Archive for the ‘Medical’ Category
Hannah Block reports for NPR:
Checking into a hospital can boost your chances of infection. That’s a disturbing paradox of modern medical care.
And it doesn’t matter where in the world you’re hospitalized. From the finest to the most rudimentary medical facilities, patients are vulnerable to new infections that have nothing to do with their original medical problem. These are referred to as healthcare-acquired infections, healthcare-associated infections or hospital-acquired infections. Many of them, like pneumonia or methicillin-resistantStaphylococcus aureus (MRSA), can be deadly.
The World Health Organization estimates that “each year, hundreds of millions of patients around the world are affected” by healthcare-acquired infections. In the United States, the Office of Disease Prevention and Health Promotion in the Health and Human Services Department estimates that 1 in 25 inpatients has a hospital-related infection. In developing countries, estimates run higher.
Hospital bed safety railings are a major source of these infections. That’s what Constanza Correa, 33, and her colleagues have found in their research in Santiago, Chile. They’ve taken on the problem by replacing them, since 2013, with railings made of copper, an anti-microbial element.
Copper definitely wipes out microbes. “Bacteria, yeasts and viruses are rapidly killed on metallic copper surfaces, and the term “contact killing” has been coined for this process,” wrote the authors of an article on copper in Applied and Environmental Microbiology. That knowledge has been around a very long time. The journal article cites an Egyptian medical text, written around 2600-2000 B.C., that cites the use of copper to sterilize chest wounds and drinking water.
Correa’s startup, Copper BioHealth, has not yet assessed the railings’ impact in Chilean hospitals. But a study of the effects of copper-alloy surfaces in U.S. hospitals’ intensive care units, published last year in Infection Control and Hospital Epidemiology, showed promising results: Their presence reduced the number of healthcare-acquired infections from 8.1 percent in regular rooms to 3.4 percent in the copper rooms.
Correa spoke with Goats and Soda a few hours before she presented her work at a Latin America innovation conference earlier this month, hosted by the Inter-American Development Bank in Washington, D.C.
You have a simple strategy to combat hospital-associated infections. Tell me what it involves. . .
A very interesting column on the actual effect of heroic life-extending medical interventions. The determination to make sure the patient’s suffering is extended as long as medically possible seems particularly odd in Christians, who, after all, believe that there’s a life after death—and in fact a glorious life—for those who have led good lives. I doubt that the prolonging the patient’s life at any cost is due to a strong conviction that this person would very much want to postpone as much as possible their arrival at an unpleasant place. So what drives it? Fear of one’s own mortality? That the idea of dying triggers blind resistance (aka “the will to survive”)? That sounds about right: can’t let them die because that would mean that I shall die.
Otherwise, I don’t get it.
Glad Coburn’s leaving the Senate, and his swan song is to block efforts to prevent veteran suicides. What a shit. As the post at the link states, the program is $22 million—not much considering the cost of the Iraq War—and as the post notes:
“This is why people hate Washington. Senator Coburn is the only person stopping this bill from becoming law,” said IAVA CEO and Founder Paul Rieckhoff. “If Senator Coburn blocks the Clay Hunt SAV Act, an enduring part of his legacy will be killing an overwhelmingly supported bipartisan suicide prevention bill for our veterans. That has real implications. If it takes 90 days to revisit this issue in the next Congress, the statistics tell us that 1,980 additional veterans will die by suicide. Senator Coburn needs to think carefully about that number in addition to his concerns about the minimal financial costs of this bill.”
As William Congreve wrote in the play The Mourning Bride, “Music hath charms to soothe a savage breast, to soften rocks, or bend a knotted oak.” And apparently it also helps some with PTSD. Scott Beauchamp writes in Pacific Standard:
Up until a few years ago, when I returned home from two tours as an Infantryman in Iraq, if I referenced the Grateful Dead, the ultimate baby boomer counterculture band, it was usually as the punch line to a joke about their cult-like army of followers or the hours-long jam sessions their live shows consisted of. I never saw myself as the type of person who would listen to them.
