research

How A Five Sentence Doctor’s Note Helped Facilitate The Opioid Epidemic

All it took was one-hundred words to kill over hundreds of thousands of Americans. A new report from the New England Journal of Medicine tells the story of how this short doctor’s note helped facilitate today’s American opioid epidemic: We found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy. In 2007, the manufacturer of OxyContin and three senior executives pleaded guilty to federal criminal charges that they misled regulators, doctors, and patients about the risk of addiction associated with the drug. Our findings highlight the potential consequences of inaccurate citation and underscore the need for diligence when citing previously published studies. Since opioids were not widely used forty years ago, so doctors did not have much data to support addictive properties. The New England Journal of Medicine performed a bibliometric analysis of the validity of the 1980 letter. There were 608 scholars that cited the letter as proof since 1980. 72% cited that addiction was rare among those prescribed opioids; however 81% of scholars did not mention that the patients were hospitalized when they receive the prescription. Because so many scholars cited the letter...

Do Teaching Hospitals Offer Better Mortality Rates?

There are many misconceptions about teaching hospitals, but the easiest mistake to make is to assume that because residents with less experience are involved at the hospital it means that patients will receive a lower standard of care. However, a new study published in JAMA shows that what may sound like a logical conclusion does not hold up. When researchers in the Boston area, led by Laura G. Burke, MD, MPH, Instructor in Emergency Medicine at the Harvard T.H. Chan School of Public Health, set out to examine this very question, they found that data from previous studies was, in many cases, decades old. To gather new data, the researchers looked at hospitalizations from 4,483 different hospitals across the U.S, taking only data from 2012-2014. The researchers then examined the mortality rates for specific medical conditions and surgeries, such as stroke, heart failure or hip replacement. In their analysis of 21.5 million hospitalizations of Medicare patients, the researchers found that the 30-day mortality rates were significantly better at major teaching hospitals, even when patient data was adjusted for age and the severity of illness, or when the hospital data was adjusted for size of hospital, etc. The 7-day and 90-day mortality rates were also better at the major teaching hospitals when compared to non-teaching hospitals. Because of their close association with medical schools, teaching hospitals may be at the...

Before You Board That Plane – Have You Had Your Measles Vaccination?

The  Measles, Mumps and Rubella (MMR) shot is one of the many immunizations recommended by the CDC for healthcare workers and it is on the immunization schedule for children as early as 12 months. However, small outbreaks of Measles continue to occur in the US, with the vast majority of these infections coming from travelers returning from overseas trips. A highly contagious virus, Measles symptoms include high fever, cough and runny nose, followed by a red rash. In about 30% of cases there are serious complications, such as brain inflammation, blindness and pneumonia. Before immunization became common in the United States there were 3-4 million cases of measles each year, but as of 2016, the WHO declared that Measles was no longer endemic in the Americas. A new study from the Annals of Internal Medicine takes a closer look at pre-travel health consultations and the missed opportunities to establish measles immunity in adults travelling overseas. In association with the CDC’s Global TravEpiNet, researchers utilized data from 24 sites where adults born after 1957 filled out a survey regarding their pre-travel medical consultations. From an initial pool of 40,810 travelers, 6,612 travelers were deemed eligible to receive the MMR vaccination at the time of the consultation, meaning that they were in good health and did not report already having the MMR vaccination. Despite their eligibility, over 53% of patients did not go...

