Healthcare Hacks

Acetaminophen Protects Against Kidney Failure Due To Trauma

Fred Lee — Thu, 04 Feb 2010 19:58:03 +0000

A team of international researchers has found that the painkiller acetaminophen may protect a person’s kidneys from the negative effects that stem from muscle trauma. Destruction of the muscle tissue can occur through accidents, excessive exercise, or adverse drug interactions, and in certain instances, the result can be life-threatening.

When muscles are injured, the cells break open, or lyse, and release their contents into the surrounding tissue. This condition is also known as rhabdomyolysis. One of the components of the cell lysate is myoglobin, a protein pigment that is subsequently filtered out of the bloodstream. The protein, however, can deposit in the kidneys and lead to oxidative damage, which in turn can cause the kidneys to fail.

Researchers have determined that acetaminophen can prevent or reduce this oxidative damage. In the study in question, published in the Proceedings of National Academy of Science, researchers administered the painkiller at equivalent human doses before and after muscle injury in animal models.

What they observed was the acetaminophen protected the kidneys while also improving kidney function. The findings warrant further investigation in human patients, and clinical trials in related endeavors are currently underway. Doctors are paying special attention to heart attack victims, who might be good candidates because of the cardiac muscle damage that they experience.

Acetaminophen is also being investigated as a way to prevent other tissue damage, including blood cell lysis, sickle cell disease, and malaria. The authors also feel that there are potential applications for acetaminophen in soldiers injured in battle.

Rhabdomyolysis is relatively rare except in situations where traumatic muscle injury occurs, whereby upwards of 85% of the patients will experience some degree of the condition. Of those cases, it has been estimated that 15% of them will undergo acute renal (kidney) failure. Rhabdomyolysis is believed to be responsible for 25% of kidney failure cases.

The kidneys are the organs responsible filtering out waste from our bodies, thus maintaining a proper balance of salts, minerals, and nutrients. When they malfunction or fail, then harmful and potentially toxic materials can accumulate in the body. This can increase blood pressure and compromise the production of red blood cells.

If the kidneys fail, then patients must undergo treatment to filter the blood. Options include dialysis, whereby the blood is filtered by an external machine, or a kidney transplant, along with any necessary diet and lifestyle changes.

For more information, visit the website for the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the National Institutes of Health (NIH).

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What Is "Concierge Medicine"?

Amer Kaissi — Thu, 04 Feb 2010 19:45:00 +0000

By Amer Kaissi

Many patients struggle with finding a primary care or specialist doctor, obtaining an appointment, and taking time from work for a traditional office visit. And even those that have a doctor find it very hard to reach him/her by phone, e-mail, or after office hours. A new report by the National Center for Policy Analysis suggests that “concierge medicine” might present a solution to some of these problems.

Concierge (also called boutique) medical practices offer exclusive access to patients for an annual fee. Doctors are typically available after traditional office hours by e-mail or telephone and through house calls. These services reduce the time-cost to patients to access care and improve quality by utilizing new technologies such as electronic medical records. Services are priced and bundled in a way that offers value for the patient’s money.

These services are likely to solve several problems that are endemic in our healthcare system. For example, 33% of patients report problems getting a timely appointment with their doctor, 24% report problems getting appointments after hours, 12% report problems getting the doctor on the phone, and 12% report that their doctor is too far away. One in every four people report problems taking time from work to see a doctor. And since less than 25% of doctors communicate electronically with patients, patients are required to schedule an office visit for a simple question or a routine prescription.

For patients, this lack of communication is perceived as leading to lower quality care. Research shows that 72% of people believe that insufficient time spent by doctors with patients is one cause of preventable medical errors, while 78% believe that medical errors could be avoided if physicians spent more time with patients.

For example, the concierge practice of DocTalker Family Medicine in Virginia allows patients to schedule an in-office appointment or even request a house call, but about half of the consults are by e-mail or telephone. The only requirement is that patients must at first have a face-to-face consultation with the doctor to establish care. After that, consultation fees are based on the amount of time required.

