Category: Morbidity

Who Will Care for Older Adults? We’ve Plenty of Know-How but Too Few Specialists

Mary Pat Campbell

Link: https://kffhealthnews.org/news/article/who-will-care-for-older-adults-weve-plenty-of-know-how-but-too-few-specialists/

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Despite the surging older population, there are fewer geriatricians now (just over 7,400) than in 2000 (10,270), he noted in a recent piece in JAMA. (In those two decades, the population 65 and older expanded by more than 60%.) Research suggests each geriatrician should care for no more than 700 patients; the current ratio of providers to older patients is 1 to 10,000.

What’s more, medical schools aren’t required to teach students about geriatrics, and fewer than half mandate any geriatrics-specific skills training or clinical experience. And the pipeline of doctors who complete a one-year fellowship required for specialization in geriatrics is narrow. Of 411 geriatric fellowship positions available in 2022-23, 30% went unfilled.

The implications are stark: Geriatricians will be unable to meet soaring demand for their services as the aged U.S. population swells for decades to come. There are just too few of them. “Sadly, our health system and its workforce are wholly unprepared to deal with an imminent surge of multimorbidity, functional impairment, dementia and frailty,” Gurwitz warned in his JAMA piece.

This is far from a new concern. Fifteen years ago, a report from the National Academies of Sciences, Engineering, and Medicine concluded: “Unless action is taken immediately, the health care workforce will lack the capacity (in both size and ability) to meet the needs of older patients in the future.” According to the American Geriatrics Society, 30,000 geriatricians will be needed by 2030 to care for frail, medically complex seniors.

Author(s): Judith Graham

Publication Date: 10 Nov 2023

Publication Site: Kaiser Health News

Pulse oximeters’ inaccuracies in darker-skinned people require urgent action, AGs tell FDA

Mary Pat Campbell

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Link:https://www.statnews.com/2023/11/07/pulse-oximeters-attorneys-general-urge-fda-action/

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More than two dozen attorneys general are urging Food and Drug Administration officials to take urgent action to address disparities in how well pulse oximeters, the fingertip devices used to monitor a person’s oxygen levels, work on people with darker skin.

In a Nov. 1 letter, the AGs noted that it had been a year since the FDA convened a public meeting of experts, who called for clearer labeling and more rigorous testing of the devices, and that no action had been taken.

“We, the undersigned Attorneys General, write to encourage the FDA to act with urgency to address the inaccuracy of pulse oximetry when used on people with darker toned skin,” said the letter, written by California Attorney General Rob Bonta and signed by 24 other attorneys general.

Pulse oximeters’ overestimation of oxygen levels in patients with darker skin has, in a slew of recent research studies, been linked to poorer outcomes for many patients because of delayed diagnosis, delayed hospital admissions, and delayed access to treatment, including for severe Covid-19 infections. Higher amounts of pigments called melanin in darker skin interfere with the ability of light-based sensors in pulse oximeters to detect oxygen levels in blood.

….

The delay has frustrated health care workers who use pulse oximeters and have studied them and followed the progress toward creating new devices that work better. “I just get mad that these things are not on the market,” Theodore J. Iwashyna, an ICU physician at Johns Hopkins, told STAT. “Just last week in my ICU, I had a patient whose pulse oximeter was reading 100% at the same time that his arterial blood gas showed that his oxygen levels were dangerously low. I need these things to work, and work in all my patients.”

Author(s):Usha Lee McFarling

Publication Date: 7 Nov 2023

Publication Site: STAT News

How to Honor Breast Cancer Awareness Month

Mary Pat Campbell

Link:https://vpostrel.substack.com/p/how-to-honor-breast-cancer-awareness

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It’s not the orgy of pink that reminds me of breast cancer. It’s the Nobel Prize in Physiology or Medicine. I have a rooting interest, and so far I’ve been disappointed. I want the prize to go to UCLA cancer researcher Dennis Slamon, who in recent years has been on the Great Mentioner’s short list (an improvement since I started paying attention a decade or so ago).

