Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Press release] Patients dismissing ‘trivial’ symptoms could delay cancer diagnosis

One of our neighbors died 5 years ago. She hid her symptoms from her family. Wondering if she would be alive today if she would have been proactive.

[Press release] Patients dismissing ‘trivial’ symptoms could delay cancer diagnosis

26 January 2015, Cancer Research UK

People who dismiss their symptoms as trivial or worry about wasting the doctor’s time may decide against going to their GP with red-flag cancer warning symptoms, according to a Cancer Research UK study* published in the British Journal of General Practice (link is external)today.

 “Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent.” – Dr Katriina Whitaker

Others might decide not to get possible cancer symptoms checked out because they fear a cancer diagnosis, they adopt a stiff upper lip, they lack confidence in the healthcare system, or they think their problem is down to ageing.

Researchers in London and Hull** looked at how people who experience possible cancer symptoms decide whether or not to seek medical help. They sent out a health survey that was completed by more than 1,700 people, aged 50 and over, from three London GP practices.

The survey specifically did not mention cancer, but incorporated a list of 17 symptoms including 10 cancer ‘alarm’ warning signs, such as persistent cough or hoarseness, unexplained lump, persistent change in bowel or bladder habits, and a sore that does not heal.***

More than 900 people reported having at least one alarm symptom during the past three months. Researchers carried out in-depth interviews with almost 50 of them, almost half (45 per cent) of whom had not seen their GP about their symptoms. ****

One woman with persistent abdominal pain did not go for a recommended test. She said: “At times I thought it was bad … but when it kind of fades away, you know, it doesn’t seem worth pursuing really.”  A man, who experienced a persistent change in bladder habits, said: “You’ve just got to get on with it. And if you go to the doctor too much, it’s seen as a sign of weakness or that you are not strong enough to manage things on your own.”

Dr Katriina Whitaker, a senior research fellow at University College London during the study, said: “Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent.

“Others felt that they shouldn’t make a fuss or waste valuable NHS resources. The stiff-upper-lip stoicism of some who decided not to go to their doctor was alarming because they put up with often debilitating symptoms. Some people made the decision to get symptoms checked out after seeing a cancer awareness campaign or being encouraged to do so by family or friends – this seemed to almost legitimise their symptoms as important.”

Reasons people gave for deciding to seek help included symptoms not going away, instinct that something was not right, and awareness or fear that they might have cancer. A man with an unexplained throat lump said: “But always at the back of your mind you’ve always got the fear of cancer …….. well it’s best to check just in case.”  However, fear also made some people decide not to check out symptoms, or if symptoms did persist some people began to think they were normal for them.

Some people waited for another reason to visit their GP and mentioned the cancer alarm symptom then. Others said they would rather use an emergency route, such as going straight to A and E, than wait to see a specialist after being referred by their GP.

Dr Richard Roope, Cancer Research UK’s GP expert, said: “The advice we give is: if in doubt, check it out – this would not be wasting your GP’s time. Often your symptoms won’t be caused by cancer, but if they are, the quicker the diagnosis, the better the outcome. Seeking prompt advice from your GP about symptoms, either on the phone or during an appointment, could be a life-saver, whatever your age. And the good news is that more than half of all patients diagnosed with cancer now survive for more than 10 years.”

January 26, 2015 Posted by | health care, Health News Items | , , , , | Leave a comment

[Press release] Three-quarters of people with seasonal and pandemic flu have no symptoms

 

English: Influenza positive tests reported to ...

English: Influenza positive tests reported to CDC by US WHO/NREVSS collaborating laboratories, national summary, 2008-2009: subtypes and percent positive tests (Photo credit: Wikipedia)

Three-quarters of people with seasonal and pandemic flu have no symptoms.

Around 1 in 5 of the population were infected in both recent outbreaks of seasonal flu and the 2009 H1N1 influenza pandemic, but just 23% of these infections caused symptoms, and only 17% of people were ill enough to consult their doctor.

These findings come from a major new community-based study comparing the burden and severity of seasonal and pandemic influenza in England over 5 years, published in The Lancet Respiratory Medicine journal.

“Reported cases of influenza represent the tip of a large clinical and subclinical iceberg that is mainly invisible to national surveillance systems that only record cases seeking medical attention”, explains lead author Dr Andrew Hayward from University College London, UK.

“Most people don’t go to the doctor when they have flu. Even when they do consult they are often not recognised as having influenza. Surveillance based on patients who consult greatly underestimates the number of community cases, which in turn can lead to overestimates of the proportion of cases who end up in hospital or die. Information on the community burden is therefore critical to inform future control and prevention programmes.”*

The Flu Watch study tracked five successive cohorts of households across England over six influenza seasons between 2006 and 2011. The researchers calculated nationally representative estimates of the incidence of influenza infection, the proportion of infections that were symptomatic, and the proportion of symptomatic infections that led to medical attention.

