My attending is throwing scalpels. What do I do?
Dear Dr. Wible, Thank you for the work that you do. I have been following your push for humane medical education for several months now. I finally decided to contact you after reading your article about how “burnout” is actually abuse. I am a med student entering my third year. I have been consistently hearing horror stories from other students about the treatment we will receive on our clinical rotations — doctors belittling us, calling us names, screaming and yelling everyday, throwing scalpels in the operating room, not giving bathroom or lunch/dinner breaks, manhandling patients under anesthesia,...
Source: Kevin, M.D. - Medical Weblog - June 16, 2016 Category: Journals (General) Authors: Tags: Physician Medical school Source Type: blogs



2-Month Old Infant Suffered Apnea and Died Following 8 Vaccines
Conclusion After watching their son get buried, Cash’s parents were thrown into a world they didn’t know much about. They were now another set of grieving parents who senselessly lost their child due to medical practices recommended under a doctor’s care. Vaccines are being ignored when compiling infant mortality data. In 2013, Cash Dewayne Thomas was one of 23,440 babies who died in the United States before reaching their first birthday, according to the latest infant mortality data published in 2016. [19] About 11,300 newborns die within their first day of life, many soon after receiving their first hep...
Source: vactruth.com - June 16, 2016 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Augustina Ursino Human Top Stories apnea Cash Dewayne Thomas Jesse Dewayne Thomas newborn vaccines truth about vaccines Vaccine Death Whitney Hill Source Type: blogs

A Patient-Centered Solution To Simultaneous Surgery
The practice of concurrent, or simultaneous, surgery has largely been hidden from public knowledge until recently, and current guidelines regulating the practice fall short in protecting and serving patients in crucial ways. Simultaneous surgery occurs when one surgeon, with the help of assistants, performs two surgeries on two different patients in different operating rooms at the same time. A series of articles published last year in The Boston Globe propelled the practice into public consciousness. In response to the ensuing outcry the American College of Surgeons revised their guidelines with respect to simultaneous su...
Source: Health Affairs Blog - June 14, 2016 Category: Health Management Authors: James Rickert Tags: Featured Health Professionals Quality patient-centered care simultaneous surgery surgeons Source Type: blogs

Prescription Drug Shortages: Data Limitations In An Era Of Big Data
In 2012 hundreds of prescription drugs were in short supply in the United States. Over 80 percent of these drugs were generic and many were commonly used as anti-infective, anesthesia, and chemotherapy agents (ASPE 2011; Woodcock and Wosinska 2012). That same year, the Food and Drug Administration (FDA) was given new and expanded powers to monitor and resolve shortages under the Food and Drug Administration Safety and Innovation Act (FDASIA). A nice recent piece in Health Affairs evaluates trends in drug shortages before and after the passage of FDASIA and by an acute versus non-acute care drug categorization. Using 2001-2...
Source: Health Affairs Blog - June 14, 2016 Category: Health Management Authors: Mireille Jacobson and Hanna Liu Tags: Drugs and Medical Technology Featured Drug Enforcement Administration drug shortages Source Type: blogs

Medical workforce census report 2015
This report provides comprehensive data on the anaesthetics workforce in the UK. It finds that while there have been increases in the numbers of consultant and specialty and associate specialist doctors since the previous census in 2010, the 2015 report confirms a number of challenges facing the specialty, including an existing unmet need for anaesthetics and intensive care medicine in trusts across the UK. Report Press release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - June 12, 2016 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Workforce and employment Source Type: blogs

