What We Learned in 2018: Health and Medicine

Developments in medicine and health that we’re still thinking about at year’s end.

We learned many doctors do not disclose financial ties when they publish research.

Dr. José Baselga, a towering figure in the cancer world, resigned from his post at Memorial Sloan Kettering Cancer Center in New York in September. An investigation by The Times and ProPublica had found that he failed to disclose millions of dollars in payments from health care companies in dozens of research articles. But Dr. Baselga wasn’t the only medical researcher who failed to make such disclosures, a problem that is aggravated by confusing advice from medical journals and a failure to adequately vet the contributors to their pages.

We were reminded about how bad the flu can really be.

In the winter of 2017-2018, 80,000 Americans died from the flu. It was the highest number in over a decade, and included 180 young children and teenagers. Some hospitals had to bring out their “surge tents” to treat the overflow of patients. While no flu vaccine is perfect at this time, the shots are particularly effective with children, and the secretary of health and human services, Alex M. Azar II, compared getting vaccinated with wearing your seatbelt. You already do that, don’t you?

We learned that when hospitals combine, patients can end up paying more.

Everywhere in the United States, hospitals are merging. Instead of creating savings that get passed on to consumers, an analysis found that in some regions, the opposite occurred. From 2010 through 2013, the price of an average hospital stay soared, with prices in most areas going up between 11 percent and 54 percent.

We learned how one city has started to turn the corner on the opioids epidemic.

Dayton, Ohio, had one of the highest opioid overdose death rates in the nation. Now, it may be at the leading edge of a waning phase of the epidemic. While the data are preliminary, a variety of factors contributed to the reduction in deaths: Medicaid expansion paying for treatment; dwindling availability of one particular drug; greater use of naloxone, which can reverse overdoses; a large network of recovery support groups; and, law enforcement and public health workers improving their coordination.

We learned that vaping among young people is a growing national problem.

E-cigarettes may help some people quit smoking, but the soaring use of Juul and other vaping devices by teenagers has motivated the Food and Drug Administration to place new limits on the sales of e-cigarette flavors. Schools are grappling with students furtively vaping, as teenagers who may never have smoked a cigarette find themselves struggling to shake a new addiction to nicotine.

We learned the disease may no longer be “a lifelong thing,” as one patient put it.

People with hemophilia, the inability to form blood clots, spend their lives menaced by the prospect of uncontrolled bleeding into a muscle or joint, or even the brain. Experimental gene therapy treatments have rid a few patients — for now, at least — of the condition. It does not yet amount to a cure, and the treatment is imperfect. But some who received the treatments are finding themselves uneasily adjusting to a life with new freedoms.

We learned untreated strep throat leads to heart failure in poor countries.

In the United States and other rich countries, cheap antibiotics cure children with strep throat easily. But in poor countries, strep can result in rheumatic heart disease and a long, slow death sentence. In Rwanda, doctors from a group called Team Heart visit once a year to perform heart valve-replacement surgery for 16 people. But there are thousands more people who need the procedure in a country that has no heart surgeons.

We learned how public health research can be compromised by private interests.

In June, the National Institutes of Health shut down a study of the effects of moderate drinking on heart attacks and stroke, following an investigation by The Times. The researchers who proposed the study sought funding from beer and liquor companies, and suggested that the results would support a daily drink as a healthy choice. The N.I.H.’s director, Dr. Francis Collins, said the trial seemed to be “set up in a way that would maximize the chances of showing a positive effect of alcohol.”

 

 

 

 

4 in 10 healthcare professionals work when they’re sick, risking patients

http://www.healthcarefinancenews.com/news/4-10-healthcare-professionals-work-when-theyre-sick-risking-patients?mkt_tok=eyJpIjoiWVdWa1lXTTBORFJpWTJSayIsInQiOiJndXNTdWM2czNvZzR6dDlRVXA4N3ZZWUhiV29FTzZ4VndOT3VGeUkzSGtGcms1QnlhSnNRTTlQbGRmcmY5UEpEY2VuWWg1UHIwTXVQUkg1ZklLZGN6SGYxMmpwc3lmZGJtK1pBcTNDNnZZZ0FmYzQ3Q2R2YWloNjVJSlorWStcL3QifQ%3D%3D

 

Patients who are exposed to a sick healthcare worker are five times more likely to get a healthcare-associated infection.

