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

Value-Based Care’s Data Problem
By RACHEL KATZ Lisa is an administrator at an Accountable Care Organization, or ACO — a new healthcare payment model that encourages coordinated, high-quality, and efficient care. Lisa’s ACO facilitates the program at about 100 clinics around California, and her mission in the first year of operating might seem elementary to an outsider: to report a set of metrics to Medicare that indicate the health of patients who had been seen at these clinics. At the start of 2015, Lisa received a panel of patients to review. She had expected a list of about 600, but instead there were 2,400. For each, she needed to report o...
Source: The Health Care Blog - May 21, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Educating community health conscious physicians
During my family medicine rotation, my very first clinical clerkship of medical school, I received the assignment of making a home visit to one of my preceptor’s patients — a man I will call Mr. Jones. Mr. Jones had congestive heart failure, COPD, and a barrage of other chronic health problems. He was a pleasant gentleman, but had a low level of health literacy and had been doing a poor job of taking his extensive list of medications, resulting in trips to the emergency room nearly once a week. My task was to assess his situation at home in order to shed light on his lack of compliance and potentially help him stay...
Source: Kevin, M.D. - Medical Weblog - May 21, 2015 Category: Journals (General) Authors: Tags: Education Medical school Source Type: blogs

Access, Excess, And Medical Transformation: Delivering Durable Health Care In Rural Nepal
Conclusion: On Impact And Scale We believe that Durable Healthcare can transform the health care industry away from the dominant fee-for-service paradigm and towards a model that incentivizes patient safety, patient-centeredness, and evidence-based medicine. Only then we will have a competitive marketplace of private sector providers who leverage public funds for the broader public good. (Source: Health Affairs Blog)
Source: Health Affairs Blog - May 21, 2015 Category: Health Management Authors: Duncan Maru and Padam Chand Tags: Global Health Innovations in Care Delivery Organization and Delivery Population Health Public Health ACOs Durable Healthcare Organization EMR health technology Nepal health care Possible triple aim Source Type: blogs

Research and Reviews in the Fastlane 084
This study demonstrated that using a simulation program, EM residents could be brought up to speed on proper sterile technique and that these lessons could be applied clinically. The authors of this study found identical CRBI rates between ED and MICU placed central lines after this educational intervention. Recommended by: Anand Swaminathan Trauma Hildebrand DR et al. Modern management of splenic trauma. BMJ. 2014; 348. PMID: 24696170 Pediatric patients with abdominal trauma can be a challenge to assess. Naturally, we often are concerned for potential splenic injury. What is the most current approach to managing splen...
Source: Life in the Fast Lane - May 21, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Education Emergency Medicine Intensive Care R&R in the FASTLANE Toxicology and Toxinology Trauma critical care examination research and reviews Source Type: blogs

Cryonics is Still in Search of Better Approaches to End of Life Management
Cryonics is the industry and collection of technologies associated with low-temperature preservation of an individual upon death, necessarily carried out as soon as possible so as to prevent tissue damage in the brain. It is connected to research and development in forms of organ preservation associated with transplant medicine. A good cryopreservation of at least the brain ensures the best chance of future restoration with all the data of the mind intact, encoded in the fine structure of neurons and synapses: a preserved individual has all the time in the world to wait, after all. The odds of success are unknown, but infi...
Source: Fight Aging! - May 21, 2015 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

FDA OPDP Issues Fifth Letter of Caution for the Year, Cites Oak Pharmaceuticals For Exhibit Banner
Almost like clockwork, the Food and Drug Administration’s Office of Prescription Drug Promotion (OPDP) has released its fifth enforcement letter of 2015—they have issued one letter in January, February, March, April, and now, as of the past week, one in May. OPDP sent the Untitled Letter to Oak Pharmaceuticals, Inc. (a subsidiary of Akorn, Inc.) regarding the company’s barbiturate anticonvulsant, Nembutal. View the promotional material here. The agency found that Oak’s table exhibit banner was misleading because it omitted “important risk information associated with the use of Nembutal,” and also omitted materi...
Source: Policy and Medicine - May 21, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Memories …
A sweet little lady was brought to the emergency department by her caregiver after having difficulty breathing at home. She got a few breathing treatments and some steroids and was doing much better an hour or so later. When I went back in the room to evaluate her, several family members were present. “Oooh. You got the good doctor. No wonder you’re doing better.” I thanked them because … obviously they were right … but I mentioned that I didn’t recall seeing their mother in the emergency department before. “She hasn’t been here in a long time. You took care of our father.” “Oh. I see. How is he doing?...
Source: WhiteCoat's Call Room - May 20, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