When this doctor retires early, here are 4 things he’ll miss
As a physician who is planning an early retirement, and is writing about the topic often, I find that retirement is frequently on my mind. It’s not difficult to articulate my desire for an early retirement. I crave the freedom and time with my family. I look forward to restful nights free from the threat of the loathsome pager. Another round of MOC is not for me, and I’m ready to live life at a different pace, exploring hobbies, staying fit, and challenging my mind in novel ways. However, I would be lying if I were to say I feel no trepidation when I contemplate my exit strategy. You see, despite the typical st...
Source: Kevin, M.D. - Medical Weblog - June 10, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Joint Replacement in Ambulatory Care Clincs; A Major Financial Threat to Hospitals
There is a major financial threat sneaking up on hospitals about which some executives may may not be fully aware. It's the recruitment of arthroplasty patients by free-standing ambulatory orthopedic surgery clinics. This topic was covered in great detail in a recent article referring to such clinic surgical procedures as "better and cheaper" (see: Replacing joints faster, cheaper and better?). Below is an excerpt from it but be sure to read the whole thing if interested because it's worth your time: ...[A patient's recent hip replacement] experience with.....
Source: Lab Soft News - June 10, 2016 Category: Laboratory Medicine Authors: Bruce Friedman Source Type: blogs

The Opioid Crisis: Nociception, Pain and Suffering
By MARTIN SAMUELS, MD In order to understand the concept of pain and its relationship to the current opioid crisis, it is prudent to review the neurology of pain an why it exists.  Several concepts are important to integrate. Nociception:  Nociception is the capacity to sense a potentially tissue damaging (noxious) stimulus.  To illustrate this one should place a forefinger in a glass of ice water and determine how long passes until an unpleasant sensation arises.  If one performs this experiment in a large group, one can recognize that, although the stimulus is the same (a glass of ice water), the...
Source: The Health Care Blog - June 10, 2016 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Research and Reviews in the Fastlane 138
This study seeks to prove a saying attributed to Hippocrates: “It augurs well, if the patient’s mind is sound, and he accepts food that’s offered him; but, if the contrary conditions do prevail, the changes of recovery are slim.” In a nutshell, Hippocrates felt that a good appetite and good cognition bode well for mortality. The author’s found that in a group of community living older adults, a graded effect was present. The more severe appetite loss or poor cognition, the more likely the patient would have a poor prognosis. Recommended by Anand Swaminathan Trauma Ogura T, et al. Nonopera...
Source: Life in the Fast Lane - June 8, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Education Emergency Medicine LITFL R&R in the FASTLANE Review Trauma critical care Intensive Care literature Resuscitation Source Type: blogs

Research and Reviews in the Fastlane 138
This study seeks to prove a saying attributed to Hippocrates: “It augurs well, if the patient’s mind is sound, and he accepts food that’s offered him; but, if the contrary conditions do prevail, the changes of recovery are slim.” In a nutshell, Hippocrates felt that a good appetite and good cognition bode well for mortality. The author’s found that in a group of community living older adults, a graded effect was present. The more severe appetite loss or poor cognition, the more likely the patient would have a poor prognosis. Recommended by Anand Swaminathan Trauma Ogura T, et al. Nonopera...
Source: Life in the Fast Lane - June 8, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Emergency Medicine LITFL R&R in the FASTLANE Review Trauma critical care Intensive Care literature Resuscitation Source Type: blogs

Is Being Nice Part of Being Ethical as a Healthcare Provider?
Being on the other side of the healthcare equation is always illuminating.  That is, last week I was a patient at our institution having major, elective, abdominal surgery.  Most of the care I received was kind and humane, but when it was not the negative effects were not small.  Before I “go negative” I would like to say that every nurse I encountered treated me with respect and empathy, and most did not know I was an attending physician. But now to the negative.  An attending anesthesiologist came into my pre-operative cubicle to interview me prior to the surgery.  She started speak...
Source: blog.bioethics.net - June 8, 2016 Category: Medical Ethics Authors: Bioethics Today Tags: Health Care empathy medical education professionalism syndicated Source Type: blogs

Fame and Fetanyl
By KAREN SIBERT, MD A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-...
Source: The Health Care Blog - June 7, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Fetanyl Source Type: blogs

