BigPharma topic #34 Via de prostaat naar de bloedbank

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De farmaceutische industrie is een hot topic, voor en tegenstanders van deze tak van sport raken altijd in felle discussies over het nut van deze industrie. Maken ze mensen beter of juist zieker?

Dus discussieer hier over dit onderwerp in het licht van BNW

Altijd Wat Wijzer - Farmaceutische industrie

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Op zaterdag 29 maart 2014 13:26 schreef samthegreat5 het volgende:

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Dat is niet waar. Er zijn namelijk ook onderzoeken die zeggen dat het risico op sterfte aan prostaatkanker lager wordt door PSA screening. Wel met een hoge NNS, maar dat maakt niet uit.

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In March 2009, the first international report on the reduction of mortality by screening was published based on an intention-to-screen analysis.
After a mean follow-up of nine years in both groups, a significant mortality reduction of 20 % was observed in the intervention group. In order to prevent 1 prostate cancer death, 1410 men needed to be screened, which is comparable with breast cancer screening. However in contrast to screening studies in other cancers, the ERSPC study into prostate cancer specific mortality showed that in order to prevented 1 man from dying of prostate cancer, 48 men had to be diagnosed with prostate
cancer in excess of the control group. There was no reduction in overall mortality.

These results are starkly in contrast with the simultaneously published results of the PLCO study from the USA [8]. The PLCO studied the mortality of prostate, lung, cervix, and ovary cancer screening in a randomised fashion. The PLCO study showed no mortality differences between its randomised arms for prostate cancer after seven years of follow-up.

Why the difference? Unfortunately, the study was compromised in various ways so it is unlikely this study will ever be able to confirm the ERSPC findings. This is because a large proportion of men in the control arm of the study had already undergone a PSA determination before or during the study, and therefore that arm of the study has to be regarded as contaminated.

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For an individual, the Prostate Risk Calculator can be useful, after being given balanced information on the benefits and disadvantages of screening. It is possible that the already high incidence of individual screening might be used in the future as an argument against more organised population screening programs. However, any fundamental changes to national health policy will have to take into account the extent of overdiagnosis, the quality of life after early detection, and the financial ramifications of population-based screening.

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CDC and other federal agencies follow the prostate cancer screening recommendations set forth by the U.S. Preventive Services Task Force, which recommends against PSA-based screening for men who do not have symptoms.

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The American Society of Clinical Oncology and the American College of Physicians recommends screening be discouraged in those who are expected to live less than ten to fifteen years, while in those with a greater life expectancy a decision should be made by the person in question based on the potential risks and benefits. In general, they conclude that based on recent research, "it is uncertain whether the benefits associated with PSA testing for prostate cancer screening are worth the harms associated with screening and subsequent unnecessary treatment."

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Op zaterdag 29 maart 2014 11:56 schreef Lambiekje het volgende:

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er wordt lang niet alles gecontroleerd. .. er is een grote kans dat je vervuild bloed krijgt van de bloedbank.

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Op zaterdag 29 maart 2014 12:58 schreef Worteltjestaart het volgende:

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Definieer "grote" kans.

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Multiple aerobic-culture surveillance studies have demonstrated that 1 in 1,000 to 2,000 platelet units are bacterially contaminated (4).
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Estimates of the fraction of cases that result in patient symptoms have been as low as 1 in 10 cases. However, in the only study that has prospectively cultured platelets that were transfused, eight culture-positive but Gram stain-negative platelet pools that were bacterially contaminated resulted in symptoms in three patients (37.5%) [A. Dykstra, G. Hoeltge, M. Jacobs, J. Miller, R. Domen, and R. Yomtovian, Transfusion 38(Suppl.):104S, 1998]. Notably, six Gram stain-positive pools (which would be expected to have had the highest bacterial load) were interdicted and never transfused.

Thus, clinical sepsis would be expected in at least 1 in 10 to 2 in 5 contaminated transfusions (200 to 1,600 cases). National passive-reporting studies from the United States, the United Kingdom, and France (Table ​(Table2)2) suggest that one-fifth to one-third would result in death (40 to 533 deaths per year) (35, 51, 57). This translates to a risk of death from a transfusion of a bacterially contaminated platelet unit of between 1 in 7,500 and 1 in 100,000. Clinical observations from university hospitals actively pursuing suspected cases of platelet-related sepsis confirm these estimates. Ness et al. from Johns Hopkins University, reported a fatality rate of 1 in 17,000 with pooled whole-blood-derived platelets and 1:61,000 with single-donor-apheresis-derived platelets (48). Similarly, University Hospitals of Cleveland observed a fatality rate of 1 in 48,000 per random platelet unit (21).

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One in 25 patients has an infection acquired during hospital stay, CDC says
_{By Lenny Bernstein March 26, 2014}

One in 25 patients in U.S. hospitals has an infection acquired as part of his or her care despite modest progress in controlling those pathogens inside medical facilities, the Centers for Disease Control and Prevention reported Wednesday in its most comprehensive look at a stubborn and lethal health-care problem.

