Waiting for a liver
The need for donor livers outstrips their supply. Each year, about one-third of those with end-stage liver disease who need an organ will receive one. Some die while on the waiting list.
The February issue of Mayo Clinic Proceedings examines how the current system for allocating organs in the United States affects recipients’ outcomes.
The United Network for Organ Sharing (UNOS) oversees organ allocation. With the goal of giving organs to the most critically ill transplant candidates, UNOS adopted the MELD — Model for End-Stage Liver Disease — scoring system in 2002. The score is calculated from the results of three lab tests.
“Unlike past evaluation systems, the MELD score de-emphasizes the length of time a patient has been waiting for a donor organ. … Research has shown that although the donor liver shortage persists, implementing this allocation system has decreased the number of patients who die while waiting for donor organs,” according to a Mayo Clinic press release.
The study looked at the evaluation practices and acceptance criteria for liver transplant used by the Mayo Clinic Jacksonville Transplant Center after implementation of MELD scoring. Researchers examined medical records from 555 patients referred for liver transplants at the Jacksonville center from Jan. 1 through Dec. 31, 2005. Of these patients, 53 percent were denied for a transplant. Half of those denied were considered too early to have the procedure, while the rest were excluded because of medical conditions and psychosocial issues — poor support systems or continuing substance abuse problems, for example.
Many were subsequently accepted.
“Patients seeking referral often undergo repeated assessments by selection committees, as their eligibility can change over time or following treatment and/or changes in conditions that led to their initial exclusion,” according to the release.
Data suggest a “broad range” of patients could benefit from early referral to a transplant center, according to the release.
Basically, management of their disease and other medical and psychosocial conditions could make them transplant candidates sooner.
To read the report, click here.
People seldom realize transplant waiting lists are anything but static: They constantly change, depending on organ availability and patients’ medical states. They’re definitely moving targets. People move up, they move down; they drop off, they’re added back.
“Our study suggests that early referral for LT (liver transplant) evaluation is beneficial for reasons unrelated to the time patients spend on the LT waiting list. If patients too early for LT were evaluated but not listed, LT centers could initiate management of ESLD (end-stage liver disease) and address psychosocial issues in a sub-group of patients who could also ultimately benefit from LT,” the authors wrote.
Although not exactly the same thing, last month I wrote about this man, Dr. Ludvik Artinyan, left, who registered on organ waiting lists in California and Oklahoma. He was able to receive a liver transplant quicker by traveling to Integris Baptist Medical Center to have the procedure performed rather than having it done in Los Angeles. Because patients’ MELD scores typically are higher in California for various reasons, double-listing likely allowed the Armenia-born physician to shave months off his wait time and perhaps saved his life.
UNOS allows potential transplant recipients to be listed in multiple regions – they must meet each site’s criteria and be ready to respond to the phone call or page when an organ becomes available.
Is the current organ allocation system fair? E-mail me at jraymond@oklahoman.com or post your thoughts at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Their bodies, ourselves
On a recent weekend I saw something spectacular. No superlatives — it really deserves to be called spectacular.
The introduction in the dimly lit anteroom at the Science Museum of Oklahoma pretty much sums up the “Our Body: The Universe Within” exhibit: A detailed look inside the human body is something that historically has been limited to doctors and researchers yet has fascinated man for millennia.
Despite its $23.95 cost per adult, the 13,000-square-foot exhibit is something everyone should see. Go now, go this weekend, go whenever — just go before it closes May 11. If you have ever wanted your child to become a physician, as just about every parent has, roll the dice and take him or her to the museum; there’s a good chance your child will leave with an abiding fascination about anatomy.
The exhibit is thought-provoking, gasp-inducing, and a real coup for the Science Museum, formerly the Omniplex. It features 18 complete bodies and 135 other body-system, anatomical and health-related items.
One of the most striking things is how respectfully the bodies on display have been treated. Even when posed, with muscles splayed, or seated, with veins and nerves hanging like plumb lines from thick rings of flesh, the bodies retain their dignity. The only time I was uncomfortable was with a man on a spinning platform who is holding his own skin in front of him. I’m not sure if I was uncomfortable because he was holding his skin or because his skin looked like a hide from any other animal.
I know how similar man is to lesser species. Anatomically, genetically and physiologically, the similarities far outweigh the differences. Still, it’s disconcerting to see how much man, stripped of speech and conscience, resembles other mammals.
