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This page shows you the most recent publications within this specialty of the MedWorm directory.

Reserve Requirements Basel Style: The Liquidity Coverage Ratio
Over the last couple of decades, reserve requirements all but vanished as a means of bank regulation and monetary control. But now a new variation on reserve requirements is being introduced through the capital controls of the Basel Accords. Canada, the UK, Sweden, Australia, New Zealand, and Hong Kong have all abolished traditional reserve requirements. In many other countries, reserve requirements have become a dead letter. In the U.S., for instance, the Fed under Alan Greenspan reduced all reserve requirements to zero except for transactions deposits (checking accounts), while permitting banks to evade reserve requireme...
Source: Cato-at-liberty - July 31, 2015 Category: American Health Authors: Jeffrey Rogers Hummel Source Type: blogs

She became a hospice nurse because of this story
The woman lying on the transport cot in the examination room was terrified. I could see it plainly in her eyes, but there was no time to stop and comfort her. I was a young, recently graduated nurse in a busy urban emergency room, struggling to keep up with its daily array of shootings, stabbings and crises. ER nurses hustled. We dealt with life and death, and we did it quickly. That may be why I paid so little attention to the pain and fear in the woman”s eyes. I asked her to get onto the examination table and duly recorded the facts: Her last menstrual period had taken place several months before; her bleeding and ...
Source: Kevin, M.D. - Medical Weblog - July 31, 2015 Category: Journals (General) Authors: Tags: Patient Nurse Source Type: blogs

Taking On The Inequities Of Rural Life: Is Life In Rural America Good For Your Health?
Is rural living good for your health? If you’re one of a quarter billion Americans who live in metro areas, you may be conjuring up an idyll of burbling streams and fresh air. But rural Americans are more likely than city dwellers to live in poverty, according to federal data compiled by the National Rural Health Association. Rural poverty rates are especially high among ethnic minorities and children, according to an analysis of Census Bureau data by the US Department of Agriculture. People living in rural counties also frequently have poor access to physicians and behavioral health providers, are more likely to smoke a...
Source: Health Affairs Blog - July 30, 2015 Category: Health Management Authors: Ned Calonge Tags: Equity and Disparities GrantWatch Access Aging Children Health Philanthropy Hunger Rural Health Care Source Type: blogs

Worth The Money? Paying To Ensure A Representative Cohort In The Precision Medicine Initiative
In his January 2015 State of the Union address, President Obama announced the $215 million Precision Medicine Initiative. Moving beyond a “one-size-fits-all” approach to medical care, the initiative is intended to produce the knowledge that physicians can use to tailor treatments according to each patient’s specific genes, environment, and lifestyle. By sequencing more genomes and linking genomic data to information in electronic health records and to participant-provided lifestyle data, the Precision Medicine Initiative will reveal to researchers and physicians the right treatments for the right patients. Since the ...
Source: Health Affairs Blog - July 30, 2015 Category: Health Management Authors: Carolyn Plunkett, Lisa Kearns and Arthur Caplan Tags: Costs and Spending Equity and Disparities Featured Health Professionals Population Health Arthur Caplan Carolyn Plunkett Ethics Lisa Kearns Personal Genome Project Precision Medicine Research Source Type: blogs

The sick and the dying can be found in hospitals of any size. Don’t forget that.
I have worked in a lot of hospitals over the past two years. Quite a few of the facilities have been critical access hospitals, which is to say that they are very small, typically having fewer than 25 inpatient beds, and are usually somewhere in the boonies. A number of characteristics allow a hospital to qualify as critical access and receive additional federal funding, but suffice to say, these places have limited resources. Let’s refer to them collectively as Tiny Memorial Hospital (TMH). TMH serves a mostly (but not only) rural patient population. Its patients may work in manufacturing or farming, in tourism or coal ...
Source: Kevin, M.D. - Medical Weblog - July 30, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Research and Reviews in the Fastlane 093
This study of 50 volunteers suggests that three commonly taught methods for finding the cricothyroid membrane (general palpation, four-finger, skin crease) are relatively inaccurate, using ultrasonography as the gold standard. I conclude:1. The landmark techniques are inaccurate for finding the CTM *and that’s okay.* Make your best guess using general palpation and if you feel nothing, use four-finger or skin crease **and then make a long vertical incision.** Once you get through the skin you are very likely to be able to feel the CTM, and even if you still can’t at that point, that’s fine too, cut to air...
Source: Life in the Fast Lane - July 29, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Education Emergency Medicine Intensive Care R&R in the FASTLANE Trauma critical care EBM literature recommendations research and reviews Source Type: blogs

