Posts Tagged ‘infections’

Summer Vacation Checklist: Add Vaccination to Your List!

Monday, May 30th, 2011

Photo from guardian.co.uk

Ahhh, summer vacation is coming. Passport? Airline tickets? Three 1oz containers? Zipper-lock bag? Sunblock? Camera? Vaccination status?

Summer is typically the busiest time for vacationers to explore new territories, or even old ones. Granted, the economy has replaced some travelers’ grand plans with much more modest ones, but many are still planning trips to Mexico and other foreign destinations. The summer is also a big time for missionary groups to head to underserved areas to provide assistance and medical care. The events of September 11th have forever changed travel for the United States and countries all over the world. There is now a new concern…..your vaccination status!

According to the Centers for Disease Control, the United States is experiencing its largest outbreak of measles in 15 years! USA Today reported a record 118 cases of confirmed measles in the USA between January 1 and May 20 of this year, mostly acquired abroad by unvaccinated individuals and brought back to the States. Measles was reported to have been “eradicated” from the USA as of the year 2000 due mostly to the efforts of immunization, but measles is still prevalent in other parts of the world.

Over 42,000 cases were diagnosed in an outbreak among young adults in Brazil in 1997! Third-world countries are not the only ones affected; over 7,500 cases have been diagnosed in France between January and March of this year, according to the CDC! And the outbreaks continue across most countries of Europe. Failure to vaccinate and receive periodic “booster shots” to provide immunity allows the virus to infect that individual who then gets sick. Since the virus is spread via respiratory droplets (coughing and sneezing), public modes of transportation allow for contact with infected individuals.

Measles is NOT just a rash!

According to the Associated Press, 2 of every 5 of these 118 patients required hospitalization; none died, but measles can have deadly consequences. Worldwide, measles causes nearly 800,000 deaths annually, mostly in small children. Some of the bad consequences include encephalitis characterized by vomiting, seizures, coma and even death; of those who survive this, approximately one-third are left with permanent neurologic deficits.

Once the spots are gone…

Interestingly, there is a late complication of measles infection, called subacute sclerosing panencephalitis (SSPE), that occurs from 5 to 15 years after the acute infection; the virus causes a slow degeneration of the brain and central nervous system long after the initial infection. Measles can also cause bronchiolitis or bronchopneumonia, and it can be associated with secondary bacterial infections due to the depleted immune system that occurs while fighting the virus.

Measles is NOT the only vaccine-preventable disease available for infection!

There have been recent outbreaks of mumps, another viral disease that has potential complications of pancreatitis, orchitis and even meningitis and encephalitis.

There have been outbreaks of Bordetella pertussis (part of the DPT vaccine), otherwise known as “whooping cough.” Pertussis can severely affect young children under 2 years, but it affects adults as well. Since the vaccine does not impart lifelong immunity, adults become a reservoir for this disease, unless a booster shot is given, and the adults spread the disease to unvaccinated children.

Haemophilus influenza type B, known as HIB, can cause typical cases of upper respiratory infections, sinusitis and otitis media (common ear infection); it can also cause epiglottitis, a potentially fatal infection of the epiglottis. The epiglottis is a flap of tissue that acts like a valve, protecting our airway when we eat and swallow food. This “valve” swells up so large from the infection that it can totally obstruct the airway and prevent a child from breathing; it is a medical emergency that can require emergent tracheostomy! An HIB vaccine has been available for years, and this infectious culprit had nearly been eradicated, as well, in the USA. The anti-vaccine movement has produced many children, adolescents and even young adults who have never received this vaccine  - et voila….there is a resurgence of HIB and Haemophilus epiglottitis.

Hepatitis B is a virus (HBV) for which a vaccine has also been available for over 20 years. It is a 3-shot regimen, but it also requires that titers be drawn after vaccination to prove immunity. HBV can be transmitted through sexual contact or any exchange of body fluids, including contaminated food in rare instances. Although the human body can fight some cases of HBV, other cases become chronic and lead to liver failure and/or liver cancer. Wouldn’t you know it? May is “Hepatitis Awareness Month” for the CDC!

There are plenty more vaccines available for a multitude of viral, bacterial and other infectious agents. Additionally, there are immunoglobulin shots that can address other infectious conditions and act as prophylaxis during your time abroad.

The Moral of the Story

Check your own vaccination status first. If you are not sure, your doctor can do blood tests to determine if you are immune to specific infectious agents…even the chicken pox virus! Secondly, take the time to check the CDC website (www.cdc.gov) for infections endemic to the area to which you are traveling. Follow guidelines offered for disease prevention and possible vaccines, medications or immunoglobulins available.

Be aware and be prepared! Protect yourself and those near and dear to you!

 

Week in Review: Miss our posts this past week? Catch-up now!

