NPR: Patient Vigilance Can Help Thwart Errors In Doctors’ Offices

Here at AGE, we always encourage seniors, family caregivers, and relatives to advocate for themselves in the doctor’s office. By asking questions, expressing your concerns, and insisting a thorough exam to address your issues, you can make sure you get the right care you need. Current findings on hospital related errors is another reason. Check out the article below to see the eye-opening statistics, and tips on how to keep yourself from becoming one! -SP

 

by Michelle Andrews

 

Serious medical errors that result in malpractice payments are almost as common in outpatient settings like physicians’ offices and urgent care clinics as they are in hospitals, according to a recent study published in JAMA.

Of nearly 11,000 malpractice claims paid on behalf of doctors in 2009, 48 percent were for problems that occurred in hospitals, while 43 percent were for outpatient errors (another 9 percent occurred in both settings).

Unlike hospitals, however, where surgical errors were the No. 1 reason for adverse events that led to malpractice payouts, in outpatient settings, the study found, there was a very different culprit: diagnostic errors.

This makes some sense since much of what happens in doctors’ offices and clinics is related to trying to figure out what’s wrong with patients.

What causes diagnostic errors and how to avoid them is a subject of growing interest among researchers and policymakers. One oft-cited study of diagnostic errors in the outpatient setting that was published in the Annals of Internal Medicine in 2006 found that usually misdiagnoses were the result of multiple errors. The most common breakdowns were failure to order appropriate diagnostic tests and failure to create a proper follow-up plan.

Why did the errors occur? Physician failures in judgment, vigilance, memory or knowledge were the top factors that led to problems.

As a patient, there’s little you can do to prevent poor judgment, for example, or a lapse of memory on the part of your physician that leads to a medical error. But there are steps that patients can take, especially in the outpatient setting, to help minimize errors, say experts. The lead author of the JAMA study, Dr. Tara Bishop, suggests the following:

  • Unlike hospitals, where things happen quickly and patients may not know what’s being done to them, in an outpatient setting patients can and should make the effort to know what medical tests and treatments are being performed, and why.
  • Follow up to get the results of tests that have been ordered.
  • If necessary, get copies of test and treatment results and send them to other practitioners who are involved with your care.
  • Carry an updated list of the medications you take with you at all times and share it with all your doctors.
  • Make sure you feel comfortable talking with your doctor and asking questions. If you don’t feel comfortable, find another doctor.

Bishop is a busy researcher. She and some colleagues just published another paper that finds doctors are more likely to stop taking new patients with private insurance than those covered by Medicare.

 

Full article at NPR.org. Click here.

Study: Low-Carb, High-Fat Diets May Not Pose Risk to Arteries

Well, hmmmm. Another study suggesting that maybe the low carb diet isn’t so bad after all. While for some folks, this might mean an about face in their eating habits, but we at the AGE Blog hope you take it all in stride. Check out the findings below and leave your thoughts too.-SP

By Kathleen Doheny
HealthDay Reporter

THURSDAY, June 2 (HealthDay News) — New research suggests that low-carbohydrate diets, with regular exercise as part of the plan, don’t appear to harm the arteries, as some experts have feared.
Click here to find out more!

“It’s pretty clear low-carb is effective for weight loss,” said study author Kerry J. Stewart, director of clinical and research exercise physiology at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. “The concern has been that because you are eating more fat this is going to put stress on your blood vessels.”

So, Stewart and his team evaluated the short-term effects of a low-carb, higher-fat diet after a single meal. The researchers also compared a low-carb diet with a low-fat diet in dieters. In each case, they found no ill effects on blood vessel health.

Stewart is due to present his findings Friday at the American College of Sports Medicine meeting in Denver.

However, one nutrition expert said longer-term research is needed before concluding that high fat intake doesn’t hurt blood vessel health.

For the first study, Stewart’s team looked at the effects of eating an extremely high-fat McDonald’s breakfast. The breakfast had more than 900 calories and 50 grams of fat. “That’s half of what you should eat in a whole day,” Stewart said.

The researchers then evaluated a marker of arterial stiffness and another measure of blood vessel health, known as endothelial function. “Even after eating this one meal, we didn’t find any vascular changes from before to after,” he said.

The arterial stiffness, in fact, improved, he noted, although he is not sure why.

Neither study had industry funding; both were financed by the U.S. National Heart, Lung, and Blood Institute.

For the diet study, Stewart assigned 55 men and women who were overweight or obese to the low-carb diet or a low-fat diet. They also had abdominal obesity and a large waist circumference (35 inches or more for women, 40 or more for men). Both are risk factors for heart disease.

