Monthly Archives: April 2017

Strategies hospitals can use to brace for a flu pandemic

by Paige Minemyer | FierceHealth
Apr 26, 2017 1:12pm

Public health officials have warned that an influenza pandemic could be on the horizon and providers may not be ready to handle the challenges that come with a wide-scale disease outbreak.
But hospitals are taking steps to prepare for an outbreak in the wake of worries over proposed budget cuts from the Trump administration that would slash funding to the Department of Health and Human Services and the National Institutes of Health.
Hospitals and health systems are including a potential flu outbreak in their emergency preparedness plans and testing strategies to limit the spread of disease, according to an article from Healthcare Dive. For example, in California, Stanford Health Care’s 20-person committee has devised a plan to provide a drive-through emergency department to avoid bringing ill patients into the hospital before they’re screened.
The system tested the program in the wake of 2009’s H1N1 flu outbreak. Patients who potentially have the flu will be screened in or near their cars, isolating them from either bringing the virus into the hospital or coming in contact with others who may have it. It also protects nonclinical staff from potential exposure, according to the article.
Other providers have tested teletriage programs that would prevent potentially ill patients from coming to the emergency department and allow for faster screening, according to the article. The Minnesota Department of Heath’s MN FluLine, for instance, has prevented about 11,000 face-to-face flu visits. Banner Health hospitals plan to keep a stockpile of disposable masks, gloves and gowns on hand in case a large outbreak occurs.
In addition to ways hospitals can prepare internally, infection control should also begin long before a patient is sick enough to seek out care, public health experts note. The Centers for Disease Control and Prevention recently updated its guidelines (PDF) to prevent a flu pandemic, with a focus on nonpharmaceutical strategies that can reduce the spread of disease. These strategies fit into three categories: personal protective measures, community measures and environmental measures.
Personal options include sick patients voluntarily isolating themselves at home or practicing better hand hygiene, and community measures can include closing schools or offices to prevent the spread of disease. Environmental measures push for better cleaning of surfaces that can harbor disease.

Illinois hospital offers housing to curb ER superusers

by Ilene MacDonald | FierceHealth
Apr 26, 2017 11:48am

One of the biggest drivers in hospital spending is the rising number of “superusers,” patients who visit the emergency room or are admitted to a general acute care hospital several times a year.
But an Illinois hospital noticed that many of its most frequent users were chronically homeless patients, who didn’t always come for medical care. In many cases they just needed a warm place to stay on a cold night.
To better help care for these patients—and cut costs—the University of Illinois Hospital (UI-Hospital) and Health Sciences System launched a housing initiative in 2015 to provide furnished apartments and support services for homeless patients.
Prior to the program, seven of the top 10 users of the organization’s ER were chronically homeless and accessed the system between 30 and 120 times a year. The organization’s $250,000 investment in the program has led to impressive results, reported AHA News. So far, the monthly hospital visits have declined by 35% and the annual cost of care for these patients dropped more than 40%.
In addition to housing, patients are assigned a case manager who coordinates their care and helps them manage money.
“We see funding housing as a way of improving health,” Avijit Ghosh, M.D., CEO of the UI Health Hospital & Clinics, said on the hospital website. “Actions like this are important to address the problems facing our community. By helping those who rely on UI Health, we’re improving the health of both the individuals and our community overall.”
Peter Toepfer, associate vice president of housing for the Center for Housing and Health in Chicago, which partners with the hospital, told AHA News that hospitals and health systems must view patients who are chronically homeless the same way they consider chronic illnesses. The best prescription, he said, is providing a homeless patient with permanent supportive housing.
SBH Health System, based in New York City’s Bronx borough, is working on a similar initiative by partnering with a developer to build housing for low-income patients.

The 5 best-paying jobs in healthcare

by Ilene MacDonald | FierceHealth
Apr 26, 2017 10:44am

It’s good to be an orthopedic surgeon. The profession leads the list of the highest paid healthcare jobs in 2017, according to new salary data from a leading professional network site.
Although another survey released by an online job recruiting website earlier this year found physicians lead the list of highest-paying jobs among all professions in the country, the latest Linkedin salary data takes a look at the top 15 earners in the healthcare industry.
Orthopedic surgeons rank number one, netting an average of $475,000, according to the report.
Following close behind are surgeons and cardiologists; each earn an average of $400.000.
Radiologists come in at number four, making an average of $373,000.
In the fifth spot are anesthesiologists, who make $368,000 a year.
But not all of the top earners require years of expensive medical training. The report finds that high earners also have roles in business development, marketing and product management. For example, global marketing directors earned $233,000 and the 11th spot on the list and senior directors of development made $225,000 and came in at 14.
It may seem surprising that healthcare CEOs and other execs don’t fall anywhere in the list, considering that many earn six- or seven-figure salaries. LinkedIn said it excluded C-suite level jobs from the analysis. In order for a title to be considered, LinkedIn said it must have had 20 or more salary reports from LinkedIn members.

