Texas

More on Inappropriate Colonoscopy.

Posted by

0


One in five screening colonoscopies performed in Medicare patients aged 70 was considered potentially inappropriate, but study design limitations might have introduced error.

Previous studies suggest that a significant number of physicians systematically perform screening colonoscopies at 5-year versus recommended 10-year intervals and that many colonoscopists recommend that surveillance colonoscopy after resection of polyps begin earlier than is accepted in guidelines.

Now, investigators have retrospectively assessed the receipt of inappropriate screening colonoscopy in Medicare beneficiaries who had received a recent colonoscopy (index colonoscopy), including a 100% sample in Texas and a 5% sample in the U.S. Screening colonoscopy was distinguished from diagnostic colonoscopy by the absence of a relevant diagnostic indication on the index colonoscopy claim or on any claim 3 months before the procedure. Early repeated colonoscopy was defined as an index colonoscopy with no diagnostic indications preceded by a colonoscopy within 10 years that had negative findings (based on the last colonoscopy if >1). An inappropriate colonoscopy was defined as an early repeated colonoscopy in patients aged 70 to 75, a routine screening colonoscopy in patients aged 76 to 85, or any screening colonoscopy in patients aged >85.

In Texas beneficiaries, 23.4% of colonoscopies were potentially inappropriate, with variation by age group (70–75, 10%; 76–85, 39%; >85, 25%). Procedure-level factors associated with increased risk for inappropriate colonoscopy were location of ambulatory surgery center or office setting (vs. a hospital) and performance by higher-volume colonoscopists (vs. lower-volume), generalists or surgeons (vs. gastroenterologists), or U.S.- trained physicians (vs. non–U.S.-trained physicians). Patient-level risk factors were male gender, white race, fewer comorbid conditions, lower educational level, and residence in an urban area. Six percent of the variance in whether a colonoscopy was potentially inappropriate was explained by the physician variable.

Comment: This study has several limitations. First, not all doctors accept USPSTF age recommendations for screening colonoscopy; many find them to be arbitrary and prefer use of the previous recommendation to stop screening when life expectancy is <10 years. Second, guidelines for postpolypectomy surveillance include consideration of findings not only from the last colonoscopy but from previous colonoscopies. For example, in patients with high-risk adenoma findings, surveillance colonoscopy is recommended at 5-year intervals even after a negative examination. These repeat examinations would have been considered inappropriate in this study. Finally, it is unclear whether the investigators were fully able to account for postpolypectomy surveillance colonoscopies, to which even the USPSTF did not apply their age recommendations.

This study will undoubtedly be cited as evidence of inappropriate colonoscopy. However, the use of claims data to identify indications for colonoscopy is fraught with problems. The absolute rates of inappropriate colonoscopy could be significantly lower than shown here, and not all of the observed trends may reflect real differences in inappropriate use.

Source: Journal Watch Gastroenterology

About a Quarter of Screening Colonoscopies in U.S. Elderly Seem Inappropriate.

Posted by

0


Roughly 25% of screening colonoscopies done among the elderly may be inappropriate, according to a JAMA Internal Medicine study of Medicare data.

Researchers examined claims data on some 75,000 Texas Medicare recipients aged 70 or older who underwent complete colonoscopy in a 1-year period starting in 2008. Procedures that were repeated early without a clear indication, or those that were done contrary to published guidelines with regard to age, were considered possibly inappropriate. In addition, a 5% national Medicare sample was also examined.

Overall, 23.4% of the cohort were found to have undergone a potentially inappropriate procedure. There was marked variation geographically both within Texas and the U.S., as well as among colonoscopists, some of whom had rates of potentially inappropriate colonoscopies above 45% (they tended to be surgeons and graduates of U.S. medical schools).

Source: JAMA

Multidrug-Resistant TB a Concern Along U.S.-Mexico Border.

Posted by

0


 

The Wall Street Journal tracks the increase in tuberculosis cases along the U.S.-Mexico border and highlights concerns about the possibility of a drug-resistant TB outbreak.