The low-carb plan included up to 55 percent fat at the beginning, and phased down to about 40 percent. It had about 15 percent carbs initially, and then went to 40 percent. The other dieters followed the American Heart Association’s low-fat diet, with no more than 30 percent fat a day.

Article continues here at USNews.com.

Living with Alzheimer’s Disease

YNN Austin recently highlighted Alzheimer’s Disease in their Healthy Living segment. Check out the video to learn more about recent research. -SP

Alzheimer’s is a degenerative disease where nerves in the brain die. Recent studies have identified new genes that may contribute to the late onset Alzheimer’s disease.

Some new developments have come out in Alzheimer’s research. Find out more in this edition of “Healthy Living.” Watch the video to check it out.

ABC News: Sugary Drinks Could Drive Up Blood Pressure

Like Salt, Sugar Might Boost Blood Pressure, Researchers Say

By KRISTINA FIORE, MedPage Today Staff Writer
Feb. 28, 2011

People with high blood pressure may have to start watching their sugar as well as their salt, new research suggests.

In a new study, those who consumed the most sugar-sweetened beverages like soda and fruit juices had higher blood pressure readings, Dr. Ian J. Brown of Imperial College London, and colleagues reported in the journal Hypertension.

The data “suggest that individuals who consume more soda and other sugar-sweetened soft drinks may have higher blood pressure levels than those who consume less, and the problem may be exacerbated by higher salt intake,” Brown said in an email to MedPage Today and ABC News.


Read more at ABC News website.

Patterns: Maternal Link to Alzheimer’s Makes a Gain

By NICHOLAS BAKALAR
Published: February 28, 2011

Alzheimer’s disease is more common in people whose mothers had the illness than in those whose fathers had it — and the evidence can be found in the brains of people who are still healthy.

Researchers studied 53 mentally healthy men and women over 60 years old. Ten had a father with Alzheimer’s, 11 a mother with the disease, and 32 had no family history of the illness. Each volunteer underwent an initial M.R.I. examination and was examined again two years later.

All the volunteers were still cognitively normal at the two-year point, but those with a family history of Alzheimer’s had significantly more brain atrophy than those without a family history. And even after controlling for age and sex, the deterioration was significantly greater in those with a maternal history of Alzheimer’s than in those with a paternal one.

The authors acknowledge that the study, published in Tuesday’s issue of Neurology, depended on volunteers reporting their parents’ illnesses accurately.

Still, the lead author, Robyn A. Honea of the University of Kansas, said scientists were getting closer to quantifying risk with brain scans. “The goal is to do a scan on someone before they get the disease and be able to tell if they’re at higher risk or starting to deteriorate,” she said. “Can we do that now? No. We need more and larger studies.”

Read the full article at The New York Times website.

Study: Are two languages better than one in preventing Alzheimer’s Disease?

Alzheimer’s self-defense: Are two languages better than one?
Posted by David W Freeman

(CBS/AP) – Two languages may be better than one when it comes to protecting your brain from Alzheimer’s disease, recent research suggests.

The research focuses mostly on people who are truly bilingual and have been for many years, but scientists say learning a new language later in life might help.

Ellen Bialystok, a psychologist at York University in Toronto, studied 450 people with Alzheimer’s. Those who were bilingual were diagnosed between four and five years later than those who spoke only one language. She discussed her research Friday at a science meeting in Washington.

More than five million Americans have Alzheimer’s disease, according to the Alzheimer’s Association. The disease is the fifth-leading cause of death.

Full article at the CBS News website.

Research: Can Prescription Amphetamine Use Raise Parkinson’s Risk?

By Stacy Lipson, HealthDay Reporter

SUNDAY, Feb. 20 (HealthDay News) — Taking prescription amphetamines may raise your risk of developing Parkinson’s disease later, new research suggests.

But, the researchers noted that the study did not prove a cause-and-effect relationship and further investigation is warranted.

Study author Stephen K. Van Den Eeden, a senior investigator at the Division of Research at Kaiser Permanente Northern California, in Oakland, said that people who reported using Benzedrine or Dexedrine at some point in their lives showed a 60 percent greater chance of developing the neurological disorder when compared to those who said they had never taken the medications.

“We already know that there are certain risks of amphetamine use,” Van Den Eeden said. “This is one concern that is unproven, but we need to take into consideration whether the benefits outweigh the known risks, and maybe potential risks.”

Amphetamines affect the release and absorption of dopamine, a key neurotransmitter implicated in the development of Parkinson’s disease, according to background information in the report. They are commonly prescribed for the treatment of attention-deficit hyperactivity disorder (ADHD), traumatic brain injuries and a chronic sleep disorder known as narcolepsy. These medications were also being routinely prescribed for weight loss when the research first began.

