| Top : 2007 : 2007_02_08 |
Doctors Superbug battle is winnableThu, 08 Feb 2007 08:33:25 GMTBy JOANN LOVIGLIO, Associated Press Writer PHILADELPHIA - Hospitals can stem the alarming spread of a dangerous and drug-resistant staph infection by screening new patients and keeping them quarantined, say doctors who tried this novel approach. One model is a pilot program started in 2001 at the Pittsburgh Veterans Affairs Healthcare System, which has dramatically cut the rate of the potentially deadly germ, called methicillin-resistant Staphylococcus aureus, or MRSA. It is resistant to most antibiotics and usually acquired in hospitals and nursing homes. Pittsburgh VA guidelines require that all patients get their noses swabbed for MRSA upon admission and discharge. Those with the bug are isolated from other patients and treated by health care workers in gowns and gloves. Even non-invasive instruments, like blood pressure cuffs and stethoscopes, are disinfected after every use with these patients. There are also strict hand-washing policies and regular data sharing. MRSA infections in the Pittsburgh VA surgical care unit have dropped more than 70 percent, according to Dr. Robert Muder, the infectious diseases director. "You don't necessarily have to do it the way we did it, but you can do it," Muder said this week at a meeting of infection control doctors at the University of Pennsylvania. Officials plan to expand the program to the 150-plus VA hospitals nationwide after seeing the Pittsburgh results. They'll start testing for MRSA in intensive care units next month and expand incrementally until everyone is getting screened. MRSA is a big problem in health care settings where it is primarily spread from patient to patient by the contaminated hands, equipment and clothing of health care workers. When it gets into the body, this form of staph can cause anything from flesh-eating infections to pneumonia. About a third of people have the germ on their skin or in their nose but aren't sick. Even so, they can still spread it. The Centers for Disease Control and Prevention estimate that about 90,000 people die from hospital-acquired infections annually. About 17,000 of those deaths involve MRSA. Other hospitals have myriad anti-MRSA approaches — a few places screen everyone, some test just high-risk patients such as those with weak immune systems or who live in nursing homes, and others screen just those in high-risk units like intensive care. "Having different hospitals doing it different ways will help us see what works," said Dr. Harold Standiford, the University of Maryland Medical Center's infection control chief. "It's going to be a continual process." The http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html Dentists begin offering spa treatmentsThu, 08 Feb 2007 10:12:36 GMTBy LINDSEY TANNER, AP Medical Writer CHICAGO - When you think of relaxation, chances are dental drills and Novocain needles don't come to mind. So it seems odd to see "dental spa" written across the clear glass doors of a dentist's office in Chicago's tony Water Tower building, and to hear soothing classical music as you lie on a cushy massaging reclining chair while the hygienist readies her tooth scraper. It may seem odd, but it's getting more and more common. Spa dentistry is a growing niche carved out by tooth doctors trying to take the bite out of going to the dentist. At the Mitchell Dental Spa in Chicago, patients are offered a flat-screen TVs to watch while the dentist is drilling, not to mention 10-minute spa treatments, including cooling eye masks and back massages by an on-staff massage therapist — all free with usual dental care. "If you have to have a dental procedure, nobody's looking forward to it. If we can create an environment so people can relax, have something to eat... give them a back massage afterward, I think we can start to turn it around and make it a really positive experience," said Dr. Margaret Mitchell, who turned her regular practice into a dental spa a few months ago. How about a tingly peppermint foot scrub while having your fillings replaced? That's offered at The Hills Dental Spa in Austin, Texas, where amenities also include herbal teas and lavender aromatherapy candles to disguise that medicinal dental office smell. Hot wax mittens during root canals are available at New York City's Manhattan Dental Spa. For $95 extra, the Madison Avenue office last year began offering acupuncture by a trained hygienist, for relaxation during dental procedures. American Dental Association data suggest that about one-fourth of U.S. adults avoid dental visits because of fear of pain or a previous bad experience. To make the experience more comfortable, dentists several years ago began offering things like television and headphones. Spa services are an extension of that trend, said Dr. Matthew Messina, a dental association spokesman. An association poll of 427 U.S. dentists in 2004 found that about half offered services including headphones, neck rests, warm towels and free snacks, while about 5 percent offered more spa-like amenities such as massages, facials and manicures. The Internet and a move toward more marketing and patient-centered care in dentistry and medicine has helped the spa trend catch on, Messina said. Some dentists have taken the spa concept a step further, opening their offices to skin specialists offering Botox and other cosmetic procedures, Messina said. "If the patient is more relaxed and the dentist is more relaxed, then it really is a kind of win-win situation." Still, he added: "Fundamentally, the dentistry has to be well-done or the rest of it is just all smoke and mirrors." Damian Clark, 24, an account manager for an online company and a new Mitchell patient, said his first visit to the Chicago office was an eye-opener, with its blond wood floors, refreshment bar and cool, airy decor. "It was shocking to me at first because it's totally not something I'm used to at all. I felt very posh," Clark said. He said all the distractions made a recent painful gum procedure almost pleasurable. "I've been referring my friends," Clark said. That kind of free advertising is part of the point of offering a spa-like environment, said Dr. Mitchell Charnas of the Manhattan Dental Spa. Charnas said patient referrals at his office have increased substantially since he began offering spa services about two years ago. "The biggest thing is you want people to get referrals, to talk well of you," Charnas said. Still, not all patients want to be pampered. "There's a pretty good mix of America that just wants the dentistry done and to get it over with," Messina said. He said his own dental office, in