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

When Health Care Transformation Fails
Last year was tough for the transformation of health care from volume to value. Two major medical home studies (Friedberg and Rosenthal) and two major readmission prevention studies (Goldman and Dhalla) had negative to underwhelming results. Thirteen of the original 32 Pioneer Accountable Care Organizations (ACOs) have dropped out of the program. Of the original 220 Medicare Shared Savings Program ACOs, only 53 held spending enough below their targets to receive performance payments. Given the significant investments these ACOs made in the infrastructure needed to manage risk, and that the top 12 ACOs were responsible for...
Source: Health Affairs Blog - April 27, 2015 Category: Health Management Authors: Stuart Pollack Tags: Featured Health Professionals Hospitals Organization and Delivery Quality ACOs adaptive reserve Health Reform National Demonstration Project PCMH triple aim Source Type: blogs

Airway Courses Galore!
Everyone who looks after critically ill patients needs to be able to manage airway crises. We all want to be better at it. We all can get better at it. Fortunately, there are plenty of courses around to help us become ‘expert enough‘. Fortunately, you can’t do too many airway courses Here are the courses I’m teaching on this year:I’ve designed a simulation-based course called the Critically Ill Airway course run by The Alfred ICU and Monash University. It focusses on cross-specialty team-based management of airway crises in the critically ill, beyond the operating theatre. It fulfils CI...
Source: Life in the Fast Lane - April 27, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Airway Anaesthetics Emergency Medicine Intensive Care ACE airway management CIA course critically ill airway criticlally ill Source Type: blogs

Healthcare Update Satellite — 04-26-2015
This article questions whether Obamacare is to blame. Good way to save money. Veterans Affairs just keeps denying claims until the veterans die. Then they mark the files as “no action necessary” so that the surviving family members don’t get benefits, either. Records falsified, employee whistleblowers being retaliated against, management lying to Congress, oh, and a supervisor who required staff members to pay $30 for fortune telling by the supervisor’s wife. If you think things are expensive now, wait to see how much they cost when they’re free. Another example of the Golden Rule. EnglandR...
Source: WhiteCoat's Call Room - April 27, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

LITFL Review 179
Welcome to the 179th 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 If you do one FOAM-centred thing this week, spend 5 minutes watching this video on patient-centred care. Thanks to the International Forum on Quality and Safety In Healthcare 2015 [SO] The Best of #FOAMed Emergency MedicineKen Milne and Salim R...
Source: Life in the Fast Lane - April 26, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs

Choosing Wisely Australia
is due to launch April 29th, enabling Australian clinicians and consumers to engage in conversation to reduce unnecessary tests, treatments and procedures an ensure high quality care.In Australia NPS MedicineWise is collaborating with medical colleges, societies and consumer groups in a National initiative to improve the quality of healthcare and facilitate better conversations between clinicians and consumers.The aim is to identify tests, treatments and procedures that are commonly used but can often provide no or limited benefit to the patient and in some cases, lead to harm. Improving conversations about medical tests ...
Source: Life in the Fast Lane - April 26, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Investigation Patients Public Health ABIM Choosing Wisely NPS NPS MedicineWise Survey Source Type: blogs

A wonderful Fisking
I’m neither terribly for nor against paramedics working as employees in the ED, but I love people ripping apart straw man arguments. Texas ENA’s Unprofessional Attack on EMS Author’s note: I generally avoid posting non-tech matters on my blog, but this unprofessional, unsubstantiated, fear-mongering attack of EMS in Texas has me boiling. I present to you something that doesn’t just affect Texas EMS, but EMS in the entirety of the United States of America. This has been fought in other states, and if it isn’t stopped now, will set a precedent and spill into many more states and regions. If you want to advance,...
Source: GruntDoc - April 26, 2015 Category: Emergency Medicine Authors: GruntDoc Tags: Amusements Emergency Medical Nursing Source Type: blogs

Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. Why?
A middle-aged male had a V Fib arrest.  He had not complained of any premonitory symptoms (which is very common).   He had a history of CAD with CABG.  Here was his initial ED ECG:There is atrial fibrillation with a rapid ventricular response.  There is profound ST depression especially in I, II, V2-V6.ST depression is common BOTH after resuscitation from cardiac arrest and during atrial fib with RVR.The patient was cardioverted.  Here is the post cardioversion ECG:ST depression, with ST elevation in aVR persists.Does this patient have ACS?  Should he necessarily go to the cath lab?Again, it i...
Source: Dr. Smith's ECG Blog - April 24, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

More from the Grantmakers In Health Annual Conference: Diane Meier on Palliative Care; a Film on Elder Care
This past week, I gave you a brief glimpse of the 2015 GIH Annual Conference in Austin, Texas. Here are two more vignettes from the conference, held in March. Its theme was Pathways to Health. Diane Meier Director of the Center to Advance Palliative Care at the Icahn School of Medicine at Mount Sinai and a past MacArthur Fellow (2008), Diane Meier was another plenary speaker. She commented to the audience of mostly foundation staffers that her body of work and career in palliative care is due to the support of private-sector philanthropy, including more than twenty foundations. Following are just some of the points she...
Source: Health Affairs Blog - April 23, 2015 Category: Health Management Authors: Lee-Lee Prina Tags: Costs and Spending GrantWatch Health Professionals Hospitals Long-term Services and Supports Quality Aging Health Care Delivery Health Philanthropy Home Health Palliative Care Physicians Workforce Source Type: blogs

Vitamin Overdose and Pregnancy
During pregnancy, it is important to get the proper nutrients to foster healthy fetal development. You may be tempted to take a multivitamin in addition to other supplements. However, vitamin overdose can occur when an individual takes more than the recommended daily amount of a vitamin. This can result when taking more than one multivitamin, or when taking individual vitamins in addition to a multivitamin. While any vitamin can be toxic if taken in large amounts, calcium and iron pose the greatest toxic risks when taken in excess. Taking a multivitamin during pregnancy is important, although it is best to talk with your d...
Source: Cord Blood News - April 23, 2015 Category: Perinatology & Neonatology Authors: joyce at mazelabs.com Tags: babies brain development Cord Blood medical research parents pregnancy affordable cord blood banking breast feeding C-section caesarian cerebral palsy due dates healthy pregnancy new baby parenting vaginal birth after caesari Source Type: blogs

Research and Reviews in the Fastlane 080
This study calls into question the current guidelines and will hopefully lead to more evidence-based recommendations in the future.Recommended by: Zack RepanshekRead More: Antibiotics for community-acquired pneumonia: Is azithromycin out? (Pulm CCM)The Best of the RestOphthalmology, Ultrasound Vrablik ME et al. The diagnostic accuracy of bedside ocular ultrasonography for the diagnosis of retinal detachment: a systematic review and meta-analysis. Ann Emerg Med 2015; 65(2):199-203. PMID: 24680547Nice meta-analysis of bedside US for retinal detachment in Annals of EM showing 97-100% sensitivity, 83-100% specificity, based...
Source: Life in the Fast Lane - April 23, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care Ophthalmology Psychiatry and Mental Health Resuscitation Trauma critical care R&R in the FASTLANE recommendations research and reviews Source Type: blogs

What Does It Take to Rescue Migrants at Sea?
European Union leaders gathered today for an emergency summit to discuss a concerted response to the humanitarian disaster unfolding in the Mediterranean Sea. As a former officer serving aboard an Italian Navy warship deployed in Operation Mare Nostrum in November 2013, Giacomo Persi Paoli is well aware of the challenges. (Source: The RAND Blog)
Source: The RAND Blog - April 23, 2015 Category: Health Management Authors: RAND Corporation Source Type: blogs

