Morning MEDtalks with Dr KK Aggarwal 20^th November 2018

Noise pollution is a rising problem in hospitals: In an editorial published Nov. 18, 2018 in the BMJ, researchers from Kings College London and the University of the Arts London argue that it is a worsening problem, with levels regularly exceeding international recommendations. Dr Andreas Xyrichis, lead author said, “Even in intensive care units, which cater for the most vulnerable patients, noise levels over 100dB have been measured, the equivalent of loud music through headphones.”

Issues to be addressed in noise pollution in hospitals (BMJ, Nov. 18, 2018)

1. Noise is often incorrectly associated with high sound pressure levels (SPLs). Dripping taps for example, may register low SPLs yet still be considered noisy. Prioritising SPL reduction does not ensure improved noise perception. Therefore, a new approach is needed, one that views the hospital soundscape as a positive and malleable component of the environment.
2. There are a number of potential sources of noise in hospitals. Alarms, televisions, rattling trolleys, and ringing phones, as well as staff, visitor, and patient conversations. However, not all of them are perceived as noise by patients - for example, some find the sound of the tea trolley pleasing, associating it with receiving a warm drink. Research has also shown that some ICU patients welcome ringing telephones as a sign that they are not alone. So far ways to measure patients perceptions of noise are limited, and more research investment is needed in this area.
3. Patients and families need clear information about likely noise levels during admissions, so they are better prepared in advance, and can consider simple solutions such as headphones with their own choice of audio content. Education for staff is also needed, to encourage a culture that considers noise reduction an integral part of safe high quality healthcare.

Is skipping med school lectures making inferior doctors? A recent study “Classroom attendance patterns and examination performance in pre-clinical medical students” by a research team at the University of Central Florida College of Medicine, led by assistant professor of pediatrics Christine A. Kauffman, MD, found that lecture attendance during medical school is not as predictive of good grades as is general perceived, given how much we pay for this seemingly invaluable resource. However, this study was undertaken in the second year, which is preclinical and which also means that all lecture-based materials were available online and attending classes in person did not mean that they did not have the class material… (Medscape)

Bullying and violence at work increase the risk of new-onset cardiovascular disease, including heart attacks and stroke, according to the largest prospective study involving nearly 80 000 employed men and women from Denmark and Sweden to investigate the link published in the European Heart Journal on Monday. The population attributable risk (PAR) was 5.0% for workplace bullying and 3.1% for workplace violence, comparable to those for standard risk factors, e.g. diabetes (4%) and risky drinking (3–6%).

Oral immunotherapy for peanut allergy: In the phase 3 PALISADE trial of oral immunotherapy (AR101) in children and adolescents aged 4–17 years, who were highly allergic to peanut, treatment with AR101 resulted in higher doses of peanut protein that could be ingested (tolerated) without dose-limiting symptoms and in lower symptom severity during peanut exposure at the exit food challenge than placebo. Overall, 67% of the participants in the active-drug group could tolerate a single dose of at least 600 mg of peanut protein, the equivalent of approximately two whole peanut kernels, during the exit food challenge… (New England Journal of Medicine, November 18, 2018).

AAP urges reforms to help teens and young adults overcome health care hurdles: In a new policy statement published Monday in the journal Pediatrics, the American Academy of Pediatrics (AAP) encourages pediatric training in community health issues such as strategies for prevention and treatment of common diseases in low- and middle-income countries. It also encourages pediatricians to be informed on best practices regarding international medical work for example how best to work with local partners to ensure awareness and respect for global health ethics … (AAP, Nov. 19, 2018).

EMA Panel recommends first oral-only treatment for sleeping sickness

The Committee for Human Medicinal Products (CHMP) of the European Medicines Agency (EMA).European Medicines Agency has adopted a positive opinion for Fexinidazole Winthrop (fexinidazole), the first oral-only medicine (tablets) for the treatment of human African trypanosomiasis, commonly known as sleeping sickness, due to Trypanosoma brucei gambiense.

5 facts about antimicrobial resistance (The Association of the British Pharmaceutical Industry)

1. One person a minute. In the UK 5,000 people are estimated to die each year (Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations, Dec 2014) from a bug resistant to antibiotics, although due to non-recording of antimicrobial resistance on death certificates this is likely to be much higher. Global figures are even harder to ascertain but estimates suggest that 700,000 are dying each year. That’s one person a minute.
2. 12 Priority Pathogens. In 2017, the World Health Organisation published the first ever list of 12 priority pathogens that are antibiotic resistant. These pathogens are ranked into three categories; critical which includes multidrug resistant bacteria (most likely to affect those in hospital or care home settings), high and medium priority which are the more common diseases which are increasingly containing drug-resistant bacteria such as gonorrhoea and food poisoning from salmonella. These pathogens pose the greatest risk to healthcare right now.
3. 11 million days of unnecessary antibiotic use. Prevention is always critical to tackling a problem. If every child in the world was to be vaccinated against pneumonia, meningitis and middle ear infections (one vaccine), it would prevent an estimated 11 million days of antibiotic use each year (Why is vaccination important for addressing antibiotic resistance? Q&A, WHO, Nov. 2016).
4. One in 5 antibiotic prescriptions is unnecessary. Research from British Society of Antimicrobial Chemotherapy found that one in 5 antibiotic prescriptions is unnecessary (J Antimicrob Chemother. 2018 Feb 1;73(suppl_2):ii36-ii43).
5. 70% of people get annoyed if they aren’t prescribed antibiotics. Evidence from the Wellcome Trust (Exploring the consumer perspective on antimicrobial resistance, Wellcome Trust, June 2015) shows that the general public feel irritated or that they haven’t been taken seriously by their GP if they’re not prescribed antibiotics. Increasing public awareness of antibiotic resistance and when and how to take antibiotics is crucial to supporting appropriate prescribing now and preventing the spread of antimicrobial resistance in the future.

Video to watch: TEDx Video: Doctor-patient relationship www.youtube(dot)com/ watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President Heart Care Foundation of India