Latest news with #JAMA
Medscape
3 hours ago
- Health
- Medscape
Supplemental Oxygen Therapy: Tailor to Your Patient's Needs
Nothing captivates patient (or physician) imagination quite like oxygen. Its power and necessity are considered self-evident. Also a given is the need for saturation to be 90% or above. It's a nice round number, and we're taught early on it's the tipping point on the sigmoidal hemoglobin curve. No one wants to be caught on the steep portion. So, the floor nurse sneaks a nasal cannula onto your patient at night, and the intern walks them wearing a pulse-ox before discharge. At $2 billion per year for oxygen, we have a problem. JAMA recently published a 'patient-centered' oxygen review. It's excellent reading. Table 1 summarizes studies of patient and caregiver feedback on oxygen use, and Box 1 provides an individual patient narrative. The described experience and related complaints are painfully familiar to anyone caring for a patient on oxygen. There isn't any 'news' here, and others have called for oxygen reform. The review highlights the evidence — or lack thereof — and is notable for its practical depiction of oxygen devices, durable medical equipment (DME) companies, and overall oxygen logistics. I regularly receive emails from the American Thoracic Society (ATS) oxygen interest group asking for feedback to help support passage of the Supplemental Oxygen Access Reform Act. I can't speak to the substance of the act, but — per its proponents — it's designed to achieve what the JAMA review advocates: oxygen reimbursement and supply tailored to individual patient needs. Great. There are things we healthcare providers can do now, though. De-implementation (or deprescribing) is critical to cost efficiency, but it's a distant second to not ordering oxygen at all. Outside of the mortality benefit for those with resting hypoxia, outcomes from oxygen prescriptions range from inconsistent to nonexistent. So, to start, if your patient does not have resting hypoxia, think twice (or perhaps three times) before walking them or doing an exercise test. This brings us to the walk-of-life prior to hospital discharge. The resulting ambulatory oxygen prescription is meant to be 'short-term,' but it is rarely so. More often, it's a gateway drug, driving long-term prescriptions and patient dependence. This is well recognized, and both the ATS and CHEST College list deprescription as part of the their 'Choosing Wisely' campaign. Therapeutic overconfidence and time constraints, along with psychological patient dependence, conspire to prevent it. Discharge is typically handled by general medicine clinicians, house staff, or advanced practice healthcare providers, none of whom are comfortable withholding therapy from someone who desaturates with ambulation. However, to quote an old adage from The House of God , 'if you don't take a temperature, you can't find a fever.' If you don't walk your patient before discharge… I'd take the same approach to nocturnal hypoxia. The Centers for Medicare & Medicaid Services (CMS) reimbursement for desaturation at night is a modern-day medical mystery. The data isn't there and there aren't guidelines recommending it. Past reviews have argued against screening or prescribing. Anecdotally, I see this less now; but again, if you eliminate reimbursement. I'm confident it won't be seen at all. Lastly, there's oxygen education to improve health literacy. This is critical but it's a heavy lift. It takes time and resources, and both are in short supply. The JAMA review recommends an oxygen specialist to shepherd the anaerobe through the DME gauntlet. If only the authors could help me pay for one. Maybe I can negotiate with CMS myself. I'll stop ordering nocturnal and ambulatory oxygen supplementation. With the savings generated, CMS will pay for a respiratory therapist to do deprescription and DME navigation. Now that's choosing wisely.
New York Times
10 hours ago
- Health
- New York Times
What's the Hardest Part of Parenting in 2025? We Want to Hear From You.
Parenting has always been difficult. But recently, something seems to have snapped. Yes, there's the quotidian struggle of prepping meals and shuttling to summer activities. But now, according to Dr. Vivek Murthy, the former surgeon general of the United States, there are 'new stressors that previous generations didn't have to consider.' A recent study published in a JAMA medical journal found a steep drop in the mental health of mothers across the country from 2016 to 2023. As parents, we live and wrestle with some of those stressors ourselves. And as reporters, we've both covered the difficulties of parenting and motherhood in our work. That's why we want to hear your personal experiences about raising children right now. We will read every response to this questionnaire and reach out if we plan to include you in any upcoming stories. We won't publish any part of your response without hearing back from you first, and we won't share your contact information outside the Times newsroom or use it for any reason other than to get in touch with you.