The bodies don’t smell because they have been treated with a special solution that “plasticizes” tissue and renders it odorless.
Two things particularly stood out to me:
- The first was how dense veins, arteries and capillaries are in some parts of the body. One memorable part of the exhibit has legs, or at least the vasculature of the legs. Take the lungs, liver and kidneys — all are stocked for blood transport, per their functions. It’s one thing to see a spongy lung and quite another to see the vessels that deliver the blood that allows us to breathe. It’s this sort of big-picture perspective that was always lacking in school. It’s one thing to study the nephons in the kidneys, for example; it’s another to see how they look together, by the millions, life-size.
- Parts of the exhibit show slices down the sagittal and transverse planes (take a look at the picture above to see what I mean). I was able to understand, for the first time, how the internal organs relate and where they are located in body cavities. I saw the ventricles, or chambers, of the brain, and the pillow the lungs provide the heart.
I got the impression the exhibit attracts doctors as well: After hearing one describe what he looks for when examining someone’s ears, I realized docs must be thrilled to share what they do with loved ones in a way words simply can’t convey. The man described looking at a patient’s ear drum, and how he would see internal structures and note them on the patient’s chart. Hearing about this and looking into an actual ear and skull must have made the woman with him understand his work so much better.
Have you been to the exhibit? What did you think? E-mail me at jraymond@oklahoman.com.
Jeff Raymond, Medical Writer
‘I have always felt different’
A paper in this month’s edition of the Journal of Pediatric Nursing describes ADHD from the perspective of college students who have it and have learned to cope.
The subject is interesting for several reasons, not the least of which because it features 16 adults recalling how ADHD affected their lives as children. Plenty of research exists on child and adolescent ADHD, but there is little out there on how the condition affects and has affected adults.
The study, from the University of North Carolina at Greensboro and Wake Forest University, is poignant in interviewees’ descriptions of how it feels to have ADHD — being called “stupid” or “slow,” not having parents understand why things don’t get finished.
The study noted common feelings among the group of loneliness and isolation.
“Can’t anyone see I’m struggling,” one study participant lamented.
Common threads through participants’ lives were:
- Trouble getting along with parents
“In their view, children with ADHD have more trouble than others,” the authors wrote.
One’s adolescence is rough no matter what, “but it tends to be a little rougher on people with special needs,” a participant noted.
Another participant described the “mass chaos fights” with parents and siblings — often due, participants said, to failing to perform chores within an expected time frame.
“Because of their distractibility and hyperactivity, participants said that they had difficulty completing tasks, causing problems with their parents,” the authors wrote.
Some parents provided support, but it was tough for them as well.
“My parents did provide support … with homework; making sure I was on top of things. But it kind of got to the point where it was nagging, but that’s how they got the actual answer from me,” a participant recalled. “They had to play 20 questions. I wasn’t trying to withhold information; it just took 20 questions to get the full description.”
- Missing a lot of material at school
Trouble paying attention and hyperactivity affected participants’ ability to learn.
“In class, I had a kind of lag time, ’cause in-between me figuring out what had been going on, the entire class moved on, so I missed out on information. So that was one of the biggest things — missing out — taking a longer time to get the entire idea,” a participant explained.
Participants learned to cope: They allowed help from their parents, asked for more time on tests or took them in different formats, recorded lectures and re-copied notes after class.
- Feeling different
Children with ADHD felt different in school, and situations such as sitting still and grasping concepts quickly made these differences clear.
“Other kids at school would call them retarded, slow, or stupid, and then ostracize them,” the authors wrote.
As such, they often had trouble making friends, and wondered why people didn’t like them. Social difficulties sometimes persisted into adulthood.
“Not only do I have a tendency to interrupt … but the main problem I have is, you need to think before you say something that can offend other people, or when you ask too many questions … they’ll say it makes them feel uncomfortable,” one participant said.
- Feeling misunderstood
“Friendships for children and adolescents with ADHD were fraught with misunderstandings,” the authors wrote.
One participant described how her friends kidded her about her problem.
“I have friends who say, ‘Oh, it’s my ADD and I don’t want to do my work. It’s my ADD kicking in.’ … and they’ll say it in front of me when they know I have it … and I’ll have it the rest of my life. I’ve gotten very mad at them,” the participant explained.
One participant suggested those with ADHD find friends who understand and will call out their names or tap them on the shoulder when they’re “zoned out.”
In 2003, according to the Centers for Disease Control and Prevention, nearly 8 percent of school-aged children were reported to have ADHD.
