Her pleas for help were shrugged off, she said, and she was repeatedly sent home from the hospital. Doctors and nurses told her she was suffering from normal contractions, she said, even as her abdominal pain worsened and she began to vomit bile. Angelica said she wasn’t taken seriously until a searing pain rocketed throughout her body and her baby’s heart rate plummeted.
Rushed into the operating room for an emergency cesarean section, months before her due date, she nearly died of an undiagnosed case of sepsis.
Even more disheartening: Angelica worked at the University of Alabama at Birmingham, the university affiliated with the hospital that treated her.
Her experience is a reflection of the medical racism, bias and inattentive care that Black Americans endure. Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention.
Black babies are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives.
The SOA Research Institute’s Mortality and Longevity Strategic Research Program is pleased to make available a research report that quantifies differences in mortality and disease prevalence by health status. Additionally, period life tables by health status, sex, and age are available in Appendix D.
Author(s):
Natalia S. Gavrilova, Ph.D. Leonid A. Gavrilov, Ph.D.
Improving diagnosis in health care is a moral, professional and public health imperative, according to the U.S. National Academy of Medicine. However, little is known about the full scope of harms related to medical misdiagnosis — current estimates range widely. Using novel methods, a team from the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence and partners from the Risk Management Foundation of the Harvard Medical Institutions sought to derive what is believed to be the first rigorous national estimate of permanent disability and death from diagnostic error.
The original research article was published July 17 by BMJ Quality & Safety. Results of the new analysis of national data found that across all clinical settings, including hospital and clinic-based care, an estimated 795,000 Americans die or are permanently disabled by diagnostic error each year, confirming the pressing nature of the public health problem.
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To identify their findings, researchers multiplied national measures of disease incidence by the disease-specific proportion of patients with that illness who experience errors or harms. Researchers repeated this method for the 15 diseases causing the most harms, then extrapolated to the grand total across all dangerous diseases. To assess the accuracy of the final estimates, the study’s authors ran the analyses under different sets of assumptions to measure the impact of methodological choices and then tested the validity of findings by comparing them with independent data sources and expert review. The resulting national estimate of 371,000 deaths and 424,000 permanent disabilities reflects serious harms widely across care settings, and it matches data produced from multiple prior studies that focused on diagnostic errors in ambulatory clinics and emergency departments and during inpatient care.
Vascular events, infections and cancers, dubbed the Big Three, account for 75% of the serious harms. The study found that 15 diseases account for 50.7% of the total serious harms. Five conditions causing the most frequent serious harms account for 38.7% of total serious harms: stroke, sepsis, pneumonia, venous thromboembolism and lung cancer. The overall average error rate across diseases was estimated at 11.1%, but the rate ranges widely from 1.5% for heart attack to 62% for spinal abscess. The top cause of serious harm from misdiagnosis was stroke, which was found to be missed in 17.5% of cases.
Specialty Utilization Specialty utilization by a total of 1802 patients evaluated at the Comprehensive COVID Center (CCC) during the first 21 months in a total of 2361 initial visits in 12 specialty clinics. The mean number of specialty clinics visited by CCC patients was 1.3 (range 1-6) and multiple clinic consultations accounted for 405 visits.
Excerpt:
Background
Persistent multi-organ symptoms after COVID-19 have been termed “long COVID” or “post-acute sequelae of SARS-CoV-2 infection” (PASC). The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers.
Methods
We performed a retrospective cohort study of patients evaluated at our multidisciplinary Comprehensive COVID-19 Center (CCC) in Chicago, IL, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19.
Results
We evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among patients tested, 742/878(85%) reported decreased quality of life, 284/553(51%) had cognitive impairment, 195/434(44.9%) had alteration of lung function, 249/299(83.3%) had abnormal CT chest scans, and 14/116(12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had similar findings than those with negative or no test results.
Conclusions
The CCC experience shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.
Keywords: Long COVID, Post-Acute Sequelae of SARS-CoV-2 Infection, PASC, Multidisciplinary Care, Health Service Delivery
Author(s): Joseph Bailey, M.D.,a,⁎ Bianca Lavelle, M.D.,b Janet Miller, B.S.,a Millenia Jimenez, B.S.,c Patrick H. Lim, M.S.,c Zachary S. Orban, B.S.,c Jeffrey R. Clark, B.A.,c Ria Tomar, B.S.,a Amy Ludwig, M.D.,a Sareen T. Ali, B.S.,c Grace K. Lank, B.S.,c Allison Zielinski, M.D.,d Ruben Mylvaganam, M.D.,a Ravi Kalhan, M.D.,a Malek El Muayed, M.D.,e R. Kannan Mutharasan, M.D.,d Eric M. Liotta, M.D. M.S.,c Jacob I Sznajder, M.D.,a Charles Davidson, M.D.,d Igor J. Koralnik, M.D.,c,1 and Marc A. Sala, M.D.a,1, for the Northwestern Medicine Comprehensive COVID Center Investigators
Long COVID occurs in approximately a third of COVID survivors and is now the third leading neurologic disorder in the United States. In May 2020, during the height of the pandemic, Northwestern Medicine physicians noticed this growing trend and established one of the first Comprehensive COVID-19 Centers in the United States to treat patients suffering from lingering impacts of the virus such as brain fog, shortness of breath and chest pain. Three years later, a new study published in the American Journal of Medicine reports key findings from more than 1,800 patients who were evaluated during the first 21 months at the Northwestern Medicine Comprehensive COVID-19 Center (CCC) with neurology, pulmonology and cardiology being the most commonly accessed specialties and still in high-demand today.
