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Tag Archives: Medical Studies

Healthcare Update — 12-31-2015

How well are patients in one Norwegian emergency department having their pain managed? According to this study in the Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine, not very well. Of patients with moderate to severe pain (58% of all study participants), only 14% received pain medications. The authors note that “Pain management is accepted as a quality indicator of care, and additional focus on strategies to improve pain management in the ED is necessary to ensure that all patients receive optimal pain assessment and treatment.” First of all, not all patients come to the emergency department with pain complaints. It gets idiotic when asking patients with a rash, a runny nose, or a cough about their level of pain. Second, the study required that anyone with a pain rating more than 3 of 10 be treated for pain. Demanding medication be given for 4 of 10 pain? Give me a break. Third if you want “strategies” to improve compliance, just take a page from the US playbook. Call pain the “fifth vital sign,” create some silly agency that monitors compliance and documentation of irrelevant metrics (you can call it NJCAHO), and create another agency to send out patient satisfaction surveys having little or nothing to do with assessing proper medical care. You’ll get 90+ percentile compliance guaranteed. Of course, then you’ll also create an incentive to prescribe an order of magnitude greater number of pain medication prescriptions, the number of deaths from drug overdoses will skyrocket, you’ll have to create a whole different system to monitor and track patients who become addicted to the pain medications and try to con doctors into writing prescriptions for more medications, other countries will make fun of your citizens for all the pain medications they use, the morale of the healthcare providers in your country will take a hit, and eventually fewer people will want to go into the healthcare profession. But the pain will be better controlled. Want to see what you’ll look like when you stick to that diet you’re beginning tomorrow for a New Year’s resolution? This web site will give you simulated before and after pictures. Unfortunately, it only has simulated females and it appears to be less accurate as the weight increases. But you can print up a picture to tape to your bathroom mirror to remind you of your goal each morning. Want some motivational quotes to paste under the before and after pictures? This Inc. article gives you 101 of them. Here are a couple of good exercise-related ones: The secret to getting ahead is getting started. No matter how slow you go, you’re still lapping everyone sitting on the couch. I’ve tweeted about this site before, but for those of you who missed it, if you need to get a full copy of a scientific article, but can’t afford the $30+ fee to download it, the site Sci-Hub will allow you to download full copies of research papers. Just paste the URL of the article into the site and it will provide you with a full copy of the article. It has 47 million articles in its library. Study in Gut magazine shows that taking proton pump inhibitors (“PPIs”) such as Protonix, Aciphex, Prevacid, Nexium, Prilosec, and Dexilant is associated with unfavorable changes the bacteria in the intestinal microbiome. These changes may explain increases in the rate of Clostridium difficile (“C. diff”) infections in PPI users. The study also notes that the changes in gut flora associated with PPI use are “more prominent than the effects of antibiotics.” Attack of the Glasshole 2.0 nears. Newest ...

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Healthcare Update 07-10-2013

New York’s Eliot Spitzer campaigning in Connecticut’s Danbury Hospital emergency department? Nope. Just some slime that backed up from the toilet and leaked down the walls into about 10 treatment rooms requiring partial closure of the ED and requiring the hospital to use a “mobile hospital tent” provided by the state. In a related article, if you ever wanted to know where the term “shit head” comes from, here’s the explanation: Some Oklahoma perv was arrested after he was found in an amusement park septic tank, looking up through the toilet drains while women were using the bathroom. A woman who took her 7 year old to use the toilet saw an eyeball looking up at her. Wrong on so many levels. Speaking about … feces … a parasite in cat feces is now being termed a “significant public health problem.” The immature forms of the parasite, called oocysts, can survive up to 18 months and only one of them is required to cause an infection. Common sources of infection are sandboxes and vegetable patches where cats are more likely to relieve themselves. Toxoplasma gondii has been called a “mind-controlling parasite” (no other puns about our elected officials here, OK?) because when it infects humans, it has been linked to schizophrenia, depression and suicidal behavior in adults and multiple congenital abnormalities including mental retardation in newborns. Oh, and Toxoplasma infections are much more common in France. Draw your own conclusions. Speaking about … infections … there’s a new tick-borne illness which is similar to Lyme disease (Borrelia burgdorferi) but worse. In addition, it doesn’t cause the typical spreading rash, most doctors don’t know the infection exists, and this infection will not show up on tests for Lyme disease. Introducing … Borrelia miyamotoi. Speaking even more about … infections … a pair of studies in the European Spine Journal shows that back pain may be related to pimples – and may be treatable with antibiotics. Propionibacterium acnes, the bacteria commonly associated with acne, was found in discs of 43% of patients undergoing surgery for disc repair. Of those patients with these bacteria present, 80% had inflammatory changes in the adjacent vertebrae. A second study showed significant improvement in disease specific disability, leg pain, and back pain after 100 days of antibiotic treatment. More evidence to me that health is related to proper balance of bacteria in the system. Now we just have to figure out what that balance is. Also makes me wonder whether chronic back pain or even ankylosing spondylitis may have an infectious basis as opposed to an “autoimmune” basis. Another survey out  – this one by the Medicus Firm – shows attitudes of physicians toward practice preferences and the UnAffordable Insurance Act. Out of 2500 doctors surveyed … More than half preferred the East Coast as the region to set up practice More than half of new graduates preferred employment by a hospital or academic center The most common reasons cited for declining physician pay were hospital employment, declining reimbursements, and time wasted entering information into electronic medical records. More than half of physicians rated the “Affordable” “Care” Act as either a “D” or an “F” in terms of being able to decrease health costs, improving the quality of care, improving efficiency of care, and as an “overall grade.” Enforcing the UnAffordable Insurance Act will be the IRS. Yes … that IRS. The IRS will enforce 47 tax provisions under Obamacare and will also collect the penalties … er … um … taxes for noncompliance. What could go wrong? Oh, and under a 253 page Obamacare rule issued ...