Helping Mice Mate: 3D Printing Ovarian Envelopes

Northwestern University researchers have tested various 3d printing techniques to discover the angles at which ovarian follicles will optimally interact with their scaffolds to increase ovary survival. 30º and 60º angles apparently provide better protection and vascularization than 90º angles. The results have been harnessed to create a prosthetic implant that is meant to help restore fertility. Sterile mice implanted with these new follicle-infused scaffolds were able to reproduce through natural mating processes. The hope for the future of this research is to provide renewed fertility to female cancer patients rendered sterile by their therapies. The ovarian bioprosthesis may also hold the key to restoring and/or improving hormone production, which has many applications, including enabling young patients to proceed naturally through puberty. Click here to review the publication in the journal Nature Communications. Below is the foreword: Emerging additive manufacturing techniques enable investigation of the effects of pore geometry on cell behavior and function. Here, we 3D print microporous hydrogel scaffolds to test how varying pore geometry, accomplished by manipulating the advancing angle between printed layers, affects the survival of ovarian follicles. 30° and 60° scaffolds provide corners that surround follicles on multiple sides while 90° scaffolds have an open porosity that limits follicle–scaffold interaction. As the amount of scaffold interaction increases, follicle spreading is limited and survival increases. Follicle-seeded scaffolds become highly vascularized and ovarian function is fully...

Could your energy drink or Starbucks kill you? Take the Caffeine Risk Calculator

As medical students and health professionals, it’s tempting to overdose on caffeine. Since we work and study for long and unorthodox hours, more often than not, it’s very easy to get ahead of ourselves while drinking our regular cup of coffee or tea. However, you might want to put a hold on the extra cup. Richland County Coroner Gary Watts reported yesterday that a 16-year old South Carolina high school student died from heart problems caused from caffeinated drinks. Watts says the teen drank a large Mountain Dew, a latte from McDonald’s, and an energy drink in just two hours, before collapsing on April 26th. Death by caffeine overdose is incredibly uncommon. However, this teen’s death begs the question: how much caffeine is too much? As we know, caffeine is highly addictive, and people who don’t consume it regularly shouldn’t consume too much at a time. According to the Food and Drug Administration (FDA), the recommended amount of caffeine consumed in the US is approximately 300 mg per person per day – the equivalent to between two and four cups of coffee. The Mayo Clinic reported that adolescent teens should never consume over 100 mg daily, and children should never consume it at all. Common symptoms of caffeine overdose include migraine headaches, insomnia, irritability, restlessness, frequent urination or inability to control urination, stomach upset, fast heartbeat, and muscle tremors, all of which require medical attention. And this doesn’t include the...

Gut Bacteria that May Cause Stroke

New research published in Nature has added convincing data to the theory that the gut bacteria biome may influence our health in many more ways than was previously known – and not just in the stomach. Researchers at the University of Pennsylvania were studying a rare genetic disorder that causes cerebral cavernous malformations where bubbles filled with blood protrude from vessels in the brain and could leak or pop at any time. Although they identified 3 different gene mutations linked to the disorder, it wasn’t until they moved their lab out of one building and into another that they made the unlikely link between the gene mutation, the brain disorder and gut bacteria. In the course of their study, students followed a research protocol that deleted specific genes in the study mice using a drug injection. Once the gene was deleted, the mice would begin to develop the brain malformations. Occasionally the injection would cause an abscess and then bacteria from the gut would leak into the bloodstream of the mice. But after they moved buildings, only the mice who developed abscesses then went on to develop the brain malformations. Other mice, even though they had the same gene deletion, did not develop the blood bubbles. Finally, the doctors discovered that a lipopolysaccharide, carried on the cell walls of Gram-negative bacteria, was signaling the brain to produce the blood...

Four Reasons to Love your Nurses

There are hundreds of reasons to thank our nurses every day, and not just for National #NursesWeek. Nurses are on the front lines and are often the first to meet our patients. We rely on them to be efficient, brilliant and caring – all at the same time.   Here are our Top Four Reasons to Love Nurses:   They are caretakers – Most nurses enter the nursing profession, not because it is glamorous or pays well, but because they truly compassionate. They want to help sick people get well, but they also want to help doctors to do their job as best they can. Nurses go the extra mile after our patients when we can’t always be there. They are educators – In his book, “Kill as Few Patients as Possible,” Dr. Oscar London explains that “working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom.” Nursing school is not easy, and, just like medical school, it takes a smart and driven person to succeed. Through their broad range of experiences and close contact with patients, nurses have a lot to teach both doctors and almost-doctors. They listen – Usually, our patients’ first interactions are with our nurses. Whether someone walks in with...