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This page shows you the most recent publications within this specialty of the MedWorm directory.
Healthcare Update Satellite — 10-21-2014
This study makes a good case for requiring orthopedic evaluation in the emergency department for every pediatric patient suffering from any type of bone or joint injury – regardless of the time of day or night. What no one is telling you about Ebola … from a Hazmat Trained Hospital Worker. The gear used to protect providers from Ebola is difficult to put on, difficult to remove, and can usually only be worn for 30 minutes at a time. The medical providers in Dallas who contracted Ebola had no protocols in place and this author believes that the “system failed them.” Patients apparently believe that b...
Source: WhiteCoat's Call Room - October 21, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Research and Reviews in the Fastlane 054
Conclusions Wrong? (emlitofnote) Critical Care, CardiologyGuyton AC. Regulation of cardiac output. Anesthesiology. 1968; 29(2): 314-26. PMID: 5635884 The modern emphasis on echo might make you think that the heart determines cardiac output. This classic paper by Guyton shows that unless the heart is failing, it has a permissive role in determining cardiac output. The real determinants are (1) the degree of vasodilation of the peripheral vasculature, especially veins, and (2) the filling of the circulatory system, indicated by the mean systemic filling pressure. Gotta love those Guyton curves! Recommended by: Chris Nick...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Clinical Research Education Emergency Medicine Infectious Disease Intensive Care Neurology Neurosurgery Obstetrics / Gynecology Orthopedics Pediatrics Trauma critical care literature R&R in the FASTLANE recommendat Source Type: blogs
Enrolling College Students In Health Insurance: Lessons From California (Part 1)
Editor’s note: As we approach the beginning of the second open enrollment period under the Affordable Care Act, Walter Zelman describes an effort he led during last year’s initial open enrollment period to enroll students in the California State University (CSU) system in coverage. Part 1 below provides background on the CSU system and the enrollment effort, the CSU Health Insurance Education Project, as well as a discussion of what worked well. Part 2, which will appear tomorrow, addresses what worked less well, as well as project results, lessons and policy implications, and next steps. In addition to Zelman,...
Source: Health Affairs Blog - October 20, 2014 Category: Health Management Authors: Walter Zelman Tags: All Categories Consumers Coverage Health Reform Insurance Policy States Source Type: blogs
The LITFL Review 153
The LITFL Review is 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. Welcome to the 153rd edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR] Kane Guthrie [KG] Mat Goebel [MG] Segun Olusany...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL R/V Source Type: blogs
Working in an ER in Liberia: A physician shares his story
In June 2014, the first patient with Ebola arrived at Liberia’s county hospital, Redemption. As tensions grew around the city of Monrovia, administrators at JFK Hospital began to devise plans for handling patients with suspected Ebola. Officials from the CDC then came and gave us lectures. They discussed prevention of spreading and what our plans would be in the event of a potential outbreak. Before that moment, there were no clear plans for what to do if a patient presented with symptoms of Ebola. No plans for isolation. No plans for treatment. To make matters worse, the scarcity of gowns, gloves, and personal protectiv...
Source: Kevin, M.D. - Medical Weblog - October 20, 2014 Category: Journals (General) Authors: Antonio Webb, MD Tags: Physician Emergency Infectious disease Source Type: blogs
Thomas Frieden And The U.S. Ebola Response
On Friday, October 17, the White House named Ron Klain the new Ebola czar. This move followed a storm of criticism in the media, on Capitol Hill, and elsewhere. The criticism focused on the multiple mistakes made by the U.S. agencies and Texas Health Presbyterian Hospital in Dallas in the weeks since Thomas Eric Duncan, infected with Ebola, arrived in the United States on September 19. Duncan set off a disturbing train of events that included secondary infections of two nurses, Nina Pham and Amber Vinson, along with the lingering threat of additional infections. That threat widened rapidly over the course of this past week...
