We, the community of physicians, had been watching these patients die and trundling them off to the morgue for years.— Dr. Barry Farr, former president, Society for Healthcare Epidemiology of America
Tag Archives: Public Health
Could It Be Sepsis? C.D.C. Wants More People to Ask
Between one million and three million Americans are given diagnoses of sepsis each year, and 15 percent to 30 percent of them will die, Dr. Frieden said. Sepsis most commonly affects people over 65, but children are also susceptible. According to one estimate, more than 42,000 children develop sepsis in the United States every year, and 4,400 die.
Sepsis develops when the body mounts an overwhelming attack against an infection that can cause inflammation in the entire body. When that happens, the body undergoes a cascade of changes, including blood clots and leaky blood vessels that impede blood flow to organs. Blood pressure drops, multiple organs can fail, the heart is affected, and death can result.
“Your body has an army to fight infections,” said Dr. Jim O’Brien, the chairman of Sepsis Alliance. “With sepsis, your body starts suffering from friendly fire.”
Sepsis appears to be rising. The rate of hospitalizations that listed sepsis as the primary illness more than doubled between 2000 and 2008, according to a 2011 C.D.C. study, which attributed the increase to factors like the aging of the population, a rise in antibiotic resistance and, to some extent, better diagnosis.
Sepsis is a contributing factor in up to half of all hospital deaths, but it’s often not listed as the cause of death because it often develops as a complication of another serious underlying disease like cancer. So although death certificates list sepsis as a cause in 146,000 to 159,000 deaths a year, a recent report estimated that it could play a role in as many as 381,000.
Yet advocacy organizations say many Americans have never heard of sepsis and don’t know the signs and symptoms.
‘Superbug’ scourge spreads as U.S. fails to track rising human toll
http://www.reuters.com/investigates/special-report/usa-uncounted-surveillance/
Fifteen years after the U.S. declared drug-resistant infections to be a grave threat, the crisis is only worsening, a Reuters investigation finds, as government agencies remain unwilling or unable to impose reporting requirements on a healthcare industry that often hides the problem.
Zika is an STD: Why are we not calling it one?
Zika is working its way around the United States. It’s spreading across Florida, and is before long expected to reach Texas, Louisiana and other Southern states. It is a dizzying trip, and one that isn’t going to end anytime soon.
The virus spreads from a type of mosquito that has now officially been confirmed to carry Zika in Miami Beach. A massive effort to kill them in South Carolina produced a disaster for the bee population there.
But while mosquitoes are a key menace when it comes to Zika, the media and public officials are too focused on them. They also need to pay attention to sex: If we are going to stop the spread of this disease, we are going to need better access to Zika testing for anyone who is sexually active in a Zika zone.
High-Risk Pools For Uninsurable Individuals
In the debate over the future of the Affordable Care Act (ACA), proposals have emerged that would repeal or weaken rules prohibiting health insurance discrimination based on health status, instead offering high-risk pools as a source of coverage for people who would be uninsurable due to pre-existing conditions.
In Congress, HR 2653 was introduced by members of the House Republican Study Committee to repeal the ACA and replace it with other changes, including state high-risk pools. This bill would authorize $50 million for seed grants to help states establish high-risk pools, and $2.5 billion annually for 10 years to help states fund high-risk pools. Recently, House Republicans released their proposal to replace the ACA, entitled A Better Way. This plan would significantly modify ACA insurance market rules to provide a one-time open enrollment opportunity; thereafter, only individuals who maintain continuous coverage would be guaranteed access to insurance without regard to their health status. This plan also would provide $25 billion over 10 years in state grants to help fund high-risk pools. Pools would be required to cap premiums (at unspecified levels) and would be prohibited from imposing waiting lists.
For more than 35 years, many states operated high-risk pool programs to offer non-group health coverage to uninsurable residents. The federal government also operated a temporary high-risk pool program established under the ACA to provide coverage to people with pre-existing conditions in advance of when broader insurance market changes took effect in 2014. This issue brief reviews the history of these programs to provide context for some of the potential benefits and challenges of a high-risk pool.
Superbug resistant to two last-resort antibiotics found in US for first time
Superbug resistant to two last-resort antibiotics found in US for first time
A strain of E. coli resistant to two last-resort antibiotics has for the first time been reported in the United States.