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Best and Worst States to Practice Medicine

Medscape did a survey and some research and came up with a list of the best and worst states in which to practice medicine. You can find the entire presentation at this link, but if you don’t want to create an account at Medscape to view the information, a summary of what they came up with was below. Doctors by far most valued a comfortable living environment in making their decisions where to practice. Other important factors in the decision included proximity of family and friends, climate, job opportunities, and malpractice climate, insurance mix, physician density, medical board activity, and tax burden. Best States to Practice Medicine In the Southwest and South Central regions, Texas was recommended as having low physician density, low cost of living, and few malpractice claims per capita, but these positives were offset by the increased health system burden of the uninsured patients and by the hot weather in Texas. In the West and Northwest regions, Idaho was recommended for its low cost of living, nonlitigious climate and good housing market. Downsides to Idaho included the dominance of two main health systems in the state and the lower than average number of registered nurses. In the Southeast, Tennessee got the nod for higher than average compensation, no state income tax and a mild climate. However, there was a high density of physicians in Tennessee and its school systems are ranked 42 out of 59 in the country. In the Mid-Atlantic, Virginia came out on top for its moderate cost of living, moderate physician density, favorable malpractice climate, low tax burden, and good quality of life. However, the compensation was the second lowest in any region. In the Midwest, Indiana was rated tops for its excellent compensation, low cost of living, low malpractice payouts and balanced lifestyles. On the down side, there isn’t as much nearby access to urban centers if that is important to you. In the Northeast, New Hampshire has great schools, comparably low cost of living for the region, a relatively low tax burden, and good nursing/PA support. However, the compensation in the Northeast is lowest in the country and the climate is cold. Worst States to Practice Medicine Worst states to practice medicine included Nevada, Hawaii, Maryland, Illinois, Connecticut, and … FLORIDA. Big surprise there.

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Healthcare Update – 05-07-2013