Embedding Civil Legal Aid Services In Care for High-Utilizing Patients Using Medical-Legal Partnership
Mr. Jackson (not his real name) is a 42-year old man who was hospitalized three times in a seven-month period at Lancaster General Hospital in Pennsylvania. These hospitalizations were due to complications from chronic obstructive pulmonary disease, morbid obesity, depression, chronic kidney disease, and lower extremity non-healing ulcers. He was depressed and concerned that he was not able to move beyond the revolving door of frequent inpatient admissions. Mr. Jackson was also incurring a large debt due to copays and uncovered services and medications. But his problems were not just medical. He was having legal problems ...
Source: Health Affairs Blog - April 22, 2015 Category: Health Management Authors: Jeffrey Martin Tags: Featured Innovations in Care Delivery civil legal aid Health Law super-utilizers Source Type: blogs

EMA Journal April 2015
Issue 2 (Vol. 28) of EMA Journal for 2015 was published online on 25th March. Editorial overview by Andrew Gosbell & Geoff HughesED Models of Care  (Abstract)A range of models of care (MOCs) have been implemented in order to improve the key ED functions of patient evaluation, treatment and/or discharge/admission. This systematic review, from Wylie et al, examined ED MOCs in terms of quality/effectiveness of care and cost, with reference to the 3 phases of emergency care: input, throughput and output. There is an absence of cost benefit analysis for MOCs to reduce ED inputs. In addition, there is substantial varia...
Source: Life in the Fast Lane - April 21, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Clinical Research Education EMA Journal LITFL EM training EMER Emergency Medicine Events Register Foreign bodies MOC Short Course Source Type: blogs

Is health reform contributing to physician burnout?
Many physicians feel burnt-out from their careers A recent Medscape survey asked doctors of all specialties whether they experienced feelings of cynicism, loss of enthusiasm and low personal accomplishment with their work. Unfortunately, the percentage of physicians with burnout has increased since the last survey in 2013, with 46 percent overall reporting these feelings. When looking at specific specialties, the most burnt-out physicians are critical care and emergency doctors. Half of primary care physicians, family doctors, internists and general surgeons also felt burnt-out. These survey results are alarming as they ...
Source: Kevin, M.D. - Medical Weblog - April 21, 2015 Category: Journals (General) Authors: Tags: Physician Health reform Primary care Source Type: blogs

LITFL Review 178
Welcome to the 178th 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 WeekThis week, the EMCrit podcast features part 2 of “Who Needs an Acute PCI” with Dr Steve Smith. This, along with part 1, is a must listen for all providers. [MG] The Best of #FOAMed Emergency MedicineDoes CAP therapy need to included coverage...
Source: Life in the Fast Lane - April 19, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

What is “Stitch phenomenon” during PTMC ?
PTMC involves a critical step , where one has to cross  the IAS to reach the LA.The septal puncture remains  somewhat a blind procedure in fluoroscopy .(Echo can still assist us. ) Stitch effect is a rare complication where the needle pierces the intrapericardial space from the right atrial side and re-enter the left atria .This wrong way entry into LA may not be recognised  untill the sheath is withdrawn and a cardiac tamponade ensues after removal. Where exactly the stitch  occurs ? What are  the anatomical planes ? This usually  happens in the superior aspects of   IAS , abutting the roof of RA and LA . The align...
Source: Dr.S.Venkatesan MD - April 16, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Mitral balloon valvotomy PTMC PTMC -Tips and tricks balloon mitral valvotomy complication during ptmc PTMC stitch effect stitch phenomenon during ptmc mitral valvotomy Source Type: blogs

Research and Reviews in the Fastlane 079
This article is a meta-analysis looking at a relatively new technique: POC Ultrasound. This review found that for ED intubations, US had a sensitivity of 98% and a specificity of 94%. The question, however, should be whether this technique is faster than End Tidal CO2, which is extremely reliable.Recommended by: Anand SwaminathanRead More: Ultrasound for Verification of Endotracheal Tube Location (ALiEM)The R&R iconoclastic sneak peek icon keyThe list of contributorsThe R&R ARCHIVER&R Hall of famer You simply MUST READ this!R&R Hot stuff! Everyone’s going to be talking about thisR&R Landmark pap...
Source: Life in the Fast Lane - April 16, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Emergency Medicine Infectious Disease Intensive Care Pediatrics Respiratory Toxicology and Toxinology Trauma critical care Education literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

