Category Archives: Medicine

Elder-Care Crisis: Early Screening For Dementia, Increased Preventative Primary-Care Are Needed

From a Wall Street Journal Opinion article (Feb 10, 2020):

How to address the elder-care crisis? Ideally, doctors would screen older patients for dementia. An early diagnosis helps patients understand treatment options, plan for the future and receive appropriate care in the hospital. 

Costs of Long-Term Elderly Care Kaiser Infographic

Other steps include: more preventive care, changes to Medicare’s rehabilitation policies, adopting new reimbursement methods, and developing new measures of success. Primary-care offices can prevent hospital visits, but Americans seeking primary care face an average wait time of 24 days. This might not be a problem for a patient in need of an annual physical, but conditions like chest pain or infections require prompt treatment. Primary-care offices that offer same-day sick visits, home visits for bed-bound older adults, or at-home monitoring of conditions could reduce emergency department volumes.

Read full article by Elizabeth Goldberg MD

Health Talk: Stanford Dermatology Professor Eleni Linos On “Tanning Bed” Cancer Research

Eleni Linos MD PhD Stanford Medicine Dermatology“Studies with financial links to the indoor tanning industry were much more likely to discuss perceived benefits of indoor tanning and to downplay the harms,” said Eleni Linos, MD, DrPH, professor of dermatology, who sees patients at Stanford Health Care’s dermatology clinic at the Hoover Pavilion. “The association is quite striking. We need scientific data to be independent of industry influence. I am concerned that funding sources may influence the conclusions of these papers.”

The BMJ podcastIn 2012, Eleni Linos, professor of dermatology at Stanford university, published a systematic review and meta-analysis of the link between non-melanoma cancer and sun-beds. That bit of pretty standard research, and a particular rapid response to it, has kicked of years of work – and in this podcast I talk to Eleni and her colleagues Stanton…

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Mayo Clinic Health: “Obesity Epidemic And Popular Diet Trends”

On the Mayo Clinic Radio program, Dr. Donald Hensrud, director of the Mayo Clinic Healthy Living Program, discusses the obesity epidemic and talks about popular diet trends, including intermittent fasting.

This interview originally aired Feb. 8, 2020.

Learn more about intermittent fasting: https://www.mayoclinic.org/healthy-li…

Podcast: “Intermittent Fasting” Study Author Mark P. Mattson MD On Diet’s Health Benefits

NEJM Journal WatchIntermittent fasting has salutary effects. Listen how Dr. Mark P. Mattson, co-author of a recent NEJM review on the topic, assesses the practice — and how he’s managed to skip breakfast for the past 30 years or so.

Evidence is accumulating that eating in a 6-hour period and fasting for 18 hours can trigger a metabolic switch from glucose-based to ketone-based energy, with increased stress resistance, increased longevity, and a decreased incidence of diseases, including cancer and obesity.

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Obesity Risks: “Fatty Liver Disease – The Silent Epidemic” (UCSF Video)

Nonalcoholic fatty liver disease (NAFLD) occurs when fat is deposited in the liver, without other causes of fatty liver identified. Dr. Danielle Brandman explores who is at risk, diagnosis, staging, complications and management.

Obesity Prevalence in US 2011 - 2017 CDC

More from: Organ Failure and Replacement: Why Organs Fail and What Therapies are Available for Organ Replacement (https://www.uctv.tv/organ-failure-rep…)

Healthcare System: “There’s No Dignity In Hospital Gowns” (BMJ)

From a The BMJ Views and Reviews article by David Oliver (February 5, 2020):

David Oliver There's No Dignity in Hospital Gowns The BMJ February 5 2020Last year the Lancet published a paper on the impact of wearing gowns, surveying 928 adult patients and carrying out structured interviews with 10 patients. Over half (58%) reported wearing the gown despite feeling uncertain that it was a medical necessity. Gown design was considered inadequate, with 61% reporting that they struggled to put it on or required assistance and 67% reporting that it didn’t fit. Most worryingly, 72% felt exposed, 60% felt self-conscious, and 57% felt uncomfortable wearing the gown.

I’ve often wondered why on earth we routinely put so many patients into hospital gowns within minutes of their arrival at hospital.

Sometimes referred to as “dignity gowns,” such dignity as they afford is only in comparison to being stark naked. They don’t come in a wide range of sizes or lengths, and they’re open along the back. You tend to get what you’re given and make do. The effect is to leave patients with lots of exposed flesh, with underwear or buttocks intermittently displayed and a feeling of extreme vulnerability, not to mention being cold if they have no other layers to wear.

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Research: CalTech Scientists Target Cancer Cells With Ultrasound

From a CalTech news article (February 4, 2020):

Ultrasonic-Cancer-Treat-14-50.2e16d0ba.fill-310x200-c100The hope, Lee says, is that ultrasound will kill cancer cells in a specific way that will also engage the immune system and arouse it to attack any cancer cells remaining after the treatment.

A new technique could offer a targeted approach to fighting cancer: low-intensity pulses of ultrasound have been shown to selectively kill cancer cells while leaving normal cells unharmed.

CalTech logoUltrasound waves—sound waves with frequencies higher than humans can hear—have been used as a cancer treatment before, albeit in a broad-brush approach: high-intensity bursts of ultrasound can heat up tissue, killing cancer and normal cells in a target area. Now, scientists and engineers are exploring the use of low-intensity pulsed ultrasound (LIPUS) in an effort to create a more selective treatment.

A study describing the effectiveness of the new approach in cell models was published in Applied Physics Letters on January 7. The researchers behind the work caution that it is still preliminary—it still has not been tested in a live animal let alone in a human, and there remain several key challenges to address—but the results so far are promising.

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Heart Health: “Marine Omega-3s” Are “Greatest Protection Against Arrhythmic Events” (BMJ)

From a British Medical Journal (BMJ) Open Heart online article:

BMJ Open Heart Journal February 2020The intake of marine omega-3s has consistently been found to have antiarrhythmic effects. When marine omega-3s are consumed, there is an increase in cellular membrane fluidity, inhibition of L-type calcium channels and a reduction in the chance of arrhythmic events during susceptible times. Prospective data suggest that maintaining an omega-3 index of about 8%, which requires consuming seafood rich in omega-3 up to five times per week or consuming over 3 g of EPA and DHA per day, may provide the greatest protection against arrhythmic events.

Marine omega-3s for the prevention of arrhythmias

Omega-3s have been theorised to increase membrane fluidity by reducing compression of the acyl chains of membrane phospholipid fatty acids, which can lead to a reduction in the ‘spring-like’ tension on membrane ion channels. This spring-like tension can reduce the ability of ions to freely move in and out of the ion channel and hence reduce its conductance. This is known as the ‘Andersen membrane spring-like tension hypothesis’ and is just one way marine omega-3s may prevent arrhythmias.

Dietary omega-3s are mainly consumed as triglycerides, which are absorbed as free fatty acids and monoglycerides. These fats then get rapidly resynthesised in the intestine and liver back to triglycerides with subsequent integration into chylomicrons, very low-density lipoprotein and low-density lipoprotein (LDL) (LDL can actually deliver omega-3s to tissues via LDL receptors).

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