“A pair psychologist from the University of Michigan recently conducted a fascinating study that shed some neurological light on the fear of loss. First, volunteers donned caps containing electrodes. Then they engaged in a computer simulated betting game, while researchers analyzed their brain electrical activity in response to winning and losing. With each bet, the medial frontal cortex in her brain showed increased electrical activity with any matter of milliseconds. But what intrigued the researchers was that negativity showed a larger dip after a loss and positivity rose after her win. In fact, during a string of setbacks, medial frontal negativity dipped lower and lower. Each loss was compounded by the previous loss. Researchers came to a simple yet profound conclusion: losses loom larger than games. In other words, the aversion to loss of a certain magnitude is greater than the attraction to gain of the same magnitude.”-Mark Batterson, Chasing the Holy Spirit, Purpose Driven Connection, volume 1, pg 84-85
Category Archives: medicine
Flu Update
Just as suspected, the Mexico mortality rate numbers were falsely elevated according to Science article. This article states case fatality rate of 0.4%.
Flu Update: What we know and what we don’t
“Influenza virus has only eight genes. The molecular structure of the most important proteins they code for is known in intimate detail. The coming and going of its epidemics have been studied by statisticians continually since the 1840s. But predicting pandemics remains a fools’ game. It falls into the category of Alvin Weinberg’s ‘trans-science’ – a question of fact that can be stated in the language of science but is unanswerable by it. Weinberg’s examples focused on the impossibility of predicting the probability of extremely improbable events. There have only been three influenza pandemics in the last century: in 1918, 1957 and 1964. The uncertainty is massively amplified by evolution – the random and frequent genetic mutations and the swapping of genes between bird, pig and human viruses….” read more from this great summary…
Flu Update: Mortality and Morbidity of Swine Flu
Mortality rate (as I suspected) based on true Mexico numbers is less than 1% (11932 cases with 42 deaths).
Age most affected remains 5-40 years old
Overall this is a mild illness but hope and pray that a second wave doesn’t occur or is just as mild. I am hopeful that gov et al will start production of vaccine for this fall.
Questions?
Flu Update
It appears that even though this virus is affecting young people that they mortality rate in Mexico was tied to poverty and delay in care, and as I have always said, it is also related to unreported number of cases.
The CDC has told schools not to close likely because of the mild illnesses the virus is causing.
There are now 2 reported deaths due to the virus in the U.S., but it turns out that both were in young people who had chronic medical conditions.
Finally, the move to level 6 by officials would not come as a surprise. If you look at the definition of pandemic, it is a new, highly infectious agent that has crossed all geographic boundaries (don’t quote me on that just check CDC or WHO website). Calling it a full blown pandemic only means that it has spread globally, it is about geography not how virulant/dangerous/deadly the virus is.
I hope this will burn itself out and continue to be a mild virus, but officials are concerned that this is just the first wave. Hopefully if there is a second wave, it is in the fall and a vaccine will provide some immunity.
Flu Update
This is a great review of our current situation. This strain so far seems to be similar to seasonal varieties in fact maybe even more mild seeing as the seasonal flu kills 1,000’s of people every year. The mortality rate in Mexico vs. U.S. et al remains unaccounted for although likely will find it is just a matter of not having all the numbers of patients who got the flu but recovered without testing.
Flu Update
So the swine flu is continuing to spread. The concerns continue to be:
- The mortality rate
- The age of the victims.
The WHO has stated that the initial mortality numbers from Mexico were not correct so they have been dramatically adjusted. The mortality rate seems to be confirmed at 19 of 506 cases in Mexico or a rate of 3%, and if you use the suspected numbers the mortality rate is less than 2%. This still seems high to me, and I continue to suspect that the mortality rate is lower but we just don’t have all the data.
The age of the people contracting the disease seems to be young. In the U.S. the average age has been 17. I did read today that there were at least 4 deaths in Mexico over age 60, but the most accurate numbers are probably from the MMWR.
The Associated Press said yesterday:
“Epidemiologist Pablo Kuri, an adviser to Mexico’s health secretary, gave a brief survey of the 16 confirmed swine flu fatalities in that country to The Associated Press. They include four males and 12 females. Three children died — a 9-year-old girl, a 12-year-old girl and a 13-year-old boy. Four were older than 60, the oldest 68.
