Sunday, April 15, 2018

Diagnosis: A New Series From The New York Times and Netflix - The New York Times

This week The New York Times Magazine is reintroducing a version of "Think Like a Doctor," the online column in which I told the story of a patient with mysterious symptoms — including posting some medical records and test results — and challenged readers to unravel the puzzle of that patient's illness and come up with a diagnosis. But this time, the stakes are higher. In that original column, which I wrote from 2011 to 2016, I already knew the final diagnosis, and I watched as readers commented and discussed the case on the site, finding their way to an answer, a suggested diagnosis. This time around, I will be presenting an unsolved case and asking our readers to do their best to actually help the patient.

Again, I will provide test results and other relevant medical data and will challenge you to think like a doctor and come up with a solution to the patient's illness. In posting these unsolved cases, we hope to leverage the knowledge and wisdom of this particular crowd — the readers of The New York Times — to make a difference in the life and well-being of someone in search of an answer, in search of a diagnosis.

Below you will find the case of a 23-year-old woman who has recurrent episodes of terrible pain in her muscles, along with urine the color of cola, often after exercising. Reader responses will be reviewed, and the most promising will be forwarded to the provider who is managing the patient's care. Updates on the patient's condition and diagnosis will be posted here as progress in the case is made, and each patient's story, along with input from readers, will be shared in the Diagnosis show on Netflix. O.K., let's get started.

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How Profiteers Lure Women Into Often-Unneeded Surgery - The New York Times

Jerri Plummer was at home in Arkansas, watching television with her three children, when a stranger called to warn that her life was in danger.

The caller identified herself only as Yolanda. She told Ms. Plummer that the vaginal mesh implant supporting her bladder was defective and needed to be removed. If Ms. Plummer didn't act quickly, the caller urged, she might die.

Ms. Plummer, 49, didn't ask many questions. Her implant was causing her discomfort, and she was impressed by how much Yolanda knew about her medical history. She was scared. "It was like I had a ticking time bomb inside of me," she said. Yolanda assured Ms. Plummer that all her expenses would be covered and that she would be set up with a lawyer to help her sue the mesh manufacturer, Boston Scientific.

Days later, court records show, Ms. Plummer was lying on an operating table in a medical office in a shopping mall in Orlando, Fla.

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Thursday, April 12, 2018

First Clinical Practice Guidelines for Sjögren's Syndrome Developed - Rheumatology Advisor

The Sjögren's Syndrome Foundation has released the first clinical practice guidelines for the disease, which includes recommendations on the management of fatigue, inflammatory musculoskeletal pain, and use of biologic agents.

Steven E. Carsons, MD, from the Division of Rheumatology and Allergy and Immunology at Winthrop University Hospital in Mineola, New York, and colleagues said they developed the Sjögren's Syndrome Foundation clinical practice guidelines after "patient requests for improved care and physician requests for guidance."

The Sjögren's Syndrome Foundation clinical expert panel consisted of clinicians, nurses, and patients who, using a modified Delphi process (75% agreement level), achieved consensus on 19 different recommendations. Three topic review groups were created on the issues of musculoskeletal pain, fatigue, and biologic use, in which panelists performed systematic reviews of the MEDLINE/PubMed and Cochrane databases and compiled data on the topics published between January 1988 and April 2015. A summary of the recommendations was recently published in Arthritis Care & Research.

"Among all chronic autoimmune rheumatic disorders, Sjögren's syndrome remains one of the most difficult to manage," Dr Carsons and colleagues wrote in their recommendations. "Development of [clinical practice guidelines] for the ocular, oral, and systemic/rheumatologic manifestations should substantially improve the quality and consistency of care, guide reimbursement policies, and decrease the overall burden of illness."

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What the Hospitals of the Future Look Like - WSJ

The days of the hospital as we know it may be numbered.

In a shift away from their traditional inpatient facilities, health-care providers are investing in outpatient clinics, same-day surgery centers, free-standing emergency rooms and microhospitals, which offer as few as eight beds for overnight stays. They are setting up programs that monitor people 24/7 in their own homes. And they are turning to digital technology to treat and keep tabs on patients remotely from a high-tech hub.

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Wednesday, April 11, 2018

Your Body Is a Teeming Battleground - The Atlantic

I went to medical school, at least in part, to get to know death and perhaps to make my peace with it. So did many of my doctor friends, as I would find out. One day—usually when you're young, though sometimes later—the thought hits you: You really are going to die. That moment is shocking, frightening, terrible. You try to pretend it hasn't happened (it's only a thought, after all), and you go about your business, worrying about this or that, until the day you put your hand to your neck—in the shower, say—and … What is that? Those hard lumps that you know, at first touch, should not be there? But there they are, and they mean death. Your death, and you can't pretend anymore.

I never wanted to be surprised that way, and I thought that if I became a doctor and saw a lot of death, I might get used to it; it wouldn't surprise me, and I could learn to live with it. My strategy worked pretty well. Over the decades, from all my patients, I learned that I would be well until I got sick and that although I could do some things to delay the inevitable a bit, whatever control I had was limited. I learned that I had to live as if I would die tomorrow and at the same time as if I would live forever. Meanwhile, I watched as what had been called "medical care"—that is, treating the sick—turned into "health care," keeping people healthy, at an ever-rising cost.

