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ccrpsorg · 1 year

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Medical Research Jobs

Medical research jobs provide individuals with the opportunity to make significant contributions to the advancement of medicine and healthcare. These positions involve conducting clinical trials, laboratory research, and analyzing data in order to develop new treatments for diseases. Working in medical research requires a high level of scientific knowledge, analytical skills, and critical thinking. Professionals in this field often collaborate with other researchers from different disciplines to conduct studies that aim to improve patient care and treatment options. Medical researchers also work closely with doctors, nurses, and other healthcare professionals so they can share their findings and better understand patient needs. With such a wide range of responsibilities, medical researchers play an essential role in driving innovation in the medical industry. The advancement of modern medicine is dependent on the insights that these professionals provide through their investigations. As such, medical research jobs offer ambitious individuals the chance to make a meaningful contribution to humanity’s ever-evolving knowledge of health and well-being.

Clinical Research Associate (CRA): Designs and implements clinical trials according to established protocols. Monitors the progress of trials and reports results to principal investigators. Salary range from $50,000 to $90,000 per year. CRA Certification through CCRPS requires completion of a 8-week course on research principles and methodology plus two years of experience in clinical research related activities such as site monitoring or data management.

Clinical Research Coordinator: This position involves coordinating the clinical aspects of research studies, such as collecting and organizing data, tracking recruitment of study participants, managing patient information, and monitoring research protocols. Salary range: $43,000 to $55,000 per year. Get CRC Certification through CCRPS: Certified Clinical Research Professional (CCRP).

Clinical Trials Manager (CTM): A Clinical Trials Manager is responsible for overseeing the entire clinical trial process from start to finish. They ensure the compliance of all study protocols while managing timelines and budgets. Salary range: $70,000-$90,000 per year; Certification through CCRPS: Certified Clinical Trial Manager (CCTM).

Medical Research Lab Technician: Responsible for performing laboratory tests according to established protocols in order to aid in medical research projects. Salary range: $35,000 to $45,000 per year. Certification through CCRPS: Certified Laboratory Technician (CLT).

Bioinformatics Scientist: Utilizes computer technology and statistical analysis in order to analyze biological data derived from experiments in medical research labs. Salary range: $75,000 to $100,000 per year Certification through CCRPS: Certified Bioinformatics Scientist (CBS).

Medical Writer: Writes and edits materials for clinical trials and other medical research projects, including study protocols and reports for publication or regulatory submission purposes. Salary range: $60,000 to $80,000 per year Certification through CCRPS: Certified Medical Writer (CMW).

Regulatory Affairs Manager: Manages the regulatory affairs process by ensuring that medical products adhere to applicable regulations throughout their development and commercialization phases. Salary range: $95,000 to $125,000 per year Certification through CCRPS for Certified Regulatory Affairs Manager (CARM)

Regulatory Affairs Specialist: Develops regulatory strategies for the submission of clinical trial applications to regulatory agencies, monitors global regulations governing clinical trial design and implementation and tracks changes in legislation affecting the development process of drugs, biologics or medical devices; coordinates communication between sponsors, investigators and regulatory authorities; prepares high-quality documents such as study protocols and amendments for submissions to regulatory bodies; participates in meetings with regulatory agencies worldwide; performs literature searches related to drug development topics; assists with ongoing maintenance of regulatory files as required by regulations. Salary range from $55,000 to $100,000 per year depending on experience level. Pharmacovigilance Certification through CCRPS requires completion of a 8-week course on research principles and methodology plus five years minimum experience in pharmaceutical industry or related fields with emphasis on Regulatory Affairs functions.

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linguistlist-blog · 5 months

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Jobs: Research Scientist (Masters- or PhD-level), Feinstein Institutes for Medical Research

ICYMI: We are recruiting for a master's-level data scientist or PhD-level postdoctoral fellow with an analytical/computational background. Masters-level and phd-level candidates will be considered. The official title for masters-level hires will be "Data Analyst" and the title for postdocs will be "Postdoctoral Fellow". Our work uses machine learning and natural language processing to develop digital biomarkers for psychiatric disorders. Lab description: PI: Sunny Tang, M.D. Ongoing projects use natur http://dlvr.it/Sz7gbz

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jobrxiv · 5 months

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Postdoctoral Position in Pediatrics Hematology/Oncology Feinstein Institutes for Medical Research Come join us in #Manhasset NY as a #postdoc in hematology/oncology to study bone marrow-associated disorders See the full job description on jobRxiv: https://jobrxiv.org/job/feinstein-institutes-for-medical-research-27778-postdoctoral-position-in-pediatrics-hematology-oncology/?feed_id=65747 #ScienceJobs #hiring #research Manhasset #UnitedStatesUS #PostdoctoralFellow

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wesleybates099 · 4 years

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The American Medical System Is One Giant Workaround

The nurses were hiding drugs above a ceiling tile in the hospital — not because they were secreting away narcotics, but because the hospital pharmacy was slow, and they didn’t want patients to have to wait. I first heard about it from Karen Feinstein, the president and chief executive of the Jewish Healthcare Foundation, who reported it at a board meeting several years ago. I wasn’t surprised: Hiding common medications is a workaround, an example of circumventing onerous rules to make sure patients get even basic care.

Workarounds are legion in the American health care system, to the extent that ECRI (formerly the Emergency Care Research Institute) listed them fourth among its list of top 10 patient safety concerns for health care organizations in 2018. Workarounds, the group writes, are an adaptive response — or perhaps one should say maladaptive response — to “a real or perceived barrier or system flaw.”

Staff use workarounds because they save valuable time. According to Anita Tucker, a business professor at Boston University, system breakdowns, or what she calls “operational failures,” and the workarounds they stimulate, can “consume up to 10 percent of a nurse’s day.” Most hospital nurses are stretched to their limits during their 12-hour shifts. No nurse has 90 minutes to lose to a slow pharmacy or an inefficient hospital bureaucracy.

