Ovarian Cancer – The Smear Test Won’t Tell You Much

According to an article published by the UK Press Association, a UK study revealed that one in three women mistakenly believe that a smear test can diagnose ovarian cancer. The test is also known as Papanicolaou test, Pap smear, Pap test, or cervical smear.

[The smear test] is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. … In taking a Pap smear, a tool is used to gather cells from the outer opening of the cervix (Latin for “neck”) of the uterus and the endocervix. The cells are examined under a microscope to look for abnormalities. The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses (HPVs). The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The test may also detect infections and abnormalities in the endocervix and endometrium.

While the smear test is customarily used to diagnose cervical cancer, it is not very helpful in diagnosing ovarian cancer. Cervical cancer and ovarian cancer are distinct medical conditions with distinct symptoms. Cervical cancer refers to malignant tissue developing in the cervix – the organ, which connects the uterus and the vagina. Last year, there were about 4,070 deaths associates with cervical cancer. The smear test is effective in diagnosing cervical cancer.

Ovarian cancer refers to malignant tissue in one or both of the ovaries. Last year, there were about 14,600 deaths associated with ovarian cancer – a much higher mortality rate when compared to that of cervical cancer. Symptoms of ovarian cancer include, but are not limited to : abdominal pressure, abdominal distention, urinary urgency, abdominal pain and discomfort, indigestion, constipation, changes in menstruation, lethargy, and pain during intercourse.

According to the article,

Almost one in three women (29%) mistakenly believe a smear test will pick up signs of ovarian cancer. …  Only 4% are confident they could spot symptoms of the disease themselves and many believe it is less common than cervical cancer. … The poll of more than 1,000 women found that twice as many (66%) had been given information about cervical cancer as those who had details on ovarian cancer (33%). Of women diagnosed with ovarian cancer, more than half (56%) did not know anything about the disease beforehand.

These numbers reveal a dangerous misconception about ovarian cancer. Many more women are diagnosed with ovarian cancer than cervical cancer. Moreover, many more women die as a result of ovarian cancer than as a result of cervical cancer. Early diagnosis is key in both instances. In this regard, being knowledgeable about these medical conditions can be a matter of life and death. Be mindful that a smear test is not helpful in diagnosing ovarian cancer.

Contributing author: Jon Stefanuca

CHIP Grants: North Carolina’s Perdue announces $9.3M grant for NC’s children’s health care

A positive initiative indeed – North Carolina’s Governor, Bev Perdue, recently announced North Carolina’s receipt of a $9.3 million grant to improve the quality of health care delivered to children.   In an article in Citizen-Times.com, it is reported that the North Carolina Department of Health and Human Services “was the lead applicant for this competitive grant and worked closely with a coalition of children’s health leaders in the state.”  According to the post, funding will be used to develop technology that tracks and measures quality of care for children.”

“This competitive grant is vital to ensuring that children in our state are healthy and ready to learn,” said Gov. Perdue. “This will help pediatric offices throughout the state make better use of technology so we can be sure that children, those with special needs in particular, are receiving the care they need.”

North Carolina is one of only ten lead states announced as part of the $100 million grant program under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Talk about someone using federal tax dollars wisely!  It will be most interesting to see how this grant money is, in fact, utilized by states such as North Carolina.  We will try to keep you posted on the success of this project.

If we are reading this legislation correctly, it appears that applications for grant money remains open until (the currently posted ending date of) March 25, 2010.  Further information on the grant program and applications, eligibility and other key aspects of the program are available online at Grants.gov.

Cerebral Palsy Verdict: $23.3 Million – Minnesota – birth injury – delay in performing C-Section

This is a report from AboutLawSuits.com:  

The family of a girl who was diagnosed with cerebral palsy as a result of a birth injury has been awarded $23.3 million by a Minnesota jury after suing a hospital for waiting too long to perform a Cesarean section.

The Minnesota cerebral palsy lawsuit was filed against Rice Memorial Hospital and Affiliated Medical Community Center by Elise Rodgers, as a result of alleged negligence during the birth of her daughter, Kylie, in June 2007. According to a report by Minnesota Public Radio, Rodgers claimed that negligent medical care caused the girl to suffer severe brain damage because doctors failed to act quickly once the fetal monitor warned the child was being deprived of oxygen during labor.

The family argued that Kylie’s umbilical cord was compromised, and that doctors should have performed a Cesarean before she suffered permanent brain damage. Kylie, who now has cerebral palsy as a result of the negligent care, requires constant suctioning of her airway, sometimes as often as every three to five minutes, in order to survive, according to the lawsuit.

