To Wait Or Not To Wait: Cord Clamping

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 After a child is born, the physician’s initial act is to clamp and cut the umbilical cord. Typically, that act occurs within the first fifteen or twenty seconds of the infant’s life while the placenta is still in the uterus. Historically, health care professionals recommended delaying the cutting of the cord only for babies who were born prematurely.  However, current studies show that waiting to cut the cord may be beneficial for all newborns.  For example, delaying the cutting of the cord may provide the infant with more placental blood.  That is important because roughly one-third of an infant’s total blood volume is in the placenta. That blood is necessary for the development of the infant’s lungs, kidneys, and liver. In addition, according to some studies, when physicians wait to clamp and cut the cord for at least two to three minutes, the infants have smoother cardiopulmonary transitions. Fetal blood contains a high concentration of stems cells that play an essential role in the development of the immune, respiratory, cardiovascular, and central nervous systems. For instance, persons conducting a Swedish study discovered that, of infants who had their cords clamped three or more minutes after birth, only .6% had an iron deficiency as compared to 5.7% of babies whose cords were clamped immediately after birth. It is not clear if delayed cord clamping could adversely affect infants. The results of an older study indicated that, when physicians delay cord clamping, there may be an increased possibility that the infant may develop jaundice, a buildup of blood that causes yellowing of the skin and eyes.  Presently, there are at least sixteen ongoing studies investigating the benefits of cord clamping. Many hospitals already have delayed clamping policies in place for pre-term infants. However, the number that have policies in place for full-term infants is unknown. With the growing acceptance of this practice, it is likely that we may soon see a rise in delayed cord clamping.

Deliberate Departure: A Candid Conversation About Physician-Assisted Suicide

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On March 7, 2017, the Center for Health Law and Policy will host a panel discussion about physician-assisted suicide.  The event will take place in the Moot Court Room at Cleveland-Marshall College of Law from 4:30 to 6:30.

Dr. Amanda Ward from Glasgow, Scotland will discuss the legal status of physician-assisted suicide in the United Kingdom.  Professor Browne Lewis, the Leon M. and Gloria Plevin Professor of Law at Cleveland-Marshall College of Law, will provide a detailed analysis of the legal landscape of physician-assisted suicide in the United States.

Dr. Michael Glasenapp, an attending physician at the Cleveland Clinic, will explain the position that the medical profession has taken on the legalization of physician-assisted suicide.  Dr. Paul Lauitzen from John Carroll University will examine the issue of physician-assisted suicide from a religion perspective.

After the program, the audience will be entertained by a Scottish bagpipe band.

FDA Requires Boxed Warnings on Hepatitis C Drugs

On October 4, 2016, the United States Food and Drug Administration (FDA) issued a safety announcement about the actions it plans to take with regards to Direct Acting Antiviral (DAA) medicines used to treat chronic hepatitis C virus (HCV). HCV is an infection that can last a person’s entire life. The virus is spread by blood contact, including transfusions, infected needles, and mother-to-baby transmission during child birth. DAA medicines reduce the amount of HCV in the patient’s body by preventing HCV from multiplying. In most cases, a patient suffering from HCV can be cured by taking the DAA medicines. If left untreated, HCV may lead to serious liver problems, including cirrhosis, liver cancer, and death.

Unfortunately, drugs that may cure HCV can cause flare ups of the hepatitis B virus (HBV). Currently, there is no cure available for HBV. It is transferred by bodily fluids. HBV reactivation may occur in any patient who has currently or previously been infected with HBV and is undergoing DAA treatment for HCV. The FDA has identified twenty-four cases of HBV reactivation in patients who had ingested DAA medicines. According to the FDA, the reported cases included two patients who died and one patient who needed a liver transplant.

As a consequence of its findings, the FDA is requiring that a Boxed Warning, the agency’s most prominent warning, about the risk of HBV reactivation be placed on the labels of DAA medicines. The warning would direct health care professionals to screen and monitor for HBV in all patients being treated with DAA medicines. In addition to being placed on the labels, the new warning will be included in the patient information leaflet or the Medication Guide for DAA medicines that comes with each new prescription.

The new warning would mandate that health care professionals screen all patients for evidence of current or prior HBV infection before starting treatment with DAA medicines, and monitor patients using blood tests for HBV flare-ups or reactivation during treatment and post-treatment follow-up.

 

 

 

A Night of Celebration-St. Vincent Charity Medical Center

Recently, I attended St. Vincent Charity Medical Center’s Caritas Awards celebration. The purpose of the celebration was to honor four individuals whose lives embody the mission of the Sisters of Charity of St. Augustine.