I don’t mean to suggest that the themes in the study are unique to those with ADHD, but I do think the research provides a window into how adults with ADHD think and the difficulties they face.
Parents of children with ADHD ought to take a look at it to see what their kids may say about their upbringing a decade from now.
Check out a blog in The New York Times on the study here. To read the study, click here.
For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Tips for stuttering
Many people know someone who stutters or stammers — an embarrassing trait that can cause a lifetime of social misery and discomfort. They won’t raise their hand in class and they try to avoid painfully embarrassing situations. The Memphis-based Stuttering Foundation believes that if parents notice their child beginning to stutter, they should seek help as quickly as possible.
The foundation also offers these seven tips:
1 ) Speak with your child in an unhurried way, pausing frequently. Wait a few seconds after your child finishes speaking before you begin to speak. Your own slow, relaxed speech will be far more effective than any criticism or advice such as “slow down” or “try it again slowly.”
2) Reduce the number of questions you ask your child. Children speak more freely if they are expressing their own ideas rather than answering an adult’s questions. Instead of asking questions, simply comment on what your child has said, thereby letting him know you heard him.
3 ) Use your facial expressions and other body language to convey to your child that you are listening to the content of her message , and not to how she’s talking.
4 ) Set aside a few minutes at a regular time each day when you can give your undivided attention to your child. During this time, let the child choose what he would like to do. Let him direct you in activities and decide himself whether to talk or not. When you talk during this special time, use slow, calm, and relaxed speech, with plenty of pauses. This quiet, calm time can be a confidence-builder for younger children, letting them know that a parent enjoys their company.
5) Help all members of the family learn to take turns talking and listening. Children, especially those who stutter, find it much easier to talk when there are few interruptions and they have the listeners’ attention.
6 ) Observe the way you interact with your child. Try to increase those times that give your child the message that you are listening to her and she has plenty of time to talk. Try to decrease criticisms, rapid speech patterns, interruptions, and questions.
7) Above all, convey that you accept your child as he is. The most powerful force will be your support of him, whether he stutters or not.
Jim Killackey, Medical Writer
Creating life
As I scanned the health page of The New York Times Web site this morning, I found this:
“Taking a significant step toward the creation of synthetic forms of life, researchers reported Thursday that they had manufactured the entire genome of a bacterium by stitching together its chemical components. “
Scientists at the J. Craig Venter Institute have constructed viruses, but bacteria are larger and much more complex. According to the story, the genome of the bacterium is 10 times longer than the longest piece of DNA previously synthesized.
“The feat is a watershed for the emerging field called synthetic biology, which involves the design of organisms to perform particular tasks, like making biofuels. Synthetic biologists envision being able to design an organism on a computer, press the ‘print’ button to have the necessary DNA made and then put that DNA into a cell to produce a custom-made creature,” the newspaper reported.
The work was published Thursday online in the journal Science.
However, the newspaper reported, synthetic biology could be used to make pathogens, or scientists’ errors could have unintended effects.
Researchers largely copied the genetic sequence of bacterium Mycoplasma genitalium.
“Moreover, Dr. Venter’s team, led by a Nobel laureate, Hamilton O. Smith, has yet to accomplish the next — and biggest — step. That would be to insert the synthetic chromosome into a living microbe and have it ‘boot up’ and take control of the organism’s functions,” the newspaper reported.
The team ordered 101 gene sequences from biotech companies companies, the newspaper reported. It joined them into bigger pieces. Scientists then inserted four large pieces into yeast, “which hooked them together using a natural gene repair mechanism.”
At some point, the newspaper reported, scientists will be able to synthesize an organism from scratch more cheaply and easily than splicing genes.
Venter is known for sequencing the human genome.
Jeff Raymond, Medical Writer
Hospital tally approaches $1 trillion
U.S. hospitals charged $873 billion in 2005 — a nearly 90 percent increase from the $462 billion charged in 1997 — according to the Agency for Healthcare Research and Quality. The inflation-adjusted 2005 bill represents the amount charged for 39 million hospital stays.
With an average annual growth rate in hospital charges of 4.5 percent, researchers predict the bill will reach $1 trillion by 2008.
AHRQ also found:
-Medicare paid $411 billion of the national bill, followed by private insurance ($272 billion) and Medicaid ($124 billion).
-The uninsured accounted for $38 billion.
