Posts Tagged ‘medicine’

REPOST: In a Culture of Disrespect, Patients Lose Out

In this recent entry on the New York Times wellness blog, Dr. Danielle Ofri points out some problems in the culture of medicine that lead to the poor treatment of patients. Read the full story below:

I’ve always thought about respect as common decency, something we should do because it’s simply the right thing to do. In the medical world, we certainly need to strive for respectful behavior, especially given our historically rigid pecking order, our ingrained traditions of hierarchical bullying and, of course, a primary constituency — patients — who are often on uniquely vulnerable footing.

But then I stumbled across two articles in Academic Medicine that talked about respect as an issue of patient safety. The authors, a group of doctors and researchers at Harvard Medical School, outlined the myriad acts of disrespect that we’ve come to accept as a way of life in medicine, and showed how these can lead to a final pathway of harm to our patients.

This shift in perspective was a shock to the system. When we tolerate a culture of disrespect, we aren’t just being insensitive, or obtuse, or lazy, or enabling. We’re in fact violating the first commandment of medicine. How can we stand idly by when our casual acceptance of disrespect is causing the same harm to our patients as medication errors, surgical mistakes, handoff lapses and missed lab results?

At one end of the spectrum are the examples of disrespectful behavior, like the volatile doctor everyone knows to steer clear of. Then there are the sadly common abuses of hierarchy — the doctor denigrating a nurse, the medical student treated like disposable goods.

Beyond these are the even more widespread passive types of disrespect, the behaviors that don’t ever get reported and are hardly noticed because they are so ingrained in the culture of medicine. Dismissive attitudes — toward other members of the medical team, toward students, toward administrators, toward patients — are as corrosive as outward manifestations of disrespect.

“Lack of respect poisons the well of collegiality and cooperation,” the authors of the articles wrote. The poisoning-of-the-well metaphor is apt. Like pornography, we know it when we see it. Ask a nurse or an intern or a medical student, and they can tell you with pinpoint accuracy which areas of the hospital are toxic to work in, and which are not. Now think of the patients who have the misfortune to be stuck in one of those toxic areas. It’s not just unpalatable; it’s unsafe.

Doctors have to take a good deal of the blame. For better or worse, we often set the tone in a medical enterprise. When we show, or tolerate, even subtle disrespect, it works its way all along the chain.

Luckily, the reverse is true. Having had the privilege of working under some of the most humane and respectful doctors, I have witnessed how everyday acts of decency and humility generate positive cascading effects toward other staff members and toward patients. Rising tides, in this case, can indeed lift all boats.

But these articles also make the point that disrespect comes from the medical system itself. When a hospital cuts its nursing staff to the bone, for example, it’s doing much more than cutting costs. It’s sending the message that nurses are interchangeable widgets whose productivity can be dialed up or down like household appliances.

This subtle disrespect can be seen in many areas: Overbooking doctors’ schedules. Piling on paperwork. Squeezing in additional responsibilities. Requiring ceaseless “compliance courses” that must be completed on personal time. The system functions because most medical professionals generally do what’s required of them to make it all work.

Though these annoyances may seem trivial, this lack of respect “undermines morale, and inhibits transparency and feedback,” the authors write. Morale, transparency and feedback are pillars of preventing medical error. Patients ultimately bear the brunt of this unhealthy atmosphere.

The solutions to a disrespectful environment are wide-ranging, and there’s no doubt that personal example, starting from the top of the hierarchy, is a powerful agent of change. Expectations of professional conduct need to be applied equally, without exemptions for the well-connected or the powerful. Confidential reporting systems for unprofessional behavior are crucial and need to be available to staff members as well as to patients and families.

Added to the clarion call should be patient safety. The connection between disrespectful behavior to patient safety should be made explicit in our efforts, since this is a rallying point that everyone can agree on. Medical staff members should absolutely be holding ourselves to the highest bar of professional and respectful conduct. We have no excuses for anything less. But beyond this, the medical system needs to re-evaluate itself and the way it respects — or disrespects — its own workers, and by extension, its patients.

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The effects of depression on risks of stroke in young women

In a statement on its journal Stroke, the American Heart Association revealed that the costs of stroke treatment are likely to increase by 20% by 2013. This projection is a worrisome one, especially for the 45 to 64-year-old demographic, which is considered to be at highest risk of suffering from a stroke.



Among this demographic, those suffering from depression are known to have higher risks of stroke. Meanwhile, a new study now suggests that the association is even stronger in younger women.

