Age and environment-related differences in gait in healthy adults using wearables

“[Abstract] Many traditional assessments of physical function utilized in clinical trials are limited because they are episodic, therefore, cannot capture the day-to-day temporal fluctuations and longitudinal changes in activity that individuals experience. In order to understand the sensitivity of gait speed as a potential endpoint for clinical trials, we investigated the use of digital devices during traditional clinical assessments and in real-world environments in a group of healthy younger (n = 33, 18–40 years) and older (n = 32, 65–85 years) adults. We observed good agreement between gait speed estimated using a lumbar-mounted accelerometer and gold standard system during the performance of traditional gait … Read More

Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT

“[Abstract] Objectives: To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50–69 years. Design: A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. Setting: Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. Participants: Between 2001 and 2009, 228,966 men aged 50–69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 … Read More

Net Adverse Clinical Events With Antiplatelet Therapy in Acute Coronary Syndromes

“Clopidogrel, prasugrel, and ticagrelor are oral platelet P2Y12 receptor inhibitors that decrease the risk of platelet-mediated coronary artery thrombosis. [..] A 1-year composite end point of death, MI [myocardial infarction], and stroke is often used to evaluate efficacy in ACS [acute coronary syndrome] trials. However, death can be defined as all-cause death, cardiovascular death, or death from vascular causes (cardiovascular plus cerebrovascular deaths). Although ticagrelor was associated with a reduction in death in the PLATO trial, no subsequent trial with ticagrelor and no trials with clopidogrel or prasugrel have shown a mortality benefit with DAPT [dual antiplatelet therapy] compared with … Read More

Rethinking Physician Visit Workflows with the AMA’s New Documentation Requirements Starting January 1, 2021

We in health information technology are optimistic that clinicians will update their clinical documentation practices so they use nomenclatures (e.g., Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], Logical Observation Identifiers Names and Codes [LOINC], RxNorm) in designated fields and then add more details within the free text portions of their electronic medical record documentation. While medical informaticists might expect to use natural language processing to extract more elements out of physician documentation, the American Medical Association (AMA) has worked to reduce documentation requirements starting January 1, 2021.1 Given the amount of time clinicians spend interacting with electronic medical records … Read More

Special Report: U.S. jails are outsourcing medical care — and the death toll is rising

“A Reuters review of deaths in more than 500 jails found that, from 2016 to 2018, those relying on one of the five leading jail healthcare contractors had higher death rates than facilities where medical services are run by government agencies. The analysis assessed deaths from illness and medical conditions, suicide, and the acute effects of drugs and alcohol. Jails with publicly managed medical services, usually run by the sheriff’s office or local health department, had an average of 12.8 deaths per 10,000 inmates in that time. Jails with healthcare provided by one of the five companies had an additional … Read More

This Addiction Treatment Works. Why Is It So Underused?

“contingency management, because the rewards are contingent on staying abstinent. A number of clinical trials have found it highly effective in getting people addicted to stimulants like cocaine and methamphetamine to stay in treatment and to stop using the drugs. But outside the research arena and the Department of Veterans Affairs, [..] it is nearly impossible to find programs that offer such treatment — even as overdose deaths involving meth, in particular, have soared. There were more than 16,500 such deaths last year, according to preliminary data, more than twice as many as in 2016. [..] Researchers say that one … Read More

A Comparison of Online Medical Crowdfunding in Canada, the UK, and the US

“The growing importance of medical crowdfunding (MCF) is reflected by trends on GoFundMe, the largest social crowdfunding platform in the world. In 2011, medical causes raised $1.6 million on GoFundMe; in 2014, the amount had increased almost a hundredfold to $150 million and in 2016, more than $650 million. [..] The growing reliance of health care consumers from the US on MCF has been attributed to increasing health care costs and the lack of a publicly funded health care system. However, the popularity of MCF in developed countries with universal health care such as Canada and the UK cannot be … Read More

Steroid Shots and the Culture of Instant Gratification

“The effects of steroid shots on acute URTIs [upper respiratory tract infections] are largely unknown. Widespread use of these drugs belies the scant published evidence that they have any effect at all on the natural courses of acute sinusitis, pharyngitis, or the common cold. What is understood is that even short-term use of systemic steroids carries the potential for troubling and sometimes dire adverse effects, including cataracts, psychosis, immunodeficiency, thromboembolism, and avascular necrosis of the hip. Acute symptomatic relief notwithstanding, the balance of efficacy vs toxicity remains speculative. Yet the consumers of health care—the public—may be so allured by the … Read More

Medical licensing reform sought to support telehealth growth, help fight pandemics

“There is a growing concern that the current patchwork of state medical licensing rules could slow telehealth’s growth and impair the nation’s response to the next pandemic since most states will likely return to their pre-COVID rules as the crisis subsides, experts said. Delaware, Michigan, Wisconsin and Washington, D.C., ended their licensure flexibilities earlier this year. At the same time, Idaho is the only state with concrete plans to allow out-of-state physicians to practice in the state permanently. [..] But it could make sense for the federal government to take the lead on reforming medical licensing since telehealth and pandemic … Read More

Observed to Expected Excess Mortality for the United States, Updated October 24, 2020

This week’s refresh of the excess mortality count from the CDC (last updated October 21 [I think]). The federal agency identified over 289,000 excess deaths across the country since the start of this year (about 15,000 more than last week’s estimate). The overall excess mortality rate increased from 11.1% last week to 11.4% this week. Data from CDC’s National Center for Health Statistics, updated October 21, 2020