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Monthly Archives: January 2017

Live Long and Be Positive

Patients with coronary heart disease who have positive expectations about recovery, expressing beliefs such as “I can still live a long and healthy life,” had greater long-term survival, researchers reported.

Among a cohort of almost 3,000 patients undergoing coronary angiography, those with the highest expectations for outcomes actually had the best outcomes, Dr. John C. Barefoot, and colleagues from Duke University Medical Center in Durham, N.C.

“Patients differ widely in terms of their psychological reactions to major illnesses such as coronary heart disease,” Barefoot’s group explained online in the Archives of Internal Medicine.

To explore the specific potential influence of recovery expectations, rather than overall optimistic personality traits, the investigators enrolled 2,818 patients with clinically significant disease and followed them for about 15 years.

Recovery expectations were assessed on the Expectations for Coping Scale, in which patients agreed or disagreed with statements such as “I doubt that I will ever fully recover from my heart problems” and “My heart condition will have little or no effect on my ability to do work.”

Patients were stratified into quartiles according to their expectation scores.

After adjustment for multiple variables, the mortality rate in the highest quartile — the most optimistic group — was 32 per 100 versus 46 per 100, respectively, “illustrating a substantial magnitude of this effect even after taking multiple covariates into account,” Barefoot and colleagues observed.

“These observations add to a compelling body of evidence that endorsing optimistic expectations for one’s future heart health is associated with clinically important benefits to cardiovascular outcomes,” Dr. Robert Gramling, and Dr. Ronald Epstein, of the University of Rochester in New York, wrote in a commentary accompanying the study.

“The degrees of evidence observed in these studies suggest that optimism is a powerful ‘drug’ that compares favorably with highly effective medical therapies,” they wrote.

Other experts advised caution, however.

“Like all observational studies, unmeasured patient characteristics may have contributed to the better outcomes,” observed Dr. Steven E. Nissen, of the Cleveland Clinic.

“Patients with a ‘positive’ attitude may simply be healthier than patients with a negative attitude. In fact, their ‘attitude’ may reflect their health status,” Nissen wrote to MedPage Today and ABC News in an e-mail.

Two “plausible” hypotheses can help explain the study findings, according to Barefoot and colleagues.

First, patients who are optimistic may use more effective strategies to cope with recovery from illness, by addressing the problem and reducing risk factors.

Second, patients whose outlook is more negative may experience worse stress that in turn could have harmful cardiac effects.

Limitations of the study, according to the investigators, included the possibility of confounders and selection bias.

“These findings argue for expanded efforts to understand the influence of recovery expectations and the potential benefits of attempts to modify them,” Barefoot’s group concluded.

However, the potential efficacy of such efforts is uncertain, according to Dr. James Kirkpatrick, of the University of Pennsylvania in Philadelphia.

“Whether a patient’s outlook can be changed (or patients can change their outlook) and improve results, and whether there are other factors which might make these patients do better, is unknown. One of those factors might be that cardiovascular providers give better care to patients with a positive outlook — perhaps spending more time with them or being more conscientious,” wrote Kirkpatrick in an email toMedPage Today and ABC News.

“Future studies will need to take this possible mechanism into account,” wrote Kirkpatrick.

The study was supported by the National Heart, Lung, and Blood Institute and the National Institute on Aging.

One author has a patent pending on an allele as a marker of cardiovascular disease and stress, and is a founder and major stockholder in Williams LifeSkills Inc.

Editorialist Gramling is funded by the National Palliative Care Research Center and the Greenwall Foundation.

Dangerous Bacteria in Outside Hospitals

The dangerous bacteria Clostridium difficile spreads not only in hospitals but also in other health-care settings, causing infections and death rates to hit “historic highs,” U.S. health officials reported Tuesday.

C. difficile is a deadly diarrheal infection that poses a significant threat to U.S. health care patients,” Ileana Arias, principal deputy director at the U.S. Centers for Disease Control and Prevention, said during a morning news conference. “C. difficile is causing many Americans to suffer and die.”

The germ is linked to about 14,000 deaths in the United States every year. People most at risk from C. difficile are those who take antibiotics and also receive care in any medical facility.

“This failure is more difficult to accept because these are treatable, often preventable deaths,” Arias said. “We know what can be done to do a better job of protecting our patients.”

Much of the growth of this bacterial epidemic has been due to the overuse of antibiotics, the CDC noted in its March 6 report. Unlike healthy people, people in poor health are at high risk for C. difficile infection.

Almost 50 percent of infections are among people under 65, but more than 90 percent of deaths are among those aged 65 and older, according to the report.

Previous estimates found that about 337,000 people are hospitalized each year because of C. difficile infections. Those are historically high levels and add at least $1 billion in extra costs to the health care system, the CDC said.

However, these estimates might not completely reflect C. difficile’s overall impact.

According to the new report, 94 percent of C. difficile infections are related to medical care, with 25 percent among hospital patients and 75 percent among nursing home patients or people recently seen in doctors’ offices and clinics.

Although the proportion of infection is lowest in hospitals, they are at the core of prevention because many infected patients are transferred to hospitals for care, raising the risk of spreading the infection there, the CDC said.

