Friday, May 28, 2010

In Ultrasound, Abortion Fight Has New Front -

"It's going to be cold, and some pressure, O.K.?"

The medical assistant guided the gelled ultrasound transducer across the pregnant woman's belly. The patient, a 36-year-old divorced woman named Laura, stared straight ahead, away from the grainy image on the screen to her side.

The technician told Laura she was at 11 weeks. "Do you want to see your ultrasound?" she asked. "I'd rather not," Laura answered promptly.

Laura, who asked that her last name not be used, had come to the New Woman All Women Health Care clinic in Birmingham with her mind set on having an abortion. And she felt that seeing the image of her bean-size fetus would only unleash her already hormonal emotions, without changing her mind.

"It just would have added to the pain of what is already a difficult decision," she said later.

Over the last decade, ultrasound has quietly become a new front in the grinding state-by-state battle over abortion. With backing from anti-abortion groups, which argue that sonograms can help persuade women to preserve pregnancies, 20 states have enacted laws that encourage or require the use of ultrasound.

Alabama is one of three states, along with Louisiana and Mississippi, that require abortion providers to conduct an ultrasound and offer women a chance to peer inside the womb.

Late last month, Oklahoma went a step further. Overriding a veto by Gov. Brad Henry, a Democrat, the Republican-controlled Legislature enacted a law mandating that women be presented with an ultrasound image and with a detailed oral description of the embryo or fetus.

A state judge quickly stayed the requirement pending a July hearing in a suit filed by two abortion providers. But the measure has prompted outrage among abortion rights advocates and raised questions about the impact of ultrasound laws.

In one of the few studies of the issue — there have been none in the United States — two abortion clinics in British Columbia found that 73 percent of patients wanted to see an image if offered the chance. Eighty-four percent of the 254 women who viewed sonograms said it did not make the experience more difficult, and none reversed her decision.

That generally has also been the case in Alabama, which enacted its law, the first of its kind in the United States, in 2002.

"About half of women opt to view them," said Diane Derzis, who owns the Birmingham clinic. "And I've never had one patient get off the table because she saw what her fetus looks like."

In some instances, the ultrasounds have affected women in ways not intended by anti-abortion strategists. Because human features may barely be detectable during much of the first trimester, when 9 of 10 abortions are performed, some women find viewing the images reassuring.

"It just looked like a little egg, and I couldn't see arms or legs or a face," said Tiesha, 27, who chose to view her 8-week-old embryo before aborting it at the Birmingham clinic. "It was really the picture of the ultrasound that made me feel it was O.K."

The National Abortion Federation, which sets quality standards for abortion providers, does not require ultrasounds in the first trimester. But many clinics routinely perform them to look for anomalies and to establish a precise gestational age, which can determine the method of extraction.

Abortion rights advocates oppose laws that require ultrasounds, even if viewing the images is voluntary.

"The laws don't work," said Vicki A. Saporta, the federation's president. "They inappropriately interfere with the patient-doctor relationship, and they don't respect women's ability to make informed choices."

The anti-abortion movement has regularly used ultrasonic imagery dating back to "The Silent Scream," the influential 1984 film that depicts an abortion in progress. More recently, Focus on the Family spent an estimated $10 million to buy ultrasound equipment and provide training for centers that steer women away from abortion.

"To be able to put a face on that baby humanizes this process and really allows the mother to connect," said Carrie Gordon Earll, a Focus on the Family spokeswoman. "Ultrasound is one of the ultimate examples of informed consent because you are seeing what you are giving permission to happen."

As with many abortion regulations, state laws regarding ultrasound vary widely. Five states, including two that enacted laws this year, require that abortion providers offer to conduct ultrasounds, according to the Guttmacher Institute, which monitors reproductive health issues. In eight others, providers who perform ultrasounds as a standard practice must offer patients a chance to see them.

Ultrasound bills were introduced in 21 statehouses in 2010, according to the institute. Gov. Charlie Crist of Florida, a Republican, must soon decide whether to sign legislation that would require doctors to perform ultrasounds and show and describe the images to patients unless they sign a refusal.

Oklahoma's new law exempts women who need an abortion for emergency medical reasons. But it does not allow exceptions for victims of rape or incest.