This is taken from the AHRQ report:
|
Table 1. Top 20 most expensive conditions treated in U.S. hospitals, 2005 |
||||
|
Rank |
Principal diagnosis |
Total national hospital bill (millions) |
Percentage of national hospital bill |
Number of hospital stays (thousands) |
|
1 |
Coronary artery disease |
$45,985 |
5.3% |
1,110 |
|
2 |
Mother’s pregnancy and delivery |
$43,925 |
5.0% |
4,712 |
|
3 |
Newborn infants |
$35,316 |
4.0% |
4,429 |
|
4 |
Acute myocardial infarction (AMI, heart attack) |
$31,946 |
3.7% |
662 |
|
5 |
Congestive heart failure (CHF) |
$30,230 |
3.5% |
1,090 |
|
6 |
Pneumonia |
$29,535 |
3.4% |
1,355 |
|
7 |
Osteoarthritis |
$26,157 |
3.0% |
738 |
|
8 |
Complication of device, implant or graft |
$25,291 |
2.9% |
616 |
|
9 |
Sepsis |
$24,801 |
2.8% |
538 |
|
10 |
Back pain (spondylosis, intervertebral disc disorders, other back problems) |
$20,327 |
2.3% |
647 |
|
11 |
Respiratory failure, insufficiency, arrest (adult) |
$19,723 |
2.3% |
336 |
|
12 |
Cardiac dysrhythmias |
$17,224 |
2.0% |
697 |
|
13 |
Acute cerebrovascular disease (stroke) |
$17,060 |
2.0% |
526 |
|
14 |
Rehabilitation care, fitting of prostheses, and adjustment of devices |
$13,848 |
1.6% |
517 |
|
15 |
Complications of surgical procedures or medical care |
$13,316 |
1.5% |
463 |
|
16 |
Gall bladder disease |
$11,719 |
1.3% |
456 |
|
17 |
Chronic obstructive pulmonary disease (COPD) |
$11,506 |
1.3% |
630 |
|
18 |
Diabetes mellitus with complications |
$11,171 |
1.3% |
491 |
|
19 |
Hip fracture |
$10,869 |
1.2% |
317 |
|
20 |
Nonspecific chest pain |
$10,027 |
1.1% |
825 |
|
Total for top 20 conditions |
$449,976 |
51.5% |
21,155 |
|
|
Total for all hospitalizations |
$873,236 |
100.0% |
39,164 |
|
|
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2005. |
||||
For more health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Radioactive
Many patients who have had nuclear medicine procedures don’t realize they can set off radiation alarms, a new study from the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality found.
The study appears in this month’s issue of The Journal of Nuclear Medicine.
Twenty million nuclear medicine procedures are performed annually in the United States. They are used to detect and evaluate heart disease, brain disorders and cancer. They also are used to treat overactive thyroids and some cancers.
To quote the journal:
“Patients who receive radiopharmaceuticals in the course of diagnosis or treatment are often released when their bodies still contain elevated amounts of radioactive material. These amounts are sufficiently high to be detected by sensitive radiation monitors for days or even weeks after administration.”
However interesting this may be, the study actually examined how often doctors tell patients about the potential to trigger an alarm.
The study found room for improvement was needed.
“Patients undergoing diagnostic procedures are less likely than patients undergoing therapeutic procedures to be informed that they could activate radiation alarms in public places,” Armin Ansari, a health physicist in the radiation studies branch of the CDC, said in a press release. “We also found that many health care professionals who administer radiopharmaceuticals to patients — or who communicate with them regarding the radiation safety aspects of their procedure — have not had any formal or systematic training in patient education, communications or counseling.”
The study, done in collaboration with the Nuclear Regulatory Commission, examined patient release procedures and practices among 66 health care facilities in 12 states. Participating facilities perform a range of procedures including cardiac stress tests; positron emission tomography; bone, lung and renal scans; thyroid uptake studies; whole body scans and brachytherapy.
The study found that health care professionals — especially those in outpatient clinics and those performing only diagnostic procedures — could better inform and counsel patients before discharge or release.
“If patients plan to travel, they should make sure they have documentation on hand specifying their procedure and that the documentation includes a contact phone number for verification, if necessary,” Ansari said.
Washington University in St. Louis provides patients with wallet cards that detail the source of their radiation exposure should they be traveling, according to the release.
Jeff Raymond, Medical Writer
Elderly visitors may overwhelm emergency rooms
Rates of visits by the elderly to emergency rooms are outpacing those of other groups, which could lead to “catastrophic overcrowding,” according to a study this week in the Annals of Emergency Medicine.