I saw the common sense that can underlie workarounds when my hospital floor instituted bar code scanning for medication administration. Using a hand-held scanner to register bar codes on medications and patients’ hospital bracelets sounds smart. But then some medications routinely came without bar codes, or had the wrong bar codes, and we nurses weren’t given an easy way to report those errors. Patients’ wrist bands could be difficult to scan and the process disturbed them, especially if they were asleep. The lists of medications on the computer screen were also surprisingly hard to read, which slowed everything down.

But the biggest problem was that the scanning software did not work with our electronic medical records — so all drugs had to be checked off in both systems. This is a huge problem when dealing with patients like those receiving bone-marrow transplants, who might get 20 drugs every morning — some of which are delivered through IVs and come with nonstandard doses. What was already a lengthy process suddenly took twice as long.

Some nurses responded to the arrival of the bar code system with workarounds, including refusing to use the scanner, or taping copies of patient bar codes to their med carts. I tried to adhere to the rules, but if I was especially busy or couldn’t get a medication to scan, I would chuck the whole process.

However, because bar code scanning has been shown to reduce errors in medication administration, the hospital officials wanted it to be done consistently. They produced a public list of all the nurses on the floor. Each nurse was labeled green, yellow or red, depending on the percentage of medications he or she administered using bar codes. Family members, doctors — anyone could see how a nurse was graded.

Over time the list worked, but the sting of it also endured. We were being punished for taking time for patients, even if it meant bending the rules. No one among the managerial class seemed to understand that nurses care a lot about patient safety. The unheard concern was that a green light for bar code scanning meant a patient could fall into the red zone for something else.

Workarounds in health care always involve trade-offs like this, and often they are trade-offs of values. Increasingly, the entire health care system is built on workarounds — many of which we don’t always recognize as such.

Consider the use of medical scribes, who complete doctors’ electronic paperwork in real time during patient visits. The American College of Medical Scribe Specialists reported that 20,000 scribes were working in 2014, and expects that number to climb to 100,000 in 2020.

I have heard doctors say they need a scribe to keep up with electronic medical records, the mounting demand of which is driving a burnout epidemic among physicians. Scribes allow doctors to talk with and examine patients without having a computer come between them, but at base they are a workaround for the well-known design flaws of electronic medical records.

As a nurse, when I first learned about scribes, I was outraged. On the job, nurses hear repeatedly how health care companies can’t afford to have more nurses or aides to work with patients on hospital floors — and yet, money is available to pay people to manage medical records. Doctors who use scribes tend to see their productivity and work satisfaction increase, but the trade-off is still there: Scribes demonstrate the extent to which paperwork has become more important than patients in American health care.

The Affordable Care Act, which I support because it has made health care available to millions of previously uninsured Americans, is also an enormous workaround. The act expanded Medicaid, protected patients with pre-existing conditions and offered subsidies to make private insurance more affordable. Obamacare, though, was never intended to make sure that all Americans had affordable care; it works around our failure to provide health care to all our citizens. In its own way, the Affordable Care Act is as jury-rigged as using ceiling tiles to stash medications.

The United States spends more per person on health care than any other industrialized country, yet our health outcomes, including overall life expectancy, are worse. And interventions like bar code scanning are a drop in the bucket when it comes to preventable medical mistakes, which are now the third-leading cause of death in the country. Our health care nonsystem is literally killing us.

As the workarounds accumulate, they reveal how fully dysfunctional American health care is. Scribes are workarounds for electronic medical records, and bar code scanning is a workaround for our failure to put patient safety anywhere near the top of the health care priority list. It’s a values trade-off that the nurses on my floor instinctively understood.

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johntropea · 7 years

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The way the immune system responds to the mind (via the vagus nerve)

Kevin Tracey, the director of the Feinstein Institute for Medical Research, discovered how the brain controls the immune system through a direct nerve-based connection. He describes this as the inflammatory reflex (i). Simply put, it is the way the immune system responds to the mind. Let me explain.

Your immune system is controlled by a nerve call the vagus nerve. But this isn’t just any nerve. It is the most important nerve coming from the brain and travels to all the major organs. And you can activate this nerve — through relaxation, meditation, and other ancient practices.

What’s the benefit of that? Well, by activating the vagus nerve, you can control your immune cells, reduce inflammation, and even prevent disease and aging! It’s true.

By creating positive brain states — as meditation masters have done for centuries — you can switch on the vagus nerve and control inflammation.You can actually control your gene function by this method. Activate the vagus nerve, and you can switch on the genes that help control inflammation.

[...]

Diane Krause, MD, PhD, from Yale University discovered that our own innate adult stem cells (cells that can turn into any cell in the body from our bone marrow) could be transformed into liver, bowel, lung, and skin cells. (ii) This is a phenomenal breakthrough. Here’s why.

It means that we have the power to create new cells and renew our own organs and tissues at any age. And how are these stem cells controlled? You guessed it: the vagus nerve.

So relaxation — a state of calm, peace, and stillness — can activate the vagus nerve. And the vagus nerve, in turn, activates your stem cells to regenerate and renew your tissues and organs.

SOURCE How the Dalai Lama Can Help You Live to 120

THE IMPORTANCE OF THE VAGUS NERVE FOR HEALTH AND WEIGHT LOSS

...the vagus nerve also helps to regulate inflammation, and inflammation is involved in just about every chronic disease. Stimulating vagus nerve signals to the brain is anti-inflammatory – it signals the brain to turn down the stress response and reduce the production of inflammatory cytokines.

Tone Your Vagus Nerve To Hack Your Nervous System

The strength of your vagus response is known as your vagal tone and it can be determined by using an electrocardiogram to measure heart rate.

Every time you breathe in, your heart beats faster in order to speed the flow of oxygenated blood around your body. Breathe out and your heart rate slows. This variability is one of many things regulated by the vagus nerve, which is active when you breathe out but suppressed when you breathe in, so the bigger your difference in heart rate when breathing in and out, the higher your vagal tone.

Research shows that a high vagal tone makes your body better at regulating blood glucose levels, reducing the likelihood of diabetes, stroke and cardiovascular disease.

Low vagal tone, however, has been associated with chronic inflammation. As part of the immune system, inflammation has a useful role helping the body to heal after an injury, for example, but it can damage organs and blood vessels if it persists when it is not needed. One of the vagus nerve’s jobs is to reset the immune system and switch off production of proteins that fuel inflammation. Low vagal tone means this regulation is less effective and inflammation can become excessive...