Half of those with C. difficile infections were already infected when they were admitted to the hospital, often after getting care at another facility, the agency noted.

The other 50 percent of infections were related to care at the hospital where the infection was diagnosed.

The CDC said that these infections could be reduced if health care workers follow simple infection control precautions, such as prescribing fewer antibiotics, washing their hands more often and isolating infected patients.

These and other measures have reduced C. difficile infections by 20 percent in hospitals in Illinois, Massachusetts and New York, the CDC said.

In England, infections have been cut 50 percent in three years, the agency said.

Patients get C. difficile infections mostly after taking antibiotics, which can diminish the body’s “good” bacteria for several months.

That’s when patients can get sick from C. difficile, which can be picked up from contaminated surfaces or spread by health care providers.

The predominant sign of C. difficile infection is diarrhea, which can cause dehydration. If serious, the infection can become deadly. Other symptoms include fever, nausea and loss of appetite.

The CDC advises that if diarrhea occurs after a patient starts antibiotics, C. difficileshould be suspected and treatment continued with another antibiotic.

Commenting on the report, infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University, said, “All these recommendations are fine; the problem is they are not going to work, you can’t stop these practices. This bug exists in a climate of overuse of antibiotics.”

It is hard to eradicate C. difficile because it buries itself in the colon, then recurs and testing isn’t always accurate, Siegel said. “It’s a pervasive problem in hospitals, and even in communities,” he said.

Medications Safety

The U.S. Food and Drug Administration (FDA) judges a drug to be safe enough to approve when the benefits of the medicine outweigh the known risks for the labeled use.

Doctors, physician assistants, nurses, pharmacists, and YOU make up your health care team. To reduce the risks from using medicines and to get the most benefit, you need to be an active member of the team.

To make medicine use SAFER:

  • Speak up
  • Ask questions
  • Find the facts
  • Evaluate your choices
  • Read the label and follow directions

Speak Up

The more information your health care team knows about you, the better the team can plan the care that’s right for you.

The members of your team need to know your medical history, such as illnesses, medical conditions (like high blood pressure or diabetes), and operations you have had.

They also need to know all the medicines and treatments you use, whether all the time or only some of the time. Before you add something new, talk it over with your team. Your team can help you with what mixes well, and what doesn’t.

It helps to give a written list of all your medicines and treatments to all your doctors, pharmacists and other team members. Keep a copy of the list for yourself and give a copy to a loved one.

Be sure to include:

  • prescription medicines, including any samples your doctor may have given you
  • over-the-counter (OTC) medicines, or medicines you can buy without a prescription (such as antacids, laxatives, or pain, fever, and cough/cold medicines)
  • dietary supplements, including vitamins and herbs
  • any other treatments
  • any allergies, and any problems you may have had with a medicine
  • anything that could have an effect on your use of medicine, such as pregnancy, breast feeding, trouble swallowing, trouble remembering, or cost

Ask Questions

Your health care team can help you make the best choices, but you have to ask the right questions. When you meet with a team member, have your questions written down and take notes on the answers. You also may want to bring along a friend or relative to help you understand and remember.

Find the Facts

Before you and your team decide on a prescription or OTC medicine, learn and understand as much about it as you can, including:

  • brand and generic (chemical) names
  • active ingredients — to make sure that you aren’t using more than one medicine with the same active ingredient
  • inactive ingredients — if you have any problems with ingredients in medicines, such as colors, flavors, starches, sugars
  • uses (“indications” and “contraindications”) — why you will be using it, and when the medicine should/should not be used
  • warnings (“precautions”) — safety measures to make sure the medicine is used the right way, and to avoid harm
  • possible interactions — substances that should not be used while using the medicine. Find out if other prescription and OTC medicines, food, dietary supplements, or other things (like alcohol and tobacco) could cause problems with the medicine
  • side effects (“adverse reactions”) — unwanted effects that the medicine can cause, and what to do if you get them
  • possible tolerance, dependence, or addiction – problems that some medicines can cause, and what you can do to avoid them
  • overdose — what to do if you use too much
  • directions — usual dose; what to do if you miss a dose; special directions on how to use the medicine, such as whether to take it with or without food
  • storage instructions — how and where to keep the medicine
  • expiration — date after which the medicine may not work, or may be harmful to use

Your pharmacy, the library, the bookstore, the medicine maker, and the Internet have medicine information made for consumers. If you have questions, ask your health care team.

Evaluate your Choices — Weigh the Benefits and Risks

After you have all the information, think carefully about your choices. Think about the helpful effects as well as the possible unwanted effects. Decide which are most important to you. This is how you weigh the benefits and risks. The expert advice from your health care team and the information you give the team can help guide you and your team in making the decision that is right for you.

Read the Label and Follow Directions

Read the label to know what active ingredient(s) is (are) in the medicine. The active ingredient in a prescription or OTC medicine might be in other medicines you use. Using too much of any active ingredient may increase your chance of unwanted side effects.