Fairview Heights, Ohio, offers TVs in treatment rooms and an airy decor, but no spa services. "I'm not a big foot massage guy, personally," Messina said. ___ American Dental Association: http://www.ada.org Study Moral beliefs may sway docs careThu, 08 Feb 2007 04:45:20 GMTBy LINDA A. JOHNSON, Associated Press Writer A disturbing number of doctors do not feel obligated to tell patients about medical options they oppose morally, such as abortion and teen birth control, and believe they have no duty to refer people elsewhere for such treatments, researchers say. The survey of 1,144 doctors around the country is the first major look at how physicians' religious or moral beliefs might affect patients' care. The study, conducted by University of Chicago researchers, found 86 percent of those responding believe doctors are obligated to present all treatment options, and 71 percent believe they must refer patients to another doctor for treatments they oppose. Slightly more than half the rest said they had no such obligation; the others were undecided. "That means that there are a lot of physicians out there who are not, in fact, doing the right thing," said David Magnus, director of Stanford University's Center for Biomedical Ethics. According to an American Medical Association policy statement, doctors can decline to give a treatment sought by an individual that is "incompatible with the physician's personal, religious or moral beliefs." But the physician should try to ensure the patient has "access to adequate health care." The survey did not examine whether these doctors act on their beliefs — that is, whether they actually withhold information or refuse to refer patients. But the researchers calculated that tens of millions of Americans might be going to such doctors. "Conscientious objection is fine ... as long as it doesn't conflict with the rights of the patient," Magnus said. "You can't abandon the patient or essentially coerce the patient by saying you won't do the procedure or refer them to someone else." The study was published in Thursday's http://www.nejm.org ACOG: http://www.acog.org AMA: http://www.ama-assn.org Hair salons raise stroke awarenessThu, 08 Feb 2007 01:23:54 GMTBy MARILYNN MARCHIONE, AP Medical Writer SAN FRANCISCO - Two women in Cincinnati had better leave big tips the next time they get their hair done. They survived strokes thanks to fast action by their beauticians, who were taking part in a novel program to raise stroke awareness as they clipped, straightened and braided their customers' hair. One stylist noticed that a woman's speech was slurred, and called for help. Another woman called her hairdresser weeks after having been in the shop, describing symptoms she was having. "The beautician recognized it as signs of a stroke, called 911, walked to the woman's apartment and waited with her until an ambulance arrived," said Dr. Dawn Kleindorfer, a University of Cincinnati neurologist who led the project and reported results Wednesday at an American Stroke Association conference in San Francisco. Beauticians and barbers increasingly are being used like churches to spread the word about stroke, cancer and other diseases. What they can do may be as important as any doctor, drug or diagnostic test. That is because the key factor to surviving a stroke and limiting its damage is time. The main treatment — a clot-busting medicine called tPA — must be given within three hours of the start of symptoms to do any good. But fewer than 5 percent of stroke sufferers wind up getting it. "By far the biggest reason is people delay going into the hospital because they don't know the signs or realize it's an emergency," Kleindorfer said. She signed up dozens of stylists in Cincinnati and Atlanta in 2005 for a pilot project to teach customers the warning signs. Why beauty shops? "This is a great captive audience," she said. "African-American hairstyles can take a long time. They're there for a long time with someone they know and trust." Doctors trained the stylists, who then quizzed nearly 400 of their customers on stroke knowledge, talked with them as they did their hair, and sent them home with wallet cards with the stroke warning signs. They used a simple memory device — FAST, which stands for face, arm, speech, time. Numbness or weakness of the face or arm, especially on one side, and slurred speech are warning signs. Time refers to the window of opportunity for help. Customers were surveyed again at follow-up appointments roughly six weeks and five months later. At the start of the program, only 41 percent could name three warning signs. By the end, 51 percent could. The number who knew no stroke symptoms also declined. Awareness of the need to immediately call 911 improved. But knowledge of stroke risk factors — high blood pressure, high cholesterol, diabetes and smoking — did not. The detection of two strokes by stylists was an unexpected benefit. The women involved did not want to be identified or discuss it. The Hazel K. Goddess Fund for Stroke Research in Women paid for the program. "I felt that it was much needed in an ethnic salon and the black community," said Dorothea Jones, owner of DJ's Image, a Cincinnati salon that participated. "We come in contact with so many people and they can take it back to their families," said Jones, who also was motivated because her nephew suffered a stroke and had to go through rehabilitation. "It's very promising," said Dr. Michael Sloan, a stroke specialist at Carolinas Medical Center in Charlotte who had no role in the study. "We're trying to find ways to get the word out," and targeting beauty shop customers and workers seems ideal, he said. "They tell them gossip, their personal lives, their secrets. That type of rapport gives an opportunity" to share health tips, Sloan said. Virgil Simons, head of the advocacy group Prostate Net, thought the same thing when he signed up hundreds of barbers to talk to customers about prostate cancer in 2004, to coincide with release of the movie "BarberShop 2." Its maker, MGM, helped finance the campaign. "Not everybody goes to the doctor," Simons said in an interview last week. "The barber is someone they've seen, in many cases, since they were a kid. He's a pillar of the community, a business leader, a culturally credible communicator. While he's cutting hair, he can say, `Hey, when is the last time you had your PSA checked?'" His project reached more than 10,000 men in its first year and now includes more than 800 barbers around the country. Other groups have used beauticians to raise awareness of breast cancer and mammograms. ___ On the Net: Stroke information: http://www.strokeassociation.org |