Category Archives: Health

Healthcare System: “There’s No Dignity In Hospital Gowns” (BMJ)

From a The BMJ Views and Reviews article by David Oliver (February 5, 2020):

David Oliver There's No Dignity in Hospital Gowns The BMJ February 5 2020Last year the Lancet published a paper on the impact of wearing gowns, surveying 928 adult patients and carrying out structured interviews with 10 patients. Over half (58%) reported wearing the gown despite feeling uncertain that it was a medical necessity. Gown design was considered inadequate, with 61% reporting that they struggled to put it on or required assistance and 67% reporting that it didn’t fit. Most worryingly, 72% felt exposed, 60% felt self-conscious, and 57% felt uncomfortable wearing the gown.

I’ve often wondered why on earth we routinely put so many patients into hospital gowns within minutes of their arrival at hospital.

Sometimes referred to as “dignity gowns,” such dignity as they afford is only in comparison to being stark naked. They don’t come in a wide range of sizes or lengths, and they’re open along the back. You tend to get what you’re given and make do. The effect is to leave patients with lots of exposed flesh, with underwear or buttocks intermittently displayed and a feeling of extreme vulnerability, not to mention being cold if they have no other layers to wear.

To read more

Healthcare: Mergers & Profit Strategies Force Many Rural And Smaller Hospitals To Close (Video)

In rural towns across the U.S. hospitals are in crisis. Since 2010, 121 rural hospitals have closed. And, the National Rural Health Association says more than one-third of all rural hospitals in the U.S. are at serious risk of shutting down.

But not all hospitals are losing money. A series of mergers and acquisitions that began in the 1990’s has created massive hospital groups. Many of these hospital consortiums are turning huge profits every year by offering high priced services to well insured patients.

Heart Health: “Marine Omega-3s” Are “Greatest Protection Against Arrhythmic Events” (BMJ)

From a British Medical Journal (BMJ) Open Heart online article:

BMJ Open Heart Journal February 2020The intake of marine omega-3s has consistently been found to have antiarrhythmic effects. When marine omega-3s are consumed, there is an increase in cellular membrane fluidity, inhibition of L-type calcium channels and a reduction in the chance of arrhythmic events during susceptible times. Prospective data suggest that maintaining an omega-3 index of about 8%, which requires consuming seafood rich in omega-3 up to five times per week or consuming over 3 g of EPA and DHA per day, may provide the greatest protection against arrhythmic events.

Marine omega-3s for the prevention of arrhythmias

Omega-3s have been theorised to increase membrane fluidity by reducing compression of the acyl chains of membrane phospholipid fatty acids, which can lead to a reduction in the ‘spring-like’ tension on membrane ion channels. This spring-like tension can reduce the ability of ions to freely move in and out of the ion channel and hence reduce its conductance. This is known as the ‘Andersen membrane spring-like tension hypothesis’ and is just one way marine omega-3s may prevent arrhythmias.

Dietary omega-3s are mainly consumed as triglycerides, which are absorbed as free fatty acids and monoglycerides. These fats then get rapidly resynthesised in the intestine and liver back to triglycerides with subsequent integration into chylomicrons, very low-density lipoprotein and low-density lipoprotein (LDL) (LDL can actually deliver omega-3s to tissues via LDL receptors).

Read full article

Top Medical Podcasts: Lung-Cancer Screenings, Placebo Effects (NEJM)

Lung-Cancer Mortality with Volume CT Screening NEJM February 2020Featuring articles on lung-cancer screening in the NELSON trial, ribociclib and fulvestrant in metastatic breast cancer, vitamin D in pregnancy and asthma, treatment thresholds for neonatal hypoglycemia, and CAR-NK cells in anti-CD19 lymphoid tumors; a review article on placebo and nocebo effects; a Clinical Problem-Solving describing a rapid change in pressure; and Perspective articles on altruism in Extremis, on abuses of FDA regulatory procedures, and on joining forces against delirium.

