More than 40 percent of inpatient operations and 33 percent of outpatient procedures are performed on older adults each year in the United States. And that number is expected to mushroom as the boomer population ages (per a July 2019 article from AARP). To improve the surgical experience for patients 75 and older, the American College of Surgeons has released 30 patient-centered standards of care. It's called the Geriatric Surgery Verification (GSV) Program. It was developed over a four-year period with input from over 50 stakeholders, including hospitals, patients, and providers.
Topics: Dr. Ken's Corner
When work hours for residents in training were capped at 80 hours per week, two questions came up:
- Will residents have enough time to learn everything they need to know?
- Will the residents' future patients suffer as a consequence?
The study's investigators faced persistent "speculation that physicians completing residency today have less robust clinical experience before entering unsupervised practice compared with pre-reform residency cohorts" (per July 2019 BMJ research.) They assumed, however, that "it might also be possible that residents who are less fatigued consolidate their knowledge better and have equivalent or greater clinical competency both during and after residency."
Only two countries worldwide allow direct-to-consumer (DTC) advertising of prescription drugs: The United States and New Zealand. Over 20 years (1997 to 2016) DTC prescription drug advertising in the U.S. increased from $1.3 billion to $6 billion "with a shift toward advertising high-cost biologics and cancer immunotherapy" (JAMA Network, January 1/8, 2019). According to the JAMA-published study, pharmaceutical companies bombarded the American consumer with 4.6 million ads in 2016. This includes 663,000 TV commercials (compared to 72,000 in 1997). The authors' conclusions: "Despite the increase in marketing over 20 years, regulatory oversight remains limited."
Topics: Dr. Ken's Corner
Despite rural-to-urban migration trends, millions of Americans still live in rural communities. Census figures show that they make up 25% of the nation's total population; yet fewer than 10% of U.S. physicians practice in rural communities, according to the National Rural Health Association. The situation is likely to get worse as older rural physicians retire and new medical school graduates choose high-paying, non-primary care specialties better suited for urban settings.
The consequences are predictable. A new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that one out of every four people living in rural areas said they couldn't get the health care they needed recently. And about a quarter of those said the reason was that their health care location was too far or difficult to get to.
Topics: Rural Physician Shortage
Instead of retiring at age 65, many doctors choose to continue practicing medicine well into their 70s and 80s. A national trend to test the competency of these older physicians appears to be gaining momentum, especially among some of the nation's largest hospital systems. Hospitals report growing concern that the mental and physical skills of some of their older physicians have deteriorated to the point of putting patient safety at risk. Paying special attention to "weeding out" impaired physicians once they have reached a certain age is proving to be a sensitive issue, to say the least.
The dramatic increase in Candida auris infections has received little publicity...until now. According to the CDC, nearly half of those who become infected with this nasty fungus die within 90 days. Upon gaining access to a patient's blood-stream, C. auris defies conventional treatment. Ninety percent of the time it's found to be resistant to at least one of the three commonly used anti-fungal medications and 30 percent of the time it's resistant to two or more of the drugs.There have been 587 cases of C. auris in the United States, says the CDC. To date, it's been reported in 12 states, the greatest concentration being in New York, New Jersey and Illinois. Fifty percent of residents in some Chicago nursing homes tested positive for the presence of C. auris. Its spread has become so much of a concern that the CDC has now placed C. auris on its list of germs classified as an "urgent threat."