Unlike other concierge practice, DocTalker has no annual membership fee, but patients who prepay $300 annually receive a 25% discount. A five-minute phone consultation or an e-mail consultation is priced at $25. While the practice does not bill insurance companies for services, patients can file their own claim.

While membership in a concierge practice can cost patients up to $2,500 per year, these services are not limited to wealthy people anymore. For example, one concierge service in Dallas costs $500 per year and is aimed at small business employees who would otherwise likely be without insurance. About 70 small business owners have memberships with the practice. They pay $40 per employee per month for their employees to get same-day primary care services and steep discounts on diagnostic tests and specialist care. While specialist services, surgeries and diagnostic tests are out of pocket, the practice negotiates on behalf of the patients much lower rates for these services.

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Medicine By Patients For Patients On The Web

Amer Kaissi — Thu, 04 Feb 2010 19:41:12 +0000

By Amer Kaissi

Patients diagnosed with life-changing conditions often find it very hard to share details of their diagnosis and treatment, including information about specific symptoms, medications, and providers with other patients with the same condition. A website that functions like a social networking virtual support group allows patients to do just that, from the comfort of their homes.

PatientsLikeMe has about 50,000 patients interacting and discussing their symptoms, treatment regimens and disease progressions. The site has a “community” for each of the following prevalent diseases:

ALS (Amyotrophic Lateral Sclerosis)
epilepsy
fibromyalgia
Chronic Fatigue Syndrome
HIV/AIDS
mood conditions
anxiety
bipolar disorder
depression
OCD (Obsessive-Compulsive Disorder)
PTSD (Post-Traumatic Stress Disorder)
MS (Multiple Sclerosis)
Parkinson’s Disease
CBD (Corticobasal Degeneration)
Devic’s Neuromyelitis Optica
MSA (Multiple System Atrophy)
PLS (Primary Lateral Sclerosis)
PMA (Progressive Muscular Atrophy)
PSP (Progressive Supranuclear Palsy)

The site is “committed to providing a better, more effective way to capture valuable results and share them with patients, healthcare professionals, and industry organizations that are trying to treat the disease.” It is free for patients, but it sells the anonymized and blinded data that patients share on the site to doctors, pharmaceutical and medical device companies, research organizations, and non-profits. It assures patients that their information is only shared to “trusted partners” and that it “is kept safe and secure.”

For example, the site conducted a research study in 2008 to evaluate the effectiveness of lithium in treating ALS. Using data from the collective experience of its members that have taken the drug, it determined that lithium didn’t work. That same conclusion was reached six months later through conventional clinical trials conducted by researchers.

This site is part of a larger movement dubbed “Patient 2.0” that is highlighted in the current issue of Time Magazine. In this empowerment movement, “laypeople are banding together and starting websites to help figure out which practitioners to see and which hospitals to avoid, which clinical trials show promise and which experimental treatments are bunk.”

Since conventional trials for new treatment and medications take so long, “patients have been rushing to come up with their own ways of achieving what the health care industry calls rapid learning.” However, many doctors caution that people should not believe everything they read on the Web, and that traditional scientific research remains the best way to make conclusions about what works and what doesn’t work.

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The Importance Of Checklists In Surgery

Amer Kaissi — Thu, 04 Feb 2010 19:36:28 +0000

By Amer Kaissi

Complex surgeries require a large team of healthcare professionals, including surgeons, anesthesiologists, nurses, technicians and others, to collaborate closely with everybody playing his/her part. However, even with the most competent and best trained healthcare professionals and the best technology available, things sometimes fall between the cracks and complications occur. To prevent this, a top surgeon suggests that something as trivial as a checklist can make a huge difference.

Studies show that the death rate in surgery is 0.4-0.8%, while the rate of complications varies between 3% and 17%. At least half of these complications are avoidable. These complications include acute renal failure, bleeding within the first 72 hours after surgery, cardiac arrest requiring cardiopulmonary resuscitation, coma of 24 hours’ duration or more, deep-vein thrombosis, myocardial infarction, unplanned intubation, ventilator use for 48 hours or more, pneumonia, pulmonary embolism, stroke, major disruption of wound, infection of surgical site, sepsis, septic shock, the systemic inflammatory response syndrome, unplanned return to the operating room, vascular graft failure, in addition to death.

