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Do We Have Enough Information About The Whole Genome Sequence To Improve Medical Care?

cake with double helix decoration - text: One base pair at a time

The popular proverbial saying “you cannot have your cake and eat it too” implies that one cannot consume something and preserve it at the same time–in other words, we cannot have it both ways.  Well, for once, maybe we can have our cake–our whole genome sequence (WGS)–and eat it too. I believe having our WGS and consuming it in small bite sizes over a lifetime may be the only way to integrate it into medicine and public health.

Rapid advances in genomic sequencing technologies are making the possibility of reliable and affordable whole genome sequencing (WGS) a reality in the next few years. We all carry about 6 billion base pairs of DNA in each of our cells, with 5-10 million inherited variants that are different among us. This genetic variation along with environmental influences provides a blueprint for health throughout the life span, and is related to virtually every disease of public health significance. There is definite interest among the public and scientists about the personal utility of this information.  In a recent survey by Nature, attitudes towards genome sequencing were explored among a sample dominated by scientists and professionals from medicine and public health. Although only 18.2% of respondents had had their genome sequenced or analyzed, 2/3 of those who had not reported they would take the opportunity should it arise. Curiosity was reported as the main single factor influencing respondents.

Can this information be useful today in improving medical care and preventing disease?   Read more »

*This blog post was originally published at Genomics and Health Impact Blog*

CDC Launches Program To Prevent Infections In Cancer Patients

As clinicians, we know that the nearly one million patients who receive outpatient cancer treatment each year are at risk for serious infections that may lead to hospitalization, disruptions in chemotherapy schedules, and in some cases, death. Even so, it appears that outpatient oncology facilities may vary greatly in their attention to infection prevention. As one example – at an oncology clinic in Nebraska, it was discovered that syringes were reused to access bags of saline that were shared among multiple patients. This unsafe practice led to the transmission of hepatitis C virus to at least 99 cancer patients, resulting in one of the largest healthcare-associated outbreaks of its kind.

To help address this problem, CDC is launching a new program called Preventing Infections in Cancer Patients, featuring tools to help both clinicians and patients prevent infections.

As a cornerstone of this new initiative, CDC worked with Read more »

*This blog post was originally published at Safe Healthcare*

Should New Mothers Leave The Hospital With Birth Control?

image from www.blisstree.com

It depends on the method and whether the mother plans to breast feed.  Ideally, it is recommended that women abstain from sexual relations for at least 4 to 6 weeks after having a baby to reduce the risk of developing vaginal infections and of course, becoming pregnant.

Pregnant women have an increased risk of developing blood clots because of hormonal changes.  This is commonly referred to as a hypercoagulable state.  Birth control pills that contain both estrogen and progestin (aka combination pills) are not recommended for the first 42 days after the delivery because they increase the risk of blood clots in the legs (Deep Venous Thrombosis, aka DVT) and also decrease breast milk production. The vaginal ring and patch are also not recommended. However, birth control pills that only contain progestin are safe to take immediately after delivery because they don’t increase the risk of developing blood clots nor do they reduce the amount of breast milk production. The Depo- Provera injection may also be given as well because it is a progestin-only product. What women are at increased risk for developing a DVT? Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

CDC Addresses Infection Transmission Through Organ Transplants

Over the past few years, my team at the CDC looked into more than 200 reports of unexpected disease transmission through organ transplantation. Of the cases that were confirmed, some had fatal outcomes. Clearly, transmission of infections through organ transplants remains a patient safety concern that calls for action.

To help address the problem, CDC recently led a team of experts to develop the Draft 2011 Public Health Service (PHS) Guideline for Reducing Transmission of HIV, HBV, and HCV through Solid Organ Transplantation. The guideline was posted to the Federal Register last week, and I encourage your review and comment.

While recognizing the critical need for organs, our team also wants Read more »

*This blog post was originally published at Safe Healthcare*

CDC Outlines The Steps For Investigating Disease Outbreaks

With the release of the movie Contagion, I thought it would be appropriate to post my cheat sheet on how to investigate a disease outbreak. Aspiring disease detectives take notes!

Scientist in biocontainment suit examining a dead ratWhat do you think of when you hear the word “outbreak”?  Maybe you envision a population decimated by a terrible, novel, and incurable disease like in the aformentioned movie Contagion or you think of Dustin Hoffman roaming around California in a blue biocontainment suit with Rene Russo trying to protect folks from a tiny monkey and narrowly preventing an airstrike by the US military?

Hollywood has done their best to capture what an outbreak is…but here are the facts. An outbreak, or epidemic, occurs when there are more cases of disease than would normally be expected in a specific time and place.  The disease may be something doctors have already seen before just in a new form or abnormally high numbers, such as foodborne or healthcare-associated infections, or it may be an emerging disease that we don’t know much about like SARS.  Either way, we need to investigate to determine why it is happening and how to prevent other people from getting sick or dying. Several people in biocontainment suits collecting samples outside a building

Outbreaks are usually noticed by an astute clinician, such as those who first noticed AIDS in New York City and San Francisco, but there are also many high tech disease detection systems available to help us spot any increase in illness. PulseNet is a laboratory network that uses PFGE (pulsed-field gel electrophoresis) to help identify foodborne outbreaks by monitoring the genetic make-up of the bacteria causing what may otherwise look like unrelated illnesses. In the recent events of the Salmonella outbreak in ground turkey, PulseNet and the National Antimicrobial Resistance Monitoring System helped identify the cause of the outbreak as well as determine how widely it had spread. Programs such as Biosense and First Watch monitor the chief complaint or reason that someone called 9-1-1 or went to the hospital (aka syndromic surveillance).  We also monitor news media for reports of outbreaks and websites such as Google Flu trends, which tracks circulating viruses and illnesses. With new technology ordinary citizens can also increasingly report outbreaks in their communities too.

The Magic Formula

So how do you figure out the who, what, when, and where of a disease outbreak? Read more »

*This blog post was originally published at Public Health Matters Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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