Studies document risks of assault for health care workers

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((C) 2015 Marco Venturini Autieri )

Looking to avoid a profession where the risk of assault is high?You might want to stay away from police work, the military and . . . health care.

A new report that reviews research on assaults against doctors, nurses and other medical personnel concludes that health care workers often experience physical and verbal attacks, and, all too often, little is done to address it.

“Health care workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored,” writes Dr. James Phillips of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, in the New England Journal of Medicine.

“Our industry is, statistically, the most violent non-law-enforcement industry in the United States. And that’s using government statistics that have been shown to under-report the actual violence that takes place by up to 70 percent,” he told Reuters Health.

The violence is often tied to patients with dementia and mental health or substance abuse problems.

But in a significant number of cases, firearms can be involved.

“Between 2000 and 2011, there were 154 shootings with injury either inside or on the grounds of American hospitals, most frequently outdoors on the hospital campus (41 percent), in the emergency department (29 percent), or on inpatient floors (19 percent),” Phillips writes. “The most frequently ascribed motives were revenge (27 percent), suicide (21 percent), and mercy killing (14 percent).”

In a mental health setting, 70 percent of staff members are physically assaulted each year, and “among psychiatric aides, the rate is 69 times the national rate of violence in the workplace,” Phillips writes.

And in nursing homes, where dementia is a problem, one survey found that 59 percent of nursing home aides reported being assaulted weekly.

“One reason health care providers are reluctant to report these is that we have compassion for our patients, and we don’t want to treat patients like they’re criminals or the enemy,” Phillips said. “So we probably make excuses when we shouldn’t, and we overlook patients who are intoxicated or on drugs, and other patients who have altered mental status because of chronic dementia or acute delirium. They are already vulnerable, and we don’t want to treat them as if they are criminals.”

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Phillips became interested in the issue after being assaulted twice in the past five years.

The first time was while training in a Chicago hospital where an intoxicated patient “spit blood in my face knowing he had hepatitis C. I was forced to undergo six months of testing. I was never asked if I wanted to file a police report or press charges.”

The second time was in a community hospital when he asked an emergency room patient to stop screaming and cursing because there were two children in the next stall. The woman threw her cell phone, struck him in the face, and then stood up and spit on him in the presence of a police officer. She was ultimately convicted of assault and battery.

“The majority of health care providers who have been assaulted don’t feel that their concerns are taken seriously,” he said.

The best solution isn’t clear because little research has been done on the best ways to thwart attacks, he adds.

Some possibilities:

– Being tough on verbal assaults; acting aggressively against such cases may prevent them from escalating.

– Changing the law to make a physical attack on a health care worker a felony.

– Redesigning patient charts to flag past instances of violence, an approach in use in the Veterans Affairs system.

Metal detectors might appear to be an option. A 2003 study reported that one emergency department with a metal detector confiscated 3,446 weapons in eight months. But firearms were seldom found. Most of the weapons were knives.

Moreover, “there’s not any evidence that reducing the number of weapons reduces violence, because so much of the violence isn’t committed with a weapon. It’s committed with fists and feet,” Phillips said.

“We don’t have any evidence that shows that any one particular solution is actually effective at reducing workplace violence,” he said.

‘Super gonorrhea’ may go global, become untreatable

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In this 2013 file photo, a sample of condoms, which are particularly helpful in not spreading drug-resistant gonorrhea.

In this 2013 file photo, a sample of condoms, which are particularly helpful in not spreading drug-resistant gonorrhea. (AP Photo/Damian Dovarganes, File)

Last year’s emergence of so-called “super gonorrhea” in Leeds hasn’t ended in the UK city. The STD is now popping up in new British cities including London, and doctors are worried it may spread faster just as it becomes untreatable.

Because the STD is so good at fighting off antibiotics, treatment typically involves a combination of two drugs—azithromycin and ceftriaxone—but resistance to azithromycin is spreading and doctors worry ceftriaxone will soon be next, reports the BBC.

The spread is a “further sign of the very real threat of antibiotic resistance to our ability to treat infections,” says Public Health England, which has had only limited success in tracking down sexual partners of those diagnosed with super gonorrhea, reports the Independent. “The spread of high level azithromycin-resistant gonorrhea is a huge concern and it is essential that every effort is made to contain further spread,” says Dr.

