Shortages of emergency drugs increase, study

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Vaccine SquareBy Michelle Andrews
Kaiser Health News

At some hospitals, posters on the wall in the emergency department list the drugs that are in short supply or unavailable, along with recommended alternatives.

The low-tech visual aid can save time with critically ill patients, allowing doctors to focus on caring for them rather than doing research on the fly, said Dr. Jesse Pines, a professor of emergency medicine and director of the Office for Clinical Practice Innovation at the George Washington University School of Medicine and Health Sciences, who has studied the problems with shortages.

The need for such workarounds probably won’t end anytime soon. According to a new study, shortages of many drugs that are essential in emergency care have increased in both number and duration in recent years even as shortages for drugs for non-acute or chronic care have eased somewhat.

The shortages have persisted despite a federal law enacted in 2012 that gave the Food and Drug Administration regulatory powers to respond to drug shortages, the study found. Continue reading

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Ovarian cancer mutations found in healthy women, UW study finds

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From the University of Washington

In a study of 36 women – 16 diagnosed with ovarian cancer and a control group of 20 with no cancer diagnosis – nearly all of the women were found to carry cancer-associated gene mutations.

“Cancer mutations are supposed to indicate the presence of cancer. This study suggests that if we sequence deeply enough, we will find cancer mutations in nearly everyone,” said Rosana Risques, a UW assistant professor of pathology, who led the study with Jeff Krimmel, a medical student.

This study suggests that if we sequence deeply enough, we will find cancer mutations in nearly everyone.

The study is a caution for scientists and clinicians trying to detect cancer based on mutations, said Michael Schmitt, a co-author of the study and co-inventor of duplex sequencing. He is an oncology fellow at UW Medicine and Fred Hutch Cancer Research Center.

Among cells stained for the P53 mutation, the brown dots are nuclei of high-grade serous ovarian cancer cells. The blue represents normal Fallopian tube epithelial cells. Photo: Courtesy of Rosana Risques

Among cells stained for the P53 mutation, the brown dots are nuclei of high-grade serous ovarian cancer cells. The blue represents normal Fallopian tube epithelial cells. Photo: Courtesy of Rosana Risques

“Because healthy tissue frequently carries low-frequency cancer-like mutations, we need exquisitely sensitive technologies to accurately define the mutational load and differentiate between truly cancerous changes versus age-associated mutations,” he said.

The study was an early test of the power of DNA duplex sequencing, a technology developed at the University of Washington. Duplex sequencing independently tags molecules along both strands of DNA. In terms of a prospective diagnostic, its accuracy is thought to be unmatched.

This research, marking the technology’s first published application in human cancer detection, was posted online today by the Proceedings of the National Academy of SciencesContinue reading

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Gov. Inslee issues directive aimed at reducing lead exposure

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Washington state Gov. Jay Inslee issued a directive Monday to the state Department of Health (DOH) and partner agencies to assist local communities with lead testing and take steps aimed at reducing lead exposure in Washington.

“While no imminent public emergency has been discovered, recent detections of lead in some water systems are highlighting the important roles our water utilities, schools, public health departments and the state play in ensuring we all have access to safe, clean drinking water,” Inslee said. “This directive will better ensure we’re working in coordination and leveraging resources effectively to tackle lead at all its primary sources, whether it’s water, paint or soil.”

Symptoms_of_lead_poisoning_(raster)

Illustration courtesy of Mikael Häggström via Wikipedia

Inslee’s directive charges DOH and other state agencies to take action to reduce the exposure to lead, not only in drinking water, but also in the state’s infrastructure and places children are proven to be most susceptible to exposure, such as older buildings that may have lead paint. Continue reading

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Even as birth rates fall, teens say they are getting less sex education

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By Michelle Andrews
Kaiser Health News

Teenage girls are catching up to teenage boys in one way that does no one any good: lack of sex education, according to a recent report.

The proportion of teenage girls between the ages of 15 and 19 who were taught about birth control methods declined from 70 to 60 percent over two time periods, from 2006-2010 and 2011-2013, the analysis of federal data found.

Meanwhile, the percentage of teenage boys in the same age group who were taught about birth control also declined, from 61 to 55 percent.

teensexedpressrelease_002

“Historically there’s been a disparity between men and women in the receipt of sex education,” said Isaac Maddow-Zimet, a coauthor of the study and a research associate at the Guttmacher Institute, a reproductive health research and advocacy group. “It’s now narrowing, but in the worst way.”

