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Healthcare Updates

Updates 180x100Healthcare Updates is something I created to aggregate healthcare-related news from around the web. I’ll usually throw in some snarky commentary and possibly some tired old cliches to try to make things more interesting.
If you’ve seen an interesting medically-related story, I’d be interested in reading it. E-mail a link to me at whitecoatrants [at] g mail dot com with the words “Healthcare Update Link” in the title. The words “Healthcare Update Link” MUST be in the title of the e-mail because I have set up filters on my e-mail account to help streamline the posting process.

Healthcare Update -- 03-07-2016

“VA suicide hotline. Your call is very important to us. Please leave a message after the beep.”  Data provided to USA Today shows that up to 1 in 5 calls to a VA suicide crisis hotline was dropped or sent to voice mail. One veteran from Illinois allegedly killed himself by laying on train tracks after being unable to reach someone on the hotline.

Want to get the munchies? Pull an all-nighter. Study shows that those with “restricted sleep” (4.5 hours per night) have higher levels of hormones that stimulate hunger and were less able to resist eating “palatable snacks.”

Study in Annals of Emergency Medicine shows that elderly patients are more likely to die after discharge when they met any of four criteria: the doctor planned to admit them and then changed the disposition to “discharge” (showing that doctor should follow their instincts), the patient had cognitive impairment, the patient’s blood pressure was less than 120 systolic, or the patient’s pulse was greater than 90. Seems odd that patients with abnormally high blood pressure are at less risk for discharge while those with potentially normal pulse rates are at higher risk for discharge. And how many nursing home patients don’t have some type of cognitive impairment?

Another study in Annals of Emergency Medicine shows that patients who overuse the emergency department one year are highly likely to overuse the emergency department in subsequent years. Younger age, Medicaid status, and mental illness were all predictors of frequent emergency department use.

I’m betting that Iraq doesn’t have patient satisfaction scores. Video shows Iraqi doctor slapping patient (twice) who yells out in pain when getting stitches. Dr. Toughguy isn’t using gloves, either.

Here’s a study showing that patient satisfaction scores are dependent upon location of care. Same doctors treated patients in both an emergency department and an urgent care center. The exact same doctors had courtesy scores that were 0.35 points lower on their Press Ganey ratings in the emergency department when compared to scores from the urgent care center. Those 0.35 points on a 1-5 scale can mean the difference between having a score in the 90th percentile and the 20th (or lower) percentile.
When is the hospital C-suite going to learn to understand grade school statistics and bias?

There’s an app for that … but it doesn’t work. Study shows that in 77% of cases, blood pressure measuring app from mHealth gave artificially low readings and hypertensive patients were falsely reassured that their blood pressure was normal. Then again, I’m sure that if you asked Press Ganey statisticians, they’d say that the app is an absolutely valid measure of blood pressure. Because they say so.

Fighting incurable MRSA infections with … viruses. Man had “raging infection” in leg after dozens of surgeries to repair damage from a car accident and antibiotics weren’t working. Doctors wanted to amputate at the hip. Patient took a trip to Georgia (the Eastern Europe country, not the US State) and underwent phage therapy. Came back cured. Why aren’t we doing more of this in the US?

Healthcare Update -- 02-01-2016

Another example of why Dr. Google and the links Dr. Google produces may lead you into poor choices for your health care. Some sites scrape the Web for keywords about drugs and side effects, then use a program to combine the pages in a manner that may cause patients to stop taking the medications. Very informative article!

Dermatologist accused of rubbing his genitals against female patient’s thighs during examinations uses unique defense – his huge gut covered over his penis, making it impossible for him to rub his genitals against the womens’ legs. That defense backfired. The doctor had to go to a urologist for a formal examination and the size of his penis – a whopping 2.5 cm (a little more than an inch) was published in a Toronto newspaper. Even worse, he was then given a chemically-induced erection and forced to “assume various positions” to see if his penis was visible.
I just shake my head in disbelief when I read some of these stories.

Your tax money hard at work. NASA spent $80,000 to see what effect space flight has on herpes virus. I was going to ask how they cleared a certain TV commentator for rocket travel, but then thought better of it. Wouldn’t want to be unprofessional, now, would I?

More of your tax money at work. NIH spending more than $400,000 using “state of the art technology” to send texts to Latino men telling them to exercise more.

What’s the risk of letting algorithms judge us? Once people know the algorithm, they game the system. But algorithms also cause a chilling effect on behavior. Stifle dissent. Make the people judging you happy so your score goes up. That doesn’t work so well in certain arenas, though … including medicine (hack hack Press Ganey cough).

An older article, but interesting nonetheless. Nine things you didn’t know about cursing. I saw an experiment about one of them – how swearing helps alleviate pain. About 0.7% of the words we use during the course of a day are swear words. That seems like a f*cking lot to me.

Larry the Cable Guy contributing to the kidney disease and fractures of elderly patients? All of those proton pump inhibitors (such as Prilosec, Protonix, Nexium) may help with your reflux symptoms, but they also increase your risk of developing infections like Clostridium difficile (“C. diff”), increase the risk of chronic kidney disease by 20-50%, cause decreased magnesium levels in your system, and contribute to osteoporosis and fractures.

