I-Team I-Depth

Acute Drug Shortages Forcing Workarounds In Hospitals

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In hospitals across Connecticut and nationwide, workarounds to compensate for medication shortages are daily routines for treating patients – and health experts say it’s not about to change any time soon. Some acute-care drugs in short supply nationally are antibiotics, antipsychotics, intravenous saline, and morphine, according to the most recent shortage list from the U.S. Food and Drug Administration. In Connecticut, hospital officials say they are turning to alternative drugs, rationing supplies, or seeking new suppliers to work around the shortages. At St. Francis Hospital and Medical Center in Hartford, Dr. C. Steven Wolf, chief of emergency medicine, said doctors most recently have been dealing with shortages of dextrose, used to treat dehydration and low blood sugar, as well as intravenous saline and other basic medications.

Pain and Anxiety Treatment

Mindfulness Moves Into The Mainstream

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More Connecticut doctors, therapists and psychologists are turning to the practice of mindfulness to help treat depression, anxiety, chronic pain and even addiction. The practice — which cultivates an awareness of the present moment and an acceptance of the feelings and emotions that come with it — has reached the mainstream and is being adopted by new fields. Veterans groups are using mindfulness and yoga as a healing tool. Teachers in some Connecticut elementary schools have incorporated it into their classrooms to help students focus. And universities are offering mindfulness training to help students deal with stress.

childhood hunger

Pediatricians Will Screen For Hungry Kids

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Like all pediatricians, Dr. Lori Smith keep tabs on many aspects of her patients’ health, but until recently the Westport-based doctor didn’t always consider whether the children she sees might be going hungry. “It wasn’t something that was necessarily on our radar,” she said. While her practice treats some lower-income patients from nearby Norwalk and Bridgeport, most of the children Smith and her colleagues see come from relatively affluent families. But Smith, who has been a pediatrician for more than 16 years, and her colleagues recently began screening all patients—regardless of their household income—for food insecurity, part of a new effort doctors and advocates hope will help prevent childhood hunger. The American Academy of Pediatrics (AAP) in October recommended that pediatricians screen all patients for hunger at well visits.

Breast Cancer

Yale: Black Women With Breast Cancer Less Likely To Benefit From Early Chemo

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Black women with breast cancer fare worse than other women when treated with early chemotherapy, according to new research from the Yale Cancer Center. Typically, black, Hispanic and Asian women are more likely to undergo neoadjuvant chemotherapy, or chemotherapy prior to surgery, than white women because they are more likely to develop advanced-stage breast cancer. But the new study found that black women are less likely to benefit from the treatment. The finding is significant because it proves further research is needed, and could impact how future research and treatment options are pursued for black women, said Brigid Killelea, the study’s first author and associate professor of surgery at Yale School of Medicine. “African American women didn’t respond as well to the chemotherapy when a pathologist looked at the tumors under a microscope after [subsequent] surgery,” she said.

Women's Health

Game Teaches Sexual Safety Is Nothing to Play With

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Researchers at Yale University are testing whether a humorous card game can help young, black women reduce their chances of contracting HIV and AIDS—part of a new but growing trend examining whether games can spur health behavior changes. Played among three to five people, “One Night Stan” has players draw cards to establish sexual scenarios and then prompts players to discuss how they would react in those settings. The game, developed by play2PREVENT, a gaming lab within the Yale School of Medicine, is still a prototype, but designers are hoping to launch a video game version eventually and bring it to a broader audience. “It’s really about evaluating sexual situations and encounters,” said Kimberly Hieftje, a developer of the game who is an associate research scientist at Yale School of Medicine and deputy director of the play2PREVENT Lab. A growing number of developers, in Connecticut and nationally, are testing whether card, video, online and mobile games are effective tools for getting people to make healthier choices.