The study, which was published online in the Journal of Adolescent Health in March, analyzed responses during the two time periods from the Centers for Disease Control and Prevention’s National Survey for Family Growth, a continuous national household survey of women and men between the ages of 15 and 44.

In addition to questions about birth control methods, the study asked teens whether they had received formal instruction at their schools, churches, community centers or elsewhere about sexually transmitted diseases (STDs), how to say no to sex or how to prevent HIV/AIDS.

Overall, 43 percent of teenage girls and 57 percent of teenage boys said in the most recent time frame that they hadn’t received any information about birth control before they had sex for the first time. Continue reading

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Synthetic drugs send states scrambling

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By Sarah Breitenbach
Stateline

626a9a5d49384bf599c632587887dc1a (1)Vials of a confiscated synthetic amphetamine called flakka that killed 61 people in Broward County in a little more than a year. States have been reworking drug laws to make it easier to classify synthetic drugs as illegal.

It’s been four months since anyone in Broward County, Florida, has died from an overdose of alpha-PVP, known as flakka, a crystal-like synthetic drug meant to imitate cocaine or methamphetamine. But the drug has already taken a deadly toll, and left health and law enforcement officials scrambling to stem a new public health crisis.

In small doses, flakka elicits euphoria. But just a little too much sends body temperatures rocketing to 105 degrees, causing a sense of delirium that often leads users to strip down and flee from paranoid hallucinations as their innards, quite literally, melt. If someone survives an overdose, they are often left with kidney failure and a life of dialysis.

Because the drugs were largely unregulated when they first hit the market, some states have struggled to combat them.

Flakka is among a growing number of addictive and dangerous synthetic drugs being produced easily and cheaply with man-made chemicals in clandestine labs in China.

But because the drugs were largely unregulated when they first hit the market, some states have struggled to combat them. Now legislators, health professionals and police are trying to eradicate the drugs by making it easier to qualify them as illegal and ramping up the criminal penalties for selling them.  Continue reading

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Opioid treatment model spawns imitators

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Two white tabletsBy Christine Vestal
Stateline

BALTIMORE — Dr. Kenneth Stoller held court on the sidewalk outside the Broadway Center for Addiction on a sunny afternoon last week, chatting with a troop of lingering patients.

He beamed as he patted a young man on the shoulder and said he’d see him tomorrow.

“It’s important for patients to see this as a place that’s safe and accepting,” he said. “For some, it’s the first place they’ve gotten positive reinforcement in their lives.”

Operated by Johns Hopkins Hospital and located two blocks from its main campus, the Broadway Center — or “911” as it’s called because of its address at 911 N. Broadway — has provided methadone maintenance therapy for people with opioid addiction for more than two decades.

But unlike most of the roughly 1,400 methadone clinics across the country, the Broadway Center offers not only methadone, but the two other federally approved addiction medications, buprenorphine and naltrexone, and a full complement of mandatory addiction counseling and group classes. In most other places, addiction treatment is fragmented, leaving patients to shop around for the care they need or settle for whatever is offered at their local opioid treatment clinic.

Unlike most of the roughly 1,400 methadone clinics across the country, the Broadway Center offers not only methadone, but the two other federally approved addiction medications, buprenorphine and naltrexone, and a full complement of mandatory addiction counseling and group classes.

“If you went to a doctor for any other disease, you’d expect to be offered all available treatment options,” said Dr. David Gastfriend, scientific adviser at the Philadelphia-based Treatment Research Institute, which studies substance abuse treatment. “Addiction treatment should be no different.”  Continue reading

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Why are so few kids getting the HPV vaccine

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9400_loresBy Michael Ollove
Stateline

Ten years after the federal government approved the first vaccines to combat the cancer-causing human papillomavirus, nine years after those vaccines were recommended for all adolescent girls, and five years after they were recommended for all adolescent boys, less than half of girls and only a fifth of boys are getting immunized.

In 2014, only 40 percent of girls ages 13 to 17 have completed the three-vaccine course of HPV immunization. (And just 22 percent of boys.)

Despite state efforts to raise vaccination rates, public health officials say that for a variety of reasons, mainly wariness over the HPV’s association with sex, parents and especially doctors have not embraced the potentially life-saving vaccine.

According to the Centers for Disease Control and Prevention, as of 2014, only 40 percent of girls ages 13 to 17 had completed the three-vaccine course of HPV immunization. (And just 22 percent of boys had done so.)

