The Sjögren's Syndrome Foundation has released the first clinical practice guidelines for the disease, which includes recommendations on the management of fatigue, inflammatory musculoskeletal pain, and use of biologic agents.
Steven E. Carsons, MD, from the Division of Rheumatology and Allergy and Immunology at Winthrop University Hospital in Mineola, New York, and colleagues said they developed the Sjögren's Syndrome Foundation clinical practice guidelines after "patient requests for improved care and physician requests for guidance."
The Sjögren's Syndrome Foundation clinical expert panel consisted of clinicians, nurses, and patients who, using a modified Delphi process (75% agreement level), achieved consensus on 19 different recommendations. Three topic review groups were created on the issues of musculoskeletal pain, fatigue, and biologic use, in which panelists performed systematic reviews of the MEDLINE/PubMed and Cochrane databases and compiled data on the topics published between January 1988 and April 2015. A summary of the recommendations was recently published in Arthritis Care & Research.
"Among all chronic autoimmune rheumatic disorders, Sjögren's syndrome remains one of the most difficult to manage," Dr Carsons and colleagues wrote in their recommendations. "Development of [clinical practice guidelines] for the ocular, oral, and systemic/rheumatologic manifestations should substantially improve the quality and consistency of care, guide reimbursement policies, and decrease the overall burden of illness."
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https://www.rheumatologyadvisor.com/diagnostics/sjogren-syndrome-first-clinical-practice-guidelines/article/651456/
Thursday, April 12, 2018
What the Hospitals of the Future Look Like - WSJ
The days of the hospital as we know it may be numbered.
In a shift away from their traditional inpatient facilities, health-care providers are investing in outpatient clinics, same-day surgery centers, free-standing emergency rooms and microhospitals, which offer as few as eight beds for overnight stays. They are setting up programs that monitor people 24/7 in their own homes. And they are turning to digital technology to treat and keep tabs on patients remotely from a high-tech hub.
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https://www.wsj.com/articles/what-the-hospitals-of-the-future-look-like-1519614660?
Wednesday, April 11, 2018
Your Body Is a Teeming Battleground - The Atlantic
I went to medical school, at least in part, to get to know death and perhaps to make my peace with it. So did many of my doctor friends, as I would find out. One day—usually when you're young, though sometimes later—the thought hits you: You really are going to die. That moment is shocking, frightening, terrible. You try to pretend it hasn't happened (it's only a thought, after all), and you go about your business, worrying about this or that, until the day you put your hand to your neck—in the shower, say—and … What is that? Those hard lumps that you know, at first touch, should not be there? But there they are, and they mean death. Your death, and you can't pretend anymore.
I never wanted to be surprised that way, and I thought that if I became a doctor and saw a lot of death, I might get used to it; it wouldn't surprise me, and I could learn to live with it. My strategy worked pretty well. Over the decades, from all my patients, I learned that I would be well until I got sick and that although I could do some things to delay the inevitable a bit, whatever control I had was limited. I learned that I had to live as if I would die tomorrow and at the same time as if I would live forever. Meanwhile, I watched as what had been called "medical care"—that is, treating the sick—turned into "health care," keeping people healthy, at an ever-rising cost.
In her new book, Barbara Ehrenreich ventures into the fast-growing literature on aging, disease, and death, tracing her own disaffection with a medical and social culture unable to face mortality. She argues that what "makes death such an intolerable prospect" is our belief in a reductionist science that promises something it cannot deliver—ultimate control over our bodies. The time has come to rethink our need for such mastery, she urges, and reconcile ourselves to the idea that it may not be possible.