Newsweek
3 days ago
- Health
- Newsweek
Gastrointestinal Cancers Are Rising Among US Adults Under 50
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. A new review published in the Journal of the American Medical Association (JAMA) reports that early-onset gastrointestinal cancers—including colon, pancreatic, and stomach cancers—are rising significantly among adults under 50 in the United States. Newsweek has reached out to the Department of Health and Human Services (HHS) and the review's authors for comment via email on Saturday. Why It Matters Cancer was one of the leading causes of death in the U.S. in 2023, with 613,349 deaths, according to the U.S. Centers for Disease Control and Prevention (CDC). The review's findings come amid the Trump administration's proposed deep cuts for scientific programming, including $18 billion in funding to the National Institutes of Health (NIH). The funding cuts are expected to have wide-reaching effects on NIH programs, including disease research and the development of new drugs. The NIH, through the National Cancer Institute, provides a significant share of funding for cancer research throughout the U.S. Health policy has been a point of contention during the Trump administration's second term, with HHS Secretary Robert F. Kennedy Jr. promoting a "Make America Healthy Again" platform. The administration has faced criticism from scientists and physicians over vaccine misinformation and skepticism toward established immunization practices, particularly amid a resurgence of measles in the country. What To Know A review authored by two doctors at the Dana-Farber Cancer Institute published in the peer-reviewed JAMA highlighted that "early-onset GI cancers, typically defined as cancer diagnosed in individuals younger than 50 years, are among the largest subset of early-onset cancers globally." It found that GI- cancers are the fastest-growing type of cancer to be diagnosed in adults under 50 in the U.S. The review noted that in the U.S. over 24,000 people were reported with early-onset GI cancers in 2022, with the vast majority, 20,800 diagnosed with colon cancer. Over the past decade, from 2010 to 2019, the age-standardized incidence rate of early-onset GI cancers in the U.S. increased 2.16 percent. Adults age 45 and older are advised to begin regular screening for colon cancer, which can help detect the disease early and reduce the risk of death. The review notes that there are "modifiable and nonmodifiable risk factors" associated with the development of early-onset gastrointestinal cancers, stating that "obesity, low-quality diet (e.g., high consumption of processed meats, sugar-sweetened beverages, and ultraprocessed foods), sedentary lifestyle, cigarette smoking, and alcohol consumption" all may increase risk. Nonmodifiable factors include family history, heredity, and bowel disease. The report relied on data from various medical articles, reviews, studies, and trials, as well as statistics from various cancer institutes over the past decade. Treatment of early-onset GI cancers often include some combination of chemotherapy, surgery, and radiation depending on the size, stage, location, and type of cancer. Demonstrators protest funding cuts outside of the National Institutes of Health (NIH) in Bethesda, Maryland, on March 8. Demonstrators protest funding cuts outside of the National Institutes of Health (NIH) in Bethesda, Maryland, on March 8. Photo by MICHAEL MATHES/AFP via Getty Images What People Are Saying Dr. Kimmie Ng, the review's co-author and director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute, told NBC News: "This really points to the importance of trying to improve screening and early detection." Dr. John Marshall, chief medical consultant at the nonprofit Colorectal Cancer Alliance, told NBC News: "It never used to happen in this age group, and now a very significant rise in 20-, 30- and 40-year-olds are getting colon cancer." Dana-Farber Cancer Institute wrote on X, formerly Twitter, on Friday: "Fewer than 1 in 5 U.S. adults screened for colorectal cancer, despite guidelines. This review in @JAMA_current by @DanaFarber charts a global rise of many GI cancers, noting colorectal cancer leads the alarming trend." What Happens Next? The proposed 2026 fiscal budget, which includes massive cuts to NIH, is before Congress. If approved, it would go into effect in October.
