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Old 02-01-2005, 12:36 PM   #1
jbt1976
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From the Chicago Suntimes--if only Gord had read this:
http://www.suntimes.com/output/healt...s-aneur01.html

Panel calls for screenings for abdominal aneurysms

February 1, 2005

BY JIM RITTER Health Reporter


About 1.5 million older Americans are walking around with a life-threatening time bomb -- a dangerous bulge in the aorta, the body's main artery.

This bulge, called an aneurysm, could burst at any time, causing profuse and usually fatal bleeding in the abdominal area.

On Monday, an influential expert panel for the first time recommended mass screening for abdominal aortic aneurysms, or AAAs, which kill at least 15,000 Americans per year.

Men between 65 and 75 who have smoked more than 100 cigarettes in their lifetimes should get one-time screenings for AAAs with ultrasounds, the U. S. Preventive Services Task Force said. About 500 such men would need to be screened to prevent one AAA-related death in the next five years.

The government-supported task force published its guidelines in the Annals of Internal Medicine.

Some doctors say the task force did not go far enough. The Society of Vascular Surgery recommends AAA screening for all men age 60 to 85, women 60 to 85 with cardiovascular risk factors and anyone older than 50 with a family history of AAA.

"We're a little disappointed about [the task force] short-changing women," said Dr. William Flinn, vice chairman of the American Vascular Association.

But men are about four times more likely than women to have AAAs. In women, most deaths from ruptured AAAs occur after age 80, and at that age, "any benefit of screening for AAA would be minimal," the Task Force said.

However, a doctor might discuss screening for women in some cases, such as that of a smoker in her early 70s with a family history of AAA, the task force said.

How the problem is fixed

Hospitals charge as much as $300 for AAA ultrasound screenings. Medicare doesn't pay for them, nor do many health plans. Vascular surgeons are lobbying Congress to require Medicare coverage. Mass screening could cost $50 to $75 per test, Flinn said.

Ruptured AAAs kill about 80 percent of patients. And survivors face major surgery, with possible complications such as heart attacks and kidney failure, Flinn said. "It's an absolute catastrophe, and totally preventable."

If caught in time, an AAA can be repaired. In a long-established technique, the surgeon opens the abdomen and replaces the bulging part of the aorta with a Dacron or Gore-Tex pipe. Patients are hospitalized up to 10 days and can take months to recover, said Northwestern Memorial Hospital vascular surgeon Dr. William Pearce.

In a newer procedure, the surgeon makes an incision in the groin and snakes a stent through the femoral artery to the aorta. Patients stay just one night, and can return to work the next day.

"It's a beautiful way to have it done," said Thomas L. Hogan of Chicago Heights, who had the less-invasive repair at Northwestern. "There was hardly any recovery whatsoever."

But stents can leak, so patients need follow-up CT scans every six to 12 months, Pearce said. Moreover, some AAAs can be repaired only with major surgery.

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Old 02-01-2005, 12:36 PM   #2
Next Saturday
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From the Chicago Suntimes--if only Gord had read this:
http://www.suntimes.com/output/healt...s-aneur01.html

Panel calls for screenings for abdominal aneurysms

February 1, 2005

BY JIM RITTER Health Reporter


About 1.5 million older Americans are walking around with a life-threatening time bomb -- a dangerous bulge in the aorta, the body's main artery.

This bulge, called an aneurysm, could burst at any time, causing profuse and usually fatal bleeding in the abdominal area.

On Monday, an influential expert panel for the first time recommended mass screening for abdominal aortic aneurysms, or AAAs, which kill at least 15,000 Americans per year.

Men between 65 and 75 who have smoked more than 100 cigarettes in their lifetimes should get one-time screenings for AAAs with ultrasounds, the U. S. Preventive Services Task Force said. About 500 such men would need to be screened to prevent one AAA-related death in the next five years.

The government-supported task force published its guidelines in the Annals of Internal Medicine.

Some doctors say the task force did not go far enough. The Society of Vascular Surgery recommends AAA screening for all men age 60 to 85, women 60 to 85 with cardiovascular risk factors and anyone older than 50 with a family history of AAA.