From The WHO: Preventing The Next Ebola
As the senior leaders of the World Health Organization, we are taking action to prevent another emergency on the scale of the current Ebola outbreak from happening again. To do this, we need partners to join us in strengthening crucial components of country and international health systems. First, robust disease surveillance that identifies disease outbreaks quickly and stops them from spreading is key to avoiding large-scale epidemics. Countries must have the ability to identify outbreaks early and the capacity to respond with enough well-trained health workers. For its part, WHO is creating a Global Health Emergency Wor...
Source: Health Affairs Blog - April 16, 2015 Category: Health Management Authors: Margaret Chan Tags: Drugs and Medical Technology Featured Global Health Ebola World Health Organization Source Type: blogs

Happy SGR Repeal Day
Yeah, it happened. The SGR is finally dead. Hooray! Sort of.I mean, it's great and all that — we'll no longer have the annual threat of a massive payment cut from a poorly crafted piece of legislation from the 1990s; we'll no longer have to endure the annual ritual of last-minute legislative theatrics to avert the yearly cuts, we'll no longer have to waste our lobbying time and effort to make sure those cuts were never allowed to go into effect.But let's not pretend this was in any way a win for physicians.The replacement for the SGR, in the "Medicare and CHIP Reauthorization Act of 2015" (MACRA - get to know that acrony...
Source: Movin' Meat - April 15, 2015 Category: Emergency Medicine Source Type: blogs

The "Language of Privacy" Is Doing Well in Police Body Camera Discussions
Matthew Feeney In David Brooks’ latest New York Times column he explains that he is now a proponent of police body cameras, but adds that he did not come to his position “happily.” According to Brooks, the debate over police body cameras has revealed that an increasing number of people have lost “the language of privacy” and “an understanding of why privacy is important.” It’s refreshing to read that Brooks does have concerns related to privacy. After all, Brooks said last June that the NSA’s snooping isn’t “particularly intrusive.”  But the rise of police body cameras is prompting a sensible conv...
Source: Cato-at-liberty - April 15, 2015 Category: American Health Authors: Matthew Feeney Source Type: blogs

The "Language of Privacy" Is Doing Well in Police Body Camera Discussions
In David Brooks’ latest New York Times column he explains that he is now a proponent of police body cameras, but adds that he did not come to his position “happily.” According to Brooks, the debate over police body cameras has revealed that an increasing number of people have lost “the language of privacy” and “an understanding of why privacy is important.” It’s refreshing to read that Brooks does have concerns related to privacy. After all, Brooks said last June that the NSA’s snooping isn’t “particularly intrusive.”  But the rise of police body cameras is prompting a sensible conversation about p...
Source: Cato-at-liberty - April 15, 2015 Category: American Health Authors: Matthew Feeney Source Type: blogs

Executive workups: The ultimate in patient-centered care
The following article is satire. LAS VEGAS, Nevada — As times have become harder for emergency departments around the country, one local hospital, Snooty Hospital and Casino (SHC), has come up with a solution to capture precious reimbursement from individuals with “enhanced diagnosis and treatment goals.” When checking into the ED either by ambulance or at the front desk, patients now have the ability to initiate what is being described as the “executive workup.” This option has led to a 150 percent increase in profit for SHC and led other hospitals in the area to consider rolling out similar services to ke...
Source: Kevin, M.D. - Medical Weblog - April 14, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Implementing Value-Based Payment Reform: Learning From The Field Of Practice
For the last four years, our team at the University of Washington (UW) has been evaluating seven value-based payment reform programs in six states for the Robert Wood Johnson Foundation (RWJF). We found that although the foundational work of value-based payment is proceeding apace for the most part, what’s missing is the sense of urgency required to move payers and providers toward patient-centered global payment based on value. Clusters of innovation are emerging across the country, and these experiments are generating valuable insights into the design and implementation of value-based payment—both what works and what...
Source: Health Affairs Blog - April 14, 2015 Category: Health Management Authors: Douglas Conrad Tags: Innovations in Care Delivery Source Type: blogs