Yahoo
3 days ago
- Climate
- Yahoo
75 million Americans under heat advisories; New Orleans braces for deluge
Almost 75 million Americans in the East and South were under heat advisories July 17 as intense summer weather gripped much of the nation, the National Weather Service said. New York City was under a heat advisory for a second straight day, and residents were urged to call 311 for help finding cooling centers and obtaining "Beat the Heat" safety tips. The National Weather Service warned that seniors and those with chronic health problems or mental health conditions faced increased risk. As the planet warms, heat-related deaths are increasing in the U.S., according to a study published last year in the American Medical Association journal JAMA. The study, which reviewed federally reported data since 1999, said more than 2,000 heat-related deaths have been reported annually in recent years. "We're not done with this heat just yet!" New York Mayor Eric Adams said in a social media post. "Be sure to hydrate, use one of our cooling centers, and check on your pets and vulnerable neighbors. Together, we can all Beat the Heat!" Storm tracker: Forecasters warn of rainy tropical system along Gulf Coast Storm could dump almost a foot of rain in Louisiana A dangerous weather system hovering over the northern Gulf probably won't develop into a tropical depression but could still produce flash flooding in the region, the National Hurricane Center said in a forecast issued July 17. Forecasters had earlier warned the system could grow more powerful as it approached the Louisiana coast, and New Orleans could soon be in the storm's crosshairs. Mayor LaToya Cantrell ordered city buildings closed to the public on July 17, 2025, although city services will remain available virtually. However, the most recent wind data and surface and rader observations indicate the swath of low pressure "remains quite disorganized," senior hurricane specialist Philippe Papin wrote. "While some additional development of this system remains possible over the next 12-24 hours, its current structure suggests its chances of developing into a tropical depression before it reaches the Louisiana coast later today are decreasing," Papin wrote. Child killed in lightning strike at NJ archery range One person was killed and 14 injured − including children − in a lightning strike at a New Jersey archery range July 16, authorities in Jackson said. The lightning strike killed a 61-year-old instructor, city officials said. 'Eight of the victims were juveniles,' Jackson Mayor Michael Reina said. 'It looks like the victims were with (Scouting America) or Cub Scouts. Unfortunately, every single one of the 14 were taken to hospital.' The strike at Black Knight Bowbenders range occurred in the evening, shortly before a severe thunderstorm warning was issued for the area, according to Joseph Candido, Jackson public safety information director. The club was hosting a competition for the scouts, Candido said. − Erik Larsen and Lisa Robyn Kruse, Asbury Park Press Louisiana residents fill sandbags, prepare for flooding In St. Charles Parish, 20 miles west of New Orleans, parish President Matthew Jewell said emergency preparedness personnel were closely monitoring the storm. He warned residents that 3-5 inches of rain could be expected by July 19, and there is the potential for up to 10 inches in some areas. Sand for sand bags was being provided at multiple locations; residents were told to bring their own shovels and proof of residency. Amanda Babbin, one of the first in line, has seen flooding before at her parish home. 'Two weeks ago, that heavy rain, my backyard flooded," Babbin told "The water started coming into the back half of my house, my garage and all." Katrina survivor taking no chances In Plaquemines Parish, 60 miles south of New Orleans, Joanne McClelland was stocking up on essentials at the Breaux Mart. McClelland, who said she was also shopping for her mother in her 90s, told she has lived through numerous storms including Hurricane Katrina. That Category 5 storm slammed onto shore in 2005 on a path of destruction that killed more than 1,300 people and was blamed for damage in excess of $100 billion. "Hopefully it won't be too bad," McClelland said of this week's storms. "But once it goes into the Gulf, warm waters, you can't take chances." How much rain could fall in New Orleans? Papin also said the storm would bring heavy rainfall to the region regardless of how well it organizes, and a flood watch was in effect for the region through Friday night. The National Weather Service in New Orleans said several rounds of heavy rainfall were forecast through at least Friday night. Up to 2 inches and some isolated higher amounts had already fallen early on July 17, and an additional 2 to 4 inches was forecast. Locally higher amounts up to 8 inches were possible. Rainfall rates in excess of 2 to 4 inches per hour are likely with some storms. What is a tropical depression? Some clusters of thunderstorms over warm ocean waters develop well-defined centers and thus become tropical cyclones. A tropical depression is a tropical cylcone with maximum sustained surface winds averaging less than 39 mph. A tropical depression becomes a named tropical storm when sustained wind speeds reach 39 mph. When winds reach 74 mph, the storm officially becomes a hurricane. This article originally appeared on USA TODAY: 75M Americans under heat advisories; New Orleans braces for deluge Solve the daily Crossword