Easing FDA Restriction Could Help Millions Hear Better (NPR)

Senate bill to allow OTC hearing aids has bipartisan support
by MedPage Today Staff
April 24, 2017
Bipartisan legislation to allow manufacturers of so-called “personal sound amplification products” to market them as over-the-counter hearing aids for people with mild to moderate hearing loss is receiving widespread support from consumer and patient’s rights groups.
The Over-the-Counter Hearing Aid Act of 2017 (HR 1652 and S 670) would direct the FDA to categorize the devices as a new class of hearing aid, allowing federal regulators to develop safety and effectiveness standards for them, NPR reports.
The FDA currently does not allow the sale of hearing aids over the counter, so the devices can only be marketed as sound amplifiers for people with normal hearing.
They range in cost from between $250 to $350, compared to thousands of dollars for traditional hearing aids.

FDA: No Codeine or Tramadol for Children Under 12 — Period

Warnings for children with medical conditions, breastfeeding moms

by Molly Walker Staff Writer, MedPage Today April 20, 2017

Use of both codeine to treat pain and coughs and tramadol to treat pain are now both contraindicated in young children under the age of 12, said the FDA in a statement.

Products containing codeine or tramadol will now carry a “Contraindication” for children under the age of 12, which is the FDA’s strongest warning. The agency cited concerns about slowed or difficult breathing or death, especially among younger children and infants in its decision to restrict the use of products containing these two drugs.

“We are requiring these changes because we know that some children who received codeine or tramadol have experienced life-threatening respiratory depression and death because they metabolize (or break down) these medicines much faster than usual (called ultra-rapid metabolism), causing dangerously high levels of active drug in their bodies,” said Douglas Throckmorton, MD, deputy center director for regulatory programs, Center for Drug Evaluation and Research, in a statement.

Throckmorton added in a media briefing that there is no way to know which children are “rapid metabolizers,” because it is genetically determined and varies by racial and ethnic group.

The FDA also added a new “Warning” advising against the use of products with codeine and tramadol in children ages 12 to 18 who are obese or have obstructive sleep apnea or serious lung disease. There is also a strengthened “Warning” advising against the use of these products among breastfeeding mothers, as it may cause serious harm to their infants.

The agency noted that since 2013, prescription products containing codeine have contained a boxed warning and contraindication for children and teens up to age 18 for pain management after removal of tonsils and adenoids. The same will now be true for tramadol-containing products.

“We understand that there are limited options when it comes to treating pain or cough in children, and that these changes may raise some questions for healthcare providers and parents,” said Throckmorton. “However, please know that our decision today was made based on the latest evidence and with this goal in mind: keeping our kids safe.”

The FDA has been evaluating the use of codeine in cold-and-cough medicines in children since 2015 and the risks of using the pain medicine, tramadol, in children ages 17 and younger since September 2015. In 2016, the American Academy of Pediatrics issued a policy statement that advised against the use of codeine in all children.

The agency advised healthcare professionals that single-ingredient codeine and tramadol is only FDA approved for use in adults. Clinicians should advise parents to seek over-the-counter products or other FDA-approved prescription medicines to treat cold and cough in children under the age of 12 years.

At the briefing, Throckmorton described these new “labeling updates” as building on “our understanding of a very serious safety issue based on the very latest evidence.” He added that the FDA plans to hold a public advisory committee later this year to discuss the broader role of prescription cold and cough medicines in children, including those containing codeine.

Medieval Meds for MRSA (Scientific American)

Researchers look to the past for new antibiotics

MedpageToday

by MedPage Today Staff April 19, 2017

A group of researchers known as the “ancientbiotics team” are turning to the Middle Ages to find new leads for treating infections as more and more pathogens become antibiotic resistant, according to Scientific American.

They are compiling a database of medieval recipes for medicines, such as a 1,000-year-old recipe for eye salve to treat a stye that contains wine, garlic, onion, and oxgall. According to the original source, Bald’s Leechbook, the mixture must stand for nine nights in a brass vessel.

This recipe turned out to have potent antistaphylococcal properties, killing Staphylococcus aureus biofilms in an in vitro model and effectively treating multi-drug resistant Staphylococcus aureus in mice.