Neurodegeneration

90 percent of the brain’s output goes into something called the pontomedullary system. The brain is constantly receiving input from receptors, and it is constantly sending outputs as well. The main output conduit is the brain stem; specifically, the parasympathetic cranial nerve nuclei and especially the vagus nerve.

The vagus nerve enervates the digestive tract and controls everything from the secretion of stomach acid and pancreatic enzymes to intestinal motility and gall bladder contraction.

If 90 percent of the brain’s output goes into the vagus area, and your brain is not firing well, you’re going to have digestive problems. (I recently recorded a podcast on the gut-brain axis with much more detail on this topic. You can find it here.)

Other symptoms of gut-brain axis dysregulation include cold hands and feet, toenail fungus that won’t heal and brain fog.

Okay. Now, guess what 3 of the main problems seniors experience are? That’s right – fatigue, depression and digestive problems. That is not a coincidence. That’s neurodegeneration.

How Distraction Is Rewiring Our Brains—and How Mindfulness Can Help

The vagus nerve connects the brain to most visceral organs—and vice versa. It is responsible for normal resting state parasympathetic processes like heart rate and digestive processes (14).

It is a bidirectional system, sending out signals to your organs and collecting information from them in return. Communication between the brain and gut has even been found to be influenced by neurotransmitters created by bacterial communities hosted in your gut (15).

The functional fitness of the vagus nerve is measured by its “vagal tone.” People with robust, high vagal tone have a greater heart rate variability than people with a more compromised, lower vagal tone. While low vagal tone is related to inflammation, poor cardiac function, and gastrointestinal dysfunction (16, 17), high vagal tone is related to healthy bodily function as well as increased positive feelings and better emotional control (18, 19).

There are many things known to exercise vagal tone to improve the gut-brain connection; among them are deep breathing, mindful meditation skills, and having the tools to foster self-love and kindness (20, 21, 18). There is a strong positive feedback loop between improved vagal tone and mindfulness and, consequently, the strength of the mind-body connection.

Episode 9 – the “gut-brain axis”

...one of the earliest signs of the brain not firing well is poor vagal activity, which will manifest as decreased pancreatic enzyme secretion, poor gallbladder function, and poor gut function overall. And it basically works like this, you have decreased activity in the brain, and we’re gonna talk about how that can happen in a second, and that decreases the activation of the vagal motor nuclei, which in turns suppresses the intestinal immune system and decreases intestinal blood flow. And when that happens you get an increased growth in pathogenic yeast and bacteria, that cause intestinal permeability or leaky gut, which we’ve talked about a lot, and leaky gut causes a state of chronic low grade inflammation.

Then the inflammatory cytokines produced in the gut travel through the blood and they cross the blood-brain barrier. One of the problems with inflammation is that it makes the blood-brain barrier leaky so you get leaky brain.

And then those inflammatory cytokines once they get into the brain activate the microglial cells, which are the second type of cell in the brain. You have neurons and then you have microglial cells. The microglial cells are the immune cells of the brain and once they’re activated by these inflammatory cytokines this is basically inflammation of the brain.

So your brain gets inflamed, you get a leaky brain and then you get inflamed brain. And that’s no fun, definitely. Cause one of the problems is that unlike the rest of the immune system in the body that has T-regulatory cells that can turn off inflammation in the brain, the microglial cells don’t get turned off. So, when you’ve got an inflamed brain it can be really tricky to reduce that inflammation without some outside help.

So, you’ve got an inflamed brain and the inflammation in the brain decreases nerve conductance and that in turn causes depression and reduced activity of the vagal motor nuclei, and of course then we’re back where we started. That reduced activity of the brain reduces the output into the vagus, and that causes more digestive problems, more inflammation in the gut, more inflammatory cytokines to be in the bloodstream and up into the brain and we’re stuck in this really viscous cycle.

[...]

...a really interesting study where they induced traumatic brain injury in mice, which is not too nice, but these mice developed leaky gut in less than six hours after having this brain injury. Even more interestingly if the researches stimulated the vagus nerve, which mimics increasing the brain output into the vagus, that actually prevented the leaky gut from developing.

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meeedeee · 7 years

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Using a visa loophole to fire well-paid U.S. information technology works and replace them with low-paid immigrants from India is despicable enough when it’s done by profit-making companies such as Southern California Edison and Walt Disney Co.

But the latest employer to try this stunt sets a new mark in what might be termed “job laundering.” It’s the University of California. Experts in the abuse of so-called H-1B visas say UC is the first public university to send the jobs of American IT staff offshore. That’s not a distinction UC should wear proudly.

UC San Francisco, the system’s biggest medical center, announced in July that it would lay off 49 career IT staffers and eliminate 48 other IT jobs that were vacant or filled by contract employees. The workers are to be gone as of Feb. 28. In the meantime they’ve been ordered to train their own replacements, who are employees of the Indian outsourcing firm HCL Technologies.

The training process was described by UCSF managers by the Orwellian term “knowledge transfer,” according to Audrey Hatten-Milholin, 53, an IT architect with 17 years of experience at UCSF who will be laid off next month.

“The argument for Disney or Edison is that its executives are driven to maximize profits,” says Ron Hira of Howard University, a expert in H-1B visas. “But UC is a public institution, not driven by profit. It’s qualitatively different from other employers.”

By sending IT jobs abroad, UC is undermining its own mission, which includes preparing California students to serve high-tech industry.

“UC is training software engineers at the same time they’re outsourcing their own software engineers,” says Rep. Zoe Lofgren (D-San Jose), whose district includes much of Silicon Valley. “What message are they sending their own students?”

As we’ve reported before, H-1B visas were created to allow American technology companies to import uniquely talented individuals from abroad; visa holders can work in the U.S. for three years, with the goal of obtaining permanent residency and ultimately citizenship.