New York Innovates in Medicaid—But Ignores a Key Member of the Team
By JOSEPH ANTOS and YEVGENIY FEYMAN New York has an opportunity to make real improvements to its Medicaid program; but it is leaving out key health care providers which might be best positioned to cut costs and improve value. The state has undertaken a $6.4 billion dollar initiative, the Delivery System Reform Incentive Payment (DSRIP) program, to reduce avoidable hospital use by 25 percent over the next 5 years. DSRIP is testing ways to do everything from cutting unnecessary emergency room visits to reducing transmission of HIV/AIDS. This could lead to healthier, more productive lives for New York’s 6 million Medicaid b...
Source: The Health Care Blog - May 20, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

America’s NATO Liabilities
Washington’s collection of European security dependents (aka, the NATO allies) seek an even stronger U.S. commitment to their defense.  That desire has clearly been on the rise since Russia’s annexation of Crimea in 2014 and the subsequent escalation of the Ukraine crisis.  Not surprisingly, Moscow’s smaller neighbors, especially the three Baltic republics, worry about the Kremlin’s intentions and want to take cover behind the shield of America’s military power.  Their latest ploy is to seek the permanent deployment of a NATO brigade (some 3,000 to 5,000 troops) on their territory.  It is a safe bet that they...
Source: Cato-at-liberty - May 19, 2015 Category: American Health Authors: Ted Galen Carpenter Source Type: blogs

Arkansas Payment Improvement Initiative: Expanding Episodes To Other Clinical Areas
Editor’s note: This post is part of a periodic Health Affairs Blog series, looking at payment and delivery reforms in Arkansas and Oregon. The posts are based on evaluations of these reforms performed with the support of the Robert Wood Johnson Foundation. The authors of this post are part of the team evaluating the Arkansas model. After the first year of implementation of the episodic payment component of the multi-payer Arkansas Payment Improvement Initiative (APII), the state has identified both successes and challenges. While previous posts go into greater detail on the nuances of Arkansas’ approach to episodes and...
Source: Health Affairs Blog - May 19, 2015 Category: Health Management Authors: William Golden, Joseph W. Thompson, Michael Motley, A. Mark Fendrick, Christopher Mathis and Michael Chernew Tags: Innovations in Care Delivery Medicaid and CHIP Payment Policy APII Arkansas Payment Improvement Initiative CMMI CMS Payment Reform PCMH SIM Testing Award States Source Type: blogs

Top stories in health and medicine, May 19, 2015
From MedPage Today: Costly Hep C Tx Could Still Save Big Money. Treating genotype 1 (GT1) chronic hepatitis C (CHC) patients with ledipasvir/sofosbuvir (Harvoni) would result in an annual societal productivity gain of approximately $2.7 billion in the U.S. Workout May Ease Pain in Women With Fibromyalgia. A strong association exists between higher physical fitness and lower levels of pain, less psychological overreaction (catastrophizing) to pain, and higher chronic-pain self-efficacy in women with fibromyalgia (FM). Robotic Prostatectomy: Volume, Complications, Disincentives. As robot-assisted radical prostatectomy (RAR...
Source: Kevin, M.D. - Medical Weblog - May 19, 2015 Category: Journals (General) Authors: Tags: News GI Rheumatology Surgery Source Type: blogs