Antibiotics Up Risk for Colon Polyps

Altered gut bacteria may be culprit in middle-age adults
• by Jeff Minerd
Contributing Writer, MedPage Today April 06, 2017
Long-term antibiotic use in early-to-middle adulthood was linked with increased risk for colorectal adenomas after age 60 in a dose-dependent manner, in an analysis of data from the Nurses’ Health Study.
Be aware that the proposed link between exposure to antibiotics and development of colorectal neoplasia is biologically plausible, as antibiotics shift the gut microbiota and interactions of these dysbiotic microbiota with mucosal immune and epithelial cells may be critical in the initiation and/or promotion of colorectal carcinogenesis.
Long-term antibiotic use in early-to-middle adulthood was linked with increased risk for colorectal adenomas in a dose-dependent manner, researchers reported.
Among patients who took long-term antibiotics in their 40s and 50s, those who used them for more than 2 weeks had a 51% risk increase (odds ratio 1.51, 95% CI 1.14-1.99), and those who used them for more than 2 months had a 69% risk increase (OR 1.69; 95% CI 1.24-2.31) compared with those who never used long-term antibiotics (P=0.001 for both comparisons), said Andrew Chan, MD, of Massachusetts General Hospital in Boston, and colleagues.
For patients who used antibiotics long-term in their 20s and 30s, those who took them for more than 2 weeks had a 41% risk increase (OR 1.41, 95% CI 1.13-1.75) and those who used them for more than 2 months had a 36% risk increase, (OR 1.36, 95% CI 1.03-1.79) compared with never-users (P=0.002 for both), they wrote online in Gut.
For antibiotic courses lasting 2 weeks or less, there was a non-significant trend toward increased adenoma risk. However, recent long-term antibiotic use, defined as within the last 4 years, was not associated with greater risk regardless of the length of time the drugs were used (P=0.44), the study found.
“To the best of our knowledge, this study is the first to link duration of antibiotic use, in a dose-dependent fashion, to colorectal adenoma, the primary precursor of colorectal cancer,” Chan’s group wrote.
“Our study suggests caution with respect to the unnecessary long-term use of antibiotics,” Chan told MedPage Today via email. “Our data support the importance of one’s own normal bowel bacteria in maintaining health. Disrupting the composition of normal gut bacteria through the long-term use of antibiotics may predispose individuals to such conditions as colorectal polyps and cancer.”
As to why the study found no risk with recent long-term antibiotic use, Chan said, “It may be that there are critical time windows during one’s lifespan within which exposure to antibiotics may be more likely to have downstream health effects.”
The investigators analyzed data from the Nurses’ Health Study, a prospective cohort study of more than 121,000 female U.S. nurses, ages 30-55, at enrollment in 1976. The study focused on 16,642 participants who were 60 or older in 2004, had reported the history of their antibiotic use through age 59 on a 2004 questionnaire, and who had undergone at least one colonoscopy between 2004 and 2010. Recent antibiotic use was assessed via questionnaire in 2008.
Chan’s group documented 1,195 cases of adenoma. They used multivariate logistic regression analysis to explore links between long-term antibiotic use and colorectal adenoma, adjusting for variables that included age, family history of colorectal cancer, diabetes, BMI, alcohol intake, smoking, red and processed meat intake, and others.
The associations were similar for low-risk versus high-risk adenomas, but appeared modestly stronger for proximal compared with distal adenomas. For example, middle-aged women with a history of 2-plus months of antibiotic use had twice the risk for a proximal adenoma (OR 2.13, 95% CI 1.35-3.35, P=0.01) but only about a 50% increase in risk for distal adenomas (OR 1.49, 95% CI 0.96-2.29, P=0.02) compared with women who never used long-term antibiotics.
“The proposed link between exposure to antibiotics and development of colorectal neoplasia is biologically plausible,” the investigators said. “Antibiotics shift the gut microbiota to temporally quasi-stable or alternative stable states. Although it is unknown what factors influence either the recovery of gut microbiota to its native state or the development of alternative states after antibiotic exposure, this dysbiosis is generally marked by a loss of diversity, alternations in the abundance of specific taxa, shifts in metabolic capacity, and reduced resistance to colonisation by invading pathogens.”
“The interactions of these dysbiotic microbiota with mucosal immune and epithelial cells may be critical in the initiation and/or promotion of colorectal carcinogenesis,” they added.
In addition, inflammation might be another mechanistic link, as many of the pathogens antibiotics are used against are known to induce inflammation, they noted.
Study limitations included the fact that it did not differentiate between different classes of antibiotics, and that the results may not be generalizable to men or specific racial or ethnic groups.
“In conclusion, early-to-middle adulthood antibiotic use was associated with increased risk of colorectal adenoma, especially in the proximal colon. These data provide additional support for the association of antibiotics with colorectal cancer and the potential mediating role of the gut microbiome in carcinogenesis,” they stated. “Additional studies investigating the impact of antibiotic exposure with gut microbial composition and function, particularly in relation to the mechanisms underlying colorectal carcinogenesis, are warranted.”
The study was funded by the NIH, the Raymond P. Lavietes Foundation, the Project P Fund, the Friends of the Dana-Farber Cancer Institute, the Bennett Family Fund, and the Entertainment Industry Foundation through National Colorectal Cancer Research Alliance.

