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The CMG Voice

Scientists predict that C-sections will cause us to evolve, with bigger heads and smaller pelvises

Posted Thursday, January 12, 2017 by Tyler Goldberg-Hoss

Humans are weird in a lot of ways. With regard to evolution, our species is weird because we’ve evolved so that a fetus’s head just barely fits through mother’s pelvis. This is different than most other primates, which generally have more space to fit the fetus coming out.

The reason for this, say scientists, is the dueling benefits of having both big heads and small pelvises. Big heads are good because they can fit bigger brains, and small pelvises are good for standing, walking and running. So we have evolved to have the biggest heads we can possibly have coming out of the smallest pelvises that will typically allow such a head to pass through. However, approximately 3% of the time, the fetus doesn’t fit. That is, of course, a life threatening complication, and apparently an evolutionary tradeoff.

Enter cesarean sections. Such a procedure has been around for hundreds of years, and more recently has become commonplace, so much so that C-sections now account for 30% of all births, according to the CDC.

Now, the risk of fetal and/or maternal death from the baby’s head not fitting through the pelvis is much less. Because of this, one scientist theorizes that babies will eventually grow bigger and bigger heads because they can, while pelvises can grow smaller. The reason is that, because such traits are desirous, such genes will be able to pass much more frequently, because those bigger headed babies won’t die during childbirth.

There is some evidence that our heads are already bigger than those of people living 150 years ago, and we know that birth weight is increasing as well.

Only time will tell if this scientist’s prediction will come to pass. In the interim, it will be necessary for physicians and nurses managing laboring women to continue to entertain the possibility that baby isn’t fitting, and perform C-sections not only for the benefit of that baby and that mother, but apparently for the benefit of a new version of the human race!

You can read an article that discusses this subject here:

Has the rise in C-sections affected human evolution? This scientist predicts yes.

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Your life is worth less in Washington if you die at 18 instead of 17

Posted Monday, January 9, 2017 by Tyler Goldberg-Hoss

Most folks (thankfully) never have to think about suing someone or some entity because they have been harmed. Similarly, most folks haven’t spent a lot of time thinking about how much a personal injury is worth. How much should this defendant pay this plaintiff because she had seven months of pain following an auto collision? Not a question we ask ourselves every day.

Similarly, death happens all the time. When it does, the loss is often defined as being “priceless” or some other concept that puts the loss above actually quantifying it. Sometimes, however, the death is the result of negligence – someone or some entity who had a responsibility to act in a certain way, failed to do so, and caused someone to die.

In those circumstances, the family of the deceased person may think about hiring an attorney and filing a lawsuit. There are lots of reasons for doing so. Perhaps the deceased made the money for the household, and that needs to be replaced. Or perhaps the family is hopeful that a civil lawsuit will result in some accountability, some deterrent to the wrongdoer to make sure this same mistake doesn’t happen again and someone else dies.

Other times the family is grief-stricken, and sometimes angry. Their family member is gone and shouldn’t be. Dad is not going to be there anymore when I want to call and talk. Wife will never take walks with me and the dogs in the woods like we used to. We’ll never grow old together. It’s not fair.

While we can’t breathe life back into the person who is gone, the only thing we can do is compensate the family for their loss with money.

In Washington, just like other states, there are laws on what you can recover (loss of relationship, economic losses, etc.), and who can recover for the loss of their relationship with the decedent.

The “who” in Washington is, unfortunately, still incredibly unfair, which is a little shocking considering how we tend to think of ourselves as fairly progressive.

In Washington there is a bright line rule: if the decedent is a minor (17 years, 364 days old), the minor’s parents can recover for the relationship they each lost. However, if the same person dies the next day (age 18 years and 0 days), the parents have no such claims. Absent really unusual circumstances, that 18 year old’s life is probably worth whatever the medical bills were related to the wrongful conduct leading to death, and funeral expenses.

Of course, this is tragic because the grieving parents now are faced with the added insult that the state places little value on their child’s life. What in some ways is more tragic, in my opinion, is that the wrongdoer faces no consequences for their actions. There is no accountability in the civil context for taking the life of an unmarried adult with no kids him or herself. Without any accountability, our society is less safe.

It is similar to playing baseball in the backyard and hitting the ball through the neighbor’s window. Of course, we have less broken windows in our community because when you break one, you are responsible for fixing it. This acts as a deterrent to backyard baseball players. But if you were not held accountable for the broken window, there is no reason not to continue to play just as you had before, windows be damned.

The Washington State Association for Justice, an organization of plaintiff trial lawyers, for years has been attempting to revise this rule to allow jurors to make the decision as to how much a loss is worth, regardless of whether the decedent is 17 years old or 18. In our office, we probably get at least 10 calls a year describing a situation where an adult child dies as a result of alleged medical negligence, but because the recoverable damages are so low, it is impossible to take their case. I hope this will change soon.

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Medical Device Reps Often in Surgery With You

Posted Friday, January 6, 2017 by Tyler Goldberg-Hoss

It is likely that you have either had a total joint replacement, or know someone who has. Of course, the surgeon is the expert on whatever device she decided was best for you, and was solely responsible for implanting it correctly.

Or was she?

