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Hawaii J Med Public Health. 2017 September; 76(9): 271.
PMCID: PMC5592385

The Weathervane

Russell T Stodd, MD, Contributing Editor

The Patient Died from a Gastric Ulcer - Not!

We like to think of a hospital as a place of refuge where problems are solved, or at least defined and alleviated. It is increasingly evident that hospitals in fact are very dangerous places and should be avoided whenever possible. In Manhattan Beach, California, a 71 year-old woman was admitted for surgical treatment of a stomach ulcer. Shortly after, she was fighting for her life, and a doctor had underlined “CRKP” on the chart an ominous abbreviation for an infection with a superbug, carpabenem-resistant Klebsiella pneumoniae. After five weeks of intensive care she expired from her infection, and the doctor signed the death certificate as death due to respiratory failure and septic shock caused by her ulcer. No mention was made of her hospital acquired CRKP. The doctor explained that had she not had an ulcer she would not have been in the hospital. Her daughter was angry and challenged the hospital administration to no avail. The case is hardly unique. An epidemic of hospital-acquired infections is going unreported, according to medical experts. Researchers at the University of Michigan found in 2014 that patient's billing record shows much more closely what the patient was being treated for rather than the death certificate. The Centers for Disease Control and Prevention (CDC) call CRKP one of the nation's most urgent health threats. Bottom Line - stay away from the hospital whenever possible.

International Schools are Answering the Call, and We do not Care About Immigration.

Medical schools in the United States (U.S.) are struggling to educate enough doctors to meet the needs in rural and other underserved areas of this country. Still, there is a shortage and the Association of American Medical colleges forecasts a worsening picture with between 40,800 and 104,900 physician deficit by 2030. International medical schools are stepping in to provide help. In 2016, 3,298 U.S. citizens from foreign schools were certified to enter American residency and fellowship programs. A few of the schools outperform when it comes to getting students into residency programs at U.S. teaching hospitals. Ross University Medical School of Medicine in Dominica, American University of the Caribbean School of Medicine in St. Maarten, along with a handful of others, regularly post match rates of 85%. Of aspiring doctors who applied for residency matches in 2016, 15% were U.S. citizens who attended foreign schools. At this time it appears obvious that the USA will benefit from the influx of foreign medical school graduates without an impact on quality of care. Go for it.

Sparks may Brighten the Sky for RPE 65.

Spark Therapeutics Inc. is a startup biotechnology company using gene therapy to improve vision. Gene therapy involves injecting genetic material to treat or prevent disease. Initial efforts in the 1990s were sidetracked when some study participants died or developed cancer. Gene therapy is gaining ground again following the successful treatment of patients with a rare enzyme deficiency in a study done in Europe. Sparks study tested 19 patients with a copy of a functional RPE 65 gene where the original gene failure caused loss of night vision, loss of peripheral vision, reduction in acuity, and eventually progresses to complete blindness. The Sparks gene is encapsulated in a virus that acts as a delivery vessel and is injected into the eye. Patients receiving therapy had improved “functional' eyesight compared with the control group. Debra Thompson, professor of ophthalmology at Michigan's Kellogg Eye Center, not involved in the study, stated, “We've all been hoping that gene therapy will be approved for these retinal diseases. Getting this close is very exciting.

“The Shot Gives You the Break You Need.” Army General Bolduc, Combat PTSD Patient.

Terms for the condition, Shell Shock, Combat Stress Reaction, Battle Fatigue, or Post Traumatic Stress Disorder the condition is roughly the same with various symptoms but no specific therapy. Sufferers are often irritable, edgy, depressed, and quick to anger. The most common psychological treatments, called exposure therapies, where the sufferer repeatedly revisits the traumatic event to weaken its effect, will prove useful in about 60% of PTSD. In recent years some military physicians have begun treating PTSD patients, especially Army Green Berets and Navy SEALS with stellate ganglion blocks. The theory is that the block locks down the autonomic nervous system and the reaction to stress hormones. Doctors inject ropivacaine in the right side of the neck, using ultra-sound to guide the needle to the ganglion. The Army has an ongoing $2 million study, but finds it hard to get volunteers. Word of mouth has caused many subjects to refuse for fear of being in a control group. They all want therapy, and they know they can get it free from military hospitals without signing up for the program. Treatment is further confused since Green Berets and SEALS want to get back to their unit, while others have an incentive to stay sick. The VA pays benefits to those suffering from combat-induced PTSD, but has no specific policy regarding the use of stellate blocks. Physician advocates of the stellate block say it improves the effectiveness of traditional treatments. Another case of “go figure.”

Hey, Doc. I've Heard of Blowing Smoke Up My—But Steam?

About half of the male population over the age of 50 has some degree of prostate enlargement. Symptoms are frequent urination at night and urinary urgency during the day. Sufferers are offered two choices, surgery or medication, both of which may cause sexual dysfunction. Now a minimally invasive procedure called Rezum (resume) developed by NxThera Inc has become widely available in the United States in the second half of 2016. Rezum uses thermal energy in the form of steam applied to the prostate with a needle. As it cools it releases heat energy into the tissue killing cells and shrinking the gland. It leaves sexual function intact. The procedure costs about $2,000, generally covered by insurance, and can be performed in the doctor's office in just a few minutes. The downside is that the duration of effectiveness is unknown.

Skin Pigment Variations are Disappearing.

Fifty years ago the Supreme Court recognized the right of racial intermarriage. In 2015 one in six American newlyweds crossed the racial line. Asian and Hispanic newlys are by far the most likely to have intermarried with nearly three in ten choosing someone of a different race. The biggest percentage increase is in African-Americans, though black men are much more likely than black women to intermarry. Negative attitudes among nonblacks toward marrying black people have taken a particularly steep drop, according to Pew analysis of data from the General Social Survey conducted by NORC at the University of Chicago. In 1990, 63% of nonblacks said they would be opposed to a close relative marrying someone who is black. By 2016, that figure had fallen to 14%. Color and culture are freely mixed in the 50th state, and no one notices or cares.

Addenda

  • Ernest Hemingway rewrote the final page of “A Farewell to Arms” 39 times.
  • The technical term for goosebumps (chicken skin) is horripilation.
  • Dezi's mother was one of the heirs to the Bacardi Rum Foundation.
  • Where there's smoke there's toast.
  • In biblical times a man had as many wives as he could afford. Just like today.
  • Help! I'm being held captive by my heredity and environment.
  • Schick has a new four blade razor. The first three are to cut your beard, and the fourth one ask your wife not to use it to shave her legs or other body parts.

ALOHA AND KEEP THE FAITH rts

(Editorial comment is strictly that of the writer.)


Articles from Hawai'i Journal of Medicine & Public Health are provided here courtesy of University Clinical, Education & Research Associates