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Will telemedicine take your job?
Telemedicine is often in the news and until recently I had only casually glossed over the latest articles. The details I paid little attention to, but the headlines I would remember. “Great for rural areas” I would read! “Extend physician reach!” “Get specialists to greater numbers of patients with unique conditions!” As a nearly graduated anesthesia resident in a large city with an abundance of doctors, I didn’t think telemedicine would have much impact on my future. None of the above headlines applied. However, I would be surprised one morning to wake up to an email that rou...
Source: Kevin, M.D. - Medical Weblog - March 18, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/lifeofamedstudent" rel="tag" > #LifeofaMedStudent < /a > Tags: Physician Hospital Surgery Source Type: blogs

BodyCap e-Celsius Electronic Pill for Core Body Temperature Monitoring
BodyCap, a company based in Caen, France, won the European CE Mark to introduce its e-Celsius swallowable wireless thermometer. Designed to monitor patients’ core temperature, the e-Celsius looks like and is ingested just like a regular drug capsule. As it moves down the GI tract, every 30 seconds the device wirelessly transmits data to an “e-Viewer” that displays the readings and records the temperature during the pill’s journey. During studies, the e-Celsius demonstrated consistency of measurements and the fact that the GI tract has a generally uniform temperature throughout. The readings have mat...
Source: Medgadget - March 13, 2017 Category: Medical Equipment Authors: Editors Tags: Anesthesiology Critical Care Medicine Pediatrics Source Type: blogs

An open letter to Psychological Medicine about “ recovery ” and the PACE trial
In conclusion, noted Wilshire et al., “the claim that patients can recover as a result of CBT and GET is not justified by the data, and is highly misleading to clinicians and patients considering these treatments.” In short, the PACE trial had null results for recovery, according to the protocol definition selected by the authors themselves. Besides the inflated recovery results reported in Psychological Medicine, the study suffered from a host of other problems, including the following: *In a paradox, the revised recovery thresholds for physical function and fatigue–two of the four recovery mea...
Source: virology blog - March 13, 2017 Category: Virology Authors: Vincent Racaniello Tags: Commentary Information adaptive pacing therapy CFS chronic fatigue syndrome clinical trial cognitive behavior therapy Dave Tuller exercise graded exercise therapy mecfs myalgic encephalomyelitis outcome PACE trial recovery Source Type: blogs

Your First Colonoscopy! What to Expect
Whee! Time for a Tube Up Your Tuchus!image:wikimedia commonsBy Crabby McSlackerSo, some perspective here: for people with serious illnesses who've been through hardcore, painful, debilitating, invasive medical procedures? A colonoscopy is probably child's play. (Although let's be clear, that's just an expression. If your child actually plays this way? We need to talk).But for most people, there's at least a little trepidation. And for many, if statistics are to be believed, that fear is significant enough to skip the procedure entirely! Well sure, it could save your life and all, but really? Do you have to?There are actual...
Source: Cranky Fitness - March 12, 2017 Category: Consumer Health News Authors: Crabby McSlacker Source Type: blogs

An Open Briefing For the President ’ s Economic Advisors (And Concerned Members of the House & Senate )
By JOE FLOWER This is a letter I sent to Gary Cohn, appointed by President Trump to head the National Economic Council and, among other things, come up with a plan for reforming healthcare. Formerly president of Goldman Sachs, Cohn may be a wizard at finance, but healthcare economics are wildly different and famously opaque. So I thought I would help him out.] Subject: A brief on healthcare economics. (8 minutes)  o Why healthcare economics are different.  o Why the ACA is failing.  o What would work. Who I am (credentials): Independent healthcare author and analyst since Jimmy Carter’s administration...
Source: The Health Care Blog - March 10, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Why This Doesn ’ t Actually Work The Way You Think It Does
By JOE FLOWER This is a letter I sent to Gary Cohn, appointed by President Trump to head the National Economic Council and, among other things, come up with a plan for reforming healthcare. Formerly president of Goldman Sachs, Cohn may be a wizard at finance, but healthcare economics are wildly different and famously opaque. So I thought I would help him out.] Subject: A brief on healthcare economics. (8 minutes)  o Why healthcare economics are different.  o Why the ACA is failing.  o What would work. Who I am (credentials): Independent healthcare author and analyst since Jimmy Carter’s administration...
Source: The Health Care Blog - March 10, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Healthcare Economics: Why This Stuff Doesn ’ t Actually Work The Way You Think It Does
By JOE FLOWER This is a letter I sent to Gary Cohn, appointed by President Trump to head the National Economic Council and, among other things, come up with a plan for reforming healthcare. Formerly president of Goldman Sachs, Cohn may be a wizard at finance, but healthcare economics are wildly different and famously opaque. So I thought I would help him out.] Subject: A brief on healthcare economics. (8 minutes)  o Why healthcare economics are different.  o Why the ACA is failing.  o What would work. Who I am (credentials): Independent healthcare author and analyst since Jimmy Carter’s administration...
Source: The Health Care Blog - March 10, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