Read the label each time you buy an OTC medicine or fill your prescription. When buying an OTC, read the “Drug Facts” label carefully to make sure it is the right medicine for you. Prescription and OTC medicines don’t always mix well with each other. Dietary supplements (like vitamins and herbals) and some foods and drinks can cause problems with your medicines too. Ask the pharmacist if you have questions.

Before you leave the pharmacy with your prescription, be sure you have the right medicine, know the right dose to use, and know how to use it. If you’ve bought the medicine before, make sure that this medicine has the same shape, color, size, and packaging. Anything different? Ask your pharmacist. If your medicine tastes different when you use it, tell your health care team.

Read and save all the information you get with your medicine.

Read the label each time before you use the medicine. Be sure it’s right in 5 ways:

  1. the right medicine
  2. for the right patient
  3. in the right amount
  4. at the right time
  5. in the right way (for example, swallow instead of chew a pill)

Follow directions on the label and from your health care team. When you are ready to use the medicine, make the most of the benefits and lower the risks by following the directions.

If you want to stop a medicine your doctor told you to use or to use it in a different way than directed, talk to a team member. Some medicines take longer to show that they are working. With some medicines, such as antibiotics, it is important to finish the whole prescription, even if you feel better sooner. When you stop using some medicines, you must reduce the dose little by little to prevent unwanted side effects.

Tips to Eat a Healthy Diet

If you are what you eat, it follows that you want to stick to a healthy diet that’s well balanced. “You want to eat a variety of foods,” says Stephen Bickston, MD, AGAF, professor of internal medicine and director of the Inflammatory Bowel Disease Center at Virginia Commonwealth University Health Center in Richmond. “You don’t want to be overly restrictive of any one food group or eat too much of another.”

Healthy Diet: The Building Blocks

The best source of meal planning for most Americans is the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services Food Pyramid. The pyramid, updated in 2005, suggests that for a healthy diet each day you should eat:

  • 6 to 8 servings of grains. These include bread, cereal, rice, and pasta, and at least 3 servings should be from whole grains. A serving of bread is one slice while a serving of cereal is 1/2 (cooked) to 1 cup (ready-to-eat). A serving of rice or pasta is 1/2 cup cooked (1 ounce dry). Save fat-laden baked goods such as croissants, muffins, and donuts for an occasional treat.
  • 2 to 4 servings of fruits and 4 to 6 servings of vegetables. Most fruits and vegetables are naturally low in fat, making them a great addition to your healthy diet. Fruits and vegetables also provide the fiber, vitamins, and minerals you need for your body’s systems to function at peak performance. Fruits and vegetables also will add flavor to a healthy diet. It’s best to serve them fresh, steamed, or cut up in salads. Be sure to skip the calorie-laden toppings, butter, and mayonnaise, except on occasion. A serving of raw or cooked vegetables is equal to 1/2 cup (1 cup for leafy greens); a serving of a fruit is 1/2 cup or a fresh fruit the size of a tennis ball.
  • 2 to 3 servings of milk, yogurt, and cheese. Choose dairy products wisely. Go for fat-free or reduced-fat milk or cheeses. Substitute yogurt for sour cream in many recipes and no one will notice the difference. A serving of dairy is equal to 1 cup of milk or yogurt or 1.5 to 2 ounces of cheese.
  • 2 to 3 servings of meat, poultry, fish, dry beans, eggs, and nuts. For a healthy diet, the best ways to prepare beef, pork, veal, lamb, poultry, and fish is to bake or broil them. Look for the words “loin” or “round” in cuts of meats because they’re the leanest. Remove all visible fat or skin before cooking, and season with herbs, spices, and fat-free marinades. A serving of meat, fish, or poultry is 2 to 3 ounces. Some crossover foods such as dried beans, lentils, and peanut butter can provide protein without the animal fat and cholesterol you get from meats. A ¼ cup cooked beans or 1 tablespoon of peanut butter is equal to 1 ounce of lean meat.
  • Use fats, oils, and sweets sparingly. No diet should totally eliminate any one food group, even fats, oils, and sweets. It’s fine to include them in your diet as long as it’s on occasion and in moderation, Bickston says.

Healthy Diet: Eat Right and the Right Amount

How many calories you need in a day depends on your sex, age, body type, and how active you are. Generally, active children ages 2 to 8 need between 1,400 and 2,000 calories a day. Active teenage girls and women can consume about 2,200 calories a day without gaining weight. Teenage boys and men who are very active should consume about 3,000 calories a day to maintain their weight. If you’re not active, you calorie needs drop by 400 to 600 calories a day.

The best way to know how much to eat is to listen to your body, says Donald Novey, MD, an integrative medicine physician with the Advocate Medical Group in Park Ridge, Ill. “Pull away from the table when you’re comfortable but not yet full. Wait about 20 minutes,” he says. “Usually your body says, ‘That’s good.’ If you’re still hungry after that, you might want to eat a little more.”

Healthy Diet: Exercise Is Part of the Plan

At the bottom of the new USDA food pyramid is a space for exercise. Exercise is an important component of a well-balanced diet and good nutrition. You can reap “fabulous rewards,” says Dr Novey, just by exercising and eating “a healthy diet of foods that nature provides.”