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

The Medicaid Expansion Experience In Michigan
As of July 2015, 30 states and the District of Columbia have expanded or planned to expand Medicaid under the Affordable Care Act (ACA). Michigan is one of only six states with a fully Republican-led state government to expand the program. The Healthy Michigan Plan (Michigan’s version of the Medicaid expansion) went into effect on April 1, 2014. One year into this expansion, Michigan’s experience has confirmed some expectations but vastly exceeded others. Michigan’s Path To Expansion In late 2012, Republican Governor Rick Snyder expressed initial concerns that the state would not have enough health care providers to ...
Source: Health Affairs Blog - August 28, 2015 Category: Health Management Authors: Marianne Udow-Phillips, Kersten Burns Lausch, Erin Shigekawa, Richard Hirth and John Ayanian Tags: Equity and Disparities Following the ACA Medicaid and CHIP Population Health Public Health CMS Healthy Michigan Plan Republican Rick Snyder Source Type: blogs

Hurricane Katrina: Remembering the Federal Failures
Ten years ago this week, Hurricane Katrina made landfall on the Gulf Coast and generated a huge disaster. The storm flooded New Orleans, killed more than 1,800 people, and caused $100 billion in property damage. The storm’s damage was greatly exacerbated by the failures of Congress, the Bush administration, the Federal Emergency Management Agency (FEMA), and the Army Corps of Engineers. Weather forecasters warned government officials about Katrina’s approach, so they should have been ready for it. But they were not, and Katrina exposed major failures in America’s disaster preparedness and response systems. Here are s...
Source: Cato-at-liberty - August 27, 2015 Category: American Health Authors: Chris Edwards Source Type: blogs

Ten Years After Hurricane Katrina: Progress And Challenges Remain For US Emergency Preparedness
Ten years ago, the nation watched in shock as Hurricane Katrina devastated the city of New Orleans. Katrina was followed closely by Hurricane Rita, impacting Western Louisiana, and these storms collectively have become synonymous with systemic failure of disaster preparedness, response, and recovery policy. They provided a wake-up call to government agencies, politicians, and community agencies alike. That following year, Congress created, among other things, an Office of the Assistant Secretary for Preparedness and Response (ASPR) in the US Department of Health and Human Services (HHS), with a mandate to reach across gove...
Source: Health Affairs Blog - August 27, 2015 Category: Health Management Authors: Nicole Lurie, Karen DeSalvo and Kristen Finne Tags: Costs and Spending Equity and Disparities Featured Health Professionals Long-term Services and Supports Organization and Delivery Population Health Public Health Quality emergency response HHS Hurricane Katrina National Health Secu Source Type: blogs

Nobody teaches a physician the emotional consequences of medicine
I have a confession to make: I sometimes look forward to my trips to the bathroom at work. Being a busy pediatrician, it can be the only alone time I get to myself; and on occasion you just need a quiet place where babies aren’t crying, and phones aren’t ringing. The other day as I was leaving the bathroom and returning to the bustling clinic, I did something strange. I knocked on the door before I exited the bathroom. It has become so much a part of my routine to knock on doors as I enter rooms that my brain apparently now knocks on doors as a reflex of sort. Luckily, no one saw me do this, and I left the bathroom pre...
Source: Kevin, M.D. - Medical Weblog - August 27, 2015 Category: Journals (General) Authors: Tags: Physician Pediatrics Source Type: blogs

Quality Improvement: ‘Become Good At Cheating And You Never Need To Become Good At Anything Else’
The Centers for Medicare and Medicaid Services (CMS) has trumpeted the recent drop in hospital readmissions among Medicare patients as a major advance for patient safety. But lost amidst the celebration is the fact that hospitals are increasingly “observing” patients (or treating returning patients in the emergency department) rather than “readmitting” them. But while re-labeling helps hospitals meet CMS’ quality standards (and avoid costly fines), it probably signals little real quality gain and often leaves patients worse off financially. Observation Status Debate over the seemingly arcane s...
Source: Health Affairs Blog - August 27, 2015 Category: Health Management Authors: David Himmelstein and Steffie Woolhandler Tags: Costs and Spending Featured Health IT Hospitals Medicaid and CHIP Medicare Organization and Delivery Payment Policy Population Health Quality CMS Discharge Emergency Medicine Hospital readmissions Observation pay-for-performa Source Type: blogs