I would have stayed the course, listening to more conventionally “cool” music, were it not for the periodic bouts of anxiety that I had brought back with me from Iraq. There was sleeplessness, hyperawareness, diffuse and undefined anxiety, and depression—the typical mélange of symptoms usually attributed to post-traumatic stress. On nights that I couldn’t sleep—and on days that I couldn’t function—I’d spend hours with music. I began with the songs that I was already familiar with—classic and independent rock mostly. But being able to sing along to tunes I knew from childhood and high school became a tedious comfort, and so, with the help of Spotify and YouTube, I began searching for more options.
I don’t remember exactly when I decided on the Grateful Dead; there wasn’t a Eureka moment. I just slowly realized that they were frequently coming up in my playlists. A majority of the time that I was listening to music at all, in fact, I was listening to the Dead. They made me feel blissful, to put it simply. That may be hard to take seriously in a post-modern milieu that demands every thinking person be a cynic, but for me, healing from the experience of war, the nourishment that I received completely overshadowed any knee-jerk embarrassment.
I’M NOT THE FIRST to make a connection between the music of the Grateful Dead and psychological healing. The much-loved neuroscientist Oliver Sacks wrote about just such a connection in his New York Review of Books essay “The Last Hippie.” In it, Sacks tells the story of Greg, a young man growing up in New York City amid the heady, mind-expanding countercultural apex of the late ’60s. Greg goes about checking all of the boxes of the youth movement experience: He moves to the Village, does a copious amount of LSD, attends live performances of the poet Allen Ginsberg, and obsesses over the music of the Dead. Following a familiar trajectory, he eventually trades in his bohemianism for the New Age and joins the Hare Krishnas; as his devotion deepens, Greg’s contact with his family all but ceases. They had no way of knowing he was suffering from health issues.
When his family was finally able to visit him years later in New Orleans, Greg was completely blind and suffering from severe cognitive impairments. A benign tumor had been left to grow in his brain, wreaking havoc on his frontal lobes. His memories of the ’60s were vivid, fresh, and accessible—but he was completely unable to make new ones. Even simple musical melodies that Sacks would play for Greg were quickly forgotten. Sacks suspected that it might be good to expose Greg to music that he remembered from the past, only in a new setting, and so he took him to a 1991 Grateful Dead concert at Madison Square Garden, where, Sacks writes, Greg came alive. The frontal lobes, parts of the brain that play a role in higher functions like memory and personality, had been damaged by the tumor, leaving Greg in something of a stupor. But at the concert, Greg was thrilled, exuberant … blissful.
THE STORY OF MY own relationship with the music of the Grateful Dead isn’t nearly as dramatic as Greg’s, but my epiphany felt just as real. The chill that I get from a transcendent Jerry Garcia solo isn’t mine alone; it has been proven by researchers at the University of North Carolina-Greensboro that music can cause obvious and measurable physiological effects. . .
Len Charlap, a retired math professor, has had two outpatient echocardiograms in the past three years that scanned the valves of his heart. The first, performed by a technician at a community hospital near his home here in central New Jersey, lasted less than 30 minutes. The next, at a premier academic medical center in Boston, took three times as long and involved a cardiologist.
And yet, when he saw the charges, the numbers seemed backward: The community hospital had charged about $5,500, while the Harvard teaching hospital had billed $1,400 for the much more elaborate test. “Why would that be?” Mr. Charlap asked. “It really bothered me.”
Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue — especially because the equipment to perform them has generally become far cheaper, smaller and more highly mechanized in the past two decades.
And echocardiograms, ultrasound pictures of the heart, are enticing because they are painless and have no side effects — unlike CT scans, blood draws,colonoscopies or magnetic resonance imaging tests, where concerns about issues like radiation and discomfort may be limiting. Though the machines that perform them were revolutionary and expensive when they first came into practice in the 1970s, the costs have dropped considerably. Now, there are even pocket-size devices that sell for as little as $5,000 and suffice for some types of examinations.
“Old technology should be like old TVs: The price should go down,” said Dr. Naoki Ikegami, a health systems expert at Keio University School of Medicine in Tokyo, who is also affiliated with the University of Pennsylvania’s business school. “One of the things about the U.S. health care system is that it defies the laws of economics, and of gravity. Once the price is high, it just stays there.” . . .
