Dr. Bray Links

Wednesday, January 31, 2018

Inspired Medicine: Getting Patients to Make Healthy Changes

The business of medicine puts its emphasis on the treatment of people who are already very sick. As an orthopedic surgeon, I got training mostly in how to repair damaged bones, joints, and flesh, and that's what I'm paid to do. But by the time someone has torn a ligament, suffered a heart attack, or lost a kidney, their lives will most likely be shorter no matter how sophisticated the drugs or surgery we have to offer.


We can't force our patients to stop smoking, exercise, eat well, get plenty of sleep, or receive vaccines. We can't grab the guns out of their hands if they've made up their minds to shoot themselves. But we can inspire them to take care of themselves.


There's a reason why the lifespans in places like Monaco and Japan are so much longer than ours, and it's not superior DNA. It has a lot to do with culture, and as physicians, we must lead the change.


Sunday, January 28, 2018

Want to Reduce Burnout? Tackle System Problems, Experts Say

In exchange for time spent on such tasks as mentoring, serving on committees, and covering shifts for other providers, Stanford's pilot program allowed faculty members to receive work- and home-related services: meal delivery, cleaning services, or grant-writing support, for instance, New England Journal of Medicine national correspondents Alexi A. Wright, MD, MPH, from Harvard Medical School and the Dana Farber Cancer Institute, and Ingrid T. Katz, MD, MHS, from Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, explain.

The initiative was successful, particularly among female faculty members, who in a survey conducted by the school were most likely to report feeling unsupported or undersupported in their career development. "Though this initiative was meant for all physicians and basic scientists, women used these services more frequently than men, and the number of female faculty members who reported 'feeling supported' had nearly doubled by the end of the pilot program," the authors write.

Programs such as time banking signify an important cultural shift in medicine, according to Tait Shanafelt, MD, who joined Stanford Medicine in September 2017 as the organization's chief wellness officer. Stanford is the first academic medical center in the country to create an executive-level position of this kind focused specifically on clinician well-being. But many more will likely follow as the true cost of burnout — medical errors, poor clinical outcomes, high turnover, low engagement — becomes increasingly obvious, Dr. Shanafelt said in an interview with Medscape Medical News. "Physician burnout is eroding the soul of medicine. Organizations need to constantly gauge the well-being of providers and develop and implement research-based interventions to address the practice considerations that contribute to clinician suffering."


Lab-Confirmed Flu Virus Linked to Imminent Risk for Acute MI

Patients with laboratory-confirmed influenza were about six times as likely to be admitted for acute MI in the following 7 days compared with the period comprising the prior and subsequent years, results of a cohort study show.[1]

The risk was especially pronounced in older patients and was independent of flu vaccination status or history of MI hospitalization. There was also a signal that other forms of respiratory infection can similarly raise the risk for MI admission.


Thursday, January 25, 2018

Dr. Greger's Daily Dozen

In the years of research required to create the more than a thousand evidence-based videos on NutritionFacts.org, Michael Greger, MD, FACLM, has arrived at a list of what he considers the most important foods to include in a healthy daily diet. Yes, greens are good for you, but how much should we try to eat each day? Dr. Greger's Daily Dozen details the healthiest foods and how many servings of each we should try to check off every day. He explains his rationale in his book How Not to Die (http://NutritionFacts.org/book). All his proceeds from his books, DVDs, and speaking engagements is all donated to charity.

NutritionFacts.org is a non-commercial, nonprofit, science-based public service provided by Dr. Greger, providing free daily updates on the latest in nutrition research via bite-sized videos. He has nearly a thousand videos on every aspect of healthy eating, with new videos and articles uploaded every day. Like this app, everything on the website is both free of ads and free of charge.

This app was developed thanks to the volunteer efforts of John Slavick.


Nonpharma Intervention Cuts Dementia Risk by a Third

Participants were randomly assigned to one of three types of cognitive training — memory, reasoning, or speed of processing — or to a control group that received no cognitive training.

Each training arm consisted of ten 60- to 75-minute sessions over 5 to 6 weeks. The memory and reasoning training took place in a classroom format with pencil-and-paper types of exercises.

"The memory training taught people strategies they can use to better remember lists of information, and the reasoning training taught strategies to recognize patterns to be able to better solve problems," said Dr Edwards.

The speed of processing training was the only computerized intervention. This training targets "mental quickness," which, said Dr Edwards, declines with age.


Green Leafy Vegetables Linked to Slower Cognitive Decline

Eating one serving of green leafy vegetables per day may help to slow cognitive decline with aging, a new study suggests.