Slamon’s work did two things: Beginning with HER2+ breast cancer, it demonstrated that cancers could be identified by specific genetic variants, rather than merely where they occur in the body. Then it showed that those variations could be targeted and treated with specific antibodies. The first practical result was the drug Herceptin, which treats the roughly 25 percent of breast cancer patients with an especially aggressive form.

….

The usual sources were still not interested in paying for research. But in 1989, Slamon was treating Hollywood honcho Brandon Tartikoff, best known for his stint as president of NBC, for Hodgkin’s lymphoma. Tartikoff’s wife Lilly was grateful for the care and asked Slamon what she might do to help him. He told her about the idea of finding a drug to treat HER2+ breast cancer. Soon thereafter, in a classic Hollywood moment, she ran into Ronald O. Perelman, who owned Revlon, at Wolfgang Puck’s original Spago restaurant. She gave him the pitch: You own Revlon. Revlon sells to women. Women get breast cancer. You and Revlon should support this research. He agreed to let his representative meet with Slamon.

At the meeting, Slamon was accompanied by his colleague John Glaspy, who is a notably blunt-spoken person. Even if they got government funding, Glaspy warned, it would take several years and by then “we’ll have a Rose Bowl full of dead women” from breast cancer. The pitch worked. 

….

In 1998, the drug was approved for treatment of Stage 4 HER2+ breast cancer and in 2006 it was approved for treating early stage cancers. A year later, it saved my life.

Author(s): Virginia Postrel

Publication Date: 9 Oct 2023

Publication Site: Virginia Postrel’s newsletter at Substack

Why do so many Black women die in pregnancy?One reason: Doctors don’t take them seriously

Mary Pat Campbell

Link: https://projects.apnews.com/features/2023/from-birth-to-death/black-women-maternal-mortality-rate.html

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Her pleas for help were shrugged off, she said, and she was repeatedly sent home from the hospital. Doctors and nurses told her she was suffering from normal contractions, she said, even as her abdominal pain worsened and she began to vomit bile. Angelica said she wasn’t taken seriously until a searing pain rocketed throughout her body and her baby’s heart rate plummeted.

Rushed into the operating room for an emergency cesarean section, months before her due date, she nearly died of an undiagnosed case of sepsis.

Even more disheartening: Angelica worked at the University of Alabama at Birmingham, the university affiliated with the hospital that treated her.

Her experience is a reflection of the medical racism, bias and inattentive care that Black Americans endure. Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention.

Black babies are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives.

Author(s): KAT STAFFORD

Publication Date: 23 May 2023

Publication Site: AP news

Unhealthy Longevity in the United States

Mary Pat Campbell

Link: https://www.soa.org/resources/research-reports/2023/unhealthy-longevity-us/

PDF: https://www.soa.org/4a525c/globalassets/assets/files/resources/research-report/2023/unhealthy-longevity-us.pdf

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The SOA Research Institute’s Mortality and Longevity Strategic Research Program is pleased to make available a research report that quantifies differences in mortality and disease prevalence by health status. Additionally, period life tables by health status, sex, and age are available in Appendix D.

Author(s):

Natalia S. Gavrilova, Ph.D.
Leonid A. Gavrilov, Ph.D.

NORC at the University of Chicago

Publication Date: August 2023

Publication Site: Society of Actuaries

Report Highlights Public Health Impact of Serious Harms From Diagnostic Error in U.S.

Mary Pat Campbell

Link:https://www.hopkinsmedicine.org/news/newsroom/news-releases/report-highlights-public-health-impact-of-serious-harms-from-diagnostic-error-in-us#:~:text=Results%20of%20the%20new%20analysis,of%20the%20public%20health%20problem.

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Improving diagnosis in health care is a moral, professional and public health imperative, according to the U.S. National Academy of Medicine. However, little is known about the full scope of harms related to medical misdiagnosis — current estimates range widely. Using novel methods, a team from the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence and partners from the Risk Management Foundation of the Harvard Medical Institutions sought to derive what is believed to be the first rigorous national estimate of permanent disability and death from diagnostic error.  

The original research article was published July 17 by BMJ Quality & Safety. Results of the new analysis of national data found that across all clinical settings, including hospital and clinic-based care, an estimated 795,000 Americans die or are permanently disabled by diagnostic error each year, confirming the pressing nature of the public health problem.  