The other nine fatalities were between 21 and 39 — unusual ages for people to die of the flu, because they tend to have stronger immune systems.
People sickened in the U.S. range in age from 1 to 81, but most are younger than 20, according to the U.S. Centers for Disease Control and Prevention.”
Associated Press said today: “Mexican Health Secretary Jose Angel Cordova said the virus that has killed 19 people in Mexico and sickened at least 506 apparently peaked here between April 23 and April 28. A drastic nationwide shutdown appears to have helped prevent the outbreak from becoming more serious, he said.
“The evolution of the epidemic is now in its declining phase,” Cordova declared.
He said officials would decide Monday whether to extend the shutdown or allow schools and businesses to reopen on Wednesday.
Pablo Kuri, an epidemiologist advising Cordova, told The Associated Press on Sunday that tests have confirmed a swine flu death in Mexico City on April 11, two days earlier than what had been believed to be the first death.
He also said there have been no deaths among health care workers treating swine flu patients in Mexico, an indication that the virus may not be as contagious or virulent as initially feared.”
We must continue to pray that the mortality numbers will be comparable to the seasonal flu (<1%) and that deaths will not be in the prime of life.
Flu Update: Fear not!
Here is a great challenge for those of us anxious Christians: Faith and Healing: H1N1
“…And what of people of faith? This may be the time that we care called not simply to pray for healing, but to be vehicles of it. It may be our turn to embrace the leper. It may be a lot of things. It is time for us to be a calming presence around those around us so that fear does not carry the day. Remember that God’s messengers in Scripture always greet their mortal hosts with these words, “Fear not!”
Flu Update: Much uncertainty still remains
Associated Press most current review of Q and A regarding the flu
The L.A. Times yesterday (April 30, 2009) has a very encouraging article pointing out that the genetic sequence of this flu has been studied and appears to be less worrisome than previous thought.
Another encouraging summary from a layperson’s blog that I am hopeful is going to be the scenerio that pans out in the end. It seems that I am finding more ‘no big deal’ articles than worry ones. I think that the truth lies somewhere in between.
Hand washing is key. Some report that the flu spreads more from contact than from the air:
“2.4 Evidence for the Mode of Influenza Transmission
Organisms, especially respiratory viruses expelled in large droplets, remain viable in droplets that settle on objects in the immediate environment of the patient. Both influenza A and B viruses have been shown to survive on hard, non-porous surfaces for 24-48 hours, on cloth paper and tissue for 8-12 hours and on hands for 5 minutes8. The virus survives better at the low relative humidity encountered during winter in temperate zones. Contact with respiratory secretions and large droplets, appears to account for most transmissions of influenza. In a report of an outbreak in a nursing home, the pattern of spread was suggestive of contact rather than airborne transmission because patients who were tube fed or required frequent suctioning had higher infection rates than those who did not require such care. Whether or not influenza is naturally transmitted by the airborne route is controversial. An outbreak of influenza on an airliner has been attributed to airborne spread; however, large droplet spread could have been responsible because the passengers were crowded together and moved about for several hours in a small, grounded airplane9. Although experimental airborne transmission of influenza A virus to mice has been reported, there is no evidence of such transmission in humans.”
And finally, here is a good summary article about the theories concerning why Mexico seems to have such a high mortality rate: Answer–unreported cases are probably MUCH higher so the 6% number is much lower?
Flu Update
Health Experts Answer Swine Flu Questions
Prevention can help: If coughing, stay home and your family stay home. Coughing is the way this thing is spread. Hand washing helps because the droplets get on hands and we humans like to touch our mucus membranes–eyes, face, mouth etc…-so wash hands.
Good News: Mortality rate may be less than previously assumed?
- mortality rate in Mexico seems to have slowed: total is 152 & health officials have speculated that tens of thousands may have contracted it so this puts the mortality rate from 6-10% to 1% or less. Still too early to know. This article gives a more accurate picture of the shear number of cases in Mexico AND that it probably has been around for months–as early as February.
