On MRSA Infections Worldwide

June 20, 2011

Methicillin-resistant Staphylococcus aureus (MRSA) infection has become increasingly common in recent years, due in large part to overuse of antibiotics. According to a 2007 report in Emerging Infectious Diseases, a publication of the Centers for Disease Control and Prevention (CDC), the average number of MRSA infections doubled nationwide between 1999 and 2005 – from 127,000 to 278,000. During the same period, the number of annual deaths from MRSA infection increased from 11,000 to more than 17,000. By increasing awareness about the risk factors associated with and steps that can be taken to avoid MRSA infection, it may be possible to reduce or eliminate its spread.

MRSA infection is caused by a strain of Staphylococcus (staph) bacteria that has become resistant to the antibiotics commonly used to treat staph infections, which include methicillin and penicillin. Generally, MRSA is spread through skin-to-skin contact, openings in the skin (cuts or abrasions), contact with contaminated surfaces, crowded living conditions, or poor hygiene. MRSA frequently manifests first on the skin as a reddish rash with lesions resembling pimples which may begin to drain pus, or lead to cellulitis, abscesses, and impetigo. In addition, the initial skin infection can spread to almost any other organ in the body, resulting in more serious symptoms and potential complications.

Designations are made between types of MRSA infection based on the location where the infection took place. Hospital-acquired MRSA (also called health-care-acquired, HA-MRSA, or HMRSA) remains one of the most common types of infection. Individuals who are hospitalized, those with invasive medical devices such as catheters, and those residing in nursing homes are at an increased risk of acquiring HA-MRSA. Community-acquired MRSA (CA-MRSA or CMRSA) is another common type of infection, and is seen most frequently in individuals participating in contact sports or those living in crowded or unsanitary conditions. While the average adult death rate among individuals with MRSA is estimated at five percent of infected patients, individuals with HA-MRSA are at an increased risk of experiencing complications including organ damage.

Dr. Marc Siegel, an associated professor of medicine at New York University, and others recommend an evaluation of the overuse of antibiotics by humans as well as in livestock as a means of eradicating MRSA and reducing drug resistance in other strains of bacteria. In addition, experts note the importance of good hygiene practices  including washing hands frequently, keeping wounds covered with bandages until they have healed, and washing soiled clothes and sheets in hot water can help to prevent the spread of MRSA. The timely diagnosis of individuals infected with MRSA achieved through an analysis of a skin sample helps to better ensure not only treatment for the individual, but also a decreased risk of infecting others.

Discuss this and other public health topics in the iCons in Medicine Forums


Physicians Using Social Media

March 22, 2010

Individuals and organizations have embraced the use of social media as a way to quickly and easily create and disseminate information, ideas, and experiences, using low-cost, web-based technology. Doctors and others in the healthcare industry have been among those utilizing these new tools, but this use is not undertaken without some concern regarding matters of patient privacy and the blurring the lines between physicians’ public and private personas.

Robert L. Coffield and Joanne E. Joiner report that to date there are at least 540 hospitals in the United States using social media tools to communicate to a general audience. This figure includes 247 YouTube channels, 316 Facebook pages, 419 Twitter accounts, and 67 blogs, and these numbers continue to grow. Further research indicates that though nine out of ten U.S. hospitals are utilizing social media in some way, only one third have a formal social networking plan in place.

Twitter, which has an estimated 6 million monthly visitors, was ranked by Neilson.com in March 2008 as the fastest-growing site in the Member Communities category for the previous month. Among the physicians using social media, particularly Twitter, to connect with patients and colleagues, are a number of “celebrity doctors,” some of whom have more than 75,000 followers. In addition to these practicing physicians, social media and social networking websites are particularly popular among medical students, residents, and interns.

Researchers from the University of Florida’s colleges of Education and Medicine 2008 conducted a survey of the Facebook profiles of medical students and residents. Over 800 medical students’ names were searched on Facebook, and 44 percent of them were found to have profiles. Of these 362, only 37 percent had restricted the level of access to information contained on their profile by altering privacy settings. Additionally, a recent survey of medical school deans indicates that medical students have been found to frequently post inappropriate material on social networking websites.The findings, published in the Journal of the American Medical Association, show that 60 percent of the 80 deans who responded to the survey knew of incidents of unprofessional conduct, and 13 percent admitted to incidents that violated patient privacy.

