by Paul Rega, MD — published on February 8th, 2010
What is the definition of barium?
What we do when treatment fails.
But I digress…….
According to a recent Harvard U. poll, most Americans do not intend to get the swine flu vaccine, assume the pandemic is over, think the threat was overblown, and that underwear should be worn on the outside. What do you think?
http://omniphysicians.com/2010/02/08/h1n1-american-complacency/
You’ve heard of speed-dating. Now that same idea is being used to match doc with patient. Ob-gyn Emily Emmet, MD, was sitting at a table in a room at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford when a teenager sat down to talk. The young woman wondered: Could Dr. Emmet be the right physician to perform her first pelvic exam? After five minutes, the conversation ended. That’s because Mandy Forbus, senior marketing specialist at the Dallas-Fort…
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by Paul Rega, MD — published on February 8th, 2010
Link: http://www.ama-assn.org/amednews/2010/02/08/bil20208.htm
Ob-gyn Emily Emmet, MD, was sitting at a table in a room at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford when a teenager sat down to talk. The young woman wondered: Could Dr. Emmet be the right physician to perform her first pelvic exam?
After five minutes, the conversation ended.
That’s because Mandy Forbus, senior marketing specialist at the Dallas-Fort Worth area hospital, had signaled it was time for the teen, and other potential patients, to move to another table and talk with another doctor.
If Doc Shop — a program Texas Health HEB launched in fall 2009 to connect patients with obstetrician-gynecologists — sounds like speed dating, it’s because it was modeled on the matchmaking process that lets singles meet a significant number of potential dates in…
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by Paul Rega, MD — published on February 8th, 2010
Link: http://www.medpagetoday.com/ProductAlert/Prescriptions/18329
WASHINGTON — A warning of a risk of progressive multifocal leukoencephalopathy has been added to the label for the multiple sclerosis drug natalizumab (Tysabri), the FDA announced.
The warning notes that the risk of PML increases with the number of natalizumab doses
The labeling change was prompted by continuing reports of PML in MS patients. The current number of confirmed cases stands at 31 — 10 in the U.S. — up from 13 as recently as last September. (See FDA Confirms 13 Cases of PML with MS Drug)
The agency noted that there have been no reports of PML in patients using the drug for less than a year. In those who’ve received 24 to 36 infusions of natalizumab, the rate of developing PML in the U.S.…
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by Paul Rega, MD — published on February 8th, 2010
Link: http://www.nytimes.com/2010/02/06/health/06flu.html?ref=health
NYT
February 6, 2010
Most Americans Think Swine Flu Pandemic Is Over, a Harvard Poll
Finds
By DONALD G. McNEIL Jr.
Most Americans do not intend to get the swine flu vaccine, assume the pandemic is over and think the flu threat was overblown, according to a poll released Friday by the Harvard School of Public Health.
As of the end of January, only about a fifth of all Americans had had swine flu shots, according to that poll and data released separately by the Centers for Disease Control and Prevention.
And, even though this flu hit children and teenagers the hardest, only about 40 percent of them have had the shots. That figure could improve because 13 percent of adults surveyed by Harvard told pollsters that they still intended to get their children vaccinated.…
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by Paul Rega, MD — published on February 8th, 2010
Link: http://www.jems.com/news_and_articles/articles/Bariatric_Patients_Pose_Weighty_Challenges.html
JEMS
- Raphael M. Barishansky, MPH, Katherine E. O’Connor, BS, EMT-P
- August 2007 EMS Insider Vol. 34 No. 8
- 2007 Aug 2
Bariatrics is the branch of medicine that deals with the causes, prevention and treatment of obesity, and the U.S. has the dubious distinction of having the highest rates of obesity of any developed country in the world. What’s even more concerning is the rapid rate at which obesity has grown in a mere 10 years.
In 1995, all 50 states reported to the Centers for Disease Control and Prevention that no more than 20% of their population was considered “obese.” But by 2005, only four states could make that claim; 17 states met or exceeded obesity prevalence rates of 25% and three states had obesity rates of…
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by Paul Rega, MD — published on February 8th, 2010
Link: http://www.washingtonpost.com/wp-dyn/content/article/2010/02/07/AR2010020702666.html?hpid=topnews
By Mary Pat Flaherty
Washington Post Staff Writer
Monday, February 8, 2010; B01
Local paramedics and firefighters don’t need to follow television shows about a half-ton teen or biggest losers to track the obesity trend.
