Published August 5, 2023
Morning Report — Not Your Typical Medical Newsletter
We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.
We’re kicking off this month with a love story featuring a practice-changing invention.
Picture it—Johns Hopkins Hospital, 1890. William Stewart Halsted, the “Father of Modern American Surgery,” serendipitously invents the first set of surgical gloves to appease his chief nurse and love interest, Caroline Hampton. She had threatened to quit after experiencing continuous skin irritation from the chemical dip Halsted required for his surgeries. Halsted later wrote, “As she was an unusually efficient woman, I gave the matter my consideration and … requested the Goodyear Rubber Company to make … two pairs of thin rubber gloves with gauntlets.” He presented her with gloves made from plaster casts of her hands, and the two shortly wed. Who needs an engagement ring?
The adoption of the gloves by nurses and later surgeons at the famed Johns Hopkins Hospital sparked their widespread use. It seems love is the mother of invention.
Alarming Uptick in Red Meat Allergy
INFECTIOUS FINDINGS
This month in tick news: these blood-sucking arthropods, whose reputation was already at a pop-quiz level of contempt, are making headlines once again. If you haven’t heard of the tick-borne illness alpha-gal syndrome (AGS), you’re not alone. The CDC estimates 42% of clinicians may have missed the memo on this potentially life-threatening allergic condition. But new AGS prevalence data from the CDC suggest it’s time to pay close attention.
What is AGS?
It’s an allergic reaction to primarily red meat set in motion by a tick bite. A lone star tick carrying alpha-gal, an oligosaccharide found in most mammals, but not humans, infects a person. That person then experiences an immune reaction when they later eat alpha-gal-containing food (eg, pork, beef, venison, gelatin, dairy products). That reaction—typically occurring several hours after the consumption of the alpha-gal—results in vague symptoms like hives, shortness of breath, and GI effects, rendering this syndrome difficult to diagnose (and on brand with other perplexing tick-associated illnesses). Severe reactions even include anaphylaxis.
If you haven’t yet seen a patient with AGS, you may soon. The CDC reports 110,000 confirmed cases between 2010 and 2022 but estimates the actual number could be closer to half a million. And it’s not a Texas thing. “Lone star” describes the tick’s star-stamped shell. Its US prevalence, as shown here, is concentrated in the East but stampeding out West like a tick-borne gold rush.
Key takeaways
The CDC urges clinicians to educate themselves on AGS to improve stats like this one: Nearly 80% of people with AGS go undiagnosed for the first seven years. Scientists haven’t developed a cure or a vaccine (yet). Treatment is tick bite prevention and avoidance of allergy triggers. Patients with AGS may need to go cold turkey (or fish or chicken) on red meat. With avoidance of allergy triggers and dodging of subsequent tick bites, AGS typically clears up after two to three years. But it could also last a lifetime.
All Work and No Play Makes Residents More Error Prone
QUALITY CARE CONUNDRUMS
William Stewart Halsted was not only the Father of Modern American Surgery and “King of Romantic Gestures” (see top blurb), he was also founder of the modern medical training model in 1897. He expected trainees to reside at the hospital (hence the term “residents”) and work unlimited hours. Well, what happened in 1897 didn’t stay in 1897. The ACGME currently allows resident shifts up to 28 hours and workweeks up to 80 hours. But a new study suggests this practice may spell peril for patients and residents, even those with more experience.
In a nationwide prospective cohort study, nearly 5,000 medical residents in year two and beyond completed a four-year survey on patient safety outcomes and their own work hours. Researchers found that senior residents who worked >48 hours/week reported increased errors, preventable adverse events, occupational exposures, and percutaneous injuries. The errors (and associated patient deaths) rose steadily when residents worked 60, 70, and 80 hours.
Key takeaways
These results validate the National Academy of Medicine’s concerns from 2008, the same concerns that prompted the ACGME to limit PGY1 interns’ shifts to 16 hours in 2011. Yet the ACGME has provided no such protection to senior residents, essentially giving them the “With great power [experience] comes great responsibility” Spider Man speech. But this latest study suggests senior residents aren’t superhuman and may, in fact, have physiologic limitations.
Some argue that shorter shifts will mean more patient handoffs and a potentially lethal game of telephone, but continuing to overwork young physicians is a dangerous solution. This study is a wake-up call for innovative strategies that keep patients safe and prevent younger physicians from hitting the eject button on their careers.
Whole-Fat Dairy Finds Redemption?
DIETARY DIGEST
The American Diabetes Association, the American Heart Association, and just about every trusted source agree: low-fat/nonfat dairy—as opposed to whole-fat—is the way to go for optimal health (beyond infancy age, of course). But a new large cohort study published in the European Heart Journal U-turns away from this long-standing dietary recommendation in the name of evidence-based research.