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To identify their findings, researchers multiplied national measures of disease incidence by the disease-specific proportion of patients with that illness who experience errors or harms. Researchers repeated this method for the 15 diseases causing the most harms, then extrapolated to the grand total across all dangerous diseases. To assess the accuracy of the final estimates, the study’s authors ran the analyses under different sets of assumptions to measure the impact of methodological choices and then tested the validity of findings by comparing them with independent data sources and expert review. The resulting national estimate of 371,000 deaths and 424,000 permanent disabilities reflects serious harms widely across care settings, and it matches data produced from multiple prior studies that focused on diagnostic errors in ambulatory clinics and emergency departments and during inpatient care.  

Vascular events, infections and cancers, dubbed the Big Three, account for 75% of the serious harms. The study found that 15 diseases account for 50.7% of the total serious harms. Five conditions causing the most frequent serious harms account for 38.7% of total serious harms: stroke, sepsis, pneumonia, venous thromboembolism and lung cancer. The overall average error rate across diseases was estimated at 11.1%, but the rate ranges widely from 1.5% for heart attack to 62% for spinal abscess. The top cause of serious harm from misdiagnosis was stroke, which was found to be missed in 17.5% of cases.  

Author(s):  David Newman-Toker 

Publication Date: 17 July 2023

Publication Site: Johns Hopkins, press release

Multidisciplinary Center Care for Long COVID Syndrome – a Retrospective Cohort Study

Mary Pat Campbell

Link:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10200714/

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Specialty Utilization Specialty utilization by a total of 1802 patients evaluated at the Comprehensive COVID Center (CCC) during the first 21 months in a total of 2361 initial visits in 12 specialty clinics. The mean number of specialty clinics visited by CCC patients was 1.3 (range 1-6) and multiple clinic consultations accounted for 405 visits.

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Background

Persistent multi-organ symptoms after COVID-19 have been termed “long COVID” or “post-acute sequelae of SARS-CoV-2 infection” (PASC). The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers.

Methods

We performed a retrospective cohort study of patients evaluated at our multidisciplinary Comprehensive COVID-19 Center (CCC) in Chicago, IL, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19.

Results

We evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among patients tested, 742/878(85%) reported decreased quality of life, 284/553(51%) had cognitive impairment, 195/434(44.9%) had alteration of lung function, 249/299(83.3%) had abnormal CT chest scans, and 14/116(12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had similar findings than those with negative or no test results.

Conclusions

The CCC experience shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.

Keywords: Long COVID, Post-Acute Sequelae of SARS-CoV-2 Infection, PASC, Multidisciplinary Care, Health Service Delivery

doi: 10.1016/j.amjmed.2023.05.002 [Epub ahead of print]

Author(s): Joseph Bailey, M.D.,a,⁎ Bianca Lavelle, M.D.,b Janet Miller, B.S.,a Millenia Jimenez, B.S.,c Patrick H. Lim, M.S.,c Zachary S. Orban, B.S.,c Jeffrey R. Clark, B.A.,c Ria Tomar, B.S.,a Amy Ludwig, M.D.,a Sareen T. Ali, B.S.,c Grace K. Lank, B.S.,c Allison Zielinski, M.D.,d Ruben Mylvaganam, M.D.,a Ravi Kalhan, M.D.,a Malek El Muayed, M.D.,e R. Kannan Mutharasan, M.D.,d Eric M. Liotta, M.D. M.S.,c Jacob I Sznajder, M.D.,a Charles Davidson, M.D.,d Igor J. Koralnik, M.D.,c,1 and Marc A. Sala, M.D.a,1, for the Northwestern Medicine Comprehensive COVID Center Investigators

Publication Date: 2023 May 22

Publication Site: National Library of Medicine

Northwestern Medicine shares new findings from the Comprehensive COVID-19 Center as significant demand remains for patient appointments

Mary Pat Campbell

Link: https://news.nm.org/northwestern-medicine-shares-new-findings-from-the-comprehensive-covid-19-center-as-significant-demand-remains-for-patient-appointments/

