Thursday, October 30, 2014

Opioids prescribed by doctors led to 92,000 overdoses in ERs in one year - LA Times

Prescription drug overdoses, a dangerous side effect of the nation's embrace of narcotic painkillers, are a "substantial" burden on hospitals and the economy, according to a new study of emergency room visits.

Overdoses involving prescription painkillers have become a leading cause of injury deaths in the U.S. and a closely watched barometer of an evolving healthcare crisis. Little was known, however, about the nature of overdoses treated in the nation's emergency rooms.

A new analysis of 2010 data from hospitals nationwide found that prescription painkillers, known as opioids, were involved in 68% of opioid-related overdoses treated in emergency rooms. Hospital care for those overdose victims cost an estimated $1.4 billion.

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Tuesday, October 28, 2014

Faces of Breast Cancer - Well - NYTimes.com

If you live with breast cancer, love someone with breast cancer or worry about your risk for breast cancer, you are part of a global community of women and men whose lives have been touched by the disease. We asked our readers to share insights from their experiences with breast cancer. Browse their stories to find people like you and join the conversation.

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http://well.blogs.nytimes.com/projects/breast-cancer-stories

Sunday, October 26, 2014

A Pain in the Neck - NYTimes.com

The 62-year-old engineer struggled as he put on his pants. His left arm, which had hurt for the last couple of days, now felt weak, and his left hand hung limp and useless, as if it were somehow paralyzed. When he went to brush his teeth, he noticed that the foamy toothpaste was pouring from his mouth. He glanced up at the mirror and was startled to see that his face was lopsided. The right side, from shaggy brow to toothpaste-covered lip, was lower than the left. The eyelid sagged, revealing the pink inner lid, and that side of his mouth was immobile.

Was this a stroke? He didn't think so. But his wife wanted to take him straight to the emergency room. He considered the option but decided against it. He had a follow-up appointment that morning with Dr. Isaac Moss, an orthopedic surgeon who was treating him for the arm pain. He figured that seeing a doctor who knew him might be better than going to the E.R. So late that morning he went to Moss's office at the University of Connecticut Health Center in Farmington.

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http://www.nytimes.com/interactive/2014/10/24/magazine/26-diagnosis.html?

Sunday, October 19, 2014

Why Doctors Need Stories - NYTimes.com

A FEW weeks ago, I received an email from the Danish psychiatrist Per Bech that had an unexpected attachment: a story about a patient. I have been writing a book about antidepressants — how well they work and how we know. Dr. Bech is an innovator in clinical psychometrics, the science of measuring change in conditions like depression. Generally, he forwards material about statistics.

Now he had shared a recently published case vignette. It concerned a man hospitalized at age 30 in 1954 for what today we call severe panic attacks. The treatment, which included "narcoanalysis" (interviewing aided by a "truth serum"), afforded no relief. On discharge, the man turned to alcohol. Later, when sober again, he endured increasing phobias, depression and social isolation.

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Credit

Four decades later, in 1995, suicidal thoughts brought this anxious man back into the psychiatric system, at age 70. For the first time, he was put on an antidepressant, Zoloft. Six weeks out, both the panic attacks and the depression were gone. He resumed work, entered into a social life and remained well for the next 19 years — until his death.

If the narrative was striking, so was its inclusion in a medical journal. In the past 20 years, clinical vignettes have lost their standing. For a variety of reasons, including a heightened awareness of medical error and a focus on cost cutting, we have entered an era in which a narrow, demanding version of evidence-based medicine prevails. As a writer who likes to tell stories, I've been made painfully aware of the shift. The inclusion of a single anecdote in a research overview can lead to a reprimand, for reliance on storytelling.

My own view is that we need storytelling in medicine, need it for any number of reasons.

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Friday, October 17, 2014

Doctors Tell All—and It’s Bad - Meghan O'Rourke - The Atlantic

A crop of books by disillusioned physicians reveals a corrosive doctor-patient relationship at the heart of our health-care crisis.

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http://www.theatlantic.com/magazine/archive/2014/11/doctors-tell-all-and-its-bad/380785/

The Rise of All-Purpose Antidepressants - Scientific American

Antidepressant use among Americans is skyrocketing. Adults in the U.S. consumed four times more antidepressants in the late 2000s than they did in the early 1990s. As the third most frequently taken medication in the U.S., researchers estimate that 8 to 10 percent of the population is taking an antidepressant. But this spike does not necessarily signify a depression epidemic. Through the early 2000s pharmaceutical companies were aggressively testing selective serotonin reuptake inhibitors (SSRIs), the dominant class of depression drug, for a variety of disorders—the timeline below shows the rapid expansion of FDA-approved uses.

As the drugs' patents expired, companies stopped funding studies for official approval. Yet doctors have continued to prescribe them for more ailments. One motivating factor is that SSRIs are a fairly safe option for altering brain chemistry. Because we know so little about mental illness, many clinicians reason, we might as well try the pills already on the shelf.