Fame and Fentanyl
By KAREN SIBERT, MD A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-...
Source: The Health Care Blog - June 7, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Fetanyl Source Type: blogs

Fight Aging! Newsletter, June 6th 2016
This study teaches us that poor wound healing and wrinkling and sagging that occur in aging skin share similar mechanisms." Reduced cell cohesiveness of outgrowths from eccrine sweat glands delays wound closure in elderly skin Human skin heals more slowly in aged vs. young adults, but the mechanism for this delay is unclear. In humans, eccrine sweat glands (ESGs) and hair follicles underlying wounds generate cohesive keratinocyte outgrowths that expand to form the new epidermis. Our results confirm that the outgrowth of cells from ESGs is a major feature of repair in young skin. Strikingly, in aged s...
Source: Fight Aging! - June 5, 2016 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Sweat Glands are Essential to Skin Regeneration, but are Sabotaged by Aging
This study teaches us that poor wound healing and wrinkling and sagging that occur in aging skin share similar mechanisms." Reduced cell cohesiveness of outgrowths from eccrine sweat glands delays wound closure in elderly skin Human skin heals more slowly in aged vs. young adults, but the mechanism for this delay is unclear. In humans, eccrine sweat glands (ESGs) and hair follicles underlying wounds generate cohesive keratinocyte outgrowths that expand to form the new epidermis. Our results confirm that the outgrowth of cells from ESGs is a major feature of repair in young skin. Strikingly, in aged s...
Source: Fight Aging! - June 3, 2016 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

Stem Cell Treatments Produce Considerable Benefits in Stroke Survivors
A small study of stem cell transplants into the brain has demonstrated striking benefits in stroke patients when administered long after the stroke itself, past the point at which any further natural recovery is expected: Injecting modified, human, adult stem cells directly into the brains of chronic stroke patients proved not only safe but effective in restoring motor function, according to the findings of a small clinical trial. The patients, all of whom had suffered their first and only stroke between six months and three years before receiving the injections, remained conscious under light anesthesia throughou...
Source: Fight Aging! - June 3, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Wanna Fight Superbugs? Stop Overprescribing Government
Conclusion  Government is like antibiotics. Some amount is necessary. But overprescribing it makes things a lot worse. A good indication you’ve overdosed on the statist Kool-Aid is when you make dismissive comments like this one Emanuel levels at current antibiotic-tracking programs: “Unfortunately, they are voluntary.” (Source: Cato-at-liberty)
Source: Cato-at-liberty - June 1, 2016 Category: American Health Authors: Michael F. Cannon Source Type: blogs

The Coolest Medical Robots in Sci-fi Movies
Here are my top 9 movies with medical robots. As a science fiction fanatic, movies that speculate about the future and depict how robots will be used fascinate me. Some of them describe robots as dumb mechanical machines while others merge them with artificial intelligence. All of their ideas may still become reality.  1) Ender’s Game One of the iconic sci-fi books meant to be on the big screen, Ender’s Game features a surgical robot performing brain surgery on one of the lead characters. The robot was actually designed by Blake Hannaford and his biorobotics team at the University of Washington, which mea...
Source: The Medical Futurist - May 31, 2016 Category: Information Technology Authors: berci.mesko Tags: Medical Robotics Medical Science Fiction GC1 Source Type: blogs