There Was No Place Like Canada
Speaking of myths about U.S. banking, another that tops my list is the myth that the Federal Reserve, or some sort of central-bank-type arrangement, was the best conceivable solution to the ills of the pre-1914 U.S. monetary system. I encountered that myth most recently in reading America’s Bank, Roger Lowenstein’s forthcoming book on the Fed’s origins, which I’m reviewing for Barron’s. Lowenstein’s book is well-researched and entertainingly written. But it also suffers from an all-too-common drawback: Lowenstein takes for granted that those who favored having a U.S. central bank of some kind (whatever they cal...
Source: Cato-at-liberty - July 29, 2015 Category: American Health Authors: George Selgin Source Type: blogs

The dilemma of treating patients, based on their contributions to society
During my third-year internal medicine rotation, I was introduced to and helped care for a patient named Casey (name changed to protect privacy). I identified with Casey because we were the same age, and I felt empathetic toward her situation. Casey was very sick, a direct result of her risky behavior. She was admitted for infective endocarditis secondary to intravenous opioid abuse. She had her second heart valve replacement eight days prior with the first replacement done nine months before. The valve replacement was done at another area hospital, and she was discharged to a skilled nursing facility for extended antibiot...
Source: Kevin, M.D. - Medical Weblog - July 28, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Dynamic Vision Is A Cornerstone Of State Payment Reform Initiatives
Faced with rising health care costs, states are designing and implementing payment reforms that fundamentally transform how the health care market provides and pays for services. Two states in particular, Ohio and Oregon, have developed an overarching vision to guide their multi-payer payment and delivery system transformations. Along the way, these states have placed an emphasis on leadership, multidisciplinary engagement, availability of federal resources, and investment in infrastructure to realize their goals. As a result, both Ohio and Oregon are implementing initiatives based on the framework of the Triple Aim and ar...
Source: Health Affairs Blog - July 28, 2015 Category: Health Management Authors: Ledia Tabor, Tess Shiras and Neva Kaye Tags: Costs and Spending Featured Health Professionals Insurance and Coverage Medicaid and CHIP Medicare Organization and Delivery Payment Policy Population Health Health Care Delivery Health Policy Ohio Oregon Payment Reform Primary Source Type: blogs

Most States Lag On Delivering Valuable, Preventive Dental Care To Low-Income Children
As our health system moves to pay for value, highly-effective but low-cost preventive medicine becomes increasingly vital. Dental sealants provide a low-cost intervention to prevent tooth decay, a health condition with serious consequences. A $48 sealant placed on a permanent molar of a child at the right time can reduce decay by 80 percent in the first two years and continue to block decay for nearly five years. In the world of public health, these outcomes are stunning. Despite this compelling evidence, in 2010 less than one-third of five- to 19-year-olds had sealants on any of their teeth. Only 25 percent of low-income ...
Source: Health Affairs Blog - July 27, 2015 Category: Health Management Authors: Bob Russell Tags: Costs and Spending Equity and Disparities Featured Health Professionals Long-term Services and Supports Medicaid and CHIP Organization and Delivery Population Health Public Health Quality bob russell CDC Children Dental Care Em Source Type: blogs

Physician success stories don’t make it to the newspaper
Jim almost convinced me.  The burning in his chest, after all, could have just been gastroesophageal reflux.  He assured me that the sensation was nothing new; that he got it from time to time after a large meal and took Tums.  I couldn’t, however, ignore that it seemed to worsen with activity.  The pain was bothersome enough to drag him into my office, without taking the time to make an appointment. Jim and I argued over the EKG.  He wanted to take his prescription and go home.  No hospitalization, no blood tests, no diagnostic studies.  I grabbed his shoulder, and did my best to convince him to reconsider. ...
Source: Kevin, M.D. - Medical Weblog - July 27, 2015 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