"How could I convince my interventionalist to come do a cath in the middle of the night?"
I just received this email today.  I receive these fairly frequently:Dear Dr. Smith:I am an Emergency physician working in an outlying hospital in _________. We have an interventional hospital to which we refer cath lab patients.  I had a 31 year old with typical chest pain and vomiting and the attached ECG. I was sure he was infarcting but couldn’t convince the interventionalist to take him (after emailing him the ECG).I treated the patient aggressively with medical management and transfered him to the tertiary center.  They did not take him to the cath lab emergently.  When he went to the cath lab t...
Source: Dr. Smith's ECG Blog - August 27, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Research and Reviews in the Fastlane 097
This article looks at the role medicolegal concerns play in the management of patients with chest pain. The authors found that up to 30% of patients would not have been admitted if physicians had an established “acceptable miss-rate” or worked in a zero medicolegal risk environment. Maybe it’s time that we make some real headway in these areas in order to cut down on unnecessary healthcare spending. Recommended by: Anand Swaminathan Read More: Expunging “Zero-Miss” from Chest Pain Evaluations (EM Lit of Note) The Best of the Rest Emergency Medicine, PulmonaryHutchinson BD et al. Overdiagno...
Source: Life in the Fast Lane - August 26, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Intensive Care Pediatrics Respiratory Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews urology Source Type: blogs

Implementing Health Reform: New Guidance On Reenrollment Of 2015 Enrollees (Updated)
August 28 update: On August 27, 2015 the Centers for Medicare and Medicaid Services (CMS) published a notice that it is seeking emergency clearance from the Office of Management and Budget (OMB) for modifications to an information collection request currently approved by the OMB for collecting information from insurers under the medical loss ratio and risk corridor programs. CMS claims that additional and more detailed information is necessary to validate data that insurers have already submitted to CMS, to resolve significant discrepancies in the 2014 benefit-year submissions, and to address a number of common errors tha...
Source: Health Affairs Blog - August 26, 2015 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage CMS insurers passive enrollment QHPs reenrollment REGTAP Source Type: blogs

American Hospitals Need to Stop Offering Fast Food, Quick!
Ban on Hospital Smoking: A Model In the 1950′s the Journal of the American Medical Association (JAMA) published what was, at the time, an incredibly surprising finding: smoking is detrimental to health1. By 1964, the Surgeon General had publically acknowledged the linkage between smoking and cancer and, by the seventies, the smoking-cancer relationship was standard curricula in U.S. medical schools 2. Despite both medical and public awareness, however, hospital policy lagged behind the science; most healthcare centers had little to no official regulation regarding smoking in their facilities2. Reducing Smoking in Hos...
Source: Disruptive Women in Health Care - August 26, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Consumer Health Care Food Policy Publc Health Source Type: blogs

The Real Dark Side of Health Care: Health Care Corruption
The editors of the prestigious Annals of Internal Medicine just stated they they were shocked, shocked to find out that physicians occasionally express disrespect for patients when the patients cannot hear or see them.  The occasion was an editorial signed by three editors whose title included the phrase, "shining a light on the dark side of health care."(1)  The editorial referred to an anonymous narrative that recounted two incidents from the past.(2)Two Alleged Incidents of Physicians' Expression of Disrespect for Patients The first incident, discussed second hand, was of a obstetrician who made a sexist comme...
Source: Health Care Renewal - August 25, 2015 Category: Health Management Tags: anechoic effect Annals of Internal Medicine health care corruption medical journals professionalism Source Type: blogs

Tips For Hospitals: Hiring Locum Tenens Physicians
This post originally appeared on The Barton Blog. It’s both expensive and time-consuming to obtain temporary coverage for a hospital or medical practice. Locum tenens clients have every right to expect high-quality care from the locum tenens providers they hire; but even the very best locums may not perform to their full potential if their onboarding isn’t carefully planned. As a locum tenens physician with licenses in 14 states, I have much experience with the onboarding process. Here are 12 tips for facilities eager to encourage smooth transitions, foster good provider relationships, and provide excellent patient ...
Source: Better Health - August 25, 2015 Category: American Health Authors: Dr. Val Jones Tags: Health Tips Barton How To Succeed Locum Tenens Success Temporary Coverage Tips For Onboarding Traveling Physicians Source Type: blogs