Accountable care for Medicaid.  No, we need real solutions.
New York officials are doing an “experiment” that should strike fear, anger, and outrage in the hearts of doctors who take care of Medicare patients. (New York has the highest Medicaid budget of any state.) As any doctor who has a high volume of Medicaid patients knows, Medicaid pays practically nothing.  Doctors who take Medicaid usually have to carry a bigger patient load to survive.  Medicaid patients are often sicker than the general population, with complicated diseases that are compounded by their environments.  They seek treatment in emergency rooms more often than other populations, have less access to healt...
Source: Kevin, M.D. - Medical Weblog - April 13, 2015 Category: Journals (General) Authors: Tags: Policy Health reform Medicare Primary care Source Type: blogs

Top stories in health and medicine, April 13, 2015
From MedPage Today: FDA Advisory Committee Hesitates to Endorse Message of Safe Smokeless Tobacco. An FDA advisory panel were reluctant to recommend a gentler warning label for one brand of smokeless tobacco products at a committee hearing on Friday. The Skinny on Dementia and Being Skinny. Individuals with body mass index values below 20 in middle age were significantly more likely than those of normal weight to develop dementia later on. Ebola Still Emergency in West Africa. Despite a downward trend in new cases, the Ebola epidemic in West Africa remains an international public health emergency. Coalition Hopes To Amp ...
Source: Kevin, M.D. - Medical Weblog - April 13, 2015 Category: Journals (General) Authors: Tags: News Infectious disease Neurology Source Type: blogs

LITFL Review 177
Welcome to the 177th 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 WeekMichelle Johnston manages to capture, in her superbly eloquent style, the heartbreak of the Wrong type of Swiss Cheese. Errors must be prevented, yes. But not at the cost of our humanity. [SO] The Best of #FOAMed Emergency MedicineThe April issu...
Source: Life in the Fast Lane - April 12, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Semantics and the $28 Million Unnecessary Test
There’s been an awful lot of Internet hullabaloo about “unnecessary testing” lately. The Choosing Wisely program keeps trying to assert that we should not perform any “unnecessary” tests. Recently, a paper was published in the Journal Academic Emergency Medicine alleging that “overordering of advanced imaging may be a systemic problem” since many emergency physicians believe that such testing is “medically unnecessary.” The paper was based on surveys that were presented to emergency physicians and the work was at least partially funded by the Veterans Administration and the National Institutes of Health...
Source: WhiteCoat's Call Room - April 10, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Source Type: blogs

Pulseless ventricular tachycardia – why did the AED not advise a shock?
This case was submitted by my friend Dr. Victoria Stephens.  She is a third year Emergency Medicine Registrar from at the University of the Witwatersrand in Johannesburg, South Africa, and a great asset to FOAMed.  Follow her on Twitter: @EMcardiac.CaseA 71 year old man was admitted to the ICU with neutropenic sepsis complicated by septic shock. He was intubated and ventilated and was started on an adrenaline infusion to maintain his blood pressure. The admission ECG was normal. Thirty-six hours into his ICU stay he went into a cardiac arrest. The monitor showed a wide complex tachycardia. CPR was commenced while...
Source: Dr. Smith's ECG Blog - April 10, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

The old school physician is who we should aspire to be
A couple of weeks ago I was on-call and had to go down to the emergency room to see a patient. Before I entered the room, I was told that the patient was accompanied by her long-time physician who was a bit “crazy and old school.” “Hmm … that’s strange … why would her physician be in the room with her?” I thought to myself. When I went in to introduce myself, sure enough sat next to her was an elderly physician probably in his late 70s or early 80s. After he greeted me with a warm and friendly handshake, he told me that he had practiced medicine in the local area for the last several decades. I still cont...
Source: Kevin, M.D. - Medical Weblog - April 9, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Primary care Source Type: blogs