Elizabeth Carlin, president of the British Association for Sexual Health and HIV. While the outbreak seems to have started among heterosexual couples, it is now infecting gay men as well.

Just last week Chancellor George Osborne declared resistance to antibiotics “an even greater threat to mankind than cancer” if there is no concerted global action. Caused by the bacterium Neisseria gonorrhoeae, gonorrhea spreads by unprotected sex, but can also pass from mother to child in utero.

In the past few years the infection rate in the UK has more than doubled, reports Vice, with only chlamydia higher up the list. Syphilis infections are up for the first time in years as well.

(A study says syphilis can’t be blamed on Columbus.)

This article originally appeared on Newser: ‘Super Gonorrhea’ May Go Global, Become Untreatable

Cure for HIV reportedly 3 years away

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HIV, or human immunodeficiency virus, particles in purple, cause the disease AIDS.

HIV, or human immunodeficiency virus, particles in purple, cause the disease AIDS. (CDC/ Dr. A. Harrison; Dr. P. Feorino)

A cure for HIV and AIDS reportedly could be just a few years away after scientists have been able to successfully snip away the virus from infected cells and prevent the disease from returning.

Scientists at the Lewis Katz School of Medicine at Temple University are confident that within the next three years they will be able to start human trials, the UK Daily Telegraph reported.

American researchers have previously shown that it’s possible to edit genes to cut the virus from DNA cells entirely.

British experts believe that this treatment, which has only been tested in labs, would allow the body to effectively “cure itself from the inside,” the newspaper reported. Human immune cells that were tested in the labs have showed no alteration to any other part of the genetic code.

“The fact that for the first time we have been able to completely eliminate segments of the viral genome in the laboratory demonstrates that we should be able to eliminate it in the human body,” lead researcher Professor Kamel Khalili told The Telegraph.

He reiterated that based on the recent findings, clinical trials could start within the next three years.

The new technique is called Crispr/Cas9. It involves targeting the genetic code of HIV which inserts into cells, according to The Telegraph. Scientists then take the Cas9 protein and edit it so it can recognize viral code.

The patient’s blood is then taken and scientists would inject Cas9, which would then seek out the HIV virus in the cells. The protein then releases and enzyme and snips out the virus. Scientists are confident that replacing 20 percent of immune cells with genetically altered cells would be enough to cure the virus.

“It is an important step forward. This is part of a wave of research that is being done using these new techniques to attack HIV in particular but also a number of other diseases,” Britain’s Manchester University Professor Matthew Cobb told Radio 4, according to the newspaper.

According to the latest statistics from the Centers for Disease Control and Prevention (CDC), more than 1.2 million people in the U.S. are living with HIV and about 12.8 percent of them are unaware that they have the virus.

Those infected take an antiretroviral drug to control the infection, but need to take it for the rest of their life. If they stop taking the treatment, the virus could cause AIDS.

Click for more from the UK Daily Telegraph.

Scientists may have found a way to destroy the bedbug

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Cimex feeding. (Louis Sorkin)

Cimex feeding. (Louis Sorkin)

Scientists have for the first time sequenced the genome of New York City bed bugs, a project that could one day offer a way to contain one of the world’s most hated insects.

One group of researchers, in a Nature Communications study, found that genes in the bedbug, Cimex lectularius, are expressed the most after it feeds on blood for the first time. The group, led by the American Museum of Natural History’s Jeffrey Rosenfeld, also compared bed bug DNA from every New York subway station and found those from different parts of the city had different genetic makeups.

Related: Destructive tussock moth outbreak threatens pine tree supply

Another group of scientists, also writing in Nature Communications, found 187 potential genes that allow these parasites to repeatedly feed on their host without causing pain. They also identify genes associated with insecticide resistance, including proteins in the animals’ cuticle that prevent insecticide penetration and enzymes that can detoxify the chemicals.

“Bedbugs are one of New York City’s most iconic living fossils, along with cockroaches, meaning that their outward appearance has hardly changed throughout their long lineage,” said one of the paper’s corresponding authors George Amato, director of the Museum’s Sackler Institute for Comparative Genomics. “But despite their static look, we know that they continue to evolve, mostly in ways that make it harder for humans to dissociate with them. This work gives us the genetic basis to explore the bedbug’s basic biology and its adaptation to dense human environments.”