WARNING SIGNS OF HEART ATTACK, STROKE & CARDIAC ARREST

HEART ATTACK WARNING SIGNS
CHEST DISCOMFORT
Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
DISCOMFORT IN OTHER AREAS OF THE UPPER BODY
SHORTNESS OF BREATH

STROKE WARNING SIGNS
Spot a stroke F.A.S.T.:
Face Drooping Does one side of the face droop or is it numb? Ask the person to smile.

Arm Weakness Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

Speech Difficulty Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like “the sky is blue.” Is the sentence repeated correctly?

Time to call 9-1-1 If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

CARDIAC ARREST WARNING SIGNS

SUDDEN LOSS OF RESPONSIVENESS

No response to tapping on shoulders.
NO NORMAL BREATHING

If any of the above signs are present CALL 9-1-1 IMMEDIATELY !

Heart attack and stroke are life-and-death emergencies — every second counts. If you see or have any of the listed symptoms, immediately call 9-1-1 or your emergency response number. Not all these signs occur in every heart attack or stroke. Sometimes they go away and return. If some occur, get help fast! Today heart attack and stroke victims can benefit from new medications and treatments unavailable to patients in years past. For example, clot-busting drugs can stop some heart attacks and strokes in progress, reducing disability and saving lives. But to be effective, these drugs must be given relatively quickly after heart attack or stroke symptoms first appear. So again, don’t delay — get help right away!

More about heart attack

Some heart attacks are sudden and intense — the “movie heart attack,” where no one doubts what’s happening… But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help.
Immediately call 9-1-1 or your emergency response number so an ambulance (ideally with advanced life support) can be sent for you. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. Learn more about heart attack symptoms in women.
Learn the signs, but remember this: Even if you’re not sure it’s a heart attack, have it checked out (tell a doctor about your symptoms). Minutes matter! Fast action can save lives — maybe your own. Call 9-1-1 or your emergency response number.
Calling 9-1-1 is almost always the fastest way to get lifesaving treatment. Emergency medical services (EMS) staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. It is best to call EMS for rapid transport to the emergency room.

More about stroke

Immediately call 9-1-1 or the Emergency Medical Services (EMS) number so an ambulance can be sent. Also, check the time so you’ll know when the first symptoms appeared. A clot-busting drug called tissue plasminogen activator (tPA) may improve the chances of getting better but only if you get them help right away.

A TIA or transient ischemic attack is a “warning stroke” or “mini-stroke” that produces stroke-like symptoms. TIA symptoms usually only last a few minutes but, if left untreated, people who have TIAs have a high risk of stroke. Recognizing and treating TIAs can reduce the risk of a major stroke.

Beyond F.A.S.T. – Other Symptoms You Should Know

  • Sudden numbness or weakness of the leg
  • Sudden confusion or trouble understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

More about cardiac arrest

If these signs of cardiac arrest are present, tell someone to call 9-1-1 or your emergency response number and get an AED (Automated External Defibrillator) (if one is available) and you begin CPR immediately.

If you are alone with an adult who has these signs of cardiac arrest, call 9-1-1 and get an AED (if one is available) before you begin CPR.

Use an AED as soon as it arrives.

Comprised of 4 steps, a life may be saved by the first responder’s quick action.

  1. Early Access
  • Call 9-1-1 or EMS Immediately
  1. Early CPR

(Cardiopulmonary Resuscitation)

Provide CPR to help maintain blood flow to the brain and body until the next step

  1. Early Defibrillation:

Defibrillation is the only way to restart a heart in sudden cardiac arrest.

An electronic device known as a defibrillator is used to deliver a shock.

Electricity flows from paddles or adhesive electrodes through the chest.

  1. Early Advanced Care:
  • After successful defibrillation, an emergency team provides advanced cardiac care on-scene, such as intravenous medications. This care continues during transport to the hospital.