Tag Archives: JAMA

Emergency Care: Flying Intervention Team Use In Acute Ischemic Stroke

In a nonrandomized controlled intervention study published in JAMA, researchers in Germany assessed whether deployment of a flying interventional team, consisting of a neurointerventional radiologist and an angiography assistant, was associated with a shorter time to endovascular thrombectomy for patients in rural or intermediate population areas in Southeast Bavaria.

This video explains the study design. Click https://ja.ma/FIT for full details.

COMMENTARY:

Stroke prevention by a healthy lifestyle, including a good diet, regular exercise, and sleep is of course preferable to treatment.

However, stroke still claims more than 100,000 lives per year in the United States, and is a major factor in disability.

Recognition of a stroke is the first crucial step, and has been discussed in DWWR previously; FAST is the Menmonic and guiding principle. Ask the patient to smile, and it may be assymmetric, with one side drooping. Ask the patient to raise both arms, and one may drift down. Ask the patient to repeat a simple sentence, and he may be unable to do so. And above all be speedy, since time is of the essence, and treatment must take place within a very few hours.

Modern medical centers in large cities frequently have a team dedicated to treating stroke. The patient goes for a CT or MRI while  the Catheter team assembles. An intravenous clot dissolver, tPA, is often used, or possibly a catheter is inserted into an artery and guided to the  proper location. Sometimes the clot is mechanically removed as in the accompanying video.

The helicopter stroke response team featured in the posting is one aspect of the speed that is so essential; any delay will result in death, sometimes permanently, of brain cells.

Acute Heart attack treatment is basically similar to stroke, and was the pioneering venture into the interventional radiology described above. Also, the heart may be the source of the clots that lodge in the brain, especially from atrial fibrillation.

Please enjoy the following video which shows how mechanical clot removal is achieved.

—Dr. C.

MEDICINE: TRANSCATHETER TREATMENTS FOR VALVULAR HEART DISEASE (JAMA VIDEO)

Transcatheter valvular repair and implantation has become increasingly common for treating patients diagnosed with valvular heart diseases.

0:00 This video summarizes the three transcatheter valvular therapies currently in use in the United States: transcatheter aortic valve implantation (TAVI), transcatheter valve-in-valve procedures, and transcatheter edge-to-edge mitral valve repair.

0:47 Transcatheter aortic valve replacement (TAVI) for patients with severe aortic stenosis regardless of surgical risk 2:47 Transcatheter valve-in-valve procedures for patients with bioprosthetic valve failure

3:35 Transcatheter mitral valve repair for high surgical risk degenerative mitral regurgitation and for severe functional mitral regurgitation regardless of surgical risk.

Read the complete review.

ANALYSIS: ‘HEALTH CARE REFORM IN THE BIDEN ERA’

President Biden has released a health care plan that proposes reducing the age of eligibility for Medicare to 60 years and introducing a public option. Larry Levitt, MPP, Executive Vice President for Health Policy at the Kaiser Family Foundation, and Karen Joynt Maddox, MD, MPH, Co-Director of the Center for Health Economics and Policy (CHEP) at @Washington University School of Medicine, and Lawrence O. Gostin, JD from the O’Neill Institute for National and Global Health Law at Georgetown University discuss prospects for health care reform under the new administration. Recorded January 21, 2021.

INFOGRAPHIC: ‘WHAT IS HERD IMMUNITY?’ – ACHIEVING IT WITH COVID-19 (JAMA)

What Is Herd Immunity?

Herd immunity occurs when a significant portion of a population becomes immune to an infectious disease, limiting further disease spread.

Disease spread occurs when some proportion of a population is susceptible to the disease. Herd immunity occurs when a significant portion of a population becomes immune to an infectious disease and the risk of spread from person to person decreases; those who are not immune are indirectly protected because ongoing disease spread is very small.

The proportion of a population who must be immune to achieve herd immunity varies by disease. For example, a disease that is very contagious, such as measles, requires more than 95% of the population to be immune to stop sustained disease transmission and achieve herd immunity.

How Is Herd Immunity Achieved?