Saturday, April 16th, 2011

From Eye Opener’s Editor, Brian Nash: Another week gone by – where does the time go? Our bloggers this past week, Theresa Neumann, Jon Stefanuca, Jason Penn, Mike Sanders and Sarah Keogh, were – in addition to practicing law – busy on the keyboard blogging away. In case you missed any posts during the week of April 10th through the 15th, here’s your opportunity to catch-up.

The “Medical Home” – find out what it is and why you should have one!

This past week, Sarah wrote two blogs on a concept that frankly I had not heard of before – the Medical Home. Her follow-up piece on how parents in particular are using emergency departments and clinics was posted yesterday, Friday, April 15th.

In her first piece, Sarah discussed a key issue about continuity of medical care for all of us but particularly our children. While there’s no doubt that there are times when taking your child to an emergency room is the only way to go in a true emergency, is it really the right place for a child to receive primary care? You see a physician or a medical specialist such as a physician’s assistant on a one-time basis. What do they really know about your child’s complete medical history? Do they really address key issues of general health care that is essential to your child’s overall health?

Her second post addresses specifically the topic of how many in this country are using facilities such as in-store clinics and emergency rooms for minor, non-emergency care. While there is no doubt that ED’s and clinics serve a vital role in the providing of healthcare in the United States, are they being used the right way? Are clinics often the only place where many in our country can obtain care for their children? Read Sarah’s posts on What is a medical home? Do your children have one? and her follow-up piece Clinics and Emergency Rooms: Helpful or Barriers to Good Pediatric Care.

A Disturbing Report on Some Area Hospitals and their Complication Rates

Earlier in the week, the new member of our legal team, Jason Penn, wrote about a recent report from the Maryland Health Services Cost Review Commission regarding a continuing failure of several local Maryland and DC hospitals to lessen the number of patients who suffer from complications while in these institutions. P.G. Hospital Center won the dubious distinction of being first in class. Jason reports that this institution, which services many of the area’s population, was fined by the state of Maryland for the number of “complications that are unlikely to be a consequence of the natural progression of an underlying disease.” The “list” includes specified complications such as “bed sores, infections, accidental punctures or cuts during medical procedures, strokes, falls, delivery with placental complications, obstetrical hemorrhage without transfusion, septicemia, collapsed lungs and kidney failure.” For information as to how the local jurisdictions deal with these hospitals in the pocketbook and who made the list, read Jason’s blog post entitled Report Card on Failing Hospitals: Prince George’s Hospital Center Tops “Complications” List.

Learn More about Medicine and Your Health

Theresa Neumann, an in-house medical specialist in our firm, posted Spinal Stroke: An atypical cause of back pain this past week. It’s one thing to have lawyers who live and breath medicine and the law write about medical conditions; it’s quite another to have real medical specialists like Theresa educate all of us on medical matters that affect the lives of so many. Theresa brings to the public’s awareness the signs, symptoms, risks and potential treatment alternatives to a catastrophically disabling condition that many just don’t know about – until it’s too late for them.

We’ve all – unfortunately – heard about or know someone who has suffered a stroke in their brain. Well, as Theresa reports, there’s an equally devastating form of stroke that can hit our spinal cord, which can render the victim paralyzed, without control of bowel or bladder, incapable of feeling sensation and a host of other life-altering consequences. We’re always appreciative of the wonderful, educational pieces Theresa brings to our blog. This piece is no exception.

The War against Super Bugs – MRSA and CRKP – are we losing the fight?

There was a time many months ago where we all became aware of the super bug infection known as MRSA. It was in the news over and over again. Have you heard much about it lately? Silence by news media might make one think that our medical institutions have won the war and the threat of this deadly infection is over. As Mike Sanders tells us – not so quick! In his blog of this past week, Deadly Super Bugs on the rise, Mike tells us who’s winning the MRSA war to and about a newcomer in the Super Bug family – CRKP.

The news is simply not good! See what seems to be working against MRSA and don’t miss the update at the end of Mike’s post about a new prevention method using honey.

Law and Medicine

Well we are lawyers – so why not a piece about our specialty area – representing patients and families of patients against healthcare providers? This past week, Jon Stefanuca wrote what we consider to be a very important piece entitled Should you sue a healthcare provider? Some guidelines to help you decide.

Some may just be surprised about the advice Jon gives in this posting. It is not a call to arms against the medical profession or even a call to our law firm so you can sue the b*****ds! Jon offers some very important advice to those who have been through an experience with a healthcare provider and are considering whether or not they have a potential lawsuit for the injuries they have suffered.

We believe this post encapsulates in large part some principles we have been advocating for a long time. Not every bad outcome means malpractice has occurred. However, how would you – as a lay person – be able to make the distinction between what is and what is not a real medical malpractice case? In addition to Jon’s sage advice, this post links to a White Paper we did on Choosing a Lawyer – a Primer. We hope if you have unfortunately found yourself faced with this issue of whether you should sue or not that you will find this blog by Jon informative and helpful in making your decision.