TechTool Thursday 062 Kids Health Info
TechTool review Kids Health Info by The Royal Children’s Hospital on iOS and Android When treating paediatric patients in an emergency department, much of our role is about parental education. And it’s important we get this right. A common question asked by doctors is where can we find good patient fact sheets. The trusted Royal Children’s Hospital in Melbourne have just created an app for this very purpose.Kids Health Info contains all the RCH patient and family fact sheets in a readable and mobile-friendly format.Website: – iTunes – Android – Website – TwitterDesignIt’s fair to say th...
Source: Life in the Fast Lane - April 9, 2015 Category: Emergency Medicine Authors: Tessa Davis Tags: Education Pediatrics Review Tech Tool Kids Health Info Source Type: blogs

Research and Reviews in the Fastlane 078
Welcome to the 78th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&...
Source: Life in the Fast Lane - April 9, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: LITFL R&R in the FASTLANE critical care Emergency Medicine recommendations research and reviews Source Type: blogs

Implementing Health Reform: Medicaid & CHIP Mental Health And Substance Use Disorder Parity
On April 6, 2015, the Centers for Medicare and Medicaid Services released a proposed rule for implementing the Mental Health Parity and Addiction Equity Act of 2008 with respect to Medicaid managed care, CHIP, and Medicaid alternative benefit plans.  (fact sheet )  Approximately 9.6 percent of adult Medicaid beneficiaries aged 18 to 64 have serious mental illnesses, 30.5 percent have any mental illness, and 11.9 percent have substance use disorders—a total of 21.6 million beneficiaries.  Approximately 8 percent, or 850,000, CHIP beneficiaries experience serious behavioral or emotional difficulties.  Mental health and...
Source: Health Affairs Blog - April 8, 2015 Category: Health Management Authors: Timothy Jost Tags: All Categories Consumers Coverage Health Reform Medicaid Mental Health Policy Substance Abuse Source Type: blogs

Are Shortages Going Down Or Not? Interpreting Data From The FDA And The University Of Utah Drug Information Service
Drug shortages are a significant public health issue that have affected many critically important drugs including chemotherapy treatments, nutritional support preparations, and antibiotics. Drug shortages can result in delaying or denying needed care to patients and may cause practitioners to prescribe an alternative therapy that poses greater risk or that may be less effective for the patient. Drug shortages have interfered with clinical trials, in some cases delaying research on important new therapies. The year 2011 was a critical one in this public health crisis. After several years of steady increases in new shortage ...
Source: Health Affairs Blog - April 8, 2015 Category: Health Management Authors: Marta Wosinska, Erin Fox, and Valerie Jensen Tags: Access All Categories Consumers Health Care Delivery Health Law Pharma Policy Public Health Research Source Type: blogs

Teaching Practical Skills with SETT UP
“There’s no body cavity that cannot be reached with a #14 needle and a good strong arm.” – Samuel Shem, The House of GodThose of us in the medical field are no strangers to the sometimes-unfortunate truth of the above quotation. (If you’re a stranger to the quotation itself then please read the book; it almost counts as CPD…) Complications whilst undertaking practical procedures are inevitable but we do our utmost to minimise them for the good of our patients. Critical analysis and reflection on one’s own practice, and particularly on the unexpected complications therein, remain the bedrock of self-improv...
Source: Life in the Fast Lane - April 8, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Education Procedure Complexity Matrix Reflective Competence SETT UP unconsciously competent Source Type: blogs

