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

Israel Stinson, Still Dead, Transferred from California to Cuba
Like Jahi McMath in early 2014, Israel Stinson has been transferred from a California hospital, despite having been determined dead. On May 23, the family withdrew as moot their emergency motion for an injunction from the U.S. Court of Appeals for the Ninth Circuit.   That motion is moot, because on Saturday, May 21, 2016 at 5:30 a.m. "an air transport team consisting of a registered nurse and a respiratory therapist, as well as a ground transport team, prepared Israel for transport with the assistance of Kaiser’s medical team." "At approximately 7:30 a.m., Israel was transported by ambulance to McClellan Airpo...
Source: blog.bioethics.net - May 24, 2016 Category: Medical Ethics Authors: Thaddeus Mason Pope, JD, PhD Tags: Health Care medical futility blog syndicated Source Type: blogs

Understanding the CMS Proposed Rule for the Medicare Access and CHIP Reauthorization (MACRA) and the Merit-Based Incentive Payment System (MIPS)
As we have reported, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA). This is a significant rule with fundamental changes for Medicare. In our continuing coverage, we will provide a more detailed analysis of the regulation. Today, we look at the rule's content related to the Merit-based Incentive Payment System (MIPS). As a refresher, the rule creates a two-track Quality Payment Program. The first is called the Merit-based Incentive Payment System (MIPS) consolidates components of the Physician Quality Reporting System (...
Source: Policy and Medicine - May 24, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

New NLM Learning Resources Database
The National Library of Medicine has made it easier to find existing web-based training materials on its resources. The Learning Resources Database has webinars, short videos, tutorials, brochures and other materials that can be downloaded and used freely. Users can find materials by subject or product, such as: Disasters and Emergencies K-12 Education Public Health Consumer Health The Database was launched two weeks ago, so not all categories have current materials attached. Additional resources are being added on an ongoing basis. Learning Resources Database: https://learn.nlm.nih.gov/ Additional information about th...
Source: BHIC - May 23, 2016 Category: Databases & Libraries Authors: Kate Flewelling Tags: General National Library of Medicine News Source Type: blogs

Integrating Health Care And Housing To Promote Healthy Aging
One of the most important public health findings over the last several decades has been that there are a number of factors, beyond medical care, which influence health status and contribute to premature mortality. Of these factors, social circumstances and the physical environment (particularly the home) especially impact an individual’s health. Housing takes on even greater importance for older Americans since they spend a significant portion of their day in this setting. Ensuring a safe, age-friendly home and utilizing the home as a potential site of care for seniors should be seen as important policy objectives to sup...
Source: Health Affairs Blog - May 23, 2016 Category: Health Management Authors: Allyson Schwartz and Anand Parekh Tags: Costs and Spending Featured Long-term Services and Supports Medicare Population Health Public Health Quality Aging falls prevention Housing MACRA money follows the person New York seniors Source Type: blogs

Syncope During Exercise in a 12-Year Old
This was sent by a paramedic who wishes to remain anonymous.911 was called because a 12 year-old female had a "seizure" at the gym. On arrival, medics found the patient supine on gym mats, conscious but lethargic. Her skin was very pale, cold, and diaphoretic, and there was no radial pulse but only a palpable brachial.  Her lips were cyanotic and firefighters had already begun oxygen therapy. She complained of nausea and bilateral rib pain not worsened by palpation or inspiration. She did not have any obvious injuries on exam, but we noticed bladder incontinence. She was still cyanotic 15 minutes after the "...
Source: Dr. Smith's ECG Blog - May 23, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

With doctors losing respect, perhaps it’s time to expose medicine’s dark side
The following is paraphrased documentation, authored by a physician I know, regarding an intoxicated patient in the ER: 1 a.m.: Patient is telling nurse, “Before I leave, I need everyone’s name for my lawsuit. Tell the phlebotomist that if he’s good, he’ll get a cut.” 1:40 a.m.: Patient is making inappropriate sexual comments and is verbally aggressive with medical staff. He is advised to stay in bed. 2:02 a.m.: Patient (who had been sleeping comfortably) wakes up and begins screaming obscenities at everyone. When a nurse asks why he was angry, he says, “What do you think, mother f*****? I will wipe your a...
Source: Kevin, M.D. - Medical Weblog - May 22, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

