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Tuesday, December 20, 2016

Woeful 21st Century Cures Act │ Atrial Fibrillation (Afib): Its Two Big Triggers │ Electronic In-Hospital Prescribing Often Excessive: Increasing Falling Risks in Seniors

YouTube's selection of 1960s music videos not only diverted me from getting to bed before 11:00 p.m. last night, but it was a few minutes after midight before I was under the covers.

I rose around 4:20 a.m. to use the bathroom, drink some water, and then irrigate my nasal passageways to enhance breathing.  My younger brother Mark was already moving about in his bedroom at that point, having newly finished his shower in preparation for his workday.

I started my day within 15 minutes before 8:00 a.m., finding my youngest step-son Pote up.  I thought that he had probably seen his girlfriend off earlier, but I was soon to hear her cough.  

But most fortunately, the two went out and drove off in Pote's older brother Tho's car before 9:50 a.m., and I was spared their presence for the best part of my day here at home.

I wanted to get out and do some local grocery shopping, but I failed.  I got too involved in the post I am working on at one of my six hosted websites.  And then instead of seeking some restoration with a good lie-down, I became involved in sheerest folly here at my computer until maybe 2:30 p.m.

I certainly needed to lie down after that abuse of my eyes.

The day outside has been quite sunny, but supposedly mild ─ i.e., several degrees above freezing.  The snow and ice are slowly melting, but not as fast as if we had rain.

Overnight, it may not quite drop to the freezing level.  If true, then that will further help with the melt, even if not much.  At least the melt won't come to an entire freeze.

I gave myself a bit of a shock in checking my chequing account balance ─ the monthly $1,600 mortgage could be debited as soon as tomorrow.  I was short by $371.26.

I have a back-up fund that contained just over $450, so I transferred over $400 from there.  But now I realize that I cannot justify much grocery shopping at all.  However, if memory is serving me, it seems to me that my smallish monthly pension has always been deposited into my account ahead of Christmas ─ the only time of the year that it arrives so early.

It will bail me out insofar as maybe buying a mess of lottery tickets as Christmas presents in lieu of anything else, but I can't get too ambitious with it ─ after all, my next pension deposit will be that much farther off, and I will again most likely be in dire straits come mortgage time in the latter part of January.

I want to leave this discussion of my day with this photo of my wife Jack that was taken on a very warm September 8.  She is posed at the back left corner of our home, with the backyard behind her:


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This nonsense from President Obama was released on Wednesday, December 7, concerning the 21st Century Cures Act:
“We are now one step closer to ending cancer as we know it, unlocking cures for diseases like Alzheimer’s, and helping people seeking treatment for opioid addiction finally get the help they need,” he said. “This bill will make a big difference, and I look forward to signing it as soon as it reaches my desk.”
Wikipedia says that he signed the Act on Tuesday, December 13. 

The Obama quote came from here:

CBSnews.com

I am pleased that the article is not all glorious praise ─ its latter part contains considerable negative views.  For example:
“The FDA over all these decades has developed a way to know what products work and which ones don’t, but in the last decade they have been pushed to lower those standards,” Diana Zuckerman, president of the National Center for Health Research, told U.S. News & World Report. “With this bill, they’d lower them even more.”
And:
“It is sorely disappointing that Congress gave Big Pharma and the medical device industry an early Christmas present by passing the 21st Century Cures Act,” said Dr. Michael Carome, director of the organization’s Health Research Group.

“This gift -- which 1,300 lobbyists, mostly from pharmaceutical companies, helped sell -- comes at the expense of patient safety by undermining requirements for ensuring safe and effective medications and medical devices,” Carome said in a statement.
The FDA is being freed up (according to that article) to do as follows:
  • Rely on data summaries and “real world evidence” instead of hard clinical trial evidence when weighing the approval of existing drugs for new uses. Right now, for example, the FDA now must consider “patient experience” and anecdotal data in its review process.
  • Use a “limited population” approval pathway for new antibiotics that would rely on a risk-benefit analysis weighing the needs of patients facing severe and untreatable infections against the possible harms to them.
  • Expand its programs for expedited approval of breakthrough medical technologies for patients with life-threatening diseases that have limited treatment options.
But NewMarketHealth.com interpreted the FDA liberties differently:
[The 21st Century Cures Act] will, for example:
  • Allow the FDA to grant new uses (to treat different conditions) to drugs already on the market, with little evidence to back them up. This is one of the biggest cash cows in pharma land. And that means millions more will be exposed to risky meds for no good reason at all.
  • Mean that more fast-tracked drugs and devices will make it to market with little to no assurance of safety.
  • Expand insurance coverage for off-label drug prescribing. Off-label prescribing is commonplace and extremely risky. Now, drugmakers will have more leeway in pushing insurance companies to pay for it.
These are sorry times.
   
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I don't know much about atrial fibrillation (Afib) ─ I don't have it, as far as I know; nor do I  know of anyone who does.  

However, a recently published study has apparently linked even "light-to-moderate" drinking to the onset of the condition:

MedPageToday.com

Some people should just never take a drink ─ I am glad that I do not account myself one of them.

Another big trigger of the condition is reportedly monosodium glutamate (MSG), as the following report lays forth (in addition to discussing the aforementioned study on alcohol):

HSIonline.com

That latter report gives tips on how to avoid MSG.

My younger brother Mark and his girlfriend Bev will be preparing this household's Christmas turkey dinner, so I am quite sure that the dressing will largely be comprised of commercial components, and will not be the delicious homemade masterpiece that my mother Irene Dorosh was capable of creating.  

However, none of us have Afib, and there will be at least five of us partaking ─ and possibly as many as eight.  As a result, no one should have too serious an exposure to any MSG-related chemicals in the meal.

I hope.

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A recent study has found that hospital patient prescriptions that are done electronically often are in excess of what is intended because the system has built-in default dosages of many of the common medications.

Where senior patients are concerned, this is leading to increased falling risks.

The study was of U.S. hospitals ─ maybe other countries' hospitals use similar defaults in their own systems?  I sure don't know.

Consumer.HalthDay.com

BestHealthNutritionals.com

JacksDailyDose.com

Those last two reports conclude with good advice.

And this is how the study concluded:
At Mount Sinai Hospital, high-risk medications were often prescribed to older inpatient fallers, one-third of whom received more than one of these medications within the 24 hours preceding the fall. Doses were higher than recommended, as were EMR [electronic medical record] default dosages. Decreasing these default doses for individuals aged 65 and older in the EMR prescribing system is a passive intervention that may decrease doses and possibly falls. Strategies are also being developed to increase prescriber awareness of the numbers of high-risk medications each person is taking.
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I am slow-cooking supper, so it is time now for me to close out with a journal entry from 41 years ago when I was 26 years old, and living in a basement housekeeping unit in New Westminster.

I was renting my quarters in a house located on Ninth Street, maybe one or two houses up from Third Avenue.

I had on my agenda this day a visit to my father Hector ─ he was living with his girlfriend Maria Fadden in an apartment at 6038 Imperial Street in Burnaby.  I would walk there and back to my room. 

I never knew just what condition I would find the pair in ─ they had alcohol issues.

I had gotten to bed the evening prior to this entry at 9:00 p.m.
SATURDAY, December 20, 1975

I had extreme difficulty after 2:00 a.m. trying to sleep, and yet I felt drained of most of my life-force; it was toward 4:00 a.m. when I got up.

I had a dream wherein I was founding a beautiful rapport with someone resembling a younger, fitter Phyllis.

Note:  yesterday I forgot to mention I am quite sure I saw Bill McMillan in Safeway

I left for dad's this morning, mailing for the Banner of Joan, and dropping off the European animals book and Recipes for a Small Planet at the library.

I followed 8th St to Imperial, then followed it; but I left it too soon, and was confused and very uncomfortable due to my bathroom needs.  But I made it, and used the laundry room toilet before knocking and getting dad & Marie up.

They were sober.

I gave dad some tissue and mom's doughnuts, plus 2 comics.

I was told that the woman who joined dad & me at the 83rd Legion 11 days ago came by and Marie threw her out in a fury.  Dad was pretty scared.

We lunched on a chicken soup, then bused into town to do some shopping, as dad had a $10 Safeway voucher from his Poppy Fund.  He had already paid me back my $20, and I had agreed to join them for a Christmas Eve turkey supper.

We got off the bus at the Biltmore close to 3:00 p.m., as they both wished a drink.

And there we remained as dad bought round after round.

I believe it was after 7:00 p.m. when dad was playing an electronic dart game, trying to break his losses to a fellow.  Marie, none too bright, kept asking where dad was, and I several times said he was playing the game which, by the way, was at a table adjacent from us right in full view of Marie.  But suddenly she said, "No he isn't," and claimed he had just gone out the door.

She got up and rushed the length of the pub after "him," and soon returned.

In exasperation I said I was beginning to think she was as stupid as they say.

This angered her, and she demanded who "they" were; I rejoined "they" were the same unspecific people that everyone refers to, including herself, when using the term.  I even pointed out what I felt would be an example, one she had used earlier in the day.

But it was as if I were in a technical discussion with a moron.  Dad had just returned to our table, and said that "you" can't win an argument with a woman.

Riled at her deficient reasoning, I drained my beer and said I wasn't going to sit there any longer, and stormed off with dad calling after me.

I jogged most of the distance back to their building.

All the outer doors were locked.  But trying my 7th actual entry door, I got in.

I went to their suite, and entered upon learning they weren't home.

I ate most of the remaining soup, then wrote a settled note explaining various matters, including that I wouldn't be dropping by again, including for the turkey supper planned for Wednesday.

It hurt to do this.

I left my key, as well as $5 which I couldn't really afford, but felt it necessary to pay for my dozen or so beers; dad will be needing cash after tonight.

My left foot feels like some bones within had separated, and to walk I limped somewhat.

Anyway, I came home, quickly prepared for bed, and retired about 11:00 p.m.
I hate reading that account.

I remember the incident with Maria in the Biltmore Hotel ─ which it is no longer.  I think it is an "affordable housing" complex now.  But it has a fairly popular Biltmore Cabaret that's still in operation.

Maria used to drive me right around the bend sometimes, but her brain was addled from drink.  She was otherwise a decent and even a loving woman.

But I had no tolerance once she became addled, and could never understand why my father was with her.  I know now that he was simply lonely, as was she.    

I don't remember that I stormed out of the Biltmore Hotel beer parlour at 2755 Prince Edward Street and then jogged back to their apartment.  That would have been a fair distance ─ as was the rest of the trip back to my room in New Westminster.

My father only wanted to show me a good time ─ he was truly a very loving man where I was concerned.  I know that he would have been calling desperately after me when I was storming off, and even trying to catch up to me.

He may even have been in tears.

So leaving the note declaring my intention not to come back ─ even for the Christmas Eve turkey feast ─ just ripped at me.  Hell, it hurts me very much now.

And I am older than my father ever got to be. 

By the way, the dream I mentioned featuring someone resembling a younger version of Phyllis ─ Phyllis is my older maternal half-sister.  She was once a Miss Richmond

And I cannot recall who Bill McMillan was ─ possibly a friend of my father's? 

Darn it.  Reading that entry after all of these years has me hurting quite badly....
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