Source: Health Affairs Blog - October 20, 2014 Category: Health Management Authors: J. Stephen Morrison Tags: All Categories Global Health Politics Prevention Public Health Source Type: blogs
Axis: Bold As Love
Axis determination is one of the most common ECG topics that I see junior doctors (and some senior doctors!) struggling with. Hopefully this tutorial will clear things up… ECG Axis Determination The diagram below illustrates the relationship between QRS axis and the frontal leads of the ECG. Image reproduced from Chung Normal Axis = QRS axis between -30 and +90 degrees. Left Axis Deviation = QRS axis less than -30 degrees. Right Axis Deviation = QRS axis greater than +90 degrees. Extreme Axis Deviation = QRS axis between -90 and 180 degrees (AKA “Northwest Axis”). There are several complem...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Edward Burns Tags: Cardiology ECG Emergency Medicine axis deviation EKG LAD rad Source Type: blogs
The striking parallels between warfare and emergency departments
Preface: I love to write about many things. People, pets, children, family, nature. But over and over I come back to a theme: my colleagues in our specialty and the forces arrayed against us. I’m not trying to be the toxic voice, the endless complainer. But if people like me don’t beat the drum, then nothing will ever change for the better. In this column I will continue to explore issues of physician satisfaction, I am reminded of a lecture I attended during residency. Let me set the stage. During residency I was also a flight surgeon in the Indiana Air National Guard. This was during Operation Desert Storm, although ...
Source: Kevin, M.D. - Medical Weblog - October 18, 2014 Category: Journals (General) Authors: Edwin Leap, MD Tags: Physician Emergency Source Type: blogs
Running a code is a team sport
“They need you in room 13,″ she said when I answered the phone and I ran back to the ICU. The patient was coding and for each minute that felt like an hour, we tried, and failed, to save her. She wasn’t breathing, her heart wasn’t working, and despite the 30 people gathered in the room, in the end, she died. 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 - October 18, 2014 Category: Journals (General) Authors: Denitza Blagev, MD Tags: Physician Emergency Hospital Source Type: blogs
There is no excuse for physicians to take advantage of vulnerable patients
Patients are being stuck with huge and unexpected medical care bills in circumstances where they have no say in selecting the physician who is billing them, and no way for them to know in advance which services the physicians would render or what it would cost them, says the New York Times. 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 - October 18, 2014 Category: Journals (General) Authors: Bob Doherty Tags: Policy Emergency Health reform Source Type: blogs
How did a Dallas hospital miss Ebola? Maybe we shouldn’t be surprised.
The first “wild” Ebola case in the United States has occurred in Dallas, Texas. The patient, who is from Liberia and had contact with a pregnant Ebola victim in his native country, was initially sent away from the emergency department (ED) of a Dallas hospital after reporting there with viral symptoms. He told the triage nurse that he had just arrived from Liberia, but despite this was sent home. How could this happen? 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 - October 17, 2014 Category: Journals (General) Authors: David Mann, MD Tags: Conditions Emergency Hospital Infectious disease Source Type: blogs
Teaching Health Centers: An Attainable, Near-Term Pathway To Expand Graduate Medical Education
We describe a near-term and attainable pathway to expand GME that could gain consensus among these stakeholders. This approach would sustain and expand Teaching Health Centers (THCs), a recent initiative that directly funds community-based GME sponsoring institutions to train residents in primary care specialties, dentistry and psychiatry. We further propose selectively expanding GME to meet primary care and other demonstrable specialty needs within communities, and building in evaluations to measure effectiveness of innovative training models. Our proposal includes: Congressional reauthorization and funding of the THC GM...