When does an ATO become a CTO following a STEMI ?
STEMI occurs due to acute occlusion of a coronary artery  (ATO) which needs emergency opening at the earliest, ideally within  3 hours , or up to 12h . The opening shall be either by pharmacological / catheter means  or both. After 24 hours opening  a ATO has questionable benefit unless the patient is hemodynamically unstable or symptomatic. What is a CTO ? Traditionally we believe 3 months is the period to call a coronary occlusion as chronic.(Previously it was 6 months) This time frame was considered appropriate based on our understanding of the infarct process , that may take up to 3 -6months for complete healing of...
Source: Dr.S.Venkatesan MD - May 18, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

LITFL Review 182
Welcome to the 182nd 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 Essentials of Emergency Medicine is offering a US resident scholarship in partnership with ALiEM and EMCrit for the October Essentials course in Las Vegas. Check it out and apply now! [AS] The Best of #FOAMed Emergency MedicineGreat pearl from ...
Source: Life in the Fast Lane - May 17, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

A Taylor Swift parody about prescription drug abuse. Yes, it went there.
ZDoggMD’s take on prescription drug abuse, set to Taylor Swift’s “Blank Space.”  The comments from the video are all over: Is it, as one commenter notes, “a genuine reflection of the issue of drug-seeking patient behavior,” or, “offensive to people who are truly suffering”?  You decide. 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 - May 17, 2015 Category: Journals (General) Authors: Tags: Video Emergency Pain management Source Type: blogs

Body of Proof Star Dana Delany Uses Incorrect CPR Technique and Protocol
In the opening scenes in the last episode of Body of Proof, a television series starring Dana Delany as medical examiner Dr. Megan Hunt, a patient was given CPR after being shot in the back. While the writers of Body of Proof, no doubt, will claim dramatic license in the depiction of the scene to further the episode’s story line, the technique and protocol used by Dr. Hunt does not fit with the standard diagnosis and treatment steps as described in the 2010 guidelines for cardiopulmonary resuscitation and practiced in real-life resuscitations by trauma surgeons, intensive care physicians, emergency medicine physician...
Source: Inside Surgery - May 15, 2015 Category: Surgery Authors: Editor Tags: Musings Body of Proof CPR Dana Delany Megan Hunt protocol Source Type: blogs

Healthcare Update Satellite — 05-14-2015
Morally corrupt and illegal at any other hospital, but the VA system will sweep it under the rug and absolutely nothing will happen about it. Patient in car just a few feet outside the emergency department calls emergency department for help getting out of car so that he could come in for treatment of his broken foot. Seattle VA Hospital tells him ”No, we’re not going to come get you. You’re going to have to call 911 and you’ll have to pay for that.” A fire captain and three firefighters end up coming to help him out of his care and wheel him into the emergency department. Meanwhile, the VA...
Source: WhiteCoat's Call Room - May 15, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Consultation on standards for non-specialist emergency care of children
Royal College of Surgeons (RCS) - These standards are intended for use by commissioners, service managers, and clinicians and they aim to ensure emergency surgical services for young people meet expected levels of quality and attain excellent outcomes in relation to governance, organisation of care, patient experience, training and service delivery. The consultation closes on 26 June 2015. Draft standards Response form RCS consultations (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - May 15, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Patient involvement, experience and feedback Quality of care and clinical outcomes Regulation, governance and accountability Source Type: blogs

EMS SignPost – Medical ID on a Refrigerator Magnet
This simple yellow magnet is embedded with an NFC (near-field communication) chip, that allows EMTs to quickly learn about a patient in an emergency. The NFC technology in the EMS SignPost magnet is the same thing that makes Apple Pay and Google Wall... (Source: blog.bioethics.net)
Source: blog.bioethics.net - May 14, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

Research and Reviews in the Fastlane 083
This study looks at intra-arrest cooling in the prehospital setting. No benefit was found for either the surrogate markers or the most important patient centered outcome of survival. Interestingly, the median temperature upon hospital presentationin the group that did not get intra-arrest cooling was 35 degrees (below the 36 degrees recommended in the TTM trial conclusions). Intra-arrest cooling may simply be a lot of money and effort spent without noticeable differences in outcomes.Recommended by: Anand SwaminathanRead More: JC: Getting Chilly Quickly 3. Hypothermia at St.Emlyn’s (St Emlyn’s)Critical CareWalkey...
Source: Life in the Fast Lane - May 14, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Resuscitation Trauma Wilderness Medicine critical care examination literature recommendations research and reviews Source Type: blogs