Physician burnout: (Un)wellness and the passion paradox
When it comes to physician wellness, I’m type A noncompliant. That realization struck me midway through my last vacation, which was notable because I didn’t travel anywhere, and the most extraordinary activity involved sleeping through the night. Shift work, especially overnight shifts, has a way of inflicting sneaky havoc upon the body and minds of the delusionally hearty. After twenty years as an emergency physician, I should know better than to grind the gears of my circadian clock. Sleep isn’t a potholed construction of naps. Academic emergency physicians are aberrant physiologic organisms prone to a particular f...
Source: Kevin, M.D. - Medical Weblog - August 24, 2015 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

How Stanford Med Got “Work-Life Balance” Wrong
By KAREN SIBERT, MD Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”? Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white? Every day, I go to work and see the example of the nurses and technicians who work right alongside me in tough thoracic surgery cases. Zanetta, for instance, is the single mother of five children. She leaves her 12-hour shift at 7 p.m. and then faces...
Source: The Health Care Blog - August 24, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Karen Sibert Stanford Medicine Workplace Wellness Source Type: blogs

Getting The WHO To Take The Reins In Global Pandemics
The World Health Organization (WHO) has a credibility problem, according to the recently released “Report of the Ebola Interim Assessment Panel.” The Panel of outside independent experts describes an under-resourced organization that is ill prepared for a global public health emergency and occasionally puts politics ahead of public health. The Panel, which convened in March 2015, calls for immediate and comprehensive reform and offers a wealth of recommendations to strengthen the WHO’s preparedness and response capacity during a public health emergency of international concern (PHEIC), such as the ongoing Ebola ...
Source: Health Affairs Blog - August 24, 2015 Category: Health Management Authors: Michael Bluman Schroeder Tags: Costs and Spending Featured Global Health Organization and Delivery Payment Policy Public Health Quality Ebola emergency funding International organizational culture WHO Source Type: blogs

Free online training program for Minnesota special needs workers
The Arc of Minnesota and the University of Minnesota are making Elsevier Publishing’s online training programs available free of charge to Minnesota residents; the list price for one of these courses is about $300. They are designed to support training special needs professionals.There are four training programs, each with a university sponsor:Direct Support (University of Minnesota): designed for direct support professionals (DSPs) and others who support individuals with disabilities.Employment services (UMass): "designed for professionals who support people with disabilities and other challenges to find employment"Pe...
Source: Be the Best You can Be - August 24, 2015 Category: Disability Tags: education employment Source Type: blogs

LITFL Review 194
Welcome to the 194th 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 When is ST elevation not ACS? Read Stephen Smith’s blog for a great case demonstrating that ST elevation = ischemia but not necessarily coronary occlusion. [AS] The Best of #FOAMed Emergency Medicine A primer on xanthochromia from Boring EM. [A...
Source: Life in the Fast Lane - August 23, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

For Patient Safety: A Reversal. What Can Healthcare Teach the Aviation Industry?
By RHONDA WYSKIEL There are more than 50 in-flight medical emergencies a day on commercial airlines — or one for every 604 flights, according to a study published in 2013. What are the odds that two emergencies would occur on the exact same flight, above the Atlantic Ocean and hours from the nearest airport? My colleague Mark, a critical care physician with whom I’d worked as an ICU nurse, and I were traveling to the Middle East for a patient safety conference. We were comfortably tucked into our seats, as he snored next to me. It must have been about 3 a.m. when I was awakened by an overhead announcement asking ...
Source: The Health Care Blog - August 23, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB aviation Johns Hopkins Patient Safety Source Type: blogs

We should treat patients, not our ideas of patients
Throughout the course of a physician’s career, many patients come across the path with numerous complaints and medical conditions requiring interpretations and actions, respectively. In a field with little time to see everybody at length, pattern recognition becomes important to make efficient decisions with regards to patient care. Usually, it involves focusing on the patient’s condition exclusively, but at times, the social aspects of a patient come into play with that decision. It’s easy to assume that a patient with a poor social situation who repeatedly shows up to the emergency room with an exacerbation of chro...
Source: Kevin, M.D. - Medical Weblog - August 22, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Primary care Source Type: blogs