In the prospective study of an older US community population, consumption of green leafy vegetables was linearly associated with slower cognitive decline.

The rate of decline among those who consumed one to two servings per day was the equivalent of being 11 years younger compared with those who rarely or never consumed green leafy vegetables, the researchers say.

Investigation of the nutrients for which green leafy vegetables are a rich or primary source indicated that higher food intakes of folate, phylloquinone, and lutein were each linearly associated with slower cognitive decline and appeared to account for the protective correlation of green leafy vegetables to cognitive change.


New Stroke Treatment Guidelines - What's Hot at ISC 2018?

DEFUSE 3: This National Institutes of Health–funded trial is looking to expand the therapeutic window for thrombectomy out to 16 hours from time of stroke onset. "The DEFUSE 3 trial is seen as complementary to the recently reported DAWN trial, which showed a benefit of thrombectomy when used out to 24 hours in patients selected by clinical mismatch," Dr Ovbiagele commented. "DEFUSE differs in that the patients were selected for inclusion using imaging techniques to identify those who had a large potentially salvageable area of brain. It will be interesting to see if the results are different with these different ways of selecting patients."  


Acupuncture for Chronic Pain: Unprecedented Advances

"Right now, we have a pretty solid foundation for the efficacy of acupuncture" for headache, osteoarthritis (OA), and musculoskeletal conditions, said Farshad M. Ahadian, MD, clinical professor of anesthesiology, University of California, San Diego.

"I think it's fair to say that acupuncture is here to stay. It's going to be a permanent addition to our tool box."

Dr Ahadian presented the data here at the Academy of Integrative Pain Management (AIPM) 28th Annual Meeting.


Wednesday, January 24, 2018

Obesity is contagious, new research finds

"The social influence component is an important component, and too much attention may have been focused just on the built environment," said Ms. Datar, a senior economist at the Dornsife Center for Economic and Social Research at the University of Southern California. "That doesn't seem to be where the answer is, that you can build all these parks and things. There's the social influence aspect that has to be addressed as well."

Ms. Datar, with co-author Nancy Nicosia of the Rand Corp., set out on a study that evaluated how location influences obesity rates in military families, who often move around the country because of where they are needed and not by personal choice.

"To be honest with you, we were not expecting to find a social contagion," said Ms. Datar, adding that the study originally was meant to look at how the built environment influenced obesity rates in neighborhoods.


Lazy lifestyles to cause surge in serious illness

More than two million older people will have at least four serious illnesses within 20 years because of the increase in obesity and lazy lifestyles, a large study warns.

Those in middle age are so unhealthy that as they get older two thirds of over-65s are forecast to have at least two conditions such as cancer, dementia or arthritis, up from half today.

Experts believe that past estimates of the rising cost of treating an ageing population are too low because they do not take into account this increasing level of sickness.


Tuesday, January 23, 2018

APOE4 Carriers Also Reap Cognitive Benefits of Healthy Lifestyle Changes

In subgroup analyses of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, the cognitive benefits of the multipronged intervention targeting diet, exercise, cognitive training, and vascular risk factors did not significantly differ between apolipoprotein E (APOE) ε4 carriers and noncarriers and might actually be more pronounced in APOE ε4 carriers.

"This is good news for people who worry that genetic risk factors for dementia may somehow hinder potential benefits from healthy lifestyle changes," Alina Solomon, MD, PhD, from the Institute of Clinical Medicine/Neurology, University of Eastern Finland in Kuopio, told Medscape Medical News.


Saturday, January 20, 2018

What's the Best 'Breathing Retraining' for Uncontrolled Asthma?

A recent trial[1] compared two methods of breathing retraining: self-taught, using a video; or three face-to-face sessions with a respiratory therapist. The training focused on diaphragmatic breathing, nasal breathing, and slow breathing, as well as controlled breath holds and simple relaxation exercises.

Compared with usual care, both methods of breathing retraining improved asthma-related quality of life. Although the interventions didn't change measures of airway inflammation or obstruction, patients reported increased control over breathing and reduced need for medication. They also felt more relaxed.

So, for your patients struggling with their asthma, consider adding breathing retraining to their treatment. Even patients who don't have easy access to respiratory therapists can benefit from the self-taught video training. It's a simple, low-cost option.


The Doctor Of The Future: Prescribing Lifestyle As Medicine | Mark Rowe | TEDxUCD

Thursday, January 18, 2018

Five-foot long tapeworm came 'wiggling out' of man's body after he ate sushi

The emergency room physician was initially skeptical when the man insisted to residents at Community Regional Medical Center, "I really want to get treated for worms" until he saw for himself the disgusting proof.