PIVO Gathers Blood Samples from Peripheral IVs, Gets FDA Clearance
Velano Vascular won FDA clearance for its second version of the PIVO needle-free vascular access device. The disposable device helps to gather blood samples from indwelling peripheral IVs, helping to avoid extra needle sticks and not using central lines to draw blood. The PIVO has a catheter that is placed into the peripheral IV and pushed down into the blood vessel, through which blood is pulled back into PIVO’s reservoir. It doesn’t have any needles, reducing the potential for injuries to the staff and repeated needle sticks for the patient, including all the consequences these events can introduce. The ...
Source: Medgadget - March 6, 2017 Category: Medical Equipment Authors: Editors Tags: Anesthesiology Cardiology Critical Care Emergency Medicine Source Type: blogs

LITFL Review 272
LITFL: Life in the Fast Lane Medical Blog LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 272nd 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 chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week The Ultrasound podcast have just released a great series on TEE for crashing patients. Here’s...
Source: Life in the Fast Lane - March 5, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

LITFL Review 272
LITFL: Life in the Fast Lane Medical Blog LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 272nd 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 chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week The Ultrasound podcast have just released a great series on TEE for crashing patients. Here’s...
Source: Life in the Fast Lane - March 5, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs

Physicians must stop losing their own
In the past few weeks, we have lost two female physician colleagues tragically to suicide, a pediatrician and psychiatrist.  In the general population, males take their lives at four times the rate of females.  However, for physicians specifically, the suicide rate is evenly distributed between genders; making our occupation the one with the highest relative risk for women to die by suicide.  This is what I wish would change about being a female physician; we must stop losing our own. We need to support each other, love one another, and face our challenges together. Fifteen years ago, a surgeon called me in ...
Source: Kevin, M.D. - Medical Weblog - March 5, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/niran-s-al-agba" rel="tag" > Niran S. Al-Agba, MD < /a > Tags: Physician Psychiatry Source Type: blogs

A physician ’s MOC debacle: Nevermind that $2,100 exam he just passed
A couple years ago, I reached the seven-year mark after my initial board certification with the American Board of Anesthesiology (ABA). At the time, it was a significant milestone. I was eligible to take the all-important Maintenance of Certification in Anesthesia (MOCA) exam. Diplomates of the ABA — that’ right, I’m considered a diplomate — in other words, a board-certified anesthesiologist. Diplomates were encouraged and incentivized to take the $2,100 exam early in the three-year eligibility window. The exam was only offered twice a year. There were testing dates during a few weeks in the summer ...
Source: Kevin, M.D. - Medical Weblog - March 5, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/physician-on-fire" rel="tag" > Physician on FIRE, MD < /a > Tags: Physician Surgery Source Type: blogs

Joint Replacement Q & A with Dr. Theodore Manson
Theodore Manson, MD is an Orthopaedic Surgeon at the University of Maryland Medical Center and an Associate Professor of Orthopaedics at the University of Maryland School of Medicine. Dr. Manson specializes in hip and knee replacements and orthopaedic trauma. Below he answers the most common questions about joint replacement.   Q. What advances have there been in joint replacements including new technologies, changes in patient-management and rehabilitation? A. One significant advancement in the last 10 years has been around pain management and early recovery protocols. The goal is to minimize the amount of narcotics...
Source: Life in a Medical Center - March 2, 2017 Category: Universities & Medical Training Authors: Hannah Braun Tags: Doctors Health Tips Orthopaedics Uncategorized Source Type: blogs