ED Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.....
Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope._____________________________________________________________________________4)    Reed MJ.  The ROSE (Risk Stratification of syncope in the emergency department) Study.  J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049  Objectives: The aim of this study was to develop and validate a clinical deci...
Source: Dr. Smith's ECG Blog - April 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Equity in the provision of palliative care in the UK: review of evidence
This report, funded by Marie Curie, finds that a significant minority of people – at least a fifth of everyone who dies – are not receiving the palliative care they need. It argues that there is need for investment to extend palliative care provision to everyone who would benefit from it. Whilst the evidence examined in this study does not indicate how much it would cost to implement more equitable provision, it does indicates that once services are in place, patients and families not only have better outcomes (including better-managed symptoms and dying in their preferred place), but the costs of providing palliative ...
Source: Health Management Specialist Library - April 8, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Local authorities, public health and health inequalities Source Type: blogs

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.....
Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope._____________________________________________________________________________4)    Reed MJ.  The ROSE (Risk Stratification of syncope in the emergency department) Study.  J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049  Objectives: The aim of this study was to develop and validate a clinical deci...
Source: Dr. Smith's ECG Blog - April 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Funding to Improve Health In Rural North Carolina Communities: When Buzzwords Meet Change
For the past few years, among some of the most frequently used “philanthropy speak” have been the words “place based” and “collective change.” Unlike many buzzwords, though, these terms have meat behind them and continue to be studied and analyzed. That is why my colleague Doug Easterling from Wake Forest University and I turned to the research to start rethinking how the Kate B. Reynolds Charitable Trust should approach grant making. (For anyone interested, I recommend reading Doug’s article ”Getting to Collective Impact: How Funders Can Contribute over the Life Course of the Work.”) Five years ago, our...
Source: Health Affairs Blog - April 7, 2015 Category: Health Management Authors: Allen Smart Tags: GrantWatch Hospitals Population Health Public Health Children Community Health Centers Counties Emergency Medical Care Health Philanthropy Health Promotion and Disease PreventionGW Primary Care Rural Health Care Social Determinants Source Type: blogs

From an ER physician:  Write your own admitting orders
While working at small rural hospital I was once again faced with the emergency physician’s dilemma.  Admitting  a patient and being told to write holding orders.  In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system.  All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble himself.  (Much less come in and see the patient old school; that would be sheer madness!) Continue reading ... Your patients are rating you online: How to respond. Manage your online reputat...
Source: Kevin, M.D. - Medical Weblog - April 7, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Shift the focus from patient satisfaction to employee satisfaction
By now, everyone in health care is accustomed to the idea of patient satisfaction data and the multi-million dollar industry ($61 million in annual revenue for Press Ganey alone) which exists thanks to the health care leaders and policy makers who embrace it.  Most physicians believe it is absurd to use it as a marker of quality care, but have accepted it anyway.  We will “play the game” in order to get paid for our work.  Although high patient satisfaction scores have been proven to be a poor indicator of quality care, and in some studies have been proven to increase morbidity and mortality, they are already so ent...
Source: Kevin, M.D. - Medical Weblog - April 7, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Top stories in health and medicine, April 7, 2015
From MedPage Today: Nicotine Replacement in Pregnancy: How Risky? The absolute risk of major congenital anomalies was similar among infants born to smokers and those born to women on nicotine replacement therapy (NRT), but respiratory problems were worse in the latter group. AS Activity Tied to Future Risk for Heart Disease. Early inflammation and disease activity predicted future elevations in arterial stiffness in ankylosing spondylitis (AS). Medicare Is Stingy in First Year of Doctor Bonuses. Dr. Michael Kitchell initially welcomed the federal government’s new quality incentives for doctors. His medical group in...
Source: Kevin, M.D. - Medical Weblog - April 7, 2015 Category: Journals (General) Authors: Tags: News Emergency Heart OB/GYN Source Type: blogs