Source: Health Affairs Blog - October 17, 2014 Category: Health Management Authors: Richard Rieselbach, Paul Rockey, Thomas Nasca, Kathleen Klink, Robert Phillips, Malcolm Cox, David Sundwall, John Frohna, and Katherine Neuhausen Tags: All Categories Disparities Health Care Costs Health Reform Hospitals Medicaid Medicare Physicians Policy Politics Primary Care Veterans Workforce Source Type: blogs
Time to set some heads a-rollin'
I still maintain that ebola virus is a very minor public health concern in the United States, it is a very big public health concern in west Africa and possibly eventually elsewhere; and it is a very big threat to the global economy and to U.S. politics. But . . .We will never persuade the American people or the ignoramuses in the corporate media that our attention and our resources should be focused on west Africa, not Kennedy Airport, if it does not appear absolutely and transparently true that our medical and public health infrastructure is fully competent to protect us. And no, it doesn't look like that. The medical di...
Source: Stayin' Alive - October 17, 2014 Category: American Health Source Type: blogs
Think big, act now: creating a community of care
This report sets out NHS Alliance’s position with regard to the future of general practice and primary care. It recommends a new approach to health care with general practice at scale at its centre and an extended primary care team incorporating community pharmacy, community eye care, housing and emergency services radiating out from it. It also makes the case for a fundamental shift in the way in which we all view and access the NHS, and the requirement for dedicated and appropriate funding to support this transformation. Report NHS Alliance - press release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - October 16, 2014 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Developments in primary and community care Source Type: blogs
Nurse Nina Pham is a hero: Stop blaming her
The director of the Center for Disease Control (CDC) in Atlanta, Georgia apologized for implying that the nurse in Texas was responsible for her own infection with the deadly Ebola virus. This comes less than two weeks after hospital officials from Texas Health Presbyterian Hospital and other prominent officials blamed a different nurse for releasing the patient with Ebola from the emergency department possibly causing an Ebola outbreak. 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 - October 15, 2014 Category: Journals (General) Authors: Sarah Beth Cowherd, RN Tags: Conditions Infectious disease Source Type: blogs
Ebola in Texas: A fascinating story of system errors
Ebola is in the United States! Everybody (please don’t) panic! Quarantine all Texans! Though that might be a good idea anyway (just kidding). More on Ebola in general in another post if I have time. First off though, we’ve found out more information about the sequence of events leading to the hospitalization of the patient, Thomas Duncan. Apparently, he came to the hospital, told people he’d come back from Liberia, and was still discharged home. He was only admitted 2 days later when his nephew called the CDC. The tale reveals a fascinating story of medical quality and system error. Contin...
Source: Kevin, M.D. - Medical Weblog - October 15, 2014 Category: Journals (General) Authors: Vamsi Aribindi Tags: Conditions Emergency Hospital Infectious disease Source Type: blogs
Research and Reviews in the Fastlane 053
This study combines the results from the WARFASA and ASPIRE trials looking at aspirin prophylaxis. The results are promising. Aspirin 100 mg reduced the rate of recurrent VTE from 7.5%/year to 5.1%/year (HR = 0.68) without a significant change in bleeding rate (0.5%/year vs 0.4%/year). We often see patients in the ED with a history of unprovoked VTE who are on no long-term prophylaxis. This article argues that we consider aspirin for all these patients. Recommended by: Anand Swaminathan Trauma Stevens AC, Trammell TR, Billows GL, Ladd LM, Olinger ML. Radiation Exposure as a Consequence of Spinal Immobilization and Extri...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Alternative Medicine Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation Toxicology and Toxinology Trauma critical care literature Source Type: blogs
An ER missed Ebola. Here’s how it could happen to you.
How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola? Despite the fact that blame spreads through hospitals faster than hemorrhagic fever viruses, I’m not interested in pinning down a single person, or a single thing, which may have allowed that to happen. I am very interested, however, in offering a few insights into what combination of factors might make it easy to send home a West African with a fever, without establishing the fact that he had a dangerous, contagious disease which finally caused his death. Continue reading ... Your patients are rating you online...
