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Wednesday, March 18, 2015

Doctors Suck When It Comes to Weight Loss and Morals

Your Doctor is an Idiot. Especially if he’s one of these guys. Or Dr. Oz.

OK, that wasn’t nice.  Or even accurate.  But it drives me nuts when people say “My doctor said _______” regarding diet and weight loss advice.  Fun fact:  Some medical schools provide as little as 2 hours of nutrition training to students, the average being less than 24 hours. (National Institute of Health paper here)  Well, at least they do teach med students to frequently repeat the phrase “make healthy diet choices and get some exercise.”  It’d just be nice if they also taught them to admit that they don’t know exactly what that means.
These Doctors admit they don't really know anything about nutrition.Case in point – These two doctors (identical twins) had a little contest to compare two extreme diets and see which was better.  What did they learn?  That neither extremely low fat or extremely low carb are sustainable.  What did I learn?  That neither twin can read, because there is ample data already available telling us that eliminating any of the 3 essential macronutrients is a bad idea. But the guy that cut out carbohydrates lost 9 pounds in a month?  Sweet!  Breaking news (if 40 year old data is breaking news) – Yes, ketosis works, but what these guys apparently still don’t know is that most of his initial weight loss was water that will come back as soon as he eats a granola and a bagel for breakfast.  You see, body composition management 101 tells us that every gram of carbohydrate stored in your body holds onto 3 grams of water.  Thus, if the average person depletes their normally stored (ballpark) 500 grams of carbohydrates (which weighs 1.1 pounds), you’ll lose not only that weight but also eliminate the 1500 grams (3.3 pounds) of water that goes with it.  That’s how I can literally pack on 6-8 pounds overnight if I have a carb-fest, and lose it over a few days with some hard work and discipline.  The point is these guys don’t have the most basic understanding of managing weight/body composition.  Perhaps worse, they don’t seems to be aware of the importance of differentiating between losing weight strictly watching numbers on the scale and losing fat while preserving muscle tissue and a strong skeleton. (let alone how to do that).
Why did I have to pick on Dr. Oz in the title?  Because my impression is that he is more interested in his ratings/popularity than in sharing the most completely accurate information, and too many people believe everything he says.  I recall his reaction/reporting on a one day diet experiment he did.  One frikkin day.  That’s not enough time to gather accurate data and his reported symptoms were unfairly attributed to the diet (which was a stupid way to try the diet anyway). He made all sorts of dramatic claims about the diet’s drawbacks, and I have to wholeheartedly disagree with the dietary advice he did give –  I’ll have to come back to that.  The parts of his TV show that I watched were like a bunch of mini-infomercials, where he ran from table to table showing products and telling us whatever the manufacturer claimed on the label.  That’s not even bad science – that’s just being a sellout.
I do want apologize here for calling names…none of these guys nor your doctor are really idiots.  Actually they are GANGSTERS. I completely respect their training and skill in their specialties, I only wanted to illustrate that nutrition is not it.  One of the twins even admits:“He realized that while he and Chris were both doctors, they really didn’t know that much about nutrition and diet.”
So please take away from this is that your doctor is not the best source of diet/nutrition/fitness advice.  Learn from people that manage their bodies for a living or lifestyle.  Better yet, start with their advice but study how everything works for yourself.

Monday, March 9, 2015

If Weight Loss Surgery Doesn't Kill You A Hospital Infection Will

Image result for healthcare acquired infections

American hospitals are filthy dirty places run by greedy criminals. Consider the following.

Keep in mind:

  • We have the knowledge to prevent hospital infection deaths.
  • We don't have to wait for a scientific breakthrough. Yet greedy hospitals have failed to act.
  • The situation is growing more dangerous because, increasingly, hospital infections cannot be cured with commonly-used antibiotics.
Sometimes connecting the dots reveals a grim picture. Several new reports about hospital-acquired infections (HAIs) show that the danger is increasing rapidly, and that the Centers for Disease Control and Prevention (CDC) isn’t leveling with the public about it.

The CDC falsely claims that 1.7 million people contract infections in U.S. hospitals each year. In fact, the truth is several times that number. The proof is in the data. One of the fastest growing infections is methicillin-resistant Staphylococcus aureus (MRSA), a superbug that doesn’t respond to most antibiotics. In 1993, there were fewer than 2,000 MRSA infections in U.S. hospitals. By 2005, the figure had shot up to 368,000 according to the Agency for Healthcare Research and Quality (AHRQ). By June, 2007, 2.4 percent of all patients had MRSA infections, according to the largest study of its kind, which was published in the 

American Journal of Infection Control. That would mean 880,000 victims a year.
That’s from one superbug. Imagine the number of infections from bacteria of all kinds, including such killers as vancomycin-resistant Enterococcus (VRE) and Clostridium difficile. Julie Gerberding, MD, MPH, director of the CDC, recently told Congress that MRSA accounts for only 8 percent of HAIs. That 8 percent figure was confirmed in a study by Emory University researchers on April 6.

These new facts discredit the CDC’s official 1.7 million estimate. CDC spokesperson Nicole Coffin admits “the number isn’t perfect.” In fact, it is an irresponsible guesstimate based on 2002 data. The CDC researchers who came up with it complained that not having actual data “complicated the problem.”
Numbers matter. Health conditions that affect the largest number of people should command more research dollars and public attention.

The problem doesn’t end there. The CDC has resisted calling on hospitals to implement the key change needed to stop some infections: MRSA screening. A study in the March issue of the Annals of Internal Medicine shows that MRSA infections can be prevented by testing incoming patients for the germ and taking precautions on patients who test positive. The test is a noninvasive skin or nasal swab. Researchers at Evanston Northwestern Healthcare System, a group of three hospitals near Chicago, reduced MRSA infections 70 percent over two years. “If it works in these three different hospitals, it will work anywhere,” said the study’s lead author, Dr. Lance Peterson, an epidemiologist.