Also see more Healthcare Updates on my other blog at EP Monthly.com Here’s a headline bound to catch your attention. Psychiatrists spend a million hours a year attempting to get approval from insurance companies to admit suicidal or mentally ill patients. Link to the study in Annals of Emergency Medicine is here. Study on Medicaid use in Oregon shows that patients who have Medicaid have no better health outcomes than people who don’t, but they do utilize “a lot more health care.” In addition, Medicaid “nearly eliminated catastrophic out-of-pocket medical expenditures.” Is Obama just dangerously misinformed about ObamaCare? Or is he willfully misleading the country? Article picks apart statements that the president is making about the UnAffordable Care Act. The rules about the UnAffordable Care Act keep evolving. Wellness programs that require workers to meet certain health standards to get lower insurance premiums cannot be included as part of minimum coverage requirements that employers must meet. Unions lobbied against wellness programs alleging that they would discriminate against unhealthy workers. South Carolina legislature flips ObamaCare the bird. State House passed a bill that makes it a criminal act to enforce or attempt to enforce the law in South Carolina. Governor Nikki Haley calls the health care exchanges “nothing more than a way to make the state do the federal government’s bidding in spending massive amounts of taxpayer dollars on insurance subsidies that we can’t afford.” Ouch. More allegations of “false advertising” relating to advertised emergency department wait times. This case is at St. Elizabeth’s Hospital in Brighton, Massachusetts. The hospital spokesperson says that the advertised time is a “door to room” time which is a “standard measure” for hospital emergency departments. Not true. False advertising and consumer fraud claims aren’t subject to the medical malpractice caps that are present in many states. Will be interesting to see where this is headed. Man’s runny nose that lasted for several years wasn’t an allergy — it was a CSF leak. And don’t go running to the ED asking for MRIs of your brain because your nose is running. This was an exceptional case. Senator Chuck Schumer wants to increase federal restrictions on hydrocodone prescriptions because they are “gateway drugs” and because “our doctors are prescribing too much of this.” Hey Chucky … how about we put federal restrictions on how many dumb laws you can try to pass? After all, those laws are a gateway to … oh I don’t know … even dumber laws? Patients gone wild. Florida patient attacks doctor after being told to stop cursing and to stop calling the staff names. Arrested and faces felony charges. More patients gone wild. New Jersey man arrested for disorderly conduct and criminal mischief in St. Luke’s Hospital emergency department. No mention of what he did to deserve such charges. JAMA study shows that children with migraine headaches were six times more likely to have experienced colic as an infant. Meanwhile, a study published earlier this year in Pediatrics showed that colicky infants often had significantly different intestinal flora than their non-colicky counterparts. Proteobacteria was increased in colicky babies while bifidobacteria and lactobacilli were decreased. More articles on doctor shopping and drug seeking patients. This Ohio article provides a couple of chilling statistics from a study done Toledo’s St. Lukes Hospital: Ohio overdose deaths totaled more than traffic fatalities by almost a third. And of the 1,544 Ohio citizens who died of drug overdoses in 2010, prescription opioids were listed on 45% of the death certificates. Defense attorney praises doctor for refusing to settle a medical malpractice case when sued for a patient ...

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Health and the Human Microbiome

I’m personally a strong believer that the interaction between our diets and our mircobiome affects our health in more ways than we realize. I think we are just starting to scratch the surface of the ways in which our microbiome keeps us well. Given that, I found a couple of recent medical studies quite interesting. First was a fascinating correlation between diet and heart disease. Presence of trimethylamine N-oxide or TMAO is a strong predictor of arterial placque accumulation in patients. Arterial placque rupture is what causes heart attacks and some strokes. TMAO levels are increased in patients who ingest carnitine – which is abundant in red meat … and energy drinks (where the ingredient is listed as “L-carnitine”). The part of the study that I found most interesting was that people who didn’t eat a diet high in red meats – vegetarians, for example – did not  produce TMAO when fed a high-carnitine diet. Researchers also found that mice which were given broad spectrum antibiotics to wipe out their intestinal flora did not produce TMAO when fed a high-carnitine diet, either. In other words, the composition of the intestinal flora within the human gut seems to affect ones ability to produce TMAO. The study didn’t prove causation, but a diet high in red meats and/or energy drinks is correlated with elevated TMAO levels. The hypothesis that still needs to be studied is whether a high-carnitine diet encourages the growth of flora that converts carnitine to TMAO – or whether it may inhibit growth of some intestinal flora that stop the conversion. A link to the actual study article is here. Similar data was published 2 years ago, so it isn’t exactly a novel concept, but I still find it fascinating. Another study showed the relationship between weight loss and gut flora Gastric bypass surgery causes weight loss. Initially, it was believed that the bypass itself caused the weight loss. These researchers took gut flora from mice who had undergone a gastric bypass procedure and implanted them into mice that had no surgery. The transfer of bacteria alone caused weight loss and decreased fat mass in the mice who never had the bypass surgery. Still another diet/health study showed a correlation between intake of fruits and decreases in hot flashes during menopause. More fruit, vegetables, pasta and red wine – similar to a “Medirerranean-style” diet – was correlated with a decrease in the incidence of hot flashes and night sweats by 20% during menopause. When I read stories like these, I always start thinking about “causation” instead of correlation. For example, in this case does a Mediterranean-style diet cause growth of bacteria that inhibit hot flashes and night sweats? If so, do other diseases that cause night sweats (say lymphoma or tuberculosis) affect the same bacteria? And if so, could changing the bacterial flora in the gut affect those diseases? I know. I know. Disengage the clutch, WhiteCoat. You’re thinking too hard. Then again, I remember when I was a medical student and our highly esteemed professors taught us that most ulcers were caused by “stress” and “Type A personalities” — until Helicobacter pylori was discovered.

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Are You Better Than 83% of Radiologists?

Fascinating study about missing obvious findings on CT studies, based on another study about selective attention. In the cited study, 83% of radiologists missed the abnormal findings on the first CT image. Don’t ruin it for anyone else, but how many of you caught all the abnormalities on the CT scan below? For those who aren’t used to looking at chest CT scans, I included a fairly “normal” CT chest cross section (except for the small nodule) at approximately the same level on the bottom for comparison (credit here).

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