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Long COVID occurs in approximately a third of COVID survivors and is now the third leading neurologic disorder in the United States. In May 2020, during the height of the pandemic, Northwestern Medicine physicians noticed this growing trend and established one of the first Comprehensive COVID-19 Centers in the United States to treat patients suffering from lingering impacts of the virus such as brain fog, shortness of breath and chest pain. Three years later, a new study published in the American Journal of Medicine reports key findings from more than 1,800 patients who were evaluated during the first 21 months at the Northwestern Medicine Comprehensive COVID-19 Center (CCC) with neurology, pulmonology and cardiology being the most commonly accessed specialties and still in high-demand today.  

….

The team evaluated 1,802 patients (350 post-hospitalization and 1,452 non-hospitalized) via telehealth or in-person at the CCC between May 2020 and February 2022. Patients were seen in 2,361 initial visits in 12 specialty clinics including neurology, pulmonology, cardiology, otolaryngology, gastroenterology, infectious diseases, endocrinology, nephrology, hematology, dermatology, psychiatry and rheumatology. Patients most commonly sought treatment from neurology (49%), pulmonology (25%) and cardiology (12%) specialists.

Among patients tested:

–        85% of patients reported decreased quality of life

–        51% had cognitive impairment

–        45% had altered lung function

–        83% had abnormal CT chest scans

–        12% had elevated heart rate on rhythm monitoring

–        Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19

–        Non-hospitalized patients with positive COVID-19 testing had similar findings than those with negative or no test results

DEMOGRAPHICS

–        65% of patients identified as female

–        Average age at first clinic visit was 47 years old

–        72% were White, 10% were Black, 4% were Asian and 13% were Hispanic

Publication Date: 13 Jul 2023

Publication Site: Northwestern Medical

$50 Billion in Opioid Settlement Cash Is on the Way. We’re Tracking How It’s Spent.

Mary Pat Campbell

Link: https://kffhealthnews.org/news/article/opioid-drugmakers-settlement-funds-50-billion-dollars-khn-investigation-payback/

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More than $50 billion in settlement funds is being delivered to thousands of state and local governments from companies accused of flooding their communities with opioid painkillers that have left millions addicted or dead.

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Most of the settlements stipulate that states must spend at least 85% of the money they will receive over the next 15 years on addiction treatment and prevention. But defining those concepts depends on stakeholders’ views — and state politics. To some, it might mean opening more treatment sites. To others, buying police cruisers.

….

What’s more, many states are not being transparent about where the funds are going and who will benefit. An investigation by KHN and Christine Minhee, founder of OpioidSettlementTracker.com, concluded only 12 states have committed to detailed public reporting of all their spending.

The analysis involved scouring hundreds of legal documents, laws, and public statements to determine how each state is divvying up its settlement money among state agencies, city and county governments, and councils that oversee dedicated trusts. The next step was to determine the level and detail of public reporting required. The finding: Few states promise to report in ways that are accessible to the average person, and many are silent on the issue of transparency altogether.

More than $3 billion has gone out to state and local governments so far. KHN will be following how that cash — and the billions set to arrive in coming years — is used.

Author(s): Aneri Pattani

Publication Date: 30 March 2023

Publication Site: Kaiser Health News

Batch-dependent safety of the BNT162b2 mRNA COVID-19 vaccine

Mary Pat Campbell

Link: https://onlinelibrary.wiley.com/doi/full/10.1111/eci.13998

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Vaccination has been widely implemented for mitigation of coronavirus disease-2019 (Covid-19), and by 11 November 2022, 701 million doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) had been administered and linked with 971,021 reports of suspected adverse effects (SAEs) in the European Union/European Economic Area (EU/EEA).1 Vaccine vials with individual doses are supplied in batches with stringent quality control to ensure batch and dose uniformity.2 Clinical data on individual vaccine batch levels have not been reported and batch-dependent variation in the clinical efficacy and safety of authorized vaccines would appear to be highly unlikely. However, not least in view of the emergency use market authorization and rapid implementation of large-scale vaccination programs, the possibility of batch-dependent variation appears worthy of investigation. We therefore examined rates of SAEs between different BNT162b2 vaccine batches administered in Denmark (population 5.8 million) from 27 December 2020 to 11 January 2022.

