09/12/17

Tuesday, September 12, 2017

More evidence too much sitting could be deadly

In a new study, people who sat the most had twice the risk of dying over a 4-year period as people who sat the least – but there could be a way to counteract the effect

From: http://www.cbsnews.com/news/more-evidence-too-much-sitting-could-be-deadly/

12 children got serious infection at New Orleans hospital

The patients acquired the infection from a machine used during their open heart surgery

From: http://www.cbsnews.com/news/12-children-contract-serious-infection-after-surgery-at-new-orleans-hospital/

მეიოს კლინიკის ტელენეონატოლოგიის პროგრამა: ტელენეონატოლოგიის სიმულირებული კონსულტაცია

From: Mayo Clinic https://www.youtube.com/watch?v=b2A2PAiphnM

CME Preview: Internal Medicine Recertification Course 2018

From: Mayo Clinic https://www.youtube.com/watch?v=gXzdGFJKhnA

Mayo Clinic Executive Health: The Real Asset is You

From: Mayo Clinic https://www.youtube.com/watch?v=fQn_mSMgr2E

How smart are you about car seats?

Follow me on Twitter @drClaire

If you’re a parent — or anyone else who has driven a child somewhere — you likely know quite a bit about car seats.

Or do you?

As both a pediatrician and a parent, I know that lots of people don’t know everything they should about car seats and booster seats. It’s understandable, as the information can be confusing, and while resources are available, many parents don’t know about them. But it’s a problem, because making a mistake when it comes to car seats can literally be life-threatening. Of the children 12 years and younger who died in motor vehicle crashes in 2015, more than a third weren’t buckled up.

Let’s test your smarts. Can you answer these questions?

When should parents change from a rear-facing seat to a forward-facing one?

a) 12 months
b) 24 months
c) When they outgrow the rear-facing seat (assuming they are at least 24 months old)

Answer: C. Turning children around too early is one of the most common car seat mistakes people make. In part, that’s because the recommendation used to be to turn children forward-facing at a year (that was the recommendation when my eldest children were babies), and some grandparents and others don’t realize it has changed. It’s also tempting to turn children around early because it’s easier to see them from the front seat.

But here’s the thing: children are safer if they are rear-facing. It’s just the physics of crashes and little bodies. So if a child turns two and is within the weight and height recommendations of the seat, leave them facing backward.

Remember, never put a car seat in a seat with an airbag — and the safest place in the car for the car seat is the middle of the back seat.

What is the youngest age you can move a child from a car seat to a booster seat?

a) 2
b) 3
c) 5

Answer: C. This is another common mistake. Just because your child has started preschool doesn’t mean they can get out of their car seat. And just because they are in kindergarten or first grade doesn’t mean they still don’t need to be in one. It is recommended that children be in a car seat, not a booster seat, until they are 5 years old, but they can, and should, stay in it if they are still within the weight and height recommendations of the seat.

How long does a child need to be in a booster seat?

a) Until the car seat belt fits properly
b) Until they are 57 inches tall
c) Until they are 8 years old

Answer: The real answer is A. It’s kind of the point of booster seats. Children should be in a booster seat until the lap portion of the seat belt goes across the upper thigh, not the belly, and the shoulder portion goes across the chest, not the neck. That’s generally at a height of 57 inches (4 feet 9 inches).

Every state is a little different when it comes to the laws about children and car restraints. Here in Massachusetts, the law says that a child must be in a car seat or booster until they are 8 years old or 57 inches tall. Other states say seatbelts alone are okay at 6 or 7 — and others use weight guidelines. You should know the laws in your state. But even if the law says it’s okay to ditch the booster seat for your child, don’t do it if he or she is shorter than 57 inches or the seat belt doesn’t fit right for some other reason. Booster seats can cut the risk of serious injury by half.

Remember, too, that with booster seats, car seats, and seat belts, no ride is too short to buckle up!

At what age can a child ride in the front seat?

a) 8
b) 10
c) 12
d) 13

Answer: D. Yup, 13. Children 12 and under should be in the back seat. They are safer there. Part of it has to do with the airbag, and the size a person should be to be safe with one. I know that this sounds arbitrary — there are lots of 11 and 12 year-olds who are adult size — but it’s the recommendation. We’d all be safer in the back seat, honestly. So even if it makes your sixth or seventh grader mad, just say no to the front seat. Better your kid be mad at you than be seriously injured — or dead.

What percentage of car and booster seats are installed or used incorrectly?

a) 11%
b) 24%
c) 46%
d) 75%

Answer: C. Almost half (thank goodness it’s not D!). There are lots of ways people mess up, including:

turning it around too soon
not installing it tightly enough, or at the wrong angle
using both the seatbelt and the LATCH system
leaving the straps too loose
putting clips in the wrong place.

