IUK Med Online | IUK Med Online
Sunday, February 25, 2018
Home Blog

Creepy Scam Targeted Young Female HCPs

0


Medpage Today

Creepy Scam Targeted Young Female HCPs

‘On the Internet, nobody knows you’re a dog.’ Now some women in medicine are feeling the bite

MedpageToday

  • by Staff Writer

In late 2015, someone claiming to be a general surgery resident named Jill Wis started messaging female clinicians, who worked in and around the operating room, over social media.

Jill told them she had taken a break midway through her second year, after watching her sister, who was also a medical student, die on the operating room table.

To honor her sister’s memory, as Jill restarted her training, she wanted to create a website, “Inspiring Women in Surgery,” that highlighted the achievements and challenges of women in the surgical field.

The women Jill contacted about the site were attractive clinicians in their 20s, 30s and 40s. They were nurses, surgical residents, anesthesiologists, physician assistants, dentists, periodontists, surgical technicians and medical students. Few were women of color and there seemed to be no African-American women.

The problem was that while the website “Inspiring Women in Surgery” was real, it’s now apparent that Jill was not. Whoever created the site misrepresented himself or herself, lying to as many as 200 women, in a bizarre “catfishing” drama. Catfishing, put simply, is when someone pretends to be someone he or she isn’t online. Some catfishes are driven by romantic desires, others by money. For some it may be just a grand practical joke on strangers.

At best, “Jill Wis” wasted countless hours of female healthcare providers’ time. At worst she — or he, as some of the victims now believe — manipulated women to share personal stories about themselves and their colleagues, photos and videos, and home addresses, phone numbers, and names of their children for possibly malevolent purposes.

From the beginning, many of the women Jill contacted sensed something amiss.

For starters, Jill chose to be anonymous. She never posted photos of her face. And her last name, Wis, now seems likely an acronym for Women In Surgery.

Jill made clear that “Jill Wis” was a pseudonym. “It is still a very tender time for me with much emotion, heartbreak, and hurt. One day i will tell you my own story, but I would only ask that you respect that.”

The website has been removed, but MedPage Today found cached versions.

She lavished praise on early-career clinicians who hadn’t had yet had time to achieve many significant successes and insisted on calling even other residents “doctor.”

And she seemed hungry for mentors.

As Heather Logghe, MD, a general surgery residency candidate at Thomas Jefferson University and the creator of the #ILookLikeaSurgeon movement , pointed out, this drew even more women to Jill’s cause.

“When a woman in medicine asks for help, we give it,” Logghe said.

Logghe spoke with MedPage Today over the phone and on email, saying she spoke on behalf of other of Jill’s targets, who refused direct interviews out of concern for their safety and for their careers.

Logghe was also contacted by Jill, but did not connect with her frequently. Some IWIS participants spoke to MedPage Today on condition of anonymity.

The Women

Jill approached a surgical resident from North Carolina online, and early on began talking about her sister’s death. Jill wanted to feature the resident on her site.

“I thought it was really odd that she volunteered so much personal information … without knowing who I was,” said the resident.

She shared own story of loss — a partner had died — but something about her conversation with Jill made the resident uneasy.

“It never quite felt like a normal exchange,” she said.

Jill pinged the resident on social media for 4 days straight, but the resident declined to be featured on Jill’s site.

Another woman, Jennifer Fluke, PA-C, currently a locum tenens physician assistant in Oregon, said Jill reached out to her about 2 years ago.

Jill likely found her after Fluke posted an Instagram pic where she wore surgical loops, Fluke said.

Fluke agreed to be featured on her site and they chatted frequently online, sometimes for hours.

Sometimes she wondered how a second year resident had the time to build a website and interview dozens of women. But Fluke rationalized that some residents just needed less sleep.

Jill did occasionally say strange things, she told MedPage Today.

“She was super obsessed with sweating in the O.R. and with straddling the patient to do compressions … That I found kind of odd,” Fluke said.

But Fluke overlooked these quirks.

“I liked the idea of changing the ‘good old boys’ mentality in the O.R. and in medicine in general … that’s why I was so happy to be a part of this.”

A Texas-based healthcare provider also began a correspondence with Jill about the same time 2 years ago.

“I’ve been told you have a very interesting story that I need to share,” Jill told her.

The provider didn’t know what she meant at first, but she did share her story and was thrilled to see it published.

“Her feature opened up so many doors for me,” she said. When she discussed a promotion with her bosses, she mentioned the site.

But Jill began messaging her constantly, and she grew annoyed.

“If I wouldn’t respond for 12, 16 hours, she would play the victim. It was ‘Did I do something wrong?'”

Jill also inserted herself into the provider’s life, giving her opinion on everything from what she should wear to an important interview — she asked for “selfies” — to what track of medicine was right for her and who she should date, the provider told MedPage Today.

When Jill made her uncomfortable, the provider would go months without talking to her.

But then she’d have what she called a “lapse in judgment” and reconnect. “I would remember the way [the things she wrote] made me feel … I felt like I owed it to her.”

She considered asking one of the other IWIS women about Jill’s behavior but worried her doubts might circle back to Jill “and then I’d just get torn down by somebody who’d done something really good for me.”

For a different Texas-based clinician, a urologist, Jill’s behavior seemed unremarkable. She was just another young resident looking for a mentor, and the urologist was happy to support her.

“I love what you represent,” Jill told the urologist in August 2016.

The urologist sent Jill photos she’d requested and completed the surveys she sent. She gave her professional advice when Jill asked for it.

Jill said she was, at this point, easing back into her residency training.

Once Jill asked the urologist to send a video of her getting gowned and gloved for surgery. The urologist did. Jill asked that the video be re-taped to include a scene of her washing her hands. The urologist usually used antiseptic not water but she refilmed the scene anyway.

“There was never anything that seemed odd,” she said. Jill’s habit of spelling out the full word “doctor” each time she messaged was a tad unusual, but, it would have been “somewhat disrespectful” to use her first name, the urologist said.

The urologist also took Jill’s anonymity as a sign of her humility.

“I don’t know that I would have spent any time doing stuff for somebody who was self-promoting,” she said.

The Book Deal

Sometime last year, Jill announced on her site that she had gotten a book deal with the New York-based publisher Simon & Schuster, according to Logghe.

On the IWIS website, she described a book deal she made in April 2016.

The title was Restricted Area and its purpose was “to tell the many stories of ALL women who work in surgery — the triumphs, the heartbreak, the passions, and the perseverance,” according to the website.

A surgeon from California was one of the women formally selected to participate.

She received an email from Jill, the surgeon saying that a colleague had nominated her for the honor.

Taking her cue from TV reality shows, Jill hyped the announcements with grandiose posts on her website.

“I hope you think it’s a prestigious group to be a part of,” she messaged another clinician whom she’d chosen for the book.

To celebrate this virtual sorority she’d created, Jill sent the women operating goggles and custom-made scrub caps with the Inspire WIS logo. Of course, she insisted on sending them to their homes, instead of work, Logghe said, which meant getting their home addresses.

The Diagnosis

Sometime in August, 2017, Jill made a different kind of announcement. She had cancer.

The California-based surgeon reached out to see if she could help.

“I just said, ‘I’m really sorry you’re going through this.’ I didn’t think there was anything shady going on,” at first.

The healthcare provider in Texas also expressed concern. At one point, she received an Instagram message that went something like, “Hi. I’m Jill’s mom. I was given a list of 6 people that she felt were very important to her and that she wanted updated on her surgery. She’s out of surgery and she’s in recovery … She just wanted me to keep you informed.”

At this point, the healthcare provider was already skeptical. Whose mother is on Instagram?, she wondered.

Publicly, women posted messages of encouragement on the IWIS website. Privately, many started to question the things Jill was saying about her condition.

“First, she had some sort of bowel issue and then all of sudden, she had bowel cancer, and then all of sudden it [metastasized] to her coronary arteries,” Fluke said.

Jill’s illness didn’t make sense, so Fluke consulted her surgeon colleagues.

They agreed something was amiss.

“Coronary artery tumors [are] unheard of and the way she was describing biopsying those particular tumors was ridiculous as well,” she said.

Fluke, who had built up a 2-year correspondence, messaged Jill, “Best of luck.” She wanted to sever their connection but when Jill asked what was happening, instead of confronting her, Fluke replied she didn’t didn’t have time to be on Facebook as much.

The surgeon from California echoed Fluke’s doubts about Jill’s description of her cancer. The way Jill described her condition, “I’m thinking, ‘You should be dead,'” said the surgeon.

Since the hospital where Jill claimed to be having her surgery was the same one where she had trained at, the surgeon asked Jill for the name of the person who had done the operation. But instead of a surgeon, Jill named a medical oncologist.

Increasing Doubts

The California surgeon corrected her and pressed her for the right name, but Jill said she was exhausted and would phone the next day. Jill never called.

Other things didn’t match up.

The surgical resident from North Carolina remembered that Jill had spoken of watching a family friend’s surgery from the gallery.

“We don’t have those anymore,” she said, at least not anywhere she’d trained.

“Furthermore, it would be really odd to watch the surgery of a family member or friend.”

Jill also never used the kind of clinical vocabulary one would expect from a resident, she added.

And the medical vocabulary she did use was off, noted the healthcare provider from Texas, whom Jill chatted with frequently.

She remembered Jill calling a scrub cap a “bouffant cap.”

“Nobody calls it that … No surgeon is going to casually say, ‘And then I donned my bouffant cap.'”

Jill also began commenting on women’s looks, calling one woman’s husband “a lucky bastard, ” and suggesting different women dress more feminine at work, Logghe said.

Last month, about 2 years after the IWIS site was born, Logghe and a few colleagues began comparing notes on Jill.

There found inconsistencies in Jill’s story: the details around her sister’s death didn’t match up — some women were told the problem was a C-section, others a mastectomy — nor did the professions of Jill’s’ parents.

And the book deal with Simon & Schuster was also made up, they discovered after phoning the publisher.

Simon & Schuster confirmed this for MedPage Today.

“We have checked and we are unable to find any records for Restricted Area or any such book as described,” a representative wrote in an email.

But the biggest lie that they discovered when talking to each other is that no one in their circle had ever spoken to Jill on the phone.

But several women had spoken to Jill’s friend “Matt.”

Jill would ask individual clinicians to reach out to Matt because he needed advice about a medical condition.

Fluke was one of the clinicians who spoke with Matt. Jill asked her to reach out to him because she said Matt had Marfan syndrome and needed surgery. Fluke had assisted on one such surgery.

They emailed a few times and talked on the phone several times after that.

“Ultimately, those conversations would turn to dating preferences … and what kinds of guys I like,” Fluke said.

She stopped answering his calls and after a while he stopped calling.

The Texas-based healthcare provider told a similar story: Jill had a male friend who would be “perfect” for her.

She said she didn’t want to call him, but a few days later the same male friend suddenly needed her help with a medical issue. Jill gave her the friend’s number, but the healthcare provider never used it.

By mid- January, Logghe and her colleagues found a last name for Matt, Jill’s friend, and checked his LinkedIn profile. They suspect that Matt noticed this, since certain premium accounts let individuals know who has viewed their profiles.

