Highlighting the hidden long-term risks of surgery, how Colorado is working to improve health equity, facilitating early detection of ovarian cancer, and more.
How Surgery Changes the Brain
Every surgical procedure comes with risks, but one potential side effect that’s probably unfamiliar to many is called postoperative cognitive dysfunction (POCD), cognitive problems that may be temporary or could result in long-term changes in behavior or brain function, such as memory, attention, judgment, and perception—especially in very old and very young patients.
According to one study, POCD occurs in 50%–80% of older patients at discharge, 20%–50% six weeks after surgery, and 10%–30% six months after surgery. Other studies link one or more anesthesia exposures in children under the age of 3 to issues with memory; fine motor skills; language; listening comprehension; and behavior, including attention deficit hyperactivity disorder (ADHD).
The exact causes are still unknown, but research is ongoing on the role anesthesia might play in altering brain function, the impact of inflammation in the body in response to tissue damage during surgery, and infection. Understanding the contributing factors and the patient’s risk for POCD is critical to planning their surgery, interventions, and follow-up care. And patients need to be aware of the possibility of changes to their brain and quality of life, and the options available to them, before they or their loved ones go into the operating room.
Source: The Guardian
Patient Perspective — In Colorado, Healthcare Diversity Is a Two-Way Street
One of the approaches to improving health equity (giving everyone the same access to healthcare, regardless of their personal characteristics and situation) involves collecting information about the demographics limiting that access, such as gender identity, race, ethnicity, sexual orientation, disability, location, socioeconomic status, etc. Understanding the population served by providers can help identify what patient needs are not being met; however, Colorado lawmakers attempting to close this gap believe the opposite also may be true—that knowing the demographics of health practitioners can help patients connect with providers who are better suited to provide their care because they share a community, cultural background, experiences, or language.
A new Colorado state law designed to advance health equity will require insurers to increase diversity in their provider networks, prompting them to request more demographic data on health professionals. Although reporting this data is currently voluntary and confidential, the practice is raising warning signals for providers who are concerned that sharing such information publicly—especially regarding sexual orientation and gender identity—may threaten their safety. Dr. Mark Johnson, president of the Colorado Medical Society, told NPR, “There could be some real problems that come out of this, so I am hoping they will be very, very sensitive to what they’re doing.”
Source: NPR
Improving Diagnosis — Spotting Ovarian Cancer Before It’s Too Late
The earlier you can detect ovarian cancer, the better your chances of survival. No screening test has been developed to detect it in its earliest stages, when the entire cancer can be surgically removed; thus, 70% of people with ovarian cancer are diagnosed at stage three or four, when the cancer has spread beyond the ovaries, with only 10% to 40% being cured of the disease after five years. Traditionally, ovarian cancer has been called a “silent killer,” because clinicians thought it has no detectable symptoms, but studies do show there are some warning signs to look for in both early and advanced stages of the disease, such as pelvic and abdominal pain, bloating, difficulty eating, feeling full quickly, and a distended abdomen.
Unfortunately, these symptoms are often misdiagnosed as gastrointestinal and urinary conditions like irritable bowel disease, or even attributed to stress or depression. But two additional factors may point to ovarian cancer: frequency of the symptoms (more than 12 times a month) and duration (for less than a year). One of the leading researchers looking at the symptoms of ovarian cancer, oncologist Dr. Barbara Goff, professor of Obstetrics and Gynecology at the University of Washington, and her team used this data to develop an index that successfully detected ovarian cancer in 60% to 85% of patients in their study—results comparable to diagnoses via blood tests for ovarian cancer.
Source: The Conversation
Infection Prevention — The Pandemic May Be Boosting Antibiotic Resistance
A new study of patients hospitalized during the pandemic suggests that COVID-19 is accelerating antimicrobial resistance (AMR), the process by which bacteria and other microorganisms become able to survive the antibiotics designed to kill them. AMR is already considered one of the biggest threats to global health; 1.2 million people died to AMR infections in 2019, and this number is expected to grow to more than 10 million by 2050. But the impact of COVID-19, which may have increased the use of antibiotic treatments and secondary infections in the hospital, could be making a bad problem even worse.