But the program has been co-opted by outsourcing firms that use the visas to import workers, mostly from India, to replace Americans in middle-level IT jobs. Those firms, including HCL, corral about half of all H-1B visas every year. The workers they import often live here barracks-style and are at the beck and call of supervisors who can revoke their residency at will. Eventually they return home to continue their assignments, without workplace benefits and at wages a fraction of what their American counterparts were paid.

UCSF officials say the decision to outsource 97 IT jobs, about 20% to the total IT headcount, was forced on it by daunting economic challenges. The state requires UCSF Health, which encompasses the university’s hospitals, to be fiscally self-sustaining, collecting its revenue entirely from patient fees, Chief Executive Mark R. Laret says.

The hospitals recorded a $42-million deficit in the last fiscal year on $3.4 billion in revenue, he told me. The red ink was partially the result of an increased caseload from Medi-Cal, the state’s Medicaid program, which was expanded under the Affordable Care Act. Medi-Cal reimbursements are so low that UCSF loses 40 cents on every dollar it spends on those patients’ treatment, he says.

In searching for costs to cut, USCF concluded that the most expendable IT employees were systems maintenance staff, whose jobs could be done for so much less by foreign workers going without high salaries and fringe benefits.

UCSF officials have convinced themselves that most of the laid-off workers will have little trouble finding new jobs in the vibrant Bay Area technology industry; they say three of the workers already have accepted other positions at UCSF and some have been offered work by HCL. “These individuals are not unemployable,” Laret says.

The university says outsourcing their work to HCL will save $30 million over the five-year term of the HCL contract, which will cost $50 million.

That’s a meager savings of 0.1% of the UCSF budget, which was $5.83 billion in 2015-16. But the key question is what the university may be giving up in terms of system security and other important considerations.

The work being sent abroad isn’t trivial. According to an email sent to the IT staff last July, it includes managing and backing up most of the system’s data; management and administration of its data networks; operations related to its telephones, email and video conferencing; and payroll and financial applications.

Laret says UCSF expects the security of all these systems to be at least as good under HCL as it is now, though he acknowledges that “there are no guarantees.” Breaches of medical systems can be exceptionally harmful; a hack attack of UCLA Health System’s network revealed in 2015 may have compromised personal and medical information of 4.5 million patients.

Some UCSF workers involved in training their replacements were less than impressed with the process. Kurt Ho, 57, a systems administrator at UCSF since 2015 who is earning about $100,000, says he spent all of two days with his replacement. “He told me he would go back to India and train his team, and would be sending me emails with questions.”

Hatten-Milholin, whose salary has been $127,000, says some of the replacements were on hand for two weeks.

“What was shocking is that the system is so complex there’s no way you can learn it in two weeks,” she told me. She and Ho are among nine workers who have filed a complaint against UCSF with the state Department of Fair Employment and Housing, asserting that they’ve been discriminated against based on national origin, age, sex or race.

Disclosure of the layoffs triggered an uproar last fall. Letters went out to UC President Janet Napolitano from House Minority Leader Nancy Pelosi (D-San Francisco) and Lofgren, who urged Napolitano to reverse the outsourcing plan and suspend the HCL contract until UC can “thoroughly examine” the public policy issues raised by the plan.

Sen. Dianne Feinstein (D-Calif.) pointedly reminded Napolitano that UC received about $8.5 billion in federal funding in 2014-15, and said she was unhappy to hear that the funds would be used “to replace Californian IT workers with foreign workers or labor performed abroad.” She added, “this is not the way” to cut costs.

UCSF responded by tinkering with the plan a bit. The university told Feinstein’s office in November that of 27 HCL employees assigned to UCSF during the transition, eight were H-1B visa holders. UCSF said all had been moved to other locations in the U.S. and would not be working any further on the UCSF program, which raises the question of why they were brought to UCSF for training in the first place.

Sending them away allowed UCSF to assert in a public statement that neither the university nor HCL would “replace the affected UCSF employees … with H-1B visa holders.”

But that’s mostly an optical illusion, says Sara Blackwell, a visa attorney who has sued Disney for discrimination on behalf of Walt Disney World employees whose jobs were outsourced to an Indian H-1B firm.

“The endgame is not to have foreign workers stay on the job here,” she says, “but to move the jobs to India.”

Blame for the outsourcing extends well beyond UCSF. The California Legislature has systematically reduced to pennies the state’s share of the budgets of UCSF and the rest of UC, which once was proudly supported by Sacramento. Meanwhile, Congress has consistently failed to close a glaring loophole allowing U.S. employers to send good American jobs overseas — instead, it has moved to expand the H1-B program at the behest of tech firms claiming, dubiously, that they can’t find enough good engineers in the U.S.

UC President Janet Napolitano seems to be trying to dodge responsibility for this policy. Although she vowed to crack down on H-1B abuses as secretary of Homeland Security, a job she held from 2009 to 2013, she’s been utterly silent about UC’s abuse of that very program on her watch.

Let’s be clear: The outsourcing of IT jobs to India isn’t UCSF policy, but emerging UC policy. Napolitano’s staff says this is UCSF’s deal. But the HCL contract on which UCSF is operating applies system-wide, and it’s up to individual campuses and schools to opt in; UCSF simply was the first to do so. According to notes from an Aug. 5 meeting of UC’s IT Architecture Committee, chief information officers at other campuses are happy to let UCSF act as a guinea pig and will “wait for a year before jumping in with HCL” in order to gauge UCSF’s experience.

Of course, if UCSF’s initiative blows up in its face, the victims will be its patients, doctors and researchers. In running a university hospital, Laret told me, “you have to make some hard choices.” That’s indisputable, but the unanswered question is whether UCSF’s choice will cost more than it saves.

Keep up to date with Michael Hiltzik. Follow @hiltzikm on Twitter, see his Facebook page or email [email protected].

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global-news-station · 4 years

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Dr. Gopi Patel recalls how powerless she felt when New York’s Mount Sinai Hospital overflowed with COVID-19 patients in March.

Guidance on how to treat the disease was scant, and medical studies were being performed so hastily they couldn’t always be trusted.

“You felt very helpless,” said Patel, an infectious disease doctor at the hospital. “I’m standing in front of a patient, watching them struggle to breathe. What can I give them?”