Source: Kevin, M.D. - Medical Weblog - October 14, 2014 Category: Journals (General) Authors: Edwin Leap, MD Tags: Physician Emergency Infectious disease Source Type: blogs
EMS ambles in with a "probably drunk" patient around 4 a.m. They report finding this 70ish homeless man with mental health issues sitting on the sidewalk. The patient complained of a group of men coming upon him and kicking him in the butt. I went to check him after he was settled in a room. To my shock, the supine gentleman was trying to pee in a urinal without success. I've seen plenty of guys peeing in the ED. My concern was that he was lying down. Anyone who has been in the ED for a period of time knows that drunk guys who are barely able to speak will still try to stand up to go. Even male hemiparetic str...
Source: Lions and Tigers and Bears - October 14, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
LITFL Review 152
The LITFL Review is 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. Welcome to the 152nd edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR] Kane Guthrie [KG] Mat Goebel [MG] Segun Olusany...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Review LITFL R/V Source Type: blogs
Medicare Advantage Physician Evaluator Jobs: Reality Versus Advertising At CenseoHealth
Physicians looking for part-time jobs to supplement their income may have run across advertisements for “lucrative” Medicare Advantage evaluation opportunities at CenseoHealth. Here’s a typical ad: Email not displaying correctly? Display this email in your browser Vision | History | Leadership | Services | Contact Us CenseoHealth is the leading Risk Adjustment provider for Medicare Advantage plans – with a network of more than 1,800 credentialed providers conducting over 20,000 member health evaluations a month. Due to our continued growth, we are currentl...
Source: Better Health - October 14, 2014 Category: American Health Authors: Dr. Val Jones Tags: Health Policy True Stories Censeo Health CenseoHealth Dangers False Advertising Frail Elderly Geriatrics Health Insurance Companies Managed Medicare Plans Medical Missionary Medicare Advantage Evaluations Part Time Work Physician Source Type: blogs
Over-reactors do not help health conversations
Yesterday morning, driving to work, I listened to Mike and Mike (a radio sports talk show). Mike Greenberg made a wonderful point about his job. He described what they do as “professional over-reactors”. They take every game and extrapolate, sometimes irrationally, about the implications of that game. Does this remind you of health reporting? A study appears in a serious medical journal, and the press “blows it up” as the next great advance. But scientific knowledge grows slowly, with fits and starts. Too often initial research reports are not confirmed with later studies. While this is a major prob...
Source: DB's Medical Rants - October 14, 2014 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
To deprescribe…Adding a new verb to the language of doctoring
What follows is my most recent editorial in the Journal of the Kentucky Medical Association. It is reposted with permission. **** One day every month, my wife Staci, a hospice and palliative care physician, goes to see an elderly woman in the nursing home. The routine has gone on for years, which is surprising because the woman was admitted to the home with terminal diagnoses. But this patient didn’t die; she keeps living, month after month. “How is she?” I often ask. “She is fine. She eats, drinks, moves around in her chair and doesn’t have the frowny face of pain.” How did a hospice doctor achieve such longe...
Source: Dr John M - October 14, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Healthcare Update Satellite — 10-13-2014
More medical news from around the web on my other blog over at DrWhitecoat.com So what are medical providers supposed to do if they are faced with a potential or actual Ebola victim? Who knows? Here’s a case you don’t see every day … Patient transferred to University of Alabama Medical Center after having what was thought to be a hand grenade embedded in his thigh. He wasn’t allowed in the emergency department, but was instead treated in an ambulance in the parking lot for more than six hours as a military consultant advised medical personnel how to remove it. Eventually was determined to be the 40...
Source: WhiteCoat's Call Room - October 13, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Ebola in the ER: What you should and shouldn’t worry about
As an ER doctor, right now I’m thinking a lot about Ebola — it’s in the news, in my inbox, and in questions from my patients. Whether it’s an outbreak, a flu epidemic, or a bombing — we in the ER see them first, and so I’m always thinking about how we’ll be ready. So, what concerns me, and what doesn’t? 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 - October 13, 2014 Category: Journals (General) Authors: Darria Long Gillespie, MD, MBA Tags: Conditions Emergency Infectious disease Source Type: blogs
Implementing Health Reform: Reference Pricing And Network Adequacy
On October 10, 2014, the Departments of Labor, Treasury, and Health and Human Services issued a frequently asked question (FAQ) regarding the use of reference-based pricing in non-grandfathered large group employer plans. Although the issue the FAQ addresses specifically is the use of reference pricing, the FAQ is remarkable insofar as it is the first departmental guidance that I am aware of that addresses the use of networks by self-insured ERISA plans. Network adequacy is an issue that has long been addressed in the nongroup and insured group market in many states by state insurance law. The ACA also requires qualifi...