"We're a little disappointed about [the task force] short-changing women," said Dr. William Flinn, vice chairman of the American Vascular Association.

But men are about four times more likely than women to have AAAs. In women, most deaths from ruptured AAAs occur after age 80, and at that age, "any benefit of screening for AAA would be minimal," the Task Force said.

However, a doctor might discuss screening for women in some cases, such as that of a smoker in her early 70s with a family history of AAA, the task force said.

How the problem is fixed

Hospitals charge as much as $300 for AAA ultrasound screenings. Medicare doesn't pay for them, nor do many health plans. Vascular surgeons are lobbying Congress to require Medicare coverage. Mass screening could cost $50 to $75 per test, Flinn said.

Ruptured AAAs kill about 80 percent of patients. And survivors face major surgery, with possible complications such as heart attacks and kidney failure, Flinn said. "It's an absolute catastrophe, and totally preventable."

If caught in time, an AAA can be repaired. In a long-established technique, the surgeon opens the abdomen and replaces the bulging part of the aorta with a Dacron or Gore-Tex pipe. Patients are hospitalized up to 10 days and can take months to recover, said Northwestern Memorial Hospital vascular surgeon Dr. William Pearce.

In a newer procedure, the surgeon makes an incision in the groin and snakes a stent through the femoral artery to the aorta. Patients stay just one night, and can return to work the next day.

"It's a beautiful way to have it done," said Thomas L. Hogan of Chicago Heights, who had the less-invasive repair at Northwestern. "There was hardly any recovery whatsoever."

But stents can leak, so patients need follow-up CT scans every six to 12 months, Pearce said. Moreover, some AAAs can be repaired only with major surgery.


________
vaporizer

Last edited by Next Saturday; 01-19-2011 at 03:44 PM.
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Old 02-01-2005, 01:10 PM   #3
Auburn Annie
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Strictly speaking his wasn't an "abdominal artery" aneurysm, but an aneurysm along another artery (renal, if I remember correctly), but it's good advice anyway. I've suggested to my husband that he get checked since his mother had one, thoughshe was a smoker and he's never been. Still, some types of aneurysms have a tendency to run in families.
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Old 02-01-2005, 01:10 PM   #4
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Strictly speaking his wasn't an "abdominal artery" aneurysm, but an aneurysm along another artery (renal, if I remember correctly), but it's good advice anyway. I've suggested to my husband that he get checked since his mother had one, thoughshe was a smoker and he's never been. Still, some types of aneurysms have a tendency to run in families.
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Old 02-01-2005, 02:22 PM   #5
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Gotta wonder about those "medical association". The AMA (AMerican Medical Assoication) is responsible for over 85,00 deaths due to false diagnosis, improper diagonsis, screw ups by doctors etc etc EACH YEAR. Now if it was any other business...say General Motots Corp and they lost 85,000 employees a year you better believe there would be an investigaion. But NOOOOOO not the AMA!
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Old 02-01-2005, 02:31 PM   #6
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Yup, this makes sense... I gotta have an ultrasound every 5 yrs after my dad had an AAA in 2003.

Also the article should have pointed out that many people experience bouts of sudden back pain, that is the biggest red flag that you have an impending AAA... dad complained of that for a year.. none of us gave it much thought!

[This message has been edited by Gord (edited February 01, 2005).]
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Old 02-01-2005, 02:31 PM   #7
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Yup, this makes sense... I gotta have an ultrasound every 5 yrs after my dad had an AAA in 2003.

Also the article should have pointed out that many people experience bouts of sudden back pain, that is the biggest red flag that you have an impending AAA... dad complained of that for a year.. none of us gave it much thought!

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Old 02-01-2005, 06:29 PM   #8
Auburn Annie
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quote:Originally posted by paddletothesea:
Gotta wonder about those "medical association". The AMA (AMerican Medical Assoication) is responsible for over 85,00 deaths due to false diagnosis, improper diagonsis, screw ups by doctors etc etc EACH YEAR. Now if it was any other business...say General Motots Corp and they lost 85,000 employees a year you better believe there would be an investigaion. But NOOOOOO not the AMA!

Sigh ... I guess I'll have to weigh in here.