Participants provided blood samples before and after each season for influenza serology, and all participating households were contacted weekly to identify any cases of cough, cold, sore throat or ‘flu-like illness”. Any person reporting such symptoms was asked to submit a nasal swab on day 2 of illness to test for a variety of respiratory viruses using Real-Time, Polymerase Chain Reaction (RT-PCR) technology.

The results show that on average 18% of the unvaccinated community were infected with influenza each winter season—19% during prepandemic seasons and 18% during the 2009 pandemic. But most (77%) of these infections showed no symptoms, and only around 17% of people with PCR-confirmed influenza visited their doctor. Compared with some seasonal flu strains, the 2009 pandemic strain caused substantially milder symptoms.

The study indicates that primary-care surveillance greatly underestimates the extent of infection and illness in the community. The rate of influenza across all winter seasons was on average 22 times higher than rates of disease recorded by the Royal College of General Practitioners Sentinel Influenza-Like Illness Surveillance Scheme.

According to Dr Hayward, “Despite its mild nature, the 2009 pandemic caused enormous international concern, expense, and disruption. We need to prepare for how to respond to both mild and severe pandemics. To do this we need more refined assessments of severity, including community studies to guide control measures early in the course of a pandemic and inform a proportionate response.”

Writing in a linked Comment, Dr Peter William Horby from the Oxford University Clinical Research Unit in Vietnam says, “In view of the undoubtedly high rates of subclinical influenza infection, an important unanswered question is the extent to which mild and asymptomatic influenza infections contribute to transmission…A large number of well individuals mixing widely in the community might, even if only mildly infectious, make a substantial contribution to onward transmission.”

He concludes, “Surveillance of medically attended illnesses provides a partial and biased picture, and is vulnerable to changes in consulting, testing, or reporting practices. As such, it is clear that reliable estimates of the infection and clinical attack rates during the early stages of an influenza epidemic requires the collection of standardised data across the whole range of disease severity, from the community, primary care, and secondary care.”

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March 28, 2014 Posted by | Public Health | , , , , , , , , | Leave a comment

[Journal Article] Search engines cannot diagnose through symptom searching – only 14% accuracy

Ever enter your symptoms into a search engine (as Google) to find what was the cause? And bring the results to your health care provider?  Believe that search engines can correctly diagnose your symptoms?
A  medical researcher not only was thinking along these  lines. He also set up a system to see if search engines could diagnose symptoms accurately.

The results were published in a scientific paper.**

Here are some remarks from medical librarians at their discussion group.

  • They don’t address the problem with these search engines of bias: Google,
    Bing, track what you’ve searched on, they aren’t ‘anonymous’ engines, thus
    biasing the results. A different computer, with different previous user
    will give different results with these search engines. Flawed article,
    in my opinion. Too bad, it is interesting.
  • This article is very interesting. While it is about validating the instrument for analyzing the webpages, they found that only 14% of the website gave a correct diagnosis. Seventy percent came up with the diagnosis as part of a differential. It sort of scares me that many medical students and other healthcare students might use search engines to find differentials. One implication is that patients who bring in webpages may actually hold the appropriate differential in their internet printout. Physicians might consider that information. The article is NOT an open access journal. The abstract does not discuss the findings of accuracy since they were testing the scoring system.

My thoughts? Familydoctor.org (American Academy of Family Physicians) has great advice
Our symptom checker flowcharts allow you to easily track your symptoms and come to a possible diagnosis.
Remember,  be sure to consult with you doctor if you feel you have a serious medical problem.

As a medical librarian, we counsel people to use any information they find as a resource when consulting with their health care provider. Information on the internet may be outdated, flawed, and sometimes even wrong.
Also, the health care providers views you as a whole person, not just a narrow set of symptoms.  They use not only your symptoms, but other factors as health history, current and past treatments, and environmental factors to work toward a treatment plan.

Related Resources

   Online symptom checkers (Standford Health System)

**  Abstract from PubMed.
Full text of article not available online for free.
Might be available for free or low cost at a local public, medical, or academic libary.
Call ahead and ask for a reference librarian.
Many medical and academic libraries offer some help to the public.

Int J Med Inform. 2014 Feb;83(2):131-9. doi: 10.1016/j.ijmedinf.2013.11.002. Epub 2013 Nov 19.

The accuracy of Internet search engines to predict diagnoses from symptoms can be assessed with a validated scoring system.

Shenker BS.