They carry that knowledge with them.
Calls for patients weighing 350 pounds come daily in the District. A patient between 400 pounds and 600 pounds is part of every workweek for many crews throughout the region. Patients topping 600 pounds are transported by emergency teams every few months.
Girth is a separate challenge.
“I think everyone has struggled with this issue, and technology is just now coming to grips with it,” said Fairfax Deputy Fire Chief Christine Louder.
Across the Washington region and the country, departments have been adapting steadily to plus-size patients. They have added specialty…
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by Paul Rega, MD — published on February 7th, 2010
Clem, an old West Virginian, pulled his car over by the side of the road and showed Jed where he’d first had sex.
“It was right down there by that tree. I remember the day plainly. It was a warm summer day. She and I were so much in love. We walked down to the tree and made love for hours,” Clem recalled.
“That sounds wonderful,” said Jed.
“Yes. It was okay until I looked up and noticed her mother was standing right there watching us.”
“Oh my God! What did her mother say when she saw you making love to her daughter?”
“Baaaaa…”
But I digress……
This abstract describes an interesting way to diagnose the long-QT syndrome.
http://omniphysicians.com/2010/02/07/provoking-the-long-qt-syndrome-lqts/
This news article is reporting on a NEJM study linking higher co-pays to deferred medical…
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by Paul Rega, MD — published on February 7th, 2010
Link: J Am Coll Cardiol, doi:10.1016/j.jacc.2009.12.015 (Published online 27 January 2010)
http://content.onlinejacc.org/cgi/content/abstract/j.jacc.2009.12.015v1?papetoc
The Response of the QT Interval to the Brief Tachycardia Provoked by Standing
A Bedside Test for Diagnosing Long QT Syndrome
Objectives: This study was undertaken to determine whether the short-lived sinus tachycardia that occurs during standing will expose changes in the QT interval that are of diagnostic value.
Background: The QT interval shortens during heart rate acceleration, but this response is not instantaneous. We tested whether the transient, sudden sinus tachycardia that occurs during standing would expose abnormal QT interval prolongation in patients with long QT syndrome (LQTS).
Methods: Patients (68 with LQTS [LQT1 46%, LQT2 41%, LQT3 4%, not genotyped 9%] and 82 control subjects) underwent a baseline electrocardiogram (ECG) while resting in the supine position and were then asked to get up quickly and stand…
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by Paul Rega, MD — published on February 7th, 2010
Link: http://www.washingtonpost.com/wp-dyn/content/article/2010/01/27/AR2010012703804.html
By ALICIA CHANG
The Associated Press
Wednesday, January 27, 2010; 5:00 PM
LOS ANGELES — Higher Medicare copays, sometimes just a few dollars more, led to fewer doctors visits and to more and longer hospital stays, a large new study reveals.
With health care costs skyrocketing, many public and private insurers have required patients to pay more out-of-pocket when they seek care. The new study confirms what many policymakers had feared: cost-shifting moves can backfire.
“Patients may defer needed care and may wind up with a serious health event that might put them in the hospital. That’s not good for the patients, not good for society, not good for anybody,” said Dr. Tim Carey, who heads the University of North Carolina’s Sheps Center for Health Services Research.
Carey had no…
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by Paul Rega, MD — published on February 7th, 2010
Modern Healthcare (1/28, Carlson) reports, “Despite all the ongoing efforts to expand the healthcare workforce, industry experts say it’s time for employers to realize that demographic trends are not going to allow them to maintain their existing staffing patterns in coming decades, according to a new American Hospital Association study.”
Data indicate that “if current trends persist,” there will be a shortage of “109,600 physicians by 2020, and…260,000 full-time-equivalent nurse positions by 2025.” The report “says hospitals need to find ways to retain their existing workforces while attracting newly educated workers.” The authors call on hospitals and health systems “to rapidly implement these strategies, learn early implementation insights, and share successful practices.”
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by Paul Rega, MD — published on February 7th, 2010
Link: http://www.medicalnewstoday.com/articles/178341.php
Bacteria Toxic To Wound-Treating Maggots
06 Feb 2010
Bacteria that infect chronic wounds can be deadly to maggot ‘biosurgeons’ used to treat the lesions, show researchers writing in the journal Microbiology. The findings could lead to more effective treatment of wounds and the development of novel antibiotics.