In the new book The Checklist Manifesto, Dr. Atul Gawande stresses the importance of checklists in preventing surgical complications. This approach requires surgical teams to stop at three crucial points before and after surgery and get information from everyone involved in the surgery.

For example, before induction of anesthesia, members of the team orally confirm that “the patient has verified his or her identity, the surgical site and procedure, and consent, the surgical site is marked or site marking is not applicable, the pulse oximeter is on the patient and functioning, all members of the team are aware of whether the patient has a known allergy, and the patient’s airway and risk of aspiration have been evaluated and appropriate equipment and assistance are available, and if there is a risk of blood loss of appropriate access and fluids are available.”

Before the surgery actually starts, a time-out is taken so that the entire team orally “confirms that all team members have been introduced by name and role, confirms the patient’s identity, surgical site, and procedure, reviews the anticipated critical events (surgeon reviews critical and unexpected steps, operative duration, and anticipated blood loss, anesthesia staff review concerns specific to the patient, nursing staff review confirmation of sterility, equipment availability, and other concerns), confirms that prophylactic antibiotics have been administered ≤60 min before incision is made or that antibiotics are not indicated and confirms that all essential imaging results for the correct patient are displayed in the operating room.”

At sign-out, before the patient leaves the operating room, “the nurse reviews items aloud with the team, the name of the procedure as recorded, that the needle, sponge, and instrument counts are complete (or not applicable, that the specimen (if any) is correctly labeled, including with the patient’s name, and whether there are any issues with equipment to be addressed. Moreover, “the surgeon, nurse, and anesthesia professional review aloud the key concerns for the recovery and care of the patient.”

While it sounds very cumbersome, going over the list takes just two minutes but can "get the dumb stuff out of the way" and allow the team to focus on the most demanding tasks, according to Gawande.

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Medical Students Believe In Alternative Medicine

Fred Lee — Wed, 03 Feb 2010 00:51:13 +0000

By Fred Lee

In what can be interpreted as a shift in the attitude towards alternative medicine, a recent survey (the largest study of its kind) has revealed that a majority of medical students believe that complementary and alternative medicine (CAM) should be afforded a more prominent place in the field of conventional medicine. The findings are published in the journal, Evidence-based Complementary and Alternative Medicine, or eCAM.

CAM includes the use of such therapies as yoga, Chinese and herbal medicine, and acupuncture. CAM procedures promote preventative care that actively involves the patient while focusing on the body’s own mending capabilities. CAM also encourages a more balanced approach to healing that incorporates both the mind and the body, and generally relies on more natural approaches.

Interest in CAM has increased dramatically in this country in recent years, yet information regarding its techniques is still largely absent from conventional medical education, and most doctors are unfamiliar with many of the CAM procedures. This may be due to the fact that, until recently, CAM was, for the most part, marginalized by Western medicine. The current study was undertaken to determine if these prevailing attitudes will change in the future.

To arrive at their findings, the authors developed a novel set of questions that they distributed to over 120 medical schools across the country. Of the 68,000 students contacted, 1,770 responded, with 74% of the respondents stating that a medical system that integrates both Western and CAM approaches would be better than either approach by itself.

The medical students also agreed (77%) that doctors who are familiar with CAM have more to offer to their patients than doctors who only know Western medicine, with 84% believing that conventional medicine would benefit from some of the underlying beliefs and ideas of CAM. And finally, 49% of the students indicated that they had themselves used CAM treatments, though that did not mean they would recommend them to their patients until more scientific evidence becomes available.

The data was evaluated in order to gain a better understanding of how future medical practitioners perceive CAM therapies. Because the response rate was so low (3%), there are future studies planned to further investigate the matter. Interestingly, while it was found that most medical students support the inclusion of CAM, there are still significant obstacles that may hinder its widespread use and acceptance.