The MDR-TB rates are still quite low compared to other nations — Mexico had 467 MDR-TB cases in 2011, and the U.S. had 124. Nearly half of the U.S. cases were in California and Texas. In San Diego, the overall TB rate is about twice the national average. Meanwhile, Los Angeles is currently trying to control its worst TB outbreak in a decade.

The article details the challenges presented by a relatively porous border, nonadherence to treatment, reduced funding, and drug-related violence.

Source: Wall Street Journal 

 

 

A New Study Says We Can’t Prevent Most Preterm Births, So What Now?

Posted by

0


When Kate McCasland came into this world early almost 18 years ago, there was no global movement to reduce deaths of preterm babies. And the staff at the Texas hospital where she was born had never before tried the simple technique that her mom believes saved her life. But Saturday’s World Prematurity Day is all about getting that same technique and other high-impact care to the millions of preterm babies who need it most.

A new study out in The Lancet today makes it clear that training and equipping health workers to care for preterm babies is the key to saving the 1.1 million such babies who die every year. That’s because we still know very little about how to prevent babies from being born too soon. A distinguished research team led by Save the Children has found that even if the United States and other high-income countries did everything science currently tells us could help, the vast majority of these early births — 95 percent — would continue.

In contrast, good care at birth allows us to save 99 percent of the half-million preterm babies born in this country each year. And even in communities around the world where high-tech intensive care is not realistic and where most preterm deaths occur, low-tech, low-cost care could save 75 percent of these young lives. Now is the time to get that proven-effective, lifesaving care to the babies who will die without it.

Back to Kate in Texas. The simple technique that helped her could, by itself, save the lives of 450,000 preterm babies born in developing countries every year. In an interesting twist, Kate’s mom, Jane McCasland, actually learned about Kangaroo Mother Care one sleepless night while watching a late-night TV documentary set in Africa. Jane’s mind raced as she saw how the mother on TV was able to help her tiny baby survive by keeping the shirtless baby wrapped to her own bare skin.

When incubators are not an option, this technique gives tiny babies the warmth their own bodies have to fight so hard to produce. It also promotes breastfeeding, another proven lifesaver. But as Jane was to find out, there were less quantifiable benefits, too.

The next day she told the staff at the Harris Methodist Fort Worth Hospital that she wanted to try the kangaroo method, only to be told that the doctors thought Jane was too small to even try. But one night soon after, a trusted nurse came to Jane and told her that Kate was having a rough night in the incubator and that her heart rate was up above 200. “Now’s the time,” she told Jane.

“I have a feeling she was totally defying some doctor’s orders,” Jane recounts today. “But a mom holding her baby, it’s the most natural thing in the world. Her heartbeat dropped, and within about three minutes she was sound asleep. She gained an ounce that very night. When you’re talking about a baby who weighs 1 pound 7, that’s a lot.”

Jane believes her daughter survived thanks to Kangaroo Mother Care, “one gutsy nurse” and the medical team who quickly supported the method once they saw how effective it was. They learned from Kate’s case, applied that to helping other babies and eventually put the picture you see above on hospital literature promoting their use of Kangaroo Mother Care.

Jane brought Kate home on what should have been her due date, nearly four months after her birth. Now a high school senior, a driven and passionate Kate has become an advocate for newborn health around Texas and around the world. And she’s decided that she wants to become a neonatal nurse herself. She told her mom that it’s a nice way to say “thank you” to the health workers who saved her life.

Jane couldn’t be prouder of her daughter or more thankful to the team at Harris, so she has nominated them for a REAL Award, a first-of-its kind award initiative designed to honor health workers and their lifesaving work around the world.

“I still look back and think, ‘Oh my gosh, how did she make it?'” Jane says. “There were no egos. It wasn’t about them. It was about getting my daughter home, and you don’t forget people like that.”

