March 3rd, 2011 by StevenWilkinsMPH in Opinion, True Stories
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We hear about stories like this all time: An elderly person falls and breaks something — a hip, a wrist, or an arm. Soon what once was a healthy, independent senior begins an inexorable downhill slide. Such is the case of my 89-year-old mother who recently fell and broke her wrist.
Turns out that 30 percent of people age 65 and older fall each year. Predictably, seniors with the following risk factors are more prone to falls:
- Using sedatives
- Cognitive impairment
- Problems walking
- Urinary tract infection
- Eye problems
- Balance issues
Similarly, when a person does fall, a cascading series of predictable clinical events occurs. It even has a name: “Post-fall syndrome.” This syndrome is characterized by things like fear of falling again, increased immobility, loss of muscle and control, lack of sleep, nutritional deficits, and so on. Seniors susceptible to falls also have higher rates of hospitalization and institutionalization.
What strikes me about falls among the elderly is that they are seemingly predictable events. And once a fall does occur, the consequences seem pretty predictable as well — enter post-fall syndrome. So if falls and their consequences are so predictable, why aren’t primary care physicians more proactive in terms of:
- Preventing falls?
- Treating post-fall syndrome?
In the case of my mother, her primary care physician and orthopedist were both very diligent at treating her episodic needs (i.e. her pain and broken bones). But little attention, if any, was given to assessing her long-term needs, such as nutrition, inability to do anything with her left hand (she’s left-handed), sensitivity to new medications (she never took drugs because they make her loopy), gait analysis, and depression counseling. Read more »
*This blog post was originally published at Mind The Gap*
March 3rd, 2011 by Dinah Miller, M.D. in Opinion, Research
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[Recently] in The New York Times, David Tuller [wrote] about a study published in The Lancet that shows that psychotherapy is an effective treatment for chronic fatigue syndrome. In his article “Psychotherapy Eases Chronic Fatigue, Study Shows,” Tuller writes:
The new study, conducted at clinics in Britain and financed by that country’s government, is expected to lend ammunition to those who think the disease is primarily psychological or related to stress.
The authors note that the goal of cognitive behavioral therapy, the type of psychotherapy tested in the study, is to change the psychological factors “assumed to be responsible for perpetuation of the participant’s symptoms and disability.”
In the long-awaited study, patients who were randomly assigned to receive cognitive behavioral therapy or exercise therapy, in combination with specialized medical care, reported reduced fatigue levels and greater improvement in physical functioning than those receiving the medical care alone — or getting the medical care along with training in how to recognize the onset of fatigue and to adjust their activities accordingly.
Interesting. Generally I like to stay away from the “it’s all in your head” debates. I’ll let the commenters do the talking here.
*This blog post was originally published at Shrink Rap*
March 3rd, 2011 by Linda Burke-Galloway, M.D. in Better Health Network, Health Tips
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Having a baby can be a beautiful thing until something goes wrong. The tragedy is that many high-risk conditions can be managed appropriately if the patient is cooperative and the healthcare provider is competent and well trained. Unfortunately, almost 600 pregnant women die in the U.S. each year from complications and the most common complication is significant blood loss after birth or postpartum hemorrhage (PPH).
PPH occurs when there is a blood loss of 500 cc or greater for a vaginal delivery and 1,000 cc after a cesarean section (C-section). Or, if you were admitted with a hemoglobin of 12 and it drops by ten points to 11, there should be a high index of suspicion for PPH as well. Therefore, if you feel lightheaded or dizzy, have palpitations or an increased heart rate after delivering a baby, inform the hospital staff immediately.
The most common cause of PPH is uterine atony or lack of contractions after the baby is delivered. Any pregnant condition that stretches the uterus significantly — such as having twins or a higher gestation, excess amniotic fluid (aka polyhydramnios), a prolonged induction of labor (greater than 24 hours) — increases the risk of PPH. Retained products of conception, such as the placenta, also places the patient at risk for developing PPH.
Other risk factors for PPH include:
- Women with a known placenta previa
- African-American women
- Hypertension or preeclampsia
- Mothers with infants weighing greater than 8.8 pounds (or 4,000 grams)
- Mothers with greater than seven children
- Women with a history of hemophilia
If you have any of the risk factors listed above, please be proactive and discuss the possibility of a PPH with your healthcare provider. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
March 3rd, 2011 by RyanDuBosar in Health Policy, Research
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High rates of inappropriate antibiotic use continued despite a 15-year campaign by the Centers for Disease Control and Prevention (CDC) aimed at Michigan physicians and consumers on the dangers of antibiotic overuse.