During the six days the law was in effect, all of the patients at the Reproductive Services abortion clinic in Tulsa averted their eyes from the ultrasound screen, said Linda S. Meek, the clinic's director. But they could not avoid hearing descriptions of fetal length and heart activity, she said. Many left in tears, but none changed course.

"It's very intrusive, and very cruel," Ms. Meek said.

The Alabama law has had no apparent impact on the number of abortions, which hovers around 11,300 a year. State law also requires that women receive a pamphlet on fetal development and a directory of adoption agencies during a 24-hour waiting period.

Staff members interviewed at three of the seven abortion clinics in the state estimated that 30 percent to 70 percent of women chose to see ultrasound images. But they said it was uncommon for women to be dissuaded.

It had happened occasionally, they said, when a sonogram revealed a multiple pregnancy or when a woman was already deeply unsure about her choice.

But a number of women at the Birmingham clinic, which was the site of a fatal bombing in 1998, said they simply did not want to subject themselves to images that might haunt them. "You almost have to think of it as an alien," said Carmen, 28, who was there for her second abortion in three years.

Like other patients, Laura, who has a 17-year-old son, said she took offense at the state's implicit suggestion that she had not fully considered her choice.

"You don't just walk into one of these places like you're getting your nails done," she said. "I think we're armed with enough information to make adult decisions without being emotionally tortured."

Low-income Cdns have more heart attacks: report - CTV News

Canadians who live in low-income neighbourhoods are more likely to have a heart attack than their wealthier counterparts, a new report indicates.

But in terms of how they fare when they get to hospital, their quality of care appears to be about the same, says the report released Thursday by the Canadian Institute for Health Information.

"This is data to support providing specific strategies to help at-risk and disadvantaged populations," said Toronto cardiologist Dr. Beth Abramson, a spokesperson for the Heart and Stroke Foundation.

"Canadians can't rely on a good in-hospital health-care system to prevent the heart disease in the first place ... I think we'll be misled if we think that equal access to health care means equal access to good health."

Almost 67,000 Canadians landed in hospital due to a heart attack in 2008-09.

A breakdown of five neighbourhood income levels found that those in the least-affluent areas were 37 per cent more likely to have a heart attack than those in the most-affluent districts.

The report says the risk of dying in hospital within 30 days was about the same for all socio-economic groups, averaging 8.3 per cent. However the most affluent patients were seven per cent more likely than the least affluent to have a procedure such as angioplasty or bypass surgery.

"Medical literature indicates that not every patient is selected for or would benefit from such a procedure," the report said.

Heart attack rates were at a high of 347 per 100,000 in Newfoundland and Labrador and a low of 169 per 100,000 in British Columbia, after population age differences were taken into account.

"B.C., who seems to be doing relatively well, has had its prevention strategy ... for many years, and that may help explain some of the differences we're seeing," Abramson noted.

The CIHI researchers said that addressing gaps in heart health between socio-economic groups and geographic areas in Canada could help improve the health of the population.

The Health Indicators 2010 report included an estimate of cost savings if all socio-economic groups had a heart-attack rate like that of the most affluent neighbourhoods.

"The overall rate of hospitalized heart attacks would have decreased by approximately 16 per cent, or the equivalent of about 10,400 hospitalized heart attacks," the report said.

"Based on 2007-2008 cost data, this represents an estimated potential savings in hospital costs of about $100 million, not including physician fees."

Abramson said individuals should make personal changes by trying to be more physically active and eat a healthy diet.

"Sometimes patients with higher socio-economic status tend to be proactive about their health and well enough educated to be able to ask the right questions," she said.

"And we certainly need to be advocates for all Canadians' health, regardless of their income or educational status."

Brushing Teeth May Keep Away Heart Disease

Brushing your teeth is not only good for your pearly whites, it also decreases your chances of suffering a heart attack, a new study indicates.

Researchers in England analyzed data from more than 11,000 people taking part in a study called the Scottish Health Survey. They examined lifestyle habits such as smoking, overall physical activity, and oral health routines.

Patients were asked whether they visited a dentist at least once every six months, every one to two years, rarely, or never. They were also asked how often they brushed their teeth -- twice daily, once a day, or less than every day.

The researchers found that:

  • 62% of participants said they went to a dentist every six months.
  • 71% said they brushed their teeth twice a day.

