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Like the man once said, the times they are a-changin’. As an article in this week’s JAMA illustrates, in much of the US life expectancy is rising. But where it’s not rising, life expectancy has not leveled off. Rather it’s dropping precipitously. Central Colorado has the highest life expectancy in the country, while counties in Kentucky, Oklahoma and Alabama are as much as 20 years lower. These findings are consistent with other studies that have shown that the US is failing to keep up with improvements in longevity in other developed countries. Here in Cook County, IL, our “constant protection of health” (at least since this poster from the Great Depression) has us somewhere in the vast middle with slow movement upward. At least it’s not a drop.

Some coincidental timing we’d rather not see -- a new study from the American Cancer Society this week found that colorectal cancer rates, which dropped at a steady clip for people born between 1890 and 1950, have been increasing for every generation born since 1950, and no one knows why; meanwhile, Rush surgeons are hosting a symposium on the latest colorectal surgical techniques on March 18.

Rectal cancers are rising particularly sharply, far faster than cancers in other parts of the large intestine or colon. And it’s the upward trend in younger people that is so concerning, not to mention puzzling. Things like smoking or a diet with few vegetables and loads of red meat are known risk factors, but the lifestyle changes in those areas are to the RIGHT side. Bets are that some unforeseen environmental factor will pop up, but until then we’re not even sure how to screen adequately.

Communicating and interacting socially can be hard for some children with autism. Researchers are looking at how improv classes may help these kids do better day to day.

Some old traditions of medical education stay firmly in place -- like the code of the white coat, its length marking hard-earned achievements along the way. Other traditions just keep moving around, like that of spending your residency working almost non-stop.

It long seemed intuitive that the old 30-hour shifts were just not a good idea -- how would you like to be the last patient an exhausted new Doc sees in hour 29? But there are faculty who think the work-hour limits have actually compromised patient care since they increase the number of patient hand-offs as shorter shifts end. Many instructors also think young doctors learn best by following a patient in the crucial first 36 hours of a hospitalization.

Last Friday, the ACGME announced new recommendations from a task force on the length of shifts medical students and residents will be allowed to work. The suggestion is that first-year physicians in hospitals be allowed to work 24-hour shifts — eight hours longer than they are permitted now. If approved, the new recommendations would go into effect next July.

Possible confirmation of what many of us intuit to be true -- the human brain is predisposed to form prejudices. An article published last week in the Journal of Cognitive Neuroscience discusses the results of fMRI studies that demonstrate the brain’s much stronger response to information about groups that are portrayed negatively.

Hugo Spiers, a neuroscientist at University College London, led the study in which participants built up a “picture” of fictitious groups by being fed snippets of information. Imaging studies showed that activity in the anterior temporal pole matched the participants’ acquisition of prejudice. Once the participants had seen enough information to feel reassured that a group was essentially “good”, brain activity in the anterior temporal pole quickly tailed off. But it continued to respond strongly to the negative snippets about the behavior of the “bad” group.

Researchers have long speculated that the brain clusters information into chunks simply as a way to control what could be information overload. The question is, once we have formed a judgement about that chunked information, how simple is it to reverse that? This suggests maybe not so much.

A little piece in the NY Times caught our eye the other day -- “why does organic milk last longer at home?”

Just shows that our vast interprofessional knowledge base is mile-wide and thimble-deep because the answer is ridiculously simple. Here we’d thought it must have something to do with moving more quickly from cow to shelf. Turns out that just the opposite is true.

Most organic milk undergoes a pasteurization process called UHT, (ultrahigh temperature). The process kills practically all micro-organisms, unlike the standard pasteurization that only kills the bugs commonly causing disease. Thus, the bacteria leading to spoilage aren’t in the UHT-pasteurized milk, and it can last for weeks, or even months, at room temperature.

The new series on Fox about the first woman to pitch in big league baseball, cleverly called “Pitch”, is as dreadfully cliche-ridden as you’d expect. But a tagline did get us wondering: “a true story on the verge of happening.” Is it really? Because back in our frolicsome youth, we were SURE that by the time we were of age the White Sox would welcome us gladly as residents of 35th and Shields.

Not so much.

Aside from the obvious cultural rules, is there a reason for that? We found a study of the mechanics of pitching in both male and female elite athletes. Published in 2009 in the Journal of Applied Biomechanics (Chu, et al. Biomechanical comparison between elite female and male baseball pitchers. Feb 2009), the authors concluded that there really isn’t a physical reason. Other than having slightly lower velocity than their male counterparts, there is very little difference between throwing like a girl and throwing like a boy.

We are a bit long in the proverbial tooth for baseball now. But we can assure you that throwing like a girl was always serious business in our ahead-of-our-time IP approach to baseball!

This is amazing -- an article published last week in the journal Nature explains the work of multiple teams of geneticists showing that all non-Africans today can trace their ancestry to a single population emerging from Africa between 50,000 and 80,000 years ago. These migrants were a branch of today’s KhoiSan people in southern Africa.

The researchers conducted highly detailed genomic scans of 787 people drawn from aboriginal populations across the globe. Anthropologists know that there were multiple migrations out of Africa after the emergence of modern humans (about 200,000 years ago). But no one ever knew if the rest of the world was populated in one massive wave of migration out of Africa, or in staggered waves over tens of thousands of years. Now we know that it’s the former.