LITFL Review 190
Welcome to the 190th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Ken and Chris over at The SGEM are trialling a new project: ‘Hot or Not’  They want to know what you think of five recently published articles. Looks like it could be an interesting addition to cutting down the Knowledge Translation window f...
Source: Life in the Fast Lane - July 26, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

I will not let a computer come between me and my patient
Ask any frontline physician at the moment what one of their biggest daily frustrations is and you will probably hear a very similar thing whether you are talking to a primary care, emergency room, or hospital physician. The thing that most takes them away from patients and makes them forget the reasons why they went to medical school in the first place, is the need to now spend most of their day staring at a screen and performing data gathering and “type and click” tasks. I personally am yet to hear of any doctor who is happy with their electronic medical record, and I’ve worked in many different hospitals up and dow...
Source: Kevin, M.D. - Medical Weblog - July 26, 2015 Category: Journals (General) Authors: Tags: Tech Health IT Source Type: blogs

What They Really Think of Us, UK Version - Health Secretary Derides NHS Doctors for Not Working Enough on Weekends
A new story from the UK suggests what top leaders of health care really think about health care professionals.  I realize that I risk showing my shallow understanding of UK politics when I comment on this, but I believe that the story is straightforward enough for someone from the US to understand, and has  lessons for the US and other countries.UK Health Secretary Says Doctors Do Not Work Enough on Weekends The story started earlier in July, 2016, when the current UK Health Secretary within the current Conservative government told National Health System (NHS) doctors they must work seven days a week, as reported...
Source: Health Care Renewal - July 26, 2015 Category: Health Management Tags: generic managers ill-informed management NHS UK Source Type: blogs

How doctors can protect their online reputation
A continuing series on physician online reputation.  Created in partnership with The Doctors Company as part of their social media resources for physicians.  Once you establish online reputation, you have to protect it. I was once reading a newspaper article where an emergency physician in Rhode Island decided it was a good idea to post interesting cases that she had seen in emergency room on Facebook. Some of those cases were so unique that people who read her Facebook feed recognized the patient she was talking about, and the hospital she worked in, and subsequently she was sanctioned by the Rhode Island Board of Medi...
Source: Kevin, M.D. - Medical Weblog - July 25, 2015 Category: Journals (General) Authors: Tags: Kevin's Take Online reputation Source Type: blogs

Red Dust, dingoes, trauma and Sepsis
Guest post by Dr Chris Edwards of EMJourney recounts his time as a remote retrieval registrar based in Alice Springs – @EMtraveller I’ve had the privilege to work as a Retrieval Registrar for the Alice Springs Hospital Retrieval Service in Central Australia for the last 6 months. How to describe it – words that spring to mind include: Challenging (unlike many other retrieval jobs, you often are intimately involved in the logistics planning) Satisfying (providing ICU level care to the most remote parts of Australia) Scary (providing ICU level care to the most remote parts of Australia!) Clinical character formi...
Source: Life in the Fast Lane - July 25, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Pre-hospital / Retrieval Alice Springs chris edwards Retrieval Medicine Source Type: blogs

Telemedicine: A Solution To Address The Problems Of Cost, Access, And Quality
This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more. When my father set up his medical practice in 1935, his arsenal of tools included a stethoscope, a black bag, and an old black DeSoto automobile. While Dad saw patients in the office, he also understood that the best care is care that patients have access to when they need it. He made house calls because he was committed to offering ...
Source: Health Affairs Blog - July 23, 2015 Category: Health Management Authors: Bill Frist Tags: Costs and Spending Drugs and Medical Technology Equity and Disparities Featured Health IT Health Professionals Insurance and Coverage Organization and Delivery Population Health Public Health Quality ACA Aspen Ideas Festival Bill Source Type: blogs