The bed bug is a parasite that feeds on exclusively on blood and has been associated with humans for thousands of years. Global infestations of bed bugs came about with the rise of heated homes and international travel, a problem that has only exacerbated by the evolution of insecticide resistance over the past 20 years.

Related: Venomous caterpillar packs a punch

The hope now is that the sequenced genome – featuring more than 38,000 genes – could lead to better insecticides for bed bugs and also help to better identify allergens associated with their infestation. For example, the researchers found that bedbugs are likely most vulnerable during the first nymph stage, potentially making it a good target for exterminators in the future.

Researchers also found that the bedbug microbiome contains more than 1,500 genes that map to more than 400 different species of bacteria, indicating that bed bugs harbor a rich suite of endosymbionts that are likely essential for their growth and reproduction. As a result, antibiotics that attack bacteria beneficial to bed bugs -but non-essential to humans – could be another weapon to control of the insects.

“Having this resources opens up a lot of potential new rounds of research in dealing with bed bugs,” said the University of Cincinnati’s Joshua Benoit, who was a co-author on the second paper and is part of the International Bed Bug Genome Project Collaboration, said in a statement. “In a year or two, we might actually develop better ways to control bed bugs.”

Related: Wasp DNA produces genetically modified butterflies

Researchers extracted DNA and RNA from preserved and living collections, including samples from a population that was first collected in 1973 and has been maintained by American Museum of Natural History. RNA was sampled from males and females representing each of the bug’s six life stages, before and after blood meals, in order to paint a full picture of the bedbug genome.

“It’s not enough to just sequence a genome, because by itself it does not tell the full story,” said Mark Siddall, one of the paper’s corresponding authors and a curator in the Museum’s Division of Invertebrate Zoology and Sackler Institute for Comparative Genomics. “In addition to the DNA, you want to get the RNA, or the expressed genes, and you want that not just from a single bedbug, but from both males and females at each part of the life cycle. Then you can really start asking questions about how certain genes relate to blood-feeding, insecticide resistance, and other vital functions.”

Researchers not only found that the bedbugs are more closely related to their subway neighbors but also other insects – showing close relationships to the kissing bug (Rhodnius prolixus), one of several vectors for Chagas disease, and the body louse (Pediculus humanus), which both have tight associations with humans.

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5 old-time diseases that are making a comeback

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Bubonic plague bacteria from a patient, in a photo obtained on 15 January 2003 from the US Centers For Disease Control.

Bubonic plague bacteria from a patient, in a photo obtained on 15 January 2003 from the US Centers For Disease Control. (CDC/AFP/File)

Measles, tuberculosis… bubonic plague?! If headlines about old-time diseases on the comeback have you worried, you’re not alone. Here’s what you need to know to stay safe (and sane) amid recent outbreaks.


Think this notorious killer died with the Middle Ages? The disease actually persists in parts of Africa, Asia, and South America. And there have been 16 reported cases of plague, with four deaths, in the United States this past year. Most recently, a 16-year-old girl from Oregon was sickened and hospitalized after apparently being bitten by a flea on a hunting trip.

You can get plague from fleas that have carried the Yersinia pestis bacteria from an infected rodent, or by handling an infected animal, according to the Centers for Disease Control and Prevention (CDC). Bubonic plague is the most common form in the U.S., while pneumonic plague (affecting the lungs) and septicemic plague (affecting the blood) are less prevalent but more serious. Symptoms of bubonic plague include fever, chills, headache, and swollen lymph glands.

RELATED: 15 Diseases Doctors Often Miss

The good news is that plague is extremely rare, has a very low risk of person-to-person transmission, and can be effectively treated with antibiotics, explained Dr. Michael Phillips, associate director of the division of infectious diseases in the department of medicine at NYU Langone Medical Center. (The bad news is that plague can be fatal if treatment isn’t started within 24 hours of the arrival of symptoms.)

To stay safe, avoid contact with wild rodents (that means squirrels and chipmunks, in addition to rats), steer clear of dead critters, and call your doctor if you develop any symptoms after being exposed to fleas or rodents, particularly in western states, where U.S. cases tend to occur.

“While we can expect to see occasional cases in parts of America, it’s highly unlikely that there would be a wide-scale outbreak,” Phillips said. “As long as you’re not mucking around where you might come up against mice and fleas, you don’t have to worry.”