In a verdict handed down earlier this month by a Kandiyohi County jury, Rodgers was awarded $10 million for the child’s future medical expenses, $1.7 million for past medical expenses, $1.5 million for future lost earnings and $10 million for disability, emotional distress and pain.

Many research studies are underway and new therapies are being developed for infants with cerebral palsy.  Nevertheless, many children are still born with this condition and its spectrum of disabilities.  When these injuries are the result of medical negligence by physicians, hospitals and/or other health care providers, the civil litigation system is there to provide for these special needs children.  Contrary to politically-charged statements by those on the right, juries do understand when these life-altering injuries are caused by negligence.  When they do and the care needs are properly presented, verdicts such as this in Minnesota are the proper result.

Horrible day in Anne Arundel County, MD:Fatal crash halts morning traffic near Arundel Mills – Early Evening Fatal Plane Crash

This was a brutal day in Anne Arundel County, MD.  As the Baltimore Sun reported –Fatal crash halts morning traffic near Arundel Mills – baltimoresun.com –

At 6:29 a.m., rescue workers were called to a collision on eastbound 100, just west of Telegraph Road, near the MARC system’s Penn Line.

The vehicle went off the road and fell about 30 to 40 feet to the train tracks below, with crews taking roughly 20 minutes to free the two victims, Cox said. One victim, a man estimated to be about 40 years of age, was flown by medevac helicopter to the University of Maryland Shock Trauma Center. The second man, estimated to be about 30 years old, was pronounced dead at the scene.

At 4:30 this afternoon, according to a news report from the Baltimore Sun, a single engine plane crashed in the backyard of a single family home.  The pilot died; no one else was injured according to the report.  The crash took place in Edgewater, near Lee Airport and not far from the intersection of Solomons Island Road and Warehouse Creek Lane.

Expanding The Role Of Nurse Practitioners: Licence To Practice Medicine Without A License

An article published by NPR comments on the nationwide movement to expand the role of nurse practitioners in light of the growing deficit of primary care physicians. According to the article:

Nursing leaders say large numbers of [nurse practitioners] …will be needed to fill gaps in primary care left by an increasing shortage of doctors, a problem that would intensify if Congress extends health insurance to millions more Americans. Advocates say nurse practitioners have the extra education and training needed to perform a variety of services, including physical exams, diagnosis and treatment of common ailments and prescribing drugs.

A study published by the Center for Workforce Studies projects that, by 2025, there will be a nationwide shortage of about 124,000 physicians. Researchers note:

Under any set of plausible assumptions, the United States is likely to face a growing shortage of physicians. Due to population growth, aging and other factors, demand will outpace supply through at least 2025. Simply educating and training more physicians will not be enough to address these shortages. Complex changes such as improving efficiency, reconfiguring the way some services are delivered and making better use of our physicians will also be needed.

Based on this rationale, a number nursing organizations, state level legislators, regulatory bodies, and various other national organizations and policy thinktanks advocate for an expanded role, particularly in the field of primary care, for nurse practitioners. According to the article, a number of states have already implemented or are presently considering legislation to expand the role of nurse practitioners. For example, a Colorado bill would enable nurse practitioners to issue orders in the same way as a physician. Practically speaking, this would mean that a nurse practitioner, in addition to being able to order medications, would also be able to issue orders directing the treatment of the patient (e.g., orders to admit the patient, CT/MRI orders, consultation orders, etc.)

While these proposed reforms may be practical and serve a utilitarian purpose, one can’t help but wonder if the quality of health care rendered to millions of Americans is going to be compromised as a consequence. The easy answer is not always the right answer. It may be true that there are more nurse practitioners in the U.S. than there are physicians (there are about 125,000 more nurse practitioners). If allowed, nurse practitioners could certainly fill the void. But, the critical inquiry remains: are nurse practitioners sufficiently qualified to serve as substitutes for physicians? For example,

The American Medical Association (AMA) and doctors’ groups at the state level have been urging state legislators and licensing authorities to move cautiously, arguing that patient care could be compromised.

The AMA issued a report in which it questioned whether nurse practitioners are sufficiently qualified to render medical care in areas currently restricted to physicians.

“To back up its claims, the report cites recent studies that question the prescription methods of some nurse practitioners, as well as a survey that reported only 10 percent of nurse practitioners questioned felt well prepared to practice primary care.”