Understanding the CMS Proposed Rule for the Medicare Access and CHIP Reauthorization (MACRA) and Alternative Payment Model (APM’s)
After reviewing the Merit-based Payment System (MIPS) in detail, we now focus our attention on the alternative payment model (APM) track of the new Quality Payment Program. This stems from the Centers for Medicare and Medicaid Services' (CMS) recently proposed rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA). Advanced APMs Beginning in 2019, eligible clinicians who participate in Advanced APMs may become qualifying participants (QPs) each year by meeting certain thresholds; upon becoming QPs, they are excluded from the MIPS program for any years in which they qualify as QPs. For 2019 and 2020,...
Source: Policy and Medicine - May 24, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Understanding the CMS Proposed Rule for the Medicare Access and CHIP Reauthorization (MACRA) and the Merit-Based Incentive Payment System (MIPS)
As we have reported, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA). This is a significant rule with fundamental changes for Medicare. In our continuing coverage, we will provide a more detailed analysis of the regulation. Today, we look at the rule's content related to the Merit-based Incentive Payment System (MIPS). As a refresher, the rule creates a two-track Quality Payment Program. The first is called the Merit-based Incentive Payment System (MIPS) consolidates components of the Physician Quality Reporting System (...
Source: Policy and Medicine - May 23, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

The Politics of Fetal Pain
Earlier this year, Utah passed a fetal pain bill that requires the use of general anesthesia on women seeking abortions at 20 weeks gestation or later.  This bill, which relies on a controversial claim that fetuses may feel pain as early as 20 weeks, has been heavily criticized as an attempt to abrogate abortion rights rather than serving a legitimate protective purpose.  The issue of fetal pain has long been a source of contention in the scientific community, and the dispute has led to several states restricting or prohibiting abortions 20 weeks or later on the basis of potential fetal pain.  While many ...
Source: blog.bioethics.net - May 23, 2016 Category: Medical Ethics Authors: Bioethics Today Tags: Health Care Politics Bioethics and the Law syndicated Women's Reproductive Rights Source Type: blogs

beating the blood brain barrier
Ouch! My writing muscle hurts! I realized this week that I have not blogged since March 23. I have so much I want to say that I don't know where to start, so it feels a little overwhelming. About 10 days ago, I had an Ommaya Reservoir, installed in my brain. Compared to my other brain surgeries it was a walk in the park but I'm still dealing with all kinds of fallout from the anesthetic, pain and healing. I had my staples out yesterday, though, so the end of the tunnel must be in sight (although my head hurts as I type this).You can see my incision and the staples here. It's in a semi-circle at the front, slightly to ...
Source: Not just about cancer - May 20, 2016 Category: Cancer & Oncology Tags: brain metastasis breast cancer cancer blog herceptin lucky metastatic news surgery weird writing Source Type: blogs

BioethicsTV: Week of May 20 – Assisted suicide, public health crisis management, and making promises
Chicago Med In its first season finale (episode 18), Dr. Downey arrives in the emergency department in distress—he is bleeding from his liver as a side effect from his cancer treatment. When he does not awake from the anesthesia, Dr. Rhodes, his protégé, suspects a stroke during surgery. A CT scan shows that Downey did not have a stroke, but rather has a large, inoperable brain tumor—his cancer has metastasized. We are told that his future prognosis is grim and that he is in unrelievable pain.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - May 20, 2016 Category: Medical Ethics Authors: Craig Klugman Tags: End of Life Care Featured Posts Media Public Health #ContainmentCW #NBCHeartbeat BioethicsTV NBCCHicagoMed promise keeping Source Type: blogs

Australian Anaphylaxis amplification
Anaphylaxis is increasingly common. The patient population death rate for anaphylaxis is Australia in 2013 was over double that reported in the UK Dr Ray Mullins, an allergist in Canberra, and colleagues from Sydney and Singapore have recently reported an increase in in the number of anaphylaxis fatalities in Australia. This is currently trending towards a 3 fold increase in anaphylaxis deaths over the study period of 15 years. Mullins and colleagues had previously identified a rise in the rate of all food allergy, with the most dramatic effect in young childhood food where hospital admission analyses showed a 50...
Source: Life in the Fast Lane - May 18, 2016 Category: Emergency Medicine Authors: Mike Cadogan Tags: Clinical Research Education Immunology allergy Anaphylaxis EpiPen mastocytosis Ray Mullins Source Type: blogs