Research and Reviews in the Fastlane 092
This study, on the other hand, was a well done, RDCT comparing tamsulosin to nifedipine to placebo in 1136 patients and showed no statistically significant difference for the primary outcome (need for further intervention at 4 weeks). Subgroup analysis showed a slight benefit for lower tract stones and the issue of utility in larger stones (> 5 mm) remains unanswered. However, with the move to reduce CT use in renal colic, we won’t know stone location or size on many patients making this drug far less useful in the real world. Recommended by Anand Swaminathan Read More: The Adventure of the Impassible Stone (EM...
Source: Life in the Fast Lane - July 23, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Emergency Medicine Intensive Care R&R in the FASTLANE Renal Resuscitation Trauma Urology critical care EBM Education recommendations research and reviews Source Type: blogs

10 things you might not know about the emergency department
1.  Wait times in most emergency departments are ridiculous. But, if you have a real emergency, you won’t have to wait. If you have abnormal vital signs, a worrisome ECG, or concerning chief complaint, you will be seen long before the person who checked in with a sore throat to get a work excuse. Patients with chief complaints like “GSW abdomen” and “found down/unresponsive” don’t wait to be seen.  And if the day ever comes (God forbid) that you have one of those problems, you won’t either. (Insider tip for non-emergencies:  show up around 6 a.m. on a Sunday morning and you probably won’t have to wa...
Source: Kevin, M.D. - Medical Weblog - July 22, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Be strong, be resilient
Resilience has come up a couple of times recently.  One was in the lyrics of Grace Petrie's song "Inspector Morse" (1), and the other in a meeting with academic colleagues, in the context of dealing with negative feedback.  It made me look for some resources, which are here...Communities can have resilience.  There is a definition here, in the context of dealing with emergencies.  So can people, for example, in this resource from the American Psychological Association.Students, more specifically, need it too.   Here is the Higher Education Academy's research briefing about the benefits of emot...
Source: Browsing - July 22, 2015 Category: Databases & Libraries Tags: feedback resilience Source Type: blogs

Public/Private Partnership To Address Housing And Health Care For Children With Asthma
Mary (not her real name) is an elementary school student with moderate to severe asthma. She struggles to manage her condition and uses her rescue inhaler frequently. Mary’s mother is concerned about several problems in their apartment, including an unresolved pest infestation and bedbugs. As Mary’s pediatrician learned during a recent appointment, the family faces eviction for non-payment of rent. Stories like Mary’s are common in Worcester, Massachusetts, where more than one in ten children suffer from asthma. Kids with uncontrolled asthma have poor health and development, and they miss a large number of school day...
Source: Health Affairs Blog - July 22, 2015 Category: Health Management Authors: Ted Kremer, Monica Lowell and Valerie Zolezzi-Wyndham Tags: Costs and Spending Equity and Disparities Health Policy Lab Long-term Services and Supports Population Health Public Health Quality asthma Children Commonwealth Medicine Community Health medical-legal partnership Prevention and Wel Source Type: blogs

Housing Is A Prescription For Better Health
Effectively managing a chronic health condition involves a myriad of tasks for anyone, ranging from scheduling and getting to frequent doctor appointments to regularly taking and refilling numerous medications and eating a healthy diet. Being homeless makes these basic tasks even more overwhelming, particularly if combined with additional chronic health and/or behavioral health conditions, which so many homeless individuals have. Compared to individuals who are stably housed, people who are homeless are more likely to visit the emergency room, have a longer stay if admitted to the hospital, and be readmitted within 30 days...
Source: Health Affairs Blog - July 22, 2015 Category: Health Management Authors: Kathy Moses and Rachel Davis Tags: Costs and Spending Featured Hospitals Long-term Services and Supports Medicaid and CHIP Population Health Public Health Quality ACA Chronic Condition Community Health homelessness Housing First Kathy Moses Kelly Cullen Communit Source Type: blogs

With The ACA Secure, It’s Time To Focus On Social Determinants
This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more. While Medicaid expansion remains a dream for Americans in many states, the integrity of both the state and federal marketplaces for insurance remained intact following the June 25 Supreme Court decision to allow the federal government to provide nationwide tax subsidies to help people buy health insurance. The following morning, Kath...
Source: Health Affairs Blog - July 21, 2015 Category: Health Management Authors: Elizabeth Bradley and Lauren Taylor Tags: Costs and Spending Equity and Disparities Featured Health Professionals Organization and Delivery Population Health Public Health ACA Aspen Ideas Festival Behavioral Health Elizabeth Bradley Social Determinants of Health Spotlight Source Type: blogs