Medical talks in India – part 3
The trip is wonderful thus far and very interesting. Yesterday and today we are in Hyderabad in southern India. Hyderabad has a large IT presence and is famous for its biryana which we had for dinner last night. It was outstanding. Some observations thus far: 1. Internists throughout the world treat mostly the same diseases and have the same concerns. 2. Infectious diseases are decreasing in India with improved public health – cholera has become much less common. 3. Non-communicable chrnoic diseases – diabetes, heart disease, hypertension, etc are increasing rapidly in India. They have significant numbers of CK...
Source: DB's Medical Rants - May 14, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Physician Data on Impact of Health Reform In 2014
By JOSHUA GRAY Over the past year, our athenaResearch team has been working with the Robert Wood Johnson Foundation (RWJF) on ACAView, an initiative that provides researchers, policymakers and the public with regular updates on how the Affordable Care Act (ACA) is affecting physician provider practices. To accomplish this, we curate and analyze data from a nationally distributed sample of 16,000 providers on the athenahealth cloud-based network. This gives us a timely view into national physician practice patterns and an ideal platform for measuring the impact of health care reform on the day-to-day practice of medicine. A...
Source: The Health Care Blog - May 13, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Lyme Disease: The Great Imitator
Spring is my favorite season. Warmer weather, budding flowers and lots of greenery in yards, gardens and parks encourages outside activities and fills me with energy. The spring season also brings out lots of crawling and flying critters like bees, butterflies, and hummingbirds, as well as some of the more unpleasant pests like ticks and mosquitos. If you enjoy spending time outside like I do, hiking, gardening or walking the dog, be aware that ticks and their bites can be not only annoying, but dangerous. Jana’s Experience Jana Braden found out how dangerous tick bites can be the hard way. She enjoyed the outdoors a...
Source: Disruptive Women in Health Care - May 13, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Chronic Conditions Source Type: blogs

Body Of Proof Star Dana Delany Mistakes Horizontal Tracheostomy for Cricothyroidotomy
InsideSurgery.com watched with interest a recent episode of the terrific ABC medical drama Burden of Proof staring Dana Delany as Dr. Megan Hunt, a neurosurgeon turned medical examiner. Although we found the Body of Proof episode much more realistic than most medical television shows, one unconventional medical decision we noted was the script calling for a tracheostomy to be performed to establish an emergency airway in the field. Dana Delany as Dr. Megan Hunt in Body of Proof This is technically not correct as an emergency airway established in the field is always a cricothyroidotomy, not a tracheostomy. No doubt, the w...
Source: Inside Surgery - May 13, 2015 Category: Surgery Authors: Editor Tags: Musings Body of Proof cricothyroidotomy Dana Delany Megan Hunt tracheostomy Source Type: blogs

For You Shooters…
… there’s a new article from some know-it-all medic in Shooting Illustrated. Last month we talked about the importance of a Range Emergency Medical Plan. This month, we talk about what needs to be in your personal blowout kit, and how to use it. Enjoy. (Source: A Day In the Life of An Ambulance Driver)
Source: A Day In the Life of An Ambulance Driver - May 13, 2015 Category: Emergency Medicine Authors: ambulancedriverfiles Tags: Shooter Self Care Shooting Illustrated Source Type: blogs