Common Off-Label Uses
Doctors commonly use antidepressants to treat many maladies they are not approved for. In fact, studies show that between 25 and 60 percent of prescribed antidepressants are actually used to treat nonpsychological conditions. The most common and well-supported off-label uses of SSRIs include:

  • Abuse and dependence
  • ADHD (in children and adolescents)
  • Anxiety disorders
  • Autism (in children)
  • Bipolar disorder
  • Eating disorders
  • Fibromyalgia
  • Neuropathic pain
  • Obsessive-compulsive disorder
  • Premenstrual dysphoric disorder
 

Investigational Uses
SSRIs have shown promise in clinical trials for many more disorders, and some doctors report using them successfully to treat these ailments:

  • Arthritis
  • Deficits caused by stroke
  • Diabetic neuropathy
  • Hot flashes
  • Irritable bowel syndrome
  • Migraine
  • Neurocardiogenic syncope (fainting)
  • Panic disorder
  • Post-traumatic stress disorder
  • Premature ejaculation

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Thursday, October 16, 2014

Experts Offer Steps for Avoiding Public Hysteria, a Different Contagious Threat - NYTimes.com

As health officials scramble to explain how two nurses in Dallas became infected with Ebola, psychologists are increasingly concerned about another kind of contagion, whose symptoms range from heightened anxiety to avoidance of public places to full-blown hysteria.

So far, emergency rooms have not been overwhelmed with people afraid that they have caught the Ebola virus, and no one is hiding in the basement and hoarding food. But there is little doubt that the events of the past week have left the public increasingly worried, particularly the admission by Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, that the initial response to the first Ebola case diagnosed in the United States was inadequate.

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Wednesday, October 15, 2014

Am I Sick? Google Has a Doctor Waiting on Video - NYTimes.com

The Internet can be a dangerous place to get medical advice. Stomachaches turn into cancer, stress becomes an endocrine tumor. Crack remedies and strange diets abound. Now Google is playing with a new technology that it hopes will help people find more reliable medical information. It's called a doctor.

Google's "Helpouts" product — a service where people can search for experts and talk to them over video — is running a trial program in which people who are searching for symptoms like pink eye and the common cold can video-chat with a doctor. The company is working with medical groups including Scripps and One Medical, which are "making their doctors available and have verified their credentials," according to a spokeswoman.

"When you're searching for basic health information – from conditions like insomnia or food poisoning – our goal is provide you with the most helpful information available," the spokeswoman said in an emailed statement.




Tuesday, October 14, 2014

With Electronic Medical Records, Doctors Read When They Should Talk - NYTimes.com

Will history someday show that the electronic medical record almost did the great state of Texas in?

We do not really know whether dysfunctional software contributed to last month's debacle in a Dallas emergency room, when some medical mind failed to connect the dots between an African man and a viral syndrome and sent a patient with deadly Ebola back into the community. Even scarier than that mistake, though, is the certainty that similar ones lie in wait for all of us who cope with medical information stored in digital piles grown so gigantic, unwieldy and unreadable that sometimes we wind up working with no information at all.

We are in the middle of a simmering crisis in medical data management. Like computer servers everywhere, hospital servers store great masses of trivia mixed with valuable information and gross misinformation, all cut and pasted and endlessly reiterated. Even the best software is no match for the accumulation. When we need facts, we swoop over the surface like sea gulls over landfill, peck out what we can, and flap on. There is no time to dig and, even worse, no time to do what we were trained to do — slow down, go to the source, and start from the beginning.

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http://well.blogs.nytimes.com/2014/10/13/with-electronic-medical-records-doctors-read-when-they-should-talk/?

Sunday, October 12, 2014

To Become a Doctor - NYTimes.com

His first week on night float, Daniel Sanchez heard "Code Blue — Radiology," over the P.A. system, and started running.

"You run," said Dr. Sanchez, 31, a first-year resident at Woodhull Medical and Mental Health Center in Brooklyn, "to wherever the location is, because code blue means the patient is going into cardiac arrest."

He was sure it was a patient of his, a woman in her 60s, who had been admitted for chest pains. His team had sent her for a CT scan.

He ran down the eighth floor hallway, then took the elevator to the second floor. It was his first code blue at Woodhull, a public hospital in Williamsburg. But in Guatemala, where he had worked at a public hospital, San Juan De Dios, as part of his medical school training, he had responded to dozens of these alarms.

"But never with the right resources," Dr. Sanchez said. "There were no monitors or defibrillators on the floor. At least half the patients died."

In radiology, his patient, an African-American woman who had just had a heart attack, was surrounded by emergency department doctors and nurses. A tall physician with braids down her back was quietly overseeing everything. A doctor touched the patient's neck and said, "It's not a code blue — she has a pulse!"

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