While there is still no simple answer to that question, a lot has changed in the six months since an entirely new coronavirus began sweeping the globe.

Doctors say they’ve learned enough about the highly contagious virus to solve some key problems for many patients. The changes could be translating into more saved lives, although there is little conclusive data.

Nearly 30 doctors around the world, from New Orleans to London to Dubai, told Reuters they feel more prepared should cases surge again in the fall.

“We are well-positioned for a second wave,” Patel said. “We know so much more.”

Doctors like Patel now have:

*A clearer grasp of the disease’s side effects, like blood clotting and kidney failure

*A better understanding of how to help patients struggling to breathe

*More information on which drugs work for which kinds of patients.

They also have acquired new tools to aid in the battle, including:

*Widespread testing

*Promising new treatments like convalescent plasma, antiviral drugs and steroids

*An evolving spate of medical research and anecdotal evidence, which doctors share across institutions, and sometimes across oceans.

Despite a steady rise in COVID-19 cases, driven to some extent by wider testing, the daily death toll from the disease is falling in some countries, including the United States. Doctors say they are more confident in caring for patients than they were in the chaotic first weeks of the pandemic, when they operated on nothing but blind instinct.

In June, an average of 4,599 people a day died from COVID-19 worldwide, down from 6,375 a day in April, according to Reuters data.

New York’s Northwell Health reported a fatality rate of 21% for COVID-19 patients admitted to its hospitals in March. That rate is now closer to 10%, due to a combination of earlier treatment and improved patient management, Dr. Thomas McGinn, director of Northwell’s Feinstein Institutes for Medical Research, told Reuters.

“I think everybody is seeing that,” he said. “I think people are coming in sooner, there is better use of blood thinners, and a lot of small things are adding up.”

Even nuts-and-bolts issues, like how to re-organize hospital space to handle a surge of COVID-19 patients and secure personal protective equipment (PPE) for medical workers, are not the time-consuming, mad scrambles they were before.

“The hysteria of who’d take care of (hospital staff) is not there anymore,” said Dr. Andra Blomkalns, head of emergency medicine at Stanford Health Care, a California hospital affiliated with Stanford University. “We have an entire team whose only job is getting PPE.”

To be sure, the world is far from safe from a virus that continues to rage. It is expected to reach two grim milestones in the next several days: 10 million confirmed global infections and 500,000 deaths. As of Thursday evening, more than 9.5 million people had tested positive for the coronavirus, and more than 483,000 had died, according to Reuters data. The United States remains the epicenter of the pandemic, and cases are rising at an alarming pace in states like Arizona, Florida and Texas.

There is still no surefire treatment for COVID-19, the disease caused by the new virus, which often starts as a respiratory illness but can spread to attack organs including the heart, liver, kidneys or central nervous system. Scientists are at least months away from a working vaccine.

And while medical knowledge has improved, doctors continue to emphasize that the best way for people to survive is to avoid infection in the first place through good hygiene, face coverings and limited group interaction.

Dr. Ramanathan Venkiteswaran, medical director of Aster Hospitals in the United Arab Emirates, said COVID-19 will likely result in permanent changes in medicine and for the general public on “basic things like social distancing, wearing of masks and hand washing.”

LEARNING ON THE FLY

In the medical field, change can be slow, with years-long studies often needed before recommendations are altered. But protocols for COVID-19 have evolved at lightning speed.

In Brazil, São Paulo-based Hospital Israelita Albert Einstein, one of the country’s leading private hospital networks, has updated its internal guidelines for treating coronavirus patients some 50 times since the outbreak began earlier this year, according to Dr. Moacyr Silva Junior, an infectious disease specialist at the center. Those guidelines govern questions such as which patients are eligible for which drugs, how to handle patients with breathing problems, and the use of PPE like masks, gowns and gloves.

“In only three months, a resounding amount of scientific work on COVID-19 has been published,” he said.

At Stanford Health Care, treatment guidelines changed almost daily in the early weeks of the pandemic, Blomkalns said. She described a patchwork approach that began by following guidelines established by the U.S. Centers for Disease Control and Prevention, then modifying them to reflect a shortage of resources, and finally adding new measures not addressed by the CDC, such as how to handle pregnant healthcare workers.

The new coronavirus has been particularly vexing for doctors because of the many and often unpredictable ways it can manifest. Most people infected experience only mild flu-like symptoms, but some can develop severe pneumonia, stroke and neurological disease. Doctors say the biggest advance so far has been understanding how the disease can put patients at much higher risk for blood clots. Most recently, doctors have discovered that blood type might influence how the body reacts to the virus.

“We developed specific protocols, such as when to start blood thinners, that are different from what would be done for typical ICU patients,” said Dr. Jeremy Falk, pulmonary critical care specialist at Cedars-Sinai Medical Center in Los Angeles.

Around 15% of COVID-19 patients are at risk of becoming sick enough to require hospitalization. Scientists have estimated that the fatality rate could be as high as 5%, but most put the number well below 1%. People with the highest risk of severe disease include older adults and those with underlying health conditions like heart disease, diabetes and obesity.

While rates of COVID-19 infection have recently been rising in many parts of the United States, the total number of U.S. patients hospitalized with COVID-19 has been steadily falling since a peak in late April, according to the CDC.

Many hospitals report success with guidelines for “proning” patients – positioning them on their stomachs to relieve pressure on the lungs, and hopefully stave off the need for mechanical ventilation, which many doctors said has done more harm than good.

“At first, we had no idea how to treat severely ill patients when we (ventilate),” said Dr. Satoru Hashimoto, who directs the intensive care division at Kyoto Prefectural University of Medicine in Japan. “We treated them in the fashion we treated influenza,” only to see those patients suffer serious kidney, digestive and other problems, he said.

Hospitals say increased coronavirus testing – and faster turnaround times to get results – are also making a difference.

“What has really helped us triage patients is the availability of rapid testing that came on about six weeks ago,” said Falk of Cedars-Sinai. “Initially, we had to wait two, three or even four days to get a test back. That really clogged up the COVID areas of the hospital.”