Even still, CAM is growing in prominence, lending some degree of credibility to its techniques and opening up the field for future endeavors. This is particularly relevant in light of the current health care debate, as well as the problems that arise in providing health care to developing countries.

The establishment of the National Center for Complementary and Alternative Medicine, or NCCAM, as well as numerous journals that specifically highlight CAM research, are testaments to these shifting attitudes.

For more information, check out the website for NCCAM.

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Exercise Today, Reap The Benefits Later In Life!

Amer Kaissi — Fri, 29 Jan 2010 17:00:05 +0000

By Amer Kaissi

Life expectancy in the U.S. has increased from 47.3 years in 1900 to 75.2 years for men and 80.4 years in women in 2005. By the year 2030, one in every five American will be 65 years or older. People in that age group typically suffer more from chronic diseases and disabilities. However, a new study shows that development of these diseases and disabilities is not inevitable if people were physically active in their midlives.

The study followed 13,535 middle-aged women over a 15-year period. In 1986, the participants were free of major chronic diseases and were asked about their exercise habits. They were asked about the average time per week that they spend on leisure-time physical activities, including walking or hiking outdoors, jogging, running, bicycling, lap swimming, playing tennis, doing calisthenics (organized exercise consisting of simple movements), aerobics, aerobic dance, and/or rowing machine exercise, and playing squash or racquet ball, in addition to stair climbing and walking.

Between 1995 and 2001, the same individuals that survived to age 70 or older were followed up to assess their health status. Successful aging was defined as no history of cancer (except nonmelanoma skin cancer), diabetes, myocardial infarction, coronary artery bypass graft surgery (CABG), congestive heart failure, stroke, kidney failure, chronic obstructive pulmonary disease, Parkinson disease, multiple sclerosis, or amyotrophic lateral sclerosis, no impairment in cognitive function, no physical disabilities, and no mental health limitations. Those who survived to at least age 70 years and met all these criteria were defined as a “successful survivors;” those who survived to at least aged 70 years but had a chronic disease history, CABG, cognitive impairment, physical or mental health limitations were defined as “usual survivors.”

Overall, there was a strong, positive association between midlife leisure-time physical activity and the odds of successful survival or exceptional overall health in later life. Not surprisingly, successful survivors at age 70 were more active in their middle age than usual survivors. For example, increasing walking pace was strongly associated with a significant increase in odds of successful aging. When compared with women whose walking pace was easy, women with a moderate walking pace were 0.9 times more likely to successfully age, whereas those whose walking pace was brisk or very brisk had 2.68-fold increased odds.

One noteworthy finding was that being physically active was associated with increased odds of successful survival for both lean and overweight women, therefore suggesting that engaging in physical activity may increase the probability of preserving optimal health, regardless of body weight. Having said that, the best odds of successful survival were related to maintaining a healthy body weight and high physical activity levels simultaneously at midlife.

Our population is aging rapidly. However, nearly 25% of all Americans do not engage in any physical activity. The results of this study showing that physical activity can promote successful survival rather than just extend life may provide enough motivation for people to start exercising.

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Is Your Hospital Tweeting?

Amer Kaissi — Thu, 28 Jan 2010 18:00:04 +0000

By Amer Kaissi

Hospitals, just like virtually any other organization in the world, are joining the social media bandwagon and starting Twitter, Facebook, and YouTube accounts, in addition to various blogs by administrators and clinicians. A new research concluded that nine in ten hospitals or health systems are currently involved in social media to some degree, but only one in three currently has a formal social media plan in place.

There are 121 hospital YouTube channels, with a total of 4,575 videos. The first Hospital Youtube channel was set up by Arkansas Children’s Hospital in 2006. Avera Health has the largest number of videos (377), while M.D. Anderson Cancer Center has the largest number of subscribers (575).

There are 103 hospitals with Twitter accounts. While the first hospital on Twitter was St. Jude Children’s in 2007, it was Henry Ford Health System that was the first to gain national attention when it performed a surgery and posted corresponding 140-character updates. Not surprisingly, Henry Ford has the largest number of “followers” at 1,489. However, St. Jude has the largest number of Facebook “friends” at 33,252.