The strain was found in the urine of a man treated at a New Jersey hospital two years ago. It was tested in 2016 as part of a larger analysis of bacteria from the hospital.
For hard-to-treat bacteria infections, the antibiotics colistin and carbapenem are considered the big guns — a last line of defense when nothing else is working. In recent months mcr-1, a gene which confers resistance to colistin, has been found in E. coli from over 30 countries, including bacteria isolated from pigs and people in China and a patient in New York City.
Similarly the gene blaNDM-5 renders the antibiotic carbapenem useless against its bacterial carrier. In 2012, the Centers for Disease Control and Prevention found carbapenem-resistant bacteria in about 4 percent of US hospitals.
Researchers and health officials have feared the joining of these two genes in a single bacterial strain, as it could set the stage for the rise of superbugs that can’t be treated with our current arsenal of drugs. The combination has been detected before in other countries, including Germany, Venezuela, and China, but until now, it has never been seen within the United States.
CDC: Most Sepsis Cases Start Outside a Hospital
http://www.medpagetoday.com/CriticalCare/Sepsis/59841?xid=fb_o_
Agency launches new campaign to raise blood infection awareness
Fatal Illness Contracted From Bagpipes
http://www.medpagetoday.com/Pulmonology/Pneumonia/59807?xid=fb_o_
Musicians who play wind instruments are at risk for a potentially fatal inflammatory lung condition that is being called “bagpipe lung,” researchers suggested.
Writing in the journal Thorax, British researchers described the case of a 61-year-old bagpipe player who died of the interstitial lung disease hypersensitivity pneumonitis (HP), which appeared to be caused by regularly breathing in mold and fungi which thrived in the moist interior of his musical instruments.
https://tpc.googlesyndication.com/safeframe/1-0-4/js/ext.js
HP is triggered by repeated exposure to airborne bacteria, fungi or molds found in the environment. More than 300 airborne substances have been shown to cause the disease.
Farmers, bird and poultry handlers, veterinary workers, and grain processors have all been previously identified as having an increased risk for the interstitial lung disease. There have also been isolated reports of musicians developing the disorder, including saxophone and trombone players, which resolved when players began routinely cleaning their instruments.
But the case is the first to link specific fungal contamination in a musical instrument to fatal HP.
Cartoon – What do you Think?
Whose Lives Should Be Saved? Researchers Ask the Public
In a church basement in a poor East Baltimore neighborhood, a Johns Hopkins doctor enlisted residents to help answer one of the most fraught questions in public health: When a surge of patients — from a disaster, disease outbreak or terrorist attack — overwhelms hospitals, how should you ration care? Whose lives should be saved first?
For the past several years, Dr. Lee Daugherty Biddison, a critical care physician at Johns Hopkins, and colleagues have led an unusual public debate around Maryland, from Zion Baptist Church in East Baltimore to a wellness center in wealthy Howard County to a hospital on the rural Eastern Shore. Preparing to make recommendations for state officials that could serve as a national model, the researchers heard hundreds of citizens discuss whether a doctor could remove one patient from lifesaving equipment, like a ventilator, to make way for another who might have a better chance of recovering, or take age into consideration in setting priorities.
At that first public forum in 2012 in East Baltimore, Cierra Brown, a former Johns Hopkins Hospital custodian, said she favored a random approach like a lottery. “I don’t think any of us should choose whether a person should live or die,” she said.
Alex Brecht, a youth program developer sitting across from her, said he thought children should be favored over adults. “Just looking at them, seeing their smiles, they have so much potential,” he said.
“Who’s going to raise them?” asked Tiffany Jackson, another participant.
The effort is among the first times, Dr. Daugherty Biddison said, that a state has gathered informed public opinion on these questions before devising policy on them. “I don’t want to be in a position of making these decisions without knowing what you think,” she told the residents. “We as providers,” she said, “don’t want to make those decisions in isolation.”
Rationing already occurs in delivering medical care in the United States, though some practices are little acknowledged. Committees struggle regularly over policies for allocating scarce organs for transplant.
During widespread drug shortages in recent years, doctors have sometimes chosen among cancer patients for proven chemotherapy regimens and among surgical patients for the most effective anesthetics. And doctors sometimes have to choose among patients who need treatment in intensive care units, which are often filled to capacity.
HENRY KOTULA 