02/21/17

Tuesday, February 21, 2017

Trump's immigration policy may worsen doctor shortage

Each year, thousands of international medical graduates come to the U.S. for training, many in underserved communities. In the wake of President Trump's travel ban, the American medical community fears that applicants may avoid the U.S. altogether, reports Tony Dokoupil.

From: http://www.cbsnews.com/videos/trumps-immigration-policy-may-worsen-doctor-shortage/

Study sees U.S. life expectancy falling further behind

Despite modest gains in life expectancy, the United States will continue to lag behind other developed countries in years ahead, new research predicts

From: http://www.cbsnews.com/news/us-life-expectancy-expected-to-fall-further-behind-other-countries/

NASA astronaut setting records and breaking barriers

Peggy Whitson, 57, is the oldest woman ever in space, and she will set a record for most time in orbit

From: http://www.cbsnews.com/news/living-stronger-nasa-astronaut-57-setting-records-and-breaking-barriers/

Oklahoma dentist runs 7 marathons in 7 days — on 7 continents

Dr. Patel, 50, was one of 33 participants in the 2017 World Marathon Challenge, seasoned runners who ran 26.2 miles every day Jan. 23-29 in Sydney, Australia; Punta Arenas, Chile; Miami, Florida; Union Glacier, Antarctica; Madrid, Spain; Marrakech, Morocco; and Dubai, United Arab Emirates.

From: http://www.ada.org/en/publications/ada-news/2017-archive/february/oklahoma-dentist-runs-7-marathons-in-7-days-on-7-continents

Registration open for correctional health care meeting

Register for the National Commission on Correctional Health Care’s annual conference, scheduled for April 29-May 2 in Atlanta.

From: http://www.ada.org/en/publications/ada-news/2017-archive/february/registration-open-for-correctional-health-care-meeting

Bone and joint problems associated with diabetes

From: http://www.mayoclinic.com/diseases-conditions/diabetes/in-depth/diabetes/art-20049314

Germs: Understand and protect against bacteria, viruses and infection

From: http://www.mayoclinic.com/diseases-conditions/infectious-diseases/in-depth/germs/art-20045289

Baltimore surgeon gives boy new hand using his foot bones

"I love seeing patients who think there is no hope, or no alternative, be offered a potential solution to a complex problem," doctor says

From: http://www.cbsnews.com/news/baltimore-surgeon-gives-boy-new-hand-using-his-foot-bones/

Lovers of Italian olive oil in for some sticker shock

Italian olive oil prices are due to jump by as much as 20 percent, after combination of bad weather and pests hit harvest

From: http://www.cbsnews.com/news/lovers-of-italian-olive-oil-in-for-some-sticker-shock/

Congressional Group Supports Vaccine Safety

Letter comes in response to President Trump's reported support for anti-vaccine groups

From: http://www.webmd.com/children/vaccines/news/20170221/congressional-group-gives-bipartisan-support-to-vaccine-safety?src=RSS_PUBLIC

Former Teen Heartthrob David Cassidy Has Dementia

Cassidy says both his grandfather and his mother struggled with dementia in their final years

From: http://www.webmd.com/alzheimers/news/20170221/david-cassidy-dementia?src=RSS_PUBLIC

Testosterone Therapy May Have Benefits, Risks

While trials show it boosts bone density and lowers anemia risk, heart risks also seen

From: http://www.webmd.com/men/news/20170221/testosterone-therapy-may-have-benefits-but-risks-too?src=RSS_PUBLIC

Greater Cleveland Dental Society’s Give Kids A Smile event draws special guest

From: http://www.ada.org/en/publications/ada-news/2017-archive/february/greater-cleveland-dental-societys-give-kids-a-smile-event-draws-special-guest

Bone and joint problems associated with diabetes

From: http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20049314

Germs: Understand and protect against bacteria, viruses and infection

From: http://www.mayoclinic.org/diseases-conditions/infectious-diseases/in-depth/germs/art-20045289

Testosterone gel study finds no memory benefit

Testosterone treatment did not improve older men's memory or mental function, according to a new study

From: http://www.cbsnews.com/news/testosterone-gel-shows-no-benefit-older-mens-memories/

Vomiting Syndrome on the Rise in Heavy Pot Smokers

Experts are trying to figure out why more heavy marijuana users are getting a rare illness that causes vomiting and abdominal pain.

From: http://www.webmd.com/mental-health/addiction/news/20170221/vomiting-syndrome-on-the-rise-in-heavy-pot-smokers?src=RSS_PUBLIC

HLHS Umbilical Cord Blood Clinical Trial

From: Mayo Clinic http://www.youtube.com/watch?v=0HHQjYW3wK8

Mayo Clinic Minute: Is pneumonia bacterial or viral?