Here’s a hospital taking patient engagement one step further
Consider, for a moment, that you are a new physician. A patient, who is a lifelong smoker, comes to your clinic complaining of shortness of breath, and after conducting several tests you diagnose him with chronic obstructive pulmonary disease (COPD). Relying on your training, you prescribe medications, arrange for follow-up visits and describe activities that can help him better manage his breathing problem. You understand that even light activities — taking a shower, making breakfast, taking the dogs outside — can be challenging, making it difficult for him to breathe. These episodes can lead to great anxiety...
Source: Kevin, M.D. - Medical Weblog - July 21, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Reasons why people with dementia are admitted to a general hospital in an emergency
This study finds the proportion of people with dementia being admitted to hospital in an emergency increased by 48% between 2008 to 2009 and 2012 to 2013. It focuses on the reasons why people with dementia are admitted to a general hospital in an emergency and considers ways in which some of these could be prevented. It recommends that although strategies to improve care for people with dementia have progressed and there is greater awareness of the symptoms, there is room for improvement. Report Dataset Press release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - July 21, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: NHS measurement and performance Quality of care and clinical outcomes Source Type: blogs

Emergency Transvenous Cardiac Pacing
This case was provided by one of our fine 5th year EM/IM residents, Rachael Krob MD. The description of the method for inserting a pacing wire is by one of our fine 3rd year EM residents, Mark Sandefur MD.CaseAn elderly male was found on the floor with altered mental status. When EMS arrived, he was obtunded but occasionally able to answer yes/no questions. He was found to be bradycardic in the 20's-30’s. Glucose was normal.  A prehospital 12-lead was recorded; unfortunately, only half of it made it into the chart:There is a slow indeterminate rhythm with a right bundle branch block morphology.  The medics repo...
Source: Dr. Smith's ECG Blog - July 21, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

We May Already Know How To Reduce The High Cost Of Covering New Medicaid Enrollees
Last week, the Centers for Medicare and Medicaid Services’ independent Office of the Actuary released its 2014 Actuarial Report on the Financial Outlook for Medicaid. Unlike previous years, this annual report is making headlines because the actuaries project that for 2014 the newly eligible Medicaid expansion population will have costs greater than the non-newly eligible Medicaid population. Continue on to the next paragraph of the report and the actuaries write that a major contributor to this increased cost projection is that states anticipated and, in their managed care contracts, accounted for high first-year costs ...
Source: Health Affairs Blog - July 20, 2015 Category: Health Management Authors: Emma Sandoe Tags: Costs and Spending Equity and Disparities Featured Medicaid and CHIP Organization and Delivery Payment Policy Population Health Public Health ACA Care coordination Coverage Emma Sandoe Enrollment Health Care Coverage Initiative Source Type: blogs

EMTs Misinterpret POLST Forms
A new study in ED Management, finds that emergency providers lack consensus on what action to take when they have Physicians Orders for Life Sustaining Treatment (POLST) forms.   In a continuing line of research by Ferdinando Mirarchi (medical director of the Department of Emergency Medicine at the University of Pittsburgh Medical Center Hamot in Erie, PA).  In a survey of emergency physicians and pre-hospital providers, responders were given scenarios in which the patient had a POLST. The providers were then asked to decide what to do. Unfortunately, providers often know that the form exists but fail to rea...
Source: blog.bioethics.net - July 20, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

Maryland’s Maverick Health Care Overhaul: A Physician Perspective
Beginning last year, the state of Maryland embarked on an extraordinary new experiment — one that could be a model for the nation. In partnership with the Centers for Medicare and Medicaid Services (CMS), Governor Martin O’Malley’s statewide hospital commission announced in January 2014 that it would address escalating health care costs by tackling the arms race of medical care. The Commission unveiled the framework for a new plan that will pay hospitals for quality over quantity, enabling them to profit from providing more appropriate—rather than simply more—care. The proposed change of incentives ha...
Source: Health Affairs Blog - July 20, 2015 Category: Health Management Authors: Martin Makary and Seth Goldstein Tags: Costs and Spending Featured Health Professionals Hospitals Organization and Delivery Population Health Public Health Quality AHRQ fee-for-service Martin Makary Martin O'Malley Maryland Patient Safety Prevention RVU targets Source Type: blogs

