Tag Archives: healthcare

Decontaminating patients cuts hospital infections dramatically

Infections in U.S. hospitals kill tens of thousands of people each year, and many institutions fight back by screening new patients to see if they carry a dangerous germ, and isolating those who do. But a big study suggests a far more effective approach: Decontaminating every patient in intensive care. Washing everyone with antiseptic wipes and giving them antibiotic nose ointment reduced bloodstream infections dramatically in the study at more than 40 U.S. hospitals. The practice could prove controversial, because it would involve even uninfected patients and because experts say it could lead to germs becoming more resistant to antibiotics. But it worked better than screening methods, now required in nine states. The study found that 54 patients would need to be decontaminated to prevent one bloodstream infection. Nevertheless, the findings are “very dramatic” and will lead to changes in practice and probably new laws, said Dr. William Schaffner, a Vanderbilt University infectious-disease specialist who was not involved in the research. Some hospitals are already on board. The study targeted ICU patients, who tend to be older, sicker, weaker and most likely to be infected with dangerous bacteria, including drug-resistant staph germs. The decontamination method worked like this: For up to five days, 26,000 ICU patients got a nose swab twice a day with bacteria-fighting ointment, plus once-daily bathing with antiseptic wipes. Afterward, they were more than 40 percent less likely to get a bloodstream infection of any type than patients who had been screened and isolated for a dangerous germ called MRSA, or methicillin-resistant Staphylococcus aureus. In the year before the experiment began, there were 950 bloodstream infections in intensive care patients at the hospitals studied. The results suggest that more than 400 of those could have been prevented if all hospitals had used the decontamination method. “We've definitively shown that it is better to target high-risk people,” not high-risk germs, said lead author Dr. Susan Huang, a researcher and infectious-disease specialist at the University of California, Irvine. The hospitals in the study are all part of the Hospital Corporation of America system, the nation's largest hospital chain. HCA spokesman Ed Fishbough said the 162-hospital company is adopting universal ICU decontamination. The study was published online Wednesday in the New England Journal of Medicine. The study focused on the MRSA germ. It can live on the skin or in the nose without causing symptoms but can be life-threatening when it reaches the bloodstream or vital organs. It is especially dangerous because it is resistant to many antibiotics. More than 70,000 ICU patients were randomly selected to get one of three treatments: MRSA screening and isolation; screening, isolation and decontamination of MRSA carriers only; and universal decontamination without screening. Partial decontamination worked better than just screening, and universal decontamination was best. About a decade ago, hospital-linked invasive MRSA infections sickened more than 90,000 people nationwide each year, leading to roughly 20,000 deaths. As hospitals improved cleanliness through such measures as better hand-washing and isolating carriers of deadly germs, those numbers dropped by about a third, with fewer than 10,000 deaths in 2011, according to the Centers for Disease Control and Prevention. The CDC has been recommending screening and isolation in certain cases. Now it's having experts review the results and help determine whether the agency should revise its recommendations, said the CDC's Dr. John Jernigan. “It is a very important finding. It advances our understanding of how best to control infections caused by MRSA” and other germs, Jernigan said. The CDC and the federal Agency for Healthcare Research and Quality helped pay for the study. Dr. Carolyn Clancy, who heads the research agency, said the findings have “the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm.” Jernigan said the decontamination approach is much simpler than screening and isolation. But he said its costs need to be studied. Huang said the five-day nose treatment costs about $35 for brand-name ointment but only $4 for a generic version. The antiseptic wipes cost only about $3 to $5 more per day than usual washing methods, she said. But those costs might be offset by other savings from avoiding widespread screening and isolation, she said. Intensive care patients are already routinely bathed. The study just swapped soap with wipes containing a common antiseptic. Some study authors have received fees from makers of antiseptic wipes or have done research or unpaid consulting for those companies. The nose ointment treatment is more controversial because it could cause more germs to become resistant to the antibiotic, Jernigan said. “That's something we're going to have to very closely monitor if this practice is implemented widely,” he said. An editorial accompanying the study voices similar concerns and notes that research published earlier this year found that using just antiseptic wipes on ICU patients reduced bloodstream infections. Two infection control specialists at Virginia Commonwealth University wrote the editorial. Editorial co-author Dr. Michael Edmond said his university's hospital is among those that already use antiseptic wipes on ICU patients. While MRSA screening and isolation is widely accepted, Edmond said that approach “takes a toll on patients.” Isolating patients who test positive for MRSA but don't have symptoms makes patients angry and depressed, and studies have shown that isolated patients are visited less often by nurses and tend to have more bedsores and falls, he said.source : http://www.foxnews.com/health/2013/05/30/decontaminating-patients-cuts-hospital-infections/

