News & Commentary

Briefly Noted May 2017

Better detection and prevention of the risk factors associated with heart disease have led to a 20% decline in cases of the disease, according to a research letter in JAMA. Despite the progress, more can be done in terms of tackling risk factors such as high LDL cholesterol levels, high blood pressure, and smoking.

The expansion of Medicaid under the ACA did not overburden primary care physician (PCP) offices as feared, according to a research letter in JAMA Internal Medicine. For the most part, PCPs were able to reorganize their offices to better handle the increased volume.

The proliferation of wearable fitness devices comes with some knotty questions about employee privacy, ReadWrite reports. And more employers are dangling the devices in front of their employee. In 2013, about 2,000 companies around the world offered workers fitness trackers; that number jumped to 10,000 in 2014. “Employees are too cavalier about the privacy implications of using corporate-provided wearables,” warns Gary Eastwood, a tech writer. “Employees need to understand why this is a problem before readily accepting a company distributed wearable and whether it is a good idea”.

The worst performing VA medical centers are in Texas and Tennessee, according to the agency’s internal data. USA Today obtained the VA star rating reports, which the VA has refused to release, claiming they are for internal use only. “VA hospitals in Dallas, El Paso, Nashville, Memphis, and Murfreesboro [Tenn.] all received one star out of five for performance as of June 30, the most recent ratings period available,” the newspaper reports.

A much smaller percentage of teens in treatment for heroin and opioid abuse are getting medication-assisted treatment (MAT) than their adult counterparts, according to a study in the Journal of Adolescent Health. Only 2.4% of adolescents in treatment for heroin received MAT compared with 26.3% of adults, and just 0.4% of teens in treatment for opioid abuse received MAT vs. 12% of adults, the researchers found. The data was from 2013, so it’s possible the teen–adult gap in MAT may now be narrower.

Informed consent? It’s not really and is more about lawyerly deflection of lawsuits than helping patients understand medical decisions, said Mikkael Sekeres, MD, and Timothy Gilligan, MD, both of the Cleveland Clinic, in a biting opinion piece in the New York Times. The “farce of informed consent” is even worse when it comes to medical research and clinical trials, they said. Patients in clinical trials are given a “25-page document that describes the trial’s purpose, its design, the medications you’ll receive, other standard treatments, and the complications you may suffer. Oh, and we’ll tell you that you are responsible for any medical costs not covered by insurance or the trial sponsor. That’s for the lawyers, again. We will then ask you to sign the final page, acknowledging your understanding and your agreement to participate in the trial.” Their suggestions included encouraging patients to ask doctors to drop the abstruse medical jargon and use common words. Patients should also repeat back to the doctor what has been said: “That way, if you’ve misunderstood what we did a poor job of explaining, there will be a chance to straighten it out”.

The VA’s efforts to prevent MRSA infections seem to be working, although MRSA transmissions in acute care spinal cord injury units have not decreased, according to a study published in the American Journal of Infection Control. The VA’s MRSA Prevention Initiative was launched in October 2007. Over the next eight years, various indicators show MRSA infections decline in ICUs and other parts of the hospitals and in long-term care facilities. The exception is MRSA transmission in the spinal cord injury units.

Some paramedics are being enlisted to help mentally ill patients and not just automatically take them to hospital emergency departments, Kaiser Health News reports. The paramedics are being trained to de-escalate situations that might get out of control. After questioning the patient about his or her mental health history, they then decide where to take the patient to the hospital.

Telestroke units that will have clot-busting tPAa, portable CT scans, and a telemedicine link to a hospital will soon be taking to the streets in Chicago, reports mHealth Intelligence. Both Northwestern Medicine Central DuPage Hospital and Rush University Medical Center are launching the units. “The question is whether the telestroke units are sustainable,” reports mHealth Intelligence. The van costs “roughly $1 million to outfit and will cost that much to keep on the road each year. Both units are currently funded by grant money”.

People who commit suicide often act on impulse. Kaiser Health News features a story about a vet who came close to killing himself but now counsels others. He aims his advice specifically at gun owners. His tips include knowing the signs of depression and keeping the weapon and ammo well away from each other. Also, call some friends.

The more patients with diabetes served by a primary care practice means the greater chance that those patients will receive higher quality care for the disease, according to a study in the Annals of Internal Medicine. Researchers with the University of Toronto conducted a cohort study of over a million adults with diabetes to examine the link between PCP patient volume and quality.

A push by some employers for telemedicine is running into a wall: Many workers know it’s available but don’t really trust remote health care consultations, reports the Chicago Tribune. The newspaper cites a report by the National Business Group on Health that says that while 70% of large employers offered the service, only 3% of employees at those companies used it during the first half of 2016.

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