Author information

  • Rutgers Robert Wood Johnson Medical School and Rutgers Robert Wood Johnson Family Medicine Residency at CentraState, United States. Electronic address: bshenker@centrastate.com.
Abstract

PURPOSE:To validate a scoring system that evaluates the ability of Internet search engines to correctly predict diagnoses when symptoms are used as search terms.METHODS:We developed a five point scoring system to evaluate the diagnostic accuracy of Internet search engines. We identified twenty diagnoses common to a primary care setting to validate the scoring system. One investigator entered the symptoms for each diagnosis into three Internet search engines (Google, Bing, and Ask) and saved the first five webpages from each search. Other investigators reviewed the webpages and assigned a diagnostic accuracy score. They rescored a random sample of webpages two weeks later. To validate the five point scoring system, we calculated convergent validity and test-retest reliability using Kendall’s W and Spearman’s rho, respectively. We used the Kruskal-Wallis test to look for differences in accuracy scores for the three Internet search engines.RESULTS:A total of 600 webpages were reviewed. Kendall’s W for the raters was 0.71 (p<0.0001). Spearman’s rho for test-retest reliability was 0.72 (p<0.0001). There was no difference in scores based on Internet search engine. We found a significant difference in scores based on the webpage’s order on the Internet search engine webpage (p=0.007). Pairwise comparisons revealed higher scores in the first webpages vs. the fourth (corr p=0.009) and fifth (corr p=0.017). However, this significance was lost when creating composite scores.CONCLUSIONS:The five point scoring system to assess diagnostic accuracy of Internet search engines is a valid and reliable instrument. The scoring system may be used in future Internet research.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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January 24, 2014 Posted by | health care | , , , , , , , , , , | Leave a comment

[Press release[ Detecting Sickness By Smell

From the 1 January 2014 Association for Psychological Science press release

Humans are able to smell sickness in someone whose immune system is highly active within just a few hours of exposure to a toxin, according to new research published in Psychological Science, a journal of theAssociation for Psychological Science.

According to researcher Mats Olsson of Karolinska Institutet in Sweden, there is anecdotal and scientific evidence suggesting that diseases have particular smells. People with diabetes, for example, are sometimes reported to have breath that smells like rotten apples or acetone.

Being able to detect these smells would represent a critical adaptation that would allow us to avoid potentially dangerous illnesses. Olsson wondered whether such an adaptation might exist already at an early stage of the disease.

“There may be early, possibly generic, biomarkers for illness in the form of volatile substances coming from the body,” explains Olsson.

To test this hypothesis, Olsson and his team had eight healthy people visit the laboratory to be injected with either lipopolysaccharide (LPS) — a toxin known to ramp up an immune response — or a saline solution. The volunteers wore tight t-shirts to absorb sweat over the course of 4 hours.

Importantly, participants injected with LPS did produce a noticeable immune response, as evidenced by elevated body temperatures and increased levels of a group of immune system molecules known as cytokines.

A separate group of 40 participants were instructed to smell the sweat samples. Overall, they rated t-shirts from the LPS group as having a more intense and unpleasant smell than the other t-shirts; they also rated the LPS shirt as having an unhealthier smell.

The association between immune activation and smell was accounted for, at least in part, by the level of cytokines present in the LPS-exposed blood. That is, the greater a participant’s immune response, the more unpleasant their sweat smelled.

Interestingly, in a chemical assay the researchers found no difference in the overall amount of odorous compounds between the LPS and control group. This suggests that there must have been a detectable difference in the composition of those compounds instead.

While the precise chemical compounds have yet to be identified, the fact we give off some kind of aversive signal shortly after the immune system has been activated is an important finding, the researchers argue. It grants us a better understanding of the social cues of sickness, and might also open up doors for understanding how infectious diseases can be contained.

 

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January 24, 2014 Posted by | Medical and Health Research News | , , , , , , | Leave a comment

The High Cost of Not Listening to Patients.

This article reminds me of my days as a medical librarian.
If I did not carefully listen to a patron (customer) or ask the right questions, I gave the person the wrong information!

Minutes spent in listening and asking focused questions often saved an hour (or more!) of fruitless searching.

So, when I talk with a health care practitioner, I am mindful to give as much relevant information as possible to so the proper diagnosis and treatment can be given!

It is also necessary that we all do whatever we can so that health care practitioners are given the time they need to listen to patients.
Ultimately this will result in lower health care costs overall.

 

From the 18 January 2013 post at The Health Care Blog

Before we can understand the high cost of not listening, we need to examine in detail the diagnostic process. I am limiting my discussion to patients with chronic or recurring symptoms lasting several months. I am not discussing acute illnesses. They fall into completely different category.