Accident and emergency statistics
House of Commons Library - This briefing provides summaries and visualisations of a wide range of NHS A&E trends, including: levels of attendance over time; attendance by age, and various measures of waiting times. Briefing House of Commons Library publications (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - July 20, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: NHS measurement and performance Source Type: blogs

The Sh$t You Read In The Newspaper
Jim almost convinced me.  The burning in his chest, after all, could have just been gastroesophageal reflux.  He assured me that the sensation was nothing new; that he got it from time to time after a large meal and took Tums.    I couldn't, however, ignore that it seemed to worsen with activity.  The pain was bothersome enough to drag him into my office, without taking the time to make an appointment.Jim and I argued over the EKG.  He wanted to take his prescription and go home.  No hospitalization, no blood tests, no diagnostic studies.  I grabbed his shoulder, and did my best to c...
Source: In My Humble Opinion - July 20, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs

Do doctors really hate Obamacare?
Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carson told Fox News that “he’s spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama’s signature health care law.” Doctors hate Obamacare, it’s alleged, because it authorizes government to “control” the practice of medicine and impose “rationing” of care, thereby harming patients.  The conservative Examiner website quotes a New Jersey family physicia...
Source: Kevin, M.D. - Medical Weblog - July 19, 2015 Category: Journals (General) Authors: Tags: Policy Health reform Obama Source Type: blogs

LITFL Review 189
Welcome to the 189th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week The American College of Emergency Physicians made some pretty significant changes to its tPA clinical policy. Find out what they were and get comments from the experts on this week’s FOAMcast. [MG] The Best of #FOAMed Emergency Medicine How ...
Source: Life in the Fast Lane - July 19, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Palpitations in a Young Healthy Male
ConclusionQTc is longer in HypoK than NormoK. Significant HypoK in the ED can be recognized on the ECG with high accuracy using QTc-B and presence of prominent U-waves. HypoK can be recognized with very high Sens, Spec, and Acc, using subjective interpretation of either the expert reader or the residents, plus QTc-B and presence or absence of prominent U-waves. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - July 19, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Acute coronary occlusion in resuscitated SCA – Cardiology MCQ
What percentage of survivors of out of hospital cardiac arrest have acute vessel occlusion? a) 20% b) 30% c) 40% d) 50% Correct answer: d) 50% About seventy percent of survivors of out of hospital cardiac arrest have coronary artery disease out of which fifty percent have an acute vessel occlusion. Studies have shown that emergency coronary angiography and revascularization improves overall one year survival from twenty five percent to sixty percent. Even in those without an ST elevation myocardial infarction (STEMI), a quarter of them may have a culprit lesion (either an occluded vessel or an irregular lesion). The post A...
Source: Cardiophile MD - July 17, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

New Health Policy Brief: The Oregon Health Insurance Experiment
A new policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) summarizes the findings of the Oregon Health Insurance Experiment. In 2008 Oregon created a lottery system to award 10,000 new Medicaid slots to eligible new enrollees. From then until the implementation of the Affordable Care Act (ACA) in 2014, Oregon periodically used the lottery system to expand its Medicaid pool. The lottery offered a unique opportunity for research of Medicaid coverage, providing a randomized study population. A group of academic researchers subsequently organized the Oregon Health Study Group and created a study popu...
Source: Health Affairs Blog - July 17, 2015 Category: Health Management Authors: Tracy Gnadinger Tags: Elsewhere@ Health Affairs Health Professionals Insurance and Coverage Medicaid and CHIP Organization and Delivery Population Health ACA Health Policy Briefs Oregon Health Plan Oregon Health Study Group Robert Wood Johnson Foundation Source Type: blogs