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The team evaluated 1,802 patients (350 post-hospitalization and 1,452 non-hospitalized) via telehealth or in-person at the CCC between May 2020 and February 2022. Patients were seen in 2,361 initial visits in 12 specialty clinics including neurology, pulmonology, cardiology, otolaryngology, gastroenterology, infectious diseases, endocrinology, nephrology, hematology, dermatology, psychiatry and rheumatology. Patients most commonly sought treatment from neurology (49%), pulmonology (25%) and cardiology (12%) specialists.
Among patients tested:
– 85% of patients reported decreased quality of life
– 51% had cognitive impairment
– 45% had altered lung function
– 83% had abnormal CT chest scans
– 12% had elevated heart rate on rhythm monitoring
– Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19
– Non-hospitalized patients with positive COVID-19 testing had similar findings than those with negative or no test results
DEMOGRAPHICS
– 65% of patients identified as female
– Average age at first clinic visit was 47 years old
– 72% were White, 10% were Black, 4% were Asian and 13% were Hispanic
More than $50 billion in settlement funds is being delivered to thousands of state and local governments from companies accused of flooding their communities with opioid painkillers that have left millions addicted or dead.
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Most of the settlements stipulate that states must spend at least 85% of the money they will receive over the next 15 years on addiction treatment and prevention. But defining those concepts depends on stakeholders’ views — and state politics. To some, it might mean opening more treatment sites. To others, buying police cruisers.
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What’s more, many states are not being transparent about where the funds are going and who will benefit. An investigation by KHN and Christine Minhee, founder of OpioidSettlementTracker.com, concluded only 12 states have committed to detailed public reporting of all their spending.
The analysis involved scouring hundreds of legal documents, laws, and public statements to determine how each state is divvying up its settlement money among state agencies, city and county governments, and councils that oversee dedicated trusts. The next step was to determine the level and detail of public reporting required. The finding: Few states promise to report in ways that are accessible to the average person, and many are silent on the issue of transparency altogether.
More than $3 billion has gone out to state and local governments so far. KHN will be following how that cash — and the billions set to arrive in coming years — is used.
Vaccination has been widely implemented for mitigation of coronavirus disease-2019 (Covid-19), and by 11 November 2022, 701 million doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) had been administered and linked with 971,021 reports of suspected adverse effects (SAEs) in the European Union/European Economic Area (EU/EEA).1 Vaccine vials with individual doses are supplied in batches with stringent quality control to ensure batch and dose uniformity.2 Clinical data on individual vaccine batch levels have not been reported and batch-dependent variation in the clinical efficacy and safety of authorized vaccines would appear to be highly unlikely. However, not least in view of the emergency use market authorization and rapid implementation of large-scale vaccination programs, the possibility of batch-dependent variation appears worthy of investigation. We therefore examined rates of SAEs between different BNT162b2 vaccine batches administered in Denmark (population 5.8 million) from 27 December 2020 to 11 January 2022.
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A total of 7,835,280 doses were administered to 3,748,215 persons with the use of 52 different BNT162b2 vaccine batches (2340–814,320 doses per batch) and 43,496 SAEs were registered in 13,635 persons, equaling 3.19 ± 0.03 (mean ± SEM) SAEs per person. In each person, individual SAEs were associated with vaccine doses from 1.531 ± 0.004 batches resulting in a total of 66,587 SAEs distributed between the 52 batches. Batch labels were incompletely registered or missing for 7.11% of SAEs, leaving 61,847 batch-identifiable SAEs for further analysis of which 14,509 (23.5%) were classified as severe SAEs and 579 (0.9%) were SAE-related deaths. Unexpectedly, rates of SAEs per 1000 doses varied considerably between vaccine batches with 2.32 (0.09–3.59) (median [interquartile range]) SAEs per 1000 doses, and significant heterogeneity (p < .0001) was observed in the relationship between numbers of SAEs per 1000 doses and numbers of doses in the individual batches. Three predominant trendlines were discerned, with noticeable lower SAE rates in larger vaccine batches and additional batch-dependent heterogeneity in the distribution of SAE seriousness between the batches representing the three trendlines (Figure 1). Compared to the rates of all SAEs, serious SAEs and SAE-related deaths per 1.000 doses were much less frequent and numbers of these SAEs per 1000 doses displayed considerably greater variability between batches, with lesser separation between the three trendlines (not shown).