Healthcare Update -- 01-28-2016

All those antibiotics for ear infections early in life may be causing your children to develop asthma and obesity later in life. Antibiotics appear to cause long-lasting changes to the mibrobiome – even when the microbiome returned to baseline several weeks after the antibiotics were finished. Macrolides (i.e. the much-coveted “Z-pak”) seemed to be the worst offenders, although amoxicillin also had a weaker but similar effect.

Seen somewhere on Twitter. Enter your age and gender and this web site will tell you how you’re most likely to die as you age. Kind of creepy. External causes tend to predominate for younger people. Cancer and cardiovascular problems dominate for older folks.

Child reportedly develops scurvy from drinking almond milk. Symptoms – including bone fractures and rash – improved with Vitamin C supplementation. The implication is that the almond milk caused the scurvy, but keep in mind that cow’s milk has very little Vitamin C, so it was a complete lack of Vitamin C in the diet, not just a switch from cow’s milk to almond milk.

Why drink almond milk when “breast is best”? In fact, a new antibiotic developed from human breast milk could help treat superbugs in the future. The protein lactoferrin reportedly kills bacteria, fungi, and viruses on contact.

Big Pharma doesn’t want to hear about breast milk as a way to fight superbugs. They want incentives, dammit. Antibiotics are only used sporadically and are generally don’t generate as much profit, leading many manufactures to abandon antibiotic research. Drug companies therefore want “prompt reimbursement” at higher prices to incentivize research. Here’s a better idea. Make antibiotics a controlled substance to stop people from prescribing them for every runny nose and cough that they come across each winter. Reduction in antibiotic use causes reduction in resistance. Although some may disagree

Pure awesomeness. If you ever want to see examples of the difference between “causation” and “correlation”, just visit this site. For example, US spending on science, space, and technology is 99.79% correlated with suicides by hanging, strangulation, and suffocation. Obviously we have to stop so much spending on science. It’s for the children.

Irish hospital canceling elective surgeries due to overcrowding. Instead, surgical wards are being used to accommodate patients admitted from the emergency departments.

Healthcare Update -- 01-18-2016

As if stool transplants weren’t bad enough … Now some people are recommending urine cocktails to treat illness. Retiree in London was diabetic, had kidney problems, and swollen ankles. After starting to drink her own urine, she is suddenly cured and looks like Taylor Swift! OK, she really looks like Bea Arthur, but her kidney problems went away. Article tries to legitimize the urine drinking experience by noting that women already take medicine made from urine of pregnant horses – Premarin. Another person interviewed for the article rubs urine on his face every day as a skin treatment. Oh, and drinking urine is supposedly in the Bible, too. As I told my kids … “Urine BIG trouble if you ever try this.”

Florida’s Medicaid managed care becomes more like Medicaid managed REFUSAL of care.

With private companies now operating the system instead of the state, the added requirement of prior approval for many services and dealing with a myriad of billing procedures and rules are just two areas that are far more complex.

“In this area, there are four different plans with four different sets of rules, four different provider handbooks, four different billing processes,” said Maggie Labarta, the president/CEO of Meridian Behavioral Healthcare, which provides mental health care and substance abuse counseling services in 10 counties. “For us, the administrative burden attached to billing has grown much more complicated. It is a lot of paper and a lot more bureaucracy.”

 Some of the insurance plans will only pay for one day of the three days required for involuntary psychiatric admissions. Most plans require pre-approval for many routine services. As a result, Medicaid has become “more cumbersome and more difficult.” But don’t worry because the patients have INSURANCE!

Award-winning screenwriter, producer, and director goes to Quebec hospital with abdominal pain. Later found unconscious in waiting room ultrasound showed ruptured aortic aneurysm. Newspaper claims patient was “denied potentially life-saving surgery.” Hospital reportedly revoked the privileges of its only vascular surgeon as part of Health Department reform and budget cuts. Patient was transferred to another hospital but died before he could make it to surgery. This patient had insurance, too.

Interesting concept. When state laws become too onerous for doing business, companies close shop and leave. GE leaving Connecticut due to Connecticut’s high-tax, high-regulation, and anti-business policies and moving to Massachusetts which is presumably more business-friendly.

California’s MemorialCare Health System wants to close a hospital and emergency department in San Clemente and replace it with an outpatient medical center and urgent care center – that wouldn’t be required to take ambulance runs. I wonder why that is. San Clemente residents fighting the proposed closure of the emergency department. California legislators refused to allow the new facility to operate as a stand-alone emergency department. As a result, there will be a 40 mile gap between the next closest emergency departments. Quite a bit of extra travel. Hope they have extra ambulances ready. When seconds count in a medical emergency, help will only be 30 minutes or more away. I’m sure a lot of those patients have insurance as well.

Is that a hernia under your shirt or ….  Leicester patient finally has 8 in x 12 in hernia repaired. Before the repair, he was arrested for shoplifting when store clerks thought he had merchandise under his shirt. Yes, this patient had insurance, also.