At the front line of medical care, at the first contact between a patient and a doctor, the patient describes physical symptom. Whatever the real underlying cause, a physical symptom is the required ticket to see a physician. The physician, on first contact, has no idea what the underlying nature of the patient’s chronic complaint really is.  At the risk of oversimplifying, there are five broad categories of the causes for complaints.

These are:

1. There is a definable medical disease in one or more organs.

2. There is no definable medical disease but the patient is in contact with an unknown toxic substance causing the symptom (inhaled, ingested, or from skin contact).

3. The patient is in a stressful or toxic relationship at home or work producing physical symptoms or even a definable medical disease. (“What the mind cannot process is relegated to the body.” Dr. William Mundy, psychiatrist, personal communication. )

4. The patient or a companion is inflicting harm. Here, there are several categories:…

 

5. There is no definable medical disease but the patient has assumed a chronic illness role in life with multiple symptoms (i.e. hypochondriasis).

Psychosomatic Illness

6. There is a sixth category; patients with psychosomatic disorders. Time and space does not permit a full discussion of this important and very common set of disorders. I suspect they represent more than fifty percent of patients seeking primary medical care. The book“The Divided Mind” explains and defines these disorders and the successful treatment applied to thousands of patients at NYU by Dr. Sorno and his colleagues. At present the medical profession denies the existence of this category. The epidemic emergence of pain clinics comes from lack of knowledge about psychosomatic disorders and their proper treatment.

Of course, the patient can have any of these, and also be suffering from a definable medical disease.

But my experience in primary care over the past 55 years — combined with studies in the medical literature —suggest that between 30 and 40 percent of first contact  primary care visits are stress related or are psychological in nature (#3 and #6  in above list).

It should be obvious that the only way to sort out these causes of symptoms requires very careful listening to the narrative of the patient’s life. Some of these causes can be determined only by listening…..

 

Read the entire article here

January 19, 2013 Posted by | health care | , , , , , , | Leave a comment

Stop Lying to Your Doctor

From the 7 March 2012 article By James Salwitz at the Health Care Blog

Doctors frighten all of us. No matter how warm and congenial they are, there is always the threat of what they may say. A few words from a physician can change your entire life. An oncologist may be the scariest of all. For this reason it can be very hard for any of us to tell our doctor the complete absolute truth.

It is easier to diminish or deny pain, then describe in detail and submit to tests. Emphasizing the balance in a diet has less risk than noting it is only 600 calories. Increasing fatigue can be blamed on stress, not progressive weakness. Everyone seems to have quit smoking, despite yellow stained nails. “Social” drinking sounds better than a daily six-pack. We carefully parcel out the information we tell our doctor. It is gut level denial and it does us no good.

Physicians understand the desire of patients to limit and control the conversation. They learn to recognize incomplete and evasive answers. They try to ask questions which produce accurate information. A compassionate doctor knows that his response to a patient’s words is as important as the question asked.

Even though it can be hard, it is in our best interests to supply good information to our caregivers. Doctors cannot make correct diagnoses or order proper treatment using erroneous data. Unneeded X-rays are frequently ordered to fill gaps in information, which the patient could have supplied.  Understanding it can be tough to disclose personal medical facts, here are several ideas that might make communication easier and more complete:

 

1) Write down a list of complaints before the visit. We tend to be more truthful with ourselves in the quiet of our home, than nervous under bright office lights.

2) Bring an “honest” friend or relative to the visit and encourage their help. Try not to snarl when they contradict what you say or fill in the blanks.

3) Take a deep breath, take your time and make a specific effort to answer completely. Do not be afraid to “take too long.”

4) Try to be objective, scientific, almost like you are answering not about yourself, but about a person in the next room.

5) When the doctor is questioning about how you feel, answer in symptoms, not in diagnoses. For example do not say “I think I have a kidney stone like I read on the Internet,” say, “I have back pain which comes in waves.”

6) Trust that the doctor is not going to gasp, faint or throw up, by what you say. While the doctor is there at that moment to take care of just you, he/she has heard it all before. The doctor will not be bored or offended.

7) Do not be bashful and do not be embarrassed. This is the place to complain, whine and focus on you. Maybe there are other people who are “worse off,” but when you are with the doctor you are the only patient.

If you still find you are hiding facts from your doctor, ask yourself whether you trust him/her.  If trust is an issue, then either discuss with your doctor or change physicians. If the doctor is distracted for a moment, pause until he/she focuses on you. If he/she never seems to focus, it is time to get a new doctor….

Conversation between doctor and patient/consumer.

Image via Wikipedia

March 14, 2012 Posted by | Consumer Health | , , | Leave a comment

   

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