A patient is angry with her emergency care bill. But here’s what she really got.
Natalie Fuelner created a well-written article in the Bangor Daily News describing some of the tribulations many new parents go through with young children. One weekend, her toddler fell face first onto a metal patio table. Immediately, the toddler’s face is full of blood. The dad panicked. Natalie was a “trembling mess” on the inside. Their physician neighbor wasn’t available to look at the child. They didn’t want to wait two and a half hours at the urgent care center. They were both still panicking, so they went to the emergency department where they were evaluated immediately by an emergency nurse and then...
Source: Kevin, M.D. - Medical Weblog - July 17, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Why physicians should be trained for in-flight emergencies
Flying on a return trip from Chicago to San Francisco, I can’t help but feel a little on edge. It’s not the fear of flying that is leaving me a little less relaxed than the pleasant, middle-aged woman peacefully slumbering in the seat next to me. It’s the possibility of hearing the announcement few doctors are comfortable hearing during travel: “Is there a doctor on this flight?” New physicians go through plenty of training throughout their years in medical school and residency that some may call extraneous. As a physician going into primary care, I have practiced countless times reading complex imaging and revie...
Source: Kevin, M.D. - Medical Weblog - July 16, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

A Conversation on Bitcoin
(Last month, the Chilean webzine El Libero interviewed me about Bitcoin and other cryptocurrency topics. Here is the English translation of the conversation with Juan Pablo Couyoumdjian.) 1. Bitcoin is a class of “crypto-currency,” but what, exactly, are these crypto-currencies? How do they emerge? And why? LHW: Cryptocurrencies — Bitcoin and its competitors — are digital assets, secured by cryptography, that can be circulated from peer to peer like currency. Like government fiat money, they are not redeemable at a fixed rate for any commodity or other money. Unlike government fiat money, there is no issuer with di...
Source: Cato-at-liberty - July 16, 2015 Category: American Health Authors: Lawrence H. White Source Type: blogs

MD? Who cares about that? The virtues of doctoring in a small town.
I had spent medical school and the better part of my adult life in another state by the time I matched into a medical internship back home. Such an opportunity allowed me the opportunity to enjoy a more familiar setting complete with the more bucolic and relaxing lifestyle I had missed for so long. Though not quite in my rural hometown, my intern year stationed me on the outskirts of the quiet farmland I had grown up on and undoubtedly served as the referral center for the typical agricultural accident or trauma more than a hundred miles away. Indeed, our trauma bay was once inhabited by a patient with the complaint of ...
Source: Kevin, M.D. - Medical Weblog - July 16, 2015 Category: Journals (General) Authors: Tags: Physician Radiology Source Type: blogs

Heartburn triggered an expensive workup. The sad part is, this isn’t shocking.
How does heartburn turn into a multi-thousand dollar workup?  The simple answer: defensive medicine.  See how this scenario plays out daily in this latest episode from Healthcare Not Fair. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - July 16, 2015 Category: Journals (General) Authors: Tags: Video Emergency Heart Source Type: blogs

Research and Reviews in the Fastlane 091
Welcome to the 91st edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out t...
Source: Life in the Fast Lane - July 15, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Emergency Medicine Haematology Intensive Care R&R in the FASTLANE Resuscitation critical care EBM literature recommendations research and reviews Source Type: blogs

Summer is a busy season for trauma anesthesiologists
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Summer is immortalized in popular culture for good reasons — no other season can match it for the variety of fun and exciting activities it brings. Unfortunately, that variety of activities and the large volume of people enjoying them inevitably lead to accidents and mishaps of all kinds. The summer months (May through August) show a significant increase in unintentional injury and deaths, particularly for those aged 0 to 14 years. Thankfully, there are many skilled people always at the ready to treat the injured. Trauma anesthesio...
Source: Kevin, M.D. - Medical Weblog - July 15, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Surgery Source Type: blogs