Scientists from the Copenhagen Wound Healing Centre, Statens Serum Institut and the University of Copenhagen in Denmark showed that maggots applied to simulated wounds heavily infected with the bacterium Pseudomonas aeruginosa, were unable to treat the wound and were left dead after 20 hours.
Chronic wounds, such as leg ulcers, affect 1% of the Western population and are painful and difficult to treat. Use of maggots to disinfect wounds is an ancient practice that regained popularity in the early 1990s. Maggot…
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by Paul Rega, MD — published on February 6th, 2010
Q: What are the three rings of marriage?
A: The engagement ring, the wedding ring and the suffering.
But I digress……….
This abstract presents a well-used technique to minimize discomfort when sticking a kid. I used it on my honeymoon!
http://omniphysicians.com/2010/02/06/the-cough-trick/
This study makes the case for using a taser in the hospital. For patients attempting suicide, for threatening families, and for those leaving AMA.
http://omniphysicians.com/2010/02/06/dont-tase-me-doc/
Should you do a skeletal survey for kids presenting with burns? Do burns suggest occult child abuse? Of 97 children <24 months of age with burns, 18 (18.6%) were also found to have fractures. Among all 1203 children <24 months of age, 649 (53.9%) had fractures. Eleven children had multiple fractures, and 12 children had fractures with radiographic evidence of healing. Two children were noted to have classic metaphyseal fractures. The rate…
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by Paul Rega, MD — published on February 6th, 2010
Introduction of the conducted electrical weapon into a hospital setting
Published online: 01 February 2010
Jeffrey D. Ho, Joseph E. Clinton, Mark A. Lappe, William G. Heegaard, Martin F.
Williams, James R. Miner
DOI: 10.1016/j.jemermed.2009.09.031
Journal of Emergency Medicine
Background: The TASER® X26 Conducted Electrical Weapon (CEW) provides painful stimuli and neuromuscular incapacitation to potentially violent persons. Use by law enforcement in society is common. Presenting a CEW is known to de-escalate some situations. Health care personnel sometimes encounter violent persons within the confines of the hospital. CEW use by health care security personnel has not been described. Objective: The objective is to describe results from the introduction of the CEW into a hospital environment. Methods: Upon introducing the CEW into an urban hospital campus, standardized reports were made describing all…
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by Paul Rega, MD — published on February 6th, 2010
Medical clearance of the psychiatric patient in the emergency department
Published online: 01 February 2010
Bruce D. Janiak, Suzanne Atteberry
DOI: 10.1016/j.jemermed.2009.10.026
Journal of Emergency Medicine
Link: http://www.jem-journal.com/article/S0736-4679%2809%2900928-7/abstract
Background: As part of the emergency department (ED) evaluation of patients with psychiatric complaints, emergency physicians are often asked to perform screening laboratory tests prior to admitting psychiatric patients, the value of which is questionable. Study Objective: To determine if routine screening laboratory studies performed in the ED on patients with a psychiatric chief complaint would alter ED medical clearance (evaluation, management or disposition) of such patients. Methods: In this retrospective chart review, the patient charts were reviewed for triage notes, history and physical examination, laboratory study results, and patient disposition. The study investigators subjectively determined if any of the laboratory abnormalities identified…
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by Paul Rega, MD — published on February 6th, 2010
Factors Associated With Pediatric Use of Complementary and Alternative
Medicine
Gurjeet S. Birdee, Russell S. Phillips, Roger B. Davis, and Paula Gardiner
Pediatrics 2010;125 249-256
BACKGROUND Limited data are available on the use of complementary and alternative medicine (CAM) and factors associated with use among the pediatric population in the United States.
METHODS Using the 2007 National Health Interview Survey data among individuals <18 years of age (n = 9417), we compared CAM users (excluding those using vitamins and minerals) and non-CAM users. Using bivariable and multivariable logistic regression models, we examined independent associations of CAM use with sociodemographic factors, prescription medication use, delays in health care caused by access difficulties, and common medical conditions/symptoms.
RESULTS In an adjusted multivariable logistic model, CAM users were more likely than non-CAM users to be adolescents rather than infants or toddlers (adjusted odds ratio [aOR]:…
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