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Subtitles may be coming for TV drug ads, the LMNO problem, & virtual reality called in to help hospital design

August 8, 2023
Reporter, Morning Rounds Writer
Good morning. I can't say I know much about virtual reality, but I love that kids are being enlisted to use it in a study to help improve the design of hospitals where they receive care. Mohana Ravindranath reports.

regulation

Coming soon to drug ads on TV (maybe): clearer messages about side effects

A display of TVs against an orange background.

Adobe

Hope you haven't been holding your breath, but regulators may soon weigh in on restrictions proposed 13 years ago to more tightly regulate those drug ads on TV we all love to hate. White House budget experts are now looking at changes the FDA suggested in 2010 to make sure commercials clearly show drug risks in ways that consumers will both notice and understand. That could mean cracking down on distracting visuals and requiring subtitles to explain safety concerns. 

Over the years drug companies have responded to criticism by saying TV ads prompt patients to talk with their doctors about a drug, but critics worry dangerous side effects are downplayed during typically upbeat commercials. STAT's John Wilkerson also notes a January study found that fewer than one-third of commonly advertised drugs had high therapeutic value, meaning only a fraction worked moderately better than existing therapies. Read more.


health

How a child's stressful life events affect the care they get

It's a searing list of horrors for children to live through, not quite captured in the CDC term "stressful life events": emotional abuse, unmet basic needs, experiences of racism, household mental illness, household substance misuse, parental incarceration, and exposure to neighborhood violence. For the first time, the 2021 National Health Interview Survey asked about these experiences for children between age 2 and 17 to see how they affected obtaining health care in the following 12 months. 

Today's report found that 1 in 5 children had lived through one of these events, and for them, emergency department visits were more common, as were unmet medical care needs due to cost. These children were also more likely to receive prescription mental health medications or therapy. They did get their well-child visits about as often as other kids, but "an annual well-child visit may not be enough engagement with the health care system," the researchers write.


practice of medicine

Opinion: Jargon shouldn't dictate care

Language can separate people in the know from people on the outside looking in. It can also drive in-the-know thinkers down the cognitive ruts. For doctors, that can mean jumbling acronyms for blood tests into one string of letters, for example. Writing in a STAT First Opinion, David Asch of the University of Pennsylvania and Roy Rosin of Penn Medicine remind us of the alphabet song: Kids start off enunciating "A, B, C," but smush letters together halfway through.

"We call this the LMNO problem: Contractions of language or contractions of behavior that reinforce each other. Once you recognize your first LMNO problem, you see them all over medicine." For lab work, that could mean needless tests and avoidable costs because CALCE-MAG-FOSS usually go together. "In the jargon of medicine, we should also make the right thing easier to say, because the easiest thing to say often defines the path taken." Read more.



Closer Look

Hospital design gets an assist from virtual reality

Researcher Priya Sathyanarayanan observing as a pediatric participant explores a hospital room in virtual reality.Courtesy XRLab Berkeley

When you think of a hospital, do harsh lights, bare walls, and windows facing parking lots come to mind? Now imagine that environment through the eyes of a child. To improve not just the experience but how young patients respond to care in hospitals, groups at UCSF Benioff Children's and Boston Children's, among others, are exploring ways to fold young patients' feedback into hospital design, like the color of walls and the placement of windows, art, and couches.

"Neuroarchitecture" isn't new, STAT's Mohana Ravindranath reminds us, but Haripriya Sathyanarayanan, a UC Berkeley Ph.D. candidate, is using a new tool to get a child's perspective: virtual reality to measure how comfortable 30 pediatric patients might be in differently designed hospital rooms. "Seeing the outside world is really nice, because a lot of times we're not allowed to leave our room or if we can it's just to our floor," high school student and study participant Ariela Rubens said. Read more.


cardiovascular health

One size does not fit all for blood pressure readings, study says

Blood pressure readings are a crucial part of health care, establishing risk for cardiovascular disease. Automated devices help people with hypertension track their progress at home, too. We're all familiar with that whoosh of an automated blood pressure reader, but how many of us have ever seen anything but one size cuff wrapped around our upper arms? Or ever had our arms measured?

A new study in JAMA Internal Medicine that tested cuffs in different sizes (too small, just right, too big) in 195 people with hypertension found strikingly inaccurate readings, depending on arm size. The bigger the cuff, the bigger the error, they report, and problems occurred not just among patients with obesity, but also those with relatively smaller arms. "With misdiagnosis to this degree comes additional, likely unnecessary, clinical testing (laboratory and imaging) and treatment, leading to increased cost, psychosocial harm, and risk for adverse events," they conclude.


addiction

Health care workers face higher risk of fatal overdoses

Amid the ongoing opioid overdose epidemic, health care workers may not come to mind as high risk. Their profile doesn't match trends in substance use disorder: Women are well-represented, particularly among nurses. They're well-educated and they have higher income. But new research in the Annals of Internal Medicine found a higher risk of fatal overdoses among registered nurses, health care support workers, and social or behavioral health workers than in the general population. 

The pre-pandemic study, which followed about 176,000 health care workers, did not find an increased risk of overdose deaths in physicians. The researchers note that registered nurses, social or behavioral health workers, and health care support workers may be at greater risk because they prescribe or administer medicines, experience job stress, and undertake physically strenuous tasks that could cause musculoskeletal injury resulting in opioid dependency.


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What we're reading

  • AI is acting 'pro-anorexia' and tech companies aren't stopping it, Washington Post
  • Attacks at U.S. medical centers show why health care is one of the nation's most violent fields, Associated Press
  • A new study put period products through the wringer. Discs came out a winner, STAT
  • Drug shortages are a boon to one industry: compounding pharmacies, Wall Street Journal
  • Sage considers ways to reduce costs following FDA rejection on drug for major depression, STAT

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