How Big Is Too Big?
By MARC-DAVID MUNK, MD With healthcare mergers now announced seemingly every week, I’ve been giving some thought to scale:  How big can/ should health systems be? Anecdotally, I’m struck that the most impressive healthcare companies in America are super- regional players:  Geissinger, Cleveland Clinic, UPMC, etc.  They seem to get a lot more attention than the national players with hundreds of facilities. Leaving aside questions like strategy (e.g. is integration of payers/doctors/hospitals the key to these successes), I’ve wondered whether regional systems are simply the right size to thrive.  My suspicion ...
Source: The Health Care Blog - May 20, 2016 Category: Consumer Health News Authors: John Irvine Tags: Economics Hospitals Uncategorized Marc David Monk Mergers Source Type: blogs

Retail Clinics Drive New Health Care Utilization And That Is A Good Thing
Once the stepchild of the American health care system, primary care is now the linchpin of efforts to improve the health and health care of individuals and communities and to bring down costs. Factors contributing to the demand for primary care include the coverage expansion under the Affordable Care Act and an aging and growing population. But here is the problem: we have a shortage of primary care providers, already acute in some areas of the country, and it’s expected to significantly grow in the years ahead. Coupled with consumer expectations that everything should be immediately accessible at the touch of a screen, ...
Source: Health Affairs Blog - May 20, 2016 Category: Health Management Authors: Deborah Bachrach and Jonah Frohlich Tags: Costs and Spending Equity and Disparities Featured Health Professionals Organization and Delivery Population Health Public Health Quality health care access Primary Care retail clinics States Source Type: blogs

Is it possible to be a Christian and practice emergency medicine?
Many young physicians in training have asked me, quietly or by e-mail, “Is it possible to be a Christian and practice emergency medicine?”  I think that they ask a good question, and likely for good reasons. In their rotations, they have witnessed, first hand, life in the ER.  They are uncertain, perhaps, because they see the frustration that boils over in the words and actions of otherwise compassionate and caring doctors and nurses. They hear the bitterness and sarcasm, the profanity, the unkind words spoken behind the glass window that separates professional from patient. They also see, hear, touch —...
Source: Kevin, M.D. - Medical Weblog - May 20, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Fonseca v. Kaiser – Briefing on Stay from Ninth Circuit
Since the district court's stay expires tomorrow, the parties in the Fonseca v. Kaiser brain death dispute have submitted briefing on an "Emergency Motion under Circuit Rule 27-3."  I have posted the briefs filed on May 19. The Ninth Circuit s... (Source: blog.bioethics.net)
Source: blog.bioethics.net - May 20, 2016 Category: Medical Ethics Authors: Thaddeus Mason Pope, JD, PhD Tags: Health Care medical futility blog syndicated Source Type: blogs

BioethicsTV: Week of May 20 – Assisted suicide, public health crisis management, and making promises
Chicago Med In its first season finale (episode 18), Dr. Downey arrives in the emergency department in distress—he is bleeding from his liver as a side effect from his cancer treatment. When he does not awake from the anesthesia, Dr. Rhodes, his protégé, suspects a stroke during surgery. A CT scan shows that Downey did not have a stroke, but rather has a large, inoperable brain tumor—his cancer has metastasized. We are told that his future prognosis is grim and that he is in unrelievable pain.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - May 20, 2016 Category: Medical Ethics Authors: Craig Klugman Tags: End of Life Care Featured Posts Media Public Health #ContainmentCW #NBCHeartbeat BioethicsTV NBCCHicagoMed promise keeping Source Type: blogs

Senator Durbin Asks Medical Associations to Endorse Mandatory Opioid CME – AMA Shows Interest
Following last month's letter to the Pharmaceutical Research and Manufacturers of America (PhRMA), asking the group to "take financial responsibility for the drug industry's role in curtailing the opioid overdose epidemic," United States Senator Dick Durbin sent a letter to four physician associations asking them to endorse mandatory CME programs. The letter, which was sent to the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American College of Emergency Physicians (ACEP), and the American Dental Association (ADA), noted several steps the Senator feels as though the associatio...
Source: Policy and Medicine - May 20, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