In her new book, Barbara Ehrenreich ventures into the fast-growing literature on aging, disease, and death, tracing her own disaffection with a medical and social culture unable to face mortality. She argues that what "makes death such an intolerable prospect" is our belief in a reductionist science that promises something it cannot deliver—ultimate control over our bodies. The time has come to rethink our need for such mastery, she urges, and reconcile ourselves to the idea that it may not be possible.

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Tuesday, April 10, 2018

Lack Of Research On Medical Marijuana Leaves Patients In The Dark : Shots - Health News : NPR

By the time Ann Marie Owen, 61, turned to marijuana to treat her pain, she was struggling to walk and talk. She was also hallucinating.

For four years, her doctor prescribed a wide range of opioids for transverse myelitis, a debilitating disease that caused pain, muscle weakness and paralysis.

The drugs not only failed to ease her symptoms, they hooked her.

When her home state of New York legalized marijuana for the treatment of select medical ailments, Owens decided it was time to swap pills for pot. But her doctors refused to help.

"Even though medical marijuana is legal, none of my doctors were willing to talk to me about it," she says. "They just kept telling me to take opioids."

Although 29 states have legalized marijuana to treat pain and other ailments, the growing number of Americans like Owen who use marijuana and the doctors who treat them are caught in the middle of a conflict in federal and state laws — a predicament that is only worsened by thin scientific data.

Because the federal government considers marijuana a Schedule 1 drug, research on marijuana or its active ingredients is highly restricted and even discouraged in some cases.

Underscoring the federal government's position, Health and Human Services Secretary Alex Azar recently pronounced that there was "no such thing as medical marijuana."

Scientists say that stance prevents them from conducting the high-quality research required for FDA approval, even as some early research indicates marijuana might be a promising alternative to opioids or other medicines.

Patients and physicians, meanwhile, lack guidance when making decisions about medical treatment for an array of serious conditions.

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Saturday, April 7, 2018

Naloxone Stops Opioid Overdoses. How Do You Use It? - The New York Times

The United States surgeon general issued a rare national advisory on Thursday urging more Americans to carry naloxone, a drug used to revive people overdosing on opioids.

The last time a surgeon general issued such an urgent warning to the country was in 2005, when Richard H. Carmona advised women not to drink alcohol when pregnant.

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Smartphones becoming primary device for physician and patient communications | Computerworld

Hospitals are making significant investments in smartphone and secure mobile platforms to enable communications between clinicians and between them and patients, according to a new survey.

Nine of 10 healthcare systems plan significant investments in smartphones and secure unified communications over the next 12 to 18 months, according to the results of the survey, performed in person by Spyglass Consulting Group; the survey included more than 100 healthcare professionals working in hospital environments.

Smartphones being provided to hospital workers for communications are a 50/50 mix of purpose-built devices for the healthcare industry and consumer models, such as the Apple iPhone or Android phones, according to Gregg Malkary, managing director of the Spyglass Consulting Group.

"The whole idea of patient-staff communications is a relatively new concept," Malkary said, referring to the 2012 requirements set down by the federal government's "meaningful use" of electronic healthcare records (EHR) standards. "So, when you look at these investments in smartphones and secure mobile communications, they really are driving clinical transformation as they try to address ... requirements.

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Can Doctors Choose Between Saving Lives and Saving a Fortune? - The New York Times

To understand something about the spiraling cost of health care in the United States, we might begin with a typical conundrum: Imagine a 60-something man — a nonsmoker, overweight, with diabetes — who has just survived a heart attack. Perhaps he had an angioplasty, with the placement of a stent, to open his arteries. The doctor's job is to keep the vessels open. She has two choices of medicines to reduce the risk for a second heart attack. There's Plavix, a tried-and-tested blood thinner, that prevents clot formation; the generic version of the drug costs as little as 25 cents a pill. And there's Brilinta, a newer medicine that is also effective in clot prevention; it costs about $6.50 a pill — 25 times as much.

Brilinta is admittedly more effective than Plavix — by all of 2 percentage points. In a yearlong trial of 18,600 patients, 10 percent died from vascular causes, heart attack or stroke on Brilinta, while about 12 percent did on Plavix. Should the doctor prescribe the best possible medicine, assuming that the man has private health insurance that will pay the bulk of the costs? Or should she try to conserve health care costs by prescribing the cheaper medicine that is nearly as good? And consider this: If the cost to you was the same — you have maxed out your co-pay and will end up with the same out-of-pocket expenditure — would you agree to take the slightly inferior drug to benefit the system as a whole? You've just had a heart attack, for God's sake. You pay thousands of dollars for health insurance. Is it fair to ask you to bear the slightly increased risk to enable some broader social good?

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Sunday, April 1, 2018

Providing hospital-level treatment at home for very sick patients - The Washington Post

Phyllis Petruzzelli spent the week before Christmas struggling to breathe. When she went to the emergency department on Dec. 26, the doctor at Brigham and Women's Faulkner Hospital near her home in Boston said she had pneumonia and needed hospitalization. Then the doctor proposed something that made Petruzzelli nervous. Instead of being admitted to the hospital, she could go back home and let the hospital come to her.

As a "hospital-at-home" patient, Petruzzelli learned, doctors and nurses would come to her home twice a day and perform any needed tests or bloodwork.

A wireless patch would be affixed to her skin to track her vital signs and send a steady stream of data to the hospital. If she had any questions, she could talk via video chat anytime with a nurse or doctor.

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