Source: Health Affairs Blog - October 12, 2014 Category: Health Management Authors: Timothy Jost Tags: All Categories Consumers Employer-Sponsored Insurance Health Care Costs Health Reform Payment Policy Source Type: blogs
Some Cardiologists still are not familiar with Sgarbossa Criteria.....
This case shows how you have to advocate for your patient. You have to be the expert. I talk to a lot of emergency physicians who have trouble convincing their interventionalist colleagues of various ECG findings. Many cardiologists and even interventionalists, are not aware of many of the newer findings of STEMI equivalent, including the Sgarbossa criteria, and especially are unaware of the modified Sgarbossa criteria. My partners and I are fortunate that at our institution there is a long history of ECG expertise in our cardiology department. We also have a very cooperative system in which all con...
Source: Dr. Smith's ECG Blog - October 12, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
The ER demonstrates the inverted priorities of American society
We fling open the doors of America’s emergency departments to help those who can’t afford health care. We have legislated this protection: No person can be turned away for financial reasons. This is very compassionate, and represents the higher angels of our culture. Alas, it also is emblematic of the stupider demons of government. You see, the ER demonstrates the inverted priorities of American society. 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 - October 11, 2014 Category: Journals (General) Authors: Edwin Leap, MD Tags: Physician Emergency Source Type: blogs
Blogorado, Day One
Lectured to a great bunch of EMS volunteers yesterday, people that embody all the good things about volunteer EMS. Good folks here in southeast Colorado. Today I finished some assignments under deadline, coon-fingered a bunch of guns, ate TWO enormous steaks from local beef, drank my share of Nerd Beer Emergency Medical Bock, was introduced ... (Source: A Day In the Life of An Ambulance Driver)
Source: A Day In the Life of An Ambulance Driver - October 11, 2014 Category: Emergency Medicine Authors: ambulancedriverfiles Tags: Blogorado Source Type: blogs
Drug Use and Skin Conditions
Diseases and complications associated with intravenous drug use are many and varied. These three videos demonstrate three skin findings associated with drug addiction and IV drug use: the track marks associated with repeated intravenous injection, the piloerection that accompanies withdrawal, and the diffuse petechiae from septic emboli of life-threatening infective endocarditis. Click here to see the track marks associated with repeated intravenous injection. Click here to see the piloerection that accompanies withdrawal. Click here to see the diffuse petechiae from septic emboli of life-threatening infecti...
Source: M2E Too! Mellick's Multimedia EduBlog - October 10, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Mystery of the Discharged Ebola Patient - Where is Sherlock Holmes When We Need Him?
As discussion, if not outright panic, about Ebola infections increases in the US, it is still hard to figure out what heath care professionals and the health care system need to do to protect patients and the public in a very changed world.One pressing question is how to identify people at risk of having the infection so as to best care for them, and to protect the public from further spread of the infection, without swamping the health care system, needlessly reducing civil liberties, or spreading further panic. To better answer question, better understanding why the first patient who was diagnosed with and then died from...
Source: Health Care Renewal - October 9, 2014 Category: Health Management Tags: Ebola virus generic management generic managers Texas Health Presbyterian Hospital Texas Health Resources Source Type: blogs
Treatment of Ebola virus infection with brincidofovir
The Liberian man who was diagnosed with Ebola virus infection after traveling to Dallas, Texas, was treated with an antiviral drug called brincidofovir. This drug had originally been developed to treat infections with DNA-containing viruses. Why was it used to treat an Ebola virus infection? Brincidofovir (illustrated) is a modified version of an antiviral drug called cidofovir, which inhibits replication of a variety of DNA viruses including poxviruses and herpesviruses. When cidofovir enters a cell, two phosphates are added to the compound by a cellular enzyme, producing cidofovir diphosphate. Cidofovir is used by viral...