Faster, wider testing also helps conserve PPE by identifying the negative patients around whom doctors don’t have to wear as much gear, said Dr. Saj Patel, who treats non-critical patients at the University of California San Francisco Medical Center. “You can imagine how much PPE we burned through” waiting for test results, he said.

Hospitals around the world acted early to restructure operations, including floor layouts, to isolate coronavirus patients and reduce exposure to others. It wasn’t always smooth, but doctors say they’re figuring out how to do it more efficiently.

“Our hospital infrastructure, and the way that we … manage people coming through the door is a lot slicker than it was earlier in the epidemic,” said Dr. Tom Wingfield, a clinical lecturer at the Liverpool School of Tropical Medicine in Liverpool, England.

‘THE PRESIDENT’S DRUG’

Hospitals said some of their early hunches about best treatments for COVID-19 patients ended up being wrong. Case in point: use of the anti-malaria pill hydroxychloroquine.

It gained attention in March, when U.S. President Donald Trump began publicly touting it. Early reports showed the drug could have some benefit, and hospitals, desperate for solutions, started giving it to critically sick patients. But subsequent trial data have told a different story, suggesting the drug is not effective for treatment or prevention, and might even cause harm. Other clinical trials of the drug are still underway.

Dr. Mangala Narasimhan, regional director of critical care at Northwell Hospital in New York, recalled the uncertainty around hydroxychloroquine. The hospital used it early on, but stopped after the negative studies were published. “That was one of our mainstays of treatment in the beginning,” Narasimhan said. “We didn’t have anything else.”

Trump’s loud support for the drug turned the medical debate into a political one. That happened in Brazil, too, when far-right President Jair Bolsonaro fiercely supported hydroxychloroquine. Hospital Sírio-Libanês, in São Paulo, is one of the many hospitals around the globe that have now abandoned it.

Some patients at Sírio-Libanês refused to be part of clinical trials involving what they called the “president’s drug,” said Dr. Mirian Dal Ben, an epidemiologist there, while others demanded to be treated with it.

The lingering questions about use of hydroxychloroquine highlight the hazards of quickly moving science. Hospitals normally rely on fully vetted research published by prominent medical journals like the Lancet and the New England Journal of Medicine to flag important medical findings. But as the pandemic built, so did the number of so-called “pre-print” studies that have not been peer-reviewed.

The Montpellier University Hospital in southern France used hydroxychloroquine on severely ill patients until the government banned the substance in May.

“I have no major regrets when looking back on the decisions that we took,” said Dr. Jacques Reynes, head of infectious and tropical diseases. “But I would say that, at the beginning, we were somewhat in a fog.”

USING WHAT’S AT HAND

But even if hydroxychloroquine looks unlikely as an effective COVID-19 treatment, hospitals continue to try new medications – both by repurposing older drugs and exploring novel therapies. Patients are being enrolled in hundreds of coronavirus clinical trials launched in the past three months.

Many hospitals said they are seeing success with the use of plasma donated by survivors of COVID-19 to treat newly infected patients.

People who survive an infectious disease like COVID-19 are generally left with blood containing antibodies, which are proteins made by the body’s immune system to fight off a virus. The blood component that carries the antibodies, known as convalescent plasma, can be collected and given to new patients.

Early results from a study at New York’s Mount Sinai Hospital found that patients with severe COVID-19 who were given convalescent plasma were more likely to stabilize or need less oxygen support than other similar hospital patients. But results from other studies have been mixed, and doctors still await findings from a rigorously-designed trial. And availability of plasma varies between regions.

At Henry Ford Hospital in Detroit, Michigan, “anecdotally everyone can provide stories” of the benefits of plasma, said Dr. John Deledda, the hospital’s chief medical officer.

But in rural New Mexico, hospitals that care for largely underserved populations struggle to find it. “There’s a limited number of blood centers” that can provide plasma, said Valory Wangler, chief medical officer at Rehoboth McKinley Christian Health Care Services, in Gallup, New Mexico. Until trial data is more conclusive, plasma is “not something we’re pursuing actively,” she said.

Dr Abdullatif al-Khal, head of infectious diseases at Qatar’s Hamad Medical Corporation and a co-chair of the country’s pandemic preparedness team, said he saw patients improve after he started using donated plasma early in the course of COVID-19 before the patients deteriorated.

Qatar is also assessing a steroid known as dexamethasone to treat COVID-19. But Khal says he wants to wait for publication of clinical data behind a recent UK study suggesting that the steroid reduced death rates by around a third among the most severely ill COVID-19 patients.

In patients with severe COVID-19, the immune system can overreact, triggering a potentially harmful cascade. Steroids are an older class of drugs that suppress that inflammatory response. But they can also make it easier for other viral or bacterial infections to take hold – making doctors leery of their use in a hospital setting or in patients with early-stage COVID-19.

Some countries, including Bahrain and the United Arab Emirates, reported using HIV drugs lopinavir and ritonavir with some success. Clinical trials, though, have suggested little benefit, and they aren’t widely used in the United States.

MIDNIGHT DELIVERY

Many of the doctors who spoke with Reuters were bullish on the use of remdesivir, the only drug so far shown to be effective against the coronavirus in a rigorous clinical trial. The antiviral developed by California-based Gilead Sciences Inc (GILD.O) was shown to reduce the length of hospital stays for COVID-19 patients by about a third, but hasn’t been proven to boost survival.

Remdesivir is designed to disable the mechanism by which certain viruses, including the new coronavirus, make copies of themselves and potentially overwhelm their host’s immune system.

It is available under emergency approvals in several countries, including the United States. But Gilead’s donated supplies are limited, and distribution and availability are uneven.

Dr. Andrew Staricco, chief medical officer at McLaren Health Care, which operates 11 hospitals across Michigan, recalls the urgency to obtain remdesivir early on. He got an email from Michigan’s health department on May 9, a week after the U.S. Food & Drug Administration authorized the drug for use in treating COVID-19. The health department said it had received a small batch from the federal government, and planned to dole it out to local hospitals based on need. Staricco wrote back, saying he had 15 to 18 critically ill patients, but was given enough to treat just four.