The stories of my medical school mentors
Popular shows like Gray’s Anatomy, ER, and House, MD have given the television watching public a good eyeful when it comes to the inner workings of medicine, hospitals, and emergency rooms. They have also shown us how the personalities of those who take up the stethoscope and reflex hammer run the gamut from the sweet, demure, tentative types to the sons of bitches who cut first and ask questions later. I can look back and remember a few attending physicians who trained me and shaped me and sometimes scared the hell (and a good night’s sleep) out of me. The first one who always comes to mind was Dr. B, who served as my...
Source: Kevin, M.D. - Medical Weblog - May 19, 2016 Category: Journals (General) Authors: Tags: Education Hospital Medical school Source Type: blogs

The sad corruption of the performance measurement movement
This rant reflects conversations with experts, but it does not qualify as good reporting.  I will take some liberties, and have not done careful checking of information.  Nonetheless I believe everything that I am typing. Too many decision makers in the performance measurement field ignore the evidence.  While the initial impetus for performance measurement came from the belief that with measurement we could improve adherence to evidence based treatments or testing.  If one truly believes in evidence based medicine, then the evidence should be indisputable and we should even have evidence that measuring performance act...
Source: DB's Medical Rants - May 19, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Posner on the Legality of the Fed's Last-Resort Lending
A recent Marginal Revolution post has alerted me to Eric Posner’s January 2016 working paper, “What Legal Authority Does the Fed Need During a Financial Crisis?”  Posner’s paper is remarkable, both for its assessment of the legality of the Fed’s emergency lending operations during the recent crisis, and for the policy recommendations Posner offers based on that assessment.[1] Posner’s account of the Fed’s actions reads like a long bill of indictment.  The Fed’s Bear Stearns rescue, for starters, “was legally questionable.”  The Fed couldn’t legally purchase Bear’s toxic assets, and it knew it.  ...
Source: Cato-at-liberty - May 19, 2016 Category: American Health Authors: George Selgin Source Type: blogs

PEM Guides Online
This month sees the release of two new eBooks for brushing up on your Paediatric Emergency Medicine Skills. Both of these eBooks are a truly great addition to your PEM reference resources. They are both free and there’s no excuse not to have them handy on your mobile. PEM Guides 2.0 by NYU Langone Medical Center Website – iBooks “PEM (Pediatric Emergency Medicine) Guides was developed as a point of care resource in our pediatric emergency departments at Bellevue Hospital Center and NYU Langone Medical Center. The PEM Guides focus on the essential diagnostic, treatment and disposition decisions. – Micha...
Source: Life in the Fast Lane - May 19, 2016 Category: Emergency Medicine Authors: Tessa Davis Tags: Book Review Tech Tool Web Culture Langone Medical Center NYU pediatric emergency medicine PEM Guide Source Type: blogs

CMS Proposed Patient Relationship Categories for MACRA
Patient engagement and patient satisfaction have been a core principle of healthcare reform under ACA and MACRA. The Centers for Medicare and Medicaid Services (CMS) recently released for public comment its proposed physician-patient relationship categories, a first step toward a Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirement that the agency establish classification code sets for such physician-patient relationships. The patient relationship categories and codes are intended to help CMS more effectively measure resource use, a major performance category under the Merit-based Incentive Payment Syst...
Source: Policy and Medicine - May 19, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Research and Reviews in the Fastlane 135
Welcome to the 135th 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 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern, 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 ...
Source: Life in the Fast Lane - May 18, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Disaster Education Emergency Medicine Intensive Care Neurology Pediatrics Pre-hospital / Retrieval Respiratory Resuscitation critical care R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Why Medicine?
By SAURABH JHA, MD Cross posted with Quartz. When I was applying to med school some 20 years ago in the UK, I was advised not to say at the interview: “I want to be a doctor because I want to help people.” The answer was considered too dull back then. And in any case, I was asked “Why medicine?” only once. “I’m not sure, but it’s not because my parents forced me.” I hesitatingly answered. The interview panel giggled at my honesty, and for breaking a stereotype about Indians. I was accepted. But I doubt that this answer would cut it today. Showing a sense of altruism is practically mandatory today for would-...
Source: The Health Care Blog - May 18, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Australian Anaphylaxis amplification
Anaphylaxis is increasingly common. The patient population death rate for anaphylaxis is Australia in 2013 was over double that reported in the UK Dr Ray Mullins, an allergist in Canberra, and colleagues from Sydney and Singapore have recently reported an increase in in the number of anaphylaxis fatalities in Australia. This is currently trending towards a 3 fold increase in anaphylaxis deaths over the study period of 15 years. Mullins and colleagues had previously identified a rise in the rate of all food allergy, with the most dramatic effect in young childhood food where hospital admission analyses showed a 50...
Source: Life in the Fast Lane - May 18, 2016 Category: Emergency Medicine Authors: Mike Cadogan Tags: Clinical Research Education Immunology allergy Anaphylaxis EpiPen mastocytosis Ray Mullins Source Type: blogs