Source: virology blog - October 9, 2014 Category: Virology Authors: Vincent Racaniello Tags: Basic virology Information adenovirus brincidofovir Dallas patient DNA polymerase ebola virus Ebolaviruses herpesvirus phosphorylation prodrug RNA polymerase smallpox viral Source Type: blogs
Doctors should be challenged to explain what they are charging and why
About a year ago, I shared details of my own out of pocket medical expenses and concluded that we have to have to be more transparent with our patients (and potential patients) about the costs they will face for our services. The urgency of price transparency as a business imperative and a professional responsibility has only increased since then. 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 - October 9, 2014 Category: Journals (General) Authors: Ira Nash, MD Tags: Physician Emergency Source Type: blogs
Teaching Kids How To Deal With Injuries
Recently our 1st grader had a really bad fall. The fall was so bad she looked like an MMA fighter. In many ways I wish she were fighting because the story would be a lot more interesting. But alas this was your typical young child meets concrete experience where the score was concrete 100, child 0. I’m not certain what happened but as I turned to face her shrill scream I saw her face was scraped from top to bottom, permanent tooth chipped and pride destroyed. My heart sank when I saw her, I thought “anything else”. We’d already dump more than $1000 into her mouth from accidents with baby teeth...
Source: Disruptive Women in Health Care - October 9, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Children Source Type: blogs
Research and Reviews in the Fastlane 052
This study looked at compliance with discharge instructions. Surprisingly (or maybe not so), 39% of pediatric patients returned to play (RTP) on the day of the injury. RTP is widely recognized as a risk for recurrent and more severe concussions as well as significant morbidity. It is the duty of the Emergency Physician to stress the importance of discharge instructions as well as the importance of appropriate follow up. Recommended by: Anand Swaminathan PediatricsSingleton T et al. Emergency department care for patients with hemophilia and von Willebrand disease. J Emerg Med. 2010; 39(2): 158-65. PMID: 18757163 Bleeding...
Source: Life in the Fast Lane - October 9, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Anaesthetics Cardiology Clinical Research Education Emergency Medicine Haematology Infectious Disease Intensive Care International Emergency Medicine Microbiology Neurosurgery Obstetrics / Gynecology Ophthalmology Source Type: blogs
A health care story that you normally don’t see in the media
Recently, my 16-month-old grandson was at a backyard barbecue with his parents. He had been eating some potato chips when he suddenly stopped breathing and turned blue. Having had CPR training, my son started rescue breathing and suspecting aspiration, performed toddler airway clearance maneuvers. No obstruction was found. The child slowly awakened but was very drowsy. 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 - October 8, 2014 Category: Journals (General) Authors: Skeptical Scalpel, MD Tags: Physician Emergency Pediatrics Source Type: blogs
Nursing homes: Our society has chosen to see only darkness
There is much to deplore in our medical system. Atrocities abound in the dark recesses of hospital wards, the overpacked waiting rooms of outpatient offices, and the algorithmic hum of insurance claim denials. Yet time and again, the most vile of of insults are hurled at one setting in particular. I’m talking of the place cursed by emergency room physicians when admitting yet another poor soul with a sacral ulcer, a place spoken of by patients and families in the most hushed and fearful of terms. I am talking of the modern day nursing home. Continue reading ... Your patients are rating you online: How to respo...
Source: Kevin, M.D. - Medical Weblog - October 8, 2014 Category: Journals (General) Authors: Jordan Grumet, MD Tags: Physician Geriatrics Source Type: blogs
The state of medical education and practice in the UK 2014
General Medical Council -The findings of this report show significant increases in the number of women becoming surgeons and specialists in emergency medicine. At the same time, the profession as a whole will soon have equal numbers of men and women doctors – already women account for 44% of all registered doctors and more than half of medical students are female. There has also been a shift in the pattern of doctors from overseas coming to work here. In the past, the largest source of overseas-trained doctors was south Asia, but recently there has been a sharp rise in doctors coming to work here from southern Europe. F...