Shocked. Shocked I am. The Unaffordable Insurance Act continues to implode. 49 of 50 states will see premium hikes in 2016. The reporter is a little math-challenged, noting that “more than one in three states, or 17 percent” will see premium increases of 20% or more, but it doesn’t take away from the fact that “The Affordable Care Act has driven up costs across the board.”

Healthcare Update - 01-06-2016

Study in American Journal of Clinical Nutrition shows that by consuming less sugar, our tastes change. Study participants who replaced 40% of simple sugars in their diet with fats/protein/complex carbohydrates rated foods 40% sweeter than control subjects who made no changes. The study suggests that, just as with so many other body processes, our bodies become tolerant of certain stimuli and we need more of the stimuli to obtain the same effect. In other words, we may be able to decrease our sugar cravings simply by avoiding sugar for a couple of months. Note how in the study, there was no difference between groups at the first month. The effects in the study took two months to become apparent and became even more pronounced at three months. Unfortunately, most people who diet don’t hold out for three months.
Related article in Time Magazine.

UK closing more hospitals to save money. Government stripping resources from emergency departments so that patients needing surgery have to be transported more than 40 miles away. Described as a “surreal situation – like a Wild West film set, with the fronts of the buildings in Main Street but nothing behind the facade.” The correct term is “Potemkin Village“. But at least the care is free – right? Added bonus: This is the system that our government is moving toward.

Irish patient waits for 20 months to have surgery for correction of severe scoliosis then has surgery canceled at last minute because hospital had too many admissions the day before. But don’t worry, folks. She has insurance!

Should patients who overdose on opioid pain medications receive future prescriptions for opioids? This study suggests that discontinuing opioids after an overdose results in a lower risk of repeated overdose. In a related article, the authors are “highly concerned” that 91% of patients in pain would continue to receive pain medications after an overdose. If doctors prescribe opiate pain medications after an overdose, we’re playing with patients’ lives. If we don’t prescribe opiate pain medications after an overdose, we’re heartless bastards who let patients suffer in pain. Either way, we get negative publicity. Another drive-by medical article.

And you thought that the guy Martin Shkreli was a dick for hiking up the price on Daraprim. Wonder whether other pharma CEOs are going to get investigated for similar actions: Potentially life-saving drug Sovaldi that cures Hepatitis C costs $1000 per pill in the United States, but only costs $4 per pill in India. According to the article, drug companies gouge US citizens on prices of many medications. Advair is $150/month in the US, $10/month in India. Crestor is $86/month in the US and $3.60/month in India. Many cancer drugs cost several thousand dollars more per month in the US than they do in other countries. I know, I know. Shkreli was arrested on securities fraud, not for hiking the price of a potentially life-saving unique medication … like Sovaldi.

Healthcare Update - 01-04-2016

Drug use (especially Ecstasy) at Australian music festivals has increased significantly over the past few years. One emergency department director noted that if people knew where the dealers had concealed the drugs to get into the festival, a lot of people would “nearly vomit.” I can tell you from experience that those places of concealment aren’t limited to music festivals, either.

Patients gone wild. South Carolina belle Megan Whit drives pickup truck into a couple of telephone poles, then asks responding officers for drink of antifreeze. Proceeds to channel the Queen of Hearts from Alice in Wonderland and repeatedly yells “Off with your head!” at the officer. Taken to the emergency department where she insisted she was pregnant and that she overdosed on narcotics. Then shouted obscenities in the emergency department for several hours before testing showed she had used cocaine, crystal meth, and marijuana. This is your brain on drugs. Any questions?

Welcome to Crazy Town. Well-written article about a day in the life of Indianapolis trauma surgeon Jamie Coleman. Many excellent pictures accompany the article. If you’re interested in medicine, this article is a must-read.

Suppose one of your New Year’s resolutions is to stop drinking. What can you expect in the next 30 days? Here’s one person’s experience.

Connecticut attorneys accused of misappropriating $4.3 million from malpractice client’s settlement and of failing to provide proof of more than $600,000 in legal expenses. Initial retainer agreement calculations would have resulted in fees of $2.66 million from the child’s $25 million settlement. Attorneys from Koskoff Koskoff & Bieder allegedly took $7 million in legal fees. Grievance committee investigating the matter finds “probable cause of professional misconduct” against attorneys in the case, but article notes that they were still allowed to keep all of the money. According to the Koskoff web site, Kathleen Nastri and James Horwitz represented the client during the trial.

Employees snooping in the medical records of a patient who committed suicide. Co-workers accessing a patient’s medical records that were then used against him in divorce proceedings. HIPAA violations are “widespread throughout the VA” according to one whistleblower – who was put on administrative leave shortly after filing a complaint. This ProPublica investigation revealed more than 10,000 privacy violations by the VA system since 2011. The Office for Civil Rights cited the VA for more privacy violations than any other health provider in the nation, yet the VA has reportedly never been sanctioned for these violations. But if a patient suffering from a heart attack at a non-VA facility gets tPA at minute number 31, the doctor’s employment is on the line. Nice system we have, huh?

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