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A total of 7,835,280 doses were administered to 3,748,215 persons with the use of 52 different BNT162b2 vaccine batches (2340–814,320 doses per batch) and 43,496 SAEs were registered in 13,635 persons, equaling 3.19 ± 0.03 (mean ± SEM) SAEs per person. In each person, individual SAEs were associated with vaccine doses from 1.531 ± 0.004 batches resulting in a total of 66,587 SAEs distributed between the 52 batches. Batch labels were incompletely registered or missing for 7.11% of SAEs, leaving 61,847 batch-identifiable SAEs for further analysis of which 14,509 (23.5%) were classified as severe SAEs and 579 (0.9%) were SAE-related deaths. Unexpectedly, rates of SAEs per 1000 doses varied considerably between vaccine batches with 2.32 (0.09–3.59) (median [interquartile range]) SAEs per 1000 doses, and significant heterogeneity (p < .0001) was observed in the relationship between numbers of SAEs per 1000 doses and numbers of doses in the individual batches. Three predominant trendlines were discerned, with noticeable lower SAE rates in larger vaccine batches and additional batch-dependent heterogeneity in the distribution of SAE seriousness between the batches representing the three trendlines (Figure 1). Compared to the rates of all SAEs, serious SAEs and SAE-related deaths per 1.000 doses were much less frequent and numbers of these SAEs per 1000 doses displayed considerably greater variability between batches, with lesser separation between the three trendlines (not shown).

Author(s): Max Schmeling, Vibeke Manniche, Peter Riis Hansen

Publication Date: 30 Mar 2023

Publication Site: European Journal of Clinical Investigation

GUN VIOLENCE ARCHIVE

Mary Pat Campbell

Link: https://www.gunviolencearchive.org/

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PUBLISHED DATE: April 20, 2023

Gun violence  and crime incidents are collected/validated from 7,500 sources daily – Incident Reports and their source data are found at the gunviolencearchive.org website.

Footnotes

  1. Number of source verified deaths and injuries
  2. Number of INCIDENTS reported and verified
  3. Calculation based on CDC Suicide Data
  4. Actual total of all non-suicide deaths plus daily calculated suicide deaths

All numbers are subject to change or incidents recategorized as new evidence is established and verified.

METHODOLOGY & DEFINITIONS AVAILABLE AT:
https://www.gunviolencearchive.org/methodology

www.gunviolencearchive.org
www.facebook.com/gunviolencearchive
On Twitter @gundeaths

Publication Date: accessed 20 April 2023

Publication Site: Gun Violence Archive

Obesity in Asia

Mary Pat Campbell

Link: https://www.genre.com/knowledge/publications/2023/april/ri23-1-en

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Figure 2 shows the incidence of cardiovascular disease and stroke in the male population.

This was derived from Gen Re’s Dread Disease experience study covering the period 2012–2015 and 2015–2019 for Hong Kong, Singapore and Malaysia. As per the analysis from the leading insurance companies of the respective market, 43% of men in Singapore, 40% of men in Malaysia and 26% of men in Hong Kong had critical illness claims due to cardiovascular disease and stroke between 2015 and 2019. When compared with the 2012–2015 analysis, it was noted that there is an increase in claims by 3% in Singapore, 10% in Malaysia and 1% points in Hong Kong, which may be associated with overweight and obesity or simply an older portfolio.

Due to increases in body weight and medical complications, insurance companies may be confronted with increasing claims which will impact their profitability. To mitigate this cost, insurance companies may have to increase the premium so as to commensurate with this rising claim cost. This increase in price will impact on the healthy population.

Health insurance premium has doubled in the past 10 years, but it is unclear how much of this premium is sufficient to cover the financial burden of the obesity pandemic. The evaluation of existing and developing new health coverages related to obesity-related conditions is an important consideration for the profitability of the health insurance providers.14

Author(s): Bharath UP

Publication Date: 12 April 2023

Publication Site: Gen Re