This World Prematurity Day, Nov. 17, take a moment to celebrate health workers whose lifesaving work includes making sure babies born too soon are not born to die. Read about the global honorees and nominate an American health worker who has touched your life at www.TheRealAwards.com.

Souce: http://www.huffingtonpost.com

Considering Death Row for Organs.

Posted by

0


Before Gov. John Kitzhaber of Oregon established a moratorium on his state’s death penalty last year, Christian Longo, a death row inmate, started a campaign to allow the condemned to donate their organs.

Mr. Longo argued that a new execution protocol that many states — including Texas — have adopted leaves inmates’ organs viable for transplantation.

“While I can potentially help in saving one life with a kidney donation now, one preplanned execution can additionally save from 6 to 10 more lives,” Mr. Longo wrote in a plea that Oregon officials denied.

No state allows death row inmates to donate their organs. Although Texas recently abandoned a three-drug cocktail in favor of a single-drug method for execution, the Texas Department of Criminal Justice said it did not intend to change its policy. There are 11,000 Texans on the organ transplant waiting list.

Criminal justice and medical experts say that the idea of recovering organs from willing convicted murderers is fraught with moral, ethical and medical challenges that make it unlikely to ever be an option.

“It’s complicated in ways that are very messy and very fuzzy,” said Richard C. Dieter, executive director of the nonprofit Death Penalty Information Center.

The Criminal Justice Department allows offenders in the general prison population to donate organs, like kidneys, while they are alive in certain cases and after death if they complete a donor form.

The prospect of death row organ donation, though, prompts several questions, said Dr. David Orentlicher, a co-director of the Hall Center for Law and Health at Indiana University’s Robert H. McKinney School of Law. Is an inmate giving free and informed consent, or is he hoping to win favorable treatment? Would a donation affect jurors in murder cases who are weighing the death penalty versus life sentences? Or prosecutors deciding whether to seek the death penalty? Or governors deciding whether to grant clemency?

There is also the possibility that allowing death row organ donation could lead jurors to issue more death sentences, Dr. Orentlicher said.

For prospective recipients, there are emotional and mental considerations, he added.

“People might say, ‘Gosh, I’m walking around with the organ of a murderer,’ ” he said. “It may be irrational, but I suspect that’s lurking there.”

The condemned have a high risk of carrying diseases like hepatitis and H.I.V. And conditions in the death chamber are not conducive to organ recovery, said Mike Rosson, regional director of the Texas Organ Sharing Alliance. To keep organs viable, they must have oxygen after the brain dies, which means the donor must be on a ventilator, and surgery must be done quickly.

“You don’t have the facility for recovery, and you have transplant surgeons whose oath is to do no harm,” Mr. Rosson said. “The situation is just ethically challenging.”

Even if all the moral, ethical and medical questions could be adequately addressed, he said, the yield of usable organs from death row inmates is likely to be small.

“I think there are avenues other than prisoners that the effort expended toward trying to increase donation would be better spent,” Mr. Rosson said.

Source: NY Times.

West Nile virus death toll in US jumps by a third.

Posted by

0


The death toll from US cases of West Nile virus, which has killed scores of people, has risen by nearly a third in a week, according to health officials.

Eighty-seven people have now died from the mosquito-borne illness, up from 66 the week before, said the Centers for Disease Control and Prevention (CDC).

The number of cases in 2012 has meanwhile risen by a quarter in the last week, to 1,993 from 1,590.

It is the largest outbreak since the virus first appeared in the US in 1999.

At least 40 of the deaths have been in Texas, the state’s health department said on Wednesday.

Texas has also recorded at least 495 cases of the most serious, neuro-invasive form of the illness.

West Nile virus peaked in 2002 and 2003, when severe cases of the disease reached nearly 3,000.

Only about one in five people infected with West Nile gets sick, and one in 150 of those will develop severe symptoms, including neck stiffness, disorientation, coma and paralysis.

This year there have been reports of the virus in 47 states, although about 75% of the cases are from five states: Texas, Mississippi, Louisiana, South Dakota and Oklahoma.