Source: Health Management Specialist Library - October 8, 2014 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Workforce and employment Source Type: blogs
Speculation about EHR role in Texas Ebola debacle vs. real evidence - will it take a lawsuit to know what's real? Probably.
In the past several days the media has been abuzz with stories about the admission, then the following retraction, by a Texas hospital that and EMR "flaw" had caused a man who had been in West Africa and was infected with the Ebola virus to be sent home, instead of admitted and put into isolation.I wrote about these matters at my Oct. 2, 2014 post "Did Electronic Medical Record-mediated problems contribute to or cause the current Dallas Ebola scare?" (http://hcrenewal.blogspot.com/2014/10/did-electronic-medical-record-mediated.html) and the followup October 4, 2014 post "Dallas Hospital reverses EHR-related explanation for...
Source: Health Care Renewal - October 7, 2014 Category: Health Management Tags: AHRQ Ebola virus Health IT Hazard Manager healthcare IT regulation healthcare IT risk Texas Health Presbyterian Hospital Source Type: blogs
The Need For A Comprehensive, Current, And Market-Representative Health Care Cost Benchmark
A recent post from Jonathan Skinner and colleagues on Health Affairs Blog posited an interesting solution to ever-increasing health care costs, suggesting that imposing price caps on all medical services, equal to 125 percent of the Medicare payment, would serve to eliminate wide variations in quoted prices for health care services. While the overall idea of controlling costs through the establishment of a mutually agreed-upon and accessible benchmark is a sound one, the use of Medicare reimbursement levels as a ceiling for this purpose would present a number of challenges. For example, Medicare does not assign a value to ...
Source: Health Affairs Blog - October 7, 2014 Category: Health Management Authors: Robin Gelburd Tags: All Categories Health Care Costs Medicare Payment Source Type: blogs
Help African Emergency Medicine Now!
aka Postcards from the Edge 010 This ‘postcard from the edge’ is by Swedish Emergency Physician Dr Katrin Hruska (@akutdoktorn), who writes a Swedish/ English language language blog called akutdoktorn. Immaculate Nagaddya is a registered nurse, working in Lugada Hospital in Uganda. It is a small hospital with about 10 000 visits per year, where she receives critically ill patients, presenting with conditions like status asthmatics, status epilepticus and severe dehydration from watery diarrhoea. Together with seven other nurses and between one and three doctors she keeps this emergency department open day and night, a...
Source: Life in the Fast Lane - October 7, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Emergency Medicine International Emergency Medicine AFCEM AFEM africa immaculate naggadya jeremiah njenga postcards from the edge Source Type: blogs
Research and Reviews in the Fastlane 051
Welcome to the 51st 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 10 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...
Source: Life in the Fast Lane - October 6, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Gastroenterology Infectious Disease Intensive Care Pre-hospital / Retrieval Respiratory Resuscitation critical care literature R&R in the FASTLANE recommendations Research an Source Type: blogs
Can Our Dysfunctional Health Care System Contain Ebola?
Not to bury the lede, I think it can, but it will be a lot harder than the talking heads on television predict.I have been writing about health care dysfunction since 2003. Lots of US politicians would have us believe we have the best health care system in the world (e.g., House of Representatives Speaker John Boehner (R-Ohio), here), Much of the commentary on Ebola also seems based on this "best health care system in the world" notion. For example, in an interview today (5 October, 2014) on Meet the Press, Dan Pfieffer, "senior White House adviser," saidThere is no country in the world better prepa...