From: Mayo Clinic http://www.youtube.com/watch?v=eJppC_W_LnQ

Kids of Older Moms Score Higher on Thinking Tests

Children with younger moms once had the advantage, but that trend has reversed, study finds

From: http://www.webmd.com/parenting/news/20170220/kids-born-to-older-moms-score-higher-on-thinking-tests?src=RSS_PUBLIC

Maine wants ban on food stamps for candy, soda

Officials say the ban will help with the state's rising obesity rate

From: http://www.cbsnews.com/news/maine-asks-feds-to-allow-ban-on-food-stamps-for-candy-soda/

David Cassidy says he’s fighting dementia

Former “Partridge Family” star David Cassidy says he’s struggling with memory loss

From: http://www.cbsnews.com/news/david-cassidy-dementia-memory-loss/

Tired of yo-yo dieting? This may help keep weight off

In a new study, people were more likely to maintain successful weight loss if they took part in this key strategy

From: http://www.cbsnews.com/news/tired-of-yo-yo-dieting-this-strategy-may-help-keep-weight-off/

Parents: How to manage injuries at home—and when you need to go to the doctor

Follow me on Twitter @drClaire

It’s a fact of life: kids get hurt. We do everything we can to keep them safe, but shy of sticking them in bubbles, which would be a bad idea for all sorts of reasons, the reality is that injuries happen. Luckily, most injuries can be managed quite well at home. Here are some tips on how to do that — and how to know when you shouldn’t.

Cuts and scrapes

The vast majority of cuts and scrapes just need a good washing (plain old soap and water is fine — use a washcloth if there is any dirt or other debris) and a clean bandage. Change the bandage daily with a washing (taking the bandage off before a bath or shower is often enough) and check out the area. If it looks at all red, a little antibiotic ointment can be helpful, but usually isn’t necessary (and can contribute to antibiotic resistance, so should be used sparingly).

Get medical attention if:

the edges of a cut gape open — that usually means stitches are needed.
you can’t stop the bleeding with pressure—with one caveat: cuts on the lip or in the mouth bleed a lot, but usually don’t need medical attention. Try some ice (or a popsicle) and wait a little while. If it’s not stopping, call your doctor for advice.
a cut or scrape is looking redder, or has spreading redness or pus, despite the antibiotic ointment.
your child develops a fever.

Animal or human bite

The first thing to do with any bite is to wash it really well. Often bites can cause puncture wounds that can be deep, so use lots of soap and run the water over it to clean it out as best you can.

Humans, it turns out, have dirtier mouths than dogs or cats — so any human bite that breaks the skin warrants a trip to the doctor.

While not all animal bites need a trip to the doctor, it’s a good idea to call the doctor for advice any time it happens, especially to sort out if there could be any risk of rabies. If your child is bitten by someone else’s pet, ask about rabies vaccination and get the contact information for the pet’s owner. Being able to confirm that the animal is vaccinated, or being able to quarantine the animal, could save your child a bunch of shots.

Bumps and bruises

The vast majority of these just need some ice and plenty of hugs. Get medical attention if:

Your child has a bad bump to the head and is vomiting, acting sleepy or having trouble doing ordinary things. It’s worth a call to the doctor for any bad bump to the head, actually, so that you can run through what happened and decide together what to do.
The bump is near or on the eye socket, and there is redness of the eye or any trouble moving the eye or with vision.
Your child has a lot of pain despite the ice and hugs, or acts sleepy or is worrying you in some other way

Eye injuries

If your child gets something small in his eye, or gets something sprayed into his eye, rinse it out very well with lots and lots of water (if you have contact lens solution, that works well too). If after the rinsing your child feels fine and the eye doesn’t look red (or looks barely red), you’re all set. But if it still hurts or the eye looks very red, head to the doctor. You should head to the doctor immediately if what gets in the eye isn’t small, or if there is any bleeding or if your child complains of any trouble seeing.

Is it broken?

Almost every parent ends up asking this question. Most of the time, the answer is no. Take a good look at the area, and have your child try to move the injured part of the body. If it’s the leg or foot, see if they can bear weight.

Get medical attention if:

there is severe pain, especially if your child feels dizzy or nauseated.
the part of the body looks crooked or otherwise different from usual.
there is severe swelling.
your child has trouble moving the injured part of the body, or can’t bear weight

If none of these are true, use ice on the area and have your child rest. But if things aren’t getting better, call your doctor to see if an x-ray might be a good idea to be sure you aren’t missing a smaller fracture.

The post Parents: How to manage injuries at home—and when you need to go to the doctor appeared first on Harvard Health Blog.