Their constant scrutiny of the IWIS website may also have caused spikes in traffic that an attentive webmaster would have noticed.

Then women began messaging Jill directly asking that their profiles be deleted.

A few days later, on Jan. 18, 2018, the Inspiring Women in Surgery website disappeared along with any sign of Jill. Matt’s social media accounts also vanished.

An Unresolved Ending

The mystery of Jill is not a closed case. While Logghe and her colleagues are fairly certain that both Jill and Matt were the same person, Logghe admitted she can’t be sure.

Other women MedPage Today interviewed, including the one whom Jill had tried to set up on a date, don’t think Jill was a man in real life — “because of the way she speaks, the things she gets emotional about,” and the way they gossiped. “Guys can’t fake that,” she said.

The Texas urologist looked for other explanations.

“Could there be an actual Jill who’s a resident and got hacked … and it spiraled and got out of control … and this person, who is a little bit unstable … is caught up in a couple of lies and is a good person? … Could there be disgruntled women surgeons who [Jill] chose not to highlight and now they’re pissed at her? … Any of those would be a possibility,” she said.

Logghe said there’s no way right to know if Jill is really one person or two, male or female.

But “there [are] so many different versions of ‘Jill,’ it is impossible for them all to be true.”

Logghe published a blog post from an unnamed colleague detailing the entire saga of Jill and the IWIS website on Logghe’s own site, Allies For Health, just after Jill disappeared.

“I share the article below, written by an individual* in the #ILookLikeASurgeon community, detailing how a single individual used the movement to harass and manipulate women surgeons for ulterior motives we may never fully understand,” Logghe wrote.

She subsequently deleted the post because the author was worried about her reputation and her safety.

The Impact

None of the women MedPage Today spoke with or that Logghe spoke with, to her knowledge, had been physically threatened or financially hurt because of their interactions with Jill.

Even labeling what happened as online harassment is difficult.

“Someone has to be uncomfortable and realize something is happening to them in order for it to be considered harassment,” said Elizabeth Carll, PhD, immediate past president of the Trauma Psychology Division of the American Psychological Association and a New York City-based psychologist.

Carll has worked with women who have been cyberbullied and cyberstalked.

Regardless of the label, being lied to took an emotional toll on the women Jill targeted, said Logghe, and it triggered a spectrum of responses “anger, betrayal and mistrust.”

Jill pressured women to share home mailing addresses and cell phone numbers as well as photographs of their children, Logghe said.

Now, they are “intensely fearful” and worry about their personal safety and their family’s.

Women also changed their social media behavior because of Jill. Some started to log into Facebook less frequently. Some stopped using photos on their social media accounts. For Logghe, a social media advocate, this reluctance to interact online has professional consequences.

“No one would go to a professional conference with a mask over their face. But if women can’t present our pictures attached to our profile … that inhibits our ability to conduct ourselves professionally on social media,” Logghe said.

Other women are more reluctant to be mentors, she added.

The healthcare provider from Texas kept the profile Jill had written framed on her wall. She included it in her resume.

Even though she suspected Jill was fake, she was crushed when she found out she was right.

“The most hurtful thing about this is that she said the kindest things … Am I supposed to be thankful? Am I supposed to be scared?”

Fluke learned she’d been scammed from a friend who had also been featured on IWIS, and her first reaction was anger.

“I had a certain amount of pride that I was selected to be part of this group of very talented and respected women … I was mad that that was taken away and I was embarrassed. “

Mainly, Fluke was angry that she and so many other women had been duped and that she kept her suspicions to herself.

“I didn’t want to be the first one to pull the thread, to unravel it all … and now I wish I had,” Fluke said.

“It’s the same thing, like you’re walking down a dark street, you should trust your gut and look over your shoulder” — but no one did.

Yet, all along, the women were “looking over their shoulder” in a sense. They told MedPage Today about checking IP addresses, doing reverse searches of images to verify their authenticity. One contacted FedEx to try to locate the address where the packages she received were being sent from.

But for two years, most of the women kept their doubt to themselves or shared them only with close friends.

Possible Motives

If there was no financial gain, it’s unclear what the person or persons behind the Jill persona gained from this project.

What happened may have been catfishing.

“It’s this idea that you’ve obscured your identity and taken on the identity of someone else, usually an identity that you think will be … more attractive than your own identity,” explained Julie Albright, PhD, of the University of Southern California.

Often the catfish or online impersonator is projecting a persona to attract a potential romantic partner or to dupe someone into giving up their money, she explained.

In this case, it’s hard to ascribe a motive without knowing the complete story, Albright said.

“It sounds like this gentleman has a kind of sexual fetish for nurses, medical related professionals and has sort of gathered up a collection of them to create his own fantasy website. And in a sense by foisting up on them this catfish identity, he kind of has a certain level of control over these women … He has a certain kind of power … ‘Send me your photo … Let me get your personal information,'” she said.

“My best guess is that there was some kind of financial plan involved. It makes no sense that this person would be getting this type of information, unless there’s an end game,” said Terry Evans, CEO of Cybersleuth Investigations in Buffalo, N.Y., a company that works with victims of internet scams.

Sometimes what these online impersonators do is make small requests during a “grooming period” that can last several years, he continued.

“I’m guessing that some of [the women] were probably manipulated into sending other kinds of materials,” Evans added.

To Carll, the catfish’s motives are more ambiguous.

“You really won’t know if this person was just doing this because they were lonely, or perhaps they were actually writing a book and just became overly personal. Or, they could have been gathering identity information for some kind of identity theft, and using the book as a way of doing that,” Carll said.

There are many explanations for what might have happened, and “not all of them have to be malevolent,” she added.

Few Options for Recourse

As for the consequences for such behavior, the truth is bound to hurt.

“The bottom line is there’s nothing you can do about it,” said Parry Aftab, JD, an internet privacy security lawyer, after hearing the story from MedPage Today.

“In your gut, you think that this is impersonation … manipulation … in your gut, you think this should be actionable.”

But unless there’s a financial loss or blackmail or fraud that directly relates to a financial loss, the women have no legal options, she explained.

“It’s terrible. It’s horrible. It shouldn’t happen, but it’s not illegal.”

Medical professionals are frequently the targets of cyber harassment. Aftab is in the process of creating a “cyberwellness” course for that reason.

“If you’re in the medical profession you tend to care more about people. And to make sure they were suckered in, this person’s sibling had died, and they gave up medicine as a resident because it hurt her so much … So all of that was immediate to them. They all want to [see] her get back to practicing and fulfilling her dreams of being a practicing physician … And if that wasn’t enough to hook in the rest, she got cancer. So, these are the people who would respond to cries for help.”

Beyond their compassion for patients, pride is also a factor.

“When you’re a medical professional, you’re used to being one of the smartest people in the room … To be able to reach out to somebody and say ‘Hey, do you really know who this is?’ after you’ve been engaging online with them is an embarrassing admission,” Aftab said.

‘Trust Your Gut’

All of the experts agreed the lesson to draw from this experience is to be more cautious.

“If someone doesn’t want to give you a name or any identity, that should really be a major red flag … If someone starts giving you personal advice that would be another red flag,” said Carll.

“The best advice I can give is if you’re suspicious, don’t check IP addresses, don’t search for the pictures online, just disengage,” Aftab said.

Logghe added that talking to colleagues “when something doesn’t feel right” is critical. Few women were totally surprised to discover that Jill wasn’t who she pretended to be, because most had suspicions, but it took time for the women to reach out and share their concerns with each other.

“I think [the story is] a good reminder about having safe practices, trusting your gut,” said the resident from North Carolina — the one who declined the offer to be profiled.

As for safety, Aftab said that catfish “tend not to be dangerous, confrontational or violent.”

“Whenever we push it we find somebody who lives in his basement wearing Pokemon pajamas,” she said.

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Creepy Scam Targeted Young Female HCPs

'On the Internet, nobody knows you're a dog.' Now some women in medicine are feeling the bite

MedpageToday

  • by Staff Writer

In late 2015, someone claiming to be a general surgery resident named Jill Wis started messaging female clinicians, who worked in and around the operating room, over social media.

Jill told them she had taken a break midway through her second year, after watching her sister, who was also a medical student, die on the operating room table.

To honor her sister's memory, as Jill restarted her training, she wanted to create a website, "Inspiring Women in Surgery," that highlighted the achievements and challenges of women in the surgical field.

The women Jill contacted about the site were attractive clinicians in their 20s, 30s and 40s. They were nurses, surgical residents, anesthesiologists, physician assistants, dentists, periodontists, surgical technicians and medical students. Few were women of color and there seemed to be no African-American women.

The problem was that while the website "Inspiring Women in Surgery" was real, it's now apparent that Jill was not. Whoever created the site misrepresented himself or herself, lying to as many as 200 women, in a bizarre "catfishing" drama. Catfishing, put simply, is when someone pretends to be someone he or she isn't online. Some catfishes are driven by romantic desires, others by money. For some it may be just a grand practical joke on strangers.

At best, "Jill Wis" wasted countless hours of female healthcare providers' time. At worst she -- or he, as some of the victims now believe -- manipulated women to share personal stories about themselves and their colleagues, photos and videos, and home addresses, phone numbers, and names of their children for possibly malevolent purposes.

From the beginning, many of the women Jill contacted sensed something amiss.

For starters, Jill chose to be anonymous. She never posted photos of her face. And her last name, Wis, now seems likely an acronym for Women In Surgery.

Jill made clear that "Jill Wis" was a pseudonym. "It is still a very tender time for me with much emotion, heartbreak, and hurt. One day i will tell you my own story, but I would only ask that you respect that."

The website has been removed, but MedPage Today found cached versions.

She lavished praise on early-career clinicians who hadn't had yet had time to achieve many significant successes and insisted on calling even other residents "doctor."

And she seemed hungry for mentors.

As Heather Logghe, MD, a general surgery residency candidate at Thomas Jefferson University and the creator of the #ILookLikeaSurgeon movement , pointed out, this drew even more women to Jill's cause.

"When a woman in medicine asks for help, we give it," Logghe said.

Logghe spoke with MedPage Today over the phone and on email, saying she spoke on behalf of other of Jill's targets, who refused direct interviews out of concern for their safety and for their careers.

Logghe was also contacted by Jill, but did not connect with her frequently. Some IWIS participants spoke to MedPage Today on condition of anonymity.

The Women

Jill approached a surgical resident from North Carolina online, and early on began talking about her sister's death. Jill wanted to feature the resident on her site.

"I thought it was really odd that she volunteered so much personal information ... without knowing who I was," said the resident.

She shared own story of loss -- a partner had died -- but something about her conversation with Jill made the resident uneasy.

"It never quite felt like a normal exchange," she said.

Jill pinged the resident on social media for 4 days straight, but the resident declined to be featured on Jill's site.

Another woman, Jennifer Fluke, PA-C, currently a locum tenens physician assistant in Oregon, said Jill reached out to her about 2 years ago.

Jill likely found her after Fluke posted an Instagram pic where she wore surgical loops, Fluke said.

Fluke agreed to be featured on her site and they chatted frequently online, sometimes for hours.

