Kids and Prescription Drug Use

high school kids

Take a moment to think of a typical high school scene; a classroom full of students, a teacher scratching at the chalkboard, kids writing notes.   Chances are 24 percent of those kids have misused or abused prescription drugs at some point in their life, a staggering number that affects 5 million American adolescents.

A look at the statistics

Misusing or abusing prescription drugs can lead to impulsive or risky behavior and to poor judgment in general. They are a contributing factor (along with alcohol and illegal drugs) to the three leading causes of death for adolescents; car accidents, homicide and suicide. For instance, unintentional poisoning deaths (due to drugs and other substances) increased by 91 percent from 2000 to 2009 for 15 to 19 year olds and by 36 percent for those between 10 and 14 years of age.

prescription drug use for teens

credit: Drugfree.org

Parents may be contributing

The Partnership Attitude Tracking Study (PATS) has shown a lax attitude from parents.

  • 23 percent of teens say their parents show less concern if they are caught using prescription drugs not prescribed to them v.s. using illicit drugs.
  • 32 percent of parents say they believe RX stimulants like Ritalin or Adderall can improve a teen’s academic performance even if the teen doesn’t have ADHD.
  • Only one in 100 parents thinks their teenagers use “study drugs” while one in eight 12th graders report using them.
  • 27 percent of teens believe that misusing and abusing prescription drugs is safer than using illicit drugs.

Emergency room visits refute the last bullet point. There were 55,306 visits to the emergency room for illicit drug use among children and adolescents in 2009 v.s. more than 66,000 visits for prescription drugs. Pain relievers such as opioids were the most commonly reported drug.

If parents think prescription drugs are safer, will they be less inclined to teach their kids to stay away from them? How can pediatricians and family practice physicians change attitudes about drug use and teens?

There have been studies that suggest that primary care behavioral interventions are not that effective and the best way to influence a child is through the home.   Top risk factors include:

  • Substance use by family members (specifically parents and/or siblings)
  • Poor parental supervision
  • Household disruption

Top Protective Factors include:

  • Parents who set clear rules and enforce them
  • Parents who regularly talk with their children about the dangers of substance use
  • Having a parent in recovery

How can physicians work to improve patient safety and discourage any form of substance abuse? Should the target be educating the child or educating their parents or both? As an M.D. or D.O. how do you educate your patients? If you are a physician, please join us inside Sermo as we discuss this important topic in more detail.

Doctor Profile: Inga Hofmann-Zhang, M.D.

leukemia, rare blood diseases

Bone marrow necrosis in myelodysplastic syndrome. Credit: Hematology.org

 

Inga Hofmann-Zhang, MD, PhD, is a real threat against children’s cancer. She is a hematologist, oncologist and researcher working at Boston Children’s Hospital, the Dana-Farber Cancer Institute, and Harvard Medical School.

One of her biggest achievements is the development of a national multi-center patient registry for childhood Myelodysplastic Syndrome (MDS) and Bone Marrow Failure Disorders (BMF). She has also worked as part of a team to isolate the first gene related to these rare disorders and hopes to find more with her continuing research.

We had the opportunity to sit down and talk with Dr. Hofmann-Zhang about her work, she gives us a fascinating look at rare childhood diseases .

Tell us a little bit about what you do?

My niche is in pediatric oncology, specifically BMF. BMF is a pre-leukemic condition that can lead into leukemia and is often very difficult to treat. The only curative treatment is a transplant. I’m the local expert for this disease group and for MDS another rare bone disorder.

What percentage of your patients have a genetic component to their disease?

It’s probably very large, although the exact percentage is unknown. For years I have been thinking that most of our pediatric patients that get MDS probably have a genetic component, an inherited predisposition that puts them at risk for getting these disorders. Only one gene has been found over the last couple of years that show there is a familial connection. My research focuses actively on finding other genes that might fall into this category and help us treat these disorders.

What I’m doing now is using the registry for MDS and BMF to collect clinical data and research samples. Genetic discovery is one main focus, can we find other genes that explain why patients get this in the first place?

We had an index family that was very puzzling to our staff, they were siblings and through analysis we found a number of candidate genes. We analyzed the whole registry of 225 patients and found about 15% of the patients have the same genetic mutation.   That knowledge is quite important. It can have an impact on care for the patient and their families. If one individual has the gene we might consider evaluating the rest of the family, as well.

Any new discoveries with bone marrow transplants?