That’s well short of the 80 percent goal set in 2010 by the federal government in its Healthy People 2020 report, which established health objectives for the nation.

Even states that require HPV inoculation for school admission or mandate that schools teach students about the virus have fallen far short of the federal benchmark.

“We think the rates are dismally low and very alarming,” said Amy Pisani, executive director of Every Child by Two, a nonprofit that aims to reduce instances of vaccine-preventable illnesses. “We clamor and clamor for a vaccine to get rid of these terrible diseases and yet we aren’t implementing them.”

Some states fare significantly worse. In Tennessee, for example, the vaccination rate for girls was 20 percent — the lowest rate in the nation — and 14 percent for boys.

Even the best performing state, Rhode Island, one of only two states plus the District of Columbia that require HPV inoculation for school admission, has rates well below the national goal, with 54 percent of girls and 43 percent of boys receiving all three HPV vaccinations. Continue reading

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Hospital safety software often fails to flag unsafe prescriptions, report

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Photo by Creativity103 under creative commons license.

By Shefali Luthra
Kaiser Health News

Medical errors are estimated to be the third-highest cause of death in the country.

Experts and patient safety advocates are trying to change that.

But at least one of the tools that’s been considered a fix isn’t yet working as well as it should, suggests a report released Thursday.

That’s according to the Leapfrog Group, a nonprofit organization known for rating hospitals on patient safety.

Almost 40 percent of potentially harmful drug orders weren’t flagged as dangerous by the systems.

Leapfrog, working with San Francisco-based Castlight Health, conducted a voluntary survey of almost 1,800 hospitals to determine how many use computerized-physician-order-entry systems to make sure patients are prescribed and receive the correct drugs, and that medications won’t cause harm.

The takeaway? While a vast majority of hospitals surveyed had some kind of computer-based medication system in place, the systems still fall short in catching possible problems.

(Photo by Creativity103 under creative commons license.)
Continue reading

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Will Seattle’s gun tax survive court challenge?

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Mike Coombs, the owner of an outdoor store in Seattle, opposes the city’s gun tax. But city leaders say it will fund medical research on reducing gun violence.

Mike Coombs, the owner of an outdoor store in Seattle, opposes the city’s gun tax. But city leaders say it will fund medical research on reducing gun violence.

By Elaine S. Povich
Stateline

SEATTLE — To Mike Coombs, owner of the Outdoor Emporium, a hunting, fishing and camping store, Seattle’s gun tax is unfair and aimed at driving him out of the city, if not out of business. To Seattle City Councilor Tim Burgess, the tax is a good way to fund medical research on reducing gun violence injuries.

The two represent the opposing poles in the debate over Seattle’s controversial tax on guns and ammunition that took effect Jan. 1 and puts this city at the center of a dispute over whether municipalities can tax firearms to pay for what they see as a public benefit or states alone have the power to regulate and tax guns.

The dispute, which emerged briefly last year in Baltimore and continues in Cook County, Illinois, involves issues such as whether the taxes are designed to suppress gun sales or drive sales out of a city or county, and whether gun violence is a public health issue that justifies taxes on firearms and ammunition to help pay for their consequences in the same fashion as taxes on cigarettes and alcohol.

Here — where the city collects a $25 tax on every gun sale and between 2 cents and a nickel on every round of ammunition, depending on the caliber — Burgess and Coombs are equally wedded to their positions.

The $300,000 to $500,000 that the tax is expected to raise this year is earmarked to fund a study of gunshot victims, including medical and behavioral interventions, by the University of Washington and Harborview Hospital’s trauma center, which treats most of the city’s gunshot victims. Continue reading

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Opioid epidemic spurs rethink on medication and addiction

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Tablet Thumb BlueBy Anna Gorman
Kaiser Health News

Drug treatment providers in California and elsewhere have relied for decades on abstinence and therapy to treat addicts. In recent years, they’ve turned to medication.

Faced with a worsening opiate epidemic and rising numbers of overdose deaths, policymakers are ramping up medication-assisted treatment.

Faced with a worsening opiate epidemic and rising numbers of overdose deaths, policymakers are ramping up medication-assisted treatment.

President Barack Obama last week said he’d allocate more money for states to expand access to the medications. He also proposed that physicians be able to prescribe one of the most effective anti-addiction drugs, buprenorphine, to more patients. Continue reading

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Step it up!

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Step it Up for National Walking Day!