First, in defense of the AMA (I cannot believe they need my help, but what the hell) - it's an ASSOCIATION, not a cabal. It is not some monolith; you would not believe how contentious any given group of physicians can be among themselves. The AMA as a group is no more "responsible" for individual deaths than the National Rifle Association is for all those gun deaths (29000) every year - and I am *NOT* a gun owner or NRA supporter, but that's another soapbox. Their mission (the AMA, that is) is to promote health, not knock off their livelihood through ignorance, carelessness or indifference, much less actual malpractice. What so many people do not 'get' is that a doctor or hospital staff can do everything right, by the book, and the patient can still have a bad outcome. That's not malpractice, folks. Malpractice involves actively doing something you KNOW is not standard of care for that particular patient in that particular situation.

Your basic newborn is far more complex than the most advanced computer ever devised. Medicine is as much art as science, imperfect on both counts. Add to this the human factor on the part of both physicians or nurses (fatigue, miscommunications) and patients, who often are less than forthcoming about the drugs (legal or over-the-counter or alternative herbals) they're taking, their health practices (e.g. sexual) that doctors have to guess at, but which can significantly affect treatment and outcome - and you have a great recipe for disaster. Healthcare is NOT cars, attempts to the contrary over the decades to run it that way. People aren't widgets - hence the lack of cookie-cutter treatments. Once size does NOT fit all, or even many.

Back to iatrogenic deaths, to which you are referring. The original Harvard study most often cited (in the Journal of the American Medical Association, BTW) was based on "the medical charts of 30,121 patients admitted to 51 acute care hospitals in New York state in 1984. They reported that adverse events/injuries caused by medical management that prolonged admission or produced disability at the time of discharge occurred in 3.7% of admissions." See http://bmj.bmjjournals.com/cgi/conte...l/320/7237/774
for more.

That's one study, more than 20 years ago, of hospitals in 1 state. Correlation is not causation. It does NOT necessarily mean that every institution will have the same rate nationwide; some will be worse, others better. I remember when the government was first tracking death rates nationwide, there was considerable alarm over a few institutions where the mortality rate was nearly 100%!! Turns out they were including hospices in the survey (duh!). Where you have an older population or sicker patient load (i.e. oncology) you will have a higher mortality rate that has nothing to do with error.

I would add that most errors, medical or otherwise, should be attributed to poor processes, not careless people. These are called latent errors. See http://pediatrics.aappublications.or...ull/111/5/1108
for examples.

Having once served on a committee charged with streamlining the admissions process from ER to patient floor, I can tell you there is no system as complicated as a hospital. The above process involved ER doctors and nurses (intake/H&P/initial diagnosis and treatment/decision to admit), physician offices (for existing patient records), laboratory and radiology (for ordered diagnostic tests), medical records (for previous admissions), admissions and central registration (to check insurance coverage AND to see if there's a room available - often not, and they have to be held in the ER for hours until there's a bed available) housekeeping and laundry (to clean the room and provide fresh linens), transport (who delivers the patient from the ER to the floor), floor clerks and nurses (who take the patient's ER records and start a floor chart, and accompany the patient to the room), volunteers (to provide the patient and family with basic hospital information, Patient Bill of Rights, etc.), pharmacy (for medications ordered), social services (if the patient will require post-discharge assistance like home care), utilization review (to examine the intake chart and check the treatment plan for appropriateness and medical necessity.) Also, on occasion Security or the Chaplain may be required if family members are very distraught. I'm sure I've left a few departments out. You can imagine trying to make a flow chart involving so many services, to get the patient the most efficient - and safe - care.

Finally, there are any number of factors beyond our control. For example, some of the most serious bacteria have become resistant to the strongest antibiotics we have (methicillin and vancomycin resistant bacteria are rare but increasing.) Bacteria are smart; they mutate when they come up against antimicrobials.

Are there way too many deaths and injuries? Absolutely! Can we do better? Hell, yes. Will we ever get it down to none? Never, not even close, for reasons cited above.