The electronic chart turns us into data druggies
We are data druggies. We spend our days like desperate junkies crawling the carpet, sifting through the shaggy strands of patient histories with shaky fingers in search of facts. Every word our patients utter we feed to the never-ending demands of the electronic chart. We find a fact and we enter it. The database grows. Someone somewhere adds another question we are supposed to ask our patients. We get back on our hands and knees. We start sifting once again. Have you been to the continent of Africa in the last twenty-one days? Click. Do you or a loved one feel threatened at home? Click. How was your experience today? Cli...
Source: Kevin, M.D. - Medical Weblog - July 15, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Health IT Source Type: blogs

What Company Will You Keep? Strategy In Health Care’s New Era
By JOE FLOWER How do you plan? Obviously, you have to. Obviously, you can’t. For your organization, and for you as a health care leader, the rapid and, at times, chaotic changes in the payment systems, the purchasers’ strategies, your population base, new technological possibilities, and the competitive landscape mean that you must plan for the future and act vigorously to make that future happen — or you fail. At the same time, those very same factors render traditional planning methods irrelevant, impossible, even deadly. The movie line that comes to mind is, “Forget it, Jake. It’s Chinatown....
Source: The Health Care Blog - July 15, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Change Management Complex Adaptive System Source Type: blogs

To Lower The Cost Of Health Care, Invest In Social Services
This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more. A repeated refrain of politicians is that health care spending in the United States is utterly out of control. We spend almost $9,000 per person per year, amounting to nearly 17 percent of Gross Domestic Product (GDP), far more than any other country, but get a poor return on investment. Life expectancy in the United States ranks 27t...
Source: Health Affairs Blog - July 14, 2015 Category: Health Management Authors: Kenneth Davis Tags: Costs and Spending Equity and Disparities Featured Hospitals Organization and Delivery Population Health Public Health Aspen Ideas Festival health outcomes Kenneth Davis OECD patients Prevention SDH SNAP social services Spo Source Type: blogs

Looking At The Future Of Alzheimer’s Disease Policy
It is time to engage public health in aggressive efforts to address Alzheimer’s disease and other dementias (AD/D) without delay. As I noted in Health Affairs in April 2014, numerous U.S. states are already taking some action. Since then an additional 12 states, for a total of 40 states, have developed state plans to address AD/D. Most are already published, with a few in development or being scheduled for updating. Public policy statements at all levels call for coordination of resources, better communication, awareness, and essential linkages. Now to achieve the outcomes envisioned in these plans and policies, further ...
Source: Health Affairs Blog - July 14, 2015 Category: Health Management Authors: David Hoffman Tags: Costs and Spending Health Policy Lab Long-term Services and Supports Population Health Public Health Aging Alzheimer's Chronic Condition David Hoffman Dementia Long-Term Care New York Source Type: blogs

Healthcare Update Satellite – 07-13-2015
Boy bitten by a mouse, mother brings boy and mouse to emergency department, wants rabies testing done. Nurse brings the mouse outside and lets it go. Mom fumes because no one recommended that her son go through rabies shots and that because the animal was released, now she’ll never know if the animal had rabies. She decides to put her son through rabies shots which are paid for by Medicaid. If the shots end up not being covered, she’ll ask the hospital to pay for them. Only problem is that according to the CDC, small rodents “have not been known to transmit rabies to humans”, so the child is going ...
Source: WhiteCoat's Call Room - July 13, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

The day this physician was labelled as disruptive
There can be little doubt that these days that political correctness has run rampant. Terms like “racist,” “sexist,” or “homophobic” are thrown around so frequently and early now that one has to wonder what is actually being accomplished. If you were to ask a physician what PC label they most fear, it would be “disruptive.” Let’s face it. We are no longer allowed to get angry, raise our voice, or express any frustration for whatever reason. Granted, some physicians boiling points are lower than others, but how we are expected to bear full responsibility for outcomes whi...
Source: Kevin, M.D. - Medical Weblog - July 13, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Orthopedics Source Type: blogs

LITFL Review 188
Welcome to the 188th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Unbelievable talk from John Hinds at SMACC US – Crack the Chest. Get Crucified. If you’re unclear why it is that the FOAM world was so saddened at John’s loss, this will quickly jog your memory. [AS] The Best of #FOAMed Emergency Medi...
Source: Life in the Fast Lane - July 13, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL review LITFL Reviews Source Type: blogs