The Center for Healthcare Research & Transformation (CHRT) released an issue brief detailing overall antibiotic prescribing for adult Blue Cross Blue Shield of Michigan (BCBSM) members. (The project is a non-profit partnership between the University of Michigan and BCBSM.)
While antibiotic prescribing in adults decreased 9.3 percent from 2007 to 2009, it increased 4.5 percent for children during the same time period. The studies found significant differences in prescribing patterns between rural southeast Michigan and the rest of the state, particularly for children. Children in rural southeastern Michigan were prescribed an average of .93 antibiotics per year, while elsewhere children were prescribed an average of 1.0 per year.
“The continuing high rate of antibiotic use for viral infections in children and adults — particularly outside of southeast Michigan — is of great concern, as is the increase in the use of broad spectrum antibiotics in children,” said Marianne Udow-Phillips, CHRT’s director. “Using antibiotics when they are unnecessary — or treating simple infections with drugs that should be reserved for the most serious infections — are practices that contribute to antibiotic resistance, making future infections harder to treat.”
Nearly half (49.1 percent) of antibiotic prescriptions in the study population were for broad spectrum antibiotics in 2009, compared to the national rate of 47 percent. Between 2007 and 2009, prescriptions for what the National Committee for Quality Assurance calls “antibiotics of concern” declined slightly in adults, decreasing 0.4 percent during that time period. In the same time period, antibiotics of concern prescribed to children increased 3.4 percent, from 44.9 percent to 46.4 percent.
One possible explanation for the rising rate in children is a rise in resistant pathogens in ear infections, according to the study brief. Other possible reasons are that kids get different infections than adults, and that some drugs that are used in adults are not used for pediatric patients. Read more »
*This blog post was originally published at ACP Internist*
March 3rd, 2011 by David H. Gorski, M.D., Ph.D. in Opinion, Quackery Exposed, Research
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Last Friday, Mark Crislip posted an excellent deconstruction of a very disappointing article that appeared in the most recent issue of Skeptical Inquirer (SI), the flagship publication of the Committee for Skeptical Inquiry (CSI). I say “disappointing,” because I was disappointed to see SI publish such a biased, poorly thought out article, apparently for the sake of controversy. I’m a subscriber myself, and in general enjoy reading the magazine, although of late I must admit that I don’t always read each issue cover to cover the way I used to do. Between work, grant writing, blogging, and other activities, my outside reading, even of publications I like, has declined. Perhaps SI will soon find itself off my reading list.
Be that as it may, I couldn’t miss the article that so irritated Mark, because it irritated me as well. There it was, emblazoned prominently on the cover of the March/April 2011 issue: “Seven Deadly Medical Hypotheses.” I flipped through the issue to the article to find out that this little gem was written by someone named Michael Spector, M.D. A tinge of familiarity going through my brain, I tried to think where I had heard that name before.
And then I remembered.
Dr. Spector, it turns out, first got on my nerves about a year ago, when he wrote an article for the January/February 2010 issue of SI entitled “The War on Cancer: A Progress Report for Skeptics.” I remember at that time being irritated by the article and wanting to pen a discussion of the points in that article but don’t recall why I never did. It was probably a combination of the fact that SI doesn’t publish its articles online until some months have passed and perhaps my laziness about having to manually transcribe with my own little typing fingers any passages of text that I wanted to cite. By the time the article was available online, I forgot about it and never came back to it — until now. I should therefore, right here, right now, publicly thank Mark (and, of course, Dr. Spector) for providing me the opportunity to revisit that article in the context of piling on, so to speak, Dr. Spector’s most recent article. After all, Deadly Hypothesis Seven (as Dr. Spector so cheesily put it) is:
From a cancer patient population and public health perspective, cancer chemotherapy (chemo) has been a major medical advance.
Dr. Spector then takes this opportunity to cite copiously from his 2010 article, sprinkling “(Spector, 2010)” throughout the text like powdered sugar on a cupcake. There’s the opening I needed to justify revisiting an article that’s more than a year old! And what fantastic timing, too, hot on the heals of my post from a couple of weeks ago entitled “Why Haven’t We Cured Cancer Yet?” Read more »
*This blog post was originally published at Science-Based Medicine*