[This message has been edited by Auburn Annie (edited February 01, 2005).]
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Old 02-01-2005, 06:29 PM   #9
Auburn Annie
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quote:Originally posted by paddletothesea:
Gotta wonder about those "medical association". The AMA (AMerican Medical Assoication) is responsible for over 85,00 deaths due to false diagnosis, improper diagonsis, screw ups by doctors etc etc EACH YEAR. Now if it was any other business...say General Motots Corp and they lost 85,000 employees a year you better believe there would be an investigaion. But NOOOOOO not the AMA!

Sigh ... I guess I'll have to weigh in here.

First, in defense of the AMA (I cannot believe they need my help, but what the hell) - it's an ASSOCIATION, not a cabal. It is not some monolith; you would not believe how contentious any given group of physicians can be among themselves. The AMA as a group is no more "responsible" for individual deaths than the National Rifle Association is for all those gun deaths (29000) every year - and I am *NOT* a gun owner or NRA supporter, but that's another soapbox. Their mission (the AMA, that is) is to promote health, not knock off their livelihood through ignorance, carelessness or indifference, much less actual malpractice. What so many people do not 'get' is that a doctor or hospital staff can do everything right, by the book, and the patient can still have a bad outcome. That's not malpractice, folks. Malpractice involves actively doing something you KNOW is not standard of care for that particular patient in that particular situation.

Your basic newborn is far more complex than the most advanced computer ever devised. Medicine is as much art as science, imperfect on both counts. Add to this the human factor on the part of both physicians or nurses (fatigue, miscommunications) and patients, who often are less than forthcoming about the drugs (legal or over-the-counter or alternative herbals) they're taking, their health practices (e.g. sexual) that doctors have to guess at, but which can significantly affect treatment and outcome - and you have a great recipe for disaster. Healthcare is NOT cars, attempts to the contrary over the decades to run it that way. People aren't widgets - hence the lack of cookie-cutter treatments. Once size does NOT fit all, or even many.

Back to iatrogenic deaths, to which you are referring. The original Harvard study most often cited (in the Journal of the American Medical Association, BTW) was based on "the medical charts of 30,121 patients admitted to 51 acute care hospitals in New York state in 1984. They reported that adverse events/injuries caused by medical management that prolonged admission or produced disability at the time of discharge occurred in 3.7% of admissions." See http://bmj.bmjjournals.com/cgi/conte...l/320/7237/774
for more.

That's one study, more than 20 years ago, of hospitals in 1 state. Correlation is not causation. It does NOT necessarily mean that every institution will have the same rate nationwide; some will be worse, others better. I remember when the government was first tracking death rates nationwide, there was considerable alarm over a few institutions where the mortality rate was nearly 100%!! Turns out they were including hospices in the survey (duh!). Where you have an older population or sicker patient load (i.e. oncology) you will have a higher mortality rate that has nothing to do with error.

I would add that most errors, medical or otherwise, should be attributed to poor processes, not careless people. These are called latent errors. See http://pediatrics.aappublications.or...ull/111/5/1108
for examples.

Having once served on a committee charged with streamlining the admissions process from ER to patient floor, I can tell you there is no system as complicated as a hospital. The above process involved ER doctors and nurses (intake/H&P/initial diagnosis and treatment/decision to admit), physician offices (for existing patient records), laboratory and radiology (for ordered diagnostic tests), medical records (for previous admissions), admissions and central registration (to check insurance coverage AND to see if there's a room available - often not, and they have to be held in the ER for hours until there's a bed available) housekeeping and laundry (to clean the room and provide fresh linens), transport (who delivers the patient from the ER to the floor), floor clerks and nurses (who take the patient's ER records and start a floor chart, and accompany the patient to the room), volunteers (to provide the patient and family with basic hospital information, Patient Bill of Rights, etc.), pharmacy (for medications ordered), social services (if the patient will require post-discharge assistance like home care), utilization review (to examine the intake chart and check the treatment plan for appropriateness and medical necessity.) Also, on occasion Security or the Chaplain may be required if family members are very distraught. I'm sure I've left a few departments out. You can imagine trying to make a flow chart involving so many services, to get the patient the most efficient - and safe - care.

Finally, there are any number of factors beyond our control. For example, some of the most serious bacteria have become resistant to the strongest antibiotics we have (methicillin and vancomycin resistant bacteria are rare but increasing.) Bacteria are smart; they mutate when they come up against antimicrobials.