Patient communication has room to grow, study shows

There's room - and need - for improvement in the discussions between doctor and patient that go into medical decision-making, according to research out on Monday. In four studies and a commentary published in JAMA Internal Medicine, the authors look at various aspects of doctors' dialogue with patients about prognoses, options and treatment preferences and find little consistency. And though not all patients want the responsibility of making treatment decisions, medical organizations have long promoted the idea of patient-centered care through shared decision-making, and the 2010 Affordable Care and Patient Protection Act that goes into effect next year incorporates the idea into law. What's more, “When physicians reach out and communicate to patients that their views are welcome, patients really like that a lot,” said Floyd Fowler, senior scientific advisor for the Informed Medical Decisions Foundation in Boston. But research in the past decade showed that U.S. patients with common medical conditions were not being adequately informed about their treatment options, so Fowler and his colleagues wanted to see if anything had changed recently. They surveyed 2,718 U.S. adults who were over 40 years old in 2011 and had seen a doctor for any of the five most commonly treated medical conditions - high blood pressure and cholesterol, prostate and breast cancer screenings and back and knee problems - during the previous two years. They found that doctors tended to discuss the pros and cons of surgeries, but not of cancer screenings or the choice of medication to treat high blood pressure or cholesterol. “Each decision has its own dynamic, and it's intriguing that the heart risk related discussions weren't very good,” said Fowler, the study's lead author. He added that doctors may view back and knee surgeries as more complicated treatments, which is why they were discussed in more detail. In a separate study of 207 kidney patients from two dialysis centers in Boston, researchers found that doctors rarely discussed very sick patients' prognoses or their eligibility for kidney transplants. Dialysis patients tend to have one- and five-year survival rates comparable to those of many cancer patients, Dr. Melissa Wachterman, a palliative care physician with the VA Boston Healthcare system, and her colleagues point out in their report. “Talking about prognosis is tough, but there are a lot of reasons why there is a benefit for patients to have this information if they want it,” Wachterman said. In their study, Wachterman's team interviewed 60 of the sickest dialysis patients and their doctors about expectations for the patients' survival and to what degree they had been discussed. The researchers found only two patients whose doctors may have discussed their prognosis with them, and that more than half of the doctors said they would refuse to discuss prognoses - even if patients asked. “I think we do a disservice to patients if we don't give them a sense that time could be short, because they have a lot that they want to do with the time they have left,” Wachterman said. In addition, the researchers found that while patients were good judges of whether or not they'd live another year, they tended to overestimate their long-term survival without their doctors' guidance. “I think - in the long term - having this kind of information can actually give people hope and the ability to plan,” Wachterman said. But not everyone may want to play an active role in their care, according to Dr. Mack Lipkin, a professor of medicine at the New York University School of Medicine and the Bellevue Hospital Center in New York City. “There are many people who want to be active participants in their care but there are also many people who prefer not to be so active,” said Lipkin, who wrote an editorial accompanying the new research. That's supported by a study of hospitalized patients, led by Hyo Jung Tak of University of Chicago, which found the vast majority wanted information on their illness and treatment options but more than 70 percent wanted doctors to make their medical decisions. Moreover, Tak's group found that patients who preferred to participate in decision-making were more expensive. They stayed, on average, an extra quarter day in the hospital and racked up $155 to $1,576 more in costs. Still, a study led by Dr. Harlan Krumholz, of Yale University School of Medicine in New Haven, Connecticut, surveyed 7,000 heart attack patients and found more than two-thirds preferred to play an active role in decision-making. A quarter of the respondents preferred to be the sole decision-maker. At the very least, Krumholz's report concludes, doctors “who aspire to provide patient-centered care” should ask patients about their decision-making preferences directly. Lipkin also said it's best to ask patients their preferences. “We think the first thing to do is ask the patient what they'd like to know, how they'd like to learn it and then tell them,” he said. Fowler added that patients who want to be a part of the decision process shouldn't be afraid to speak up, and he hopes they get used to sharing in the process as the Affordable Care Act emphasizes shared decision-making initiatives. “We're hoping these types of changes that are in the works really happenâ€¦ and that when we repeat the study three or four years from now we'll start to see a difference. That would be great,” he said.source : http://www.foxnews.com/health/2013/05/28/patient-communication-has-room-to-grow-study-shows/