A new study suggests that healthcare professionals should heed their own advice: Stay home when sick.

Some four in 10 healthcare professionals work while experiencing influenza-like illness, according to findings published in the November issue of the American Journal of Infection Control, the journal of the Association for Professionals in Infection Control and Epidemiology.

As in all workplaces, contagious employees risk infecting others when they turn up for work. But with higher concentrations of older patients and individuals with immunosuppression or severe chronic diseases in healthcare facilities, flu-like transmission by healthcare workers naturally presents a public health hazard.

The research pointed to an earlier study showing that patients who are exposed to a sick healthcare worker are five times more likely to get a healthcare-associated infection.

The annual study, conducted via a national online survey, collected data from from 1,914 professionals during the 2014-2015 flu season. Respondents self-reported influenza-like illness, defined as the combination of a fever and cough or sore throat, and listed factors that prompted them to turn up for work.

The survey assessed a variety of health occupations across multiple institutions: physicians; nurse practitioners and physician assistants; nurses; pharmacists; assistants/aides; other clinical pros; nonclinical pros; and students. Four types of work settings were assessed: hospitals, ambulatory care or physician offices, long-term care facilities and other clinical settings.

Of the 1,914 professionals surveyed, 414 reported flu-like illness. Of these, 183 — or 41.4 percent — reported working for a median duration of three days while experiencing flu-like symptoms.

Hospital-based healthcare professionals had the highest frequency of working with flu-like illnesses (49.3 percent), compared to those at long-term care facilities (28.5 percent). Clinical professional healthcare workers were the most likely to work with the flu (44.3 percent), with pharmacists (67.2 percent) and physicians (63.2 percent) among those with the highest frequency.

The survey found that assistants and aides (40.8 percent), nonclinical workers (40.4 percent), nurse practitioners/physician assistants (37.9 percent), and other clinical workers (32.1 percent) worked while sick.

The most common reasons for healthcare professionals to opt from taking sick leave included feeling that they could still perform their job duties; not feeling “bad enough” to stay home; feeling as if they were not contagious; sensing a professional obligation to be present for coworkers; and difficulty finding a coworker to cover for them. Among the workers who felt they could still perform their job duties, 39 percent sought medical attention for their symptoms, as did 54 percent of those who didn’t think they were contagious. Almost 50 percent of workers in long-term care settings who reported for work when sick reported doing so because they couldn’t afford to lose the pay.

Healthcare professionals with self-reported flu symptoms missed a median number of two work days. Of those, 57.3 percent visited a medical provider for symptom relief; 25.2 percent were told they had influenza. The Centers for Disease Control and Prevention recommends that anyone with such symptoms wait 24-hours after a fever breaks before returning to work.

Previously published results from the survey showed that only 77.3 percent of respondents reported getting a flu shot.

Saint Vincent Hospital sued for firing six employees who refused flu shots

http://www.beckershospitalreview.com/legal-regulatory-issues/saint-vincent-hospital-sued-for-firing-six-employees-who-refused-flu-shots.html

Image result for courtroom flu shot

The Equal Employment Opportunity Commission is accusing Erie, Pa.-based Saint Vincent Hospital of religious discrimination, reports Erie Times-News.

The commission filed a lawsuit Thursday in U.S. District Court in Erie, alleging Saint Vincent fired six employees who refused to get flu shots due to their religious beliefs, according to the article. At the same time, the group contends, the hospital granted medical exemptions to 14 other employees in late 2013 and early 2014, according to the article.

The commission claims the hospital violated Title VII of the Civil Rights Act of 1964.

Saint Vincent officials said in a statement obtained by Erie Times-News that the hospital’s “mandatory flu vaccination policy allows employees to apply for an exemption to the policy based upon religious beliefs or health concerns. Requests for exemption are always given careful and appropriate consideration. We respectfully disagree with the (commission’s) position and characterization of how the employee claims outlined in this lawsuit were handled by the hospital.”

According to the report, the commission previously attempted to reach a settlement with Saint Vincent, which is now part of Pittsburgh-based Allegheny Health Network.

Are Masks a Good Alternative to Flu Shots for Healthcare Workers?

http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/54905

At some hospitals, it’s vaccinate or be fired