“Displaced people at a government camp on the outskirts of...
"Displaced people at a government camp on the outskirts of Maiduguri, Nigeria, were given rice provided by a @unitednations and @icrc emergency food program. The camp — where photographer @ashgilbertson traveled to take this photo — holds nearly 30,000 civilians who have fled from Boko Haram. In northeastern Nigeria, #BokoHaram has inflicted years of suffering, upending the lives of hundreds of thousands of people, stealing something, or everything. Now, a deep suspicion is raging against anyone who has lived alongside the group — even girls who were held hostage, repeatedly raped and left to raise infants fathered b...
Source: Kidney Notes - May 18, 2016 Category: Urology & Nephrology Authors: Joshua Schwimmer Source Type: blogs

How to marginalize doctors who are jerks
I don’t know about you, but I’m up to my eyeballs in patient experience focus, metrics, and nomenclature. Of course, we all get it and are committed to taking great care of our patients, but, with all due respect, what about us? The caregivers, the clinicians, the physicians. Does anyone care about our experience? I do. In fact, it’s pretty much what I spend most of my waking hours thinking about. And much as my partners and I are committed to improving it, sometimes if feels like we (clinicians) conspire against ourselves even in what may seem to be the simplest ways: like lack of kindness and respect. “Who cares ...
Source: Kevin, M.D. - Medical Weblog - May 17, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

I’d hate to be his patient
I don’t know about you, but I’m up to my eyeballs in patient experience focus, metrics, and nomenclature. Of course, we all get it and are committed to taking great care of our patients, but, with all due respect, what about us? The caregivers, the clinicians, the physicians. Does anyone care about our experience? I do. In fact, it’s pretty much what I spend most of my waking hours thinking about. And much as my partners and I are committed to improving it, sometimes if feels like we (clinicians) conspire against ourselves even in what may seem to be the simplest ways: like lack of kindness and respect. “Who cares ...
Source: Kevin, M.D. - Medical Weblog - May 17, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

My relationships with patients last generations
At 6 a.m. one morning, I was playing tennis at our local athletic club a few months ago.  Sam, working at the front desk came running down onto the courts.  “There is an emergency and a woman on the phone says she needs your help.” I will be honest; I panicked a little.  My husband was home asleep as were my four children.  My thoughts as I raced up two flights of stairs to reach the phone were, “Could they be injured or in trouble?” A young woman was crying and saying her mom was asking for me.  I still could not figure out who was on the phone.  Who knew I was here, at this time of the morning? “It’s ...
Source: Kevin, M.D. - Medical Weblog - May 17, 2016 Category: Journals (General) Authors: Tags: Physician Pediatrics Source Type: blogs

A patient encounter that almost pushes this doctor over the edge
It’s the beginning of October, it’s Sunday, and it’s been an uneventful shift thus far. However, in exactly seventy minutes, a patient that I’ve just seen — one that I think has nothing more than an upset stomach — will collapse and begin a fight for her life. I’m at the nursing station scribbling on a chart when a lanky man leans over me, a toddler in his arms. He’s looking at the nurse, but really he’s talking to me. He asks why his son has to wait, insisting that his child be seen first “because he’s a baby.” I look at the child — curious, ...
Source: Kevin, M.D. - Medical Weblog - May 16, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Pediatrics Source Type: blogs