WIRED
3 days ago
- Health
- WIRED
At Least 750 US Hospitals Faced Disruptions During Last Year's CrowdStrike Outage, Study Finds
Jul 19, 2025 11:54 AM Of those, more than 200 appear to have had outages of services related to patient care following CrowdStrike's disastrous crash, researchers have revealed. Photograph:When, one year ago today, a buggy update to software sold by the cybersecurity firm CrowdStrike took down millions of computers around the world and sent them into a death spiral of repeated reboots, the global cost of all those crashed machines was equivalent to one of the worst cyberattacks in history. Some of the various estimates of the total damage worldwide have stretched well into the billions of dollars. Now a new study by a team of medical cybersecurity researchers has taken the first steps toward quantifying the cost of CrowdStrike's disaster not in dollars, but in potential harm to hospitals and their patients across the US. It reveals evidence that hundreds of those hospitals' services were disrupted during the outage, and raises concerns about potentially grave effects to patients' health and well-being. Researchers from the University of California San Diego today marked the one-year anniversary of CrowdStrike's catastrophe by releasing a paper in JAMA Network Open, a publication of the Journal of the American Medical Association Network, that attempts for the first time to create a rough estimate of the number of hospitals whose networks were affected by that IT meltdown on July 19, 2024, as well as which services on those networks appeared to have been disrupted. A chart showing a massive spike in detected medical service outages on the day of CrowdStrike's crashes. Courtesy of UCSD and JAMA Network Open By scanning internet-exposed parts of hospital networks before, during, and after the crisis, they detected that at minimum 759 hospitals in the US appear to have experienced network disruption of some kind on that day. They found that more than 200 of those hospitals seemed to have been hit specifically with outages that directly affected patients, from inaccessible health records and test scans to fetal monitoring systems that went offline. Of the 2,232 hospital networks they were able to scan, the researchers detected that fully 34 percent of them appear to have suffered from some type of disruption. All of that indicates the CrowdStrike outage could have been a 'significant public health issue,' argues Christian Dameff, a UCSD emergency medicine doctor and cybersecurity researcher, and one of the paper's authors. 'If we had had this paper's data a year ago when this happened," he adds, 'I think we would have been much more concerned about how much impact it really had on US health care.' CrowdStrike, in a statement to WIRED, strongly criticized the UCSD study and JAMA's decision to publish it, calling the paper 'junk science.' They note that the researchers didn't verify that the disrupted networks ran Windows or CrowdStrike software, and point out that Microsoft's cloud service Azure experienced a major outage on the same day, which may have been responsible for some of the hospital network disruptions. 'Drawing conclusions about downtime and patient impact without verifying the findings with any of the hospitals mentioned is completely irresponsible and scientifically indefensible,' the statement reads. 'While we reject the methodology and conclusions of this report, we recognize the impact the incident had a year ago,' the statement adds. 'As we've said from the start, we sincerely apologize to our customers and those affected and continue to focus on strengthening the resilience of our platform and the industry.' In response to CrowdStrike's criticisms, the UCSD researchers say they stand by their findings. The Azure outage that CrowdStrike noted, they point out, began the previous night and affected mostly the central US, while the outages they measured began at roughly midnight US east coast time on July 19—about the time when CrowdStrike's faulty update began crashing computers—and affected the entire country. (Microsoft did not immediately respond to a request for comment.) 'We are unaware of any other hypothesis that would explain such simultaneous geographically-distributed service outages inside hospital networks such as we see here' other than CrowdStrike's crash, writes UCSD computer science professor Stefan Savage, one of the paper's co-authors, in an email to WIRED. (JAMA declined to comment in response to CrowdStrike's criticisms.) In fact, the researchers describe their count of detected hospital disruptions as only a minimum estimate, not a measure of the real blast radius of CrowdStrike's crashes. That's in part because the researchers were only able to scan roughly a third of America's 6,000-plus hospitals, which would suggest that the true number of medical facilities affected may have been several times higher. The UCSD researchers' findings stemmed from a larger internet-scanning project they