Once a common illness among children and young adults, cases of mumps in the US have dropped by 99 percent since a vaccine was introduced in 1967. But occurrences crop up, particularly among close-knit communities. The CDC reports that there have been 688 reported cases of mumps in the US in 2015, including small outbreaks at universities in Pennsylvania, Iowa, and Wisconsin. In 2014, there was a mini-outbreak among professional hockey players.

The virus that causes mumps is spread in close quarters (think college dorms or locker rooms) via coughing, sneezing, talking, or sharing cups or eating utensils. Symptoms of mumps include fatigue, fever, head and muscle aches, and loss of appetite, followed by puffy cheeks caused by swelling of the salivary glands. There is no treatment, but most people recover fully in a few weeks. Complications are rare, but can include hearing loss, meningitis, and inflammation of the testicles or ovaries.

RELATED: 12 Facts You Should Know About Ovarian Cysts

The only way to prevent the mumps (aside from avoiding people with it) is to get the MMR (measles-mumps-rubella) vaccine. Though usually administered to kids, you can get the vaccine at any time. It’s not foolproof (two doses are 88 percent effective at preventing the disease, per the CDC), and its protection can wear off over time, but it’s vastly better to get the shot than not. Booster doses are often recommended during outbreaks.


Like mumps, measles was once widespread: in its heyday, nearly every American child got the disease before they turned 15, and an estimated 400 to 500 Americans died from it each year, according to the CDC. Widespread adoption of the vaccine in the 1960s, however, led to the elimination of the disease from the U.S. in 2000.

Not so fast: measles has made a troubling comeback of late, with a spike of 667 cases reported in 2014, and another 189 in 2015. Many of this year’s cases stemmed from an outbreak at two Disney theme parks in California.

The virus that causes measles is spread via coughing and sneezing, and is so contagious that 90 percent of non-immune people near someone infected will get it, according to the CDC.

“It travels like a gas through the air,” Phillips said, making it “the ultimate transmissible infection.”

Symptoms of measles include fever, cough, runny nose, red eyes, and a rash that typically begins at the hairline and spreads downward across the body. Complications can include diarrhea and ear infections, and in rare cases, life-threatening pneumonia and encephalitis.

There is no treatment, which makes vaccination imperative. Experts have attributed the recent surge to lax vaccination habits; in some cases, unvaccinated people may have picked up the bug overseas and spread it to communities of unvaccinated people. Two doses of the MMR (measles, mumps, and rubella) vaccine are about 97 percent effective at preventing the disease; it’s particularly important to get vaccinated if you’re traveling internationally.

“Prevention is the hallmark,” Phillips said. “If we develop pockets of under-vaccinated people and start having enough transmission, even those individuals who are vaccinated will be at risk.”

RELATED: Adult Vaccines: What You Need and When


Leading up to the 1882 discovery of the bacteria Mycobacterium tuberculosis, this scourge killed one out of every seven people living in the United States and Europe. Antibiotics have dramatically reduced its deadliness, particularly in the US, and as recently as the 1990s it was believed that tuberculosis could be eliminated from the world by 2025, according to the National Institute of Allergy and Infectious Diseases. But it persists, killing between 2 and 3 million people globally each year. Though most Americans don’t consider TB a threat, it’s showing signs of a resurgence: there were 9,421 reported US cases of TB in 2014, according to the CDC, and 555 deaths in 2013 (the last year for which data are available). Recent cases include three teachers at a New York City elementary school, a San Antonio high school student, and another high school student outside of San Diego.

TB is caused when Mycobacterium tuberculosis attacks the lungs. It’s spread through the air when an infected person coughs, sneezes or talks (though not by shaking hands, kissing, or sharing food, drink, or toothbrushes). People with compromised immune systems are especially vulnerable. Symptoms of TB include a cough that lasts three weeks or longer, often producing blood, as well as fatigue, fever and weight loss.

“Many cases we’re seeing involve folks who were infected years before, were asymptomatic, and then the disease reactivates later in life,” explained Phillips.

The good news is that TB is curable with treatment, though several different antibiotics must be taken over 6 to 12 months. To stay safe, avoid contact with TB patients, particularly in crowded, enclosed environments. If you think you may have been exposed to someone with TB, see your doctor immediately for testing and possible treatment.

TB is scary enough on its own, but health professionals are particularly worried about the rise of antibiotic-resistant TB throughout the world.