Running shoes full shotWalking is the most common form of physical activity, and its many benefits are well-documented. Six months ago, U.S. Surgeon General Vivek Murthy called on Americans to Step it Up! and be more physically active through walking.

Today, April 6th, is National Walking Day. The Division of Nutrition, Physical Activity, and Obesity encourages you to join us in celebrating this observance by getting up and walking on this day—and then turning that activity into part of a healthy lifestyle.

Don’t know how to get your steps in or feel like you don’t have time? There are many ways to increase walking without making major changes to your routine. Make one of your meetings at work a walking meeting. Park further away from the entrance to your building or the grocery store.  Bond with your family over a walk after dinner. Walk to your terminal at the airport instead of taking the train. Take a few extra laps around the mall while shopping.

Walking can be done in many places and can be fit into busy schedules.

Walking Resources:  

Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities

Walking and Walkability: Approaches to Increase Physical Activity and Improve Health

2016 Bicycling and Walking Benchmarking Report

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Patients’ assessment of their health gaining importance in treatment

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Stethoscope DoctorBy Michelle Andrews
Kaiser Health News

For Erin Moore, keeping her son’s cystic fibrosis in check requires careful monitoring to prevent the thick, sticky mucous his body produces from further damaging his lungs and digestive system.

Moore keeps tabs on 6-year-old Drew’s weight, appetite, exercise and stools every day to see if they stray from his healthy baseline. When he develops a cough, she tracks that, too.

It’s been nearly a year since Drew has been hospitalized; as a baby he was admitted up to four times annually. Erin Moore credits her careful monitoring, aided by an online data tracking tool from a program at Cincinnati Children’s Hospital Medical Center called the Orchestra Project, with helping to keep him healthy.

Clinicians have typically focused more on physical exams, medical tests and biological measures to guide patient care.

Erin Moore, center, tracks the cystic fibrosis symptoms of her 6-year-old son, Drew, far left, using an online data tracking tool from Cincinnati Children’s Hospital Medical Center. (Courtesy of Holly Burkholder Photography)

“Now I have a picture of what health looks like for Drew,” said Moore, 35. “Tools like Orchestra that allow patients to take a more active stance in managing our health are still really undervalued.”

That may be changing, according to a study in the April issue of the journal Health Affairs that examines the movement to incorporate “patient-reported outcomes” into clinical care.

It may seem like a no-brainer to include patients’ assessments of their physical and mental conditions and quality of life into medical care, but such patient-generated data has traditionally been confined to research rather than clinical settings.

Clinicians have typically focused more on physical exams, medical tests and biological measures to guide patient care.

However, as patient-centered medical care has taken hold in recent years, there’s been a growing interest in finding ways to use outcomes reported by individuals to help guide care.

“How are you feeling?” is a pretty standard conversation starter during a doctor’s visit. Continue reading

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Amid public feuds, venerated medical journal finds itself under attack

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New-England-Journal-of-MedicineBy Charles Ornstein
ProPublica.

The New England Journal of Medicine is arguably the best-known and most venerated medical journal in the world. Studies featured in its pages are cited more often, on average, than those of any of its peers. And the careers of young researchers can take off if their work is deemed worthy of appearing in it.

But following a series of well-publicized feuds with prominent medical researchers and former editors of the Journal, some are questioning whether the publication is slipping in relevancy and reputation.

The Journal and its top editor, critics say, have resisted correcting errors and lag behind others in an industry-wide push for more openness in medical research. And dissent has been dismissed with a paternalistic arrogance, they say.

In a widely derided editorial earlier this year, Dr. Jeffrey M. Drazen, the Journal’s editor-in-chief, and a deputy used the term “research parasites” to describe researchers who seek others’ data to analyze or replicate their studies, which many say is a crucial step in the scientific process. And last year, the Journal ran a controversial series saying concerns about conflicts of interest in medicine are oversimplified and overblown.

“They basically have a view that 2026 they don’t need to change or adapt. It’s their way or the highway,” said Dr. Eric Topol, director of the Scripps Translational Science Institute and chief academic officer at Scripps Health in La Jolla, California.

Topol and another cardiologist were called out by Drazen and his co-authors last year after they wrote an opinion piece in The New York Times saying the data behind a groundbreaking study about blood pressure treatment should be made available to doctors right away 2014 not delayed for journal publication.

“Most people are afraid to say anything about the New England Journal because they’re afraid they won’t get something published there,” said Topol, whose last piece appeared in its pages in 2011. “That’s part of this oppression.” Continue reading

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