Researchers compared adult patient admissions at 271 U.S. hospitals before and during the pandemic and assessed AMR rates per 100 admissions, analyzing them according to whether drug-resistant infections were acquired before hospitalization or in the hospital. Study co-author Dr. Karry Bauer of Merke Sharp & Dohme (MSD) noted an increase in AMR during the pandemic in both COVID-positive and -negative patients, telling Medical Xpress, “Hospital-acquired infections are a major concern, with antimicrobial resistance rates significantly higher during the pandemic than before.”
More research is needed on the pandemic’s impact on AMR, in the United States and worldwide, but it’s clearly important to keep a close eye on drug-resistant infections and to use this data and trends to continue promoting antimicrobial stewardship and prepare for what the future will bring.
Source: Medical Xpress
Mental Health — ICU Stays Are Traumatic for the Patient’s Family Too
People with a loved one in the intensive care unit (ICU) with COVID-19 may be facing a health risk of their own: a greater chance of developing post-traumatic stress disorder (PTSD) from the experience. A survey of family members after a relative was hospitalized with COVID-19 in an ICU across 12 U.S. hospitals found that 63% of respondents (201 out of 316) showed PTSD symptoms. Many of these family members were unable to visit their loved one in the hospital during the pandemic, contributing to them feeling a lack of control, sudden changes in circumstance, and the need to make fast and difficult decisions—a recipe for stress, anxiety, and depression.
The study, published in JAMA Internal Medicine, underscores the need to involve families in their loved one’s care as much as possible; pay attention to their risk factors for anxiety, depression, and PTSD; and consider screening them following the ICU stay and connecting them with professional help. Lead author of the study, Dr. Timothy Amass, assistant professor of Medicine at the University of Colorado School of Medicine, told CNN, “What the literature really suggests was the more you can get someone involved at the bedside, the more empowered they feel to express their needs and the needs of their loved one.”
Source: CNN
Technology — Robots Helping Ease Clinician Burnout
For the multitudes of healthcare workers experiencing pandemic burnout around the United States, help is coming from an unlikely place: robots specially designed to deliver supplies, medicine, lab samples, and even a patient’s teddy bear throughout the hospital. They come with cute names like Moxi and Tug, and some of them have expressive faces. But these delivery bots are also extremely limited in their capabilities, awaiting instructions from nurses via kiosks or text message, perhaps even unable to call an elevator to move from floor to floor on their own. As with anything in today’s internet-connected world, they could also present cybersecurity risks.
Although some healthcare staff may be worried about their jobs, for those who are already overworked—and have been for a while, even before COVID-19—and considering leaving the profession, others welcome the robot revolution. The robot assistants can handle simple but time-consuming and repetitive tasks such as picking up medication and cleaning up after mealtime, freeing nurses to focus on caring for and talking with patients. Since February, when two of the Diligent Robotics–designed Moxi robots were introduced to Mary Washington Hospital in Fredericksburg, Virginia, they have given back 600 hours of worker time.
Source: Wired
Pediatrics — This Doctor’s Changing Pediatric Emergency Medicine at UPMC
As one of a handful of people in the United States with training in both pediatric emergency medicine and emergency medical services (EMS), Dr. Sylvia Owusu- Ansah is blazing new trails in pediatric emergency care—a field which gets little attention, as emergencies are relatively rarer for children than adults. As director of prehospital and EMS at UPMC Children’s Hospital, Owusu-Ansah has been working to improve the hand-off of pediatric patients from the ambulance to the emergency room. This also involves providing more specialized training and support, which empowers paramedics and emergency medical technicians (EMTs) to provide better care for young patients before they even reach the hospital, which might include observing potential health concerns in the home when they get that call.
Just some of Owusu-Ansah’s innovations since she was appointed at UPMC Children’s: initiating a pediatrics track in the EMS fellowship track, connecting with youth in the community so their only association with healthcare professionals doesn’t revolve around illness, and increasing staff diversity and inclusion. What drives her pioneering spirit? “I’m of the belief that everyone is here for a purpose, for a reason,” she told the Pittsburgh Post-Gazette. “Especially with COVID, time is short. You don’t know how much of it you have, so you try to make the biggest impact you can.”
Source:
Pittsburgh Post-Gazette