An open letter to America’s physicians on the opioid epidemic
The medical profession must play a lead role in reversing the opioid epidemic that, far too often, has started from a prescription pad. For the past 20 years, public policies — well-intended but now known to be flawed — compelled doctors to treat pain more aggressively for the comfort of our patients. But today’s crisis plainly tells us we must be much more cautious with how we prescribe opioids. At present, nearly 2 million Americans — people across the economic spectrum, in small towns and big cities — suffer from an opioid use disorder. As a result, tens of thousands of Americans are dying eve...
Source: Kevin, M.D. - Medical Weblog - May 16, 2016 Category: Journals (General) Authors: Tags: Conditions Pain management Source Type: blogs

The collapse of civilization
Yes, it has happened in war zones, but it's also happening in Venezuela right now due to gross misrule and the collapse of oil prices. The Gulf monarchies prepared for this eventuality by putting money away. They won't be able to live on their savings forever, but the Saudis have acknowledged that the end of the era when money gushes from oil wells is coming, and they have vowed to diversify their economy. Norway, though not as dependent on petroleum as the Saudis, is also preparing for the gravy train to end.Alaska and Louisiana did not plan; nor did West Virginia plan for the collapse of the coal industry. All three stat...
Source: Stayin' Alive - May 16, 2016 Category: American Health Source Type: blogs

Improving Maternal Health in the U.S. and Around the World
Since 1990, the United States is the only World Health Organization (WHO) region that has actually had an increase in maternal deaths. Although many think that maternal health problems are isolated to the developing world, challenges persist in our country. This is despite spending the most in the world on hospitalization for pregnancy and childbirth. In contrast, the countries that have been most successful in reducing maternal deaths have often achieved these results by using a midwifery model of care—an example that the U.S. may benefit from. Midwifery programs provide advanced education and training to support this m...
Source: Disruptive Women in Health Care - May 16, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Childbirth Children Policy Women's Health Source Type: blogs

ST Elevation: Inferior MI or Early Repol? Ultrasound Speckle Tracking Can Help.
We reported on Speckle Tracking recently in the American Journal of Emergency Medicine, where you can read about it in detail:Diagnosis of acute coronary occlusion in patients with non–ST-elevation myocardial infarction by point-of-care echocardiography with speckle tracking: a case reportWith Speckle Tracking, you mark the endocardium visually on a still picture, and then the computer follows that endocardium through the cardiac cycle, both showing and plotting its wall motion.It is the next best thing to a contrast echocardiogram.Here is the video he obtained:The three segments at lower left are the inferior wall ...
Source: Dr. Smith's ECG Blog - May 16, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

“After Julio Rafael Parucho suffered a serious head injury...
"After Julio Rafael Parucho suffered a serious head injury a year ago, doctors removed a quarter of his brain. But because of a shortage of doctors, Julio, 32, has had to wait a year for a follow-up operation. The economic crisis in Venezuela, where Julio lives, has exploded into a public health emergency. Luis Razetti Hospital, where @meridithkohut photographed Julio, is a battlefield clinic in a country where there is no war. Even among Venezuela's failing hospitals, Luis Razetti has become one of the most notorious. For the past 2 and a half months, the hospital hasn't had a way to print X-rays, so patients must use a s...
Source: Kidney Notes - May 16, 2016 Category: Urology & Nephrology Authors: Joshua Schwimmer Source Type: blogs

LITFL Review 231
Welcome to the 231st 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 Paul Marik, critical care legend, takes on lactate in this incredible podcast from the Intensive Care Network. My brain is still recovering. [SO]   The Best of #FOAMed Emergency Medicine Rory Spiegel delves into the intricacies of non-infe...
Source: Life in the Fast Lane - May 15, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Foreign policy through the lens of an emergency physician
These seem unrelated, but give me a chance. I was eating outside at a restaurant with my 5 month old, Max, and a car with a modified muffler hit the gas right in front of us. In Australia, you’d call the driver a “hoon.” The noise terrified my boy, and I felt something I’m not used to: protective rage. When Max stopped crying my mind went to struggling families, kids, bombs, drones and suicide bombers, naturally. So I thought I’d type on medicine and foreign affairs. When you arrive in an ER with one-sided leg/arm/face paralysis, you’ll probably be whisked to a CT scanner to see whether...
Source: Kevin, M.D. - Medical Weblog - May 15, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Doctors need to recognize the signs of human trafficking. Here’s how.
It was 2 a.m. on a typically hectic Friday overnight shift in the emergency department. A young woman, Kelly, checked into triage, accompanied by her older boyfriend Jim, who explained that Kelly had abdominal pain and some vaginal bleeding. Jim wanted her checked out and maybe some pain medicine to help her rest at home. Kelly had no identification. She appeared younger than her stated age of 18. I also noticed track marks punctuating both of her arms: a sign of IV drug use. She immediately looked to Jim after answering all my questions. If this sounds suspicious, that’s because it is. While clinicians are trained to a...
Source: Kevin, M.D. - Medical Weblog - May 15, 2016 Category: Journals (General) Authors: Tags: Conditions Emergency Source Type: blogs

