Category Archives: General Health

Medical Error -Overestimated as Cause of Death

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A recent NY Times article provides some context to previous studies claiming that medical error could cause 100,000-250,000 deaths per year: Aaron Carroll Death by Medical Error

Here’s some excerpts:

When I started out as a doctor in 1999, the Institute of Medicine published a blockbuster report that declared that up to 98,000 people were dying in United States hospitals each year as a result of preventable medical errors. Just a few months ago, a study in the BMJ declared that number has now risen to more than 250,000, making preventable medical errors in hospitals the third-largest cause of death in the country in 2013…

There are about 2.5 million deaths each year in the United States, about 700,000 of which are hospitalized patients. This means that medical errors — in hospitals — would have to account for up to 10 percent of all deaths, or up to more than a third of hospitalized patients. That’s hard to fathom….

It’s somewhat sensationalistic to keep coming up with increasing numbers. I’m not sure it’s doing much good. After the publication of the initial report, defenders of the 98,000 number argued that even if the numbers were wrong, bringing attention to this problem would be good in itself.

Unfortunately, research doesn’t necessarily back that up. A 2010 study in The New England Journal of Medicine followed 10 North Carolina hospitals in the 10 years after the Institute of Medicine report. They found that the overall rate of harms, and the rate of preventable harms, did not significantly improve over that period.

My take: The article, in full, makes some compelling arguments that medical errors are overly-attributed as causes of death. At the same time, the article does not dismiss the importance of medical errors.  Many of the harms from medical errors do not result in death.

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Raynaud’s Phenomenon

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IN 1862, Maurice Raynaud described a 26-year-old female patient: “Under the influence of a very moderate cold…she sees her fingers become ex-sanguine, completely insensible, and of a whitish-yellow color.  This phenomenon …lasts a variable time, and terminates by a period of very painful reaction, during which the circulation is re-established…and recurs to the normal state.”

An updated review on Raynaud’s: FM Wigley, NA Flavahan. NEJM 2016; 375: 556-65.

This review highlights treatments and the differential diagnosis of primary Raynaud’s phenomenon form secondary causes (eg scleroderma, SLE, dermatomyositis, Sjogren’s and others).

A) Pallor phase B) Cyanotic phase C) Normal nailfold capillaries (primary phenomenon) D) Abnormal nailfold capillaries typical of microvascular disease

A) Pallor phase B) Cyanotic phase C) Normal nailfold capillaries (primary phenomenon) D) Abnormal nailfold capillaries typical of microvascular disease

Addressing Medical Issues Before International Travel

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Briefly noted: An highly detailed but concise review of “Medical Considerations before International Travel” DO Freedman et al. NEJM 2016; 375: 247-60.

Figure 1:

  • Risk assessment: medical history, prior travel experience, specific itinerary (region, season), type of accommodations, risk tolerance, financial challenges
  • Standard Interventions: Immunizations, Malaria prophylaxis (if risk), Traveler’s diarrhea strategy
  • Focused education: vectorborne diseases, altitude illness, thrombosis risk, STDs/bloodborne infections, transportation risks (eg no car seats), respiratory infections, medical kit, medical insurance

Tables:

  • Table 1: Practices for reducing disease risk (too many to summarize)
  • Table 2: Vaccine Recommendations
  • Table 3: Malaria Prophylaxis
  • Table 4: Recommendations based on location

Short Take Video Link (2 min): Travel Health and Safety

CDC: Traveler’s Health Website

Travel Resource: GeoSentinel Website

My take: This is a handy updated reference for international medical travel

Related blog posts:

beach hut

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Bedtime in Preschool-Aged Children and Risk for Adolescent Obesity

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An upcoming article (Journal of Pediatrics, (DOI: http://dx.doi.org/10.1016/j.jpeds.2016.06.005)shows an association between bedtime and the development of obesity:

Full-text link: Bedtime in Preschool-Aged Children and Risk for Adolescent Obesity

Abstract:

Objective

To determine whether preschool-aged children with earlier bedtimes have a lower risk for adolescent obesity and whether this risk reduction is modified by maternal sensitivity.

Study design

Data from 977 of 1364 participants in the Study of Early Child Care and Youth Development were analyzed. Healthy singleton-births at 10 US sites in 1991 were eligible for enrollment. In 1995-1996, mothers reported their preschool-aged (mean = 4.7 years) child’s typical weekday bedtime, and mother-child interaction was observed to assess maternal sensitivity. At a mean age of 15 years, height and weight were measured and adolescent obesity defined as a sex-specific body-mass-index-for-age ≥95th percentile of the US reference.

Results

One-quarter of preschool-aged children had early bedtimes (8:00 p.m. or earlier), one-half had bedtimes after 8:00 p.m. but by 9:00 p.m., and one-quarter had late bedtimes (after 9:00 p.m.). Children’s bedtimes were similar regardless of maternal sensitivity (P = .2). The prevalence of adolescent obesity was 10%, 16%, and 23%, respectively, across early to late bedtime groups. The multivariable-adjusted relative risk (95% CI) for adolescent obesity was 0.48 (0.29, 0.82) for preschoolers with early bedtimes compared with preschoolers with late bedtimes. This risk was not modified by maternal sensitivity (P = .99).

Conclusions

Preschool-aged children with early weekday bedtimes were one-half as likely as children with late bedtimes to be obese as adolescents. Bedtimes are a modifiable routine that may help to prevent obesity.

My take: Another potential reason to heed Samuel Jackson’s advice: Go the F- to Sleep (early)

Related blog posts:

Vickery Creek

Vickery Creek

Addicts and Anti-Diarrhea Drugs

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According to NY Times:

Addicts Who Can’t Find Painkillers Turn to Anti-Diarrhea Drugs

Here’s an excerpt:

The active ingredient, loperamide, offers a cheap high if it is consumed in extraordinary amounts. But in addition to being uncomfortably constipating, it can be toxic, even deadly, to the heart.

A report published online in Annals of Emergency Medicine recently described two deaths in New York after loperamide abuse. And overdoses have been linked to deaths or life-threatening irregular heartbeats in at least a dozen other cases in five states in the last 18 months.

Most physicians just recently realized loperamide could be abused, and few look for it. There is little if any national data on the problem, but many toxicologists and emergency department doctors suspect that it is more widespread than scattered reports suggest.

Meerkat, Atlanta Zoo 2016

Meerkat, Atlanta Zoo 2016

Latest Obesity Data Discouraging

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From LA Times (reporting on CDC study): In U.S., 38% of adults and 17% of kids are now obese

“How do government agencies, private foundations, industry groups and professional societies squander hundreds of millions of dollars? By trying to fight America’s obesity epidemic.

Two new studies show that the best efforts of all these players – as well as schools, churches and individual healthcare providers – have largely failed to keep most Americans from getting fatter.”

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Zip Code vs. Genetic Code

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Several posts have highlighted the importance of poverty contributing to high mortality, including the following:

The following infographic shows again how your zip code is likely more important than your genetic code.

Lower Teen Birthrate

Lower Teen Birthrate