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The CMG Voice

Can Antibiotics Alone Treat Appendicitis?

Posted Thursday, May 18, 2017 by Gene Moen

For more than a century, surgery has been the standard treatment for appendicitis. Conventional medical wisdom has been that an infected or inflamed organ should be surgically removed, especially when the human body seems to do fairly well without an appendix.

The conventional wisdom may be overturned by a clinical study being done at UCLA, where Dr. David Talan (board certified in both emergency medicine and infectious disease medicine) leads a team to address questions about drugs being an alternative to surgery. The importance of the study is that one in 10 people in the U.S. will be diagnosed with appendicitis, and the risks and costs of surgery are multiplied by the 300,000 appendectomies performed each year in the U.S. In fact, this is the most common emergency surgery.

It has been thought that, because appendicitis carries the risk of rupture and death, emergency surgery was always needed. But if caught early, physicians are learning that antibiotic treatment alone may be reasonable and adequate to treat the condition. A number of studies in the U.S. over the past several years have found that, although antibiotics worked for many patients, about 25% required surgery. But the number of patients studied was insufficient to allow broad conclusions to be reached.

The UCLA study will look at the outcomes of more than 1,500 patients at UCLA and other hospitals who are diagnosed with appendicitis. Randomly selected patients will be treated with antibiotics alone or with surgery. Tracked over a period of a year, the study will look at disease recurrence, length of hospital stay, and treatment costs. The hope is that lessons learned will allow patients to be treated with drugs on an outpatient basis, thus reducing the costs associated with hospitalization. The study will be completed in 2021.

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New Study Shows Decrease In Total Medical Malpractice Claims, Increase In Size Of Paid Claims.

Posted Monday, May 15, 2017 by Gene Moen

Researchers at Brigham and Women’s Hospital in Boston found that claims paid by physicians’ insurers have been substantially decreasing over the last two decades. However, the amount paid on each claim has been increasing. These trends will not be surprising to attorneys who represent injured patients. The reason for both trends is relatively simple: the cost of pursuing a malpractice claim has become so great that few attorneys can afford to file a “modest” claim for damages. As a result, there are fewer cases filed, but those that are filed are in cases with large damages, and thus larger amounts are paid on the claims on average.

The study was interesting, also, in breaking down claims paid by various specialties, such as dermatology, neurosurgery, etc. The largest amounts paid were for neurosurgery. Again, most claimants’ attorneys will understand that, because of the higher cost of pursuing such a claim, only the larger damages claims can be justified.

Part of the reason for the high cost of such claims is that neurosurgery experts are very expensive even when one can find a neurosurgeon who is willing to testify against another neurosurgeon. Some of the experts in neurosurgery sub-specialties charge as much as $1,200 an hour to simply review records and consult with an attorney. Contrast that with family practice claims, where it is much easier to find credible experts and charges are usually $500 an hour or less.

The breakdown on types of claims was also interesting. The most common claims involved misdiagnoses, surgical errors, and treatment-related mistakes. Roughly 32 percent of all paid claims involved the patient’s death.

The conclusions of the researchers may not be completely accurate, since they are assuming that the decrease in claims means that they have become more difficult to win at trial. While that may be true (in part because of the anti-lawsuit propaganda campaign by insurers and medical groups – which tends to taint jury verdicts), the reality is cost is a very big driver of decisions about bringing a medical malpractice lawsuit. A typical case that goes to trial may cost the attorney $100,000+ in out-of-pocket costs. To invest that much money, not to mention other resources in time and effort, requires a careful weighing of risks and benefits before filing a lawsuit.

Attorneys for medical malpractice claimants know that this is not a law practice for the faint-of-heart. Almost all such claims are handled on the basis of a contingent-fee, which means a loss not only results in no payment for the attorney’s time, but also means the attorney absorbs the costs that have been advanced.

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Can Virtual Reality Diagnose Concussions?

Posted Thursday, May 11, 2017 by Gene Moen

In a recent blog post, we discussed the ways in which virtual reality (VR) and other electronic devices are being used to help treat patients with various medical problems. Not mentioned in that blog was that several studies have investigated the use of a Nintendo Wii balance board for treating brain-injured patients.

In a new study, VR is now being used to diagnose head injuries. Researchers at the University of Birmingham and the University of East Anglia in England conducted trials to evaluate the use of a VR headset to detect subtle neurological changes that can help assess concussions.