District Court Dismisses Chicago's Painkiller Marketing Lawsuit Against Four of Five Opioid Manufacturers; Purdue Pharma Still on the Hook
District Court Judge Jorge Alonso of the Northern District of Illinois recently dismissed the City of Chicago’s lawsuit against four out of five pharmaceutical manufacturers that the city accused of marketing opioids in violation of Illinois’ consumer fraud laws and for causing doctors and pharmacies to submit, and the city to pay, claims that were false. Judge Alonso found the majority of allegations lacked the necessary specificity needed for a successful case. For example, while the City alleged fraudulent marketing schemes in fairly good detail, the complaint failed to mention the names of Chicago doctors or consum...
Source: Policy and Medicine - May 13, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Implementing Health Reform: Clarifying Requirements For Coverage Of Contraceptives And Other Preventive Services
The Affordable Care Act requires nongrandfathered individual and group insurers and group health plans to cover certain preventive services without cost sharing. Specifically, it requires coverage of: evidence-based items and services given an “A” or “B” rating by the United States Preventive Services Task Force (USPSTF) with respect to the individual involved; immunizations as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control; children’s preventive care and screenings as recommended by Health Resources and Services Administration (HRSA) guidelines; Women’s prev...
Source: Health Affairs Blog - May 12, 2015 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage contraceptives Prevention Source Type: blogs

Tips to avoid medical errors in the emergency department
Emergency medicine physicians: Could these be your cases? A 35-year-old presents with shortness of breath and numbness to the legs. CXR and EKG are normal. She is discharged to see her doctor in two days, but is found dead at home. Autopsy reveals a dissecting aortic aneurysm. A 15-month-old is triaged to fast track and seen by a physician assistant for fever, lethargy, and ear pain. Treatment includes Augmentin. The next day the patient is admitted with pneumococcal sepsis and meningitis with severe brain damage. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A ...
Source: Kevin, M.D. - Medical Weblog - May 12, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Malpractice Source Type: blogs

Medical Talks in India part 2
Yesterday and today I am in Chandigarh. Chandigarh is a planned city in northwestern India. Chandigarh, also known as The City Beautiful, is a city and a union territory in the northern part of India that serves as the capital of the states of Haryana and Punjab. PGI – The Postgraduate Institute of Medical Education and Research (PGIMER) – was a major highlight. This institution and hospital (> 2000 beds) is dedicated to teaching residents. They do not have medical students. Yesterday I talked about Hyponatremia. Afterwards I met with internal medicine leaders of the Institute. In our tour today, I learned muc...
Source: DB's Medical Rants - May 12, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

#SAEM15 panels
I'm very happy to be in San Diego for SAEM's Annual Meeting - and fortunate to be participating in a few didactic sessions this week. Here are links to the program, slides and references.Tuesday  1-5:30pm - Nautilus 3: Social Media Bootcamp - led by Brett Rosen - slidesWednesday 1:30pm - DS-18 Point Loma Ballroom A: I'll speak on clinical decision support projects for residents, as part of Jeff Nielson's panel called "Emergency Informatics Research: Interesting, Approachable Projects for the Resident or Career Scientist" along with Jason Shapiro and Adam Landman - slides - referencesWednesday 2:30 pm - ...
Source: Blogborygmi - May 12, 2015 Category: Emergency Medicine Authors: Nick Genes Source Type: blogs

Keeping Nepal safe moving forward: A doctor’s take
“She’s safe,” my friend and fellow resident told me over the phone just hours after reaching his Mom in Kathmandu. A text from my undergraduate Hindi Professor read, “My own family is safe. But it’s hard to comprehend the amount of loss. My own house in which I was born is gone.” Calls, texts, and emails over the last week have been reassuring in the midst of media depictions of intense devastation.  Their loved ones are safe. But I wonder, for how long? Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out h...
Source: Kevin, M.D. - Medical Weblog - May 11, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

An emergency physician defends the profession from the New York Times
With the flurry of Twitter posts about Maureen Dowd’s article “Stroke of Fate” in the New York Times, it almost seems as if the subject is already stale. Maureen Dowd is the Pulitzer Prize-winning op-ed columnist for the New York Times who tells a compelling story about a young patient who suffered from a stroke. The patient was healthy triathlete, and she initially attributed the symptoms of her stroke to a migraine headache. Ms. Dowd’s article also touched upon the frustration and fear that patients feel after the diagnosis of a stroke which was an important part of the article. However, somewhere in the middle o...
Source: Kevin, M.D. - Medical Weblog - May 11, 2015 Category: Journals (General) Authors: Tags: Conditions Emergency Neurology Source Type: blogs