Sitting on the Couch, Talking Evolution
I’m seated here, in upholstered comfort, with two questions. The couch is a dreadful, shameless pun, which I will explain in a moment. The questions though, are real. Both questions relate to the relevance of evolution in emergency medicine. The first is how does our current understanding of evolution help us be better clinicians? The second question is what do we not yet know? Or, in other words, what is the depth of our ignorance? (Please don’t answer that. It is a rhetorical question*). Evolution. To briefly recap the last three and a half billion years (give or take), it started when a few basic molecules chunked t...
Source: Life in the Fast Lane - May 15, 2016 Category: Emergency Medicine Authors: Michelle Johnston Tags: Literary Medicine antiphora apocrisis epiplexis epitemesis evolution qSOFA rhetorical question subjectio Source Type: blogs

HHS Issues Health Equity Final Rule
On May 13, the Office of Civil Rights (OCR) of the Department of Health and Human Services (HHS) issued a final rule implementing section 1557 of the Affordable Care Act. The rule finalizes a proposed version issued in September of 2015, analyzed in this blog at that time. The final rule was accompanied by a press release, summary, and series of fact sheets. Section 1557 of the ACA provides that an individual shall not, on the basis of race, color, national origin, sex, age, or disability, be excluded from participation in, denied the benefits of, or subjected to discrimination under any health program or activity of whi...
Source: Health Affairs Blog - May 14, 2016 Category: Health Management Authors: Timothy Jost Tags: Equity and Disparities Featured Following the ACA Insurance and Coverage Medicaid and CHIP Medicare age discrimination disability discrimination health equity national origin discrimination racial discrimination sex discrimination Source Type: blogs

JellyBean 033 with Anne Creaton
Bula! So Anne Creaton is knee deep in Fiji. Knee deep in another culture. Knee deep in Government Bureaucracy. Knee deep in the most beautiful water in the world. What a woman! I worked with Anne a few years ago when she helped start up the Ambulance embedded aeromedical service called Adult Retrieval Victoria in Melbourne. That wasn’t hard enough for her. So she headed off to Fiji to try to bring some of what she had learned to the Pacific. Now I don’t know what you know about Fiji. It is an incredibly interesting place with an incredibly interesting mix of people.I know that I don’t know enough about the history of...
Source: Life in the Fast Lane - May 14, 2016 Category: Emergency Medicine Authors: Doug Lynch Tags: JellyBean Anne Creaton Fiji Source Type: blogs

The story of an exhausted doctor daughter
I am a doctor daughter. I am exhausted. My emotions are bubbling close to the surface, and I fear that at any moment, someone will do or say something to me that will cause me to lose control, which I’m not allowed to do because I’m also a female physician in a leadership role, and our emotions must be held in check. I watched one of my mentors be memorialized last week after he lost his battle with cancer. This week, I will watch my father, a man who has meant more to me in my life than any other except my husband, go through a revision prostate surgery, a bone marrow biopsy, and an inpatient stay for a urinary tract ...
Source: Kevin, M.D. - Medical Weblog - May 12, 2016 Category: Journals (General) Authors: Tags: Physician Cancer Pediatrics Source Type: blogs

What John Stossel gets right, and wrong, about health care
I was saddened to hear that one of my favorite libertarians, the wonderful journalist John Stossel, has taken ill. True to form, however, he’s taking it in stride (he nonchalantly quipped, “seems I have lung cancer”), and I want to take this opportunity to wish him very well indeed. I enjoy his reporting and writing, and have learned a great deal from Mr. Stossel over the years. But that doesn’t mean he’s always right. In a great piece about his recent diagnosis and workup at one of America’s “premier” hospitals, Stossel goes to great lengths to praise the quality of me...
Source: Kevin, M.D. - Medical Weblog - May 12, 2016 Category: Journals (General) Authors: Tags: Policy Emergency Hospital Source Type: blogs