Health officials think a mild winter and early spring fostered the breeding of mosquitoes that bite infected birds.

  • Source: BBC.

 

 

Mysterious Louisiana Sinkhole Raises Concerns of Explosions and Radiation.

Posted by

0


A nearly 400-foot deep sinkhole in Louisiana has swallowed all of the trees in its area and enacted a mandatory evacuation order for about 150 residences for fear of potential radiation and explosions.

The 400-square-foot gaping hole is in Assumption Parish, La., about 50 miles south of Baton Rouge.

The sinkhole sits in the middle of a heavily wooded space where it has consumed all of the soaring cypress trees that had been there. Flyover photos show some of the treetops still visible through the mud.

Authorities enacted a mandatory evacuation for between 100 and150 homes in the area, but most people have chosen to stay, according to the Mayor’s Office of Emergency Preparedness. If any of the dangers seem to become more imminent, the order will be escalated to a forced evacuation.

While officials are not certain what caused the massive sinkhole, they believe it may be have ben caused by a nearby salt cavern owned by the Texas Brine Company.

After being used for nearly 30 years, the cavern was plugged in 2011 and officials believe the integrity of the cavern may have somehow been compromised, leading to the sinkhole.

On Thursday, Louisiana’s Department of Natural Resources required that Texas Brine drill a well to investigate the salt cavern as soon as possible, obtain samples from the cavern and provide daily reports on their findings. It could take up to 10 days to set up the drilling process, even with an expedited process.

“We have to arrange for the driller. We have to pick a location. We have to be very careful to not be in a point that’s too close to the sinkhole because of the weight of the rig,” Texas Brine Company spokesman Sonny Cranch told ABCNews.com today. “We don’t want to aggravate the situation.”

The sinkhole is on the outside edge of the salt dome where this particular brine well is located.

“There are some indications that it very well may have been connected, but there’s just indications,” Cranch said. “There’s nothing concrete that has connected the sinkhole to the cavern.”

There was bubbling in the water and the sinkhole is near areas where there has been exploration for oil and gas in the past, which would make the presence of low levels of naturally occurring radioactive material (NORM) possible.

The state’s Department of Environmental Quality said water samples from the sinkhole showed oil and diesel on its surface, but initial readings did not detect radiation.

In the days after the sinkhole opened up on Aug. 3, nearby Highway 70 was closed down because officials discovered that the sinkhole caused a 36-inch natural gas pipeline to bend and feared the possibility of an explosion, according to ABC News’ Baton Rouge affiliate WBRZ.

“That’s why the mandatory evacuation is going to stay on, because there is a risk for explosion,” John Boudreaux of from Assumption Parish Emergency Preparedness said at a meeting with residents on Tuesday, WBRZ reported.

“We are determined to do everything we can to find the answer,” president of Texas Brine Mark Cartwright told the residents.

Some community members were visibly frustrated with the situation and lack of answers.

“You can give us a straight answer because that’s all we want,” one woman said at the meeting. “We want to know when we can come home and be safe. Because you all go home after a days work. You’re safe, but we’re not.”

Gov. Bobby Jindal issued a declaration of emergency allowing the Governor’s Office of Homeland Security to assist in the efforts if necessary.

“This is extremely serious and it’s been going on for too long to still be at this point,” Kim Torres, spokeswoman for the Office of Emergency Preparedness, told ABCNews.com today. “The people are very aware of how serious this is.”

Source: Yahoo News

CDC Seeing More West Nile Virus Disease .

Posted by

0


West Nile virus appears to be making a comeback this year, the CDC reports. So far, the agency has received reports of 241 cases of West Nile virus disease, including 4 deaths.

Nearly 80% of the cases were from Texas, Mississippi, and Oklahoma, but infections in people, birds, or mosquitoes have been reported in 42 states.

This is the highest number of cases for this time of year since 2004. The number of infections typically peaks in August. CDC officials say it is not clear why there is more activity this year.

Source: CDC news