Most folks who are not involved in health care do not know that hospitals make deals with device manufacturers like Stryker and Medtronic for joint replacement and other implantable devices. Part of that deal routinely involves support with those devices, including while in the operating room.

These representatives rely upon close relationships with surgeons for their commissions, and as a result must be intimately familiar with the device in question so he or she can answer any questions the surgeon may have during the procedure. Sometimes surgeons are lax in research a particular device and are unprepared when time comes for surgery. In such circumstances, reps become necessary to a successful surgical outcome.

A recent survey was conducted asking device representatives a series of questions. Of note, 88% of responding representatives said they had provided verbal instructions to a surgeon during a procedure, while 37% participated in a surgery in which they themselves felt their involvement was excessive because the surgeon was not sufficiently prepared to implant a device.

Recently an orthopedic surgeon at Loma Linda in California convinced his hospital to negotiate for devices directly with the manufacturing companies and train employed surgical techs in a fashion similar to how the device reps were trained. Whether other hospitals will follow suit is unclear at the moment.

You can read an article about the culture of device representatives in the operating room here:

Medical Device Employees Are Often in the O.R., Raising Concerns About Influence

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New Technology Identifies Antibiotics To Treat Drug-Resistant Infections

Posted Monday, January 2, 2017 by Gene Moen

A recent article in the journal Emerging Microbes & Infections reports on new technology developed by researchers at the National Institutes of Health to deal with drug-resistant infections. Infections with multidrug-resistant (MDR) organisms have emerged as a major public health crisis, with two million infections and an estimated 23,000 deaths in the United States annually. Most people are familiar with MRSA (methicillin-resistant staphylococcus aureus), which used to be only a hospital-based infection but is now also recognized as a community-acquired infection. But the number of such drug-resistant infections has grown over the past decade. Treating them is a continuous and increasing problem for physicians.

The incidence is increasing, partly due to the selective pressure from widespread use of antibiotics in both humans and animals. In the past, many physicians routinely prescribed antibiotics for relatively minor infections, sometimes even for viral illnesses where antibiotics would have no benefit, because patients were insistent on getting them. The current trend is to sharply limit such prescriptions to avoid the development of yet more drug-resistant organisms.

Current treatment of bacterial infections commonly requires broad-spectrum antibiotics until a pathogen can be isolated, identified and antimicrobial susceptibility testing performed, which can take several days. The research described in the recent article described a new way to identify drugs and drug combinations that may be useful in combating drug-resistant organisms. The new screening method uses a potential new approach to repurpose known drugs and compounds to deal with such infections, especially those that are hospital-borne.

In the research study screening covered 4,000 approved drugs and compounds, and identified 25 that suppress the growth of two drug-resistant strains of Klebsiella pneumonia that have become resistant to most major types of antibiotics. Klebsiella pneumonia has become a source of fatal infections in many hospitals across the country. This new approach is now being utilized to identify more drug combinations to treat other drug-resistant infections.

The article noted that “the results demonstrate that this new assay has potential as a real-time method to identify new drugs and effective drug combinations to combat severe clinical infections with MDR organisms.”

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Do Electronic Medical Records Improve Medical Care? Listen To The Nurses

Posted Monday, December 19, 2016 by Gene Moen

We have written other blog posts that talk about the advantages and disadvantages of electronic health records (EHR) in hospitals. Many of the complaints about them are similar to those for any new electronic device. The bugs need to be found and corrected by the IT personnel. But the EHR systems have been in use for a decade now and the pervasive problems seem to persist.

A November 2016 report in the American Journal of Nursing outlines the persistent complaints from nurses about the problems of EHR systems. The complaints were divided into four categories: ease of use, patient safety, communications, and tech support.

Nurses felt that the EHR systems in their hospitals often were not useful for nurses. Up to an hour of each shift was needed for a nurse to enter data into the systems, and the systems often created difficulties in finding data or information. The report concluded that “what has been achieved … is the ability to transfer the task of date entry from a paper platform to an electronic platform, but the actual work of documentation is still largely manual.”

Patient safety was one of the major reasons why EHR was advocated. The use of alerts and barcodes, for example, meant fewer mistakes and missed problems. But the “cut and paste” ease of EHR sometimes means a nurse can simply repeat an earlier assessment rather than doing a time-consuming new one. The experience of nurses is that they increasingly use “workarounds” to address the flaws in the EHR systems. 67% of nurses in one study said that they had to use such “workaround” to prevent negative impact on the quality of care and avoid persistent flaws in the systems.

Communication improvement was another major reason the EHR systems were implemented. Yet a shocking 90% of nurses in a major study said that EHR did not improve communications between nurses and patients, and 94% said that also applied to communications between nurses and other members of the health care team.

Complaints about EHR tech support was endemic in hospitals. Only 30% of nurses felt their facility’s IT department responded quickly and well to problems and vulnerabilities identified by nurses. 67% of nurses working in for-profit inpatient settings felt that their IT departments were “incompetent” in fixing problems.

There is no question that EHR systems got off to a rocky start and are slowly evolving from a simple data-collection and recording systems to ones that actually assist the providers in caring for patients. As an author of the nursing report stated: “The problems … will fade in the next few years as increasing amounts of data are automatically populated via medical device integration, sensors, imaging, voice recognition, and so on, rather than manual entries.”

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