“We’re seeing more and more cases that are multi-drug-resistant, which means it requires a second or a third line therapy to treat,” Phillips said. “We have to think globally about this one: helping to prevent cases overseas and working on new drug development can only help keep us safe domestically.”

Scarlet fever

Largely forgotten over the past century thanks to the rise of antibiotics, this bacterial infection is perhaps best known for the role it plays in the classic children’s book The Velveteen Rabbit. (When the young protagonist comes down with scarlet fever, all his toys, including his beloved rabbit, must be destroyed, on doctor’s orders.)

Researchers have recently been tracing scarlet fever’s comeback in Asia (with more than 5,000 cases over the past five years in Hong Kong and 100,000 in China) and the United Kingdom (roughly 12,000 cases over the past year).

RELATED: The 20 Biggest Lessons We Learned About Our Health in 2015

Caused by the same type of bacteria behind strep throat (Streptococcus), scarlet fever commonly afflicts children ages 5 to 12, and shares many symptoms with strep (fever, sore throat, headache, nausea), along with a red, sandpapery rash that appears on the chest and neck and may spread across the body. Like strep, scarlet fever can be diagnosed via a throat swab or throat culture, and can be effectively treated with antibiotics. Researchers are concerned, however, that newer outbreaks may be related to antibiotic resistance, which can make scarlet fever harder to knock out with drugs.

To stay safe, avoid contact with infected people (the disease spreads via sneezes or coughs), wash your hands regularly (as you would to ward off any communicable disease), and seek treatment as soon as symptoms develop.

“It’s easily transmitted in group settings,” Phillips said, “so there is the risk that when a toxigenic strain moves into a community, it would spread rapidly.”

This article originally appeared on

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Another killer could top cancer by 2050—and we’re to blame

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The dead body of a man lies on a gurney.

The dead body of a man lies on a gurney. (AP Photo Manu Brabo)

We’ve already been warned about an “antibiotic apocalypse.” Now a new study says medicine-resistant infections will take more lives annually than cancer does by 2050 unless action is taken, CNBC reports.

According to the Review on Antimicrobial Resistance, deaths caused by drug resistance will rise from 700,000 in 2015 to an estimated 10 million per year in 2050.

The problem: People around the world are taking more antibiotics, rendering them less effective, while global food production uses at least as many, theGuardian reports.

Meanwhile, fewer new antibiotics are being made. In time, the study says, we may no longer be able to treat diseases that are now curable. “The problem is straightforward,” writes Jim O’Neill, who chairs the Review, in the Guardian.

“As valuable as scientific breakthroughs may be, it takes a lot of work to turn them into marketable drugs. And … antibiotics generally produce low—and sometimes even negative—returns on investment for the pharmaceutical makers that develop them.” So he’s calling on philanthropists and governments to create an R&D fund to create new antimicrobial drugs.

He estimates a cost of less than 0.1% of global GDP, far less than the alternative: “$100 trillion in lost production by 2050 and 10 million lives lost every year.” (Here’s the latest food chain to go antibiotics-free.)

This article originally appeared on Newser: New Killer to Top Cancer by 2050—and We’re to Blame

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A dose of singing does stroke patients good

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June 23, 2010: A 3D display is seen through glasses during a demonstration by virtual reality content and technology provider Solidray at the 3D and Virtual Reality Expo in Tokyo.

June 23, 2010: A 3D display is seen through glasses during a demonstration by virtual reality content and technology provider Solidray at the 3D and Virtual Reality Expo in Tokyo. (REUTERS/Yuriko Nakao)

In a hospital atrium at Mount Sinai Beth Israel this week, a choir gave its first public performance. Wearing light-up necklaces and accompanied by drums and guitar, the performers rang bells and sang such holiday classics as “Silver Bells” and “Joy to the World,” occasionally breaking out in harmony.

While every member of the choir sings, some are united by a less common bond: They have lost much of their ability to speak.

The group, Singing Together Measure by Measure, is made up of those who have had strokes and those who care for them, both family members and health-care professionals. It is part of a clinical trial, led by Joanne Loewy, director of the hospital’s Louis Armstrong Center for Music and Medicine, creating therapy around a phenomenon that has been noted for centuries: that some people who can’t speak can still sing.