David H. Brendel, MD, PhD, chair of McLean Hospital’s Institutional Review Board, has similar concerns for medical students’ disregard for protecting patient privacy when posting information on social networking websites. In Dr. Brendel’s case, this concern extends also to practicing physicians using Facebook and other sites, and he advises the following four guidelines for doctors when using online networking websites:

  1. Address a patient’s online invitation immediately and in person to avoid damaging the therapeutic relationship.
  2. Do not include information obtained through social networking websites to a patient’s medical record without their consent.
  3. Use discretion when posting personal information online.
  4. Understand the privacy policies available on social networking websites and use them to limit access to personal information.

Some healthcare providers chose to connect with patients not only through social networking websites, but also to exchange emails. Results of a 2009 study by Manhattan Research indicated that five percent of approximately 9,000 U.S. adults who participated had send or received an email from a doctor, and 49 percent wanted to do so in the future. Additional data from Manhattan Research included in a report entitled indicate that experts in “Physicians in 2012: The Outlook on Health Information Technology,”five specialties are most likely to contact their patients via email or online messaging: dermatology, medical oncology, neurology, endrocrinology, and infectious disease.

Many physicians are still reluctant to employ the use of email or social media to connect with patients because of privacy risks, despite the potential for beneficial physician and patient interaction. According to Robert L. Coffield and Joanne E. Joiner, even physician-to-physician contact through social networking websites can be problematic if the individuals involved are not careful to ensure that patient information and identifiers are not shared. To prevent some of these issues, telemedicine programs are sometimes utilized. Telemedicine is defined by Merriam-Webster’s dictionary as “the practice of medicine when the doctor and patient are widely separated using two-way voice and visual communication (as by satellite or computer).” It has grown since its first inception to include not only physician-to-patient contact, but also physician-to-physician Unlike standard, “public” social networking websites, iCons in Medicine is medical social networking and telemedicine website which allows doctors to request and send teleconsultations on difficult cases. To ensure patient privacy, iCons in Medicine relies on secure connections and one-on-one sharing of patient data.

Physicians who would like to provide or request teleconsultations can register online to take part in the program. Non-physician individuals with an interest in healthcare can also sign up to participate in the iCons in Medicine network as General Members.


Medical Social Networking

May 12, 2009

Social networking websites have become increasingly popular in recent years. Kerri Breen of the CBC News reports that YouTube has become the third most popular website in the world, Facebook now has over 200 million users, and Twitter has grown 2,565 percent in the past year. Through the new channels offered by these social networking websites and tools, users can discuss anything from cat toys to a bothersome rash on their arms.

Fighting a Cold Online
The ever-increasing popularity of these Web 2.0 sites offers new opportunities for their application to improve health and medical care. The New York Times reports that during the last week of April, “Swine Flu” was the most searched term on Yahoo, the Wikipedia page on “Swine influenza” received 1.3 million page views, and an estimated 125,000 tweets a day on Twitter mentioned the illness. Despite this increase in discussion about the virus, Alessio Signorini, a PhD candidate in Computer Science at the University of Iowa, told the NYT that this “noise” does not indicate actual trends in the spread of the virus. Dr. Philip Polgreen further explained that by tracking indicators within popular search terms, such as symptoms of a condition or virus, it is possible to better track its spread and plan more effectively for inoculations.

Growth in Internet use has also led to a rise in self-diagnosis and/or self-prescription. Through tools like Twitter or Facebook, individuals can simply state that they do not feel well, and are much more likely to do so than to visit a doctor. While this could potentially lead to their not getting necessary treatment, other forms of web use may help to ease discomfort, physical and/or psychological, caused by certain conditions. A number of websites have been introduced which allow patients with specific conditions (e.g., MS, diabetes, eczema) to form a community. ABC Health and Wellbeing reports that research indicates that patients with psoriasis indicated their perceived quality of life had improved following the use of these online support websites. Center for Connected Health and Boston’s Massachusetts General Hospital researchers have also found that these online networks provide a valuable base of information and support to patients, and that health outcomes can be further improved through physician involvement.

A number of social networking websites have also been developed to allow physicians, clinicians, researchers, and medical specialists to link to one another and discuss various areas of their practice. In addition to sites which allow doctors to create social connections, others, like iCons in Medicine, provide the opportunity for healthcare providers in remote or medically underserved areas to request assistance on difficult cases from physicians in 30 medical specialties. Through these teleconsultations and the social networking tools provided by programs like iCons in Medicine, doctors can collaborate on difficult cases and improve patient health at the point of care.

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