Funtabulously Frivolous Friday Five 113
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 113 Question 1 What did Valsalva (1666-1723) note as “..leaving the tongue tingling unpleasantly for the better part of the day“ + Reveal the Funtabulous Answer expand(document.getElementById('ddet89085732'));expand(document.getElementById('ddetlink89085732')) Gangrenous pus He also noted that it did “not taste good“. The things we do for science…. [Reference] Question 2 What does the acron...
Source: Life in the Fast Lane - August 21, 2015 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five berry sign FFFF filovirus GOMER hippocratic oath house of god malignant thyromegaly valsalva Source Type: blogs

3 EMTs have a jam session in an ambulance. And they’re good.
What do EMTs do in between calls?  Talented folks, those first responders. 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 - August 21, 2015 Category: Journals (General) Authors: Tags: Video Emergency Source Type: blogs

2 weeks of chest pain, weakness. Presents with tachycardia.
A middle-aged male with no significant past history complained of chest pain for 2 weeks.  He stated that it was intermittent and there were no identifiable triggers. The pain was located at upper left chest without radiation and was "sharp" and aggravated by deep inspiration.  He endorses some SOB.On exam he appeared somewhat lethargic, with a normal body habitus, and had the following vital signs:  BP 116/77 mmHg | Pulse 117 | Temp(Src) 36.4 °C (97.5 °F) | Resp 16 | SpO2 95%.Cardiac exam was normal.  There was bilateral mild pitting edema.An ECG was recorded:What do you think and what do you want to...
Source: Dr. Smith's ECG Blog - August 21, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

NHS Indicators: England, August 2015
House of Commons Library - This statistical summary for NHS England covers the following areas: accident and emergency attendance and performance; ambulance call volume and response times; waiting times for routine treatment; waiting times for cancer diagnosis and treatment; cancelled operations; delayed transfers of care; diagnostic waiting times and activity; waiting times for mental health treatment; workforce numbers for doctors, nurses and other staff; hospital activity, referrals and admissions; and bed availability and occupancy. Briefing Commons Library publications (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - August 21, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: NHS finances and productivity NHS measurement and performance Source Type: blogs

Antibiotics for Appendicitis: Penny wise but pound foolish
By SAURABH JHA A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 % of patients. Depending on how this is framed, you can celebrate a 70 % success or lament a 30 % failure. Much of the debate in healthcare is a battle of framing.The study has limitations. Finland is not just a land of the midnight sun but a land of fewer laparascopic surgeries than the USA. This is important because if done properly laparoscopic surgery has a lower morbidity than open surgery, as Skeptical Scalpel explains. Should we be excited that antibiotics can be us...
Source: The Health Care Blog - August 20, 2015 Category: Consumer Health News Authors: suchandan roy Tags: THCB Saurabh Jha Source Type: blogs

The ‘Must Do’ List: Certain Patient Safety Rules Should Not Be Elective
The modern patient safety field was built on a foundation of “systems thinking,” namely, that we should avoid assigning individual blame for errors, instead focusing on identifying and fixing dysfunctional systems. While this approach is largely correct and is responsible for many of the field’s successes, it needs to be balanced with a need for accountability. Today, while there is an increasing appreciation of the importance of achieving such balance, leaders of health care delivery systems are unsure about how and when to enforce certain safety standards and rules. We believe that the time has come to articulate c...
Source: Health Affairs Blog - August 20, 2015 Category: Health Management Authors: Robert Wachter Tags: Health Policy Lab Health Professionals Hospitals Organization and Delivery Population Health Public Health Quality Just Culture Lucian Leape Institute National Patient Safety Foundation National Quality Forum Robert Wachter Source Type: blogs