We Are Engaged! A Commitment To Patients
The solution to combating health care costs may lie in maximizing patient involvement. Under the Centers for Medicare and Medicaid Services’ (CMS) Shared Savings Program, Accountable Care Organizations are eligible for financial incentives if they meet certain performance measures, which aim to improve outcomes, care delivery, and patient experience. Currently, thirty-three quality measures have been defined, seven of which measure patient experience. Three of these patient experience measures include: providers ability to communicate with patients; health promotion and education; and Shared-Decision Making. Seemingly, t...
Source: Health Affairs Blog - May 11, 2015 Category: Health Management Authors: Anubhav Kaul Tags: Featured Organization and Delivery Population Health Public Health BIDMC CMS EHRs Lown Institute Patient Engagement Prevention SDM Shared-Decision Making Source Type: blogs

Stu Marshall on Airway Strategies
Stuart Marshall is an anaesthetist with a PhD in Human Factors and is the Clinical Director of Simulation Education at The Alfred (based at the Australian Centre for Health Innovation). In this FOAM video, created for the Critically Ill Airway (CIA) course, Stu provides an interactive guide to how an airway expert develops a strategies for airway management.CIA airway strategy from Stu Marshall on Vimeo.Feel free to discuss your plans for the scenarios presented in the video. Depending on your context, your plans may be quite different to those described…The next CIA course is December 8th and 9th 2015, registration...
Source: Life in the Fast Lane - May 11, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Airway Anaesthetics Emergency Medicine Intensive Care airway strategies CIA critically ill airway stuart marshall Video Source Type: blogs

Social Media and Patient Information
<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">In the most recent issue of </span><em style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><a href="http://www.clinicalethics.com/">The Journal of Clinical Ethics</a></em><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">, authors Genes and Appel explore the ethical considerations at play when physicians might use the inte...
Source: blog.bioethics.net - May 11, 2015 Category: Medical Ethics Authors: Hayley Dittus-Doria Tags: Clinical Ethics Health Care Doctor-Patient Relationships Public Trust social media syndicated Source Type: blogs

LITFL Review 181
Welcome to the 181st 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 Mel Herbert discusses “Why We Do Emergency Medicine” from Essentials of Emergency Medicine 2014. Powerful talk about what we do every day. [AS]The Intensive Care Network has a must-listen update from the legendary John Myburgh on fluid resuscita...
Source: Life in the Fast Lane - May 10, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Factors determining the survival after coronary artery bypass surgery
The most important factor is the left ventricular function. Those with poor left ventricular function have poor survival. Left ventricular function can also deteriorate due to inadequate myocardial protection during surgery. The type of grafts used also has influence on the survival. Live arterial grafts like left internal mammary artery  or dual internal mammary artery grafting give better long term results. Saphenous vein grafts in general give poorer long term results. But it may not be always feasible to harvest the left internal mammary artery in an emergency surgery, due to time constraints. Progression of native ve...
Source: Cardiophile MD - May 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Source Type: blogs

Do it for Mom: Sign Up to Support Electronic Access to Your Health Records Today
By LYGEIA RICCIARDI and PETER LEVIN In many families, the mother serves as the Family Health CEO, managing healthcare for her parents, kids, spouse, and herself. It’s Mom who schedules the doctor’s appointments, hunts down the immunization records for school, sorts out the bills, and reminds you to take your pills. 