After adjusting the data for cardiovascular risk factors such as obesity, smoking, social class, and family heart disease history, the researchers found that people who admitted to brushing their teeth less frequently had a 70% extra risk of heart disease.

People who reported poor oral hygiene also tested positive for bloodstream inflammatory markers such as fibrinogen and C-reactive protein.

"Our results confirmed and further strengthened the suggested association between oral hygiene and the risk of cardiovascular disease," Richard Watt, DDS, of University College London, says in a news release. "Furthermore, inflammatory markers were significantly associated with a very simple measure of poor oral health behavior."

He says more studies are needed to confirm the findings and to determine whether oral health and cardiovascular disease are causal or simply risk markers.

The findings of the study were not necessarily shocking, the researchers say, because scientists have increasingly wondered about a possible connection between dental disease and cardiovascular health.

"Inflammation plays an important role in the pathogenesis of atherosclerosis, and markers of low grade inflammation have been consistently associated with a higher risk of cardiovascular disease," they write.

Poor oral hygiene is the major cause of periodontal disease, a chronic infection of the tissues surrounding the teeth. Thus, gum infections seem to add to the inflammatory burden on individuals, increasing cardiovascular risk, the researchers say.

Oral infections are common, so doctors should be alert to infections in the mouth as signs of increased inflammation, and tell patients to brush their teeth and maintain good oral hygiene, the researchers conclude.

The study is published in the journal BMJ.

Thursday, May 27, 2010

New Breed of Specialist Steps In for Family Doctor -

By the time Djigui Keita left the hospital for home, his follow-up appointment had been scheduled. Emergency health insurance was arranged until he could apply for public assistance. He knew about changes in his medication — his doctor had found less expensive brands at local pharmacy chains. And Mr. Keita, 35, who had passed out from dehydration, was cautioned to carry spare water bottles in the taxi he drove for a living.

The hourlong briefing the home-bound patient received here at the Hospital of the University of Pennsylvania was orchestrated by a hospitalist, a member of America's fastest-growing medical specialty. Over a decade, this breed of physician-administrator has increasingly taken over the care of the hospitalized patient from overburdened family doctors with less and less time to make hospital rounds — or, as in Mr. Keita's case, when there is no family doctor at all.

Because hospitalists are on top of everything that happens to a patient — from entry through treatment and discharge — they are largely credited with reducing the length of hospital stays by anywhere from 17 to 30 percent, and reducing costs by 13 to 20 percent, according to studies in The Journal of the American Medical Association. As their numbers have grown, from 800 in the 1990s to 30,000 today, medical experts have come to see hospitalists as potential leaders in the transition to the Obama administration's health care reforms, to be phased in by 2014.

Under the new legislation, hospitals will be penalized for readmissions, medical errors and inefficient operating systems. Avoidable readmissions are the costliest mistakes for the government and the taxpayer, and they now occur for one in five patients, gobbling $17.4 billion of Medicare's current $102.6 billion budget.

Dr. Subha Airan-Javia, Mr. Keita's hospitalist, splits her time between clinical care and designing computer programs to contain costs and manage staff workflow. The discharge process she walked Mr. Keita and his wife through can work well, or badly, with very different results. Do it safely and the patient gets better. Do it wrong, and he's back on the hospital doorstep — with a second set of bills.

"Where we were headed was not a mystery to anyone immersed in health care," said P. J. Brennan, the chief medical officer for the University of Pennsylvania's hospitals. "We were getting paid to have people in the hospital and the part of that which was waste was under the gun. These young doctors, coming into a highly dysfunctional environment, had an affinity for working on processes and redesigning systems."

More ...

Wednesday, May 26, 2010

Medical Symptoms & Questions - infoMedMD

InfoMedMD, contains over 100 private questionnaires - called InfoMeds - to give you information on various medical situations. There are medical symptom checkers, prognosis evaluators, disease screening, procedure screenings and even InfoMeds on lifestyle enhancement. Through a series of medical questions, these InfoMeds can provide you with personalized health care information.

Medical News and Free CME from MedPage Today

MedPage Today is the only service for physicians that provides a clinical perspective on the breaking medical news that their patients are reading. Co-developed by MedPage Today and The University of Pennsylvania School of Medicine, Office of Continuing Medical Education, each article alerts clinicians to breaking medical news, with summaries and actionable information enabling them to better understand the implications.