Technically, the study is focused on a condition called aphasia, a brain disorder that causes difficulties speaking and communicating but doesn’t necessarily affect intelligence. It is common among stroke patients, occurring in about one-third of the 750,000 people in the U.S. who have strokes each year, according to the National Aphasia Association, an advocacy group.

Having a stroke often destroys certain neural pathways in the brain, including those used for speech. Music, which uses a more complex set of pathways, can help restore lost brain function, Dr. Loewy said.

“It’s a perfect population to study, because you can actually connect the preserved pathways and reactivate them through music,” she added.

For the trial, which is ongoing, 40 stroke patients are randomly divided into two groups. All the patients receive standard post-stroke care but one of the groups is also assigned music therapy.

Before and after a six-month period, a research team measures the patients’ changes in mood, neurological function and language ability. Dr. Loewy and her collaborators, music therapists Andrew Rossetti and Naoko Mizutani, aim to see if participating in the weekly choir sessions makes a measurable difference on stroke survivors’ recovery.

Click for more from The Wall Street Journal.

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A ruptured eardrum turns out to be something much more

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My shift is over and I’m ready to head out the emergency department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, “Get out of here. Don’t even think about staying late. You can’t save the world.”

With me leaving, the department will drop to single coverage with Jim taking the reins alone the rest of the night. Despite his words, the dejected look on his face reads, “Help!”
It’s going to be a long and grueling overnight shift for Dr. Jim.
I look up at the monitor and it says, “ruptured eardrum.” That’s easy, I think to myself. I’ll stay late and see at least one more patient to help out. I walk in the room and it’s a 16-year-old girl, in a green and white basketball uniform, with her mom and dad, who looks like he could be a retired football linebacker.



“I got hit in the ear with the ball. I can’t hear at all, and my ear’s bleeding. This is the second time, it’s happened. Last time I couldn’t play basketball for a week,” she says.

“Okay, let’s take a look,” I say.

I put a couple of drops of peroxide in the ear to soften up the dried blood. Hmm? There are no bubbles. I clean out the ear and … what is that smell? Do I smell raspberry jelly? I clean out the ear more and look at the ear drum. It’s perfect. There’s no rupture and no laceration in the canal. Her ear is completely normal.

“I won’t be able to play this weekend, will I?” she asks. “Just put me on the injured list this weekend, and we’re good to go,” she says with a bubbly smile. Being that she’s 16, and still a minor I ask her parents if she and I can talk in private for a minute. They say okay, I have a female nurse come with me, and we close the door.

“Did you put something in your ear?” I ask. “Like raspberry jelly or something, to make it look like blood?”

“Yes,” she says, looking deflated.

She then confesses that she doesn’t want to go to the tournament and concocted the whole story to have a reason to be injured, so she could go to her boyfriend’s party, instead. I thank her for her honesty.

“Can I go now?” she asks.

I discharge her and on the way out the dad comes back in.

“Doc, she faked it didn’t she? I know she doesn’t want to play in the tournament.”

Without speaking, I gave a half nod. He smiled and walked out. Even though I was dog-tired after working 12 1/2 hours and staying late, I finished the shift a little lighter, with a simple case where no one died, no one bled out, or inappropriately demanded narcotics.

A week later prior to a shift, our ED director Dr. Bob comes to me and says, “Hey Bird, how’ve you been? I’ve got some good news, bad news and ugly news. Which do you want first?”

“None of it,” I answer.

“Okay, the good news.”

Then, with the phrase no ER physician ever wants to hear, “Remember that kid you saw last week? The one with the bleeding ear?”

“No. Wait, do you mean the one with raspberry jelly coming out of the ear?” I chuckle.

“Yeah, that one. Well, she’s alive,” he continues.

“I figured that. I haven’t seen death by raspberry jelly, yet,” I laugh.

Then he drops this on me, “The bad news is she attempted suicide the night after you discharged her.”

“Wow, that’s terrible. There was no sign of that at all. It was just a simple ear complaint. What’s the ‘ugly’ news?” I ask, half not wanting to know.

“The ‘ugly’ news is that it’s your fault, at least according to the girl’s father,” says Director Bob.

“What?” I exclaim half-shocked, half-knowing I should never be shocked by anything that happens in or around the circus that is the emergency department.