The New England Journal of Medicine logo

Intense (VO2peak) Aerobic Exercise Raises Cognition, Alzheimer’s Disease Risks Lowered In Older Adults

From the Brain Plasticity Journal (Dec 26, 2019):

Brain Plasticity Journal 2020In conclusion, increased CRF (cardiorespiratory fitness) following this six-month intervention was associated with enhanced brain glucose metabolism in the PCC (posterior cingulate cortex), a region linked to AD, and cognition among late-middle-aged individuals at risk for AD. If these findings are supported by a larger-scale study, this would provide strong evidence that adults at risk for AD may enhance brain function and cognition by engaging in aerobic exercise training.

PCC glucose metabolism correlated positively with change in VO2peak (the highest value of VO2 attained upon an incremental or other high-intensity exercise test, designed to bring the sub- ject to the limit of tolerance)…Improvement in executive function correlated with increased VO2peak. Favorable CRF adaptation after 26 weeks of aerobic exercise training was associated with improvements in PCC glucose metabolism and executive function, important markers of AD.

Aerobic exercise has been associated with reduced burden of brain and cognitive changes related to Alzheimer’s disease (AD). However, it is unknown whether exercise training in asymptomatic individuals harboring risk for AD improves outcomes associated with AD. We investigated the effect of 26 weeks of supervised aerobic treadmill exercise training on brain glucose metabolism and cognition among 23 late-middle-aged adults from a cohort enriched with familial and genetic risk of AD.

Read full study

High, Non-Transparent Prices And Aggressive Collection Tactics Erode Trust In Healthcare (JAMA)

From a JAMA Network online article (February 4, 2020):

Billing Quality is Medical Quality JAMA Network ViewpointHigh medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care. In a survey of 1000 patients, 64% reported that they delayed or neglected seeking medical care in the past year because of concern about high medical bills. The field of quality science in health care has developed measures of medical complications; however, there are no standardized metrics of billing quality.

JAMA NetworkA recent study found that only 53 of 101 hospitals were able to provide a price for standard coronary artery bypass graft surgery. Notably, among the hospitals that provided a price, the price ranged from approximately $44 000 and $448 000 and was not associated with quality of care as measured by risk-adjusted outcomes and the Society of Thoracic Surgeons composite quality score.

Possible metrics of assessing billing quality JAMA

In the same way that there is wide variation in pricing, aggressive collection tactics also can be highly variable by institution. In a recent analysis, 36% (48/135) of hospitals in Virginia garnished wages of patients with unpaid medical bills, and 5 hospitals accounted for 4690 garnishment cases in 2017, representing 51% of all cases.7 In total, 20 054 lawsuits were filed in Virginia against patients for unpaid debt. For many hospitals that sue patients, legal action follows multiple attempts to contact patients through letters and calls, and some hospitals may offer to set up payment plans or even negotiate charges.

Read more

 

Sleep Studies: Even Low-Levels Of Light At Night Causes Diabetes In Elderly

From a Sleep Medicine online release (January 2020):

Sleep Medicine January 2020Our findings suggest that LAN (low-level light at night) exposure increases the incidence of diabetes in a general elderly population. Further research involving a large cohort with new-onset diabetes is warranted to elucidate these findings.

Highlights

  • Humans are commonly exposed to light at night.
  • Higher light exposure at night was significantly associated with higher incidence rate of diabetes.
  • The association was consistent in the analysis using the cut-off values of LAN as 3 and 5 lux.
  • Strengths include large samples adjusting a number of confounders.

The circadian timing system, located within the suprachiasmatic nucleus of the hypothalamus, controls fundamental energy homeostasis. Clock gene mutations induce obesity in mice, and the disruption of internal circadian rhythms decreases daily energy expenditures and leptin levels in humans. Light information received by the brain influences human circadian timing and metabolism; low-level light at night (LAN) significantly increased body mass and led to prediabetes in mice. In humans, bedroom LAN affected obesity parameters; however, the association between LAN and the incidence of diabetes in humans has not been studied.

Read more