Certainly there is a current emphasis on head injuries in football in the U.S that is comparable to the emphasis in Europe on head injuries in soccer. Collision at the goal and “heading” a soccer ball have been known to cause head injuries. In the study, players wore the headset while standing on a balance board and following directions. The inability to comply with some directions helped detect subtle neurological problems.

This particular study was hampered because of the need to connect the VR device to a computer terminal. It is thought that future research may use a mobile VR headset, such as Google Cardboard or Samsung Gear VR.

The use of immersive VR for concussion diagnosis remains an area that has only had limited research to date. But it is likely that, as preliminary results are reported, more researchers will focus on it. The interaction between medicine and electronics is developing rapidly, and it is likely that many new studies will focus on both the diagnostic and treatment potentials of electronic devices.

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Is Wireless Medicine In The Future?

Posted Monday, May 8, 2017 by Gene Moen

We all know that wireless is the wave of the electronic future. Wires are becoming things of the past in electronics and fewer people are tripping over them. New research is even finding ways to use wireless technology in the medicine of heart pacemakers.

A group of researchers at Mount Sinai School of Medicine in New York City have conducted a study of using wireless technology in left ventricular pacing systems. In the study, acoustic energy was transmitted from a pulse generator (implanted under the skin over the rib cage) to a left ventricular endocardial pacing electrode. The acoustic energy was transduced to electrical energy.

The experiment was used in patients who did not respond to conventional CRT (implanted cardiac resynchronization therapy), in which an implant resynchronizes the contractions of the heart’s ventricles by sending tiny electrical impulses to the heart muscle, which can help the heart pump blood throughout the body more efficiently. By placing the left ventricular pacing site away from scar tissue it can function more effectively.

This technique is still in the very early stages, and there were numerous technical glitches that need to be dealt with, including concerns about battery life because acoustic energy is being transduced to electrical energy. The study authors stated that “once technical issues have been solved with these systems, randomized clinical trials will be necessary to definitely determine whether leadless systems will be superior to conventional pacemakers.”

As the rapid pace of change in computers and electronics continues, there is no doubt that wireless electronics will receive more attention from physicians and scientists who are looking for new ways to treat common medical conditions.

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New Targeted Therapies For Lung Cancer

Posted Thursday, May 4, 2017 by Gene Moen

Two years ago, we authored a blog post about loss of a chance in lung cancer cases, emphasizing non-small cell lung cancer (which comprise about 75% of all lung cancers). The blog post included the following:

“About 85 to 90% of lung cancers are known as ’non-small cell lung cancer,’ a name which covers several subtypes of lung cancer that are grouped together because of similarities in the approach to treatment and outlook. Patients with stage 3b non-small cell lung cancer are typically not offered surgery and treated only with chemo-radiation therapy. These patients have a five-year survival rate of only about 10%. A new study, however, indicates that certain patients with lung cancer that has spread throughout the chest could live longer by undergoing surgery to remove diseased lung tissue instead of only receiving radiation therapy.”

New research and studies, however, are developing targeted therapies (sometimes called precision medicine) that hold the promise of transforming lung cancer into a chronic disease by substantially increasing long-term survival rates. Dr. Edward Kim of the Carolinas HealthCare System Levine Cancer Institute in Charlotte, N.C., has described how testing for certain markers in a patient’s tumor can lead to using a “matching” drug that has fewer side-effects and much greater efficacy.

An example is the “tyrosine kinase inhibitor,” which is used for tumors that have a specific mutation called the “epidural growth factor receptor mutation.” Patients with this particular kind of tumor can simply take a pill as opposed to undergoing systemic chemotherapy. Many of these targeted therapies work even when the lung cancer has metastasized to other organs or parts or the body.

There is another class of drugs, called ALK, which was recently approved by the FDA for lung cancer tumors that have a specific characteristic called “PD-LI”. Dr. Kim said that almost 50% of his center’s lung cancer patients have tumor biomarkers that can be matched to particular drugs that will increase their chance of a cure or of a longer life-expectancy. He stated: “It’s really important to assess not only where the disease is, but what are the markers that are unique to each individual’s tumor.”

From the viewpoint of attorneys representing lung cancer patients, the provable damages from a late-diagnosed lung tumor may be greatly increased because more effective treatments are now available. Only a few years ago, most attorneys declined such cases because, once there were symptoms, the chances of successful treatment were very small.

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