Bone marrow transplants have come a long way in terms of the type of conditions we transplant as well as our outcomes. It’s a very harsh and toxic treatment with a lot of potential side effects and definitely a chance of dying from the actual procedure.

We have gotten a lot better at making transplants more effective and to decrease toxicities and side effects for many conditions. As for conditions we treat, traditionally it was done for malignant conditions, relapsed leukemia or sometimes for solid tumors. Now there are conditions we’ve started to do transplants for that aren’t malignant such as adrenoleukodystrophy and immunodeficiency syndromes.

How is your success rate?

It’s hard to put a number to it, with MDS the overall cure rate is 50 percent, plus or minus but it depends on the stage and grade of the disease. A lot of our patients we catch early and with bone marrow transplants they have a very high rate of cure rate as high as 80 percent to 90 percent.

Do you ever have problems finding donors?

Inga Hofmann, M.D. Boston Children's Hospital and Dana-Farber

Inga Hofmann-Zhang, M.D. Boston Children’s Hospital and Dana-Farber

For almost everyone we find some source of stem cells. There’s up to 15 million people in the registries now that we can draw from. For almost all patients we find a donor, it’s not always a perfect one but an acceptable one in most patients. An alternative source could be umbilical cord blood. Some people have a hard time if they have an HLA type that is very rare.

As an M.D. or D.O. we welcome comments below or inside Sermo as part of a community discussion. Have you ever worked with a rare disease specialist on a patient case?

If you’d like to learn more about Dr. Hofmann-Zhang you can view a video of her here.

 

Concussions, Kids and Sports: Should we set limits?

 

doctors and concussions, physicians and concussions

Click to enlarge

Physicians made it clear in a recent poll that age limits and warnings are needed for children playing sports as a way to decrease the rate of incidence and severity of concussions.  Fully 90 percent of nearly 2,350 Sermo Physician Poll support age limits or warnings about concussions for child athletes.

The question posed: Do you think age limits should be imposed in sports (like football or soccer) that may cause concussions in children?

  • 48% Yes, impose age limits
  • 42% No, but warnings should be issued
  • 10% No, no limits or warnings necessary

Perhaps one neurologist inside Sermo summed it up best,

“There is not a day goes by (and I see 4 to 5 concussed athletes per day, sometimes more) that I don’t see an athlete who was put back in the game or left in the game after suffering a sports related head injury.”

Not all concussions are sports related

Sports injuries caused 46.5 percent of all concussions. Football players are most likely to receive an injury during play, accounting for 22 percent of all sports related injuries. These stats were presented last week at the American Medical Society for Sports Medicine (AMSSM).

An emergency medicine Sermoan wrote, “Part of the reason they sustain injuries playing organized sports is that they no longer play UN-organized sports … I contend that the reason you see injuries from organized sports (played too early and too intensely) is that it’s the only place kids are allowed to stretch their wings and take some chances.”

Girls suffer more than boys

While a football player is the poster child for childhood athletic concussions, girls are suffering more severe concussions with longer recovery times.   One study reported that females are more likely to suffer concussions while playing soccer or basketball or while biking.

The researchers from the AMSSM showed “overall, females reported higher symptom scores at the initial visit and had longer symptom duration than males. Females also were more likely to require neuropsychological testing than males, which might indicate that concussions have a greater impact on female pediatric patients.”

High school athletics aren’t helping

A study of 778 high school athletes, both girls and boys, shows how common injury happens and how often children play while injured. During the season 11.1 percent of girls playing soccer and 10.4% of boys playing football, had a “concussion incident.” 69 percent of concussed athletes reported playing with symptoms and 40 percent reported that their coach was not aware of their concussion.

Does this highlight the need for more vigilance from coaches and other side-line supporters to make sure kids get taken out of the game when an incident occurs? Do we need to educate kids more about the dangers so they don’t under-report their symptoms to stay in the game?

Sub-clinical injuries do cumulative damage

A paper presented last week at the American Association of Neurological Surgeons (AANS) shows that even less severe impacts have a toll over a season of athletic play.

The researchers looked at 45 high school football players and instrumented them with Head Impact Telemetry Systems (HITs). They also did MRI scans pre- and post-season.  “We demonstrate that a single season of football play can produce MRI-measurable brain changes that have been previously associated with mild traumatic brain injury,” the authors wrote.

Return to Play Laws

Clearly there are many issues – from awareness to diagnoses to the spirit of athletic play – that need to be considered when it comes to children’s safety. Currently nearly every state, with the exception of Mississippi, has “return to play” laws. They cover educating coaches parents and athletes, and guidelines for removing and returning athletes to play.