The American College of Cardiology Scientific Session on MACRA
The American College of Cardiology recently held the 65th Annual Scientific Session and Expo, where several sessions focused on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). During the session it was clear that CMS's intention was to only accept ACO's that accept risk in the APM model payments. Piecing Together the MACRA Puzzle One session, entitled Piecing Together the MACRA Puzzle, was hosted by Robert Furno, Nancy Foster, and Harold Miller. This session started out with a broad overview of the MACRA program, followed by a presentation on how hospitals are preparing for MACRA, and then a presentat...
Source: Policy and Medicine - May 12, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Obama and the TREAT Act
I just read an article in the Daily Beast that reads like a better version of something I would write about the value of medication-assisted treatment of opioid dependence.  I appreciate Christopher Moraff telling a story that has been untold far too long, and I hope the story raises questions across the country. But I have something else on my mind that deserves a story of its own.  I am just a small-town psychiatrist in the Midwest, of course, and so I could be missing something.  I watch Veep and House of Cards, but I assume that the political games in those shows are grossly exaggerated.  I’ll...
Source: Suboxone Talk Zone - May 12, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine Legal Public policy Suboxone treatment heroin addiction Obama patient cap TREAT Act Source Type: blogs

Treating Pain Without Feeding Addiction at ‘Ground Zero’ for Opioids - The New York Times
BRIDGEPORT, W.Va. — The doctors wanted to talk about illness, but the patients — often miners, waitresses, tree cutters and others whose jobs were punishingly physical — wanted to talk only about how much they hurt. They kept pleading for opioids like Vicodin and Percocet, the potent drugs that can help chronic pain, but have fueled an epidemic of addiction and deadly overdoses. "We needed to talk about congestive heart failure or diabetes or out-of-control hypertension," said Dr. Sarah Chouinard, the chief medical officer at Community Care of West Virginia, which runs primary care clinics acro...
Source: Psychology of Pain - May 12, 2016 Category: Anesthesiology Source Type: blogs

The Tangled Hospital-Physician Relationship
By GOLDSMITH, KAUFMAN and BURNS Together, hospital and physician services account for more than half of national health spending. In its 2014 National Health Expenditures estimates, the Centers for Medicare and Medicaid Services’ actuaries make the hospital (nearly $1 trillion) and physician practice (nearly $600 billion) sectors appear to be independent and non-overlapping. This is an optical illusion. Hospitals and physicians are, in day-to-day practice, hopelessly intertwined. And while power appears to be shifting from physicians to hospitals with the increasing salaried employment of physicians, appearances can ...
Source: The Health Care Blog - May 12, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Research and Reviews in the Fastlane 134
This article is a large, population-based, retrospective cohort of adults> 65 years of age. It compares those who were prescribed a macrolide with those prescribed a non-macrolide antibiotic looking at the primary outcome of a presentation for a ventricular dysrhythmia at 30 days and a secondary outcome of all-cause mortality at 30 days. They found no difference. While it’s a suboptimal study methodology, this is further evidence that we need not fear these complications. But, this shouldn’t stop us from restricting treatment to only those who need it (i.e. don’t prescribe a Z-pack for a URI). Recommen...
Source: Life in the Fast Lane - May 11, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Clinical Research Education Emergency Medicine Intensive Care critical care R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

The Tangled Hospital-Physician Relationship
Together, hospital and physician services account for more than half of national health spending. In its 2014 National Health Expenditures estimates, the Centers for Medicare and Medicaid Services’ actuaries make the hospital (nearly $1 trillion) and physician practice (nearly $600 billion) sectors appear to be independent and non-overlapping. This is an optical illusion. Hospitals and physicians are, in day-to-day practice, hopelessly intertwined. And while power appears to be shifting from physicians to hospitals with the increasing salaried employment of physicians, appearances can be deceiving. This post discusse...
Source: Health Affairs Blog - May 9, 2016 Category: Health Management Authors: Jeff Goldsmith, Nathan Kaufman and Lawton Burns Tags: Costs and Spending Featured Health Professionals Hospitals Medicare Payment Policy Population Health Quality ACOs Bundled Payments EMTALA MACRA Medicare Part B Physicians Source Type: blogs