What a difficult slog! In a world where we can video chat for free, book our travel and pay our bills online, and even go to college without leaving the living room, simple things like getting a list of current medications are almost impossible.  As Family Health CEO, poor Mom fills out the same info...
Source: The Health Care Blog - May 10, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Paced rhythm. Are there hyperacute T-waves? See the T-wave evolution, even in paced rhythm.
This was sent to me by John Larkin, from Australia, who has a great ECG Blog called "ECG of the Week," where he posted it, and graciously allowed me to post it here.The ECG is from an elderly male with multiple co-morbidities including significant cognitive impairment, cardiac failure and diabetes. He presented to the Emergency Department with several hours of chest pain and has a pacemaker in-situ for an unknown indication.Here is his ECG:John's thoughts on the ECG are as follows:·         Regular V-paced rhythm at 60 bpm with LAD.·       &n...
Source: Dr. Smith's ECG Blog - May 10, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Addressing end-of-life care in the emergency department
“I need a doctor in here!” As I walk into the resuscitation room in the emergency department (ED), I see Mr. G, a cachectic elderly gentleman barely holding onto his breath. After a rapid assessment, it is clear that he is tiring and cannot maintain breathing on his own for much longer. “We need to secure his airway” — with my command, the resident applies an oxygen mask, cracks open the airway box and prepares to intubate Mr. G, a respiratory therapist rushes in to assist the resident, and two nurses insert IV lines and gather medication. Continue reading ... Your patients are rating you online: How to resp...
Source: Kevin, M.D. - Medical Weblog - May 9, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Cartoon: That Moment When You Realize Your Child Took Your Emergency Training Very Literally
(Source: Better Health)
Source: Better Health - May 8, 2015 Category: American Health Authors: Dr. Val Jones Tags: Friday Funny 911 Calling 911 cartoon Children Emergency Training EMS Pediatrics Source Type: blogs

Silent Killers Amidst The Fast And The Furious
Attention to Ebola is important. The virus’s ability to easily cross regional and national borders makes it a significant threat to global health and national security. The swift and aggressive international response to the 2014 outbreak of the Ebola virus, which has killed at least 10,000 people in Liberia, Sierra Leone, and Guinea, has been laudable and has resulted in positive outcomes, such as reduced disease transmission and strengthened global health and coordination systems. For example, staff from the Centers for Disease Control and Prevention in the United States, including those from various divisions at the Na...
Source: Health Affairs Blog - May 7, 2015 Category: Health Management Authors: Karen R. Siegel, K.M. Venkat Narayan and Christine Hancock Tags: Costs and Spending Featured Global Health Public Health chronic disease Diabetes Ebola H1N1 Source Type: blogs

Confronting cognitive bias in the ER
As an internist, working in the emergency room feels at times like the dark underbelly of medicine. The frenetic pace, the need to make decisions within highly uncertain conditions, and reliance on technology all cut against the grain of the internists credo of “being a doctor’s doctor.” If internists are biased in how they arrive at diagnoses, emergency medicine doctors face such bias on an exponential scale. Clinical decision-making is a tricky process, and so far no checklist or educational strategy has made it less tricky. Below are three strategies to further understand and demystify clinical bias. Continue read...
Source: Kevin, M.D. - Medical Weblog - May 7, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Top stories in health and medicine, May 7, 2015
From MedPage Today: How to Rein In Out-of-Control Healthcare Costs. We all know the medical bill horror stories, but now we have to act on them. More ED Visits Since Obamacare. One objective of the Affordable Care Act was to increase access to primary care and curb visits to emergency rooms. Now the president of the American College of Emergency Physicians says the approach is not only misguided, it’s also not working. RA Cachexia Persists Despite Treat-to-Target. The “treat-to-target” approach for rheumatoid arthritis (RA), which has been highly successful in improving disease activity, inducing remiss...
Source: Kevin, M.D. - Medical Weblog - May 7, 2015 Category: Journals (General) Authors: Tags: News Cancer Rheumatology Source Type: blogs

Nepal Earthquake Response Shows Need for Better International Planning
The U.S. provided supplies after the earthquake in Nepal, but they piled up at points of delivery because Nepalese customs authorities insisted that standard inspections be followed, even in an emergency situation. These kinds of bureaucratic challenges can be more easily overcome if they are identified and addressed before crises arise. (Source: The RAND Blog)
Source: The RAND Blog - May 7, 2015 Category: Health Management Authors: RAND Corporation Source Type: blogs

Research and Reviews in the Fastlane 082
This article outlines the EXTRIP workgroup’s recommendations based on their systematic review. Our focus should be on dialyzing patients with altered mentation, renal impairment and the presence of dysrhythmias.Recommended by: Anand SwaminathanRead More: Hemodialysis in lithium poisoning: what is the evidence? (The poison review)Critical Care, Respiratory Kim NH et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013; 62: D92-9. PMID: 24355646 (FREE OPEN ACCESS ARTICLE)We’re very savvy with acute PE but I must confess to being less than knowledgable about chronic VTE. There’s ...
Source: Life in the Fast Lane - May 6, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine Haematology Intensive Care R&R in the FASTLANE Respiratory Resuscitation Toxicology and Toxinology Trauma critical care examination literature recommendations research and reviews Source Type: blogs