After being unraveled, the tapeworm ended up being 5.5 feet long. The patient said he felt the worm "wiggling out" and then, began to remove the worm, which started moving.


This new blood test can detect early signs of 8 kinds of cancer

Scientists have developed a noninvasive blood test that can detect signs of eight types of cancer long before any symptoms of the disease arise.

The test, which can also help doctors determine where in a person's body the cancer is located, is called CancerSEEK. Its genesis is described in a paper published Thursday in the journal Science.

The authors said the new work represents the first noninvasive blood test that can screen for a range of cancers all at once: cancer of the ovary, liver, stomach, pancreas, esophagus, colon, lung and breast.

Together, these eight forms of cancer are responsible for more than 60% of cancer deaths in the United States, the authors said.


Tuesday, January 16, 2018

Are Meta-Analyses a Form of Medical Fake News? | Circulation

How many dreadful manuscripts describing the results of a meta-analysis are submitted to and rejected from journals each year? We cannot know, but many published meta-analyses do not use appropriate methods or contribute meaningfully to medical thought or patient care. Some journals avoid all meta-analyses, whereas others pride themselves on publishing only the best; still others are delighted to have anything to print in an era where the number of opportunities to publish greatly exceeds the number of valid observations.

Many have critically examined the methodology of meta-analysis, and others have set standards for their execution. Despite such guidance, meta-analyses continue to proliferate, but we should ask: do they really contribute? Esteemed organizations regard the conclusions of a well-executed meta-analysis as a higher level of evidence than a single well-done clinical trial. This commentary explains why this cannot possibly be true.


Nora Gedgaudas The Silent Autoimmunity Explosion

Monday, January 15, 2018

Engineered commensal microbes for diet-mediated colorectal-cancer chemoprevention | Nature Biomedical Engineering

Chemoprevention—the use of medication to prevent cancer—can be augmented by the consumption of produce enriched with natural metabolites. However, chemopreventive metabolites are typically inactive and have low bioavailability and poor host absorption. Here, we show that engineered commensal microbes can prevent carcinogenesis and promote the regression of colorectal cancer through a cruciferous vegetable diet. The engineered commensal Escherichia coli bound specifically to the heparan sulphate proteoglycan on colorectal cancer cells and secreted the enzyme myrosinase to transform host-ingested glucosinolates—natural components of cruciferous vegetables—to sulphoraphane, an organic small molecule with known anticancer activity. The engineered microbes coupled with glucosinolates resulted in >95% proliferation inhibition of murine, human and colorectal adenocarcinoma cell lines in vitro. We also show that murine models of colorectal carcinoma fed with the engineered microbes and the cruciferous vegetable diet displayed significant tumour regression and reduced tumour occurrence.


L-carnitine for hyperthyroidism?

Old studies in animals and unblinded studies in a few hyperthyroid patients suggested that L -carnitine is a periferal antagonist of thyroid hormone action at least in some tissues. This conclusion was substantiated by our recent observation that carnitine inhibits thyroid hormone entry into the nucleus of hepatocytes, neurons, and fibroblasts. In the randomized, double-blind, placebo-controlled 6-month trial reported here, we assessed whether 2 or 4 g/d oral L-carnitine were able to both reverse and prevent/minimize nine hyperthyroidism- related symptoms. We also evaluated changes on nine thyroid hormone-sensitive biochemical parameters and on vertebral and hip mineral density (bone mineral density). Fifty women under a fixed TSH-suppressive dose of L -T(4) for all 6 months were randomly allocated to five groups of 10 subjects each. Group 0 associated placebo for 6 months; groups A2 and A4 started associating placebo (first bimester), substituted placebo with 2 or 4 g/d carnitine (second bimester), and then returned to the association with placebo. Groups B2 and B4 started associating 2 and 4 g/d carnitine for the first two bimesters, and then substituted carnitine with placebo (third bimester). Symptoms and biochemical parameters worsened in group 0. In group A, symptoms and biochemical parameters worsened during the first bimester, returned to baseline or increased minimally during the second bimester (except osteocalcin and urinary OH-proline), and worsened again in the third bimester. In group B, symptoms and biochemical parameters (except osteocalcin and urinary OH-proline) did not worsen or even improved over the first 4 months; they tended to worsen in the third bimester. In both the A and B groups, the two doses of carnitine were similarly effective. At the end of the trial, bone mineral density tended to increase in groups B and A (B > A). In conclusion, L-carnitine is effective in both reversing and preventing symptoms of hyperthyroidism and has a beneficial effect on bone mineralization. Because hyperthyroidism depletes the body deposits of carnitine and since carnitine has no toxicity, teratogenicity, contraindications and interactions with drugs, carnitine can be of clinical use.


