Archive for May, 2015
Doctors use vital signs as a relatively straightforward way to detect an illness or monitor a person’s health. Key ones include blood pressure, body temperature, breathing rate, and heart rate. A report from the newly christened National Academy of Medicine (formerly the Institute of Medicine) proposes using 15 “vital signs” to track how health care in the United States measures up. These include life expectancy, well-being, access to care, patient safety, evidence-based care, and others. Why bother creating such a list? Health care costs in the U.S. are the highest in the world, yet people in many countries that spend less on health care are in better health overall and have better health care outcomes. In order to improve the performance of health care, we need to measure how it is doing in a logical, sustainable way. These vital signs will help us answer questions about what we are doing well and where we must improve.
Hospice care improves quality of life in the dire circumstances of a person’s last days. It can enable the dying to spend this time in peace, surrounded by family and friends, and in little pain. Studies confirm what many know intuitively. Family members are likely to experience major depression following the loss of a loved one. A recent study published in today’s online JAMA Internal Medicine looked at whether hospice care reduces the severity of bereavement-related depression in people who had recently lost a spouse. While the researchers saw no difference between spouses whose partners were enrolled in hospice and those how weren’t, major depression was less common in spouses who received support from a hospice program.
For the past 25 years, US News and World Report has been listing the “best hospitals” in the United States. In a Viewpoint article in this week’s JAMA, the magazine’s top health analysts describe how they are expanding and changing the way they rate hospitals. The current ratings aren’t designed for use by patients in need of typical hospital care. That’s changing. The US News team has spent more than a year analyzing more than 5 million patient records regarding more than a dozen common procedures and medical conditions from more than 4,300 hospitals. Ratings for five of these — hip replacement, knee replacement, coronary artery bypass surgery chronic obstructive pulmonary disease, congestive heart failure — were published online today. The new ratings use only performance measures such as patient safety, technology, and survival rates after admission. Keep in mind that ratings like these can help, but they’re mostly limited to data, and aren’t the whole picture. Other organizations also provide hospital rankings and ratings.
A strong or weak hand grip carries more than just social cues. It may also help measure an individual’s risk for having a heart attack or stroke, or dying from cardiovascular disease. As part of the international Prospective Urban and Rural Epidemiological (PURE) study, researchers measured grip strength in nearly 140,000 adults in 17 countries and followed their health for an average of four years. Each 11-pound decrease in grip strength over the course of the study was linked to a 16% higher risk of dying from any cause, a 17% higher risk of dying from heart disease, a 9% higher risk of stroke, and a 7% higher risk of heart attack. Interestingly, grip strength was a better predictor of death or cardiovascular disease than blood pressure. What’s the connection? It’s possible that grip strength measures biological age.
The release of new guidelines on mammography never fails to renew the heated controversy over the potential benefits and harms of this procedure. The latest draft guidelines from the U.S. Preventive Services Task Force (USPSTF) are no exception. The USPSTF recommends that women begin having mammograms at age 50 and stop at age 75. (The American Cancer Society and other medical organizations recommend that women begin getting regular mammograms at age 40.) The draft recommendations say there isn’t enough evidence to recommend or discourage the use of a new technique called 3-D mammography for screening, and also say there isn’t enough evidence to recommend that women with dense breasts, who are at higher risk of breast cancer, should have an ultrasound or MRI in addition to screening mammography. Comments can be made on the USPSTF draft until 8:00 pm Easter Time today. A final version of the recommendations is expected to be released in the fall of 2015.
When appendicitis strikes, an operation to remove the appendix has long been the route to recovery. But a new strategy called “antibiotics first” could help some people avoid surgery for appendicitis. A clinical practice article in today’s New England Journal of Medicine explores the idea of antibiotics first for appendicitis. The main advantage is that it could eliminate the need for surgery in some people with appendicitis. The drawbacks are that it leaves open the possibility of repeat bouts of appendicitis, with an appendectomy still down the road. It could also lead to lingering symptoms and a sense of uncertainty that could affect quality of life. Although immediate surgery is the standard of care for appendicitis, an antibiotics first approach could be appropriate now for individuals who prefer not to have surgery, aren’t healthy enough for surgery, or aren’t near a medical center that routinely does laparoscopic appendectomy.
Can a Mediterranean-type diet with extra servings of nuts and extra-virgin olive oil help protect memory and thinking skills with age? A study in this week’s JAMA Internal Medicine suggests that it might. The findings come from a small substudy done as part of the PREDIMED trial, which showed that a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced heart attacks, strokes, and other cardiovascular problems among people at high risk for them. Although the results of the new PREDIMED study are promising, its small size and the fact that it wasn’t designed to look at connections between diet and brain health mean the results need to be taken with a grain of salt. That said, since there’s no downside to following a Mediterranean diet, an added bonus beyond great taste could be protecting memory and thinking skills.
Environmentally friendly asthma inhalers may be good for the atmosphere, but they have nearly doubled what people with asthma are paying out of pocket for their inhalers. That’s the take-home message from a study led by Dr. Anupam Jena, an assistant professor of health care policy and medicine at Harvard Medical School and an internist at Massachusetts General Hospital. The findings were published online today in JAMA Internal Medicine. In 2008, the FDA banned a class of asthma inhalers that contained ozone-depleting propellants called chlorofluorocarbons (CFCs). The switch to CFC-free inhalers has led to an average increase of $10 per inhaler prescription, which has effectively doubled their cost.
Each year, several million people with neck or back pain get injections of anti-inflammatory steroid medications. When they work (they don’t always), such injections can bring profound relief. But injecting these medications into the spine can cause partial or total paralysis, brain damage, stroke, and even death. Case reports beginning in 2002 highlighted serious problems linked to spinal steroid injections. In 2014, the FDA started requiring a warning on the labels of injectable steroids. A Viewpoint article in this week’s Journal of the American Medical Association spotlights new safety recommendations to help prevent these rare but real problems. The new recommendations are part of the FDA’s Safe Use Initiative.
Pets can provide their owners with more than companionship. A new study, published online in the journal PLoS One, shows that pets can also help create human-to-human friendships and social support, both of which are good for long-term health. The effect isn’t limited to dogs. Other kinds of pets, including cats, rabbits, and snakes, can also be catalysts for making friends and finding social support. In a survey of residents of four cities, being a pet owner was the third most common way that respondents said they met people in their neighborhoods. Pet owners were 60% more likely than non–pet owners to get to know people in their neighborhoods they hadn’t known before. They were also more likely to have reported befriending someone they met through a pet-related connection or getting social support from them. As described in Get Healthy, Get a Dog, a Special Health Report from Harvard Medical School, pet ownership has many direct physical and mental health benefits.