Herd immunity may be achieved either through infection and recovery or by vaccination. Vaccination creates immunity without having to contract a disease. Herd immunity also protects those who are unable to be vaccinated, such as newborns and immunocompromised people, because the disease spread within the population is very limited. Communities with lower vaccine coverage may have outbreaks of vaccine-preventable diseases because the proportion of people who are vaccinated is below the necessary herd immunity threshold. In addition, the protection offered by vaccines may wane over time, requiring repeat vaccination.

Achieving herd immunity through infection relies on enough people being infected with the disease and recovering from it, during which they develop antibodies against future infection. In some situations, even if a large proportion of adults have developed immunity after prior infection, the disease may still circulate among children. In addition, antibodies from a prior infection may only provide protection for a limited duration.

People who do not have immunity to a disease may still contract an infectious disease and have severe consequences of that disease even when herd immunity is very high. Herd immunity reduces the risk of getting a disease but does not prevent it for nonimmune people.

Herd Immunity and COVID-19

There is no effective vaccine against coronavirus disease 2019 (COVID-19) yet, although several are currently in development. It is not yet known if having this disease confers immunity to future infection, and if so, for how long. A large proportion of people would likely need to be infected and recover to achieve herd immunity; however, this situation could overwhelm the health care system and lead to many deaths and complications. To prevent disease transmission, keep distance between yourself and others, wash your hands often with soap and water or sanitizer that contains at least 60% alcohol, and wear a face covering in public spaces where it is difficult to avoid close contact with others.

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HEALTH VIDEO: ‘SURGEON GENERAL HYPERTENSION REPORT’ (JAMA NETWORK)

The US Surgeon General’s office has released a report emphasizing the importance of making hypertension control a national public health priority. Vice Admiral Jerome Adams, MD, MPH, the 20th US Surgeon General, discusses the report’s background and recommendations.

Recorded October 7, 2020.

VIDEOS: STARTING INSULIN EARLY FOR TYPE 2 DIABETES

JAMA NETWORK (AUG 5, 2020): 2020 American Diabetes Association (ADA) guidelines recommend that after a trial of metformin, doctors add additional drugs based on the presence of cardiovascular and kidney-related comorbidities, risk of weight gain and hypoglycemia, and cost. In this video, Irl B. Hirsch, MD, of the University of Washington in Seattle, explains the rationale for starting insulin next for patients with persistent HbA1c elevation above 9-9.5% despite lifestyle changes and metformin.

Click https://ja.ma/2DhR4DV for complete details.

PODCAST: “THE EFFECTS OF HEARING LOSS ON COGNITIVE DECLINE” (JAMA REVIEWS)

Even limited hearing loss might be associated with cognitive decline. If true, early intervention with hearing aids might help people have better cognitive performance. 

Michael Johns III, MD, online editor for JAMA Otolaryngology, speaks with Justin Golub, MD, MS, assistant professor of otolaryngology at Columbia University, whose research has shown that very mild hearing loss can be associated with cognitive disability.

COMMENTARY

Hearing loss and cognitive ability decline together as we age, starting earlier in some people than others.

LIVING A HEALTHY LIFE STYLE-with good SLEEP, DIET, EXERCISE and COGNITIVE STIMULATION -seems to help benefit almost everything, including hearing, while a poor life style, neglecting the 4 Pillars, smoking, and drinking alcohol to excess seems to hasten our aging.

Certain medications, often taken to treat the results of a poor life style, can also harm our hearing.

LOUD SOUNDS (such as AMPLIFIED MUSIC), especially if prolonged, are particularly bad. SOUND POLLUTION contaminates the modern world as much as industries‘ excesses. I would often wear ear plugs to Football games (108 dB on my meter) and even in row 4 of the Symphony.

Once damaged, the delicate HAIR CELLS of our inner ear don’t grow back, although medical science once again is working feverishly to save us from ourselves.

Hearing aids can now be programmed to compensate for our particular pattern of frequency loss.

The premise made in the above article and podcast, that decreased HEARING is accompanied by (and Causes?)decreased COGNITION could be supported by a study demonstrating that Improved hearing restores the cognition. I understand that early results may suggest a cognitive benefit of hearing aids.

But PRESERVING BOTH with healthy living would of course be better- at least in my opinion.

Prevention, unfortunately, is a very hard sell in a world of costly medical treatments, where we are protected from directly confronting those costs by ever-expanding insurance. How about Medical savings accounts?

—Dr. C.

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