- U.S. confirmed is at 91 and 1 death which again means that there could be tenfold more unconfirmed cases again pointing to the mortality rate being at the worst 1% if 1/91 rate continues…
- The other concern has been that it is killing 25-45 year olds, but we still haven’t seen the numbers to know for sure. The first U.S. death was in a baby from Mexico, and unfortunately, the baby was in the age range that we typically see being most effected by the flu–under 2 and over 65.
- Here is a reassuring article putting potential ‘worst case scenerio’ stats together to point out that even if this were as bad as the ‘Spanish’ flu of 1918….
Pray and wait.
Flu Update
Question #1: Why is the mortality rate so high in Mexico?
Ans: There are many theories but no clear answers (yet), but the good news is that it appears that the death rate is slowing and the total cases are slowing as well in Mexico.
I would rank the theories in their most likely order:
1. not enough data and we will find that there were/are a lot more cases so the mortality rate is falsely elevated
2. virus changed minutely/just enough to make itself less lethal but more contagious
3. differences in population–worse health, bad air polution, delay in going to seek medical attention, genetic differences, more herd immunity in U.S.–many of us might think: “Mexico is so poor and their health system must be worse than ours.” One of my partners assurred me that Mexico Cities healthcare system is very clean and modern so that theory is probably not accurate.
4. Some other infection–some speculate that there is another supra-infection or co-infection that is making the death rate higher in Mexico.
Question #2: Are the deaths highest in the young–25-45 age range in Mexico?
Ans: Again, no data has been available, but some rumors and speculations that that is the case. If that is true, experts worry that may mean we are dealing with a flu strain like the 1918 strain which was very bad.
Some more links:
Global Map
Daily Update for Emergency Physicians
Incidental notes:
I worked 10 hours last night in the Emergency Department, and we were testing for the flu on EVERYBODY that had any symptoms at all suggestive of the flu–all were negative. I would think that we would start to see cases if this thing is going to spread like most epidemics do…More to follow….
Also one of my partners is interviewing today a researcher who has created a vaccine (tested only on animals but seems to work) that is non-typable. This means that this vaccine would work on ANY strain of the flu…WOW…for more details look for his interview on his website.
Is this a bad flu or not?
Answer: We don’t know yet. This is a concise video clip summarizing that point.
Flu: What are the true numbers?
Mexico: 86 confirmed deaths (only 20 of which have been confirmed to have the swine flu); 1400 confirmed cases
These numbers are concerning. I will make an educated guess that most of the 86 deaths are from the flu but there are 1,000’s of unconfirmed cases to go with the 1400 confirmed cases. For example, in New York approximately 100 kids came down with flu symptoms, but the health department only tested 8–all of which were positive for the swine flu. This means that there are a lot of people with this flu that are unconfirmed cases. I am hopeful that when the dust/stats settle, we will find that the Mexico numbers are more likely 80 dead out of 8000 (I hope or just wishful thinking)–which is a 1% mortality rate rather than the 6-8% mortality currently being reported there.
Now why are we not seeing any mortalities (yet)? Is it just too few cases? Or has the flu changed? Or is there some kind of herd immunity from exposure to prior flu vaccines etc.?
Any thoughts???
Swine Flu: Just another flu?
So what is the deal with this? Some of us were all geared up for the bird flu to erupt into a pandemic of epic proportions. A pandemic simply means that a certain illness spreads throughout the world. Not everyone gets the illness just a certain percentage get it (20% range). If this flu (virus) is mild then everyone or many people just get sick with a bad cold–no big deal. The only concern as I see it is if this flu has a high mortality rate. The initial numbers from Mexico are concerning-60-80 dead, effecting the 25-45 age group, and total infected 1000. This would mean a mortality rate of 6-8%. Now that is alarming and high enough for all of us to be concerned. However, this is certainly not the real number(s). There are likely 1000’s or at least 2000 people who have probably gotten the flu and have had little or no symptoms which probably makes the mortality rate more like 3-4% (still high). The only other problem is if the number dead is actually higher than 60-80. Unfortunately, it doesn’t seem like we can get a clear picture of the extent and accuracy of these reports from Mexico.