A Rare Intervention for an Unusual Exposure
​Children like to put things in their mouth, ears, nose, and eyes. A 9-year-old boy superglued his right eye shut and came to our pediatric emergency department. He thought the glue was an over-the-counter eye lubricant and filled his entire eye with the glue.​​Overdoses and poisonings are a dangerous threat to children. In fact, unintentional poison overdose or ingestion has continued to claim hundreds of children's lives. More than 300 children in the United States ages 0 to 19 are seen at EDs for poisoning and two of them die each year. (CDC. April 28, 2016; http://bit.ly/2kjVmhO.)Not all toxic exposures are inges...
Source: The Procedural Pause - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

How Yoga Helps with Depression, Anxiety and Addiction
Aerobic movement of any kind helps to relieve depression and anxiety by boosting our brain’s dopamine levels and providing endorphins. But some types of exercises are superior for healing chronic conditions, mood disorders, and addiction. Yoga’s therapeutic benefits have been studied in recent decades, with much of the research being in randomized controlled trials — the most rigorous for proving efficacy. There are many types of yoga, of course — from the more aerobic power yoga to a meditative gentle yoga. Hatha yoga, the most studied, combines physical postures (asanas) and controlled breath...
Source: World of Psychology - March 1, 2017 Category: Psychiatry & Psychology Authors: Therese J. Borchard Tags: Alcoholism Alternative and Nutritional Supplements Anxiety and Panic Bipolar Depression Exercise & Fitness Mindfulness Personal Self-Esteem Stress Bikram yoga despressive episode Mood Disorder stress reduction Yoga styles Source Type: blogs

A Trick for Ocular Anesthetic​
Watch Helen Karellas Bardis, NP, show off her pediatric pearl! This simple trick works well if you need to use ocular anesthetics for pediatric eye exams.Add a few drops of the saline directly onto the fluorescein paper, and then suck the fluid back up into the saline dropper. This way, you don't have to put a piece of paper onto a child's eye. It is far less scary to have drops administered.This trick also works with tetracaine/proparacaine for an all-in-one staining anesthetic.Watch the video.Tags: ocular anesthetic, eye, fluoresceinPublished: 2/25/2017 10:32:00 AM (Source: The Procedural Pause)
Source: The Procedural Pause - February 25, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Perioperative brain health:  The need to better understand this public health problem
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. During the course of our careers as physicians, we have cared for or are aware of an elderly patient in the intensive care unit or ward who has exhibited delirium, or an acute confused state. This is particularly common after surgery and anesthesia. While simply being in the hospital can lead to delirium, several questions remain. Have best practices and guidelines been fully implemented to decrease this risk? Are clinicians continuing to administer drugs to elderly patients and those with mild cognitive impairme...
Source: Kevin, M.D. - Medical Weblog - February 23, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/lee-a-fleisher-and-roderic-g-eckenhoff" rel="tag" > Lee A. Fleisher, MD and Roderic G. Eckenhoff, MD < /a > Tags: Conditions Neurology Surgery Source Type: blogs

Are Electronic Health Records the Solution? Doesn ’t Seem Like it
Electronic health records (EHR) streamline physician and patient interactions, and they ’re the easiest way to access a patient’s medical history, medications, and radiology images. The original initiative behind EHRs was to create more efficient medical care, and ultimately reduce costs. Yet, a recentstudy from Stanford University and the National Bureau of Economic Research demonstrate that doctors who find themselves regularly using EHR also request more complete blood tests (CBCs), CT scans, and x-rays than physicians who don ’t use the system. These services rack up expenses that can be considered re...
Source: radRounds - February 23, 2017 Category: Radiology Authors: Julie Morse Source Type: blogs

Clarius Wireless, Handheld Ultrasounds Cleared in Europe
Clarius, a company based in British Columbia, Canada, received European CE Mark approval for its wireless C3 and L7 ultrasound scanners. These devices are highly portable, battery powered, and use an Android or iOS smartphone or tablet for displaying the scans. They’re even water resistant, so can be used in a wide variety of in-clinic and field applications. We were so impressed here at Medgadget that these scanners made it to our Best Medical Technologies of 2016 list. The Clarius C3 multipurpose ultrasound is designed to image the abdomen and lungs; it also incorporates a virtual phased array for quick scans ...
Source: Medgadget - February 21, 2017 Category: Medical Equipment Authors: Editors Tags: Anesthesiology Cardiology Critical Care Emergency Medicine Military Medicine Ob/Gyn Pediatrics Radiology Sports Medicine Surgery Urology Vascular Surgery Source Type: blogs