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https://www.theatlantic.com/magazine/archive/2018/05/barbara-ehrenreich-natural-causes/556859/
I never wanted to be surprised that way, and I thought that if I became a doctor and saw a lot of death, I might get used to it; it wouldn't surprise me, and I could learn to live with it. My strategy worked pretty well. Over the decades, from all my patients, I learned that I would be well until I got sick and that although I could do some things to delay the inevitable a bit, whatever control I had was limited. I learned that I had to live as if I would die tomorrow and at the same time as if I would live forever. Meanwhile, I watched as what had been called "medical care"—that is, treating the sick—turned into "health care," keeping people healthy, at an ever-rising cost.
In her new book, Barbara Ehrenreich ventures into the fast-growing literature on aging, disease, and death, tracing her own disaffection with a medical and social culture unable to face mortality. She argues that what "makes death such an intolerable prospect" is our belief in a reductionist science that promises something it cannot deliver—ultimate control over our bodies. The time has come to rethink our need for such mastery, she urges, and reconcile ourselves to the idea that it may not be possible.
More ...
https://www.theatlantic.com/magazine/archive/2018/05/barbara-ehrenreich-natural-causes/556859/
Tuesday, April 10, 2018
Lack Of Research On Medical Marijuana Leaves Patients In The Dark : Shots - Health News : NPR
By the time Ann Marie Owen, 61, turned to marijuana to treat her pain, she was struggling to walk and talk. She was also hallucinating.
For four years, her doctor prescribed a wide range of opioids for transverse myelitis, a debilitating disease that caused pain, muscle weakness and paralysis.
The drugs not only failed to ease her symptoms, they hooked her.
When her home state of New York legalized marijuana for the treatment of select medical ailments, Owens decided it was time to swap pills for pot. But her doctors refused to help.
"Even though medical marijuana is legal, none of my doctors were willing to talk to me about it," she says. "They just kept telling me to take opioids."
Although 29 states have legalized marijuana to treat pain and other ailments, the growing number of Americans like Owen who use marijuana and the doctors who treat them are caught in the middle of a conflict in federal and state laws — a predicament that is only worsened by thin scientific data.
Because the federal government considers marijuana a Schedule 1 drug, research on marijuana or its active ingredients is highly restricted and even discouraged in some cases.
Underscoring the federal government's position, Health and Human Services Secretary Alex Azar recently pronounced that there was "no such thing as medical marijuana."
Scientists say that stance prevents them from conducting the high-quality research required for FDA approval, even as some early research indicates marijuana might be a promising alternative to opioids or other medicines.
Patients and physicians, meanwhile, lack guidance when making decisions about medical treatment for an array of serious conditions.
More ...
https://www.npr.org/sections/health-shots/2018/04/07/600209754/medical-marijuanas-catch-22-limits-on-research-hinders-patient-relief
For four years, her doctor prescribed a wide range of opioids for transverse myelitis, a debilitating disease that caused pain, muscle weakness and paralysis.
The drugs not only failed to ease her symptoms, they hooked her.
When her home state of New York legalized marijuana for the treatment of select medical ailments, Owens decided it was time to swap pills for pot. But her doctors refused to help.
"Even though medical marijuana is legal, none of my doctors were willing to talk to me about it," she says. "They just kept telling me to take opioids."
Although 29 states have legalized marijuana to treat pain and other ailments, the growing number of Americans like Owen who use marijuana and the doctors who treat them are caught in the middle of a conflict in federal and state laws — a predicament that is only worsened by thin scientific data.
Because the federal government considers marijuana a Schedule 1 drug, research on marijuana or its active ingredients is highly restricted and even discouraged in some cases.
Underscoring the federal government's position, Health and Human Services Secretary Alex Azar recently pronounced that there was "no such thing as medical marijuana."
Scientists say that stance prevents them from conducting the high-quality research required for FDA approval, even as some early research indicates marijuana might be a promising alternative to opioids or other medicines.
Patients and physicians, meanwhile, lack guidance when making decisions about medical treatment for an array of serious conditions.
More ...
https://www.npr.org/sections/health-shots/2018/04/07/600209754/medical-marijuanas-catch-22-limits-on-research-hinders-patient-relief
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