The Tangled Hospital-Physician Relationship
By GOLDSMITH, KAUFMAN and BURNS Together, hospital and physician services account for more than half of national health spending. In its 2014 National Health Expenditures estimates, the Centers for Medicare and Medicaid Services’ actuaries make the hospital (nearly $1 trillion) and physician practice (nearly $600 billion) sectors appear to be independent and non-overlapping. This is an optical illusion. Hospitals and physicians are, in day-to-day practice, hopelessly intertwined. And while power appears to be shifting from physicians to hospitals with the increasing salaried employment of physicians, appearances can be d...
Source: The Health Care Blog - May 12, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

CNN Special Report on Prescription Addiction
We have been talking about the opioid addiction in America for several months now, from Congressional hearings, to new Centers for Disease Control (CDC) guidelines, to what solutions exist for patients and their loved ones. In response to the epidemic, CNN hosted a program entitled “Prescription Addiction,” hosted by Anderson Cooper and Dr. Sanjay Gupta. The program featured guests including: addicts of opioids and heroin, family members of addicts who are no longer “themselves,” family members of addicts who have passed on due to their addictions, physicians, treatment center owners, and others, and was a questio...
Source: Policy and Medicine - May 12, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Research and Reviews in the Fastlane 134
This article is a large, population-based, retrospective cohort of adults > 65 years of age. It compares those who were prescribed a macrolide with those prescribed a non-macrolide antibiotic looking at the primary outcome of a presentation for a ventricular dysrhythmia at 30 days and a secondary outcome of all-cause mortality at 30 days. They found no difference. While it’s a suboptimal study methodology, this is further evidence that we need not fear these complications. But, this shouldn’t stop us from restricting treatment to only those who need it (i.e. don’t prescribe a Z-pack for a URI). Recomme...
Source: Life in the Fast Lane - May 11, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Clinical Research Education Emergency Medicine Intensive Care critical care R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

CONCUSSION: Bioethics, Foot Ball and Post Traumatic Lies.
Concussion is a documentary biography about medical science’s triumph over a social and corporate conspiracy to suppress evidence of a serious preventable disease. Forensic pathologist, Bennett Omalu, MD, discovered a pathognomonic sign confirming chronic traumatic encephalopathy (CTE). He happened to find it in a cluster of professional football players during autopsies. Concussion was written and directed by Peter Landesman, who managed a riveting story pace, despite most of the visuals occurring in the inglorious world of microscopes and morgues —done to death on television. Will Smith’s Dr. ...
Source: blog.bioethics.net - May 11, 2016 Category: Medical Ethics Authors: September Williams, MD Tags: Health Care syndicated Source Type: blogs

Let’s apply a little reality to the referrals from the ER
I remember seeing so many charts in my career on which the well-meaning emergency room physician wrote the following:  “Follow up with your primary care doctor.”  Or, if they didn’t have one, “Follow up in one week with a primary care doctor.”  I laughed to myself.  Usually, the people we say that to have either no insurance, inadequate insurance or inadequate motivation to even call the persons to whom we may refer them.  Or they find themselves in an area with next to no primary care physicians to begin with.  Call all you want. It won’t happen. The same thing is now happening as adminis...
Source: Kevin, M.D. - Medical Weblog - May 11, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Sleep Drugs: What Every Woman Should Know
The post below first appeared on Law Street. Sleepless nights; nights full of tossing and turning. It happens to all of us–but for some it’s more frequent than others. In fact, an estimated 50 to 70 million American adults suffer from sleep disorders like insomnia or obstructive sleep apnea. Many turn to prescription sleep medications for relief– but women are more likely to take sleep drugs than men. About 3.1 percent of American men and 5 percent of American women report having used a prescription sleep medication within the last 30 days. What does this use of sleep aids mean for women? Read on to learn more...
Source: Disruptive Women in Health Care - May 11, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Women's Health Source Type: blogs