Sometimes she wondered how a second year resident had the time to build a website and interview dozens of women. But Fluke rationalized that some residents just needed less sleep.

Jill did occasionally say strange things, she told MedPage Today.

"She was super obsessed with sweating in the O.R. and with straddling the patient to do compressions ... That I found kind of odd," Fluke said.

But Fluke overlooked these quirks.

"I liked the idea of changing the 'good old boys' mentality in the O.R. and in medicine in general ... that's why I was so happy to be a part of this."

A Texas-based healthcare provider also began a correspondence with Jill about the same time 2 years ago.

"I've been told you have a very interesting story that I need to share," Jill told her.

The provider didn't know what she meant at first, but she did share her story and was thrilled to see it published.

"Her feature opened up so many doors for me," she said. When she discussed a promotion with her bosses, she mentioned the site.

But Jill began messaging her constantly, and she grew annoyed.

"If I wouldn't respond for 12, 16 hours, she would play the victim. It was 'Did I do something wrong?'"

Jill also inserted herself into the provider's life, giving her opinion on everything from what she should wear to an important interview -- she asked for "selfies" -- to what track of medicine was right for her and who she should date, the provider told MedPage Today.

When Jill made her uncomfortable, the provider would go months without talking to her.

But then she'd have what she called a "lapse in judgment" and reconnect. "I would remember the way [the things she wrote] made me feel ... I felt like I owed it to her."

She considered asking one of the other IWIS women about Jill's behavior but worried her doubts might circle back to Jill "and then I'd just get torn down by somebody who'd done something really good for me."

For a different Texas-based clinician, a urologist, Jill's behavior seemed unremarkable. She was just another young resident looking for a mentor, and the urologist was happy to support her.

"I love what you represent," Jill told the urologist in August 2016.

The urologist sent Jill photos she'd requested and completed the surveys she sent. She gave her professional advice when Jill asked for it.

Jill said she was, at this point, easing back into her residency training.

Once Jill asked the urologist to send a video of her getting gowned and gloved for surgery. The urologist did. Jill asked that the video be re-taped to include a scene of her washing her hands. The urologist usually used antiseptic not water but she refilmed the scene anyway.

"There was never anything that seemed odd," she said. Jill's habit of spelling out the full word "doctor" each time she messaged was a tad unusual, but, it would have been "somewhat disrespectful" to use her first name, the urologist said.

The urologist also took Jill's anonymity as a sign of her humility.

"I don't know that I would have spent any time doing stuff for somebody who was self-promoting," she said.

The Book Deal

Sometime last year, Jill announced on her site that she had gotten a book deal with the New York-based publisher Simon & Schuster, according to Logghe.

On the IWIS website, she described a book deal she made in April 2016.

The title was Restricted Area and its purpose was "to tell the many stories of ALL women who work in surgery -- the triumphs, the heartbreak, the passions, and the perseverance," according to the website.

A surgeon from California was one of the women formally selected to participate.

She received an email from Jill, the surgeon saying that a colleague had nominated her for the honor.

Taking her cue from TV reality shows, Jill hyped the announcements with grandiose posts on her website.

"I hope you think it's a prestigious group to be a part of," she messaged another clinician whom she'd chosen for the book.

To celebrate this virtual sorority she'd created, Jill sent the women operating goggles and custom-made scrub caps with the Inspire WIS logo. Of course, she insisted on sending them to their homes, instead of work, Logghe said, which meant getting their home addresses.

The Diagnosis

Sometime in August, 2017, Jill made a different kind of announcement. She had cancer.

The California-based surgeon reached out to see if she could help.

"I just said, 'I'm really sorry you're going through this.' I didn't think there was anything shady going on," at first.

The healthcare provider in Texas also expressed concern. At one point, she received an Instagram message that went something like, "Hi. I'm Jill's mom. I was given a list of 6 people that she felt were very important to her and that she wanted updated on her surgery. She's out of surgery and she's in recovery ... She just wanted me to keep you informed."

At this point, the healthcare provider was already skeptical. Whose mother is on Instagram?, she wondered.

Publicly, women posted messages of encouragement on the IWIS website. Privately, many started to question the things Jill was saying about her condition.

"First, she had some sort of bowel issue and then all of sudden, she had bowel cancer, and then all of sudden it [metastasized] to her coronary arteries," Fluke said.

Jill's illness didn't make sense, so Fluke consulted her surgeon colleagues.

They agreed something was amiss.

"Coronary artery tumors [are] unheard of and the way she was describing biopsying those particular tumors was ridiculous as well," she said.

Fluke, who had built up a 2-year correspondence, messaged Jill, "Best of luck." She wanted to sever their connection but when Jill asked what was happening, instead of confronting her, Fluke replied she didn't didn't have time to be on Facebook as much.

The surgeon from California echoed Fluke's doubts about Jill's description of her cancer. The way Jill described her condition, "I'm thinking, 'You should be dead,'" said the surgeon.

Since the hospital where Jill claimed to be having her surgery was the same one where she had trained at, the surgeon asked Jill for the name of the person who had done the operation. But instead of a surgeon, Jill named a medical oncologist.

Increasing Doubts

The California surgeon corrected her and pressed her for the right name, but Jill said she was exhausted and would phone the next day. Jill never called.

Other things didn't match up.

The surgical resident from North Carolina remembered that Jill had spoken of watching a family friend's surgery from the gallery.

"We don't have those anymore," she said, at least not anywhere she'd trained.

"Furthermore, it would be really odd to watch the surgery of a family member or friend."

Jill also never used the kind of clinical vocabulary one would expect from a resident, she added.

And the medical vocabulary she did use was off, noted the healthcare provider from Texas, whom Jill chatted with frequently.

She remembered Jill calling a scrub cap a "bouffant cap."

"Nobody calls it that ... No surgeon is going to casually say, 'And then I donned my bouffant cap.'"

Jill also began commenting on women's looks, calling one woman's husband "a lucky bastard, " and suggesting different women dress more feminine at work, Logghe said.

Last month, about 2 years after the IWIS site was born, Logghe and a few colleagues began comparing notes on Jill.

There found inconsistencies in Jill's story: the details around her sister's death didn't match up -- some women were told the problem was a C-section, others a mastectomy -- nor did the professions of Jill's' parents.

And the book deal with Simon & Schuster was also made up, they discovered after phoning the publisher.

Simon & Schuster confirmed this for MedPage Today.

"We have checked and we are unable to find any records for Restricted Area or any such book as described," a representative wrote in an email.

But the biggest lie that they discovered when talking to each other is that no one in their circle had ever spoken to Jill on the phone.

But several women had spoken to Jill's friend "Matt."

Jill would ask individual clinicians to reach out to Matt because he needed advice about a medical condition.

Fluke was one of the clinicians who spoke with Matt. Jill asked her to reach out to him because she said Matt had Marfan syndrome and needed surgery. Fluke had assisted on one such surgery.

They emailed a few times and talked on the phone several times after that.

"Ultimately, those conversations would turn to dating preferences ... and what kinds of guys I like," Fluke said.

She stopped answering his calls and after a while he stopped calling.

The Texas-based healthcare provider told a similar story: Jill had a male friend who would be "perfect" for her.

She said she didn't want to call him, but a few days later the same male friend suddenly needed her help with a medical issue. Jill gave her the friend's number, but the healthcare provider never used it.

By mid- January, Logghe and her colleagues found a last name for Matt, Jill's friend, and checked his LinkedIn profile. They suspect that Matt noticed this, since certain premium accounts let individuals know who has viewed their profiles.

Their constant scrutiny of the IWIS website may also have caused spikes in traffic that an attentive webmaster would have noticed.

Then women began messaging Jill directly asking that their profiles be deleted.

A few days later, on Jan. 18, 2018, the Inspiring Women in Surgery website disappeared along with any sign of Jill. Matt's social media accounts also vanished.

An Unresolved Ending

The mystery of Jill is not a closed case. While Logghe and her colleagues are fairly certain that both Jill and Matt were the same person, Logghe admitted she can't be sure.

Other women MedPage Today interviewed, including the one whom Jill had tried to set up on a date, don't think Jill was a man in real life -- "because of the way she speaks, the things she gets emotional about," and the way they gossiped. "Guys can't fake that," she said.

The Texas urologist looked for other explanations.

"Could there be an actual Jill who's a resident and got hacked ... and it spiraled and got out of control ... and this person, who is a little bit unstable ... is caught up in a couple of lies and is a good person? ... Could there be disgruntled women surgeons who [Jill] chose not to highlight and now they're pissed at her? ... Any of those would be a possibility," she said.

Logghe said there's no way right to know if Jill is really one person or two, male or female.

But "there [are] so many different versions of 'Jill,' it is impossible for them all to be true."

Logghe published a blog post from an unnamed colleague detailing the entire saga of Jill and the IWIS website on Logghe's own site, Allies For Health, just after Jill disappeared.

"I share the article below, written by an individual* in the #ILookLikeASurgeon community, detailing how a single individual used the movement to harass and manipulate women surgeons for ulterior motives we may never fully understand," Logghe wrote.

She subsequently deleted the post because the author was worried about her reputation and her safety.

The Impact

None of the women MedPage Today spoke with or that Logghe spoke with, to her knowledge, had been physically threatened or financially hurt because of their interactions with Jill.

Even labeling what happened as online harassment is difficult.

"Someone has to be uncomfortable and realize something is happening to them in order for it to be considered harassment," said Elizabeth Carll, PhD, immediate past president of the Trauma Psychology Division of the American Psychological Association and a New York City-based psychologist.

Carll has worked with women who have been cyberbullied and cyberstalked.

Regardless of the label, being lied to took an emotional toll on the women Jill targeted, said Logghe, and it triggered a spectrum of responses "anger, betrayal and mistrust."

Jill pressured women to share home mailing addresses and cell phone numbers as well as photographs of their children, Logghe said.

Now, they are "intensely fearful" and worry about their personal safety and their family's.

Women also changed their social media behavior because of Jill. Some started to log into Facebook less frequently. Some stopped using photos on their social media accounts. For Logghe, a social media advocate, this reluctance to interact online has professional consequences.

"No one would go to a professional conference with a mask over their face. But if women can't present our pictures attached to our profile ... that inhibits our ability to conduct ourselves professionally on social media," Logghe said.

Other women are more reluctant to be mentors, she added.

The healthcare provider from Texas kept the profile Jill had written framed on her wall. She included it in her resume.

Even though she suspected Jill was fake, she was crushed when she found out she was right.

"The most hurtful thing about this is that she said the kindest things ... Am I supposed to be thankful? Am I supposed to be scared?"

Fluke learned she'd been scammed from a friend who had also been featured on IWIS, and her first reaction was anger.

"I had a certain amount of pride that I was selected to be part of this group of very talented and respected women ... I was mad that that was taken away and I was embarrassed. "

Mainly, Fluke was angry that she and so many other women had been duped and that she kept her suspicions to herself.

"I didn't want to be the first one to pull the thread, to unravel it all ... and now I wish I had," Fluke said.

"It's the same thing, like you're walking down a dark street, you should trust your gut and look over your shoulder" -- but no one did.