The idea that nurse practitioners are qualified to serve as substitutes for physicians it truly worrisome. There is a reason why nurse practitioners are not physicians – they don’t have the same level of training and expertise. Surely, there are patients with fairly simple medical complaints, which probably could be addressed by nurse practitioners; however, what about the inevitable complex patient? Are nurse practitioners sufficiently trained to simultaneously recognize the interplay of multiple medical conditions, as well as determine the interplay of necessary medications, radiographic studies and necessary follow up care? I for one will make sure to be seen by a physician.

Contributing author: Jon Stefanuca

We’ve Heard of MRSA – Now We Learn that Doctors Struggle to Treat Gram-Negative Bacterial Infections – NYTimes.com

An article in yesterday’s New York Times by Andrew Pollack – Doctors Struggle to Treat Gram-Negative Bacterial Infections – NYTimes.com – brings to the public’s awareness that  Gram-negative organisms such as Klebsiella pneumoniae and Acinetobacter are becoming almost as common but have very few treatment options in the form of effective antibiotic coverage.        

The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Their cell structure makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA.

Mr. Pollack reports that “[a]ccording to researchers at SUNY Downstate Medical Center, more than 20 percent of the Klebsiella infections in Brooklyn hospitals are now resistant to virtually all modern antibiotics. And those supergerms are now spreading worldwide.”

The number of infections occurring annually in hospitals is simply staggering – roughly 1.7 million hospital-associated infections, according to the Centers for Disease Control and Prevention. More horrifying is the CDCP’s estimate that when taking into account all types of bacteria combined, these organisms cause or contribute to 99,000 deaths each year.

“For Gram-positives we need better drugs; for Gram-negatives we need any drugs,” said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-U.C.L.A. Medical Center in Torrance, Calif., and the author of “Rising Plague,” a book about drug-resistant pathogens.

Mr. Pollack’s article also sheds light on yet another little-known but equally tragic fact – a physician’s choices in treating some of these deadly Gram-negative bacteria are not without significant risks to the patient – neuro and nephrotoxicity.

Doctors treating resistant strains of Gram-negative bacteria are often forced to rely on two similar antibiotics developed in the 1940s — colistin and polymyxin B. These drugs were largely abandoned decades ago because they can cause kidney and nerve damage, but because they have not been used much, bacteria have not had much chance to evolve resistance to them yet.

“You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.”

As many are aware or becoming increasingly aware, the drug-resistant bacteria are believed to be the by-product of overuse of antibiotics by healthcare providers over the past many decades.  Specialists in infectious disease have been vocal advocates for the judicious use of antibiotic therapy and avoidance of the ‘take a pill’ first approach by many front line providers such as internists.

In his article, Mr. Pollack provides a link to a campaign started by the parents of a 27 year old young man, who survived his post-operative, hospital-acquired MRSA infection twice only to die a victim of a Gram-negative organism, Enterobacter aerogenes. These advocates for prevention of hospital-acquired infections, Armando and Victoria Nahum, started the Safe Care Campaign.  A visit to this site is most instructive and we invite you to do so.

Seat belt law not ‘clicking’ with House

A House subcommittee has killed a bill in Virginia, that would have made the failure to wear a seatbelt a primary offense.  Although there is another version of the bill that has cleared the Virginia Senate, it has been referred back to the same subcommittee that killed the first bill.  Some believe this bill will suffer the same fate:

Last week, the subcommittee voted to table House Bill 901, sponsored by Delegate William K. Barlow, D-Smithfield.

“This is the second year I’ve tried it. It never passes in the subcommittee,” Barlow said. “The bill gets killed at the lowest level.”

Now the subcommittee has been assigned Senate Bill 9, proposed by Sen. Harry B. Blevins, R-Chesapeake. It passed 24-16 in the Senate last month.

Blevins said he is not optimistic about the reception SB 9 will receive in the House Militia, Police and Public Safety Committee.

“The bill doesn’t have much of a chance,” Blevins said. “I’m a realist.”

Opponents of the bill cite government intrusion as a justification for rejecting such a law.

An article, as published through the online site of The Gainesville Times, briefly outlined the current law:

Currently, Virginia law states that “occupants of front seats who are 16 years or older are required to use safety lap belts and shoulder harnesses.” However, breaking that law is a secondary offense: Police may cite you for a seat-belt violation only if they see you committing another offense, such as speeding or running a red light.

Regardless of where you stand on the issue, ask yourself:  “What is the risk of having my seatbelt on, vs. not wearing one at all?”  Are there children in the car with you?  What kind of a message does it send to them if we do not buckle up?  Would you tell your child that they do not have to wear their seatbelt, or be ‘ok with it’ if they didn’t?  Remember, as much as we can control our vehicle, we can never control anyone else’s.  Be safe out there, please!