Between 1964 and 1973, 66,348 study participants answered two questions concerning amphetamines: The first asked if the person had ever taken weight-loss drugs in general, while the second asked about the use of Benzedrine and Dexedrine in particular. After 1995, researchers followed up on the participants and found that 1,154 had been diagnosed with Parkinson’s. The mean follow-up period was 38.8 years. While those who said they had taken Benzedrine or Dexedrine showed an increased risk for being diagnosed with Parkinson’s, those who simply said they had taken weight-loss drugs in general did not.

Read more at HealthDay blog at the Business Week website.

Daily walks do more than just clear your head

Brisk walking linked to better memory for seniors
(AP) – 50 minutes ago

WASHINGTON (AP) — A section of the brain involved in memory grew in size in older people who regularly took brisk walks for a year, researchers reported Monday.

The new study reinforces previous findings that aerobic exercise seems to reduce brain atrophy in early-stage Alzheimer’s patients, and that walking leads to slight improvement on mental tests among older people with memory problems.

The new analysis, led by researchers at the University of Pittsburgh and University of Illinois at Urbana-Champaign, appears in Tuesday’s edition of the Proceedings of the National Academy of Sciences.

The study involved 120 sedentary people, ages 55 to 80. They were divided into two groups: Half began a program of walking for 40 minutes a day, three days a week to increase their heart rate; the others only did stretching and toning exercises.

The hippocampus, a region of the brain involved in memory, tends to shrink slightly with age and that’s what happened in the group that only did stretching. But among people who took part in the walking program, the hippocampus region of the brain grew in size by roughly 2 percent.

Researchers found that there was some memory improvement in both groups, but “in the aerobic exercise group, increased hippocampal volume was directly related to improvements in memory performance.”

“We think of the atrophy of the hippocampus in later life as almost inevitable,” Kirk Erickson, professor of psychology at the University of Pittsburgh and the paper’s lead author, said in a statement.

Added Art Kramer, director of the Beckman Institute at the University of Illinois and the senior author: “The results of our study are particularly interesting in that they suggest that even modest amounts of exercise by sedentary older adults can lead to substantial improvements in memory and brain health.”

Read more here.

Giving Alzheimer’s Patients Their Way, Even Chocolate

This is a great article from the New York Times coverage on Alzheimer’s disease and its impact on American life. What we love about this article is how it explains the emotional needs of Alzhiemer’s patients and their caregivers, and the connection to improving care and quality of life for individuals diagnosed with Alzheimer’s disease. Read the article and let us know what you think or what you’ve experienced.-SP

By PAM BELLUCK, NYT

PHOENIX — Margaret Nance was, to put it mildly, a difficult case. Agitated, combative, often reluctant to eat, she would hit staff members and fellow residents at nursing homes, several of which kicked her out. But when Beatitudes nursing home agreed to an urgent plea to accept her, all that changed.

Disregarding typical nursing-home rules, Beatitudes allowed Ms. Nance, 96 and afflicted with Alzheimer’s, to sleep, be bathed and dine whenever she wanted, even at 2 a.m. She could eat anything, too, no matter how unhealthy, including unlimited chocolate.

And she was given a baby doll, a move that seemed so jarring that a supervisor initially objected until she saw how calm Ms. Nance became when she rocked, caressed and fed her “baby,” often agreeing to eat herself after the doll “ate” several spoonfuls.

Dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic “nip at night,” said Tena Alonzo, director of research. “Whatever your vice is, we’re your folks,” she said.

Once, Ms. Alonzo said: “The state tried to cite us for having chocolate on the nursing chart. They were like, ‘It’s not a medication.’ Yes, it is. It’s better than Xanax.”

It is an unusual posture for a nursing home, but Beatitudes is actually following some of the latest science. Research suggests that creating positive emotional experiences for Alzheimer’s patients diminishes distress and behavior problems.

In fact, science is weighing in on many aspects of taking care of dementia patients, applying evidence-based research to what used to be considered subjective and ad hoc.

With virtually no effective medical treatment for Alzheimer’s yet, most dementia therapy is the caregiving performed by families and nursing homes. Some 11 million people care for Alzheimer’s-afflicted relatives at home. In nursing homes, two-thirds of residents have some dementia.

Caregiving is considered so crucial that several federal and state agencies, including the Department of Veterans Affairs, are adopting research-tested programs to support and train caregivers. This month, the Senate Special Committee on Aging held a forum about Alzheimer’s caregiving.

“There’s actually better evidence and more significant results in caregiver interventions than there is in anything to treat this disease so far,” said Lisa P. Gwyther, education director for the Bryan Alzheimer’s Disease Research Center at Duke University.

Click here to go to the New York Times website for the full article.