The present pilot study has shown that L-Carn + Se significantly reduced symptoms associated with SHyper, improving QoL of patients, without significant modifications of their endocrine profile. In addition, it is noteworthy that the extension of treatment seems necessary to prevent symptoms reappearance. Prospective randomized controlled trials are needed to address clinicians to define the appropriate treatment-settings for this disorder.'


Saturday, January 13, 2018

Over-the-counter mouthwash use and risk of pre-diabetes/diabetes - ScienceDirect

Over-the-counter mouthwash comprises part of routine oral care for many; however, potential adverse effects of the long-term daily use have not been evaluated. Most mouthwash contain antibacterial ingredients, which could impact oral microbes critical for nitric oxide formation, and in turn predispose to metabolic disorders including diabetes. Our aim was to evaluate longitudinally the association between baseline over-the-counter mouthwash use and development of pre-diabetes/diabetes over a 3-year follow-up.


Thursday, January 11, 2018

Perverse Incentives: Do You See What I See? - PulmCCM

Recently, a 91-year-old relative had a serious intracerebral hemorrhage, but recovered miraculously. It is really hard for him to get around, but he always goes for an annual checkup. His stroke wasn't going to stop him from his routine.

During the visit, his physician told him that the office x-ray equipment wasn't working, and that he needed to return in 2 weeks for his routine annual chest x-ray (which was normal during his recent stroke). When I heard the story, I told him that the x-ray wasn't needed. He didn't need to make special arrangements to return to the office.

So he asked: "Why would a physician ask me to return for a test that I didn't need?"

Good question. Why do physicians check the serum cholesterol in women who have advanced ovarian cancer?

Too many physicians order tests and recommend procedures primarily because they can be paid to do them.

Many healthcare practices -- and entire health systems -- focus on generating revenues in every possible way. The goal is to eke out every dollar from every patient interaction. In many instances, it means encouraging patients to undergo tests and procedures that are not needed but will be reimbursed.

This obsession with revenues is destroying medicine.


Pfizer to Halt Alzheimer’s and Parkinson’s Drug Research | The Scientist Magazine(R)

 US pharmaceutical corporation Pfizer announced plans this week to abandon research of new drugs to treat Alzheimer's and Parkinson's diseases. The decision will result in about 300 layoffs in the company's neuroscience discovery and early development programs, which are located in Massachusetts and Connecticut, according to a statement emailed to journalists.

"We have made the decision to end our neuroscience discovery and early development efforts and reallocate funding to those areas where we have strong scientific leadership and that will allow us to provide the greatest impact for patients," the company says in the statement (via Reuters).


Monday, January 8, 2018

US child mortality ranks worst among 20 wealthy countries, study finds - CNN

The United States has the worst overall child mortality rate compared with those of 19 other wealthy nations in the Organisation for Economic Co-operation and Development.
That's according to a study published in the journal Health Affairs on Monday.
The study examined child mortality rates between 1961 and 2010 in the US and comparable nations in the OECD, a group of 35 countries, founded to improve economic development and social well-being around the world. It found that mortality rates were not evenly distributed.

"This study should alarm everyone. The US is the most dangerous of wealthy, democratic countries in the world for children," said Dr. Ashish Thakrar, lead author of the study and an internal medicine resident at Johns Hopkins Hospital and Health System in Baltimore.


Hospital Medicine: Better, or Less Personal, Care?

"As the number of physicians caring for a patient increases, the depth of the relationship between patient and physician tends to diminish — a phenomenon of particular concern to those who regard the patient–physician relationship as the core of good medical care."

More physicians involved in a patient's care may result in miscommunication and discoordination of care, especially at admission and discharge.

"From the patient's point of view, it can be highly disconcerting to discover that the physician who knows you best will not even see you at your moment of greatest need — when you are in the hospital, facing serious illness or injury," Dr Gunderman explains. "The patient–physician relationship is built largely on trust, and levels of trust are usually lower among strangers."

Community physicians are also at risk for less professional and personal fulfilment when they do not oversee their patients' hospitalizations. Potential disadvantages for the medical profession include increased fragmentation of patient care, faster burnout, and less knowledge sharing and camaraderie.