“Yeah, I know. No good deed goes unpunished. Plus, they filled out a Press Ganey survey, giving you the lowest scores possible then filled a formal complaint with administration,” says Director Bob, acting irritated at me. “Now it’s my job to smooth this crap over, somehow.”

“A complaint about what?” I ask.

“Well, they’re claiming you violated EMTALA, and committed malpractice by missing the diagnosis,” says Director Bob.

“What? She got a screening exam and there was no inkling of depression whatsoever. That’s a crock of #&@$,” I say, in disbelief.

“Maybe, but administration is very concerned, plus they are worried there may be a HIPAA violation, also. You know contract renegotiations are coming up soon. They’ve been holding the blow torch to my back over metrics, and now this. Let’s just say they’ve made some threats,” says Bob.

“What diagnosis are they saying I missed? The kid put jelly in her ear for Pete’s sake. And HIPAA, I didn’t violate HIPAA? First of all, she’s a minor, plus I didn’t tell the father anything,” I say exasperated.

“Let me see,” Director Bob says dropping his glasses, looking down at his notes. “You may have violated HIPAA by telling the father the girl faked the injury, when that was supposed to be a private conversation between you and the girl. Then when he confronted her, and told her she couldn’t go to some party, she goes and swallows a handful of his pain pills and overdoses. The missed diagnosis was suicidal depression, and you violated EMTALA by not doing a proper medical screening exam, specifically, a psychological screening exam. I’m quoting the complaint now: ‘The doctor is 100% responsible for this.’”

“You’ve got to be kidding me,” I say.

“Unfortunately I’m not. Now, for the bad news,” he continues.

“Wait a minute, that was the ‘good’ news? Whatever, just tell me,” I say.

“They plan to contact an attorney and are threatening to sue you, the hospital, and the group,” he says.

“Of course. This is utterly nauseating and ridiculous. I don’t have time for this, I have to go start my shift,” I answer, more than ready to be done with this conversation.

“Make sure you draw up a draft apology letter for me, so I can send that out to the family. Admin requires it, you know,” says Director Bob.

“Apology, for what?” I ask.

“No, I’m not, but don’t worry about it,” says Director Bob, in a nervous hurry. “You know how the system works. It’s just business, Bird. Just get back out there, keep cranking those patients through the department as fast as possible, keep the Press Ganey scores up and everything will be just fine.”

“BirdStrike” is an emergency physician who blogs at Dr. Whitecoat.


Originally available here

How to cure America’s pain crisis without risking addiction

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Feb. 19, 2013 – FILE photo of OxyContin pills at a pharmacy in Montpelier, Vt. (AP)

Feb. 19, 2013 – FILE photo of OxyContin pills at a pharmacy in Montpelier, Vt. (AP)

The last thing the world needs right now is more suffering.

More than 100 million Americans suffer from chronic pain,  at an annual cost of $635 billion. That’s more than we spend treating cancer, diabetes, and heart disease combined.  And the incidence of pain is rising.

Worse, our efforts to treat this pain have led to a significant increase in the use of prescription pain relievers, with tragic and often ineffective outcomes.

Taken together, these trends constitute a pain crisis — one that demands a new treatment model that better balances safety and effectiveness through the responsible use of prescription drugs and alternative therapies.

Moving toward a more integrated model of pain management will require a real investment in educating doctors and patients.

How did the pain crisis come about? Advocacy for pain sufferers grew in the 1990s, as many medical professionals began to recognize that pain was being undertreated.   To help their patients, they turned to powerful opioids like oxycodone and hydrocodone.

Prescriptions soared. In 2013 alone, 207 million prescriptions were written for opioids.

Today, hydrocodone still tops the list of most prescribed drugs.

But opioids turned out to be more addictive and dangerous than previously thought. With long-term use, some patients develop tolerance, meaning they require higher and higher doses to get the same amount of pain relief. And most patients become physically dependent on the drugs, which means they go through withdrawal if they stop taking them suddenly.

The unintended, yet devastating, consequence of our current pain management practices is a prescription drug abuse epidemic — one punctuated by a four-fold increase in opioid-addiction related hospitalizations and triple the number of fatal overdoses involving prescription drugs, and a resurgence of heroin use.

Around 16,000 people now die from overdoses involving prescription opioids each year – accounting for more deaths than overdoses from all illegal drugs combined.

To reverse this crisis, healthcare providers need to treat both acute and chronic pain in ways that don’t exacerbate prescription drug abuse.