“Seniors are using the emergency department more and more frequently, and given the needs of this population and the nature of their medical problems, the current state of overcrowding is likely to continue to escalate dramatically,” Dr. Mary Pat McKay of The George Washington University Medical Center said in a press release. “These patients tend to be sicker and are more likely to be admitted from the emergency department to the hospital, but with many hospitals running a deficit of inpatient beds, I don’t see where these patients are going to go.”
Researchers studied ER visits from 1993 to 2003, and found that visits per 100 people 65 and older increased faster than the visit rate for any other age group, with an overall increase of 26 percent during the study period.
“People aged 65 and older are the fastest growing segment of the U.S. population. As emergency patients, they use the most resources, stay the longest, and are the most likely to be admitted to the hospital of all emergency patients. Researchers conclude that emergency department visits in the United States for patients between 65 and 74 could nearly double from 6.4 million in 2003 to 11.7 million by 2013,” according to the release.
AARP Policy Director John Rother called on elected officials to “heed the warnings” of the report and recognize that the health care system must deliver appropriate, affordable care.
“The trends released today underscore the need to make sure emergency departments can meet the demand for care by older people, but we also need a better understanding of why emergency room use by older people is on the rise and why these patients may not be getting care from their personal physicians,” he said in the release.
The study suggests older Americans are having more genuine emergencies, rather than increasingly visiting the emergency department.
For health and medical news and commentary, visit The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
E Pluribus Unum
From many, one.
My cloning experiment began Monday when Dr. Terrence L. Stull of the Children’s Medical Research Institute explained the procedure.
Although Stull and everyone in his lab were too polite to say so, I gather explaining such basic experimental techniques is similar to teaching a child multiplication tables or how to conjugate simple verbs in another language — something exceedingly mundane for an expert. But Stull said he still finds this stuff remarkable.
My little exposure to it in college gave me the same feeling, although I don’t think I have the personality to be a successful scientist.
Paul Whitby, a Ph.D.-holding bacteria researcher from England who works in Stull’s lab, explained how he would swab the inside of my cheek and then isolate and clone a gene active in oxygen transportation. This gene is one the lab has studied in the past, so they are familiar with how to isolate and clone it.
You use specific enzymes to isolate a section of DNA you’re looking for, whose sequence you hopefully already know. You combine it with a plasmid (a circular piece of bacterial DNA into which other DNA can be spliced), which takes up the new DNA. The bacteria then can be grown in such a way that you can tell which ones have taken up plasmids with the new DNA. To be sure you have what you want, you sequence the DNA.
Should we successfully get my gene spliced and taken up, we could then grow bajillions of clones of the bacteria.
I have two more visits to make before the process is complete. I’ll go into a little more detail and explain practical applications when I write my story.
From many cells to one, back to many. E Pluribus Unum. Sort of.
For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Diabetes is seldom alone
A recent study from the University of Michigan Health System and the Veterans Administration Ann Arbor Healthcare System found 92 percent of older diabetes sufferers have at least one major chronic condition in addition to diabetes, and nearly half have three or more diseases besides diabetes.
“The sheer number, and the severity, of these other conditions appears to decrease patients’ ability to manage their diabetes,” according to a press release, which suggested doctors learn to better treat “the whole person” rather than that person’s individual ailments.
The study was published online before appearing in next month’s issue of the Journal of General Internal Medicine. Researchers used data from a nationally representative sample of 1,901 adults with diabetes who were 55 years old or older in 2002.
The researchers looked at the influence a range of medical conditions had on participants’ ability to manage their diabetes and whether the conditions were linked to diabetes.
“Patients are dealing with these issues day to day, and they’re affecting the way people prioritize and manage their own self-care,” author Dr. Eve Kerr said in the release. “Meanwhile, we physicians talk to patients about their diabetes, but not about how their heart failure or their hypertension is affecting how they manage their diabetes. These results show that we need to be treating the whole patient, but we don’t yet have systems designed to do that.”
The more diseases a person had along with diabetes, the study found, the more they prioritized the other conditions ahead of diabetes. Participants also often didn’t associate the other conditions with diabetes, such as understanding how the metabolic disorder puts them at higher risk of heart disease and stroke. Lack of awareness of the association often means diabetes sufferers don’t put enough emphasis on controlling blood pressure and cholesterol, for example.
Jeff Raymond, Medical Writer