The cases that we have seen in the U.S. seem to be mild (again the actual case numbers are probably much higher but many are getting the flu or exposed to the flu but not getting any symptoms). So has this flu already mutated to a milder form? Hopefully and possibly. Viruses like this tend to mutate to a high infection rate and low mortality rate so that they can stay around. If the mortality rate is too high, the virus itself dies off (aka ebola), and if the infectivity rate is too low, this will eliminate the virus as well.
The CDC is saying that prior flu vaccines will not give us any immunity, but I would guess that they might provide a little. Certain antiviral medications (tamiflu) are reported to be effective in shortening the duration of illness, but this could change as the virus mutates.
The bad news:
- mortality in Mexico cases appears to be 6-8% (BUT again that is probably less & the virus may have mutated to a less lethal form)
- it is spreading (although I would have thought that it would have spread more rapidly by now…again all viruses are different and maybe this one is less contagious than others or it just has not had time to mutate enough to change into a very contagious form)
- If it is like prior flu epidemics/pandemics it will have 2-3 waves but hopefully by then a vaccine will help reduce impact
- In Mexico it is killing 25-45 year olds–bad news for most of us–BUT remember: 1. these reports are probably not accurate and mortality rate is probably a lot less 2. cases outside of U.S. are without deaths so far.
The good news:
- It’s the flu. Nothing more. Cough, fever, body aches and MOST will be without any symptoms or not get it. (pray that it’s mortality rate is low)
- Mortality is zero in the cases outside of Mexico so far.
- Antivirals seem to work.
- Vaccine will be available likely in 3 months or more
What is the flu? It is any form of the inFLUenza virus. This swine flu has probably been around in the population for years. You can find reports of cases of and deaths due to swine flu but very, very few and all related to being near pigs (aka bird flu is just a certain strain of influenza that effects people that are in contact with birds–note also that there are many different strains of what we call bird flu as well–calling it bird or swine just means that its host (where the virus came from) was a bird or a pig). The problem comes with one of these influenza strains mutates to be contagious from pig to human and then human to human and then highly contagious between human to human then we get epidemics/pandemics.
There may be more to follow. Posts on uberlumen are not usually about current events so not sure how many flu updates to expect. As always please post/add your comments below. (If I get a lot of feedback then maybe that will motivate me to continue updates.)
sites of interest:
google map-this is several maps created to follow the outbreaks
How can we improve the Emergency Room Experience
This is a VERY informative interview by a patient who came into an emergency room with chest pain. We as care givers have a lot to learn.
- TELL our patients what we are doing; what are the tests we are doing for?
- UPDATE our patients periodically with results
- SEND them home with what we think they might have wrong and what we think they don’t have wrong
- DON’T take so long to discharge our patients….WAITING time is always stressful and agrevating to our patients
- LISTEN to our patients carefully and make sure that they can’t LISTEN in to our casual conversations
Vital Signs of Healing: VALUE-Are You Enough? Lecture
Please enjoy a brief lecture on the Vital Signs of Healing: VALUE asking the age old question are you enough?
There are 4 books that I mention during this lecture:
How to Win Friends and Influence People by Dale Carnegie
The Return of the Prodigal Son by Henri Nouwen
Vital Signs of Healing: VALUE-Are You Enough? Q&A
This is the GREAT discussion time that we had concerning VALUE. Join us! Share with us YOUR answers and please leave us a comment below.
The Vital Signs of Healing: VALUE handout: vital signs of healing: value
Here is a brief list of YOUR answers to this VITAL question:
What are some ways that we can show our patients that we think that they have value or that we think that they are ‘enough’?
- put yourself at their level
- eye contact
- show kindness and help out even when it is not your patient
- do a little extra if you see a need
- getting to know them beyond their chief complaint
- communicate consistency between the doctor and the nurse
- not about you
PLEASE share with us YOUR answers by posting a comment below. THANKS for joining us!
Vital Signs of Healing: VALUE-Are You Enough? Introduction
Enjoy this brief audio introduction to the curriculum entitled: Vital Signs of Healing. There are 4 physical vital signs and 4 Vital Signs of Healing: Love, Value, Virtue, and Healing. This is an introduction to a lecture about the Vital Sign: VALUE. We had this picture up on the screen for part of our discussions:
Who do YOU most relate to in this picture? And why? Please leave us your insights by adding a comment below.