Misleading Metrics
Editor’s Note: This essay contains excerpts from Extreme Measures: Finding a Better Path to the End of Life, coming February 21st, 2017 from Penguin-Random House. A few years ago, while at a family get-together, I sat across from a retired hospice social worker named Terry. I am a physician whose practice alternates between attending on the wards of an inner-city intensive care unit and serving as a consultant on the hospital’s palliative care team. I didn’t set out to practice this uncommon combination of medical specialties. I started out totally dedicated to using the miraculous technologies in my crit...
Source: Health Affairs Blog - February 21, 2017 Category: Health Management Authors: Jessica Nutik Zitter Tags: End of Life & Serious Illness Health Professionals Hospitals 30-day mortality statistic advance directive Palliative Care Source Type: blogs

What is pain for?
We’re told we need pain – without the experience, we risk harming our bodies and living short lives. With pain, and for most people, we learn to not go there, don’t do that, don’t do that AGAIN, and look at that person – don’t do what they’re doing! Thirst, hunger, fear, delicious tastes and smells, the feelings of belonging, of safety and security, of calm and comfort: all of these are experiences we learn about as we develop greater control over our bodies. Pain is an experience we learn to associate with actual or possible threat to “self”. Let’s take a moment ...
Source: HealthSkills Weblog - February 19, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Coping strategies Pain Pain conditions Resilience/Health acceptance biopsychosocial Clinical reasoning Research Therapeutic approaches values Source Type: blogs

Masimo MightySat Rx Oximeter Cleared in Europe to Measure Breathing Rate
Masimo has announced that European regulatory authorities have given clearance for its MightySat Rx fingertip pulse oximeter to be used to measure the respiration rate of patients, in addition to all the other measurements it performs. The respiration rate from the pleth (RRp), as Masimo calls it, notices how the respiratory cycle changes the nature of the pulses detected by the oximeter. While it’s accurate in most patients, it’s contraindicated for those that move a lot and those with certain conditions that produce irregular breathing. It’s compatible for use in children and adults, and the device can ...
Source: Medgadget - February 17, 2017 Category: Medical Equipment Authors: Editors Tags: Anesthesiology Cardiology Critical Care Emergency Medicine Pediatrics Source Type: blogs

MEDNAX ’s (parent company of VRAD) Recent Acquisition of Radiology Alliance Indicates the Medical Group is Doing More than Teleradiology and Neonatal Care
MEDNAX, Inc, the nation-wide mega conglomerate of mainly neonatal services, has recently acquired Radiology Alliance, PC, the largest private radiology group in Tennessee. This is an unsuspected purchase for MEDNAX, Inc., as the medical group with headquarters in Florida mainly specializes in teleradiology through VRAD, neonatal, maternal-fetal, pediatrics, and anesthesia. Yet, the acquisition is apart of the group ’s initiative to expand and streamline their services. This is also a signal that they are moving into traditional “brick and mortar” radiology beyond teleradiology.  Is the threat of tele...
Source: radRounds - February 15, 2017 Category: Radiology Authors: Julie Morse Source Type: blogs

LifeFlow Rapid Infuser for Sepsis and Shock Rolling Out in U.S.
410 Medical, a company out of Durham, North Carolina, is releasing in the U.S. its LifeFlow Rapid Infuser for treating patients afflicted by sepsis or shock. The device can help infuse 500 milliliters of crystalloid fluid into a patient within two and a half minutes, including in both adults and children, and an entire liter can be delivered within five minutes. The FDA cleared device has so far been tested at the WakeMed Health & Hospitals in Raleigh, North Carolina. “I had a chance to use LifeFlow today to treat a critically ill two-year-old. The child presented lethargic, with high temperature and heart r...
Source: Medgadget - February 14, 2017 Category: Medical Equipment Authors: Editors Tags: Anesthesiology Critical Care Emergency Medicine Military Medicine Pediatrics Source Type: blogs

Connecticut APRN Reporting Policy Starting to Come to Fruition...Kind Of
We have previously written about Connecticut policy that was aimed at reporting payments from pharmaceutical and device manufacturers to healthcare providers. Back when the law was originally passed, Connecticut planned to require pharmaceutical and device manufacturers to report payments and transfers of value to advance practice registered nurses (APRNs), starting July 2015. APRNs include: nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. The first reporting date is from July 1, 2015 to July 1, 2017, and requires annual reports (rather than quarterly filings). Under the Connecticut...
Source: Policy and Medicine - February 13, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