Hospitalists may suffer from lack of outpatient experience, becoming less accountable to nonhospitalized patients and their communities, and therefore less effective advocates for comprehensive medical care. Their employment by hospitals may shift their loyalty away from patients and their profession.


Mortality Lower When Inpatients See Their Own PCP in Hospital

Unadjusted 30-day mortality was lowest among patients cared for by PCPs, followed by the rates in those cared for by hospitalists and other generalists (8.6%, 10.8%, and 11.0%, respectively; test of difference, P < .001).

"These findings persisted in adjusted analyses for PCPs (AOR, 0.94; 95% CI, 0.91 - 0.97; P < .001) and other generalists (AOR, 1.09; 95% CI, 1.07 - 1.12; P < .001), with hospitalists as the reference group," the authors write.

This pattern also remained significant in a sensitivity analysis that accounted for the complexity of the admission and patient disease burden. "For example, patients cared for by PCPs had the lowest 30-day mortality across all 3 physician groups at all quantiles of DRG complexity and patient comorbidities," the authors write.


Many Adults With Arthritis Not Receiving Exercise Counseling

"[T]he prevalence of counseling remains low for a self-managed behavior (exercise) with proven benefits and few risks, especially among those who are inactive. Various strategies such as health care provider education and training in exercise counseling and electronic medical record prompts might increase health care provider counseling for exercise among adults with arthritis," Jennifer Hootman, PhD, from the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues write.

Approximately 54 million Americans have arthritis. Many of these people also have common comorbidities, such as diabetes, heart disease, and obesity, for which exercise is recommended to improve disease control.  However, arthritis pain can be a barrier to exercise for people with these conditions.

At the same time, exercise can decrease the pain of arthritis. The American College of Rheumatology recommends exercise as first-line nonmedication therapy for managing osteoarthritis symptoms. One of the goals of the Healthy People 2020 initiative is to increase counseling about the benefits of exercise for people with arthritis.


Ibuprofen linked to male infertility, study says - CNN

Ibuprofen has a negative impact on the testicles of young men, a study published Monday in the journal Proceedings of the National Academy of Sciences found. When taking ibuprofen in doses commonly used by athletes, a small sample of young men developed a hormonal condition that typically begins, if at all, during middle age. This condition is linked to reduced fertility.
Advil and Motrin are two brand names for ibuprofen, an over-the-counter pain reliever. CNN has contacted Pfizer and Johnson & Johnson, the makers of both brands, for comment. 


Sunday, January 7, 2018

Targeting the Warburg effect for Cancer Treatment: Ketogenic Diets for Management of Glioma

A promising approach to cancer control is to develop interventions to slow or halt progression of early stages of carcinogenesis to invasive disease as indicated by biomarkers of disease progression as well as related symptom burden. Our goal is to utilize a broad-spectrum approach targeting multiple signaling pathways that result in modulation of apoptosis, proliferation, inflammation and related pathologies, relevant to progression in early stage disease to advanced cancers. The metabolic pathways which support rapid growth of tumors represent a promising therapeutic target for cancer. Ketogenic therapies in the form of a KD and/or pharmacological modulators using exogenous KAs represent one potential tool to exploit the metabolic vulnerabilities of tumors. A number of distinct yet interrelated effects of ketosis may be implicated in the potential anti-tumor effects of ketosis (Fig. 2). Ketogenic therapy for CNS tumors, including glioma, extends far beyond the originally proposed mechanism of reducing glucose availability, and may work through multiple and yet distinct mechanisms such as reducing inflammation, altering in oxidative stress, enhancing anti-tumor immunity, altering gene expression, sensitizing tumors to standard of care and adjuvant therapies, among others (Fig. 5). Some of these mechanisms may depend directly on ketone signaling, supporting the notion that an elevation in blood ketones is a significant component of ketogenic therapy for CNS tumors. To date, case reports and pilot projects have reported moderate success evaluating KD in patients with advanced stage disease (HGG). However, it is important to acknowledge that advanced stage disease, including GBM, display significant increases in genomic complexity and a variety of cell-signaling redundancies. Thus, clinicians face multiple patient-related (due to illness, compliance and other co-morbidities) and metastatic disease- related challenges. It is possible that the KD would be more effective in earlier stage disease (LGG) and provide an opportunity to potentially increase the likelihood of pinpointing targets for transformational therapies. However, to date, there continues to be a paucity of research that exploits these mechanisms and systematically examines interventions such as the ketogenic diet, relevant to tumor progression in glioma. If successful, these novel treatments could provide a non-toxic, cost-effective adjuvant therapy to standard of care in a disease currently with a grim prognosis.