Kevin Drum quotes from the article with emphasis added:
The five hospitals within a 15-mile radius of Mr. Charlap’s home here charge an average of about $5,200 for an echocardiogram, according to an analysis of Medicare’s database. The seven teaching hospitals in Boston, affiliated with Harvard, Tufts and Boston University, charge an average of about $1,300 for the same test. There are even wide variations within cities: In Philadelphia, prices range from $700 to $12,000.
….In other countries, regulators set what are deemed fair charges, which include built-in profit. In Belgium, the allowable charge for an echocardiogram is $80, and in Germany, it is $115. In Japan, the price ranges from $50 for an older version to $88 for the newest, Dr. Ikegami said.
Because Mr. Charlap, 76, is on Medicare, which is aggressive in setting rates, he paid only about $80 toward the approximately $500 fee Medicare allows. But many private insurers continue to reimburse generously for echocardiograms billed at thousands of dollars, said Dr. Seth I. Stein, a New York physician who researches data on radiology. Hospitals pursue patients who are uninsured or underinsured for those payments, he added.
Best medical system in the world, eh?
This is a positive development, reported at NPR by Ina Jaffe:
It’s a sunny autumn afternoon and a good time to make apple crisp at Pathstone Living, a memory care facility and nursing home in Mankato, Minn. Activities staffer Jessica Abbott gathers half a dozen older women at a counter in the dining area, where the soundtrack is mostly music they could have fox-trotted to back in the day.
It seems residents can always find something to do around here. That can help to relieve the agitation common in some people with Alzheimer’s or other forms of dementia — agitation that in other nursing homes might be managed with antipsychotic drugs.
Though antipsychotics are approved to treat serious mental illnesses like schizophrenia and bipolar disorder, the FDA says the drugs can increase the risk of death for people with dementia. Still, they’re prescribed for nearly 300,000 nursing home residents nationally.
A few years ago, antipsychotics were used frequently at Pathstone, too.
“We saw these as medications that were supposed to help the patient and, of course, we gave them to them with the feeling that we were doing good,” saysShelley Matthes, a registered nurse who is head of quality assurance for the nonprofit Ecumen, which runs Pathstone and about a dozen other nursing facilities in Minnesota.
Dr. Tracy Tomac is a psychiatrist and medical consultant at Pathstone. In the old days, a resident might have been started on antipsychotics to deal with an emergency, Tomac says, “but they would just stay on it. They would never be taken off for many months or even years.”
So in 2009, she and a colleague at a small Ecumen nursing home near Duluth decided to see if they could reduce the use of antipsychotics there.
“At the end of six months or so,” Tomac says, “we were able to get them all off any antipsychotics.”
The next year they extended the policy to all of Ecumen’s nursing homes. “Our goal, Matthes says, “was to reduce our antipsychotic use by 20 percent. And in the first year we reduced it by 97 percent.”
Continue reading. An important sidebar:
Nursing Home Patients Bill Of Rights
All U.S. residents of nursing homes have specific legal rights, detailed in the Nursing Home Reform Act of 1987. Some of the most important rights include:
- The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms.
- The right to confidentiality of personal and clinical records.
- The right to current clinical records of the resident upon request , and to get those records within 24 hours (excluding hours occurring during a weekend or holiday) of when the resident or a legal representative makes the request.
- The right to choose a personal attending physician, to be fully informed in advance about care and treatment, and to be fully informed in advance of any changes in care or treatment that may affect the resident’s well-being. Also, the resident (or a legal representative) has the right to participate in planning care and treatment or changes in care and treatment.
Finally, psychoactive drugs (including antipsychotics as well as drugs for depression and anxiety) may be administered only on the orders of a physician and only as part of a written plan designed to eliminate or modify the symptoms for which the drugs are prescribed. Such drugs may be given only if, at least annually, an independent, external consultant reviews the appropriateness of the drug plan of each resident receiving such drugs.
Source: Cornell University Law School Legal information Institute
At the link, NPR lets you check medication rates at facilities local to you:
Check NPR’s interactive database . . . to see the history of antipsychotic drug usage at nursing homes in your area and how they compare to national and state averages.