An Open Letter to Kaiser Permanente Northern California
By RACHEL KATZ I am writing this letter because for two months I tried to get ahold of Darryn Carter, a case manager at your company who was assigned to process a complaint I filed about care I received that I feel was harmful and irresponsible. The legal and rational reason for this current writing is this: the letter I received from Darryn Carter rejecting my complaint claim stated that I have a legal right to see the documentation and evidence used to make the decision about my case. I would like to see that evidence file, and I have not been able to get in touch with Mr./ Ms. Carter or anyone else at Kaiser to send th...
Source: The Health Care Blog - February 13, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Bureaucracy Kaiser Permanente Rachel Katz Source Type: blogs

Immigrants make America great
In 1949, my maternal grandparents left everything and everyone they knew — a happy family, a comfortable home, a thriving medical practice — to travel further across the Earth than any of their family ever had before, to come through Ellis Island, and to trek to the Mayo Clinic so my grandfather could become a pioneering anesthesiologist. Twenty-one of my aunts, uncles, and cousins have since followed in their footsteps and practice today as doctors in the United States. My sister and I, too, became physicians. In 1960, my father flew to New York with $20 in his pocket and a burning desire to pursue the America...
Source: Kevin, M.D. - Medical Weblog - February 13, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/alexi-gharib-nazem" rel="tag" > Alexi Gharib Nazem, MD, MBA < /a > Tags: Physician Health IT Source Type: blogs

What New Resident Work Hours Mean For Physician Well-Being And Patient Safety
Late last year, the Accreditation Council for Graduate Medical Education (ACGME) issued proposed revisions to the Common Program Requirements for residency and fellowship training. At the heart of the proposed new requirements is this philosophy: Residency education must occur in a learning and working environment that fosters excellence in the safety and quality of care delivered to patients today and in the future. The important corollary is that physician well-being is crucial to their ability to deliver the safest, best possible care to patients. In keeping with this philosophy, the proposed changes to the Common Progr...
Source: Health Affairs Blog - February 9, 2017 Category: Health Management Authors: Thomas Nasca Tags: Featured Health Professionals Quality ACGME duty hours graduate medical eduction Physicians resident training Source Type: blogs

CE Mark Approval for Shift Labs ’ DripAssist Infusion Rate Monitor
Three months ago we sat down with Dr. Beth Kolko, CEO of Shift Labs, to learn more about DripAssist Infusion Rate Monitor, a device that automates the calculation of IV infusion drip rates and total infusion volumes while also being able to alert a nurse when a drip rate changes or stops. At that time, DripAssist had already been FDA approved. At the end of last month, Shift Labs completed another regulatory milestone by securing CE Mark approval for DripAssist. Following this announcement, European Union member countries will now be able to benefit from accurate medication dosing as well as infusion time and cos...
Source: Medgadget - February 6, 2017 Category: Medical Equipment Authors: Michael Batista Tags: Anesthesiology Cardiology Critical Care Emergency Medicine Pediatrics Source Type: blogs

Reservoir electrodes for electroencephalograph headgear appliance: Key Neurotech Patent #5
— Illustrative image from U.S. Patent No. 6,301,493 Today we are sharing a 2001 patent assigned to Sedline, Inc. (As mentioned, we are featuring a foundational Pervasive Neurotech patent a day, from older to newer by issue date) U.S. Patent No. 6,301,493: Reservoir electrodes for electroencephalograph headgear appliance. Assignee(s): Sedline, Inc. Inventor(s): Dominic P. Marro, Thomas T. Washburn, Denis E. LaBombard Technology Category: EEG Issue Date: October 9, 2001 SharpBrains’ Take: While patents in the neurotechnology category of EEG are more frequently being directed towards either EEG signal analy...
Source: SharpBrains - February 4, 2017 Category: Neuroscience Authors: SharpBrains Tags: Cognitive Neuroscience Health & Wellness Technology brain data EEG EEG headset electrodes electroencephalograph headgear Neurotechnology patent sedline inc Source Type: blogs

8 survival tips for families with babies in the NICU
Bringing a child into the world is nothing short of a miracle. It’s not comforting to think about, but even if you do everything “right,” there can always be circumstances beyond your control. Whether you have been told to plan for a stay in the NICU or it’s unexpected, here are survival tips from nurses for orienting yourself to the NICU. 1. Try to see your baby as soon as possible. It may mean getting there in a wheelchair or going there in a post-anesthesia fog, but the sooner you see the new life you have brought into this world, the better off you will both be. 2. Before you go, ask the nu...
Source: Kevin, M.D. - Medical Weblog - February 3, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/raissa-hacohen" rel="tag" > Raissa Hacohen < /a > Tags: Patient Intensive care Pediatrics Source Type: blogs