The truth behind why doctors don’t tell the truth
There are two key scenarios when doctors fail to tell “the whole truth and nothing but the truth so help me God.” Sometimes doctors give a diagnosis we’re not 100 percent sure of and other times we don’t diagnose something we’re almost 100 percent sure of. The truth is complicated and often more gray than black and white. Scenario #1: “You have [insert diagnosis here].” My dad recently awoke from sleep like you would aboard a ship on rough seas that smacks a giant wave. The room was spinning, he’d lost his balance and he was vomiting. He was evaluated and treated in the emergency department in my little hom...
Source: Kevin, M.D. - Medical Weblog - August 20, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Research and Reviews in the Fastlane 096
This study assessed the speed and accuracy of medication administration in simulated pediatric resuscitations. 10 teams consisting of physicians and nurses participated in a cross over study, so that they did one simulation with the new syringes and one without. Time to delivery of medications was quicker with the new syringes (47 versus 19 seconds, a difference of 27 seconds; 95%CI 21-33 seconds). Teams were also more accurate using the new color-coded syringes, with dosing errors occurring 17% of the time with the conventional approach and 0% of the time with the new syringes (absolute difference 17%; 95% CI 4-30%). Obvi...
Source: Life in the Fast Lane - August 19, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma EBM Intensive Care literature R&R in the FASTLANE recommendations research and reviews Respiratory urology Wilderness Medicine Tagg Source Type: blogs

The price of certainty in the ICU
Mr. J was as close to a typical sixty-year-old patient as possible, wary of doctors and selective in when he took his blood pressure medications. On a sunny Thursday, he woke up nauseated and called an ambulance. During evaluation in the emergency room, his blood pressures reached atmospheric levels (nearly 300 systolic). He began seizing, which soon stopped and was transferred to the ICU. As the admitting resident, I dutifully went through the potential causes of his elevated blood pressure: medication noncompliance, surreptitious cocaine use, and even the zebra diagnosis of a pheochromocytoma. As for the seizure, I held ...
Source: Kevin, M.D. - Medical Weblog - August 19, 2015 Category: Journals (General) Authors: Tags: Physician Heart Intensive care Source Type: blogs

Heading Off The Looming Diabetes-Tuberculosis Epidemic
Tuberculosis (TB) has recently made headlines in the U.S. And news of these cases remind us once again that TB is far from conquered. This disease infects about 8.6 million people every year and kills 1.5 million, more than any other infectious disease except human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS). Increasingly, TB’s spread is fueled by rising rates of diabetes—as with HIV, diabetes weakens the immune system, making a person more vulnerable to TB infection and illness—particularly in emerging economies like India and China, which are the source for much of th...
Source: Health Affairs Blog - August 19, 2015 Category: Health Management Authors: Anthony Harries Tags: Costs and Spending Equity and Disparities Featured Global Health Organization and Delivery Population Health Public Health Diabetes epidemics HIV/AIDS TB World Diabetes Foundation World Health Organization Source Type: blogs

Why Prisons Should Try Readmissions Penalties
By STUART M. BUTLER By the end of 2013 there were approximately 1.5 million people in state or federal prisons, and the U.S. incarceration rate is the highest in the world. And while there is debate about the relationship between this level of imprisonment and crime rates, there is considerable research to show that a spell of incarceration exacerbates economic and social conditions for families as well as former inmates, especially in low-income neighborhoods. That has led the Obama Administration and some interesting strange-bedfellow groups to call for alternatives to prison for some infractions. The other side of the p...
Source: The Health Care Blog - August 19, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Hospitals Prison Readmissions Penalty Source Type: blogs

The Knife and Gun Club: Scenes from an Emergency Room [EOL in Art 99]
In The Knife and Gun Club: Scenes from an Emergency Room, award-winning photojournalist Eugene Richards explores the emergency room of Denver General Hospital. A witness to terrible pain, to life-and-death decisions, and to occasional joy, Richar... (Source: blog.bioethics.net)
Source: blog.bioethics.net - August 18, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

Paramedics Aren't Just for Emergencies
Paramedics are doing more than stabilizing patients and taking them to hospitals. They give IV medication, dress wounds, take lab tests and talk to patients about post-hospital care—at home. (Source: WSJ.com: The Informed Patient)
Source: WSJ.com: The Informed Patient - August 18, 2015 Category: Consumer Health News Tags: FREE Source Type: blogs