First Lawsuit Filed In Kleen Energy Blast – Courant.com

You will probably recall the horrific blast that occurred on February 7, 2010, at Kleen Energy power plant in Middletown, Connecticut. Six workers were killed and 26 others were injured when an explosion ripped through the building.  It was reported that a gas line purge was being conducted at the time.  For a reminder on the details of this event, see our posting filed that same day in February.   You can also watch a news report on the investigation into the cause of the explosion as well.    

Today we have learned through an article in the Hartford Courant that the first lawsuit relating to this incident was filed in the Superior Court in Hartford, CT.

Two employees of a subcontractor, Ducci Electrical Contractors, on the site that day, Timothy Hilliker and Harold Thoma, are the first to file a suit relating to this incident.  It is alleged that “…the Feb. 7 purge was poorly supervised, that active welding and grinding were taking place on-site at the time of the explosion and that a gas-fueled torch heater was running at the time of the deadly blast.”

Hilliker and Thoma are being represented by Joel Faxon of Stratton Faxon.  In an interview with the Hartford Courant, Faxon provided the essence of their claim:

“These guys showed up to work and had no concept of what was going on. There was no supervisor telling them what to do.”

Faxon said that Thoma had just stepped out of the Ducci construction trailer when the blast occurred. He suffered head injuries and has been in and out of the hospital. Hilliker was in the trailer when the blast occurred and was thrown into a wall; he also had head injuries.

Faxon said his firm represents about 12 people who were working at the plant when the blast occurred. The lawsuit names O&G Industries, the general contractor for the billion-dollar construction job; Keystone Construction and Maintenance Services Inc., which was supervising the purge; and plant owner Kleen Energy Systems LLC.

According to the report, the pipeline purging, which is the still under investigation for possible criminal charges, is expected to be the subject of much discussion at a National Fire Protection Administration safety seminar this week in San Francisco.

Dan Horowitz, a spokesman for the NFPA, stated, “You don’t want to ventilate in an area where gas can accumulate near people and ignition sources,” Horowitz said. According to Horowitz, the board is recommending a ban of indoor purging of gas lines and will state that gas should be discharged outdoors, away from all confined areas.

UPDATE:  2/25/10 – new warrant issued for site – see today’s posting in boston.com.

Doctor Training Aided by Drug Industry Cash

Title have you wondering?

This article, as posted on the New York Times website yesterday, highlights a survey performed in 2006 and 2007, which shows that the majority of medical residency programs to train doctors in internal medicine in the United States, accepted financial support from the drug industry.

The Association of Program Directors in Internal Medicine conducted the survey. Responses were returned by 236 of the nation’s 381 internal medicine program directors, who together train more than 22,000 doctors.

Of special note in the survey results, the authors wrote, programs where fewer graduates passed tests from the American Board of Internal Medicine — “one indicator of program quality” — were also more likely to accept the assistance.

Dr. Furman S. McDonald, a co-author of the survey report and director of internal medicine residency at the Mayo Clinic, said it was unclear whether the lower test scores indicated a lack of overall support for the residency programs that took industry money, or a negative effect from the information being imparted by the pharmaceutical industry.

“As the pass rates went down,” he said of the new doctors’ test scores, “the odds of accepting pharmaceutical support went up.” Dr. McDonald called for more research in that area.

Residency programs in internal medicine typically last three years after medical school, “a particularly formative time for physicians,” the study said.

The article goes on to state that, although 72% of the survey respondents said drug industry financing was not desirable, many within that group took the money, anyway.  The reason?  According to two-thirds of the directors who reported taking the money, it was due to “inadequate financing from other sources.”

Who could possibly ban such pharmaceutical financing?  The Accreditation Council for Graduate Medical Education, that’s who. According to the article , the council declined comment.  Let’s hope the council doesn’t wait too long to step in and investigate this troublesome survey.

$16.5 Million Malpractice Verdict – CA – Neurosurgery

Trent Hughes and wife, Lisa, won a $16.5 million dollar verdict in a California court against neurosurgeon, Dr. Christopher Pham.    

Medical records indicated that Mr. Hughes received a spinal cord injury November 2, 2003, while off-roading and was flown to Riverside County Medical Center. Mr Hughes sustained a spinal fracture with compression unrelieved by surgery from Dr. Pham until two days following the initial injury.

The allegations in this lawsuit were that by the time Dr. Pham performed the surgery, it was too late and that the damage to Mr. Hugh’s spinal cord had become irreversible.

The Plaintiffs received compensation for the loss of consortium, lost income, medical expenses (past and future), pain and suffering and rehabilitative costs.

Contributor:  Caitlynn Gillyard