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Tag Archives: microbiome

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 — 10-21-2014

More healthcare related news from around the web on my other blog at EP Monthly Let’s call the first part of this post the Ebola Chronicles Treating one Ebola patient would wipe out the ICU in an average-sized hospital and may even bankrupt some smaller facilities. Most states won’t even allow disposal of waste from Ebola patients. Then there’s the Ebola patient in the US you didn’t know about. Doctor infected with Ebola while working for the WHO in Sierra Leone was treated in Emory Hospital’s biocontainment unit for the past 6 weeks. Now is “well on his way to a full recovery.” Baylor Medical Center in Texas requires that patients knock on glass door and answer Ebola screening questions before being allowed in emergency department. Clipboard idiot walking alongside Dallas Ebola patient Amber Vinson and directing people in hazmat suits grabs hazmat trash bag and discards it, then boards the flight — with no hazmat gear. Were he and his clipboard quarantined after touching waste from the Ebola patient? Of course not. The only conclusion we can make from this scenario is that clipboards must prevent Ebola. Vomiting is now an actionable offense. California’s Southwestern College evacuates and institutes quarantine after student who flew on same airplane as Amber Vinson gets sick and vomits in class But vomiting and dying … not so much. Patient on Nigeria flight to JFK vomits and dies. Officials give corpse a “cursory” exam, declare he does not have Ebola, then whisk him from the airplane. Nothing to see here, folks. Move along. Move along. Don’t look now … actress Tori Spelling quarantined in hospital with symptoms of Ebola. Well, she did have a fever and an “uncontrollable” cough, but she was hospitalized for bronchitis. That reminds me. I have symptoms of Ebola, too. My muscles are sore … after I worked out yesterday. Just wait until flu season hits. And finally, the lawyers are already figuring out ways to profit from Ebola, suggesting that hospitals may have liability if they miss a diagnosis of Ebola. Now back to regular news … Buying insurance on the Obamacare exchange? Last year’s enrollment period began October 1. This year, you can enroll and find out how much your rates have increased … on November 15, 2014 … after the elections. This strategic timing can only mean that rates are set to skyrocket. If they were trending downward, the elected officials who voted to pass Obamacare would be using that fact in their campaigns. Want to see the names of the numbskulls who voted for this abominable law? Roll call of Senators who voted for Obamacare (a party line vote by Democrats) Roll call of House members who voted for Obamacare (pretty much a party line vote by Democrats as well) Did I mention that elections are a couple of weeks away and that many of these people want to be re-elected? More on the microbiome. Stress and shock may really cause a heart attack – by affecting the bacteria present in arterial walls. The stress hormones released during sudden stress may cause the bacterial biofilm over the arterial walls to dissolve, causing placques within the walls to rupture. In the future, managing bacteria within an arterial plaque (carotid arteries typically have Pseudomonas growing inside) may be just as important as managing a patient’s cholesterol. What happens to all the kids who are sent from schools to the emergency department for psychiatric evaluations? In 92.2% of cases, they’re sent home, and in half of those cases they aren’t even given psychiatric follow up. The study notes that only ...

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Healthcare Update — 10-13-2014

See more medical news from around the web at my other blog at EP Monthly. _________________ NEW SITE SPONSOR! Need to renew your BLS, ACLS, or PALS certificate? You can get your certificate the SAME DAY by taking an online course and passing the online test at Pacific Medical Training. By clicking on THIS LINK, you’ll also get a 15% discount on the course fees. That’s a $25 savings for your ACLS recertification! _________________ Straight out of Men in Black. UC Davis researchers have discovered that they can erase certain memories in mice by using flashes of light. China is cracking down on pharmaceutical price fixing. Some company executives received prison sentences of between 2 and 4 years for their actions – although unfortunately those prison sentences were suspended. Government department heads are also being investigated since they are responsible for and must be punished for law violations committed by their subordinates. Even the cats were amazed. 18 year old woman who had habit of chewing on her hair goes to doctor with abdominal pain and malnourishment. Rushed to surgery where a 9 pound hairball was removed. Yes, you read that correctly. A nine pound hairball. Like she had a baby Cousin Itt inside of her. The Limits of Friendship. How many friends can an average person realistically have in their social circle? Based on human brain size … about …. Oh go on and read the article. The discussion is pretty interesting. Baylor University Medical Center reportedly at risk of losing all federal funding if it doesn’t submit an acceptable action plan regarding psychiatric patient elopement. CMS inspectors recently found six cases in which psychiatric patients walked away from the hospital’s emergency department before treatment concluded and determined that those “elopements” put patients in “immediate jeopardy” of their health and safety. The Netherlands has a slightly different way to treat patients with severe psychiatric problems: Euthanization. The rate of death by lethal injection for patients with severe psychiatric problems tripled from 14 cases in 2012 to 42 cases in 2013. Counting “terminal sedation,” euthanasia accounts for one in eight deaths in the Netherlands. But at least the patients in the Netherlands have insurance – just like us. No more curly fries for me for a while. Woman puts potato in her vagina after being assured by her mother that doing so would be a fail-safe contraceptive method. Turns out mom was right. Guys tend to run the other way when they see roots growing out of your hoo hah. Fortunately, doctors were able to remove the budding spud without surgery. And if anyone makes any Mr. Potatohead jokes, I’m going to be sick. I just know it. The hormones from birth control pills found in sewage found to cause feminization of of male minnows. This caused the number of minnows in the Ontario waterways to decrease to 1% of the usual population. As a result, the number of lake trout decreased – lake trout are the minnow’s main predator. Also as a result, the number of insects in the area began increasing – insects are the minnow’s main source of food. When estrogen was removed from the water supplies, all of the changes reversed. Wait a minute. Obamacare requires that birth control pills be provided at no cost. That must mean that the government wants less fish and more insects in our country. What effect has the Affordable Care Act had on employment in the US? Mostly negative, according to this paper from the Mercatus Center at George Mason University. It creates financial incentives for employees to work less. Part ...

