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Screening for HIV

Screening for HIV

In the United States, an estimated 1.2 million people are infected with HIV, and about 50,000 new cases emerge each year. Since the first cases of AIDS were reported in 1981, more than 1.1 million people have been diagnosed with the disease, and nearly 595,000 deaths have been attributed to it. About 20% to 25% of individuals living with HIV are unaware that they are infected with the virus. According to the U.S. Preventive Services Task Force (USPSTF), there is convincing evidence to suggest that identifying and treating HIV infection can markedly reduce the risk for HIV to progress to AIDS, AIDS-related events, and death in people who have immunologically advanced disease. Clinical data also show that initiating antiretroviral therapy (ART) earlier in patients with HIV—when they are most likely to be asymptomatic and detected by screening rather than clinical presentation—can decrease risks for AIDS-related events or death and transmission of HIV to uninfected people. Updated Recommendations In 2013, the USPSTF updated its 2005 recommendation statement on screening for HIV for adolescents, adults, and pregnant women. The USPSTF reviewed new evidence on the effectiveness of treatments for HIV in people with CD4 counts exceeding 0.200 × 109 cells/L. It also reviewed data on the effects of screening, counseling, and ART use on risky behaviors and HIV transmission risk as well as the long-term cardiovascular harms of ART. “The new USPSTF HIV screening guidelines now align more closely with recommendations that were released by the CDC back in 2006,” adds Dr. Volberding. According to the USPSTF recommendations, which were published in the Annals of Internal Medicine, all adults and adolescents...
Combating Malnutrition

Combating Malnutrition

With as many as one in three patients entering the hospital malnourished, physicians and other healthcare providers must understand the adverse effects malnutrition has on patient outcomes. It delays recovery from illness and increases complications as well as frequency of hospital admissions and length of stay. Research has shown measurable and positive effects when malnourished patients receive nutritional treatment. For patients with at least one known subsequent readmission, oral nutrition supplementation provided during hospitalization has been associated with a significant reduction in the probability of 30-day readmission. Studies have also shown that nutrition interventions can significantly reduce the risk of pressure ulcers. For gastrointestinal surgery patients, nutrition interventions have led to substantial reductions in overall complications. Nutrition Care Model One of the most critical aspects to comprehensively identify and treat malnutrition is to drive interdisciplinary collaboration among dietitians, nurses, hospitalists, and other physicians. To address this issue, the Alliance to Advance Patient Nutrition published a consensus paper outlining the problem of malnutrition and recommended steps to improve outcomes. The alliance describes a nutrition care model that offers practical ways for healthcare providers in hospitals to collaborate to promptly diagnose and treat malnourished patients and those at risk for malnutrition. The model emphasizes the following six principles: • Create an institutional culture where all stakeholders value nutrition. • Redefine clinicians’ roles to include nutrition care. • Recognize and diagnose all malnourished patients and those at risk. • Rapidly implement comprehensive nutrition interventions and continued monitoring. • Communicate nutrition care plans. • Develop a comprehensive discharge nutrition care and education plan. For each of these steps, there are specific actions physicians can take to make...

Searching for Drugs and Crossing Ethical Lines

Back in September, I blogged about a case of a man in Tennessee who was sedated, intubated, and placed on a ventilator without his consent so that an emergency physician could perform a rectal exam looking for drugs. The court ruled that the man’s Fourth Amendment rights against an unreasonable search were violated. It gets worse. In New Mexico, a man is suing several law enforcement agencies and officers and doctors because of what some might consider an excessive search. See what you think. When the man was pulled over for running a stop sign, officers say he was clenching his buttocks, which led them to suspect he was hiding drugs in his rectum. They obtained a search warrant, but a doctor at the first hospital they took the prisoner to refused to do the search saying he believed it was not ethical. A second hospital was much more accommodating. At that institution, he allegedly underwent two digital rectal exams, two abdominal x-rays, and three enemas—all without his consent. He was forced to defecate in front of the police. After those procedures yielded nothing, he was sedated, and a colonoscopy was performed, also without consent and also negative for drugs. According to the report, the search warrant was not valid for the county in which the second hospital was located and had expired well before the colonoscopy was done. Here’s the punch line. At the end of the video in the link to the story, the reporter mentions that the hospital has billed the man for its services and is considering sending the bill to a collection agency if...
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