Stopping Surprise Medical Bills: Federal Action Is Needed
Surprise medical bills occur when patients cannot avoid being treated by providers outside their health plan’s contracted network — either because the provider is not chosen by the patient, for example the emergency department physician or the anesthesiologist assisting a surgery, or because patients are not even aware that the provider is involved in their care, such as a pathologist examining a biopsy. Contracted, in-network providers have agreed to accept discounted reimbursement rates negotiated with health plans, and health plans typically charge patients lower cost sharing liability for contracted service...
Source: Health Affairs Blog - February 1, 2017 Category: Health Management Authors: Loren Adler, Mark Hall, Caitlin Brandt, Paul B. Ginsburg and Steven Lieberman Tags: Costs and Spending Featured Health Professionals Hospitals Payment Policy balance billing Emergency Medicine surprise billing Source Type: blogs

America ’s veterans deserve the best, and safest, pain treatment
Pain is usually considered a symptom, not a life-threatening medical problem. But for Army veteran Richard Dejarnette, 52, constant excruciating pain in his right leg made his life intolerable, and he believes he wouldn’t be alive today if a physician anesthesiologist at the VA West Los Angeles Medical Center hadn’t been there to help him. On December 14, the Department of Veterans Affairs announced the wise decision to keep physician anesthesiologists at the head of the anesthesia care team at VA hospitals nationwide, ensuring that veterans like Mr. Dejarnette will continue to receive first-class anesthesia ca...
Source: Kevin, M.D. - Medical Weblog - January 31, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/ajit-rai" rel="tag" > Ajit Rai, MD < /a > Tags: Physician Pain management Source Type: blogs

MKSAP: 68-year-old man with a right intertrochanteric fracture
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated in the hospital for a right intertrochanteric fracture sustained in a mechanical fall. He reports right hip pain but no other symptoms. He has hypertension and type 2 diabetes mellitus and was in his usual state of health prior to the fall. He checks his blood glucose level several times daily; his average blood glucose level is 150 mg/dL (8.3 mmol/L), with a low of 92 mg/dL (5.1 mmol/L) and a high of 208 mg/dL (11.5 mmol/L). Surgical repair is scheduled for tomorrow at 7 a...
Source: Kevin, M.D. - Medical Weblog - January 28, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Orthopedics Source Type: blogs

The real danger of maintenance of certification and what to do about it
In the interests of full disclosure, I acknowledge with delight that I have a non-time limited board certificate from the American Board of Anesthesiology (ABA), issued before the year 2000. I can just say “no” to recertification. The more I learn about the American Board of Medical Specialties (ABMS) and its highly paid board members, the more disillusioned I’ve become. It’s easy to see why so many physicians today have concluded that ABMS Maintenance of Certification (MOC) is a program designed to perpetuate the existence of boards and maximize their income, at the expense primarily of younge...
Source: Kevin, M.D. - Medical Weblog - January 27, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/karen-s-sibert" rel="tag" > Karen S. Sibert, MD < /a > Tags: Physician Primary care Surgery Source Type: blogs

Benzos and Buprenorphine
The high safety of buprenorphine, except when combined with a benzodiazepine, has been twisted in comments about the drug (and in the minds of regulators) to buprenorphine being uniquely dangerous when combined with benzodiazepines, which is not true. I’ve heard more and more from insurers, regulators, and well-meaning agencies about the dangers of combining buprenorphine and benzodiazepines.   Some insurers protest paying for buprenorphine if patients are taking benzodiazepines.  Medicaid recently sent a letter that described a ‘severe risk’ of using benzodiazepines in patients on buprenor...
Source: Suboxone Talk Zone - January 27, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Benzos Buprenorphine pharmacology risks Suboxone tolerance buprenorphine and benzodiazepines suboxone overdose xanax and suboxone Source Type: blogs