A Sneak Peak of the Week Ahead

As you can see, our bloggers were quite busy last week. Well, this coming week will be no different. The days ahead will be consumed with representing our clients in depositions, investigations, filing pleadings and court appearances….and writing and posting some interesting, important blogs on aneurysms (did you know they can present as back pain?), laughing gas coming back for moms in labor, sleep deprivation for nurses (and how well that plays out in your healthcare) and some other good stuff our writers are busy working on this weekend and during the week ahead.

Stay tuned – stay informed! Read the Eye Opener and tell your friends about us too! …and don’t forget to join our social networking communities on Facebook and Twitter.

Sepsis – Simple steps in ER saves lives

Thursday, October 7th, 2010

Following summer headlines citing extensive hospital deficiencies in screening a fatal illness known as sepsis, there is some good news out of Kaiser Permanente this week.

Sepsis as defined by Wikipedia as a serious medical condition affecting the whole body. As we know, it can even be fatal. Sepsis is caused when a harmful infectious organism invades the body. Invasion can occur through the blood, urine, lungs, skin, or body tissue. The body reacts with an inflammatory response that is characterized by fever or low body temperature, low blood pressure, and an increasing high white blood cell count.  In earlier times the condition was commonly called “blood poisoning”.

As the patient becomes sicker, the body becomes overwhelmed by an acid called lactate acid. It is formed as a result of lowered oxygen to organs and tissue resulting in a condition known as lactic acidosis. As the condition progresses, the body eventually can not overcome the acidosis and low tissue oxygen perfusion. Death ensues often despite aggressive medical treatment.

Kaiser reported 17 participating hospitals in Northern California began using a 6-step diagnostic and treatment tool known as a “sepsis bundle” in 2008 to rapidly diagnose and treat sepsis. Using this new tool and computerized medical records, Kaiser found the patient death rate improved significantly from 25% to 11%, the patients’ hospital stays were 3 days shorter, and $36 million was saved.

However, just the day before Kaiser released their data, another article in FierceHealthcare – daily news for healthcare executives - listed infections add an average 19 days to a hospital stay with a cost per patient of $43,000. This study was published by the Agency for Healthcare Research and Quality who concluded that 12% of all infections were classified as sepsis. Two months ago, Fierce Healthcare reported excerpts from new research published in the Archives of Surgery by a surgeon named Laura Moore practicing at Houston’s Methodist Hospital. Dr. Moore performed a retrospective review of 364,000 general surgery patients registered in the American College Of  Surgeons National Surgical Quality Improvement Database. Sepsis occurred in 2.3% totaling 8,372 patients.  She also wrote mortality from sepsis has doubled in the last 20 years. Sepsis is the leading cause of death in general surgery ICU’s.

In December 2008, the European Society of Critical Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine launched the Surviving Sepsis Campaign. Sepsis is estimated to kill 1,400 people worldwide each day. Mortality rates from severe sepsis are rated as high as lung, breast, and colon cancer. The campaign wrote severe sepsis is expected to grow at 1.5 % annually with an additional 1 million cases per year in the USA by 2020. The campaign sited the cause for this is due to the aging population and increasing invasive medical procedures. HIV and cancer rates are increasing, which will also impact severe sepsis rates.

Sepsis varies greatly in its progression and symptoms seen in each patient. This makes early diagnosis and treatment challenging for even the best ICU physicians. Symptoms such as fever, rapid pulse rate, and respiratory difficulty are commonly seen in a host of other medical conditions. Obtaining an accurate diagnosis can take precious time. In an effort to improve the diagnosis and survival rates, the campaign challenged to USA hospitals to adopt and implement a “sepsis bundle” program and begin reducing mortality by 25% over the next 5 years.

So what is a sepsis bundle? The Surviving Sepsis Campaign chose medical therapies called “elements” designed to give physicians worldwide a framework to standardize sepsis practices. Their specific intent was to reduce the chaotic approaches seen in many clinical settings. The campaign founders consolidated world medical care data and practices that had shown clear positive impact on outcomes. They challenged critical care physicians to choose a grouping of these elements based on their patient population. Next,  physicians were to apply their individualized “sepsis treatment bundle” and  study the outcomes by using the campaign’s measurement database. By choosing to delete an element(s), the hospital would be classified as non-compliant and their performance data would likely show poorer outcomes.

In the sepsis resuscitation bundle, there were 5 critical elements. In the sepsis management bundle there were 4 elements.  So neither bundle is too complicated or intricate to put into medical practice. Now two years later, those early hospitals that accepted the challenge and implemented a sepsis bundle program are publishing their success data. Another fine example was published by Barry Evans, RN, MSN, Adult Critical Care Data Coordinator at the University of Rochester/Strong Health.

Kudos to Kaiser Permanente California, Strong Health, and all the other critical care services who accepted the 2008 challenge for US patients and are making it happen. Can’t wait to see the campaign’s worldwide end data in 2013!