LITFL Review 230
Welcome to the 230th 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  The Australian and New Zealand College of Anaesthetists have uploaded some talks from their recent ASM. Listen to Anil Patel talk on THRIVE (think NODESAT on steroids!), Stuart Marshall talk on Human Factors in airway management, and Helen K...
Source: Life in the Fast Lane - May 8, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Don’t be ashamed to receive an epidural during childbirth. Here’s why.
Life as a resident doctor can bring some of the most memorable patients encounters of our career. After all, this is the time in our training when we are the most naïve, vulnerable and most importantly impressionable. There is a certain patient scenario, however, which has changed the way I view one the most important experiences a patient can have: labor. Let me explain. I get paged for an epidural.  Once I arrive, I am often surprised by the look of defeat and despair on the patients face. I often ask the reason for concern or hesitation. “I thought I could do it naturally, but I’m ready for the epi...
Source: Kevin, M.D. - Medical Weblog - May 8, 2016 Category: Journals (General) Authors: Tags: Conditions OB/GYN Source Type: blogs

My double life: Mental illness in the health care
I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have carried the diagnosis of major depressive disorder since I was 11 years old. My family noticed something was wrong well before I was actually diagnosed, and after a few years of going to therapy and not im...
Source: Kevin, M.D. - Medical Weblog - May 6, 2016 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

ABIM MOC Survey Results Announced
We have previously written about the way the American Board of Internal Medicine (ABIM) is seeking physician input on Maintenance of Certification (MOC) assessments. recently, ABIM announced the findings from that recent survey. All ABIM Board Certified physicians were invited to participate in the survey, and over 9,200 responded, a 4.7% response rate. ABIM presented the results from the survey ("Improving the MOC Assessment Experience") at a recent ABIM meeting, in front of more than seventy leaders of medical societies. Following the presentation, the ABIM Board of Directors and Council continued discussions...
Source: Policy and Medicine - May 5, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

A Deep Dive on the MACRA NPRM
By JOHN HALAMKA As promised last week, I’ve read and taken detailed notes on the entire 962 page MACRA NPRM so that you will not have to. Although this post is long, it is better than the 20 hours of reading I had to do!Here is everything you need to know from an IT perspective about the MACRA NPRM. 1.  What is the MACRA NPRM trying to achieve with regard to healthcare IT? The MACRA NPRM proposes to consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for...
Source: The Health Care Blog - May 5, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

A Deep Dive on the MACRA NPRM
As promised last week, I’ve read and taken detailed notes on the entire 962 page MACRA NPRM so that you will not have to.Although this post is long, it is better than the 20 hours of reading I had to do!Here is everything you need to know from an IT perspective about the MACRA NPRM.1.  What is the MACRA NPRM trying to achieve with regard to healthcare IT?The MACRA NPRM proposes to consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for eligible professio...
Source: Life as a Healthcare CIO - May 5, 2016 Category: Information Technology Source Type: blogs

Become somebody: The importance of physician advocacy
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. “I said, ‘Somebody should do something about that.’  Then I realized I am somebody.” – Lily Tomlin Each day, family, work and extracurricular activities all compete for our attention. They are positive aspects of our lives but can be overwhelming at times.  When legislative or regulatory issues arise that might impact our profession or patient safety, it is easy to simply say “shouldn’t somebody do something about that?!”  Sometimes we get angry when “someone&...
Source: Kevin, M.D. - Medical Weblog - May 5, 2016 Category: Journals (General) Authors: Tags: Policy Primary care Source Type: blogs