The first recipient of the evening was Dr. Lloyd Cook. Dr. Cook was recognized as the Physician of the Year. The award was given to Dr. Cook because of his passion for healing and his commitment to his patients. For example, Dr. Cook’s practice was recognized with a Gold Star Achievement Award from the Better Health Partnership for the successful treatment and management of his patients with hypertension. The award was presented by Tony and Rachelle Coyne.

The second award winner was Cleveland attorney Margaret Wong. Attorney Wong received the St. Vincent de Paul Award, an award that is given to acknowledge community service. In an attempt to serve others, Attorney Wong has created several endowed scholarships. She also contributed the largest leadership gift to St. Vincent Charity’s “Care Beyond Medicine” campaign. The award was presented by Sister Judith Ann Karam and Dr. David F. Perse.

The third person to be honored was Mary Martin, a nurse at St. Vincent Charity. Nurse Martin was given the Clinical Nursing Excellence Award because of her dedication to her patients and her contributions to the nursing profession. For more than fifteen years, Nurse Martin has cared for patients in St. Vincent Charity’s post-surgery recovery unit. The award was presented by Zydrunas and Jennifer Ilgauskas.

The final award presented was the Radiant Sprit Award. That award was given to Eugene Jordan, a painter at St. Vincent Charity. Mr. Jordan has worked at St. Vincent Charity for over thirty years as a painter in plant operations. Mr. Jordan has spent his life mentoring and encouraging others, especially children. For the last ten years, Mr. Jordan has played Santa Claus at Marion Sterling School. The award was presented by the Honorable Kevin J. Kelley.

St. Vincent Charity has occupied the Central neighborhood in Cleveland for over 150 years. It shares the Campus District with Cleveland State University. The celebration included an announcement describing the manner in which these two institutions will work together to improve the lives of the people living in the community.

 

The leaves are changing colors and slowly falling from the trees. October is the gateway between Fall and Winter.  It is also the official start of influenza (flu) season. In 2015, there were over 40 million cases of the flu and 970,000 people were hospitalized because of the illness.

The flu is more than an inconvenience. For some people, the flu can be dangerous.  Young children and elderly persons are at the most risk.  However, the Centers for Disease Control (CDC) recommends that every person over the age of six months get the flu vaccine. According to Dr. Tom Frieden, the director of the CDC, a 5% increase in flu vaccination would prevent 800,000 illnesses and 10,000 hospitalizations. The traditional flu vaccine protects against three or four strains of the flu virus.

You should talk to your doctor before getting a flu shot if you have had an allergic reaction to a flu shot or you are suffering from Guillain-Barre syndrome or another serious illness.

The majority of flu is spread by young, healthy, unvaccinated children and adults. It takes about two weeks for the vaccine to take effect.  Fall is known for fairs, football and the flu.  Enjoy the first two and take steps to avoid the third one.

RioWaterMost of the sports included in the Winter Olympics are held on the snow. A significant number of the competition at the Summer Olympics take place in the water. In 2008, when the International Olympic Committee (IOC) selected Rio de Janeiro (Rio) to host the Olympics, the members were concerned about water pollution in that country. Before the 2016 Summer Olympics started, Rio officials took steps to ensure that the water would be safe for the athletes. Athletes like swimmer Michael Phelps probably felt protected because of the bacteria-killing chlorine used to treat the pools. However, there was some cause for concern when a diving pool turned green and emitted a foul odor. Eventually, officials concluded that the green color was a result of a proliferation of algae and posed no threat to the athletes.

Officials may have a difficult time easing the fears of sailors and other athletes who compete in events that take place in the sea. Raw sewage has been washing down from Rio into the Guanabara Bay for decades. As a result, the water is horribly polluted. For example, an independent study conducted by the Associated Press showed that the water contained high levels of viruses and bacteria from human sewage. In addition, experts confirmed that they found the super bacteria carbapenem-resistant Enterobacteriaceae (CRE) in several of Rio’s beaches and in the Rodriogode Freitas lagoon. The lagoon empties into the Guanabara Bay where the Olympic sailing competitions are held. CRE refers to a family of germs that is highly resistance to antibiotics. Exposure to water contaminated with CRE may put sailors with open wounds at risk for urinary tract, blood, and wound infections. In Rio, some of the sailors are washing themselves and their boats with soap as soon as they get out of the Guanabara Bay. Because only one athlete has become ill as a result of being in the water it appears that the precautions are working. Nevertheless, athletes are putting themselves at risk in order to fulfill their dreams of Olympic gold.