Childhood Fever – Nineteenth Century Medical Mystery

Ignaz Semmelweis, a young Hungarian doctor working in the obstetrical ward of Vienna General Hospital in the late 1840s, was dismayed at the high death rate among his patients.

He had noticed that nearly 20% of the women under his and his colleagues’ care in “Division I” (physicians and male medical students) of the ward died shortly after childbirth.

This phenomenon had come to be known as “childbed fever.” Alarmingly, Semmelweis noted that this death rate was four to five times greater than that in “Division II” (female midwifery students) of the ward.

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“Robot versus Surgeon: No Clear Winner”

An article in Medpage Today noted “Robot-assisted radical prostatectomy (RARP) led to complication rates, readmission rates, and rates of additional cancer therapy similar to those of conventional surgical prostatectomy, a review of almost 6,000 cases showed.”

“First-year reimbursements were greater for patients undergoing robot assisted compared with open radical prostatectomy.”

“Introduced a decade ago, robot-assisted prostatectomy has become the dominant surgical technique for patients with localized prostate cancer. Investigators in some studies have suggested that robotic prostatectomy has driven the overall prostatectomy rate to a level beyond what would have been expected given current demographic and clinical trends.”

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“…Now the NIH Says That This Routine Gender Bias in Basic Research Must End.”

The New York Times article noted “For decades, scientists have embarked on the long journey toward a medical breakthrough by first experimenting on laboratory animals. Mice or rats, pigs or dogs, they were usually male: Researchers avoided using female animals for fear that their reproductive cycles and hormone fluctuations would confound the results of delicately calibrated experiments.”

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“…Medical Trials —Often Fail to Include Older Participants.”

A Boston Globe article noted for older patients the “cardiologist must develop a treatment plan despite little published evidence to guide his clinical decisions.”

“There are almost no data to guide cardiovascular disease management for people who are over 80 and relatively poor data for people over 70… ‘You have smart and caring doctors trying to practice evidence-based medicine, but there is little evidence.’”

“While doctors and policymakers have long recognized that translating drugs from adults to children might not be as easy as halving the dose, and that the toxicities that are common in men might be different than in women, researchers say that the same understanding lags when it comes to older adults.”

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“…Doctors Didn’t Know Whether the Medication Was FDA Approved for the Condition”

The NPR noted: “One study found that 1 in 5 prescriptions written in doctor’s offices has not been approved by the Food and Drug Administration to treat the condition it is being used for.”

“It’s actually quite common for doctors to write ‘off label’ prescriptions, including using cancer drugs to treat migraine headaches or blood pressure medication for heart failure.”

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Most Medical Devices … Approved for Pediatric Use Weren’t Tested on Kids First

A Reuters Health article noted “Children are not simply ‘small adults,’ and a device found to be safe and effective in adults may have a very different safety and effectiveness profile when used in a pediatric population…” “Without this data, it is difficult for clinicians and parents to make informed treatment decisions that weigh the risks and benefits of a particular treatment…,” The new study examined what kind of testing has been done on medical devices meant for kids since an act of Congress incentivized their development seven years ago.

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Both Physicians and … the General Public … Become “Enamored” with New Treatment Options … Even When the Evidence Is Limited or Lacking.”

“Don’t just ask the doctor which type of treatment you should get…,” “Ask the doctor, ‘What happens if I don’t get this treatment? How does this affect the outcome?’”

A Kaiser Health News article noted ”Older breast cancer patients who received radiation treatment after surgery were more likely to undergo a more expensive and somewhat controversial type of radiation called brachytherapy if they got their care at for-profit rather than nonprofit hospitals…”

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What’s the Difference between Non-profit and For-profit Hospitals?

Almost a dozen not-for-profit hospitals in New Jersey have been bought by for-profit companies. The debate is on n New York and Connecticut where for-profit ownership is basically “prohibited.”

A recent article Ct Mirror article noted “State law makes it difficult, if not impossible, for for-profit hospitals to operate in Connecticut. But Tenet Healthcare, a national, for-profit hospital chain, is in the process of acquiring four Connecticut hospitals. That’s inspired two competing efforts in the legislature. One push is to change state law to make it easier for hospitals to be run by for-profits. The other is to restrict the ability of hospitals to become for-profit.”

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Mount Sinai to Open Kidney Stone Center

A comprehensive outpatient Kidney Stone Center, which will offer patients new minimally invasive techniques and a holistic approach to prevention, will be the first of its kind in New York City when it opens this fall in two Manhattan locations.

The Center will be headed by Mantu Gupta, MD, who was recently named Director of Endourology and Stone Disease for the Mount Sinai Health System, Chair of Urology at Mount Sinai Roosevelt and Mount Sinai St. Luke’s, and Professor of Urology.

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