Yet, all along, the women were "looking over their shoulder" in a sense. They told MedPage Today about checking IP addresses, doing reverse searches of images to verify their authenticity. One contacted FedEx to try to locate the address where the packages she received were being sent from.

But for two years, most of the women kept their doubt to themselves or shared them only with close friends.

Possible Motives

If there was no financial gain, it's unclear what the person or persons behind the Jill persona gained from this project.

What happened may have been catfishing.

"It's this idea that you've obscured your identity and taken on the identity of someone else, usually an identity that you think will be ... more attractive than your own identity," explained Julie Albright, PhD, of the University of Southern California.

Often the catfish or online impersonator is projecting a persona to attract a potential romantic partner or to dupe someone into giving up their money, she explained.

In this case, it's hard to ascribe a motive without knowing the complete story, Albright said.

"It sounds like this gentleman has a kind of sexual fetish for nurses, medical related professionals and has sort of gathered up a collection of them to create his own fantasy website. And in a sense by foisting up on them this catfish identity, he kind of has a certain level of control over these women ... He has a certain kind of power ... 'Send me your photo ... Let me get your personal information,'" she said.

"My best guess is that there was some kind of financial plan involved. It makes no sense that this person would be getting this type of information, unless there's an end game," said Terry Evans, CEO of Cybersleuth Investigations in Buffalo, N.Y., a company that works with victims of internet scams.

Sometimes what these online impersonators do is make small requests during a "grooming period" that can last several years, he continued.

"I'm guessing that some of [the women] were probably manipulated into sending other kinds of materials," Evans added.

To Carll, the catfish's motives are more ambiguous.

"You really won't know if this person was just doing this because they were lonely, or perhaps they were actually writing a book and just became overly personal. Or, they could have been gathering identity information for some kind of identity theft, and using the book as a way of doing that," Carll said.

There are many explanations for what might have happened, and "not all of them have to be malevolent," she added.

Few Options for Recourse

As for the consequences for such behavior, the truth is bound to hurt.

"The bottom line is there's nothing you can do about it," said Parry Aftab, JD, an internet privacy security lawyer, after hearing the story from MedPage Today.

"In your gut, you think that this is impersonation ... manipulation ... in your gut, you think this should be actionable."

But unless there's a financial loss or blackmail or fraud that directly relates to a financial loss, the women have no legal options, she explained.

"It's terrible. It's horrible. It shouldn't happen, but it's not illegal."

Medical professionals are frequently the targets of cyber harassment. Aftab is in the process of creating a "cyberwellness" course for that reason.

"If you're in the medical profession you tend to care more about people. And to make sure they were suckered in, this person's sibling had died, and they gave up medicine as a resident because it hurt her so much ... So all of that was immediate to them. They all want to [see] her get back to practicing and fulfilling her dreams of being a practicing physician ... And if that wasn't enough to hook in the rest, she got cancer. So, these are the people who would respond to cries for help."

Beyond their compassion for patients, pride is also a factor.

"When you're a medical professional, you're used to being one of the smartest people in the room ... To be able to reach out to somebody and say 'Hey, do you really know who this is?' after you've been engaging online with them is an embarrassing admission," Aftab said.

'Trust Your Gut'

All of the experts agreed the lesson to draw from this experience is to be more cautious.

"If someone doesn't want to give you a name or any identity, that should really be a major red flag ... If someone starts giving you personal advice that would be another red flag," said Carll.

"The best advice I can give is if you're suspicious, don't check IP addresses, don't search for the pictures online, just disengage," Aftab said.

Logghe added that talking to colleagues "when something doesn't feel right" is critical. Few women were totally surprised to discover that Jill wasn't who she pretended to be, because most had suspicions, but it took time for the women to reach out and share their concerns with each other.

"I think [the story is] a good reminder about having safe practices, trusting your gut," said the resident from North Carolina -- the one who declined the offer to be profiled.

As for safety, Aftab said that catfish "tend not to be dangerous, confrontational or violent."

"Whenever we push it we find somebody who lives in his basement wearing Pokemon pajamas," she said.

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

Exaggerated Medical Press Releases: That’s Improbable!

0


Medpage Today

Exaggerated Medical Press Releases: That’s Improbable!

Also, earprints to solve crimes?

MedpageToday

  • by Improbable Research

A 2016 study found that exaggerations in medical science press releases do not appear to influence the news coverage of those findings.

A recent study reported that macaques “form preferences for brand logos repeatedly paired with images of macaque genitals.”

Can an ear-print be used as evidence of a crime? A forensic anthropologist in India explores this possibility.

Two philosophers discuss ways to frustrate someone’s desire using scenarios involving tea drinking.

That’s Improbable! is MedPage Today‘s weekly roundup of clinically, um, relevant finds at Improbable Research, which awards the Ig Nobel Prizes.

2018-02-25T08:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Exaggerated Medical Press Releases: That’s Improbable!

Also, earprints to solve crimes?

MedpageToday

  • by Improbable Research

A 2016 study found that exaggerations in medical science press releases do not appear to influence the news coverage of those findings.

A recent study reported that macaques "form preferences for brand logos repeatedly paired with images of macaque genitals."

Can an ear-print be used as evidence of a crime? A forensic anthropologist in India explores this possibility.

Two philosophers discuss ways to frustrate someone's desire using scenarios involving tea drinking.

That's Improbable! is MedPage Today's weekly roundup of clinically, um, relevant finds at Improbable Research, which awards the Ig Nobel Prizes.

2018-02-25T08:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

Transgender Care in Dermatology

0


Medpage Today

Transgender Care in Dermatology

Ways to improve cultural competence and access to care

MedpageToday

  • by Dermatology Times

Addressing dermatologists’ unfamiliarity with the transgender community and their skin health needs will help eliminate a barrier to care for this underserved population, according to an expert.

The skin conditions for which transgender patients seek dermatologic care are not unique, said Brian Ginsberg, MD, of Chelsea Skin & Laser in New York City, but these issues often require a different approach in this population. “Many transgender men suffer from significant acne. Acne is something we’re prepared to treat, but some of the care may be a little different than the conventional approach.”

For many transgender men, he explained, taking testosterone fuels severe acne that requires treatment with isotretinoin. Under the iPLEDGE program for reducing fetal exposures, “Most trans men have to register as females of childbearing potential (FCBPs), which could be a very large barrier to their care because it is often a difficult conversation for many doctors to have with these patients. It’s also understandably difficult for many patients to accept” that they must register as FCBPs,” he stated.

Navigating these conversations requires building strong relationships with patients, and emphasizing the necessity of registering as required. “Hopefully, the governing bodies for the iPLEDGE program will change the registration requirements in the future,” he said.

Testosterone administration is also known to cause androgenetic alopecia, Ginsberg added, but, “There’s still no large-scale study about how to treat this patient population.”

Current conventional treatment for male pattern hair loss includes using finasteride or minoxidil foam. “But it’s still unclear what dose is the most appropriate in this population. In cisgender men, we use the 1 mg dose, but in many cisgender women, we use 5 mg. Will trans men necessitate the standard dose for cisgender men, which is what we currently do, or will they need a higher dose?,” Ginsberg stated. “There are studies that show that 1 mg is effective in this population,” but no definitive large-scale trials.

Dermatologists also must be aware that putting trans males on finasteride can have secondary effects, such as blocking the development of desired testosterone effects including hair growth, voice changes, and muscle mass redistribution. “A recommendation for many of these patients is to wait until they’ve hit their desired outcome of secondary sex changes before initiating finasteride treatment,” he advised.

Additionally, neuromodulators and fillers that dermatologists use for rejuvenation can greatly help to masculinize or feminize facial features in trans patients. “This is very important in this population because there’s a very high rate (20%-50% in the U.S.) of illicit injection use — of people going to non-doctors and having nonmedical-grade products put into their faces. And we’re seeing a lot of complications from those injections,” Ginsberg cautioned.

Dermatologists should “be prepared to treat the complications that arise from illicit injections,” he stressed. “But we also need to create an environment where these patients feel comfortable coming to us to get proper care initially, and prevent these negative outcomes in the first place. Overall, a huge priority in terms of dermatology and the transgender community is improving cultural competence and access to care.”

This article originally appeared on our partner’s website Dermatology Times, which is a part of UBM Medica. (Free registration is required.)

Ginsberg disclosed no relevant relationships with industry.

2018-02-24T16:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Transgender Care in Dermatology

Ways to improve cultural competence and access to care

MedpageToday

  • by Dermatology Times

Addressing dermatologists' unfamiliarity with the transgender community and their skin health needs will help eliminate a barrier to care for this underserved population, according to an expert.

The skin conditions for which transgender patients seek dermatologic care are not unique, said Brian Ginsberg, MD, of Chelsea Skin & Laser in New York City, but these issues often require a different approach in this population. "Many transgender men suffer from significant acne. Acne is something we're prepared to treat, but some of the care may be a little different than the conventional approach."

For many transgender men, he explained, taking testosterone fuels severe acne that requires treatment with isotretinoin. Under the iPLEDGE program for reducing fetal exposures, "Most trans men have to register as females of childbearing potential (FCBPs), which could be a very large barrier to their care because it is often a difficult conversation for many doctors to have with these patients. It's also understandably difficult for many patients to accept" that they must register as FCBPs," he stated.

Navigating these conversations requires building strong relationships with patients, and emphasizing the necessity of registering as required. "Hopefully, the governing bodies for the iPLEDGE program will change the registration requirements in the future," he said.

Testosterone administration is also known to cause androgenetic alopecia, Ginsberg added, but, "There's still no large-scale study about how to treat this patient population."

Current conventional treatment for male pattern hair loss includes using finasteride or minoxidil foam. "But it's still unclear what dose is the most appropriate in this population. In cisgender men, we use the 1 mg dose, but in many cisgender women, we use 5 mg. Will trans men necessitate the standard dose for cisgender men, which is what we currently do, or will they need a higher dose?," Ginsberg stated. "There are studies that show that 1 mg is effective in this population," but no definitive large-scale trials.

Dermatologists also must be aware that putting trans males on finasteride can have secondary effects, such as blocking the development of desired testosterone effects including hair growth, voice changes, and muscle mass redistribution. "A recommendation for many of these patients is to wait until they've hit their desired outcome of secondary sex changes before initiating finasteride treatment," he advised.

Additionally, neuromodulators and fillers that dermatologists use for rejuvenation can greatly help to masculinize or feminize facial features in trans patients. "This is very important in this population because there's a very high rate (20%-50% in the U.S.) of illicit injection use -- of people going to non-doctors and having nonmedical-grade products put into their faces. And we're seeing a lot of complications from those injections," Ginsberg cautioned.

Dermatologists should "be prepared to treat the complications that arise from illicit injections," he stressed. "But we also need to create an environment where these patients feel comfortable coming to us to get proper care initially, and prevent these negative outcomes in the first place. Overall, a huge priority in terms of dermatology and the transgender community is improving cultural competence and access to care."

This article originally appeared on our partner's website Dermatology Times, which is a part of UBM Medica. (Free registration is required.)

Ginsberg disclosed no relevant relationships with industry.

