300x176When surgeons insist on cutting on patients using the million-dollar da Vinci robot system, patients should demand to know why — and to be skeptical to the nth degree whether the device-based operation will be beneficial to them, or if it is yet another way for doctors and hospitals to make medical care exorbitantly expensive and to boost their profits.

NBC News, as part of a global investigation of medical devices and their harms, deserves credit for adding yet more disturbing disclosures with a detailed story about the da Vinci. The report clearly seeks to be balanced and doesn’t deliver as hard-hitting a point of view as The Bleeding Edge, a recent and important HBO documentary on the surgical robot system.

Still, there are plenty of disturbing items that ought to stop lawmakers, regulators, safety advocates, and patients, and force a hard re-thinking about da Vinci:

admitting-300x210Federal regulators have warned nursing homes nationwide to improve the quality and safety of their patient care or face consequences that operators may hasten to heed. That’s because new penalties and rewards will hit them in a place that counts — their pocketbooks.

Two-thirds of the nation’s nursing homes will see a year’s worth of their Medicare funding reduced, the nonprofit, nonpartisan Kaiser Health News Service (KHN) reported, “based on how often their residents ended up back in hospitals within 30 days of leaving.”

KHN said that:

diagnosis-300x200If patients weren’t already unhappy with drive-by medicine, in which clinicians spend on average of 15 minutes with them in an office visit, safety experts warn that too many doctors’  providing of harried care can worsen a medical menace that’s already hard to ignore: misdiagnosis.

Figuring out what ails a patient and taking a correct course of action already is a “complex, collaborative activity that involves clinical reasoning and information gathering,” reports Liz Seegert, a seasoned health journalist and a senior fellow at the Center for Health Policy and Media Engagement at George Washington University.

But, in a briefing posted online for her journalistic colleagues, she goes on to amass some eyebrow-raising information on diagnostic errors, their frequency, harms to patients, and why experts in the field see corrections in this area needed, stat. Among the data points she reports:

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