Whole-fat cream rises to the top
Researchers from the multinational Prospective Urban and Rural Epidemiological (PURE) study collected self-reported data from nearly 150,000 people to determine which foods are most protective against cardiovascular disease (CVD) and premature death. Without getting too far into the study design weeds (we’re afraid of the lone star tick), we’ll just say that the researchers developed an elaborate zero-to-six–point scoring system that rates the protective value of a person's diet based on their intake of the following food groups: fruits, vegetables, legumes, nuts, fish, and dairy—whole fat. A higher score equals a healthier diet. At 10-year follow-up, those who scored five or more points saw greater risk reductions in mortality (30%), CVD (18%), myocardial infarction (14%), and stroke (19%) than those scoring one or less. The big surprise: whole-fat dairy held its own among the usual suspects of protective foods.
Key takeaways
The study authors assert that science supports adding whole-fat dairy to the list of recommended foods, but before we take an eraser to current guidelines, let’s zoom out a bit. The study’s strength (ie, large scale, diverse population) is also a limitation. The study sampled participants from high-, middle-, and low-income countries, and “the associations were strongest in areas with the poorest quality diet,” said senior author Prof. Salim Yusuf. Expectedly, consuming whole-fat dairy would improve health outcomes in those with limited access to food. This study offers food for thought but needs further validation from robust US trials. For now, we’re passing on the scoop of whole-fat ice cream in favor of a grain of salt.
FDA Approves …
AHA Clears the Air: E-Cigs as Harmful as Traditional Cigs
CARDIO CORNER
How it started: The early 2010s saw e-cigarettes rise in popularity like autotune up the pop charts. Marketing execs asserted that the limited ingredients and lack of combustion made e-cigs a “healthier” alternative to traditional cigs, and audaciously slapped a “tobacco cessation product” claim on them. Meanwhile, the American Heart Association (AHA) was giving e-cigs a skeptical side-eye and calling for more regulation.
How it’s going: Approximately 2.55 million children and teens are using e-cigs, or vaping (up a half million from 2021). And the AHA’s early whispers of concern have now reached a crescendo. The healthcare giant recently released a new scientific statement outlining the link between e-cigs and increases in
- hemodynamic measures like heart rate and blood pressure
- COPD, chronic bronchitis, emphysema, and asthma
- EVALIs (e-cigarette or vaping product use-associated lung injuries)
- substance use disorders
- use of other tobacco products (ie, e-cigs seemingly do NOT promote smoking cessation)
Key takeaway
We doubt you’ve fallen off your chair reading that inhaling a “cocktail of nicotine, thickeners, solvents, and flavors” likely wreaks havoc on the pulmonary and cardiovascular systems. But the AHA hopes that sounding the alarm and putting more research muscle behind identifying the long-term effects of vaping will help curtail it's widespread use. Data from 2019 showed that almost a quarter of US high schoolers use e-cigs. On the flip side, the trendline for traditional smoking has sloped down to its lowest rate since the Surgeon General first alerted the public to its hazards nearly 60 years ago. Let’s hope progress is considerably faster for vaping decline.
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- End of AIDS could happen by 2030, UN says
- Racial and ethnic differences in males with melanoma: A retrospective cohort study of 205,125 cases from the National Cancer Database
- Risk for chronic kidney disease progression after acute kidney injury: findings from the chronic renal insufficiency cohort study
- Coffee consumption decreases the connectivity of the posterior Default Mode Network (DMN) at rest
- Preliminary clinical and cost effectiveness of augmented depression therapy vs cognitive behavioral therapy for the treatment of anhedonic depression (ADepT)
Morning Report is written by:
- Alissa Scott, Lead Author
- Emily Ruge, Author, Editor
- Aylin Madore, MD, MEd, Editor
- Ariel Reinish, MD, MEd, Editor
Would you like to share your feedback with Morning Report? Drop us an email at morningreport@pri-med.com to let us know how we’re doing.
Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.
Enjoying Morning Report? Subscribe & Share It With Your Colleagues!
Is Morning Report for you? It is if . . .
You're someone who needs quick-hitting, accurate medical news and you're a fun and witty healthcare professional who wants your news with some flare.
You don't just need to know about the latest metabolism study–you also need to know how it parallels an Alanis Morissette hit. If you're reading about acupuncture treatment, you need us to skip the needle puns and get right to the point. We keep things simple, but when we do get into the scientific weeds, we always remind you to check for ticks.
Subscribe to receive the Morning Report directly in your inbox the first Saturday of every month.
As a leader in CME/CE for 27+ years, Pri-Med provides evidence-based in-person and online CME/CE for primary care clinicians. Explore our education to earn credits and stay informed on the most current clinical strategies relevant to your daily practice.