Dual antiplatelet therapy beyond 1 year after coronary stenting
It is now standard practice to give dual antiplatelet therapy (DAPT) for one year after implantation of a drug eluting stent in a coronary artery. The question of continuing has been addressed in the DAPT Study. Now the results of the DAPT Study for the diabetic subset has been published in Circulation [1]. Around twelve thousand patients who received dual antiplatelet therapy for one year after coronary stenting and free of ischemic or bleeding complications were randomized to further 18 months of dual antiplatelet or single antiplatelet therapy. It was found that there is a further reduction in stent thrombosis...
Source: Cardiophile MD - May 5, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Coronary Interventions Source Type: blogs

FDA ER-LA REMS Day 2 of the Drug Safety and Risk Management Advisory Committee
Day Two of the Joint Meeting of the Drug Safety and Risk Management Advisory Committee (DSaRM) and the Anesthetic and Analgesic Drug Products Advisory Committee (AADPAC) was lively and full of debate and conversation. The day started out with comments from the FDA, followed by presentations by Joanna G. Katzman, MD, MSPH, of the University of New Mexico Health Sciences Center and Graham McMahon, MD, the President and CEO of the Accreditation Council for Continuing Medical Education (ACCME). The bulk of the morning was spent on the "Open Public Hearing" portion, where twenty-three participants, from various wa...
Source: Policy and Medicine - May 4, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

FDA ER-LA REMS Day One of Meeting of the Drug Safety and Risk Management Advisory Committee
Discussion ensued as to whether the rate of success is translating into improved outcomes. The discussion seemed as though it was positive for CE and REMS, and that some industry leaders recognize that working with CE providers to help educate providers is beneficial to patients and the healthcare system overall. The meeting continues Wednesday, May 4, 2016, with discussions that are expected to elicit recommendations from the panel members.       Related StoriesCME and the Opioid CrisisFDA Opinion on Proactive Response to Prescription Opioid AbuseThe FDA Shield - The Medtronic Infuse Ca...
Source: Policy and Medicine - May 3, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Hello world!
Welcome to WordPress. This is your first post. Edit or delete it, then start writing! (Source: Waking Up Costs)
Source: Waking Up Costs - May 1, 2016 Category: Anesthesiology Authors: claven1 Tags: Uncategorized Source Type: blogs

Hello world!
Welcome to WordPress. This is your first post. Edit or delete it, then start writing! The post Hello world! appeared first on Waking Up Costs. (Source: Waking Up Costs)
Source: Waking Up Costs - May 1, 2016 Category: Anesthesiology Authors: claven1 Tags: Uncategorized Source Type: blogs

Addiction Treatment Has it ALL WRONG
Today on SuboxForum members discussed how long they have been treated with buprenorphine medications.  Most agreed that buprenorphine turned their lives around, and most are afraid they will eventually be pushed off the medication.  Most buprenorphine patients described a reprieve from a horrible illness when they discovered buprenorphine.  But most have new fears that they never anticipated– that their physician will die or retire, that politicians will place arbitrary limits on buprenorphine treatment, or that insurers will limit coverage for the medication that saved there lives. I joined the discus...
Source: Suboxone Talk Zone - April 30, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine recovery Suboxone Suboxone Forum addiction counseling character defects heroin addiction Vivitrol Source Type: blogs

Breaking Down The MACRA Proposed Rule
The mother ship has landed. On Wednesday, April 27, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated proposed rule that would establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These policies were established by the latest, permanent ‘doc fix,’ the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). For additional background, please refer to recent Health Affairs Blog posts on MACRA, MIPS, and APMs, as well as a comprehensive brief on MACR...
Source: Health Affairs Blog - April 29, 2016 Category: Health Management Authors: Billy Wynne, Katie Pahner and Devin Zatorski Tags: Costs and Spending Featured Health Professionals Medicaid and CHIP Medicare Organization and Delivery Payment Policy Quality APMS CMS EHRs MACRA mips payment models Source Type: blogs