The drug was so precious, he said, that state police troopers were responsible for transporting it to the hospital – which they did, dropping it off around 1 a.m. the next morning.

Health officials originally directed remdesivir for use on the most critically ill patients. But doctors later found they got the best results administering it earlier.

“We started finding that, actually, the sooner you get treated with it, the better,” Staricco said. “We’ve revisited our criteria for giving it to patients three different times.”

Data on the drug, he said, is still scarce. But his anecdotal observations on the benefits of early treatment were echoed by several U.S. doctors.

‘COPY-CATTING’

Gilead on Monday said it aims to manufacture another 2 million courses of remdesivir this year, but did not comment on how it plans to distribute, or sell, those supplies for use by hospitals. The company has licensed the antiviral to several generic drugmakers, who will be allowed to sell the medication in over 100 low-income nations.

Although much about the coronavirus remains unknown, a key reason hospitals say they now are more prepared owes to teamwork.

Many doctors described a kind of unofficial network of information sharing.

In hard-hit Italy, Dr. Lorenzo Dagna of the IRCCS San Raffaele Scientific Institute in Milan, organized conference calls with institutions in the United States and elsewhere to share experiences and anecdotes treating COVID-19 patients.

McLaren’s Staricco said the Michigan hospital chain adopted its policy on use of blood thinners by looking at peers at Detroit Medical Center and Vanderbilt University Medical Center.

As more institutions put their guidelines online, he said, there was “lots of copy-catting going on.”

The post Doctors see hope in new COVID-19 treatments appeared first on ARY NEWS.

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yourarchiesmith01-blog · 5 years

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The Opinions Of Americans About Healthcare Reform Still Varies Widely

The Opinions Of Americans About Healthcare Reform Still Varies Widely. One month after President Barack Obama signed the important health-reform tally into law, Americans abide divided on the measure, with many people still unsure how it will affect them, a untrained Harris Interactive/HealthDay poll finds. Supporters and opponents of the reform package are roughly equally divided, 42 percent to 44 percent respectively, and most of those who object the new law (81 percent) verbalize it makes the "wrong changes learn more. They are shoveling it down our throats without explaining it to the American people, and no one knows what it entails," said a 64-year-old female Democrat who participated in the poll. Thirty-nine percent said the remodelled regulation will be "bad" for people like them, and 26 percent aren't sure. About the only obsession that people agreed on - by a 58 percent to 24 percent the better - is that the legislation will provide many more Americans with adequate health insurance breast ko chhota krne ke liye kudarti ilaj. "The popular is divided partly because of ideological reasons, partly because of partisanship and partly because most people don't get a load of this as benefiting them. They see it as benefiting the uninsured," said Humphrey Taylor, chairman of The Harris Poll, a ceremony of Harris Interactive. Some 15,4 percent of the population, or 46,3 million Americans, dearth health insurance coverage, according to the US Census Bureau cheap caliplus no rx. Those 2008 figures, however, do not enumerate people who recently lost health insurance coverage in the thick of widespread job losses. The centerpiece of the voluminous health reform package is an bourgeoning of health insurance. By 2019, an additional 32 million uninsured people will advance coverage, according to the Congressional Budget Office. The measure also allows young adults to chain on their parents' health insurance plan until age 26, and that change takes effect this year. So "I cogitate that people are optimistic about stuff that they know about for sure, which is the under-26 provision, and then just the fluffy nature of just what's been promised to them," said Stephen T Parente, director of the Medical Industry Leadership Institute at the Carlson School of Management at the University of Minnesota in Minneapolis, and a ex- cicerone to Republican Presidential candidate Sen John McCain. Expanding coverage to children under 26 "promises to be a extent cheap and easy way to cover a group that was clearly disadvantaged under the unused system," noted Pamela Farley Short, professor of health policy and direction and director of the Center for Health Care and Policy Research at Pennsylvania State University. And "It will give parents placidness of mind and save them money if they were paying for COBRA extensions or individual policies so their kids would not be uninsured. So I reflect that change will be popular and may help to build fortifying for the exchanges and the big expansion of coverage in 2014". However, on other measures of the legislation's impact, public opinion is mixed, the Harris Interactive/HealthDay receive found. More people think the plan will be bad for the supremacy of care in America (40 percent to 34 percent), for containing the cost of health distress (41 percent to 35 percent) and for strengthening the economy (42 percent to 29 percent). People often mark off quality in terms of access to the doctors they like, but "it's not clear any of this really changes or affects that". And he added, "No one is unequivocally saying this is thriving to solve the expense problem". While President Obama said his plan would "bring down the cost of health supervision for millions of families, businesses, and the federal government," many have questioned the legislation's cost-containment provisions. In a despatch issued last week, Chief Medicare Actuary Richard S Foster said overall governmental health expenditures under the health-reform package would increase by an estimated $311 billion, or 0,9 percent, compared with the amounts that would otherwise be played out from 2010 to 2019. Meanwhile, some health insurers have proposed high premium rate increases in anticipation of health reform. Anthem Blue Cross of California, a segment of Indianapolis-based Wellpoint Inc, the nation's largest insurer, in February proposed raising indemnity rates as much as 39 percent on some policyholders in California. The company twice delayed the reprove hikes in the wake of negative publicity and, on Thursday, the California Department of Insurance announced that Anthem had remote the rate-hike request. Prompted by Anthem's proposed rate increases, Sen Dianne Feinstein (D-Calif) proposed legislation that would supply authority to the federal supervision to review "potentially unreasonable" rate increases and has vowed to press ahead with the measure. So how would opponents modulation the new health-reform package? A 41-year-old Independent male poll sharer would like to see "an actual way to pay for this bill without mortgaging our great grandchildren". A Republican male, maturity 77, said it should have included malpractice limits. Creating a nationalistic insurance exchange would be more efficient than the state-based exchanges in the law, said an Independent female, seniority 30. Neither the President nor the Democrats in Congress get much political credit for their legislative victory, with 48 percent of those polled saying Obama did a sad job (versus 40 percent who support his efforts). The general is even more critical of House Speaker Nancy Pelosi (58 percent neutralizing versus 23 percent positive) and Congressional Democrats (59 percent versus 25 percent). But Republicans in Congress fared even worse, with a 68 percent to 18 percent maturity saying they did a corrupt job. Harris Interactive's Taylor suspects that, if Obama and the Democrats are celebrated in passing popular bills, like financial market regulation, or if the economy improves faster than economists predict, that could encourage public sentiment and "possibly have a halo effect on the health-care bill". And if those things don't happen? "I have no disquiet that many Republicans will campaign against this in the fall and it will be one of the sticks they use to tempo the Democrats" premature ejaculation. The Harris Interactive/HealthDay poll, conducted online April 14-16, labyrinthine a national cross section of 2,285 adults 18 and older.