Numerous hospital CEOs have been blogging in the last few years. But one of the earliest (and probably most popular) blogs has been that of Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston.

Since this is a new trend, it is typically handled by few people within a hospital’s web department as most of them report they have three or fewer people monitoring their social media. It seems that Twitter, YouTube, and Facebook are the most popular platforms and also the most effective in terms of driving traffic to the hospital’s Web site. The study also reports that 92% of all hospitals who are involved in social media did that in order to attract new patients. However, only 12.5% of them have experienced any success in that area. Other reasons for involvement in social media included improving community relations, customer service, employee engagement, and crisis management.

Social media can definitely provide another mechanism for hospitals to interact with patients at a relatively low cost. But the real question remains: how important is it for the patient that his or her hospital is tweeting or has a Facebook account? Obviously, having a social media presence will never replace high quality care and excellent face-to-face customer service. But the new generation of hooked-up patients is demanding that their hospital connect to them using their own language and tools.

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Is "Sorry" Enough After A Medical Error?

Amer Kaissi — Thu, 28 Jan 2010 17:36:02 +0000

By Amer Kaissi

In a previous post, I discussed the issue of medical errors. These are mistakes that are typically committed by physicians, nurses, pharmacists, and other healthcare professionals which cause injury or death to patients. The include errors in diagnosis, errors in administration of drugs and other medications, errors in surgery, errors in the interpretation of laboratory and imaging tests, and errors in the use of medical equipments. A 1999 report estimated that between 44,000-98,000 people die in the U.S. each year due to medical errors, which is equivalent to a 747 crashing every other day.

When a healthcare provider commits a mistake, the standard practice in the past was to hide the error, deny that it ever happened, and definitely not to inform the patient or his/her family members. In the last few years, however, several organizations have encouraged providers, especially doctors, to change their approach, apologize to the patient, and explain what went wrong. Although it sounds very good, this approach has one main and obvious risk: the patient and family might use what the provider says if they decide to file a lawsuit. However, according to the Sorry Works! Coalition, providers and organizations that apologize after committing an error, are less likely to get sued by patients than those than don’t.

The Sorry Works! Coalition is an advocacy organization for disclosure, apology (when appropriate), and upfront compensation (when necessary) after errors and mistakes have occurred. It believes and advocates “that the litigation crisis is largely a customer service crisis -- not a legal problem -- that can be solved anytime.” Therefore, it recommends that providers and organization should use a customer service framework in a programmatic approach that encourages communication and problem solving with patients after potential mistakes. Even if the patient still decides to sue, it argues that it is to the providers’ benefit to have apologies, expressions of grief, and offers of upfront compensation brought into the court because “a sympathetic defendant who has done the right thing is a lousy target in the court room.”

It is important to note that there are a number of states that have passed (or are considering passing) immunity for apology laws. These “statutes allow health care providers to apologize and offer expressions of grief without their words being used against them in court.” This initiative was first started in 2006 when then Senators Barack Obama and Hilary Clinton introduced MEDiC (National Medical Error Disclosure and Compensation) in order to provide grant money to health care providers to implement programs for disclosure and compensation.

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Are Blood Glucose Test Strips For Diabetic Patients Overused?

Amer Kaissi — Thu, 28 Jan 2010 17:00:05 +0000

By Amer Kaissi

People with diabetes can benefit from regularly checking their blood glucose. Using meters which comprise test strips is the most accurate way to do this, because it allows patients to keep a log of their results, a vital tool in keeping their condition under control.

Typically, after inserting a strip into the meter, the diabetic person uses the lancing device on the side of his/her fingertip to get a drop of blood and then squeezes the finger until a drop of blood forms. He/she then touches and holds the edge of the test strip to the drop of blood, and the blood glucose level appears on the meter's display. The test strips are recommended for people who have diabetes and are taking insulin or diabetes pills, on intensive insulin therapy, pregnant, having a hard time controlling their blood glucose levels, having severe low blood glucose levels from high blood glucose levels, or having low blood glucose levels without the usual warning signs.