Having installed car seats myself, I know how tough it can be. Luckily, there’s help available. The National Highway Traffic Safety Administration has all sorts of information and resources to help parents keep their children safe in the car, including buying and installation help for car seats and booster seats and information on how to get your seat inspected. Safe Kids has information on how to find technicians who can help you with installation problems and questions.

There are also lots of great resources on healthychildren.org, the parent education website of the American Academy of Pediatrics — check out their car seat information for families.

The post How smart are you about car seats? appeared first on Harvard Health Blog.

From: Claire McCarthy, MD https://www.health.harvard.edu/blog/how-smart-are-you-about-car-seats-2017091212389

Conferencia Mundial de la OMS sobre las ENT: declaración del Dr. Tedros, Director General de la OMS

From: World Health Organization https://www.youtube.com/watch?v=nIXh6pDrDHY

Serious illnesses linked to pet store puppies

The outbreak has sickened at least 39 people in seven states

From: http://www.cbsnews.com/news/petland-puppies-camylobacter-infections-warning/

Should you let your dog sleep in the bedroom?

New research looks at quality of sleep for pet owners who keep their dogs in their rooms at night

From: http://www.cbsnews.com/news/should-dogs-sleep-in-the-bedroom/

Football fans weigh concerns about players' brains

The majority of people surveyed believe head injuries for players pose a major problem for the sport, but that doesn't deter many from watching

From: http://www.cbsnews.com/news/football-fans-still-loyal-despite-concerns-about-players-brains/

Immune-focused drug targets advanced melanoma

The drug is a more effective option for patients who've had surgery to remove advanced tumors, according to new research

From: http://www.cbsnews.com/news/opdivo-melanoma-immune-focused-drug/

Mom who chose baby over chemotherapy dies

Doctors say Carrie DeKlyen chose to forgo chemotherapy to treat her brain cancer since it would have meant ending her pregnancy

From: http://www.cbsnews.com/news/carrie-deklyen-brain-cancer-baby-over-chemotherapy-dies-detroit-michigan/

National Health Checkup: Obstacles, opportunities in cancer care

From: Mayo Clinic https://www.youtube.com/watch?v=562nLKSK-Uk

PARP Inhibitors

From: Mayo Clinic https://www.youtube.com/watch?v=0aPglyeOWHs

Too many pain pills after surgery: When good intentions go awry

As a physician with an interest in reducing opioid-related problems, I frequently hear stories from colleagues and friends about their loved ones who either struggle with opioid addiction or have even died from opioid-related overdose. My follow-up question to them is usually: “How did it begin?” Almost every time the answer is the same: the individual experienced acute pain either from a trauma or surgery, was started on opioids by a doctor, and then couldn’t quit.

My son’s baseball coach, who is not in the medical field, described it perfectly. He went in for a minor back surgery and was discharged with 60 tablets of oxycodone (the opioid medicine in Percocet and Oxycontin). For the first couple of days, he had significant pain and used the pain pills. After the pain began to subside and acetaminophen and ibuprofen were sufficient, he stopped using the oxycodone. But after discontinuing the medication, he began feeling terrible, experiencing body aches, restlessness, and insomnia. He took another oxycodone and felt better. Fortunately, he had the insight to recognize what was going on: he was withdrawing from the opioid, even after taking it for only a few days. Had he continued treating his withdrawal with oxycodone, he may have become hooked. “I dodged a bullet,” he told me.

The problem of adverse effects and unused opioids

This story, repeated time and again, is interesting in light of a recent study published in JAMA Surgery. The paper was a meta-analysis that combined the results of six previous studies investigating use of opioids by patients after seven different surgical procedures. In the era of the opioid epidemic, where we know that the vast majority of pills taken for non-medical reasons (e.g., abuse) are obtained from friends or family members, the results are staggering: 42% to 71% of the prescribed opioids went unused. Furthermore, 16% to 29% of patients experienced adverse effects directly attributed to the opioids.

Multiple government and public health agencies recommend discarding unused opioids. It’s not safe to flush them down the toilet as they can contaminate our water supply, but most police stations and now commercial pharmacies have bins where unused medications can be safely disposed. Despite this, the study discovered that only 4% to 30% planned to dispose of the medications and only 4% to 9% planned to use a safe disposal method.

Why are opioids prescribed often and in larger amounts?

A key question is why overprescribing after surgery is occurring. I believe there are two likely explanations. The first is that surgeons, appropriately, do not want their patients to suffer from pain after an operation. The second is that, in many states, it is impossible to phone in a prescription for a controlled substance (e.g. an opioid pain medication). Therefore, a patient actually has to come back to clinic to pick up a prescription, which causes inconvenience to both the patient and the prescriber. Providing a prescription for 60 or 90 pills makes sense considering this barrier. Several states are implementing ways to provide electronic prescriptions that would make the doctor’s office visit unnecessary if a refill is needed, but it will take time before most doctors can do this.