Saturday, January 6, 2018

DNA Damage May Underlie Alcohol Link to Cancer Risk

In the Cancer Research UK Science Blog, Dr Patel stated that in mice that lacked the enzyme that breaks down acetaldehyde, he and his colleagues "saw huge amounts of DNA damage" after just one dose of ethanol. Acetaldehyde is the main metabolic product of alcohol.

"Bits of DNA were deleted, bits were broken, and we even saw parts of chromosomes being moved about and rearranged," he added.


Friday, January 5, 2018

Depo birth control shot linked to risk of HIV infection | Endocrine Society

In addition to these clinical studies, the review's authors examined animal, cell and biochemical research on the form of progestin used in DMPA—medroxprogesterone acetate, or MPA. The analysis revealed MPA acts differently than other forms of progestin used in contraceptives. MPA behaves like the stress hormone cortisol in the cells of the genital tract that can come in contact with HIV.

"The increased rate of HIV infection among women using DMPA contraceptive shots is likely due to multiple reasons, including decreases in immune function and the protective barrier function of the female genital tract," Hapgood said. "Studying the biology of MPA helps us understand what may be driving the increased rate of HIV infection seen in human research. These findings suggest other forms of birth control should rapidly replace DMPA shots."  


The Big Vitamin D Mistake

Since 2006, type 1 diabetes in Finland has plateaued and then decreased after the authorities' decision to fortify dietary milk products with cholecalciferol. The role of vitamin D in innate and adaptive immunity is critical. A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L. The largest meta-analysis ever conducted of studies published between 1966 and 2013 showed that 25-hydroxyvitamin D levels <75 nmol/L may be too low for safety and associated with higher all-cause mortality, demolishing the previously presumed U-shape curve of mortality associated with vitamin D levels. Since all-disease mortality is reduced to 1.0 with serum vitamin D levels ≥100 nmol/L, we call public health authorities to consider designating as the RDA at least three-fourths of the levels proposed by the Endocrine Society Expert Committee as safe upper tolerable daily intake doses. This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.


Wednesday, January 3, 2018

Unfiltered Fervor: The Rush to Get Off the Water Grid - NYTimes.com

 At Rainbow Grocery, a cooperative in this city's Mission District, one brand of water is so popular that it's often out of stock. But one recent evening, there was a glittering rack of it: glass orbs containing 2.5 gallons of what is billed as "raw water" — unfiltered, untreated, unsterilized spring water, $36.99 each and $14.99 per refill, bottled and marketed by a small company called Live Water.

"It has a vaguely mild sweetness, a nice smooth mouth feel, nothing that overwhelms the flavor profile," said Kevin Freeman, a shift manager at the store. "Bottled water's controversial. We've curtailed our water selection. But this is totally outside that whole realm."


Monday, January 1, 2018

Risk Factors for Hospital-Onset C difficile Identified

The authors found that carbapenems, third- and fourth-generation cephalosporins, metronidazole, and piperacillin/tazobactam all increased the risk for CDI. However, the risk dropped with use of clindamycin, macrolides, and tetracyclines.

"The clindamycin findings are somewhat surprising in that clindamycin has been classified as a high risk for development of a CDI in both the hospital and in the community," the authors write. "This finding may be due to reduced use of clindamycin over time." The results suggesting a possible protective effect from tetracycline and macrolide match up with previous research findings, they write.


Arthritis in Chikungunya Patients Not Due to Persistent Virus

"The finding of chronic joint pain in one fourth of the patients infected with CHIKV approximately 2 years after initial infection has important implications for prediction of the magnitude of disability and health system costs after the Latin American epidemic," the authors write in an article published online December 20 in Arthritis & Rheumatology. "Prior predictions had over-estimated the expected frequency of CHIKV-related joint pain in Latin America indicating 48% of CHIKV-infected people were predicted to have chronic chikungunya arthritis 20 months after acute infection."


Hospitalist Tackles Chronic Disease With Food Pharmacies

Inspired by programs in other parts of the country, Dr Nguyen worked to establish at her hospital a food pharmacy, a program that allows physicians to prescribe healthy food to patients and gives them affordable access to those foods. Today, she is a chronic disease specialist with the San Francisco Department of Public Health and a leader of the San Francisco Health Network's Food Pharmacy program. She continues to see patients as a hospitalist about 2 weeks of the year.