The CDC’s 2011 survey of 183 hospitals showed that an estimated 648,000 patients nationwide suffered 721,000 infections, and 75,000 of them died — though it is impossible to tell from the data how many deaths were directly attributable to the acquired infection, said Michael Bell, deputy director of CDC’s division of health care quality promotion. Nevertheless, “today and every day, more than 200 Americans with healthcare-associated infections will die during their hospital stay,” CDC Director Tom Frieden said in a news release.

The most common infections are pneumonia (22 percent), surgical site infections (22 percent), gastrointestinal infections (17 percent), urinary tract infections (13 percent), and bloodstream infections (10 percent), the agency reported in the study, published Wednesday in the New England Journal of Medicine.

When coupled with the growing risks posed by of antibiotic resistant bacteria, the prevalence of hospital-acquired infections remains a serious problem for care-givers, one that the CDC is continuing to battle on a state-by-state and even hospital-by-hospital basis, Bell said in a news conference Wednesday afternoon.

“Sooner or later everyone is likely to become a patient somewhere,” he said. “We go to the hospital hoping to become better, and mostly we do, but not always.”

Atop the list of pathogens acquired in hospitals is the bacterium clostridium difficile (commonly know as c. diff), which can cause gastroenterological illnesses so severe that removal of a patient’s colon is sometimes required, Bell said. It was responsible for 12.1 percent of the infections turned up by the survey. Also common was methicillin-resistant staphylococcus aureus (MRSA), a staph infection that has become resistant to common antibiotics.

Such infections — rather than ones associated with devices such as central catheters, urinary catheters and ventilators, comprised the majority of the health-care-related infections revealed by the survey. Indeed, Bell said, the rate of infections from “central lines” that are placed into patients’ major blood vessels has been cut nearly in half since 2008, and the infection rate after surgery has declined by 20 percent in the same time.

But urinary tract infections, which are not as dangerous, remain persistent, he said.

About 34 million people were admitted to U.S. acute care hospitals in 2012, according to the study, which did not look at other in-patient settings such as nursing homes. The infection rate declined when compared with the results tallied by the CDC in 2007, but those were based on historical data rather than a survey, Bell said.

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At the news conference, Victoria Nahum, executive director of the Safe Care Campaign, urged hospital patients to insist on “compulsive hand hygiene” and other best practices by their care-givers, including physicians, and visitors. That may mean patients will have to overcome the fear of questioning doctors about their hygiene while hospitalized, or have a relative or friend do it for them, she and Bell said.

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Nahum’s son, Joshua, died in 2006 at age 27 of a health-care-related infection just two months after two other members of her family suffered complications from similar infections.

President Obama’s proposed fiscal 2015 budget includes money to battle antibiotic resistance. Bell said the continuing effort will require hospitals to remain judicious about the use of antibiotics in order to gradually lessen resistance to them, in the hope that some will become effective again. He said the problem of widespread resistance also is prompting new approaches to controlling bacteria.

“I remain extremely cautious regarding the growing threat of antibiotic resistance,” Nahum said.

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Jeremy Hunt says hospitals will be obliged to report medical errors

Every hospital in England will have a legal duty to own up to mistakes and errors that cause harm to patients under a new duty of candour to be introduced by the Government.

Jeremy Hunt, the Health Secretary, will announce today that in future all healthcare providers must notify patients about incidents where severe or moderate harm has occurred, and provide an apology.

At the same time Mr Hunt will lay out new plans to reduce avoidable medical errors in the NHS by half over the next three years potentially saving up to 6,000 lives a year.

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Op zaterdag 29 maart 2014 20:33 schreef Worteltjestaart het volgende:

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Dank voor de uitgebreide post, maar het ging me er om dat Lambiekje zijn onzin eens zou duiden

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In the United States, the frequency of avoidable transfusion fatalities attributable to misidentification of the pretransfusion blood sample, the blood unit, or the recipient has been reported to range from 1 per 600,000 to 1 per 800,000 transfusions (2,6). The estimated incidence of nonfatal transfusion errors in the United States ranges from 1 in 12,000 to 1 in 19,000 transfusions (2,6).

The United Kingdom’s Serious Hazards of Transfusion (SHOT) group, which tracks adverse events on a voluntary basis and currently covers more than 90% of all red cell usage in the United Kingdom, recently reported an error incidence of 1 in 16,000 (335 errors per 5.5 million units of red blood cells transfused between 1996 and 1999) (10). Transfusion errors accounted for 54% of all transfusion-related complications, and ABO incompatibility as a possible life-threatening condition was reported 97 times, leading to 4 deaths (∼1 per 1,400,000 transfusions) and 29 cases of immediate major morbidity (∼1 per 200,000 transfusions) (10). By contrast, the SHOT initiative recorded only 19 cases of confirmed transfusion-transmitted infection (∼1 per 300,000 transfusions), including four cases of hepatitis B, three cases of hepatitis C, and one case of HIV. Eleven cases (one hepatitis A infection, one malaria, and nine bacteremias) were attributable to infections for which no testing of donations is performed (10). In the United States, the aggregated risk of transmission of HIV, human T-cell lymphotropic virus, hepatitis C virus, and hepatitis B virus is 1 per 34,000 blood units transfused (3), or less than half the risk of transfusion error (1 in 12,000 to 1 in 19,000 transfusions).