A study conducted by Australian researchers tracked about 10,500 women with the average age of 52 and without a history of stroke. The women were surveyed every three years for 12 years, and it was found that about 24 percent were depressed at each survey.



The researchers found that depression almost doubled the risk for stroke, even when factors like age, education, blood pressure, heart disease, alcohol intake, physical activity, smoking, diabetes, and body mass index were accounted for. A previous study on the same subject found that the risk was increased by 30 percent, although the average age in the 2011 study was 14 years older. Additionally, there are studies that found no increased risk in people over 65.

The study is considered as merely an addition to the growing body of knowledge on the effect of depression on the risks of certain diseases on people. Larger studies are needed to determine whether depression truly does nearly double the risks in younger women.



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Incontinence and inebriation: What really happens after weight loss surgery

When diet and exercise no longer do the job, people resign to the idea of losing weight by going under the knife. In the US, 35.7 percent of adults are said to be obese. This huge percentile gives people an idea on why bariatric surgery is considered as one of the most famous surgical procedures of all time, despite its downturn in numbers in the past few years.


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Bariatric surgery is considered a standard procedure in various medical institutions and is one of the elective medical procedures commonly considered under an insurance plan. Commonly known as weight loss surgery, it is designed to help people lose weight – be it for aesthetic purposes or health considerations. The process involves the reduction of the stomach’s size by inserting a special medical device inside the body or by removing a portion of it.

To date, many speculations and studies have been made on the effects of bariatric surgery. Recently, the news about weather forecaster Al Roker’s embarrassing incident at the White House made headlines. Roker’s personal experience is one of the most common things that happen to people who underwent weight loss surgery.


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Fecal and urine incontinence is common among obese people, especially those who are in the critical stages of obesity. The National Institutes of Health asserts that bariatric surgery reduces the severity of urine incontinence, but the same effect doesn’t apply to fecal incontinence for some unknown reason. In fact, studies show that over 50 percent of those who have undergone this surgery observed that their fecal incontinence worsened.

Aside from experiencing fecal incontinence, people who underwent weight loss surgery consume more alcohol two years after their procedure, as reported by Reuters. The report furthers that it may have something to do with the effect of the resized stomach on alcohol tolerance. Another possible reason is that people may find themselves substituting drinks for food. This effect of the surgery is still under clinical observations and is subject to in-depth studies. However, people who had weight loss surgery are advised to monitor their alcohol intake, and consult with their doctor if there is a change in their drinking habits.


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Satori World Medical is affiliated with the best hospitals all over the world that offer different medical procedures, including bariatric surgery. Its website lists the other treatments its International Centers of Excellence provide.

Breath test could detect colorectal cancer

Discover the breakthrough in the field of medicine that deals with detecting colorectal cancer from this news article.




The death rate for colorectal cancer has been dropping for more than 20 years, thanks in part to improved screening methods, according to the American Cancer Society. Yet it is still the second-leading cause of cancer-related deaths for men and women combined in the United States.

Colonoscopy screenings can prevent about two-thirds of colorectal cancers from developing by detecting precancerous polyps, said Dr. Ted Gansler, director of medical content for ACS. The ACS recommends men and women over the age of 50 should have a colonoscopy once every 10 years or a yearly fecal blood test.

“Unfortunately, only about half of people age 50 and older in the U.S. are up-to-date on their testing for colorectal cancer,” Gansler said.

Dr. Donato Altomare and his colleagues hope to change that. The researchers have completed a small clinical trial on a breath test that screens for colorectal cancer using volatile organic compounds. The results of their study were published this week in the British Journal of Surgery.

Altomare believes patients would be more willing to take a screening breath test over a colonoscopy because the breath test would be quicker, less expensive and non-invasive.

The study

Researchers tested 37 patients with colorectal cancer and 41 patients who had a clean colonoscopy. Patients who were receiving chemotherapy and/or radiation were excluded, as were patients with other colon issues like inflammatory bowel disease. Nineteen of the cancer patients had stage I or II cancer; 18 had stage III or IV.

Study participants remained in a room for 10 minutes to create equilibrium between their breath and the surrounding air. Their exhaled breath was then collected in a bag and processed to determine each individual’s volatile organic compound, or VOC.

Using VOCs to diagnose cancer is a new frontier in cancer screening, according to the researchers. Scientists say tumor growth causes metabolic changes that lead to specific compounds that can be detected in exhaled breath. Ongoing studies are assessing the ability of a breath test to diagnose lung cancer, breast cancer, skin cancer and liver cancer.