2018-02-24T16:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

Anticoagulation Post-Surgery; ARDS Tx: It's PodMed Double T (with audio)

0


Medpage Today

Anticoagulation Post-Surgery; ARDS Tx: It’s PodMed Double T

Also: dermatology consults for cellulitis in the hospital, and avoiding delirium in the ICU

MedpageToday

video-image

Loading the player…
  • by Johns Hopkins Medicine

PodMed is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.

This week’s topics include anticoagulation after knee or hip surgery, proper treatment of ARDS, dermatology consults for cellulitis in the hospital, and avoiding delirium in the ICU.

Program notes:

0:39 Management of ARDS

1:37 Mechanical ventilation is important

2:34 Volume of air with each breath

3:21 Anticoagulation after hip or knee replacement

4:22 Aspirin versus NOAC

5:23 No studies of only aspirin

5:35 Benefits of in hospital dermatologists

6:35 Got correct diagnosis in cellulitis

7:31 Prevention of delirium in the ICU

8:31 Treatment with haloperidol did not improve outcomes

10:14 End

Transcript:

Elizabeth Tracey: Recognizing really common skin infections in the hospital.

Dr. Rick Lange: Can medications prevent delirium in ICU patients?

Elizabeth: How can we manage acute respiratory distress syndrome?

Dr. Lange: Do we need expensive medications to prevent blood clots after hip or knee replacement?

Elizabeth: That’s what we’re talking about this week on PodMed TT, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a medical journalist at Johns Hopkins.

Dr. Lange: I’m Rick Lange, Professor of Medicine and President of the Texas Tech University Health Sciences Center in El Paso and also Dean of the Paul L. Foster School of Medicine here.

Elizabeth: In this flu season, where we’re taking a look at all of these people who are getting hospitalized with the flu, I think we should turn first to the management of acute respiratory distress syndrome. This is a review paper that’s in the Journal of the American Medical Association. It takes a look at a very large number of studies and best practices. For me, I think one of the noteworthy things about this was that they identified prone positioning, putting on their stomach rather than on their back while they’re being ventilated, as something that can be important in helping people survive. Other than that, though, they said, “Hey, we really do still need mechanical ventilation.”

Dr. Lange: Elizabeth, ventilating somebody while they’re laying flat on their stomach reduces mortality in individuals that have the most severe involvement with what’s called “acute respiratory distress syndrome,” which is a leaking of fluid in the air sacs that prevents adequate oxygenation. As you said, it usually occurs in the ICU after things like infection or pancreatitis or trauma. As you mentioned, mechanical ventilation ends up being important, but if applied inappropriately, it actually worsens the injury. For example, when I train, we try to use the highest amount of pressures and high volumes to try to pop those airways open. We now know that that leads to mechanical or ventilatory injury and makes things worse.

This article not only talks about the use of mechanical ventilation, but how to apply it to minimize an injury. The other thing that was important about this is there have been a number of different medications that have been studied in this condition and none of them have been helpful, so the most important thing is to properly mechanically ventilate these patients until they can get over their acute lung injury.

Elizabeth: I think we reported a few years ago this idea that the title volume really needs to be appropriate for the size of the person, but at least I’ve witnessed clinically some challenges with regard to implementing that. Have you seen the same thing?

Dr. Lange: For those that aren’t familiar, title volume is the amount or the volume of air that you put into the individual with each breath. What happens with ARDS is it makes the lungs stiffer, oftentimes requires a little bit higher pressure. The value of this particular study is it goes into great detail to highlight the best therapy in these individuals.

Elizabeth: Well, as I suggested, right now in our current flu season, lots of people are being hospitalized. One of the concerns, of course, is that there are inadequate numbers of ventilators if we really had a pandemic.

Dr. Lange: Fortunately, that hasn’t been the case now. But as I alluded to, we lose more people through deaths from ARDS than we do, for example, through HIV or cancer on an annual basis. So the proper treatment, trying to prevent it by treating the acute injury before it becomes an issue, is also important.

Elizabeth: Let’s turn to one of yours, then. I love the way that you served it up. In the New England Journal of Medicine, what I said, any coagulation after someone has hip or knee replacement and you said, “Wow! Do we need to use the expensive stuff?”

Dr. Lange: Hip and knee replacement are two of the most common orthopedic surgeries done, not only in the United States, but across the world as well. Individuals that have those surgeries or predisposed to developing a clot in their lower extremity, it could move to the lung. Both of these conditions, that is deep vein thrombosis and pulmonary embolism, collectively are known as venous thromboembolism. People are most likely to get this within several weeks after their surgery, so they’re prescribed anticoagulation medication to prevent the blood clots, for between two and five weeks, after their surgery.

Most commonly prescribed are oral anticoagulants, these new medications called NOACs or low-molecular-weight heparin. They’ve been proven to be effective. But the real question is can we use something that may be just as effective, a lot less expensive, with an acceptable side effect profile? Here enters aspirin. One of the more commonly used anticoagulants, rivaroxaban, costs about $400 for a one-month supply. Aspirin is pennies on the dollar.

What the study investigators did was they looked at over 3,400 patients who were having a knee or hip replacement. They put them on rivaroxaban for five days after the surgery, but then after that, they either switched them to aspirin or continued them on rivaroxaban and followed them for 90 days to look at the incidents of venous thromboembolism. What they discovered was there was no difference between the therapies. The incidents of venous thromboembolism was less than 1% with either of those therapies, and there was no increased bleeding risk with either of the therapies. What that means is we can treat people with rivaroxaban for a short period of time, for five days after hip or knee replacement, and then switch them to a less expensive aspirin.

Elizabeth: Plus easier for everybody because you can buy that just over the counter almost anywhere. Here’s one question about that. Why do you say they need to have the rivaroxaban in the five days post surgically?

Dr. Lange: Well, we don’t have any studies that have used only aspirin and compared that to what I’m going to call “more effective anticoagulants.”

Elizabeth: Let’s turn to a journal that I don’t think in the many years we’ve been recording we have actually ever reported from, that’s JAMA Dermatology, right now a big dermatology meeting going on. I thought this one was fascinating because I’ve seen so many people who’ve been in the hospital with cellulitis, pretty severe skin infection that actually can result in some significant mortality in some folks. What they did in there is actually two studies in JAMA Dermatology, is they had inpatient dermatologists come and consult on these folks. They showed that there was a really positive impact on duration of antibiotic use, on how long they were hospitalized. It turned out to be a good thing, suggesting at the end of the day that we ought to have a subspecialty of inpatient dermatology and get these folks to round and consult.

Dr. Lange: Cellulitis, an infection of the skin in soft tissue, is a clinical diagnosis. There’s no tests you can hang your hat on, and that’s treated by either emergency room physicians or primary care physicians in the hospital. Most of the time, we don’t really think that we need a dermatologist to help with that condition, but what this study showed was that a third of the time what was thought to be the diagnosis, it was incorrect. It was called pseudocellulitis, and in those individuals, antibiotics may not be helpful.

Secondly is oftentimes we don’t know what the appropriate duration of antibiotic therapy is, so a large number of these patients that weren’t cured by the dermatologist were on antibiotics for a longer period of time than they should have been. Then lastly, dermatologists improved wound care in half the individuals. Their expertise helped the patients get better, use fewer antibiotics, and actually saved about $600 per patient to have the dermatologist see them. I’m glad you picked this particular article.

Elizabeth: I was startled, actually, by the magnitude of the savings if you have this kind of a consult.

Dr. Lange: I agree with you. We spend over $4.5 billion in about 650,000 hospitalizations annually with this. The estimated cost savings is over $200 million by getting the dermatologist involved.

Elizabeth: Win-win. Finally, let’s turn back to you. Another really important problem in the hospital, the development of delirium in folks in the ICU, and is there anything we can really do about that?

Dr. Lange: It’s estimated about a third of patients that spend time in the ICU, two or more days, will develop delirium. We’d like to prevent that because that delirium is associated not only with long-term cognitive defects, but it can actually prolong the hospitalization and mechanical ventilation, and it increases hospital cost. There’s been a lot of enthusiasm for using a long-available antipsychotic named Haldol or Haloperidol to prevent delirium. We used it 35 years ago when I was training, and it continues to be used. Is it really effective? We don’t really have any studies to establish that.

These investigators did that by looking at almost 2,000 critically ill adults at 21 different ICUs that were at risk of developing delirium, and half of them got randomized to Haldol at one of two doses, and half of them got routine care. Those that were treated with Haldol, it didn’t improve their survival at 28 days. It didn’t improve their survival at 90 days, and it didn’t decrease either the incidents of delirium, or when patients got it, its duration as well.

Elizabeth: I certainly am in favor of a reduction of the use of drugs in all settings, actually, if they’re not really needed, if they don’t exert a benefit. I would love to see us get our arms around ways to effectively prevent delirium because it’s so troubling not just for the patient, but also for the family.

Dr. Lange: In fairness, what the investigators did for all the patients when they put in strategies designed to decrease the risk of delirium, these are non-pharmacologic strategies, things like making sure you mobilize the patient as quickly as possible. You try to improve the circadian rhythm of the patients. You try to prevent oversedation, and you try to use visual and audio aids to keep them in the proper day-sleep cycle. These things have been shown to help prevent delirium, and this was applied to all the patients. When you do that, the addition of Haldol was not beneficial. That’s why for our non-medical people listening, many of us will have relatives in the ICU and demanding that the doctor give them medication to prevent delirium. What I want them to know is we don’t have any such medications available now.

Elizabeth: Right. Maybe they can be helpful with regard to some of these other strategies like the early mobilization.

Dr. Lange: Exactly, and trying to preserve the sleep-wake cycle as well and not trying to oversedate the patient.

Elizabeth: Very good. I’m going to talk about that one this week on the blog, so that’s a look at this week’s medical headlines from Tech Tech. I’m Elizabeth Tracey.

Dr. Lange: I’m Rick Lange. Y’all listen up and make healthy choices.

2018-02-24T14:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Anticoagulation Post-Surgery; ARDS Tx: It's PodMed Double T

Also: dermatology consults for cellulitis in the hospital, and avoiding delirium in the ICU

MedpageToday

video-image

Loading the player...
  • by Johns Hopkins Medicine

PodMed is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.

This week's topics include anticoagulation after knee or hip surgery, proper treatment of ARDS, dermatology consults for cellulitis in the hospital, and avoiding delirium in the ICU.

Program notes:

0:39 Management of ARDS

1:37 Mechanical ventilation is important

2:34 Volume of air with each breath

3:21 Anticoagulation after hip or knee replacement

4:22 Aspirin versus NOAC

5:23 No studies of only aspirin

5:35 Benefits of in hospital dermatologists

6:35 Got correct diagnosis in cellulitis

7:31 Prevention of delirium in the ICU

8:31 Treatment with haloperidol did not improve outcomes

10:14 End

Transcript:

Elizabeth Tracey: Recognizing really common skin infections in the hospital.

Dr. Rick Lange: Can medications prevent delirium in ICU patients?

Elizabeth: How can we manage acute respiratory distress syndrome?

Dr. Lange: Do we need expensive medications to prevent blood clots after hip or knee replacement?