That’s fortunate, because the problem is everywhere. The June 2007 survey found that MRSA is “endemic in virtually all U.S. healthcare facilities.” Screening is necessary because patients who unknowingly carry MRSA bacteria on their body shed it in particles on wheelchairs, blood pressure cuffs, virtually every surface. These patients don’t realize they have the germ, because it doesn’t make them sick until it gets inside their body, usually via a surgical incision, a catheter, or a ventilator for breathing. With screening, hospitals can identify the MRSA-positive patients, isolate them, use separate equipment, and insist on gowns and gloves when treating them. Screening is common in several European countries that have almost eradicated MRSA, and some 50 studies show that it works in the U.S. too.

Delay can defeat the purposes of screening. A study released in March in the Journal of the American Medical Association grabbed headlines when it purported to prove that screening is ineffective. But the study, conducted at a hospital in Geneva, Switzerland, was flawed. Many patients did not receive their test results until their hospital results were half over, and 41 percent of MRSA positive patients had already had their surgeries. The excessive delays allowed the germ to spread.

Because the evidence is compelling that screening works, Congress and seven state legislatures are considering making screening mandatory. Illinois, New Jersey and Pennsylvania acted in 2007. Why is legislation needed? Because the CDC, which is responsible for providing guidelines for hospitals on how to prevent infections, has failed to recommend that all hospitals screen patients. The CDC’s lax guidelines give hospitals an excuse to do too little.

It is common for government regulators to become soft on the industry they are supposed to regulate. A coziness develops. Federal Aviation Administration inspectors failed to insist on timely electrical systems inspections, according to news reports. The same may be true at the CDC, where government administrators spend too much time listening to hospital executives and not enough time with grieving families.

The preventable proportion of nosocomial infections: an overview of published reports

S Harbarth, H Sax, P Gastmeier - Journal of Hospital infection, 2003 - Elsevier
... the SENIC data reporting an average reduction effect of 28% for hospital-acquired bacteraemia
after ... at the university hospital and 111 (52%) at the community hospital were considered ... 20 and
30% of all nosocomial infections occurring under current healthcare conditions can ...

[HTML] Wound infection after elective colorectal resection

RL Smith, JK Bohl, ST McElearney, CM Friel… - Annals of …, 2004 -
... is a particular emphasis by the Joint Commission of Accreditation of Healthcare Organizations ...
infection rate, but the resultant costs from dressing changes and prolonged hospital stays as ...
probably due the extensive growth and availability of the home health care resources over ...

Overview of nosocomial infections caused by gram-negative bacilli

RA Weinstein, R Gaynes… - Clinical Infectious …, 2005 -
... and; National Nosocomial Infections Surveillance System. Division of Healthcare Quality
Promotion ... During the past 20 years, changes in health careinfection-control practices ... pathogens
associated with consistently increasing proportions of hospital-acquired pneumonias, SSIs ...

Hospital-acquired candidemia: the attributable mortality and excess length of stay

SB Wey, M Mori, MA Pfaller… - Archives of Internal …, 1988 -
... We also attempted to match for the most important surgical procedure the cases had undergone
before acquiring the infection... sions during the study period. The infection rate for hospital-acquired
Candida bloodstream infections in¬ creased from 5.1 to 10.3 per 10000 ...

Influenza in the acute hospital setting

CD Salgado, BM Farr, KK Hall, FG Hayden - The Lancet infectious diseases, 2002 - Elsevier
... Excess hospital costs are also due in part to absenteeism of healthcare workers who become
ill during an influenza outbreak, since hospitals must cover the ... 17 One study estimated a mean
excess hospital cost of over $7500 per episode of nosocomially acquired influenza. ...

Surveillance of Nosocomial Infections A Fundamental Ingredient for Quality

RP Gaynes - Infection Control, 1997 - Cambridge Univ Press
... adverse events.2 A key tenet of the ongoing revolution in health care is the ... in interhospital compar-
isons, several members of the Society for Healthcare Epidemiology of ... Hospital-acquired
complications in a randomized controlled clinical trial of a geriatric consultation team. ...

Feeding back surveillance data to prevent hospital-acquired infections.

R Gaynes, C Richards, J Edwards… - Emerging infectious …, 2001 -
... A surveillance system to monitor hospital-acquired infections requires standardization, targeted
monitoring ... is deputy chief, Healthcare Outcomes Branch, Division of Healthcare Quality Promotion ...
His main research interests are health-care acquired infections and antimi- crobial ...

Neonatal sepsis: an international perspective

S Vergnano, M Sharland, P Kazembe… - Archives of Disease in …, 2005 -
... The latest news, research, events, opinion and guidance related to quality and safety in health
care... delivered and die at home without ever being in contact with trained healthcare workers
and ... are needed to compare patterns of resistance in babies born in and out of hospital...

Nosocomial infections in pediatric intensive care units in the United States

MJ Richards, JR Edwards, DH Culver, RP Gaynes - Pediatrics, 1999 - Am Acad Pediatrics
... that children under 2 years of age have the highest nosocomial infection rates in PICUs with up
to 25% of children in this group infected... In: Mayhall CG, ed. Hospital Epidemiology and Infection
Control. ... (1989) Epidemiologic study of 4684 hospital-acquired infections in pediatric ...

Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review

ABA Sari, TA Sheldon, A Cracknell, A Turnbull - Bmj, 2007 -
... Healthcare organisations should consider routinely using structured case note review on samples
of medical ... Thomas E, Petersen L. Measuring errors and adverse events in health care... Improving
patient care by reducing the risk of hospital acquired infection: a progress report. ...