Politico: Electronic record errors growing issue in lawsuits
The indefatigable Arthur Allen of Politico.com has authored a nice piece on the issue of EHRs being a cause of medical malpractice, with resultant litigation.  I was a contributor:Electronic record errors growing issue in lawsuitsBy Arthur Allen5/4/15 6:40 AM EDThttp://www.politico.com/story/2015/05/electronic-record-errors-growing-issue-in-lawsuits-117591.htmlMedical errors that can be traced to the automation of the U.S. health care system are increasingly an issue in medical malpractice lawsuits.Some of the doctors, attorneys and health IT experts involved in the litigation fear that safety and data integrity probl...
Source: Health Care Renewal - May 6, 2015 Category: Health Management Tags: Arthur Allen healthcare IT litigation healthcare IT risk Politico Source Type: blogs

Implementing Health Reform: Antidiscrimination Litigation Under Section 1557 Of The ACA
Dozens of cases have been filed over the past five years challenging various aspects of the Affordable Care Act and its implementation. Two of these have made it to the Supreme Court (three if you count Hobby Lobby v. Sebelius). In its 2012, National Federation of Independent Business v. Sebelius decision, the Court upheld the ACA’s individual responsibility requirement but seriously undermined the ACA’s expansion of Medicaid to low-income adults by making it a state option. King v. Burwell, which the Court will decide in the next couple of months, threatens to withdraw tax credits from millions of Americans who live ...
Source: Health Affairs Blog - May 6, 2015 Category: Health Management Authors: Timothy Jost Tags: Equity and Disparities Following the ACA ACA litigation Gilead section 1557 SEPTA Source Type: blogs

Another day, another EHR outage: MEDSTAR EHR goes dark for days
At my March 2, 2015 post "Rideout Hospital, California: CEO Pinocchio on quality of patient care during hospital computer crash" (http://hcrenewal.blogspot.com/2015/03/rideout-hospital-california-ceo.html) I highlighted a stunning example of when the light shone through the corporate B.S. about health IT outages, thanks to a letter to the editor by a family member of an affected patient:Letter: Re: Rideout Hospital computer problemshttp://www.appeal-democrat.com/opinion/letter-re-rideout-computer-problems/article_4a408cc0-be47-11e4-9b7b-93c22da930d4.html Friday, February 27, 2015 I am writing in regard to comment...
Source: Health Care Renewal - May 6, 2015 Category: Health Management Tags: healthcare IT crash healthcare IT outage MedStar Health Patient care has not been compromised Politico Source Type: blogs

The NYT, Maureen Dowd, and Dr. Caplan
Behold, a very worthy rant.  Recommended. No related posts. (Source: GruntDoc)
Source: GruntDoc - May 6, 2015 Category: Emergency Medicine Authors: GruntDoc Tags: Emergency Rants Source Type: blogs

Successful Acute Care Payment Reform Requires Working With The Emergency Department
Note: The work reflected in this post and our May 6th MEDTalk, “Reimagining Emergency Medicine: Moving to Integrated Care for the Ill and Injured," is made possible through the Merkin Initiative on Physician Payment Reform and Clinical Leadership, a Brookings Institution project to engage clinicians in health care delivery and financing reform. The May 6 event will bring together practicing emergency physicians and leaders from health insurers, Medicare, and health care organizations to discuss the future of the acute care system. More than a third of all patient encounters in the United States---354 million per year-...
Source: Health Affairs Blog - May 5, 2015 Category: Health Management Authors: Jesse Pines Tags: Costs and Spending Featured Hospitals Innovations in Care Delivery Organization and Delivery Payment Policy Quality Alternative Payment Methodology Chesapeake Regional Information System for our Patients Emergency Medicine ER For Emerg Source Type: blogs