Blog

Preventing delirium, “pink Viagra” moves toward approval, and are home births safer?

+SHARE

June 11, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page.

 

Features:

In The Atlantic, Sandra Boodman describes the lesser-known condition of delirium, which affects mostly elderly patients after being heavily sedated, on ventilators, or in ICU settings. The symptoms: Inability to focus, hallucinations, disruption of consciousness and cognition. And these can last long after discharge. Often confused with dementia, “ICU psychosis,” as it is known, can coexist with dementia, but they are different illnesses. Still, the underlying cause for delirium remains unclear. Preventing delirium may be the best course of action. Some hospitals are trying to prevent the condition by more carefully using medications, weaning patients off ventilators sooner, and controlling hospital environments that may trigger delirium, like lighting. Ryan Greysen, MD, at the University of California, San Francisco advocates a non-medical approach. “There’s no gene therapy, no new drug. I think we need to put this in the realm of hospital protocol, which conveys the message that preventing and treating delirium is just as important as giving people their meds on time.” Sharon Inouye, MD, MPH, at Harvard Medical School, has developed the Confusion Assessment Method, a tool being used widely to assess delirium. “Medical care has evolved to be absolutely inhumane to older people,” she says. “…we shouldn’t treat every little symptom with a pill. Sometimes a hand rub or a conversation or a glass of herbal tea can be as effective as an anti-anxiety drug.”

 

A recent report from the UK’s National Institute for Health and Care Excellence (NICE), calling home birth a safe option for women with low-risk pregnancies, has drawn some attention in the United States, and highlights some important cultural differences in medical care in other developed countries. Out-of-hospital birth is far more common in the UK than the US. The treatment intensity associated with an in-hospital birth, and the accompanying high rates of C-section, may not benefit women or babies. In a Perspective in the New England Journal, Neel Shah, MD MPP, an American OB/GYN and founder of Costs of Care, notes that “the fact that nearly half of first-time mothers who initially intend to have a home birth are transferred to hospitals may be a sign of a working system rather than a failing one.” The level of system integration present in the UK makes it possible to respect and accommodate women’s preferences for birth at home, while providing effective access to care for births that become complicated. In the US, systems and professional attitudes about out-of-hospital birth have been slow to adjust, denying many women the ability to have the kind of birth experience they wanted, and potentially putting women who choose home birth at greater risk if their delivery goes wrong.

 

A federal advisory committee recently recommended that the FDA approve flibanserin, or “pink Viagra,” an antidepressant intended to treat hypoactive sexual desire disorder in premenopausal women. Twice the FDA has determined that the drug’s marginal benefit does not outweigh its hefty risks (like potentially fatal hypotension and syncope when combined with birth control or alcohol). But after an intense lobbying campaign led by the manufacturer, the drug is under consideration for approval once again. Adriane Fugh-Berman, MD, director of PharmedOut, warns, “To approve this drug will set the worst kind of precedent — that companies that spend enough money can force the FDA to approve useless or dangerous drugs.” And, while the pharmaceutical industry pushes what Fugh-Berman calls “a mediocre aphrodisiac with scary side effects,” women are denied needed services that are safe and effective. A piece in The Atlantic describes the lack of training and resulting dearth of abortion providers in the United States, and the stark geographic variations in availability of abortion services.

 

Announcements:

 

The Lown Institute is accepting applications from incoming chief residents for the new RightCare Educator Program. Help shape a more rational medical culture by implementing RightCare Rounds in your institution. Deadline for applications is Tuesday, June 30. A small stipend will be provided. For more information, see here.

 

Have you signed up for RightCare Action Week? It’s our grassroots initiative that engages people across the country to take action to show what our healthcare system should look like. On RightCareActionWeek.org, you’ll find an Action Forum, where you can submit, vote on, and discuss Action Ideas with your friends and colleagues. Sign up today.

 

Headlines:

 

More on flibanserin

 

Conflict of interest

 

Public health and social policy

 

Healthcare reform

 

Healthcare politics

 

Payment system

 

Cost of care

 

Health professional workforce

 

Substance abuse and harm reduction

 

Pharma

 

Delivery system innovation

 

Medical evidence

 

End-of-life care

 

Prisons

 

Hospital care

 

Vaccines

 

Patient safety

 

Medicaid

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.