Author(s): Max Schmeling, Vibeke Manniche, Peter Riis Hansen
Publication Date: 30 Mar 2023
Publication Site: European Journal of Clinical Investigation
Gun violence and crime incidents are collected/validated from 7,500 sources daily – Incident Reports and their source data are found at the gunviolencearchive.org website.
Footnotes
Number of source verified deaths and injuries
Number of INCIDENTS reported and verified
Calculation based on CDC Suicide Data
Actual total of all non-suicide deaths plus daily calculated suicide deaths
All numbers are subject to change or incidents recategorized as new evidence is established and verified.
METHODOLOGY & DEFINITIONS AVAILABLE AT: https://www.gunviolencearchive.org/methodology
www.gunviolencearchive.org www.facebook.com/gunviolencearchive On Twitter @gundeaths
Figure 2 shows the incidence of cardiovascular disease and stroke in the male population.
This was derived from Gen Re’s Dread Disease experience study covering the period 2012–2015 and 2015–2019 for Hong Kong, Singapore and Malaysia. As per the analysis from the leading insurance companies of the respective market, 43% of men in Singapore, 40% of men in Malaysia and 26% of men in Hong Kong had critical illness claims due to cardiovascular disease and stroke between 2015 and 2019. When compared with the 2012–2015 analysis, it was noted that there is an increase in claims by 3% in Singapore, 10% in Malaysia and 1% points in Hong Kong, which may be associated with overweight and obesity or simply an older portfolio.
Due to increases in body weight and medical complications, insurance companies may be confronted with increasing claims which will impact their profitability. To mitigate this cost, insurance companies may have to increase the premium so as to commensurate with this rising claim cost. This increase in price will impact on the healthy population.
Health insurance premium has doubled in the past 10 years, but it is unclear how much of this premium is sufficient to cover the financial burden of the obesity pandemic. The evaluation of existing and developing new health coverages related to obesity-related conditions is an important consideration for the profitability of the health insurance providers.14
One thing that is tied to the national emergency is an extension of COBRA deadlines for people who are out of work. These deadlines are extended during the “outbreak period” which ends 60 days after the end of the national emergency.
The DHS rules for vaccine mandates for foreign travelers at land border crossings from Canada and Mexico rely on the national emergency as their legal basis, so theoretically they will end with the national emergency. But there has been no official actions to lift those rules, and I suspect the White House expects this vaccine mandate to continue for at least another month. (See section on travel vaccine mandates further down for more details.)
I drank the bespoke pathogenic cocktail as part of what’s known as a “human challenge study” run by the Center for Vaccine Development at the University of Maryland, Baltimore. In a human challenge study, adult volunteers are exposed to a pathogen. The study I was involved in was intended to test an experimental vaccine. The process may sound somewhat medieval, but these studies are critical scientific tools that prioritize participant safety. From 1980 to 2021, over 15,000 volunteers have been exposed to one of dozens of diseases in such studies, and not one has died.
Dysentery can be fatal. While Shigella is treatable with antibiotics, resistance is evolving at a worrying pace, and tens of thousands of children still succumb to it every year in the developing world. Those it does not kill are often left with stunted growth.
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For my assistance in the development of a potentially lifesaving vaccine, I was paid $7,350. My motivations were altruistic to a degree: I wanted to pay my privilege forward. As I told Business Insider, however, I am not a complete saint and would not have done it for free.
As far as the Internal Revenue Service (IRS) is concerned, the compensation for my bout of dysentery has zero charitable component; it’s just regular old income, indistinguishable from, say, freelance writing or mowing lawns. If, God forbid, I am ever audited, I hope the IRS agent believes me when I say that’s just my diarrhea money.
I maintain, though, that I should not be taxed on that $7,350 at all: Treating clinical trial compensation as taxable income is just bad policy.
Tranq – the deadly “zombie” drug formally known as xylazine – is circulating across New York and has been tied to dozens of deaths in the state, Senate Majority Leader Chuck Schumer warned Sunday.
Use of the flesh-rotting substance is “spreading” in Syracuse, Albany, Rochester and the Greater New York City area, Schumer said, as he called on increased federal funding for the state to help fight the disturbing trend.
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Tranq, a veterinary drug, is Narcan-resistant, meaning its effects cannot be reversed in the event of an overdose.
It is said to cause skin and bone to deteriorate or rot over time.
The US Drug Enforcement Administration recently issued a public safety alert, announcing that the agency had seized mixtures of xylazine and fentanyl in 48 of the 50 states.