From: Claire McCarthy, MD http://www.health.harvard.edu/blog/parents-how-to-manage-injuries-at-home-and-when-you-need-to-go-to-the-doctor-2017022111222

Mayo Clinic Minute: A chemist's historic holiday discovery

From: Mayo Clinic http://www.youtube.com/watch?v=QowI-4YyTEg

Alzheimer's research grant - Dr. Nilufer Ertekin-Taner

From: Mayo Clinic http://www.youtube.com/watch?v=uSCHzXM5Acw

Vaccine for early breast lesions: Dr. Keith Knutson

From: Mayo Clinic http://www.youtube.com/watch?v=jedOYLobxDI

Dr Wald on heart health improvements by gender

From: Mayo Clinic http://www.youtube.com/watch?v=mEfwGp6s09s

Dr Wald on heart health awareness through family history

From: Mayo Clinic http://www.youtube.com/watch?v=JGNzR3aTLiI

Dr. John Wald on African American concern about heart health

From: Mayo Clinic http://www.youtube.com/watch?v=ARsF6MEwjlc

Dr. John Wald National Health Checkup

From: Mayo Clinic http://www.youtube.com/watch?v=sd7iGHmSOFk

The Short- and Long-Term Prognosis for Obamacare

The law still stands despite IRS decision to process tax returns without insurance status

From: http://www.webmd.com/health-insurance/news/20170220/the-short--and-long-term-prognosis-for-obamacare?src=RSS_PUBLIC

How Trump's revised travel ban could impact doctors and patients

President Trump is finalizing a revised version of his travel ban, temporarily barring people from seven Muslim-majority countries from entering the U.S. This comes at a delicate time for the American medical system. Tony Dokoupil reports on how the travel ban could impact patient care.

From: http://www.cbsnews.com/videos/how-trumps-revised-travel-ban-could-impact-doctors-and-patients/

Trump's travel ban causing angst for America's health system

One-in-four doctors in the U.S. is foreign born, including an estimated 15,000 from the seven Muslim-majority countries already included in the ban

From: http://www.cbsnews.com/news/trump-travel-ban-impact-on-international-doctors-american-health-system/

A primary care doctor delves into the opioid epidemic

Our nephew Christopher died of a heroin overdose in October 2013.¹ It had started with pain pills and experimentation, and was fueled by deep grief.² He was charismatic, lovable, a favorite uncle, and a hero to all the children in his life. His death too young was a huge loss to our family. I have always felt that I didn’t do enough to help prevent it, and perhaps, in a way, even contributed.

Good intentions with unintended consequences

My medical training took me through several big-city hospitals where addiction and its consequences were commonplace. Throughout all of it, great emphasis was placed on recognizing “the fifth vital sign,” i.e. pain, and treating it.

I distinctly remember as a medical student wearing a little pin with the word “PAIN” and a line across it. One was considered a bad doctor if they didn’t ask about and treat pain. And so, treat we did. This medical movement, combined with the mass marketing of OxyContin and a swelling heroin trade, has created the current opioid epidemic.⁴

It generally starts with pain pills: Percocet, Vicodin, Oxycodone or OxyContin, either prescribed or given or bought. Quickly, a person finds that she or he needs more and more of the drug to get the same effect. Almost overnight, they need the drug just to feel normal, to stave off the horror of withdrawal. Street heroin is cheaper and easier to come by than pills, and so, people move on to the next level. Just like Christopher.

Recent data from the Centers for Disease Control (CDC) and the National Institute for Drug Abuse (NIDA) show that deaths from overdose of opioids have been rising every year since 1999.^5,6 (OxyContin came to market in 1996). Deaths from heroin overdose have recently spiked: a 20% increase from 2014 to 2015.⁷ And most recently we’re seeing fentanyl, an extremely potent synthetic opioid, where even a few small grains can kill.

So, if we doctors helped everyone get into this mess, we should help them get out of it, no?

Needed: Treatment that works

As the opioid epidemic has exploded, so has the demand for treatment. But treatment is almost impossible to come by. The U.S. is short almost 1 million treatment slots for opioid addiction treatment.^{8, 9} And not all treatments offered are that effective.

The “traditional” treatment of detoxification, followed by referrals to individual therapy or group support (think Narcotics Anonymous), may work well for some, but the data suggest that there are more effective approaches. In fact, a growing body of evidence very strongly supports medication, combined with therapy and group support, as the most effective treatment currently availabe.^10,11,12

“Detox” followed by therapy has consistently shown poor results, with more than 80% of patients relapsing, compared to treatment with medications, with only 15% relapsing.^10,11 Medications, specifically methadone and buprenorphine, can help prevent withdrawal symptoms and control cravings, and can help patients to function in society.^10,11,12 Suboxone (a combination of the drugs buprenorphine and naloxone) has many advantages over methadone. It not only prevents withdrawal and controls cravings, but also blocks the effects from any illicit drug use, making it more difficult for patients to relapse or overdose. In addition, while methadone can only be prescribed through certified clinics, any primary care provider who completes a training course can prescribe Suboxone. That means treatment for opioid use disorders could be much more widely available.