There was more than one exodus from Africa in those 150,000 years, for sure. But for whatever reasons, those other waves did not succeed in passing their DNA to the rest of the globe. Europeans, Asians, Australians, all stock from the same root. That’s just mind-boggling.

We noted an interesting tidbit in Donald Trump’s appearance with Dr Oz -- Trump revealed that he’d had CT angiography, and Oz said the scores were good. That exchange begs an important question: why would one undergo CT angiography to begin with?

As this image shows, CT angiography can be useful in evaluating things like the degree of a patient’s pulmonary hypertension. Current guidelines from the American College of Cardiology and the American College of Radiology say that the testing should not be done on most asymptomatic patients. However, several studies have shown that the imaging is overused, with suggestions that it’s still being applied in the old fee-for-service mode -- if you can pay for, then we’ll do it. (For example, see 2012 survey results from the Emergency Department Benchmarking Alliance.)

So, in a backdoor kind of way, the Oz/Trump show was rather revelatory.

#CT imaging #healthcare spending #pulmonary hypertension

An Epi-Pen update from the NY Times: Mylan (Epi-Pen’s manufacturer) and some prominent advocates are pushing to have the device added to a federal list of preventive medical services. This move that would eliminate the out-of-pocket costs of the product for millions of families. Oh, and by the way, mute the nationwide protests.

A big potential beneficiary of the campaign is Mylan itself. The company would be able to continue charging high prices for the product without patients complaining about the cost.

What a coincidence!

#epi-pen #mylan #pharmaceuticals #healthcare spending

Makes sense to us -- curb your appetite with some real sugary goodness! An article in JAMA Internal Medicine on Monday detailed how the sugar industry paid researchers for decades to help shape dietary recommendations, right around the same time (1970) as this informative ad. Their primary goal: deflect attention from sugar and onto fat.

This is important in no small part because the debate about the relative harms of sugar and saturated fat continues today. For many decades health authorities encouraged Americans to improve their health by reducing their fat intake. As a result, many people upped their consumption of low-fat, high-sugar foods. Many nutritionists say that shift helped to fuel today’s obesity crisis.

Why does one kid develop asthma and concomitant allergies to what seems like all flora and fauna, and a kid right next to him doesn’t? Allergy researchers are still trying to puzzle through that one, but a fascinating piece in the current issue of Nature Medicine demonstrates another link to the gut microbiome.

Researchers at Henry Ford in Detroit and UC San Francisco link a particular pattern of microbes in the guts of one-month-old infants to two important things: first, a three-fold higher risk of developing allergic reactions by age two, and second, asthma by age four. They surmise that a disrupted microbial ecosystem in the guts of these babies leads to hyperactive immune systems and eventually to chronic asthmatic inflammation of the lungs.

http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.4176.html

A need Rush will be addressing soon with an online, interprofessional course aimed at primary care providers at MyCME -- mental health disorders. Watch for it around the first of October

To the surprise of no one, a study published online last week by JAMA Internal Medicine shows that a large number of people who screen positive for depression are not receiving treatment. According to this research, of the 46,417 adults screened, 8.4 percent were positive for depression and 28.7 percent of those adults received any treatment for it

Screening for the condition has gotten increased attention through the efforts of the U.S. Preventive Services Task Force recommendations. The screening doesn’t do much good, though, if there’s little or no follow-up treatment. The task of managing many common mental health conditions, including depression, is left to primary care providers. This course seeks to help.

http://www.mycmesite.com/

Building the Evidence Base of Blood-Based Biomarkers for Early Detection of Cancer

For the first time, cancer researchers have a comprehensive list of the blood biomarkers already identified as possible cancer screening markers. Just because of the sheer number or papers and books published each year, it’s been difficult to know exactly what has been legitimately identified. This list will hopefully help to focus future studies on developing screening tools based on blood testing.

Like every other clinical center, Rush builds a treatment plan after identifying a cancer once it has already developed. But for a few specific cancers, like colon cancer, biomarkers can be identified before a person develops the disease. That person can then benefit from aggressive surveillance through regular colonscopies.

A study discussed at last week’s annual meeting of the American Orthopaedic Society for Sports Medicine showed that concussion rates among kids doubled between 2007 and 2014. The big question is whether the increase reflects a true rise in the number of injuries or an increase in diagnoses -- perhaps both as clinicians and the public have become more aware of head injuries in recent years.

Dr Jeff Mjaanes, director of the Chicago Sports Concussion Clinic at Rush, agrees with other experts that rest, especially for young people, is vital for recovery. Key to assuring that rest, though, is accurate diagnosis of a brain injury in the first place.

In the current study, the most significant jump in occurrence was seen among 10- to 14-year-olds, whose injury rate more than tripled. They were followed closely by 15- to 19-year-olds.The specific causes of those concussions are unknown, but head injuries from sports and other physical activities -- such as bike riding and skateboarding -- are likely the main drivers.

Opioid use has been getting an enormous amount of public attention of late, driven in no small part by our realization that addiction is occurring among the middle classes. A number of Rush clinicians have long known that there are effective, non-pharmacologic approaches to pain control.

See this presentation from Angela Johnson, part of Rush’s Cancer Center, (”Pediatric Grand Rounds (Recorded): An Overview of Integrative Medicine in Pediatric Care”) about evidence-based alternatives.

http://cmetracker.net/RUSH/Enduring

Important piece appearing in the new issue of The Lancet Neurology. This research team found evidence of tissue damage caused by blasts alone, not by concussions or other injuries.

#interprofessional education #Rush university medical center #neurology

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