Strokes – Family History a Significant Risk Factor

According to an article published by WebMD, individuals whose parents have had a stroke by age 65 are more likely to have a stroke.

Strokes are generally defined as disturbances of blood flow in the brain as a result of a ruptured blood vessel, a blockage within the lumen of the blood vessel, or some other ischemic process. The ischemic process can cause brain tissue to die, resulting in death or permanent brain injury. In all respects, strokes represent medical emergencies.

Among other things, the following are generally considered to be risk factors for developing a stroke: previous history of strokes, brain trauma, advanced age, increased lipid levels, increased blood pressure, diabetes, atrial fibrillation, and smoking.

The results of the study suggest that a person’s family history of strokes should also be considered in assessing the risk for developing a stroke.

Researchers studied 3,443 people who initially were stroke free and second-generation participants in the Framingham Heart Study. The participants’ parents had reported 106 strokes by age 65, and offspring 128, over the 40-year study. People with a parent who had a stroke by age 65 had twice the risk of having a stroke at any age and four times the risk by 65, after adjusting for conventional risk factors.

Contributing author: Jon Stefanuca

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

Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children

Medical News Today recently issued a report on a study, done by the Columbia Center for Children’s Environmental Health at Columbia University’s Mailman School of Public Health, in which children who were exposed to acetominophen (Tylenol) prenatally were at increased risk to have asthma symptoms by age 5.  Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children.

While the study involved 300 African-American and Dominican Republic children living in New York City, the potential relevance for broader concern for African-American and Hispanic children  is evident.

[The study] found that the relationship was stronger in children with a variant of a gene, glutathione S transferase, involved in detoxification of foreign substances. The variant is common among African-American and Hispanic populations. The results suggest that less efficient detoxification is a mechanism in the association between acetaminophen and asthma.

“These findings might provide an explanation for some of the increased asthma risk in minority communities and suggest caution in the use of acetaminophen in pregnancy,” says Matthew S. Perzanowski, PhD, assistant professor of Environmental Health Sciences at the Mailman School of Public Health.

What is of some related interest is the fact that online postings regarding acetaminophen suggest that this may be the drug of choice for conditions as short-term fever and minor pain during surgery.

For example, Medicinenet.com’s posting, (which certainly predates this study) states in pertinent part:

SIDE EFFECTS: When used appropriately, side effects with acetaminophen are rare.

This most recent study appears to have some similarity to a prior study, at least according to the article on Medical News Today:

In a similar study conducted in the UK, the frequency of acetaminophen use during pregnancy and the magnitude of association in the UK study were similar to that in New York City.

So – Moms-To-Be, consider discussing this study with your OB before reaching for that bottle of Tylenol.

Bariatric Surgery Can Be Safer Than Living With Obesity

For those of us in the law, who have litigated dozens of bariatric surgery cases, the following article from Medical News Today (Bariatric Surgery Can Be Safer Than Living With Obesity) must be read with the following paragraph from the article kept in the forefront when patients are decided WHERE to go to have this surgery performed:

To help alleviate a patient’s fears before surgery, the bariatric team ensures that patients and their families are thoroughly informed and comfortable with the procedure. Prior to surgery, patients undergo medical, psychological and nutritional evaluations, plus they attend two patient support groups and three educational classes.

Wondering what this surgery is all about?  It’s the medical term for what may commonly be called ‘weight loss’ surgery.  To get a basic understanding of the procedure as well as the ‘before and after’ care issues that are key to a successful procedure, here’s a video from YouTube.

Keep in mind that there are a lot of surgeons doing bariatric surgery; however, in most instances, the way you avoid a visit to your lawyer’s office is to chose the right surgeon and facility.

The American Society for Metabolic and Bariatric Surgery has a useful website on which there’s a patient primer about this procedure.  You can learn about the Centers for Excellence Program of the Society and get a listing of the members of the organization, who perform this surgery in your area.  It’s definitely worth checking out before you sign-up with a surgeon to have this potentially life-saving but nonetheless risky procedure performed.

Patients – Know Thy Physician!

What’s Going On? – Birth Weights In The US On The Decline

A recent article  in Medical News Today reports a perhaps concerning trend in lower birth weights for infants in the United States.  The research was performed by the Harvard Pilgrim Health Care Institute’s Department of Population Medicine, an affiliate of Harvard Medical School, and analyzed 15 years of data from National Center for Health Statistics Natality Data Sets, looking at 36,827,828 U.S. babies born at full-term between 1990 and 2005.

As the author of the Medical News Today article, Jessica Cerretani, points out, there are potentially serious concerns about this trend.

While the decline may simply represent a reversal of previous increases in birth weights, it may also be cause for concern: babies born small not only face short-term complications such as increased likelihood of requiring intensive care after birth and even higher risk of death, they may also be at higher risk for chronic diseases in adulthood.

This study was published in Obstetrics & Gynecology, February 2010, Volume 115, No. 2, Part 1.

Maybe that picture of the chubby little cherub was ‘just right.’

As the authors of the Harvard-based study noted:

Future research may identify other factors not included in the current data that might contribute to lower birth weight, such as trends in mothers’ diets, physical activity,stress, and exposure to environmental toxins. “There’s still a lot we don’t know about the causes of low birth weight,” says Oken. “More research needs to be done.”

Few Breast Cancer Surgeons Follow Quality Of Care Standards

Today’s online issue of Medical News Today offers good insight for women, who have been diagnosed with breast cancer.  A recent study by the University of Michigan Comprehensive Cancer Center notes that the standards of care in the treatment of such patients calls for, among other things, “consulting with other specialists and providing resources and education to help patients make treatment decisions.”

“Despite the mantra for multidisciplinary decision-making and care intake for patients, surgeons in the community are reporting relatively little of that in their practices,” says lead study author Steven J. Katz, M.D., M.P.H., professor of internal medicine at the U-M Medical School and professor of health management and policy at the U-M School of Public Health.

As further noted by one of the co-directors of the program at U-M Comprehensive Cancer Center:

“Either doctors are not convinced these elements matter or there are logistical constraints in terms of building these standards into their practices. What the implications are for patients is unknown. These results suggest patients might find a more integrated practice among surgeons with higher volume. But we don’t know whether that matters with regards to patient decision making, quality of life and satisfaction,” says Katz, who is also co-director of the socio-behavioral program at the U-M Comprehensive Cancer Center.

The authors of the article (for a full review, see Few Breast Cancer Surgeons Follow Quality Of Care Standards), in Medical News Today cite the following statistics with respect to breast cancer – “Breast cancer statistics: 194,280 Americans will be diagnosed with breast cancer this year and 40,610 will die from the disease, according to the American Cancer Society.”

It would seem that the moral of the story in this report for women dealing with this disease is – make sure you discuss your options with your doctor and specifically discuss the concept of a multi-disciplinary approach in the formation of your treatment choices.

There is also an encouraging report on the U-M Comprehensive Cancer Center’s site that speaks to their scientists having “uncovered an important link between inflammation and breast cancer stem cells that suggests a new way to target cells that are resistant to current treatments.”