However, a new Canadian study suggests that many diabetics who use the strips, especially those that are not taking insulin, may not need to. The study tracked test strip utilization between 1997 and 2008. It found that the use of test strips over this time period among older patients has increased by more than 250%, with use increasing among all diabetes patient groups, including those at low risk of drug-induced hypoglycemia. It reported that “30% of patients who did not use drug therapy to control their diabetes and 60% of patients taking oral glucose-lowering drugs not known to cause hypoglycemia were dispensed blood glucose test strips, despite evidence of no clear clinical benefit and some suggestion of harm.” For diabetics who are not taking insulin, some evidence suggests that regular self-monitoring can lead to increased discomfort, inconvenience, and worsening of depression, while it does not lead to improvement in the patients’ condition.

The study concludes that “in light of the overall costs and questionable benefits for many patients, […] we estimate that test strip use among older patients could have been reduced by between 9.5 million and 74.5 million in 2008.” Since each strip costs almost $1 and patients use multiple strips per day, it is suggested that these cost savings can be used to improve diabetes care in ways that are better supported by evidence. Instead of over-reliance on the test strips, experts suggest that patients should focus on their diet, exercise, weight and blood pressure.

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Low-Carb Diets Help Lower Blood Pressure

Fred Lee — Wed, 27 Jan 2010 18:36:02 +0000

By Fred Lee

In a recent comparison of weight loss methods, one that included a low carbohydrates diet was found to be effective in battling hypertension. When compared to the use of the drug orlistat, both methods were successful in reducing total body weight, but focusing on carbohydrate consumption in particular seemed to have the most pronounced effect on a person’s blood pressure, a common health problem in overweight people. Orlistat, marketed under the trade name, Xenical, functions by preventing the absorption of fat into the body.

The findings, published in the current issue of the Archives of Internal Medicine, support the advantages of a dietary approach to weight loss, which unlike the use of medication, is more economical and has fewer side effects. Previous studies had supported the effectiveness of reducing carbohydrates in conjunction with orlistat, but this was the first time the two had been compared to one another. Furthermore, most subjects in weight loss studies are relatively healthy and do not have chronic health conditions, which include diabetes, high cholesterol, arthritis, and hypertension.

To arrive at their conclusions, doctors followed 146 overweight patients with a range of health problems for one year. They were either put on a low-carbohydrate diet or given the medication, orlistat, in combination with a low-fat diet. Both methods proved to be equally effective in lowering body weight by nearly 10%, as well as improving cholesterol and glucose levels.

The real difference was seen in their respective effects on blood pressure, surprising even the authors of the study. Almost half (47%)of the patients who were assigned low-carbohydrate diets discontinued their hypertension medication or had it reduced, compared to only 21% of the orlistat group, along with a commensurate decrease in systolic blood pressure.

The mechanism by which low-carbohydrate diets lower blood pressure is not clearly understood, but needless to say, opens up many avenues of future research. The findings also support the notion that while diets are effective at achieving weight loss, the inclusion of counseling in order to arrive at the optimal approach may in fact improve the end result and result in important quality of life changes.

Hypertension, also known as high blood pressure, is a chronic condition that can lead to numerous health problems, including heart attacks, strokes, and aneurysm. High blood pressure is also the leading cause of renal failure in the United States, and even a moderate elevation of blood pressure can shorten one’s life expectancy.

According to the American Heart Association, hypertension affects nearly one in three adults in this country, or 73 million Americans. Hypertension is also estimated to affect nearly 2 million teenagers and children. Certain situations predispose people to high blood pressure, including obesity, sedentary lifestyle, high salt diets, smoking, and alcohol consumption.

If hypertension is not severe, it can often be effectively treated through modifications in diet and lifestyle, as well as medication. If you are suffering from hypertension, speak with your doctor about your options, and check out the website for the American Heart Association.

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