Decades of research have shown the effectiveness of “multimodal” approaches to treating pain.  A multimodal model maintains that treatment for pain requires much more than just using opioids.

This approach focuses on treating the whole person through traditional methods along with self-care, pain education, and complementary or alternative treatments.

Effective pain care regimens might include medications other than opioids, like acetaminophen — the same compound sold as Tylenol — or nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen.  When combined with other therapies, this approach is known as “multimodal analgesia.” And it can expedite recovery and reduce morbidity, while carrying fewer adverse effects than opioids.

Multimodal care also recognizes that pain is a multifactorial problem. It arises from a number of sources: surgeries, broken bones or diseases such as cancer, AIDS, or arthritis; recreational or work injuries; car accidents; and elusive causes – an inexplicable headache or back pain – that can be difficult to pin down, but no less real.

Because pain is so unique and complex, every patient needs an individualized approach for treatment. Opioid pain medications are just one, oftentimes over-used, tool to treat pain.

A multimodal approach might involve stress management and relaxation, physical therapy, improved sleep and nutrition habits, and exercise. Patients may also need to learn to pace their activities so that they are realistic about how much they can do in a certain time period.

And in some cases, a multimodal approach will mean getting patients on the right dose of an appropriate medicine. Most people benefit from prescription drugs, take them as prescribed, and increase their overall health and quality of life by using them appropriately.  But prescribing an opioid isn’t always the first place to start.

Moving toward a more integrated model of pain management will require a real investment in educating doctors and patients.

Few physicians have adequate training in pain relief, and there’s a lack of standard practice to guide them. Non-drug alternatives have traditionally not been covered by insurance. They also require the patient to engage in the healing process and not expect a magic bullet.

Safe and effective pain management is a balancing act. Careful and judicious use of prescription drugs will remain an important tool for physicians in treating pain. But they and their patients should not overlook other tools to relieve pain and improve quality of life.

The pain crisis in America must end. Pain sufferers and their loved ones have already endured enough.

Bob Twillman, Ph.D., FAPM is Executive Director of the American Academy of Pain Management and Member of the Alliance for Balanced Pain Management.

Originally available here

Most cancer cases due to lifestyle choices, not ‘bad luck,’ study suggests

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A 3-D rendering shows a cancer cell.

A 3-D rendering shows a cancer cell. (iStock)

Between 70 and 90 percent of cancer cases are linked to avoidable lifestyle choices like exposure to radiation and toxic chemicals, suggests a study published online Wednesday in the journal Nature.

That conclusion, drawn from researchers at Stony Brook University in New York, adds to ongoing study of the causes of cancer and individuals’ ability to reduce their risk. It also challenges findings published in the journal Science earlier this year that suggested most cancer cases are primarily due to “bad luck.”

Johns Hopkins University researchers made the previous observation after studying the interaction between stem cell divisions and cancer risk in various tissues. They determined that— independent of lifestyle choices and known cancer risks— the more those divisions occurred, the higher the individual’s cancer risk would be. Researchers argued that some cancers were clearly linked to lifestyle choices— like lung cancer and smoking— but that for other cancers, the stem cell division and cancer risk relationship still existed regardless of those choices.

“What they did was interesting, but I was startled by the conclusion,” Yusuf Hannun, a cancer researcher at Stony Brook University and author of the new paper, said in a Nature news release.

Hannun and his team set out to re-examine that notion by analyzing mathematical models, epidemiological data, and cancer cell mutation patterns. They concluded that mutations during cell division rarely resulted in cancer— even in tissues with relatively high rates of cell division, according to the news release. And, they wrote, in nearly all of the disease instances, some level of exposure to environmental factors, like carcinogens, was necessary to trigger cancer.

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While Johns Hopkins mathematician Cristian Tomasetti, a study author for theScience paper, argued that the  Stony Brook study doesn’t account for certain characteristics of tumor growth, other specialists welcomed the new findings as they encourage cancer prevention efforts.

“By not smoking, your lifetime risk of lung adenocarcinoma drops dramatically,”  Edward Giovannucci, who studies cancer prevention at the Harvard T. H. Chan School of Public Health and wasn’t involved in either study, said in the news release. “The fact that your risk of pelvic sarcoma is even lower because there’s less stem-cell division— so what?”

Originally Available here