Basically, treatment with medications, and especially Suboxone, is effective, and safer than anything else we have to offer. Yes, relapses can occur, but far less frequently than with traditional treatment.^10,14,15 And death from heroin overdose? Far, far less.¹⁶

Biases against treating opioid use disorder with medications

Despite their effectiveness, there is stigma associated with treating substance use disorders with medication. I admit that I had my own doubts as well. People say, as I did, “Oh, you’re just replacing one drug with another.” But a lot of hard science has accumulated since 2002, when the FDA approved Suboxone for the treatment of opioid addiction.¹⁷

Think about it. Is shooting street heroin that’s cut with God knows what, using needles infected with worse, really the same as using a well-studied, safe, and effective daily oral medication? Some may claim “Oh, you’re just creating another addiction.” Would you tell someone with diabetes who depends on insulin that they’re “addicted”? Then why say that to someone with opioid use disorder who depends on Suboxone? This is literally the reasoning that played out in my head as I have learned about treating opioid addiction, or, more correctly stated, opioid use disorder.

Stepping up

I’ve decided that it’s time to do something. There’s a great need for doctors willing and able to treat opioid use disorder. In 2016, surgeon general Vivek Murthy issued a strident call to action to all U.S. healthcare providers, asking them to get involved.¹⁸

This issue has been on my mind and soul since Christopher’s death, so I started educating myself, and contacted our hospital’s substance use disorders specialist with my motivation and concerns. In the few months since then, I’ve taken the training course to become a licensed prescriber, and am working with the team to begin treating a small group of patients.

In my 16 years of clinical training and practice, I have witnessed all of this firsthand: the blatant, medically rationalized over-prescription of pain meds, the stigma and undertreatment of opioid use disorder, and the unnecessary, premature death of a really good kid. I’m just starting off on this, and I’m still learning, but my hope is to keep another family from experiencing unnecessary loss. (For more information see Medication-Assisted Treatment for Opioid Addiction)

Take the online course OpioidX: The Opioid Crisis in America. This course challenges common beliefs about addiction and the people who become addicted to opioids. Through an increased understanding of the biology of addiction, the course aims to reduce the stigma around addiction in general, and help people discover the multiple pathways to evidenced-based treatment. A variety of Harvard Medical School clinicians and health policy experts explain these topics and you’ll hear stories first-hand from those who have experienced addiction, or whose lives have been touched by this the opioid epidemic.

Sources

Generally Medicine: Ripped from the family
Generally Medicine: Drugs, Violence, and Tragedy in our Family
Mularski R.A., White-Chu F., Overbay D., Miller L., Asch S.M., Ganzini L. Measuring Pain as the 5th Vital Sign Does Not Improve Quality of Pain Management. Journal of General Internal Medicine, 31 May 2006.
http://www.huffingtonpost.com/kristine-scruggs-md/the-opioid-epidemic-how-d_b_9865680.html
https://www.cdc.gov/drugoverdose/data/statedeaths.html
https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
https://www.cdc.gov/drugoverdose/data/heroin.html
Jones, C.M., Campopiano, M., Baldwin, G., and McCance-Katz, E. National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health, August 2015.
http://www.theatlantic.com/health/archive/2015/10/why-80-percent-of-addicts-cant-get-treatment/410269/
Wakeman S.E. Using Science to Battle Stigma in Addressing the Opioid Epidemic: Opioid Agonist Therapy Saves Lives. American Journal of Medicine, May 2016.
Bart, G. Maintenance medication for opiate addiction: the foundation of recovery. Journal of Addictive Diseases. October 2012.
Connery H.S. Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Harvard Review of Psychiatry, March/April 2015.
Mattick, R.P., Breen, C., Kimber, J., and Davoli, M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 6 February 2014,
Mauger S., Fraser R., Gill K. Utilizing buprenorphine-naloxone to treat illicit and prescription-opioid dependence. Neuropsychiatric Disease & Treatment, 7 April 2014.
Colson J., Helm S., Silverman S.M. Office-based opioid dependence treatment. Pain Physician, July 2012.
Schwartz, R.P., Gryczynski, J., O’Grady, K.E. et al. Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009. American Journal of Public Health, May 2013
Subutex and Suboxone Approval Letter. U.S. Food and Drug Administration (October 8, 2002). fda.gov.
Murthy V.H. Ending the Opioid Epidemic — A Call to Action. New England Journal of Medicine, 22 December 2016.

The post A primary care doctor delves into the opioid epidemic appeared first on Harvard Health Blog.

From: Monique Tello, MD, MPH http://www.health.harvard.edu/blog/a-primary-care-doctor-delves-into-the-opioid-epidemic-2017022011199