Elizabeth: That's what we're talking about this week on PodMed TT, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I'm Elizabeth Tracey, a medical journalist at Johns Hopkins.

Dr. Lange: I'm Rick Lange, Professor of Medicine and President of the Texas Tech University Health Sciences Center in El Paso and also Dean of the Paul L. Foster School of Medicine here.

Elizabeth: In this flu season, where we're taking a look at all of these people who are getting hospitalized with the flu, I think we should turn first to the management of acute respiratory distress syndrome. This is a review paper that's in the Journal of the American Medical Association. It takes a look at a very large number of studies and best practices. For me, I think one of the noteworthy things about this was that they identified prone positioning, putting on their stomach rather than on their back while they're being ventilated, as something that can be important in helping people survive. Other than that, though, they said, "Hey, we really do still need mechanical ventilation."

Dr. Lange: Elizabeth, ventilating somebody while they're laying flat on their stomach reduces mortality in individuals that have the most severe involvement with what's called "acute respiratory distress syndrome," which is a leaking of fluid in the air sacs that prevents adequate oxygenation. As you said, it usually occurs in the ICU after things like infection or pancreatitis or trauma. As you mentioned, mechanical ventilation ends up being important, but if applied inappropriately, it actually worsens the injury. For example, when I train, we try to use the highest amount of pressures and high volumes to try to pop those airways open. We now know that that leads to mechanical or ventilatory injury and makes things worse.

This article not only talks about the use of mechanical ventilation, but how to apply it to minimize an injury. The other thing that was important about this is there have been a number of different medications that have been studied in this condition and none of them have been helpful, so the most important thing is to properly mechanically ventilate these patients until they can get over their acute lung injury.

Elizabeth: I think we reported a few years ago this idea that the title volume really needs to be appropriate for the size of the person, but at least I've witnessed clinically some challenges with regard to implementing that. Have you seen the same thing?

Dr. Lange: For those that aren't familiar, title volume is the amount or the volume of air that you put into the individual with each breath. What happens with ARDS is it makes the lungs stiffer, oftentimes requires a little bit higher pressure. The value of this particular study is it goes into great detail to highlight the best therapy in these individuals.

Elizabeth: Well, as I suggested, right now in our current flu season, lots of people are being hospitalized. One of the concerns, of course, is that there are inadequate numbers of ventilators if we really had a pandemic.

Dr. Lange: Fortunately, that hasn't been the case now. But as I alluded to, we lose more people through deaths from ARDS than we do, for example, through HIV or cancer on an annual basis. So the proper treatment, trying to prevent it by treating the acute injury before it becomes an issue, is also important.

Elizabeth: Let's turn to one of yours, then. I love the way that you served it up. In the New England Journal of Medicine, what I said, any coagulation after someone has hip or knee replacement and you said, "Wow! Do we need to use the expensive stuff?"

Dr. Lange: Hip and knee replacement are two of the most common orthopedic surgeries done, not only in the United States, but across the world as well. Individuals that have those surgeries or predisposed to developing a clot in their lower extremity, it could move to the lung. Both of these conditions, that is deep vein thrombosis and pulmonary embolism, collectively are known as venous thromboembolism. People are most likely to get this within several weeks after their surgery, so they're prescribed anticoagulation medication to prevent the blood clots, for between two and five weeks, after their surgery.

Most commonly prescribed are oral anticoagulants, these new medications called NOACs or low-molecular-weight heparin. They've been proven to be effective. But the real question is can we use something that may be just as effective, a lot less expensive, with an acceptable side effect profile? Here enters aspirin. One of the more commonly used anticoagulants, rivaroxaban, costs about $400 for a one-month supply. Aspirin is pennies on the dollar.

What the study investigators did was they looked at over 3,400 patients who were having a knee or hip replacement. They put them on rivaroxaban for five days after the surgery, but then after that, they either switched them to aspirin or continued them on rivaroxaban and followed them for 90 days to look at the incidents of venous thromboembolism. What they discovered was there was no difference between the therapies. The incidents of venous thromboembolism was less than 1% with either of those therapies, and there was no increased bleeding risk with either of the therapies. What that means is we can treat people with rivaroxaban for a short period of time, for five days after hip or knee replacement, and then switch them to a less expensive aspirin.

Elizabeth: Plus easier for everybody because you can buy that just over the counter almost anywhere. Here's one question about that. Why do you say they need to have the rivaroxaban in the five days post surgically?

Dr. Lange: Well, we don't have any studies that have used only aspirin and compared that to what I'm going to call "more effective anticoagulants."

Elizabeth: Let's turn to a journal that I don't think in the many years we've been recording we have actually ever reported from, that's JAMA Dermatology, right now a big dermatology meeting going on. I thought this one was fascinating because I've seen so many people who've been in the hospital with cellulitis, pretty severe skin infection that actually can result in some significant mortality in some folks. What they did in there is actually two studies in JAMA Dermatology, is they had inpatient dermatologists come and consult on these folks. They showed that there was a really positive impact on duration of antibiotic use, on how long they were hospitalized. It turned out to be a good thing, suggesting at the end of the day that we ought to have a subspecialty of inpatient dermatology and get these folks to round and consult.

Dr. Lange: Cellulitis, an infection of the skin in soft tissue, is a clinical diagnosis. There's no tests you can hang your hat on, and that's treated by either emergency room physicians or primary care physicians in the hospital. Most of the time, we don't really think that we need a dermatologist to help with that condition, but what this study showed was that a third of the time what was thought to be the diagnosis, it was incorrect. It was called pseudocellulitis, and in those individuals, antibiotics may not be helpful.

Secondly is oftentimes we don't know what the appropriate duration of antibiotic therapy is, so a large number of these patients that weren't cured by the dermatologist were on antibiotics for a longer period of time than they should have been. Then lastly, dermatologists improved wound care in half the individuals. Their expertise helped the patients get better, use fewer antibiotics, and actually saved about $600 per patient to have the dermatologist see them. I'm glad you picked this particular article.

Elizabeth: I was startled, actually, by the magnitude of the savings if you have this kind of a consult.

Dr. Lange: I agree with you. We spend over $4.5 billion in about 650,000 hospitalizations annually with this. The estimated cost savings is over $200 million by getting the dermatologist involved.

Elizabeth: Win-win. Finally, let's turn back to you. Another really important problem in the hospital, the development of delirium in folks in the ICU, and is there anything we can really do about that?

Dr. Lange: It's estimated about a third of patients that spend time in the ICU, two or more days, will develop delirium. We'd like to prevent that because that delirium is associated not only with long-term cognitive defects, but it can actually prolong the hospitalization and mechanical ventilation, and it increases hospital cost. There's been a lot of enthusiasm for using a long-available antipsychotic named Haldol or Haloperidol to prevent delirium. We used it 35 years ago when I was training, and it continues to be used. Is it really effective? We don't really have any studies to establish that.

These investigators did that by looking at almost 2,000 critically ill adults at 21 different ICUs that were at risk of developing delirium, and half of them got randomized to Haldol at one of two doses, and half of them got routine care. Those that were treated with Haldol, it didn't improve their survival at 28 days. It didn't improve their survival at 90 days, and it didn't decrease either the incidents of delirium, or when patients got it, its duration as well.

Elizabeth: I certainly am in favor of a reduction of the use of drugs in all settings, actually, if they're not really needed, if they don't exert a benefit. I would love to see us get our arms around ways to effectively prevent delirium because it's so troubling not just for the patient, but also for the family.

Dr. Lange: In fairness, what the investigators did for all the patients when they put in strategies designed to decrease the risk of delirium, these are non-pharmacologic strategies, things like making sure you mobilize the patient as quickly as possible. You try to improve the circadian rhythm of the patients. You try to prevent oversedation, and you try to use visual and audio aids to keep them in the proper day-sleep cycle. These things have been shown to help prevent delirium, and this was applied to all the patients. When you do that, the addition of Haldol was not beneficial. That's why for our non-medical people listening, many of us will have relatives in the ICU and demanding that the doctor give them medication to prevent delirium. What I want them to know is we don't have any such medications available now.

Elizabeth: Right. Maybe they can be helpful with regard to some of these other strategies like the early mobilization.

Dr. Lange: Exactly, and trying to preserve the sleep-wake cycle as well and not trying to oversedate the patient.

Elizabeth: Very good. I'm going to talk about that one this week on the blog, so that's a look at this week's medical headlines from Tech Tech. I'm Elizabeth Tracey.

Dr. Lange: I'm Rick Lange. Y'all listen up and make healthy choices.

2018-02-24T14:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Loading the player...



Source link

D.C. Week: White House Takes New Poke at ACA

0


Medpage Today

D.C. Week: White House Takes New Poke at ACA

FDA warns patients of new risks of clarithromycin

MedpageToday

  • by Washington Correspondent, MedPage Today

WASHINGTON — Cheaper healthcare plans that skirt core consumer protections in Obamacare could become available this year, if a new rule from the Trump administration is enacted.

Partial-Coverage Health Plans to Get Gov’t Boost

The Trump administration took steps on Tuesday to increase availability of insurance plans that don’t comply fully with the Affordable Care Act.

Currently these cheaper, less comprehensive plans are only available to consumers for periods of less than 3 months under the ACA, but a draft rule released by the departments of Health and Human Services (HHS), Labor, and Treasury would make the legal duration up to, but not including, 12 months.

The proposed rule, in addition to reversing the Obama-era provisions, goes one step further in seeking comment on whether these “short-term limited-duration plans” should also be renewable. Critics say that making such plans widely available would bifurcate the market, making premiums unaffordable for older and sicker patients who need conventional full-coverage plans.

During a call with reporters on Tuesday morning, HHS Secretary Alex Azar, JD, said the rule was “one step in the direction of providing Americans with health insurance options that are both more affordable and more suited to individual and family circumstances.”

Former CMS Chiefs Debate Drug Prices

Two former government officials sparred over the best way to tackle out-of-control healthcare spending at the Healthcare Costs Innovation Summit sponsored by West Health on Wednesday.

While they agreed on certain issues, like the gridlock in Congress, things got interesting when the issue of drug costs popped up.

Andy Slavitt, MBA, administrator for the Centers for Medicare and Medicaid Services (CMS) under President Obama, faced off with Mark McClellan, MD, PhD, professor and director of the Duke-Margolis Center for Health Policy at Duke University, who ran CMS during the George W. Bush administration. They offered sharply different views on the best ways to contain drug prices.

Slavitt supported “the biggest hammer”: Allowing Medicare to negotiate drug prices.He said he never understood why the Department of Veterans Affairs could negotiate drug prices for its system when Medicare couldn’t do the same.

FDA Warns Heart Patients Away from Clarithromycin

The FDA cautioned Thursday that the antibiotic clarithromycin (Biaxin) appears to increase the risk of heart events and death in people with coronary heart disease — potentially years after taking the drug.

Clinicians should consider other antibiotics for heart disease patients, the agency said. The move stemmed from FDA’s review of the 10-year data from the CLARICOR trial. FDA initially alerted clinicians about the risk in 2005 based on the unexpected increase in deaths seen among coronary heart disease patients who took the antibiotic for 2 weeks, a risk that showed up only a year or more later. Other observational studies have yielded mixed results on long-term risks.