#percent #health #people #insurance #reform #harris #interactive

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blockheadbrands · 6 years

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These Senators Are All Talk, No Action on Cannabis Legalization

Bruce Barcott of Leafly Reports:

Talk is cheap. In Congress it goes for pennies on the pound.

In the days following Attorney General Jeff Sessions’ decision to rescind the Cole memo, politicians around the country raised their voices in outrage.

Many have spoken out against Jeff Sessions. But who has acted? We tallied the votes.

Governors, state attorneys general, and members of Congress issued statements and tweets about states’ rights. They pledged to protect adult-use laws and the rights of medical patients.

But who has acted? Almost no one, so far.

In fact, a number of senators who expressed a burning desire to halt Sessions and his cannabis-hating crusade in its tracks have not so much as signed on as a co-sponsor of any of the four major pieces of legislation addressing the issue in the US Senate. As of mid-January, one of the most powerful bills—Sen. Cory Booker’s Marijuana Justice Act—had only a single co-sponsor, Oregon Sen. Ron Wyden.

The four Senate bills currently treading water in the upper chamber are:

The Marijuana Justice Act (S. 1689): Sponsored by Sen. Cory Booker (D-NJ), this act would get the federal government out of the marijuana prohibition business. Bonus: S. 1689 contains equity provisions for those people and places most damaged by the war on drugs.

The CARERS Act (S. 1374): Prior to Booker’s MJA (above), this was the strongest serious measure brought forth in the post-2012 era. The bill would extend the principle of federalism to State drug policy, provide access to medical cannabis, and enable research into the plant’s medicinal properties.

The SAFE Banking Act (S. 1152): Sponsored by Sen. Jeff Merkley (D-OR), this bill would create protections for depository institutions that provide financial services to cannabis-related businesses.

The Small Business Tax Equity Act (S. 777): Sponsored by Sen. Ron Wyden (D-OR), this bill amends the Internal Revenue Code to exempt a trade or business that conducts marijuana sales in compliance with state law from the prohibition against allowing business-related tax credits or deductions for expenditures in connection with trafficking in controlled substances. It effectively ends the IRS’s glaring 280E rule, which economically hobbles legal cannabis companies.

Especially glaring: California Sen. Kamala Harris, the rising Democrat representing a state with more than 47,000 jobs tied to legal cannabis. California’s senior senator, Dianne Feinstein, is notoriously anti-cannabis and not expected to change anytime soon. So the actions of Harris may be critical in terms of safeguarding an industry worth an estimated $2 billion to $5 billion. Among legalization advocates, Harris was trending as a political target on Twitter this past week:

WA Progressive @WAProgressive

Is Senator Kamala Harris Sincere About Supporting Marijuana Reform? She has yet to cosponsor any reform bills like other Senate Dems have. https://www.weednews.co/is-senator-kamala-harris-sincere-about-supporting-marijuana-reform/ …

2:15 PM - Jan 9, 2018

Is Senator Kamala Harris Sincere About Supporting Marijuana Reform?

It wasn’t that long ago that many in the political world considered supporting cannabis reform to be political suicide. After Oregon failed to legalize cannabis in 2012 I text my friend that...

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I’ve compiled a table of senators from the eight legal adult-use states, their public words on the Sessions move, and their actions in the senate, below.

Senators from Legal Adult-Use States:

Click on table to enlarge.

Cannabis Jobs Count: Legal Marijuana Supports 149,304 Americans

It’s Not Just the Legal States

Surprisingly, much of the support for the Senate’s leading cannabis measures comes from elected officials who don’t represent adult-use states. Some come from states where medical cannabis is legal. Some, like Rand Paul (R-KY) and Mike Lee (R-UT), hail from places where nearly all forms of cannabis are highly illegal.

And some, like Sen. Chuck Schumer of New York, talk a big game but so far have delivered big fat zeroes when it comes to co-sponsorship of cannabis bills.

Senators from Other States:

Click on table to enlarge.

Who’s Acted on Their Convictions?

I do have a roll of honor, though it’s a short one. The senators with the strongest record of standing up for patient protections, states’ rights, and the cannabis industry are:

Sen. Cory Booker (D-NJ), initial sponsor of both the CARERS Act and the Marijuana Justice Act.

Sen. Lisa Murkowski (R-AK), co-sponsor of the CARERS Act and the SAFE Banking Act.

Sen. Cory Gardner (R-CO), who’s both co-sponsored bills and taken the lead this past week in resisting Sessions.

Sen. Michael Bennet (D-CO), Gardner’s quieter compatriot from Colorado, defending his state’s cannabis jobs.

Sen. Ron Wyden (D-OR), creator of the Small Business Tax Equity Act, to end the injustice of IRS Rule 280E.

Sen. Jeff Merkley (D-OR), creator of the SAFE Banking Act to allow legal businesses in his state to bank safely.

Sen. Mazie Hirono (D-HI), a newcomer to the cause, co-sponsor of both CARERS and SAFE Banking.

Sen. Rand Paul (R-KY), whose state isn’t even medical-legal, but continues to support liberty on this issue.

Notice anything odd? Yes: There are both Republicans and Democrats on the honor roll. Cannabis is a bipartisan issue.

I urge you to call the members of Congress from your state and ask them what they’re doing this week to support and protect state cannabis laws.

TO READ MORE OF THIS ARTICLE ON LEAFLY, CLICK HERE.

https://www.leafly.com/news/politics/these-senators-are-all-talk-no-action-on-cannabis-legalization

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