The results

No differences were found in the VOC profiles of patients in different stages of the cancer. The breath test analysis correctly identified 32 of the 37 patients with colorectal cancer and incorrectly diagnosed cancer in seven of the 41 healthy patients. Overall, the breath test had an accuracy rate of 76% in identifying patients with cancer.

The researchers concluded breath VOC analysis appears to have potential for detecting colorectal cancers, but further technical development is needed to improve the device’s accuracy. Altomare said larger studies also need to be done to confirm the test’s reliability.

Going forward

“This is an interesting study, but a lot more research is needed before chemical analysis of exhaled breath might be added to the list of tests currently recommended for colorectal cancer screening,” Gansler said.

Altomare and his team plan to use the breath analysis on patients with precancerous polyps to see if the test can detect them.

“The main goals of current screening tests are not just to find any colorectal cancer, but rather to find early – curable – cancers and precancerous polyps that can be removed to prevent cancer from developing,” Gansler explained.

Altomare also plans to study whether the test works on people who have other colon issues – i.e., whether it can distinguish between cancer and inflammatory diseases. He is working with a professor in the chemical department at the University of Bari in Italy to create an electronic nose, “which we hope will further make the colorectal cancer screening by breath analysis more easy and available as a screening tool for the general population.”

In the meantime, Gansler urges people to take advantage of screening methods that are already available and have been proven to be effective in saving lives.


Big Doses of Vitamin C May Lower Blood Pressure

Discover how Vitamin C help lower blood pressure and reduce risks of heart disease in this article from

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Taking large doses of vitamin C may moderately reduce blood pressure, according to an analysis of years of research by Johns Hopkins scientists. But the researchers stopped short of suggesting people load up on supplements.

“Our research suggests a modest blood pressure lowering effect with vitamin C supplementation, but before we can recommend supplements as a treatment for high blood pressure, we really need more research to understand the implications of taking them,” says Edgar “Pete” R. Miller III, M.D., Ph.D., an associate professor in the division of general internal medicine at the Johns Hopkins University School of Medicine and leader of the study published in the American Journal of Clinical Nutrition.

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Roughly 30 percent of adults in the United States have high blood pressure, or hypertension, an important risk factor for heart disease and stroke. Successful treatment may include drugs, exercise, weight loss, and dietary changes such as reducing salt intake. Some experts believe that large amounts of vitamin C, an essential micronutrient found primarily in fruits and vegetables, could lower pressure as well, but randomized, controlled dietary intervention studies — the gold standard of nutrition research — have produced mixed results.

Miller and his colleagues reviewed and analyzed data from 29 randomized, controlled, previously published clinical trials that reported systolic and/or diastolic blood pressure values and also compared vitamin C intake to a placebo. What they found is that taking an average of 500 milligrams of vitamin C daily — about five times the recommended daily requirement — reduced blood pressure by 3.84 millimeters of mercury in the short term. Among those diagnosed with hypertension, the drop was nearly 5 millimeters of mercury.

By comparison, Miller says, patients who take blood pressure medication such as ACE inhibitors or diuretics (so-called “water pills”) can expect a roughly 10 millimeter of mercury reduction in blood pressure.

Five hundred milligrams of vitamin C is the amount in about six cups of orange juice. The recommended daily intake of vitamin C for adults is 90 milligrams.
“Although our review found only a moderate impact on blood pressure, if the entire U.S. population lowered blood pressure by 3 milliliters of mercury, there would be a lot fewer strokes,” Miller says. Miller cautions, however, that none of the studies his team reviewed show that vitamin C directly prevents or reduces rates of cardiovascular disease, including stroke.

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Scientists have focused on vitamin C’s potential role in blood pressure reduction because of the nutrient’s biological and physiological effects. For example, vitamin C may act as a diuretic, causing the kidneys to remove more sodium and water from the body, which helps to relax the blood vessel walls, thereby lowering blood pressure.

Nutritional supplements are a $28 billion-a-year industry, and marketing claims, newspaper stories and testimonials often make them hard to resist, Miller says. People often view supplements as a “natural alternative” and preferable to drugs for high blood pressure or other ailments, he adds, despite mounting evidence that many supplements don’t work and in some cases may cause harm.

“People love to take vitamins regardless of the evidence or lack of it,” Miller says. “We’re trying to raise the bar and provide evidence-based guidance about whether supplements help or actually do harm.” With respect to vitamin C, he says, the jury is still out.

Other study authors from Johns Hopkins include Stephen P. Juraschek, an M.D., Ph.D. candidate; Eliseo Guallar, M.D., Dr.Ph.; and Lawrence J. Appel, M.D., M.P.H.