However, as the study in JAMA shows, these large amounts may be far more pills than is required. As an example, consider another intriguing study of patients being treated for an acute extremity fracture. The researchers provided patients with special pills that contained both oxycodone and a small radio transmitter that became activated in the stomach. The researchers were able to detect exactly when the opioid was taken. Patients were instructed to use up to one week of oxycodone. At follow up, the average number of pills used was eight. Most of the severe pain was gone in just three days. There was no more need for opioids than a few pills, certainly less than 15.

Here’s what you can do to protect yourself and your community

How can the public protect itself? Physicians have a duty to educate about the risks and benefits of all treatments rendered, including when prescribing opioids. That unfortunately doesn’t always occur. So here’s my advice: if you are prescribed an opioid for acute pain, including after surgery, take all of the non-opioid pain medications permitted by your doctor as instructed (e.g. acetaminophen and ibuprofen, if not contraindicated). Add the opioid if, and only if, the pain is not bearable with the other medications. And once the pain is tolerable, stop the opioid and safely dispose of it by bringing it back to your pharmacy, if they have a disposal bin, or any DEA-recommended collection site. Finally, consider having a discussion with your doctor about the number of pills you are likely to need in the first place before the prescription is written. Being informed about safely using opioids could prevent dependence, and, ultimately, save your life.

The post Too many pain pills after surgery: When good intentions go awry appeared first on Harvard Health Blog.

From: Scott Weiner, MD https://www.health.harvard.edu/blog/too-many-pain-pills-after-surgery-when-good-intentions-go-awry-2017091112381

Earn CE, learn about oral health in a corrections environment

Dental professionals who want to learn more about correctional health care issues and refine skills needed to manage dental problems in correctional settings are invited to a conference in Chicago Nov. 4-8.

From: http://www.ada.org/en/publications/ada-news/2017-archive/september/earn-ce-learn-about-oral-health-in-a-corrections-environment

Image quality focus of research for 2017 Ahlstrom award recipient

Dr. Brittany Kurzweg wants to make sure clinicians have the best diagnostic image available to them when treating patients. Her innovative research on the subject scored her the 2017 Robert H. Ahlstrom New Investigator Award, which highlights the role dental informatics standards play in dentistry.

From: By Michelle Manchir http://www.ada.org/en/publications/ada-news/2017-archive/september/image-quality-focus-of-research-for-2017-ahlstrom-award-recipient

Could Hormone Supplements for Menopause Return?

New study suggests the therapy won't increase risk of early death

From: http://www.webmd.com/menopause/news/20170912/could-hormone-supplements-for-menopause-return?src=RSS_PUBLIC

Did Firm Fake Patients for Cancer Drug Sales?

Federal indictment, Senate investigation surround company that makes sprayable form opioid fentanyl.

From: http://www.webmd.com/cancer/news/20170907/did-firm-fake-patients-for-cancer-drug-sales?src=RSS_PUBLIC

Statins Help Healthy People Drop 'Bad' Cholesterol

Study found taking them lowered risk of heart disease, death in those with high LDL levels

From: http://www.webmd.com/cholesterol-management/news/20170907/statins-help-healthy-people-drop-bad-cholesterol?src=RSS_PUBLIC

Magnetic Brain Stimulation May Quiet 'Voices'

Noninvasive treatment worked for a third of patients in study, though effects were temporary

From: http://www.webmd.com/schizophrenia/news/20170907/magnetic-brain-stimulation-may-quiet-voices?src=RSS_PUBLIC

Can't Afford the Dentist? You're Not Alone

Many also mistakenly believe Medicare will cover their dental care

From: http://www.webmd.com/oral-health/news/20170907/cant-afford-the-dentist-youre-not-alone?src=RSS_PUBLIC

"Speechless" Micah Fowler Talks About Acting With Cerebral Palsy

"Speechless" star Micah Fowler shares his take on acting with cerebral palsy.

From: http://www.webmd.com/a-to-z-guides/features/micah-fowler-10-questions?src=RSS_PUBLIC

Long-Acting Inhaler May Help in Early COPD, Too

Doctors may consider starting medications sooner

From: http://www.webmd.com/lung/copd/news/20170906/long-acting-inhaler-may-help-in-early-copd-too?src=RSS_PUBLIC

Is an occasional drink OK during pregnancy?

A new review looks at the data on whether it's safe for pregnant women to have a drink now and then

From: http://www.cbsnews.com/news/is-an-occasional-drink-ok-during-pregnancy/

Screen For Cervical Cancer Over 30 With HPV Test

New advisory says women can get the screen once every 5 years, in lieu of Pap tests every 3 years

From: http://www.webmd.com/cancer/cervical-cancer/news/20170912/screen-for-cervical-cancer-over-30-with-hpv-test?src=RSS_PUBLIC

Is an Occasional Drink OK During Pregnancy?

Evidence isn't yet clear, but a new review says there's a slight chance of possible harm

From: http://www.webmd.com/baby/news/20170912/is-an-occasional-drink-ok-during-pregnancy?src=RSS_PUBLIC