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Battling diarrhea with … yeast

Recently-published meta-analysis shows that the yeast Saccharomyces boulardii has “clear beneficial effects” on children with acute diarrhea. Pooling of 22 studies showed that duration and amount of diarrhea was significantly reduced in children who took the supplement. Interesting back story to the discovery of Saccharomyces boulardii: The yeast is found on the skin of lychee fruits. French scientist Henri Boulard discovered Saccharomyces boulardii in the 1920s after noticing that natives of Southeast Asia were chewing on the skin of lychee fruits in an attempt to control the symptoms or cholera. You can purchase Saccharomyces boulardii from Amazon without a prescription. Saccharomyces boulardii is related to another yeast – Saccharomyces cerevisiae – which is found on the skin of grapes and plums and is used in brewing beer and baking. Antibodies to Saccharomyces cerevisiae are often seen in patients who have inflammatory bowel disease such as Crohn’s disease and ulcerative colitis, suggesting that Saccharomyces cerevisiae may play a role in bowel inflammation. Then I begin wondering whether the link between beer and “beer belly” may be related to more than just the alcohol and the extra calories in the beer.

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Healthcare Update — 09-04-2013

Find more updates on my other blog at EPMonthly.com University of Iowa settles malpractice lawsuit after plaintiff attorney obtains confidential documents about why a neurosurgeon left the hospital system. Point to remember is that those confidential settlements aren’t as confidential as you might believe. Not sure whether this is a good or bad announcement. On one hand, emergency department closures across Nova Scotia are down by 21% and 25 of 38 hospitals had no ED closures over the prior year. On the other hand, emergency departments were still closed 5% of the time and one commenter notes that the professionals staffing the emergency departments to keep them open are paramedics and LPNs, not physicians. So is some care better than no care at all? Is this a model that should be replicated in the US? Another study showing how gut flora may play a large part in weight control. Swiss study shows that patients gained an average of 5 pounds after they stopped smoking – even when their diet went unchanged. While gut flora of control patients who smoked and who didn’t smoke remained the same, there was a significant shift in the intestinal bacteria of those patients who stopped smoking — including an increase in Proteobacteria and Bacteroides. Small community hospital in Florida closes its doors and residents lose nearby emergency services – although with only 3-4 inpatients per day this week and 25 beds, it likely didn’t have a large ED volume. Rural North Carolina’s Blowing Rock Hospital also closing its emergency department effective October 1. Oh, and add Flint River Hospital in Montezuma, GA to the list of hospitals closing their emergency departments. Yet another hospital closes. Chicago’s Sacred Heart Hospital is now closed and some of its physicians are being sued by the feds for performing “unnecessary” tracheostomies on poor and elderly patients. Criminal charges could also be filed. Multiple patients in Denver area hospitals are having bad reactions from synthetic marijuana, including Black Mamba and Spice. Reactions include hallucinations where patients jump off buildings and cessation of breathing requiring ventilator support. Jury awards $6.4 million to patient who had mitral valve prolapse and who was never referred to a cardiologist. More than 10 years after the diagnosis was initially made, the patient became “very ill”, complaining of fatigue, loss of appetite and abdominal pain. He was sent to several consultants, but none apparently evaluated his heart. Two months after symptoms began, patient suffers a stroke due to bacterial endocarditis. Patients gone wild … er, um … vampire? Unresponsive patient wakes up when medics trying to draw his blood and bites one of them on the back. Police officer punches patient in back of head to get him to let go. Blah! But they vere taking MY blood! Blah! Blah! Just another day in the ED … Georgia’s Floyd Emergency Department having a lot of patients going wild. First a patient gets upset with staff, throws a cup of urine on a staff member, then begins cursing. He gets arrested and charged with multiple crimes. Then, in a separate incident, another inked patient gets arrested for swearing at hospital staff and then fighting with an officer called to the scene. Same town, different story – woman arrested for DUI and unlawful conduct during a 911 call after trying to get a friend with an asthma attack to the Floyd ED. Rocking times in Rome, GA. The latest rage: “Foam parties”? Go out dancing and end up with three feet of bubbles all around you on the dance floor. All fine and dandy until someone loses an ...

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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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