Low radiation scans help identify cancer in earliest stages

Results of the study will be presented at the ATS 2013 International Conference. "Lung cancer is the leading cause of cancer-related death and has a poor survival rate," said Sue Yoon, nurse practitioner at VA Boston HealthCare West Roxbury Division. "Most of our veterans in these ages have a heavy smoking history and early screening is desirable to improve outcomes. Our study was undertaken to learn how often we would discover significant abnormalities and how to adapt our existing processes and interdisciplinary approaches to accommodate additional patients." Conducted according to guidelines set forth by the National Comprehensive Cancer Network (NCCN), the study was based in part on the results of the National Lung Cancer Screening Trial (NLST) which found that LDCT resulted in a 20 percent reduction of lung cancer mortality compared to chest x-ray among heavy smokers aged 55 to 74 years. …

The DSM-5 is here: What the controversial new changes mean for mental health care

The most recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has arrived, and the latest changes have caused divisions among those in the psychiatric community. &#160; Often touted as the psychiatrist’s “Bible,” the DSM is published by the American Psychiatric Association and establishes the almost universal standard by which doctors classify, diagnose and ultimately treat mental disorders – making it an essential part of the psychiatric profession. &#160;The DSM is utilized not only by clinicians, but researchers and health insurance companies as well. Even government officials take interest in the DSM’s criteria in order to determine grant funding, insurance coverage and new health care policies. The latest version is the DSM’s fifth edition, and it is the manual’s first major revision in nearly 20 years since the publication of the DSM-IV in 1994. &#160;The DSM-5’s release brings some radical new changes, which have been met with both praise and disgust from mental health professionals. Some of the most highly debated changes include the elimination of Asperger’s disorder and the addition of a few new controversial conditions such as cannabis withdrawal, gambling addiction and the highly contested disruptive mood dysregulation disorder (DMD). So what do these changes mean for those currently dealing with mental health disorders? &#160;Read on to learn more about the DSM-5’s biggest changes and the possible impact they may have on mental health care. Combination of autism spectrum disorders into single category One of the most publicized changes in the DSM-5 involves grouping all of the subcategories of autism into a single category known as autism spectrum disorder (ASD). &#160;This move effectively eliminates previously separate diagnoses of autism – including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive development disorder “not otherwise specified” (PDD-NOS). This merging of categories creates a “sliding scale” for autism, meaning individuals will be diagnosed somewhere along the autism spectrum, given the personal severity of their symptoms. Many parents and health care providers have speculated that this transformation may end up excluding some of those already diagnosed with an autism disorder, like Asperger’s or PDD-NOS. “I think (exclusion from the spectrum) frankly yet to be determined, but if anything, the specificity is going to go up, meaning the false positives are going to be less likely,” Dr. Alexandar Kolevzon, associate professor of psychiatry and pediatrics at Mount Sinai Hospital in New York City, told FoxNews.com. “This universe of people with PDD-NOS – it’s possible that some of those patients may no longer meet those criteria. &#160;Some of the debate revolves around Asperger’s, but it seems to me that most people diagnosed with Asperger’s will still be on the autism spectrum.” Over the past decade, the United States has seen a striking increase in the amount of autism diagnoses, with the Centers for Disease Control and Prevention estimating that one in 88 children suffers from an autism spectrum disorder. &#160;According to Kolvezon, numerous epidemiological studies have found that the majority of children accounting for this incidence are those with PDD-NOS – a diagnosis given to those with communication issues and pattern behavior but who do not meet the full criteria for autism or another pervasive developmental disorder. Kolevzon said it’s possible that over-diagnosis of PDD-NOS has led to this increase in autism spectrum disorder cases. “What happens in the community is that the diagnosis of autism spectrum disorder virtually guarantees a whole host of therapies – such as speech therapy, occupational therapy, behavioral therapy, and potentially physical therapy,” Kolevzon said. “Theoretically, it’s possible that community providers and clinicians are incentivized to label kids with PDD-NOS, because it would make it more likely to receive appropriate services.” The autism spectrum disorder scale will further refine the way providers diagnose autism, Kolevzon said, by recognizing differences from person to person rather than trying to generalize them into one of four categories. The creation