However, the agency said it couldn’t determine why clarithromycin holds greater mortality risk for heart disease patients. Nor could the FDA make any new recommendations about use in patients without heart disease, as long-term safety hasn’t been objectively studied in that group, the agency said.

Next Week

On Tuesday, the House Judiciary Committee will explore the proposed merger of CVS Health and Aetna, and more broadly, competition in the pharmaceutical supply chain.

Also, a subcommittee for the House Committee on Science, Space & Technology will examine sexual harassment and misconduct in Science.

On Wednesday, a health subcommittee for the House Energy & Commerce Committee will discuss ways to balance enforcement actions and patient safety amid the opioid crisis.

On Thursday, the same subcommittee for the House E & C Committee will hear an update on the Merit-based Incentive Payment System (MIPS).

On Thursday and Friday, the Medicare Payment Advisory Commission(MedPAC) meets to examine Medicare payment policies.

On Friday, the FDA’s Vaccines and Related Biologics Product Advisory Committee will discuss “recommendations on the selection of strains to be included in the influenza virus vaccine” for 2018-2019.

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

D.C. Week: White House Takes New Poke at ACA

FDA warns patients of new risks of clarithromycin

MedpageToday

  • by Washington Correspondent, MedPage Today

WASHINGTON -- Cheaper healthcare plans that skirt core consumer protections in Obamacare could become available this year, if a new rule from the Trump administration is enacted.

Partial-Coverage Health Plans to Get Gov't Boost

The Trump administration took steps on Tuesday to increase availability of insurance plans that don't comply fully with the Affordable Care Act.

Currently these cheaper, less comprehensive plans are only available to consumers for periods of less than 3 months under the ACA, but a draft rule released by the departments of Health and Human Services (HHS), Labor, and Treasury would make the legal duration up to, but not including, 12 months.

The proposed rule, in addition to reversing the Obama-era provisions, goes one step further in seeking comment on whether these "short-term limited-duration plans" should also be renewable. Critics say that making such plans widely available would bifurcate the market, making premiums unaffordable for older and sicker patients who need conventional full-coverage plans.

During a call with reporters on Tuesday morning, HHS Secretary Alex Azar, JD, said the rule was "one step in the direction of providing Americans with health insurance options that are both more affordable and more suited to individual and family circumstances."

Former CMS Chiefs Debate Drug Prices

Two former government officials sparred over the best way to tackle out-of-control healthcare spending at the Healthcare Costs Innovation Summit sponsored by West Health on Wednesday.

While they agreed on certain issues, like the gridlock in Congress, things got interesting when the issue of drug costs popped up.

Andy Slavitt, MBA, administrator for the Centers for Medicare and Medicaid Services (CMS) under President Obama, faced off with Mark McClellan, MD, PhD, professor and director of the Duke-Margolis Center for Health Policy at Duke University, who ran CMS during the George W. Bush administration. They offered sharply different views on the best ways to contain drug prices.

Slavitt supported "the biggest hammer": Allowing Medicare to negotiate drug prices.He said he never understood why the Department of Veterans Affairs could negotiate drug prices for its system when Medicare couldn't do the same.

FDA Warns Heart Patients Away from Clarithromycin

The FDA cautioned Thursday that the antibiotic clarithromycin (Biaxin) appears to increase the risk of heart events and death in people with coronary heart disease -- potentially years after taking the drug.

Clinicians should consider other antibiotics for heart disease patients, the agency said. The move stemmed from FDA's review of the 10-year data from the CLARICOR trial. FDA initially alerted clinicians about the risk in 2005 based on the unexpected increase in deaths seen among coronary heart disease patients who took the antibiotic for 2 weeks, a risk that showed up only a year or more later. Other observational studies have yielded mixed results on long-term risks.

However, the agency said it couldn't determine why clarithromycin holds greater mortality risk for heart disease patients. Nor could the FDA make any new recommendations about use in patients without heart disease, as long-term safety hasn't been objectively studied in that group, the agency said.

Next Week

On Tuesday, the House Judiciary Committee will explore the proposed merger of CVS Health and Aetna, and more broadly, competition in the pharmaceutical supply chain.

Also, a subcommittee for the House Committee on Science, Space & Technology will examine sexual harassment and misconduct in Science.

On Wednesday, a health subcommittee for the House Energy & Commerce Committee will discuss ways to balance enforcement actions and patient safety amid the opioid crisis.

On Thursday, the same subcommittee for the House E & C Committee will hear an update on the Merit-based Incentive Payment System (MIPS).

On Thursday and Friday, the Medicare Payment Advisory Commission(MedPAC) meets to examine Medicare payment policies.

On Friday, the FDA's Vaccines and Related Biologics Product Advisory Committee will discuss "recommendations on the selection of strains to be included in the influenza virus vaccine" for 2018-2019.

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

Glaucoma Drainage Devices Linked to Lower QOL

0


Medpage Today

Glaucoma Drainage Devices Linked to Lower QOL

Timely diagnosis and preoperative discussions about potential psychosocial effects are key

MedpageToday

  • by Contributing Writer, MedPage Today

Action Points

  • Note that this cohort study found that the use of a glaucoma draining device (GDD) was associated with worse quality of life compared with trabeculectomy.
  • Be aware that this was not a randomized trial. The GDD group had had more preceding surgical procedures, which may have biased the results.

The use of a glaucoma draining device (GDD) in patients with glaucoma was associated with poorer health-related quality of life (HRQOL) compared with surgical or medical management, a prospective cohort study found. The researchers speculated that this may be due in part because patients treated with a GDD may be self-conscious about the device when they interact with others.

The results, reported by Cheryl Khanna, MD, of the Mayo Clinic in Rochester, Minn., and colleagues in JAMA Ophthalmology, showed that compared with trabeculectomy, the use of a GDD was associated with worse HRQOL scores of self-perception (difference, -12.3; 95% CI -20.9 to -3.7), interactions (-9.3; 95% CI -15.1 to -3.6) and general function (-9.4; 95% CI -18.9 to 0.0) as measured by subscales on the Adult Strabismus-20 questionnaire (AS-20) on adjusted analyses.

Compared with for medical treatment, the HRQOL scores for those with a GDD were similarly lower for self-perception (-14.7; 95% CI -23.9 to -5.5) and interactions (-7.4; 95% CI -13.5 to -1.3) on the same AS-20 subscales. Other factors associated with reduced HRQOL included worse diplopia, lower mean deviation (MD) on visual field testing in either eye, poorer visual acuity in either eye, and younger age.

“Use of a glaucoma drainage device was associated with reduced quality of life in this study even when accounting for visual acuity, visual field loss, diplopia, age, and sex in adjusted analyses,” the investigators observed. “Our findings of reduced HRQOL in AS-20 self-perception and interactions subscales highlight negative self-perception in patients who undergo GDD implant, and ophthalmologists should be conscious of the potential contributors to poor HRQOL and openly discuss them with patients when gauging surgical options.”

The findings are in contrast to those in a previous report in which investigators concluded that there did not appear to be any identifiable differences in the safety or efficacy of aqueous shunts and trabeculectomy for the treatment of glaucoma.

For the current study, 160 patients treated for glaucoma completed two HRQOL questionnaires — the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) and the AS-20. A total of 87 patients were treated surgically and 73 were treated medically. Of those with surgical treatment, 36 had undergone GDD placement and 51 had undergone trabeculectomy.

Worse diplopia as measured on six subscales of the two HRQOL questionnaires was associated with reduced HRQOL, as was lower best-eye MD as measured on five of the six subscales. Lower worst-eye MD as reflected on four of the six subscales was also associated with a reduced HRQOL, as was lower worst-eye visual acuity seen on five of six subscales. Lower best-eye visual acuity as measured on two of the six subscales, along with younger age, were both associated with reduced HRQOL as well.

“Overall, in our study, more severe diplopia, more severe glaucoma in either eye (worse MD on visual field testing), poor visual acuity, treatment type, and younger age were associated with reduced quality of life,” Khanna et al wrote.

“These findings suggest that patients with glaucoma should be assessed for diplopia before and after surgery, given the negative effect of diplopia on HRQOL, and potential psychosocial effects of glaucoma drainage devices should be discussed during preoperative counseling.”

Limitations of the study, the team noted, included the fact that patients were not assessed for their personality type, depressive symptoms, or economic status, among other factors that can affect HRQOL scores.

AAO Perspective

Asked for his opinion, Andrew Iwach, MD, clinical spokesperson for the American Academy of Ophthalmology (AAO), who was not associated with the study, said that ophthalmologists generally try to delay or avoid incisional surgery when possible. “First of all, most patients can be successfully treated with topical medications or in-office laser procedures, and you don’t want to have glaucoma incisional surgery unless you need it,” he told MedPage Today.

He said that the main reason for this — and why the AAO recommends that everyone get their eyes screened for signs of glaucoma by the age of 40 — is that early on, patients don’t realize they are losing their vision because they are still asymptomatic. “So the idea is to design an intervention that will minimize the impact on the quality of a patient’s life today, while doing enough to protect their vision for the rest of their life — and the GDDs do that.”

The other reason Iwach said that there was reason to question the findings of the study is that patients who received the GDD were more likely to have undergone multiple previous surgeries and have other ocular conditions than those in the other groups — conditions that could affect HRQOL indices as well: “There are also different types of designs for GDDs, and more than half of the cases in this study had the larger, higher-risk GDDs.”

The risks of trabeculectomy not discussed in the paper include trauma and very serious infections, where patients can suddenly lose significant vision long after the surgery has been done, he explained. “No procedure is perfect, so it’s important to talk to the patient and modify and adjust your recommendations based not only on the state of the eye but also the patient’s lifestyle to minimize the impact of the intervention.

“To me, the take-home message is: Timely diagnosis,” Iwach emphasized. “The more we have to save, the less typically we have to do. The earlier the diagnosis, the better.”

The authors reported having no conflicts of interest.

Iwach reported a financial relationship with Bausch + Lomb.

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Glaucoma Drainage Devices Linked to Lower QOL

Timely diagnosis and preoperative discussions about potential psychosocial effects are key

MedpageToday

  • by Contributing Writer, MedPage Today

Action Points

  • Note that this cohort study found that the use of a glaucoma draining device (GDD) was associated with worse quality of life compared with trabeculectomy.
  • Be aware that this was not a randomized trial. The GDD group had had more preceding surgical procedures, which may have biased the results.

The use of a glaucoma draining device (GDD) in patients with glaucoma was associated with poorer health-related quality of life (HRQOL) compared with surgical or medical management, a prospective cohort study found. The researchers speculated that this may be due in part because patients treated with a GDD may be self-conscious about the device when they interact with others.

The results, reported by Cheryl Khanna, MD, of the Mayo Clinic in Rochester, Minn., and colleagues in JAMA Ophthalmology, showed that compared with trabeculectomy, the use of a GDD was associated with worse HRQOL scores of self-perception (difference, -12.3; 95% CI -20.9 to -3.7), interactions (-9.3; 95% CI -15.1 to -3.6) and general function (-9.4; 95% CI -18.9 to 0.0) as measured by subscales on the Adult Strabismus-20 questionnaire (AS-20) on adjusted analyses.

