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Morning Rounds Shraddha Chakradhar

It is an off year for your Morning Rounds writer, but happy voting to those living in areas with an election today! 

New guidelines for colorectal cancer screening issued

The American College of Physicians just released new guidelines for colorectal cancer screening, and now recommends that physicians screen all adults ages 50-75 with an average risk for signs of the disease. The updated guidelines — which were developed in consultation with the American Cancer Society, the U.S. Preventive Services Task Force, and others — encourage physicians to discuss with patients the benefits, harms, and associated costs of three screening methods before pursuing any procedure. Previously, the organization gave doctors the option to choose from one of four screening methods. The old guidelines, issued in 2015, also suggested different time frames for how often a specific procedure needed to be repeated: For example, doctors were previously encouraged to perform one of two blood tests every year, but the new screening guide moves this to every two years. 

A rare mutation could be protective against Alzheimer’s, case report finds 

A rare gene variant known to help transport cholesterol around the bloodstream may play a role in protecting against Alzheimer’s disease, according to a new case report. A woman of Colombian descent with a genetic mutation known to cause early-onset Alzheimer’s lived into her 70s before she developed mild dementia, researchers said. And even though the woman had abundant amyloid plaques — thought to cause cognitive impairment — she had few signs of neurodegeneration. Sequencing her genome, researchers found that she has the "Christchurch mutation” in the APOE gene, which seems to prevent the death of neurons, even in a brain with a lot of amyloid. The finding is only based on this one case, which is “exceedingly uncommon and possibly unique,” researchers warn. 

Unclean waiting areas — and not long wait times — are a bigger problem for patients

A new survey of negative patient experiences finds that patients rank unpleasant waiting areas as a bigger reason for not returning to a facility than long wait times. Here’s more: 

  • Waiting areas: Some 30% of respondents said dirty waiting areas at urgent care and primary care facilities would keep them from returning. Some 11% said the same for waiting times at urgent care centers, while 6% said so for primary care. 

  • Urgent care: Patients visiting these facilities were twice as likely to report dissatisfaction if they had to see more than two health professionals during a visit. 

  • Primary care: Women were 2.5 times more likely than men to say they wouldn’t want to return if the doctor or nurse forgets their name. At the same time, men were five times more likely to not want to return because of waiting rooms that lack entertainment options.

Inside STAT: Most IVF 'add-ons' rest on shaky science, studies find 


Sarah Chamberlin at home on Long Island. (ALICE PROUJANSKY FOR STAT)

When Sarah Chamberlin’s doctor suggested that a drug called Neupogen might help her become pregnant through IVF, she didn’t hesitate. After all, she and her husband had already been through five rounds of artificial insemination and two cycles of in vitro fertilization — none of which had led to pregnancies. And Neupogen, the doctor explained, would help Chamberlin’s immune system stop rejecting IVF embryos, which he called "genetically incompatible" with her. New research, however, finds little evidence that “add-ons” like Neupogen — which are not essential to IVF but have increasingly become available in the past four decades  — improve the chances of a healthy, full-term pregnancy, and some may actually reduce a woman’s chance of conceiving. STAT’s Sharon Begley has more here

Medicare beneficiaries still face financial hardship paying health bills

More than half of seriously ill Medicare recipients report having difficulty when it comes to paying medical bills, according to a small, new survey. A third of very ill Medicare beneficiaries also report having trouble paying for prescriptions drugs. As a result of their illness, nearly 40% of these patients said they had exhausted all their savings, while about 30% report being contacted by a collections agency. One of the problems, the authors noted, is that although Medicare is often a better alternative for poor and older individuals than commercial options, there is currently no cap on out-of-pocket spending for these patients. 

To that end, another survey — from Kaiser Family Foundation — found that in 2016, the average Medicare recipient spent $5,460 in out-of-pocket health costs. Most of this spending went toward services (and not premiums), including paying for prescriptions. 

Only 11% of NCAA team lead physicians are women

A wide gap exists in the gender makeup of the physicians who help NCAA athletic teams, according to new research. In the 2018-2019 academic year, nearly 89% of the team head physicians were male, while 11% were female. This was especially striking given that there is more parity among NCAA athletes — 56% men and 44% women — and more than a third of U.S. physicians are women. These disparities also existed among NCAA head athletic trainers: Fewer than a third were women. At the same time, some 52% of assistant athletic trainers were women. In a related commentary, experts suggest that job ads and performance appraisals should be reviewed for any wording that may contribute to a male-gendered stereotype, which the authors say is often aligned with athletics. 

What to read around the web today

  • A new Alzheimer’s therapy is approved in China, delivering a surprise for the field but also questions. STAT
  • He wanted cold medicine, but CVS rejected his Puerto Rican ID. The New York Times
  • Melania Trump is coming to Boston this week as part of her ‘Be Best’ initiative. The Boston Globe
  • After an unprecedented death, FDA offers few hints for the future of its strategy on fecal transplants. STAT Plus
  • My year of concussions. The New Yorker

Thanks for reading! More tomorrow,

Shraddha

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Tuesday, November 5, 2019

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