Articles Posted in Clinical guidelines

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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Dr. Otis Brawley, formerly of the American Cancer Society

The rising flood of health care hype, bunk, and conflicts of interst really can harm patients, as has just been emphasized by a $105-million jury verdict, the brave actions of a leading patient advocacy expert, and the commentary of an expert health researcher and New York Times columnist.

In a more perfect world, a patient like Dawn Kali, 45, and a mother of four, wouldn’t give the time of day to the wild claims of Robert Oldham Young. Both live in San Diego, and when she was diagnosed with cancer, she told a court that she found Young persuasive.

hpvshot-300x231Women may need to double-up on their consultations with their specialists about treatment for serious gynecological concerns, as new studies have raised troubling questions about a much-touted minimally invasive surgery for early-stage cervical cancer.

These concerns, in a more perfect world, also would prompt greater questioning and oversight by doctors, hospitals, regulators, and lawmakers of surgical “innovations.”

The procedure now in question removes the uterus, part of the vagina, and other surrounding tissues via small incisions and with special laparoscopic instruments, including robots. Surgeons have advocated for this surgery rather than making a large incision in an “open” procedure, arguing the less invasive approach promotes less discomfort and faster healing for patients.

crowdfunding-300x150Although the sky-high cost of providing medical care to sick or injured friends and loved ones might seem good reason to encourage community altruism to the nth degree, new technologies that have made it easy, fast, and convenient to “crowd source” online donations also may be sending well-intentioned gifts to dubious and dangerous types of treatment.

A new  study by researchers in Atlanta and New York shows that campaigns on GoFundMe and other social media platforms, sought to raise tens of millions of dollars, and brought in millions for sketchy health-related applications. Experts found “1,059 campaigns that raised money for five unproven or possibly risky treatments: homeopathy or naturopathy for cancer, hyperbaric oxygen for brain injury, experimental stem cell therapy for brain or spinal cord injuries, and long-term antibiotics for chronic Lyme disease,” reported Stat, an online health and medicine news site.

CNN reported that online solicitations were targeted to allow patients to seek dubious therapies at “clinics” in Germany and Mexico (homeopathic or naturopathic cancer care), New Orleans (hyperbaric oxygen for brain injury), and Panama, Thailand, India, China, and Mexico (“stem cell” treatment).

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Same story, new data, and a message that needs repeating: Over-the-counter supplements — sold as safe alternatives to prescription drugs for weight loss, muscle building, and sexual enhancement — may be risky and not beneficial to your health. Indeed, many of them are adulterated with strong prescription drugs.

As the Washington Post reported of a newly published study:

Researchers found unapproved and sometimes dangerous drugs in 746 dietary supplements, almost all of them marketed for sexual enhancement, weight loss or muscle growth … [A scientific] review of a Food and Drug Administration database of contaminated supplements for the years 2007 to 2016 most commonly turned up sildenafil — the drug sold as Viagra — and other erectile dysfunction drugs in sex enhancement products; sibutramine and the laxative phenolphthalein, both banned by the FDA, in weight-loss supplements; and steroids or their analogues in muscle-building products. About 80 percent of the supplements were contaminated by one pharmaceutical that should not have been in the product. Twenty percent contained at least two such drugs, and two of the supplements contained six unapproved drugs. One product contained a drug that raises blood pressure and another drug that lowers it. Despite these contaminants, fewer than half the products were recalled.

flu1918-300x209Although shots carry their own risks, just as any medical treatment does, new data from 2017’s killer flu season shows the folly of patients ignoring influenza’s wrath and skipping the vaccination for it. Youngsters and seniors, especially, need to get these inoculations.

The federal Centers for Disease and Control reported that 80,000 Americans died last winter due to the flu, the infectious disease’s highest toll in 40 years, far exceeding the previous peak of 56,000 such deaths recorded decades earlier.

Youngsters were hit hard in the most recent season, as the Washington Post reported:

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