Breaking The Fee-For-Service Addiction: Let’s Move To A Comprehensive Primary Care Payment Model
This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more. With much fanfare earlier this year, the Obama administration announced an aggressive goal to process half of all Medicare payments by the end of 2018 through alternative payment models as opposed to traditional fee-for-service (FFS). Primary care is one of the most urgent sectors needing such payment reform. As Bob Berenson succinct...
Source: Health Affairs Blog - August 17, 2015 Category: Health Management Authors: Rushika Fernandopulle Tags: Costs and Spending Equity and Disparities Featured Health Professionals Hospitals Long-term Services and Supports Medicare Organization and Delivery Payment Policy Population Health Quality ACOs fee-for-service Grameen America Source Type: blogs

Bringing Clinicians, Patients, and Financial Administrators into a Common Conversation About Affordable Care
By NEEL SHAH, MD and DAN MICHELSON It all started a few years ago with an out-of-the-blue e-mail: “Neel – I saw the work you are doing via the article in the journal ‘Leadership’.  Congratulations as this is a great area of focus to pursue – the need to take down the complexity as it relates to cost/charge/reimbursement is a tough and an important issue.  There may be some interesting ways we can collaborate.  Best, Dan” That e-mail would lead to a major initiative, a National Story Contest called The Best Care, The Lowest Cost: One Idea at a Time that we are launching this week.  More on that below, bu...
Source: The Health Care Blog - August 17, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Yes, I am a Rhodes Scholar who is “just” a family doctor. Here’s why.
“So you’re a Rhodes Scholar, and you’re just a family doctor?” If I was paid a dollar each time I’m asked this question, I can safely retire. It seems innocent enough, and it’s usually asked without malice. But the fundamental assumption behind this question alarms me: that family doctors are somehow less competent and less valuable to society than specialist doctors. It’s an assumption that cannot be more wrong. Not only is such implicit stigmatization unfair to family doctors, it also misleads the future of our profession and harms the patients we serve. Are family doctors less competent? Common accusations...
Source: Kevin, M.D. - Medical Weblog - August 17, 2015 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

LITFL Review 193
Welcome to the 193rd 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 See FOAM4GP’s Simplify the Message on how to explain a medical condition or treatment to a patient using something in their lives they can relate to. Or as Orson Scott Card puts it, “Metaphors have a way of holding the most truth in th...
Source: Life in the Fast Lane - August 16, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

CCC Update 011
Updates to the LITFL Critical Care Compendium are coming thick and fast at the moment. Here’s a quick summary as these entries don’t appear in the LITFL blog feed, and you otherwise need to search for them using search keywords in the CCC table, by googling “litfl ccc searchterm” or by searching GoogleFOAM. Remember, constructive feedback is the fuel that LITFL runs on, hit us with it! Here’s what is new in the CCC since CCC Update 010: Cerebral venous thrombosis This condition reared its head in the last round of FCICM exam vivas I believe — and it wouldn’t surprise me if it...
Source: Life in the Fast Lane - August 15, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Critical Care Compendium Education Emergency Medicine Intensive Care CCC cerebral venous thrombosis early mobilistation extremity trauma ICU acquired weakness MODS Source Type: blogs

Nursing Homes are restarting the ‘don’t send the MAR’ game
For a primer, from 2007, here. Another patient, another absent MAR (if you don’t know that acronym, you didn’t read the lead in article!). Usually they send when we call, but not recently. Here’s an amalgamation of some cases: Calls are made by the nurses at my behest. The MAR Will Not be Sent. Per nursing, whom I work with daily and trust implicitly, here are the objections proffered: 1) It’s illegal to send our signatures Really? No, it’s not. 2) It’s our policy not to send MAR’s Good luck with that policy. It’s going to get you in trouble. 3) You don’t need that. As ...
Source: GruntDoc - August 15, 2015 Category: Emergency Medicine Authors: GruntDoc Tags: Emergency Nursing Source Type: blogs

The Hunger Games of health care is here. Who will be our Katniss?
“Doctor, the patient is complaining,” said my secretary in a hush-hush voice. “She has been waiting for 30 minutes.” “She” had an appointment for later in the afternoon but phoned our office about 2 hours before the scheduled time, and requested to come earlier. No emergency. No acute complaints. We always try to accommodate, and pushed to “squeeze” her in. The earlier time, of course, overlapped with another patient who ran just a little bit late. She seized the moment, and released her stress and frustration by calling us “liars” and storming out of the office after a very ugly scene. This was...
Source: Kevin, M.D. - Medical Weblog - August 13, 2015 Category: Journals (General) Authors: Tags: Policy Health reform Primary care Source Type: blogs