Compared with for medical treatment, the HRQOL scores for those with a GDD were similarly lower for self-perception (-14.7; 95% CI -23.9 to -5.5) and interactions (-7.4; 95% CI -13.5 to -1.3) on the same AS-20 subscales. Other factors associated with reduced HRQOL included worse diplopia, lower mean deviation (MD) on visual field testing in either eye, poorer visual acuity in either eye, and younger age.

"Use of a glaucoma drainage device was associated with reduced quality of life in this study even when accounting for visual acuity, visual field loss, diplopia, age, and sex in adjusted analyses," the investigators observed. "Our findings of reduced HRQOL in AS-20 self-perception and interactions subscales highlight negative self-perception in patients who undergo GDD implant, and ophthalmologists should be conscious of the potential contributors to poor HRQOL and openly discuss them with patients when gauging surgical options."

The findings are in contrast to those in a previous report in which investigators concluded that there did not appear to be any identifiable differences in the safety or efficacy of aqueous shunts and trabeculectomy for the treatment of glaucoma.

For the current study, 160 patients treated for glaucoma completed two HRQOL questionnaires -- the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) and the AS-20. A total of 87 patients were treated surgically and 73 were treated medically. Of those with surgical treatment, 36 had undergone GDD placement and 51 had undergone trabeculectomy.

Worse diplopia as measured on six subscales of the two HRQOL questionnaires was associated with reduced HRQOL, as was lower best-eye MD as measured on five of the six subscales. Lower worst-eye MD as reflected on four of the six subscales was also associated with a reduced HRQOL, as was lower worst-eye visual acuity seen on five of six subscales. Lower best-eye visual acuity as measured on two of the six subscales, along with younger age, were both associated with reduced HRQOL as well.

"Overall, in our study, more severe diplopia, more severe glaucoma in either eye (worse MD on visual field testing), poor visual acuity, treatment type, and younger age were associated with reduced quality of life," Khanna et al wrote.

"These findings suggest that patients with glaucoma should be assessed for diplopia before and after surgery, given the negative effect of diplopia on HRQOL, and potential psychosocial effects of glaucoma drainage devices should be discussed during preoperative counseling."

Limitations of the study, the team noted, included the fact that patients were not assessed for their personality type, depressive symptoms, or economic status, among other factors that can affect HRQOL scores.

AAO Perspective

Asked for his opinion, Andrew Iwach, MD, clinical spokesperson for the American Academy of Ophthalmology (AAO), who was not associated with the study, said that ophthalmologists generally try to delay or avoid incisional surgery when possible. "First of all, most patients can be successfully treated with topical medications or in-office laser procedures, and you don't want to have glaucoma incisional surgery unless you need it," he told MedPage Today.

He said that the main reason for this -- and why the AAO recommends that everyone get their eyes screened for signs of glaucoma by the age of 40 -- is that early on, patients don't realize they are losing their vision because they are still asymptomatic. "So the idea is to design an intervention that will minimize the impact on the quality of a patient's life today, while doing enough to protect their vision for the rest of their life -- and the GDDs do that."

The other reason Iwach said that there was reason to question the findings of the study is that patients who received the GDD were more likely to have undergone multiple previous surgeries and have other ocular conditions than those in the other groups -- conditions that could affect HRQOL indices as well: "There are also different types of designs for GDDs, and more than half of the cases in this study had the larger, higher-risk GDDs."

The risks of trabeculectomy not discussed in the paper include trauma and very serious infections, where patients can suddenly lose significant vision long after the surgery has been done, he explained. "No procedure is perfect, so it's important to talk to the patient and modify and adjust your recommendations based not only on the state of the eye but also the patient's lifestyle to minimize the impact of the intervention.

"To me, the take-home message is: Timely diagnosis," Iwach emphasized. "The more we have to save, the less typically we have to do. The earlier the diagnosis, the better."

The authors reported having no conflicts of interest.

Iwach reported a financial relationship with Bausch + Lomb.

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

DMARDs Tied to Lower Dementia Risk in RA

0


Medpage Today

DMARDs Tied to Lower Dementia Risk in RA

Study of U.K. database showed 40% reduced risk

MedpageToday

  • by

Chronic conventional disease-modifying antirheumatic drug (cDMARD) use was associated with 40% lower risk of dementia (nearly 50% with methotrexate use), according to British researchers who analyzed rheumatoid arthritis (RA) patients from the UK Clinical Practice Research Database

They compared 3,876 cDMARD users with 1,938 nonusers among incident RA and found a reduced risk of dementia (hazard ratio 0.60; 95% CI 0.42-0.85). The effect was strongest in methotrexate users (HR 0.52, 95% CI 0.34-0.82).

These results suggest a new potential therapeutic role for DMARDs and the possible contribution of inflammation on dementia.

Jack Cush, MD, is the director of clinical rheumatology at the Baylor Research Institute and executive editor of RheumNow.com. A version of this article first appeared on RheumNow, a news, information and commentary site dedicated to the field of rheumatology. Register to receive their free rheumatology newsletter.

2018-02-24T08:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

DMARDs Tied to Lower Dementia Risk in RA

Study of U.K. database showed 40% reduced risk

MedpageToday

  • by

Chronic conventional disease-modifying antirheumatic drug (cDMARD) use was associated with 40% lower risk of dementia (nearly 50% with methotrexate use), according to British researchers who analyzed rheumatoid arthritis (RA) patients from the UK Clinical Practice Research Database

They compared 3,876 cDMARD users with 1,938 nonusers among incident RA and found a reduced risk of dementia (hazard ratio 0.60; 95% CI 0.42-0.85). The effect was strongest in methotrexate users (HR 0.52, 95% CI 0.34-0.82).

These results suggest a new potential therapeutic role for DMARDs and the possible contribution of inflammation on dementia.

Jack Cush, MD, is the director of clinical rheumatology at the Baylor Research Institute and executive editor of RheumNow.com. A version of this article first appeared on RheumNow, a news, information and commentary site dedicated to the field of rheumatology. Register to receive their free rheumatology newsletter.

2018-02-24T08:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

Prednisone vs. Budesonide: Steroids for Crohn’s Treatment

0


What Are the Side Effects of Prednisone and Budesonide?

Prednisone

Side effects of prednisone and other corticosteroids range from mild annoyances to serious, irreversible organ damage, and they occur more frequently with higher doses and more prolonged treatment.

Common side effects include:

  • Retention of sodium (salt) and fluid
  • Weight gain
  • High blood pressure
  • Loss of potassium
  • Headache
  • Muscle weakness
  • Nausea
  • Vomiting
  • Acne
  • Thinning skin
  • Restlessness
  • Problems sleeping

Serious side effects include:

This drug also causes psychiatric disturbances, which include:

Other possible serious side effects of this drug include:

Prednisone and diabetes: Prednisone is associated with new onset or manifestations of latent diabetes, and worsening of diabetes. Diabetics may require higher doses of diabetes medications while taking prednisone,

Allergic reaction: Some people may develop a severe allergic reaction (anaphylaxis) to prednisone that includes swelling of the airways (angioedema) that may result in shortness of breath or airway blockage.

Immune suppression: Prednisone suppresses the immune system and, therefore, increases the frequency or severity of infections and decreases the effectiveness of vaccines and antibiotics.

Osteoporosis: Prednisone may cause osteoporosis that results in fractures of bones. Patients taking long-term prednisone often receive supplements of calcium and vitamin D to counteract the effects on bones. Calcium and vitamin D probably are not enough, however, and treatment with bisphosphonates such as alendronate (Fosamax) and risedronate (Actonel) may be necessary. Calcitonin (Miacalcin) also is effective. The development of osteoporosis and the need for treatment can be monitored using bone density scans.

Adrenal insufficiency and weaning off prednisone: Prolonged use of prednisone and other corticosteroids causes the adrenal glands to atrophy (shrink) and stop producing the body’s natural corticosteroid, cortisol.

Necrosis of hips and joints: A serious complication of long-term use of corticosteroids is aseptic necrosis of the hip joints. Aseptic necrosis is a condition in which there is death and degeneration of the hip bone. It is a painful condition that ultimately can lead to the need for surgical replacement of the hip. Aseptic necrosis also has been reported in the knee joints. The estimated incidence of aseptic necrosis among long-term users of corticosteroids is 3%-4%. Patients taking corticosteroids who develop pain in the hips or knees should report the pain to their doctors promptly.

How should prednisone be tapered, and what are the withdrawal symptoms and signs?

Patients should be slowly weaned off prednisone. Abrupt withdrawal of prednisone after prolonged use causes side effects because the adrenal glands are unable to produce enough cortisol to compensate for the withdrawal, and symptoms of corticosteroid insufficiency (adrenal crisis) may occur. These symptoms include:

Therefore, weaning off prednisone should occur gradually so that the adrenal glands have time to recover and resume production of cortisol. Until the glands fully recover, it may be necessary to treat patients who have recently discontinued corticosteroids with a short course of corticosteroids during times of stress (infection, surgery, etc.), times when corticosteroids are particularly important to the body.

Budesonide

The most common side effects of budesonide are:

Excessive corticosteroid use causes:

Serious side effects of budesonide include:



Source link

iMedicalApps: This Week's Top Apps for iPhones and iPads

0


Medpage Today

iMedicalApps: This Week’s Top Apps for iPhones and iPads

Nursing certification and pulmonology apps are must-downloads this week

MedpageToday

  • by

Every week, new medical platforms and apps are added to app stores. To save you time, we’ve sorted through them to find the most exciting new medical apps. Here are this week’s top picks:

Broncho+ is based on images provided by pulmonologist J.F. Dumon, MD, and anatomopathologist L. Garbe, MD. Endoscopic images allow the user to observe tracheal and bronchial tumors and compare them with normal bronchoscopic images. Additionally, the app describes the various lesions and provides dissected pictures.

The CPAN CAPA Certification app was created by the American Board of Perianesthesia Nursing Certification. Perianesthesia nurses can utilize this app to prepare for the certification exam. The app provides users with general information about the exam, resources for study, and reminders, lesson plans, and practice exams.

For more of our picks, visit iMedicalApps.com.

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

iMedicalApps: This Week's Top Apps for iPhones and iPads

Nursing certification and pulmonology apps are must-downloads this week

MedpageToday

  • by

Every week, new medical platforms and apps are added to app stores. To save you time, we've sorted through them to find the most exciting new medical apps. Here are this week's top picks:

Broncho+ is based on images provided by pulmonologist J.F. Dumon, MD, and anatomopathologist L. Garbe, MD. Endoscopic images allow the user to observe tracheal and bronchial tumors and compare them with normal bronchoscopic images. Additionally, the app describes the various lesions and provides dissected pictures.

The CPAN CAPA Certification app was created by the American Board of Perianesthesia Nursing Certification. Perianesthesia nurses can utilize this app to prepare for the certification exam. The app provides users with general information about the exam, resources for study, and reminders, lesson plans, and practice exams.

For more of our picks, visit iMedicalApps.com.

1969-12-31T19:00:00-0500

last updated

Comments