Are there way too many deaths and injuries? Absolutely! Can we do better? Hell, yes. Will we ever get it down to none? Never, not even close, for reasons cited above.


[This message has been edited by Auburn Annie (edited February 01, 2005).]
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Old 02-01-2005, 08:18 PM   #10
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Well, Norm, to put it a bit more succintly (no offense Annie), that would be why they call it PRACTICING medicine.
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Old 02-01-2005, 08:59 PM   #11
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That would be the Carnegie Hall method? As in how do I get to Carnegie Hall? (practice, practice, practice)
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Old 02-01-2005, 08:59 PM   #12
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That would be the Carnegie Hall method? As in how do I get to Carnegie Hall? (practice, practice, practice)
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Old 02-01-2005, 10:03 PM   #13
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It's intelligent discussions like this that make me proud to be a member of this board.
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Old 02-01-2005, 10:03 PM   #14
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It's intelligent discussions like this that make me proud to be a member of this board.
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Old 02-02-2005, 09:00 AM   #15
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Agreed 100% with Annie and I own guns.

The death rate of GM employees getting killed on the job was a bad correlation but I see what Norm was getting at. Still, like Annie said, there are so many unknowns with the human body, what each individual is doing eating etc., Dr's have a tough, tough job. Besides, what would the death rate be without them?
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Old 02-02-2005, 09:53 AM   #16
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quote:Originally posted by TheWatchman:
Agreed 100% with Annie and I own guns.

The death rate of GM employees getting killed on the job was a bad correlation but I see what Norm was getting at. Still, like Annie said, there are so many unknowns with the human body, what each individual is doing eating etc., Dr's have a tough, tough job. Besides, what would the death rate be without them?


Uh, well, actually with or without them, the mortality rate is 100% - eventually. It's just a delaying action in the meantime.

[This message has been edited by Auburn Annie (edited February 02, 2005).]
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Old 02-02-2005, 09:53 AM   #17
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quote:Originally posted by TheWatchman:
Agreed 100% with Annie and I own guns.

The death rate of GM employees getting killed on the job was a bad correlation but I see what Norm was getting at. Still, like Annie said, there are so many unknowns with the human body, what each individual is doing eating etc., Dr's have a tough, tough job. Besides, what would the death rate be without them?


Uh, well, actually with or without them, the mortality rate is 100% - eventually. It's just a delaying action in the meantime.

[This message has been edited by Auburn Annie (edited February 02, 2005).]
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Old 02-02-2005, 10:30 AM   #18
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hmm, i certainly haven't read every word of this thread but best of health to all and hope all get the best treatment possible when required , keep up with those regular preventative checkups and please always consider filling out your organ donor card, or go one further and donate your body so that our new med students and healthcare workers (my heros ) can 'practice' on folks who are already dead

...and i don't even own a gun (but i need one, i have my own Punx Phil to deal with this spring, lol)

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(is it 6 more weeks or 6 more MONTHS of winter?)
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Old 02-02-2005, 10:30 AM   #19
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hmm, i certainly haven't read every word of this thread but best of health to all and hope all get the best treatment possible when required , keep up with those regular preventative checkups and please always consider filling out your organ donor card, or go one further and donate your body so that our new med students and healthcare workers (my heros ) can 'practice' on folks who are already dead

...and i don't even own a gun (but i need one, i have my own Punx Phil to deal with this spring, lol)

Wierton Jimmie

(is it 6 more weeks or 6 more MONTHS of winter?)
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Old 02-02-2005, 10:45 PM   #20
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quote:Originally posted by Auburn Annie:
Uh, well, actually with or without them, the mortality rate is 100% - eventually. It's just a delaying action in the meantime.

[This message has been edited by Auburn Annie (edited February 02, 2005).]


Uh, well, actually my point is that Dr's save countless lives everyday. For example, Lightfoot. Without Dr's, he would not have made it. Dr's also make a diagnosis which sometimes leads to curing a condition. A Dr can save your life when your 16 and you can live until 99. Sure, I guess the Dr just delayed the inevitable death in the meantime. Geeze.
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