What’s the Definition of Interoperability? A Conversation With EXTREME’s Adam Wright
By LEONARD KISH Adam Wright of Partners and colleague Dean Sittig asked themselves, with all the talk about information blocking and interoperability happening in congressional hearings this year, “How should we actually define interoperability?” To answer their question, they did research on use cases and published a definition in a JAMIA article, “What makes an EHR “open” or interoperable?“ Leonard Kish, Principal at VivaPhi, sits down with Wright to talk about the EXTREME (EXtract, TRansmit, Exchange, Move, Embed) use-case based definition and more. LK: So let’s just start from the begin...
Source: The Health Care Blog - August 13, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Leonard Kish Source Type: blogs

Research and Reviews in the Fastlane 095
This article reveals the lack of knowledge about contrast reactions, but also reinforces the real risk of repeat reactions despite treatment. The authors found that despite premedication, patients with a history of a prior reaction were still at a significantly increased risk of a recurrent reaction. The bottom line is that premedication may not work. Be ready to treat these patients aggressively if symptoms occur. Recommended by:Daman Langguth Emergency Medicine, RespiratoryRaja AS, et al. Effects of Performance Feedback Reports on Adherence to Evidence-Based Guidelines in Use of CT for Evaluation of Pulmonary Embolism...
Source: Life in the Fast Lane - August 12, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education Emergency Medicine Intensive Care Respiratory Resuscitation Urology Wilderness Medicine critical care EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Breaking The Graduate Medical Education Policy Logjam
This report proposed major reforms which would create a GME system with greater transparency, accountability and strategic direction that aligns with national needs. Stakeholder response to the IOM Report currently is being evaluated by Congress in the Health subcommittee of the House Energy and Commerce (E&C) committee. Their input from various stakeholders has been complex and lacking in consensus, thereby perpetuating the GME policy logjam, creating a daunting challenge and thereby decreasing prospects of any comprehensive legislative GME reform in this session of Congress. Since the introduction of the “resident ...
Source: Health Affairs Blog - August 12, 2015 Category: Health Management Authors: Richard Rieselbach, David Sundwall, Kenneth Shine, Ted Epperly and Byron Crouse Tags: Costs and Spending Featured Health Policy Lab Health Professionals Medicaid and CHIP Medicare Organization and Delivery Population Health Quality COGME HHS House Energy and Commerce committee IOM report MACRA Primary Care Rur Source Type: blogs

Recap – The Intersection of Health and Housing: Opportunities and Challenges Panel
It was an honest, eye-opening remark during the Alliance for Health Reform panel on Friday, when speaker Barbara DiPietro talked about a common obstacle for patients when they receive a prescription for an illness: many drugs have side effects, some of which may lead to a few more visits to the restroom. For most people with a permanent home or workspace, especially when it comes to making a recovery from an illness or condition, this is an inconvenient, but necessary, reality. However, for homeless people who do not have access to bathroom facilities 24/7, they do not have the luxury of taking a treatment with such side e...
Source: Disruptive Women in Health Care - August 12, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Access Disparities Source Type: blogs

Making payment work better to support new models of urgent and emergency care: an introduction
Monitor -This document is for all organisations involved in the commissioning or delivery of urgent and emergency care services, including NHS 111, community pharmacy, community care urgent response and social care urgent response services, in-hours urgent primary care, GP out-of-hours, 999, ambulance, walk-in centres, urgent care centres, emergency department attendances and emergency admissions. It is intended for chief executives, clinicians and others who require a broad understanding of a potential new payment approach being developed by Monitor and NHS England to support the service reform, but who do not need to acc...
Source: Health Management Specialist Library - August 12, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: NHS finances and productivity Source Type: blogs

Reinventing Home Health
Accountable care is finally coming to home health. The Centers for Medicare and Medicaid Services (CMS) is launching a value-based reimbursement (VBR) pilot program for Medicare home health care agencies. The model is part of the 2016 Home Health Prospective Payment System proposed rule, which was published in the Federal Register on July 10. In the current reality of home health care, if you are a home health provider and not part of a hospital or health system, your world looks something like this: A hospital discharge planner (your customer) chooses which agency will care for the homebound patient (also your customer)....
Source: Health Affairs Blog - August 11, 2015 Category: Health Management Authors: John Marchica Tags: Costs and Spending Health Professionals Long-term Services and Supports Medicare Payment Policy Population Health ACOs BAYADA CMS home healthcare triple aim value-based reimbursement Source Type: blogs