Currently there is no legislation that sets age limit for contact sports although 14 has been mentioned for football and 10 has been proposed by a few groups.  The skull hardens to adult levels around the age of 15.

What do you think about concussions and child athletes? When should a child be allowed to play full contact sports? Should we just let kids play or come up with age restrictions and better guidelines to protect them? We discuss concussions and children regularly inside Sermo. If you’re an M.D. or D.O. we’d love to have you join us in the community.

Sermo Reaches 260,000 Physicians

Sermo, Sermo MD

Sermo has swelled its membership numbers by 30 percent in just six months with a focus on clinical and practice management discussion. Now surpassing 260,000 members, we are taking a moment to thank our physicians for their support.

Our physicians are changing the face of medicine as they actively discuss clinical cases and challenges of being a physician in the rapidly changing world of medicine. From discussions on genetic research to reviewing new surgical techniques, Sermo doctors have grown their engagement on the platform. Mission work is often mentioned, and answering each others’ daily practice questions remain frequent topics of interest.

At the core of Sermo’s recent resurgence is our focus on clinical collaboration through upgrades to our iConsult app. Physicians can upload patient information and request consults from specialties of their choice – “expert targeting”. In real-time, doctors crowdsource their collective expertise and bring the collective knowledge of an average of 200 years of medical schooling and experience to each patient case.

Over the years, physicians collaborated on tens of thousands of cases and although many successes go unreported, over 50% of iConsult cases posted are “Solved on Sermo.” Our average solve time is just 20 hours and most cases receive a first reply within 10 minutes.

“There’s a reason Sermo is experiencing another period of hyper-growth coupled with an all-time high engagement levels,” said Jon Michaeli, SVP ofglobal community at WorldOne. “We’ve become the hub for scientific discussion, clinical collaboration, healthcare thought leadership, and learning throughout the medical world. We see again and again how Sermo helps physicians in critical moments and delivers resources that save lives. That’s what makes Sermo different from any other healthcare social network or community.”

Our HUBS – complex disease state and medical specialty knowledge bases – continue to grow, and we will be introducing a handful more before the end of 2014.

We’ll soon commence landmark collaborations with leading teaching hospitals and research centers as we aggregate and reflect physicians’ opinions and experiences. Our Sermo Physician Polls already have had an impact on the conversation surrounding medicine.

Sermo is Latin for “conversation”, we work everyday to keep our physicians’ voice in the center of the healthcare dialogue. If you are an M.D. or D.O. please join us inside the community and join your colleagues in being heard. We’ll see you inside.

Math and Cancer: How Researchers Are Improving Patient Outcomes

breast cancer cells

Algorithms can help beat cancer in a new approach to personalized medicine.

Researchers at Dana-Farber Cancer Institute have developed a mathematical model to help predict tumor growth and how it’s likely to behave given different treatment options.

The study analyzed breast cancer samples from 47 patients undergoing pre-operative chemotherapy to shrink their tumors. Biopsy samples were taken at diagnosis and again when chemotherapy was completed.

Tumors contain a variety of cancer cells that change over time, known as tumor heterogeneity. The researchers looked at the changing gene information to help pinpoint the best treatments. They found gene location within a tumor and heterogeneity changes affected patient outcomes.

After analyzing the information they found a few trends:

  • Cancer treatments with zero or partial response had few changes in how many copies of DNA segment are present.
  • Tumors with less genetic diversity respond better to treatment than tumors with more genetic complexity
  • Cancer cells that grow more rapidly seem to be easier to kill with treatment

Physicians in the near future can run a gene sample and target the best treatments for their patients, potentially improving patient outcomes.

Oncolytic viruses can get a math assist

Researchers in Ottawa have also been using mathematical models to predict which tumors will respond to “cancer killing viruses.” Oncolytic viruses can be introduced into a cancer patient. The virus will target cancer cells while leaving healthy cells alone. The results can be dramatic but only if the cells are susceptible to the infection.

Dr. Mad Kaern, Canada Research Chair at the University of Ottawa Institute of Systems Biology said, “By using mathematical models to predict how viral modifications would actually impact cancer cells and normal cells, we were able to accelerate the pace of research. It allows us to quickly identify the most promising approaches … something that is usually done through expensive and time-consuming trial and error.”

What do you think about mathematical modeling to improve cancer outcomes? How about the layering of algorithms with genetic testing? We’ll be talking about this in more detail inside Sermo, if you’re an M.D. or D.O. please join us.