Funtabulously Frivolous Friday Five 143
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 143 Question 1 What is Fagan famous for in evidence-based medicine (nothing to do with Oliver Twist)? + Reveal the Funtabulous Answer expand(document.getElementById('ddet275353453'));expand(document.getElementById('ddetlink275353453')) The Fagan nomogram converts pre-test porbabilities into post-test probabilities using the likelihood ratio for any given test.   Question 2 What do a sloth bear and local peo...
Source: Life in the Fast Lane - April 29, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five airway Fagan nomogram Guedel hyperthyroidism Jod-Basedow phenomenon King George the second Madhuca flowers pericardial tamponade twin lannister Wolf-Chaikoff effect Source Type: blogs

BioEthicsTV: A night of consent issues on ChicagoMed
by Craig Klugman, Ph.D. On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus. The first major storyline concerned a 16-year-old in abdominal pain who enters the ED with her father, a heroin addict. Although in pain and in need of a diagnostic endoscopy, the patient refuses any and all medications: She fears that even one dose will turn her into the addict that her father has been for her entire life. The doctors try the endoscopy without anesthetic or pain medications and they are unable to get through the procedure.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - April 27, 2016 Category: Medical Ethics Authors: Craig Klugman Tags: Clinical Ethics Featured Posts Informed Consent Reproductive Medicine BioethicsTV NBCCHicagoMed Source Type: blogs

Do not be this person.
This week I wanted to die, in a sustained and sincere manner, rather than return to work after my first shift back from vacation.Why?Because I had a patient. Who weighed six hundred pounds. That's a BMI of 79.9 if you're counting, and not something that you want to aspire to. However, the trouble was not the patient. The trouble was one of her family members, the one Person You Should Never, Ever. Be.This Person was, she claimed, a cousin-level relative of my patient and, she claimed, a neuro ICU nurse. The fact that she was a neuro ICU nurse at a hospital in the most far-flung district of the most distant, inbred county o...
Source: Head Nurse - April 22, 2016 Category: Nursing Authors: Jo Source Type: blogs

CME and the Opioid Crisis
Dramatic increases in death due to prescription opioid abuse has gained national attention. In the last month alone, the Centers for Disease Control and Prevention (CDC) has issued new guidelines on prescribing opioids, the Food and Drug Administration (FDA) has issued restrictive labeling guidelines on immediate release opioids, and Congress has held almost weekly hearings on the issue of opioid abuse. All major party candidates for President have stated that reducing opioid abuse is a top priority of theirs. Congress is in the midst of passing several large bills designed to restrict access to prescription opioids and he...
Source: Policy and Medicine - April 21, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

What We Think We Know and Don't Know About tDCS
image: Mihály Vöröslakos / University of Szeged “Don't Lose Your Head Over tDCS,” I warned last time. Now the infamous cadaver study has reared its ugly hot-wired head in Science News (Underwood, 2016).The mechanism of action of transcranial direct current stimulation (tDCS) had been called into question by Dr. György Buzsáki during his presentation at the Cognitive Neuroscience Society meeting....Or had it?To recap, my understanding was that an unpublished study of transcranial electrical stimulation (TES) in human cadaver heads showed a 90% loss of current when delivered thro...
Source: The Neurocritic - April 21, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs

What We Think We Know and Don't Know About tDCS
image: Mih ály Vöröslakos / University of Szeged “ Don't Lose Your Head Over tDCS , ” I warned last time. Now the infamous cadaver study has reared its ugly hot-wired head in Science News ( Underwood, 2016 ). The mechanism of action of transcranial direct current stimulation ( tDCS ) had been called into question by   Dr. Gy örgy Buzsáki during his presentation at the Cognitive Neuroscience Society meeting. ...Or had it? To recap, my understanding was that an unpublished study of transcranial electrical stimulation (TES) in human cadaver heads showed a 90% loss o...
Source: The Neurocritic - April 21, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs