Early surgery for hip fractures can save lives

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This is something that any senior or anyone caring for a senior should see.

Researchers at Southmead Hospital (UK) report that surgery within 24 hours of injury save lives among elderly patients with hip fractures.

They analyzed data from 241,446 British patients, measuring the death rate in the 30 days after admission. They found that if surgery were delayed past 24 hours, the death rate increased by 8%. The death rate increased by 20% if surgery were delayed 48 hours.

The concern with elderly patients is whether they need time to stabilize after an injury. It turns out that taking that time can add to their risk.

Has your doctor seen that report?


Sources:

  1. BBC News, “Early Hip Fracture Surgery Will Save Hundreds of Lives,” 20 April 2017. http://www.bbc.com/news/uk-england-bristol-39655669

 

Surgical Safety

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This finding appeared today, and it raises all sorts of questions about the quality of care in some hospitals in the US:

South Carolina saw a 22 percent reduction in post-surgical deaths in hospitals that completed a voluntary, statewide program to implement the World Health Organization Surgical Safety Checklist. (1)

In the South Carolina test, 14 hospitals volunteered to use the checklist, and saw a decline in deaths within the thirty days following surgery. Other hospitals in the state saw a slight increase in deaths during the same period. The trial program was run in these hospitals between 2010 and 2013.

The writers make a point that hospitals need to truly commit to the procedure, not treat it  as “a checkbox.”

There are two items that are shocking about this:

  • That the country with the most expensive healthcare in the world needs to learn this from others, and
  • The checklist has been in existence since 2008. (2)

Has your hospital adopted this checklist? If not, do you want to find one that has?

 


Sources:

  1. Alex B. Haynes, Lizabeth Edmondson, Stuart R. Lipsitz, George Molina, Bridget A. Neville, Sara J. Singer, Aunyika T. Moonan, Ashley Kay Childers, Richard Foster, Lorri R. Gibbons, Atul A. Gawande, William R. Berry. Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative. Annals of Surgery, 2017; 1 DOI: 10.1097/SLA.0000000000002249
  2. Institute for Healthcare Improvement, “World Health Organization (WHO) Surgical Safety Checklist and Getting Started Kit.” http://www.ihi.org/resources/Pages/Tools/WHOSurgicalSafetyChecklistGettingStartedKit.aspx

More on Diabetes

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The US is seeing modest, steady growth in the incidence of diabetes among children and teens. A new analysis of data from 2012 to 2012 shows

  • An increase in Type 1 Diabetes of 1.8% per year and
  • An increase in Type 2 Diabetes of 4.8% per year.

While there’s a genetic component, diabetes risk is associated with

  • Family history
  • Immune system issues
  • Diet and weight (and exercise)
  • Blood pressure

Europeans understand that how you care for yourself affects health care costs and health insurance rates for everyone around you. It’s not just about you. Teaching a child to veg in front of a computer or TV simply shortens the child’s life.

However, one of the frustrations with public health data is lack of currency. Has the situation gotten better or worse in the last five years?  My guess is worse, but we simply don’t know.


Sources:

  1. Elizabeth J. Mayer-Davis, Jean M. Lawrence, Dana Dabelea, Jasmin Divers, Scott Isom, Lawrence Dolan, Giuseppina Imperatore, Barbara Linder, Santica Marcovina, David J. Pettitt, Catherine Pihoker, Sharon Saydah, Lynne Wagenknecht. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. New England Journal of Medicine, 2017; 376 (15): 1419 DOI: 10.1056/NEJMoa1610187
  2. NIH/National Institute of Diabetes and Digestive and Kidney Diseases. “Rates of new diagnosed cases of type 1 and 2 diabetes on the rise among children, teens: Fastest rise seen among racial/ethnic minority groups.” ScienceDaily. ScienceDaily, 14 April 2017. <www.sciencedaily.com/releases/2017/04/170414105821.htm>.
  3. International Diabetes Foundation, “Risk Factors.” http://www.idf.org/about-diabetes/risk-factors
  4. Mayo Clinic, “Diabetes.” http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091

Diagnostic Errors

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Facts to consider:

  • 10% of initial medical diagnoses are wrong and contribute to between 40,000 and 80,000 deaths in the US each year. That’s comparable to annual deaths from breast cancer. (2)
  • According to a study by Johns Hopkins, 13% of stoke victims on their initial visit to an ER are sent home without proper diagnosis or treatment. (1)

What you need to consider:

  • Every patient needs an advocate, especially if the patient is unable to express his or her concerns.
  • Doctors are human and humans make mistakes. If the doctor’s diagnosis doesn’t feel right, push back.
  • If it’s important, get a second opinion from an independent medical professional.

Sources:

  1. Merrill Goozner, “Editorial: Diagnosing Wisely,” Modern Medicine, 25 September 2015 (republished, 6 April 2017). http://www.modernhealthcare.com/article/20150926/MAGAZINE/309269984
  2. Society to Improve Diagnosis in Medicine. http://www.improvediagnosis.org/

A vaccine for colon cancer?!

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Thomas Jefferson University Hospital is on a roll.  Wow.

This time it’s immunotherapy for colon cancer. As the ACS notes, this is only one of several improvements in cancer treatment now in the works.  However, it might be a particularly important one.

A drug developed by researchers at the Hospital is about to enter Phase II clinical trials. Here’s the story:

After identifying the Guanylate Cyclase C enzyme in the early 1990s, Scott Waldman, MD, and Adam Snook, MD, are set to take a vaccine that targets the enzyme to destroy metastatic tumors to a phase II trial in 2017.

Here’s what you should know.

1. Dr. Waldman and Dr. Snook are both professors at Thomas Jefferson University in Philadelphia, and Dr. Waldman is the chair of the department of pharmacology and experimental therapeutics.

They reported the enzyme has been “shown to be highly accurate for detecting the spread and predicting recurrence of colorectal cancer.” The duo’s vaccine instructs the immune system to stop metastatic tumor cells and destroy them.

2. Dr. Waldman said the preliminary findings on the vaccine “mean we have the potential to limit the aggressive nature of this disease and prevent metastases.”

3. Exton, Pa.-based Targeted Diagnostics & Therapeutics holds the rights to the drug and has supported the work in Dr. Waldman’s lab.

4. After 15 years of research and several lab and animal-based studies, Dr. Waldman’s new drug application was approved by the FDA in 2013. His phase I trial tested the safety and tolerability of the drug in stage I and II cancer patients. It was safe and well-tolerated.

5. Dr. Waldman recently secured funding for a phase II trial. It’s set to take place in 2017, pending FDA approval. It will assess the vaccine’s effectiveness with intent of commercializing the vaccine. The trial will take two years.

6. If the trial can show efficacy, the physicians will seek Orphan Drug Status to “fast-track” it to the market.

In short, the drug identifies colon cancer cells to the body’s immune system for attack. The Phase I trial established that the drug itself would do no immediate harm to the patient. Phase II will assess how effective it is.

What you should consider:

  • IF the drug works as it appears to, trials like this can be lifesavers for patients with advanced colon cancer. 
  • Do you know someone who might want to participate in the trial?

Sources:

  1. Eric Oliver, “Metastatic tumor-destroying vaccine for colon cancer patients to begin phase II trial: 6 key notes,” Becker’s GI and Endoscopy, original date, 16 November 2016, (re)published 4 April 2017. http://www.beckersasc.com/gastroenterology-and-endoscopy/metastatic-tumor-destroying-vaccine-for-colon-cancer-patients-to-begin-phase-ii-trial-6-key-notes.html
  2. Viral Gene, Inc., “Viral Gene Announces Breakthrough in Colon Cancer: New Vaccine Targets Enzyme to Help Destroy Metastatic Tumor Cells,” press release, 22 November 2017. http://www.prnewswire.com/news-releases/viral-gene-announces-breakthrough-in-colon-cancer-new-vaccine-targets-enzyme-to-help-destroy-metastatic-tumor-cells-300366844.html
  3. American Cancer Society, “What’s new in colorectal cancer research?” 1 March 2017. https://www.cancer.org/cancer/colon-rectal-cancer/about/new-research.html

Ibuprofen, Naproxen, Motrin, Aleve, and Advil

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Dr. Susan Orrange republished this warning on the GoodRx site this week, and it’s worth repeating here given the number of people who take these drugs.

NSAIDs, or nonsteroidal anti-inflammatory drugs, lead the list for medication induced kidney damage because of their widespread use. NSAIDs are used to treat a host of conditions such as fever, rheumatoid arthritis, menstrual pain, and inflammation among many others. Use of NSAIDs like ibuprofen, naproxen, Motrin, Aleve, and Advil can reduce the amount of blood flow to the kidneys, resulting in a higher risk for kidney damage or failure. People with heart failure, liver disease, or previous kidney problems are at even higher risk when taking NSAIDs. To reduce the amount of risk associated with NSAID use, try to use these medications at the lowest effective dose for the shortest period of time.

When my wife first went under treatment by the Headache Center at Thomas Jefferson University Hospital, she was put into a hospital for five days expressly to allow the doctors to “detox” her from Aleve.  The doctors there considered more than 8 pills in a 30-day period to be a potentially dangerous overdose.  That’s far less than the directions on the box indicate.


Sources:

  1. Dr. Sharon Orrange, “The 10 Worst Medications for Your Kidneys,” GoodRx, 9 Novermber 2016. https://www.goodrx.com/blog/10-worst-medications-for-your-kidneys/?utm_medium=email&utm_source=sendgrid.com&utm_campaign=em_nurture&utm_content=blog_kidney&e=66e4013215cd54de978d8ff77403d770&c=fixed__&c=0

Healthcare in the US: Restating the Problem

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The following is from a longer piece by Dr. Jeffrey Lieberman (MD) of Columbia University.  The entire address is on Medscape (see footnote), but I thought these paragraphs explain the current healthcare mess with brevity and precision.  The passage is unedited.

What should be done? I am not a politician, I am not a legislator, I am not an economist. I am a physician, but it seems to me that this is not rocket science. This really is something for which common sense could articulate the questions and develop a way to answer.

The first question is, is healthcare a right or is it a commodity? If it is a commodity, then you get what you pay for. If it is a right, then everybody deserves it. If it is a right, then it is the government’s responsibility to ensure that everyone deserves it. If that is the case, as was suggested with the passage of the Medicare and then Medicaid legislation, then how much is the government prepared to spend? How do we in a society want to spend? Is it 5% of our GDP? Is it 25% of our GDP? That determines how much money we can spend on delivering healthcare to the entire population.

This then needs to be translated into an infrastructure, work force, and financing system that will enable this care to be provided at whatever level we as a society, represented by our government, have determined should be done. What are the benefits and what are the limitations? Are we going to give everything possible to everyone through end-of-life care or are we going to have to ration it?

This is not an unprecedented situation; other countries have dealt with this already. There are single-payer systems, there are single-provider systems, there are hybrid systems. There are nonexistent healthcare systems. We really have a default system in which nobody has taken the responsibility to try to develop something in an enlightened fashion, and the result is what we have, which is not working.

Another issue that must be considered in any serious approach to try to deal with healthcare has to do with how we view biomedical research and the advances that it provides. The real solution to disease care cost is through research which provides, ostensibly, a better understanding and better treatments—and, ultimately, cures for illness. We have seen this over history how scientific breakthroughs lead to medical innovations that lead to reduction of disease and mortality, reduction in cost, greater productivity, longer lives.

Right now, we barely fund biomedical research.

My comment:  The Affordable Care Act and Trumps AHCA were both band-aids rather than solutions to fundamental problems.  Both sought to make the current mess more livable rather than actually fix anything.  Now, Trump’s budget proposes cutting funds for medical research to use for the border wall, which pushes any possible solution further into the future. While one might question whether spending on medical research is correctly prioritized, moving money from there to concrete in a desert solves nothing.


Sources:

  1. Jeffrey A. Lieberman, MD, “‘I’m Mad as Hell!’: Healthcare in America Today,” Medscape, 28 March 2017. http://www.medscape.com/viewarticle/877282?nlid=113688_1521&src=WNL_mdplsfeat_170328_mscpedit_wir&uac=153634BV&spon=17&impID=1317735&faf=1#vp_3