Source: Health Care Renewal - October 6, 2014 Category: Health Management Tags: Ebola virus financialization generic managers ill-informed management perverse incentives public health organizations Source Type: blogs
Prevent the overdose of OTC pain medications
Recently in the emergency room, I saw a 35-year-old patient — we’ll call her Jane — who was vomiting blood. The source of the vomiting turned out to be a bleeding ulcer caused by unintentionally overdosing on ibuprofen. Jane was in pain — she was taking prescription ibuprofen for her chronic knee pain — but she was also taking over-the-counter (OTC) Advil® during the previous five days for menstrual cramps. Jane did not know that the active ingredient in Advil is ibuprofen, so she was doubling up on this pain reliever. Continue reading ... Your patients are rating you online: How to respond. Man...
Source: Kevin, M.D. - Medical Weblog - October 6, 2014 Category: Journals (General) Authors: Byron Cryer, MD Tags: Meds GI Medications Source Type: blogs
Hospital at Center of Ebola Outbreak Reverses Its Story
By THCBist The Dallas hospital at the center of the Texas Ebola outbreak has changed its story. Last Thursday, the hospital blamed a poorly designed electronic medical record for the failure to diagnose Duncan when he arrived at the hospital’s emergency room with symptoms consistent with Ebola, including a fever, stomach cramps and headache. According […] (Source: The Health Care Blog)
Source: The Health Care Blog - October 6, 2014 Category: Consumer Health News Tags: THCB CDC EMR Epic Systems Patient Zero Texas Health Presbyterian Tom Frieden Source Type: blogs
Complexity, Uncertainty, and Ambiguity in Professional Practice: Re-Engineering the Notion of Expertise in High-Stakes Situations
By: Sayra Cristancho, PhD, assistant professor, Department of Surgery, and scientist, Centre for Education Research & Innovation, Western University At 10 years old, I had the dream of becoming an astronaut. Not one who flies space shuttles…I wanted to be a flight surgeon. I dreamed of being in a situation where I had to take control of a health care emergency in space. At the same time, my country, Colombia, was going through the worst violence and social crisis in its history. Complexity, uncertainty, and ambiguity were the norm of our family life. Watching on TV when a bomb exploded, I always wondered how those fi...
Source: Academic Medicine Blog - October 6, 2014 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective ambiguity complexity high-stakes situations systems engineering uncertainty Source Type: blogs
Missing the first US Ebola case – A learning opportunity in patient safety and caregiver distraction
It was a mistake to send the Liberian national Thomas Eric Duncan home from a Dallas emergency room after he presented with fever and pain, which were early signs of Ebola infection. It would be a larger mistake to miss an important learning opportunity. This case demonstrates what I believe to be a major threat to patient safety—caregiver distraction. Doctors and nurses are increasingly prevented from giving full attention to the important things in patient care. The degree of value-added nonsense has reached the point where delivering basic care has gown dangerous. This morning, in Canada, news of a case of deadly drug...
Source: Dr John M - October 6, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Would Clinical Decision Support Have Helped Prevent the Ebola Misdiagnosis?
ART PAPIER, MD Thirteen years ago, in the midst of widespread publicity about anthrax-laden letters poisoning people, emergency room physicians sent a postal worker home with a diagnosis of the flu. He later died from anthrax inhalation. Fast forward to 2014, with the Ebola outbreak in Liberia dominating healthcare coverage, a man who had just returned […] (Source: The Health Care Blog)
Source: The Health Care Blog - October 5, 2014 Category: Consumer Health News Tags: THCB Ebola Institute of Medicine Misdiagnosis Symptoms VA Source Type: blogs
An Extremely Teachable Moment
JOHN MANDROLA, MD It was a mistake to send the Liberian national Thomas Eric Duncan home from a Dallas emergency room after he presented with fever and pain, which were early signs of Ebola infection. It would be a larger mistake to miss an important learning opportunity. This case demonstrates what I believe to be a […] (Source: The Health Care Blog)
Source: The Health Care Blog - October 5, 2014 Category: Consumer Health News Tags: OP-ED THCB Alert Fatigue Distracted doctoring EHR medical error Texas Health Presbyterian Source Type: blogs