The Last Mile In Community Health: Reaching The Hardest To Serve
This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more. In the wake of the West African Ebola crisis, we—as a global community—have had time to reflect on the striking inequities in health systems, the intersections between health and global security, and the lessons learned about coordinated emergency efforts. Ultimately, though, as our colleague Raj Panjabi from Last Mile He...
Source: Health Affairs Blog - August 11, 2015 Category: Health Management Authors: Wendy Taylor Tags: Costs and Spending Equity and Disparities Featured Global Health Health Professionals Organization and Delivery Population Health Public Health Quality Aspen Ideas Festival Community Health Ebola Spotlight Health USAID Wendy Ta Source Type: blogs

What happens when the best medicine has to offer can’t be offered to everyone?
“We have an admission.” The dreaded four words for most interns on a day you are swamped with discharges while trying to get your post rounds orders in. “Hypertensive emergency and possible osteomyelitis of the foot,” my senior informed me with a few other details as we made our way to the emergency department. Mr. Rodriguez was a very pleasant middle-aged gentleman, with graying hair and a goatee.  I introduced myself, explained my role in the healthcare team, and informed him why he was being admitted to hospital. Mr. Rodriguez nodded his head every few seconds, but his blank stare betrayed the fact that he did ...
Source: Kevin, M.D. - Medical Weblog - August 10, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Improving Patient Safety Through The National Action Plan For Adverse Drug Event Prevention
Editor’s Note: This is one of several posts Health Affairs Blog is publishing stemming from sessions at the June 2015 AcademyHealth Annual Research Meeting (ARM) in Minneapolis. Watch Health Affairs Blog for additional posts on topics raised at the ARM. Every day, media reports about opioid overdose bring attention to growing concerns about the risks associated with this class of medication. Opioid overdose—as the result of unintentional dosage error, aberrant medication-related behavior, and other factors—is just one example of an adverse drug event (ADE) that is a significant cause of drug-related inju...
Source: Health Affairs Blog - August 10, 2015 Category: Health Management Authors: Don Wright Tags: Drugs and Medical Technology Featured Public Health Academy Health Annual Research Meeting ADE Action Plan Healthy People 2020 ODPHP opioids Source Type: blogs

Magical thinking
Many people have superstitions of one kind or another. Our #1 has more than a few, and they contribute to his disabilities. For example, he bicycles miles out of his way to take certain favored routes for no reason he can describe.He’s had these problems all his life. The only thing I can compare them too is a beloved dog of ours who developed an intractable aversion to the back yard of a new home. Nothing, absolutely nothing, would persuade her to put her paws on the unfrozen ground there. We have no idea where this came from, but it never wavered over the last seven years of her life.It may be some dysfunctional associ...
Source: Be the Best You can Be - August 10, 2015 Category: Disability Tags: adult autism brain and mind cognitive impairment persuasion sport Source Type: blogs

LITFL Review 192
Welcome to the 192nd 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 An excellent review from St. Emlyn’s of the NICE guidelines in major trauma. Far more progressive than ATLS. [AS] The Best of #FOAMed Emergency Medicine Neil Long posts a fantastic set of videos on orthopedic splinting on LITFL. [AS] Excellent d...
Source: Life in the Fast Lane - August 9, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs

The problem with resident training hours: The numbers don’t add up
Being an intern and resident in today’s day and age of medicine is proving to be more difficult than ever. I’ve written about resident work hours before, but now that I have finished intern year, I have a lot more to say regarding this issue.  I recently reread Dr. Pauline Chen’s article “The Impossible Workload for Doctors in Training,” and also read “The Real Problem with Medical Internships” by Dr. Sandeep Jauhar published in New York Times, and it really got me thinking. An op-ed published in JAMA last year urged doctors and the higher-ups responsible for residency program accreditation...
Source: Kevin, M.D. - Medical Weblog - August 9, 2015 Category: Journals (General) Authors: Tags: Education Residency Source Type: blogs