A Patient With a Biventricular Pacemaker Presenting With Chest Pain
This is a paper authored by Brooks Walsh (a brilliant ECG enthusiast and emergency physician at Yale), with a little help from me and our electrophysiologist here at Hennepin, Rehan Karim.Unfortunately, you can't get the full text for free, but for those of you with institutional subscriptions, you can see this interesting report.Even without full text, you can see most of the article at this link:A Patient With a Biventricular Pacemaker Presenting With Chest Pain (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - April 7, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Bill Maher, your comments on doctors don’t matter
Dear Bill Maher, I respect your First Amendment right to exercise free speech. In regards to your recent comments on doctors, however, your words don’t matter. Here’s why. There is a concept known as the beauty of medicine; I attempt to capture it in the following paragraphs. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 6, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Primary care Source Type: blogs

Medicine: A profession that saves lives but often silences death
The sad thing is, I hardly remember the patient. Everything about her is just an overhead pediatric trauma alert followed by the flurry of cutting clothes off, throwing IV lines, and calling out our primary and secondary survey — “blown right pupil,” “unequal breath sounds,” “gross deformity to left ankle,” and then, “no pulses” — followed by the age-old barbaric resuscitation efforts that are now muscle memory to us, as we compressed her sternum still with bits of her Forever 21 bra on it and shoved a MAC blade past her pink braces. Continue reading ... Your pat...
Source: Kevin, M.D. - Medical Weblog - April 6, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Access your emergency medical identification via smartphone
As medical providers, we recognize the value and importance of emergency medical identification (EMI), especially for our patients who live with chronic medical conditions, such as diabetes, epilepsy, and severe allergies. Of particular concern are those who may require emergency care during a time when they are unable to communicate, but how often do we address this topic with our patients, and do they really listen? Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 5, 2015 Category: Journals (General) Authors: Tags: Tech Emergency Health IT Source Type: blogs

LITFL Review 176
Welcome to the 176th 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 Brilliant podcast reviewing when to activate the cath lab for emergency PCI, pearls and pitfalls in diagnosing acute MI from Weingart and Steve Smith. [AS] The Best of #FOAMed Emergency MedicineLooking to add in situ simulation to your departme...
Source: Life in the Fast Lane - April 5, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

My experience with an emergency airway management CME
Physicians need to complete about 50 hours of some kind of continuing medical education (CME) every year. The ideal kind of class is one that we actually attend in person, with teachers who are expert in the field being taught and are somewhere near the cutting edge. CME classes are especially nice when they include something hands-on rather than just a lecture format because much of medicine is hands on and because that wakes us up and keeps us focused. There are other ways to get education, such as studying written materials or attending classes taught via video presentation, and they are an important way for physicians ...
Source: Kevin, M.D. - Medical Weblog - April 4, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

When It Comes to Police Body Cameras, Federalism Is Key
Matthew Feeney Last week, Sens. Rand Paul (R-KY) and Brian Schatz (D-HI) introduced legislation that would create a pilot grant program to assist state and local police agencies in leasing or purchasing body-worn cameras. The bill requires states, “units of local government,” and Indian tribes wishing to receive a full grant to commit to a range of reforms related to privacy, police practice, and data storage. The bill presents something of a dilemma for libertarians like me, who want increased accountability and transparency within law enforcement but are also hesitant to support federal policy prescriptions for issu...
Source: Cato-at-liberty - April 3, 2015 Category: American Health Authors: Matthew Feeney Source Type: blogs

Targeting The Opioid Drug Crisis: A Health And Human Services Initiative
Deaths from drug overdoses have been rising steadily over the past two decades and have surpassed car accidents to become the leading cause of injury death in the United States.  Millions of Americans rely on prescription opioids for much needed relief from the pain caused by illness and injury, but in the past decade we have seen increases in addiction, overdose, and deaths due to these drugs.  From 1999 to 2013, the rate for drug poisoning deaths involving opioid analgesics nearly quadrupled. Total drug poisoning deaths continue to rise each year, as does the share of deaths due to heroin and prescription opioids.  Th...
Source: Health Affairs Blog - April 3, 2015 Category: Health Management Authors: Richard Frank Tags: All Categories Pharma Physicians Policy Public Health Substance Abuse Source Type: blogs