of disruptive mood dysregulation disorder Within the past decade, more and more children as young as 2 years old have been diagnosed with bipolar disorder, leading to the prescription of powerful antipsychotic medication that can be quite intense for children at such a young age. According to the Agency for Healthcare Research and Quality, hospital stays for childhood bipolar disorder have increased by 434 percent from 1997 to 2010. &#160; The trend began in the mid-1990s, when doctors from Harvard University stated that bipolar disorder presented differently in children than that of adults. However, recent studies have found that many of these diagnoses were false, causing what many have described as the “false epidemic.” To combat this trend, the DSM-5 is eliminating the diagnosis of pediatric bipolar disorder and creating a brand new category called disruptive mood dysregulation disorder (DMDD), described as intense outbursts and irritability beyond normal temper tantrums in young children. While the move is meant to address an established problem, many are worried that the category will be applied too liberally. “My concern is this category will be applied to individuals where the reason for these blow ups is for something else. &#160;You can see it in kids with anxiety disorders and ADHDâ€¦.Even the head of the DSM committee asked, ‘Are we going to label kids with temper tantrums?’” Dr. Max Wiznitzer, a pediatric neurologist for UH Rainbow Babies &#38; Children’s Hospital in Cleveland, Ohio, told FoxNews.com. “The thing is we have to make sure people are going to be rigorous in application and not just apply to any kid with temper tantrums or sleep deprivation.” ‘Dependence’ to ‘addiction,’ cannabis withdrawal and gambling disorders The DSM’s chapter on substance abuse has also undergone changes, now being called the Substance Use Disorders chapter. &#160;The diagnostic criteria for these conditions have been expanded, but one of the biggest changes deals with the swapping of two seemingly similar words when describing these disorders: the term “dependence” is out and the term “addiction” is in. According to Dr. Yasmin Hurd, professor of psychiatry at Mount Sinai, the change is subtle but necessary. “It was quite confusing, especially with the term dependence,” Hurd told FoxNews.com. &#160;“It had association with severe psychological dependencies, generating a lot of confusion. &#160;Now the DSM-5 just talks about addiction, in context, being about the compulsive nature of the disorder.” For example, patients being prescribed pain medication may wind up hooked on the drug, but they are still taking the medication under the guidance of a physician. &#160;They aren’t necessarily seeking out the medication by themselves, but if they are taken off the drug they may still have psychological withdrawal. In this case, they aren’t dependent on the drug, but they are addicted - according to the new guidelines. In addition to the word swap, new controversial categories of gambling disorders and cannabis withdrawal have been created in the DSM-5 – decisions based on multiple human and animal studies. “Experts in the field know that people who have severe cannabis use – they’ll go through cannabis withdrawal,” Hurd said. “There is a misnomer in our society that people can’t get addicted to marijuana. &#160;That’s not true. &#160;There are more people that meet the criteria for abuse of cannabis than any other illicit drug.” Similar to the changes made to the autism spectrum disorders, substance use disorders will also be categorized more on a sliding scale, depending on the severity of each patient’s symptoms. “You’re going to have many people with alcohol and cannabis addiction who have mild addiction, but very few heroin addicts are going to be mild,” Hurd said. Other major changes Along with the more controversial changes, the DSM-5 is also refining the criteria for post-traumatic stress disorders (PTSD), including a subtype for PTSD in preschool children. &#160;The diagnosis for attention deficit hyperactivity disorder is also getting a revision, with the elimination of a previously required symptom and the changing of the required age of onset from age 7 to age 12. Obsessive compulsive disorder (OCD), once categorized under anxiety disorders, is now getting its own category of Obsessive-compulsive and related disorders. &#160;Along with OCD, this category includes Body Dysmorphic Disorder (BDD), Trichotillomania (TTM, or hair pulling) and a brand new disorder called Hoarding Disorder. The DSM-5 incorporates many more changes that have psychiatrists locked in heated debate, but Wiznitzer noted that these tensions will always exist as long as doctors continue to learn more about the human brain. “Homosexuality used to be in the DSM as a psychiatric disorder; that was two versions ago,” Wiznitzer said. “Autism wasn’t even in the first two versions of the DSM, it was childhood schizophrenia. &#160;Then we changed the criteria over time. &#160;Basically anytime you change something, it’s always met with resistance.” Click for more information on the DSM-5.source : http://www.foxnews.com/health/2013/05/21/dsm-5-is-here-what-controversial-new-changes-mean-for-mental-health-care/