Disparities

Yale: Cancer-Screening Guidelines May Play Role In Decline In Screening Rates

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Declines in several key cancer-screening procedures among the elderly can be linked to shifts in screening guidelines issued by major public health organizations, according to recently released findings by Yale researchers. James Yu, associate professor of therapeutic radiology at the Yale School of Medicine, and Sean Maroongroge, a third-year medical student, gleaned data from Medicare billing records from 2000 to 2012, analyzing more than 230 million screenings for prostate, breast, and colorectal cancers. Yu, a member of the Yale COPPER Center (Cancer Outcomes, Public Policy, and Effectiveness Research Center), and Maroongroge, also tracked evidence-based screening guidelines issued by five prominent organizations: the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (ACOG), the American College of Gastroenterology (ACG), and the American Urological Association (AUA). They found that the rates for mammography, which is the primary means of screening for breast cancer, declined 7.4 percent overall during the period studied; prostate screening rates rose 16 percent during the first seven years studied then declined to 7 percent less than the 2000 rate by 2012. Colorectal cancer screening rates also dropped overall.

Women's Health

Calcium Poses No Increased Risk Of Cardiac Ailments In Women

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Despite studies that may have turned off older women from taking calcium supplements, experts and new findings say there is no increased risk of having cardiovascular problems – if women communicate with their doctors and take the supplements properly. “I don’t think women should be overly concerned about taking calcium supplements in the recommended doses,” said Dr. Jaime Gerber, an associate clinical professor of medicine and clinician in the cardiology department at the Yale School of Medicine. There is “no real clear indication” that taking calcium supplements heightens people’s risk for cardiac ailments, he said. Traditionally, many women – particularly those who are approaching menopause or who are post-menopausal – have taken calcium supplements in an effort to ward off osteoporosis, a disease that reduces bone density and affects women more commonly than men. About 54 million people in the United States are affected by osteoporosis and low bone mass, according to the National Osteoporosis Foundation, and that number is expected to jump to 64.4 million by 2020.

Veterans' Health

Yale Study Finds Higher Risk Of Death Among Veterans Taking Opioids Long-Term

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Taking certain prescription painkillers or anxiety medications for long periods of time may increase patients’ risk of death, according to a recent Yale School of Medicine study of veterans. Researchers who examined the medical records of about 64,000 veterans found that patients who took opioids or benzodiazepines long-term, for 90 days or more, had a higher risk of death – from any cause – than those who did not. The risk of death was even greater for patients who took both types of medication at the same time. More than a quarter of the veterans studied were HIV-positive, and they had a higher risk of death than those without the virus. Opioids are painkillers that include Vicodin and Oxycontin while benzodiazepines, such as Valium, typically are prescribed to treat anxiety and insomnia.

Fines & Sanctions

Highest Prescribers Of Cancer Drug Paid As Speakers

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Eight of the top 10 prescribers of a potent narcotic used for cancer pain were paid more than $870,000 in speaking fees by the drug maker in 2013 and 2014 — indicating that Derby nurse Heather Alfonso was not the only high prescriber compensated by the company. Alfonso, an advanced practice registered nurse (APRN) who worked at the Comprehensive Pain and Headache Treatment Center in Derby, pleaded guilty last month to accepting $83,000 in kickbacks from 2013 to March 2015 from the drug company Insys Therapeutics, which has heavily marketed a painkiller called Subsys, a sublingual fentanyl spray approved only for cancer patients. Alfonso was paid to speak about Subsys at more than 70 “dinner programs,” but most of those programs were attended only by her and a sales representative for Insys, or by Alfonso’s colleagues and friends who had no authority to prescribe the drug, according to the U.S. Attorney’s Office for Connecticut. Alfonso faces a maximum prison term of five years and a fine of up to $250,000 on the charge of receiving kickbacks in connection with a federal healthcare program. In pleading guilty, she admitted that the money she was paid influenced her prescribing of Subsys, often to non-cancer patients, federal investigators said.

Women's Health

Yale: Taking More Breast Tissue Reduces Need For Second Surgery

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Breast cancer patients who have additional tissue removed during a partial mastectomy are half as likely to need a second surgery, according to a Yale Cancer Center study released today. The study could have a major impact on thousands of patients, sparing them a second operation, according to researchers. “No one likes going back to the operating room, especially not the patients who face the emotional burden of another surgery,” said Dr. Anees Chagpar, the study’s lead author, associate professor of surgery at Yale School of Medicine and director of The Breast Center, Smilow Cancer Hospital at Yale-New Haven. Nearly 300,000 women nationwide are diagnosed with breast cancer each year. Most of them have early stages of the disease, and more than half of those undergo partial mastectomies to remove the cancer, Chagpar said.