call Ransomwhere?, funded by the Advance Research Projects Agency for Health and launched in early 2024 with the intention of detecting hospitals' ransomware outages. As a result of that project, they were already probing US hospitals using the scanning tools ZMap and Censys when CrowdStrike's July 2024 calamity struck. For the 759 hospitals in which the researchers detected that a service was knocked offline on July 19, their scans also allowed them to analyze which specific services appeared to be down, using publicly available tools like Censys and the Lantern Project to identify different medical services, as well as manually checking some web-based services they could visit. They found that 202 hospitals experienced outages of services directly related to patients. Those services included staff portals used to view patient health records, fetal monitoring systems, tools for remote monitoring of patient care, secure document transfer systems that allow patients to be transferred to another hospital, 'pre-hospital' information systems like the tools that can share initial test results from an ambulance to an emergency room for patients requiring time-critical treatments, and the image storage and retrieval systems that are used to make scan results available to doctors and patients. 'If a patient was having a stroke and the radiologist needed to look at a scan image quickly, it would be much harder to get it from the CT scanner to the radiologist to read,' Dameff offers as one hypothetical example. The researchers also found that 212 hospitals had outages of 'operationally relevant' systems like staff scheduling platforms, bill payment systems, and tools for managing patient wait times. In another category of 'research relevant' services, the study found that 62 hospitals faced outages. The biggest fraction of outages in the researchers' findings was an 'other' category that included offline services that the researchers couldn't fully identify in their scans at 287 hospitals, suggesting that some of those, too, might have been uncounted patient-relevant services. 'Nothing in this paper says that someone's stroke got misdiagnosed or there was a delay in the care of someone getting life-saving antibiotics, for instance. But there might have been,' says Dameff. 'I think there's a lot of evidence of these types of disruptions. It would be hard to argue that people weren't impacted at a potentially pretty significant level.' The study's findings give a sprawling new sense of scope to anecdotal reports of how CrowdStrike's outage affected medical facilities that already surfaced over the last year. WIRED reported at the time that Baylor hospital network, a major nonprofit health care system, and Quest Diagnostics were both unable to process routine bloodwork. The Boston-area hospital system Mass General Brigham reportedly had to bring 45,000 of its PCs back online, each of which required a manual fix that took 15 to 20 minutes. In their study, researchers also tried to roughly measure the length of downtime of the hospital services affected by the CrowdStrike outage, and found that most recovered relatively quickly: About 58 percent of the hospital services were back online within six hours, and only 8 percent or so took more than 48 hours to recover. That's a far shorter disruption than the outages from actual cyberattacks that have hit hospitals, the researchers note: Mass-spreading malware attacks like NotPetya and WannaCry in 2017 as well as the Change Healthcare ransomware attack that struck the payment provider subsidiary of United Healthcare in early 2024 all shut down scores of hospitals across the US—or in the case of WannaCry, the United Kingdom—for days or weeks in some cases. But the effects of the CrowdStrike debacle nonetheless deserve to be compared to those intentionally inflicted digital disasters for hospitals, the researchers argue. 'The duration of the downtimes is different, but the breadth, the number of hospitals affected across the entire country, the scale, the potential intensity of the disruption is similar,' says Jeffrey Tully, a pediatrician, anesthesiologist, and cybersecurity researcher who coauthored the study. A map showing the duration of the apparent downtime of detected medical service outages in hospitals across the US. Courtesy of UCSD and JAMA Network Open A delay of hours, or even minutes, can increase mortality rates for heart attack and stroke patients, says Josh Corman, a cybersecurity researcher with a focus on medical cybersecurity at the Institute for Security and Technology and former CISA staffer who reviewed the UCSD study. That means that even a shorter-duration outage in patient related services across hundreds of hospitals could have concrete and seriously harmful—if hard to measure—consequences. Aside from drawing a first estimate of the possible toll on patients' health in this single incident, the UCSD team emphasizes that the real work of their study is to show that, with the right tools, it's possible to monitor and learn from these mass medical network outages. The result may be a better sense of how to prevent—or in the case of more intentional downtime from cyberattacks and ransomware—protect hospitals from experiencing them in the future.