“@deathunderglass is taking over...
"@deathunderglass is taking over the@muttermuseum@instagram account this week to showcase some of the specimens in the museum collection related to forensic science!@deathunderglass is a collaboration between a forensic pathologist and forensic photographer that generates images of human tissue at high magnification. We tend to think that drug abuse is a social issue that popped up in the last 50 years. Think again - the history of drug abuse in America goes back quite a long way. Elixirs, tonics, and tablets containing cocaine were incredibly popular from the 1850s to the early 1900s and its use was promoted by medical lu...
Source: Kidney Notes - May 11, 2016 Category: Urology & Nephrology Authors: Joshua Schwimmer Source Type: blogs

Respect your nurse. Your life may depend on it.
Monday morning. As I click through the usual beginning of the week barrage, I open an email from my ER chief. My heart drops into my stomach, where it begins to race. He’s forwarded a letter of concern from a specialist from a different hospital. It’s about a patient that I failed to help, and failed to diagnose, so she had to seek help elsewhere. As I read the details, I remember the case. I pick up the phone and tell him the story: It’s Friday night. 10 p.m. I have the overnight shift; the one that’s supposed to start at eleven, but I’ve been called in early. Very early. It’s st...
Source: Kevin, M.D. - Medical Weblog - May 10, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Heart Source Type: blogs

How a patient gave this doctor his first coaching session
In 1991, I took a sub-internship in cardiology with a clinically-minded attending named Eddie Atwood. One day he stopped me in the hall: “You have a few minutes toward the end of the day?” “Sure. What’d I do?” I just knew some sort of defining verdict headed toward my Dean’s letter, to be shown to all residencies and preserved in an archive of medical student iniquities, was surely coming. “You students are all the same.” He smiled, his hand on the shoulder of my white coat. “Not everything is a score or a pass/fail, you know. Sometimes there’s just a conversation.” Continue reading ... Your patients...
Source: Kevin, M.D. - Medical Weblog - May 10, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Primary care Source Type: blogs

The proctor seized during a USMLE Step 3 test. See what this doctor did next.
USMLE Step exams are a rite of passage in medical education. They mark the  transition from pre-clinical years to clinical years, from medical school to residency and from intern to resident. One of the more difficult aspects of the transition to residency was convincing myself that I really was a doctor. The habits of explaining my role as a student, of hedging every statement with “I’ll need to ask the resident,” proved difficult ones to break. As I studied for my Step 3 exam, the final step, I hoped that this milestone would be the one after which I would believe I was a real doctor. With the exam approaching,  ...
Source: Kevin, M.D. - Medical Weblog - May 9, 2016 Category: Journals (General) Authors: Tags: Physician Neurology Source Type: blogs

The Tangled Hospital-Physician Relationship
Together, hospital and physician services account for more than half of national health spending. In its 2014 National Health Expenditures estimates, the Centers for Medicare and Medicaid Services’ actuaries make the hospital (nearly $1 trillion) and physician practice (nearly $600 billion) sectors appear to be independent and non-overlapping. This is an optical illusion. Hospitals and physicians are, in day-to-day practice, hopelessly intertwined. And while power appears to be shifting from physicians to hospitals with the increasing salaried employment of physicians, appearances can be deceiving. This post discusses th...
Source: Health Affairs Blog - May 9, 2016 Category: Health Management Authors: Jeff Goldsmith, Nathan Kaufman and Lawton Burns Tags: Costs and Spending Featured Health Professionals Hospitals Medicare Payment Policy Population Health Quality ACOs Bundled Payments EMTALA MACRA Medicare Part B Physicians Source Type: blogs

I thank my father for the gift of freeze-frame
I settle into the bent-wicker chair on my lanai and try to relax. It’s a perfect island day, the temperature warm, the breeze cool, and I gaze out over the pool to the tops of the coastal mangroves. I’ve just come home from a shift at the local free clinic, and my mind is occupied by the work we did today.  My fourth-year medical students encountered some difficult patients, and we struggled to get them the care they needed. In particular, I spent twenty minutes talking down an angry man with suicidal and homicidal ideation, and as I sink deeper into the fluffy tropical print cushions, I am wondering why I was not afr...
Source: Kevin, M.D. - Medical Weblog - May 9, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Psychiatry Source Type: blogs