A Patient with Cocaine Chest Pain and Prehospital Computer interpretation of ***STEMI***
A 20-something male drank heavily of ethanol and used cocaine, then was involved in a stressful verbal altercation, at which time he developed chest pain.911 was called and the medics recorded this ECG (unfortunately, leads V4-V6 are missing)Due to marked ST Elevation, the computer read was ***STEMI***What do you think?He arrived in the ED and had this ECG recorded:Very similar to the prehospital ECG.The Mortara (Veritas algorithm) Interpretation was:p.p1 {margin: 0.1px 0.0px 0.1px 1.0px; font: 9.0px Arial}MARKED ST ELEVATION, CONSIDER SEPTAL INJURY ***ACUTE MI***What do you think?The ECG shows Brugada morphology in V...
Source: Dr. Smith's ECG Blog - January 24, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

When selecting health insurance policies, beware of surprise gaps in coverage
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As a lifelong resident of southeast Louisiana and a veteran of numerous weather and flood-related events that have required me to use my homeowners and flood insurance, I am very familiar with gaps in insurance coverage.  Insurance policies are very detailed agreements that many of us read over quickly, but really don’t know what is or is not covered until the time comes to make a claim.  And although we do tend to know the cost of our insurance premium, only after an event do we realize the true cost of the ins...
Source: Kevin, M.D. - Medical Weblog - January 24, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kraig-s-de-lanzac" rel="tag" > Kraig S. de Lanzac, MD < /a > Tags: Physician Patients Primary care Source Type: blogs

Ultrasound Helps Release Drugs from Nanoparticles Into Brain
Researchers at Johns Hopkins University have come up with a simple way of using ultrasound to release drugs from special nanoparticles delivered into the brain. The technology would allow for targeted drug delivery, making sure the medication is delivered where the ultrasound beam is focused while preventing its from influencing the rest of the body. The biodegradable plastic nanoparticles are made of a hydrophilic exterior, to travel through the body, and a hydrophobic interior, to contain propofol, a commonly used small molecule anesthetic tried in this study. They are too large to move through the blood-brain barri...
Source: Medgadget - January 23, 2017 Category: Medical Equipment Authors: Editors Tags: Nanomedicine Neurology Neurosurgery Oncology Source Type: blogs

11 Things Star Wars Could Learn From Medical Technology Today
No one can doubt I’m an enthusiastic Star Wars fan. I have a LEGO-Millennium Falcon and the Death Star at home. However, as The Medical Futurist I cannot help but see what medical technologies the episodes featured.  The digital health innovations we have today are so amazing that they could even improve the futuristic Star Wars universe with lightsabers and ubiquitous space travel. I binge-watched all 7 episodes to find the 11 most interesting technologies we already possess, but Star Wars not. Here they are. 1) Why is there no instant wound healing? The most obvious discovery was that laser guns are common wea...
Source: The Medical Futurist - January 19, 2017 Category: Information Technology Authors: TMF Tags: Medical Science Fiction future Health Healthcare scifi star wars technology Source Type: blogs

Nurse Practitioners Rock 2017!
Ten or fifteen years ago, many ordinary healthcare consumers may not have known much -- if anything -- about nurse practitioners. Moreover, only a small percentage would have received care from an NP. But in January of 2017, nurse practitioners are gaining ground like never before, so many nurses who are thinking about career mobility are likely considering the NP or APRN path.U.S. News and World Report Is On the MarkSome of you may have seen the substantive articlepublished by U.S. News and World Report in early January of this year. It was their annual job rankings for the top 100 jobs in the U.S., and nurse practitioner...
Source: Digital Doorway - January 18, 2017 Category: Nursing Tags: advanced practice nurses advanced practice registered nurses APRN APRNs career career development career management NP NPs nurse practitioners nursing Source Type: blogs

GE Releases New Portable Ultrasound, The Vscan Extend
GE Healthcare, the company that wowed the world with its tiny Vscan ultrasound a number of years ago, is unveiling a new device for performing ultrasound exams in a variety of settings. The Vscan Extend features two ultrasound probes built into the transducer head, which is connected via a wire to a smartphone-like touchscreen display. The device weighs just under a pound (400 grams) and is small enough to fit into a pocket. Thanks to DICOM integration, it can connect to a hospital’s PACS (picture archiving and communication system) and upload images seamlessly to keep on record. The device is intended for multiple c...
Source: Medgadget - January 11, 2017 Category: Medical Equipment Authors: Editors Tags: Anesthesiology Cardiac Surgery Cardiology Critical Care Emergency Medicine Military Medicine Ob/Gyn Pediatrics Radiology Sports Medicine Thoracic Surgery Urology Vascular Surgery Source Type: blogs

Research and Reviews in the Fastlane 168
Welcome to the 168th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&a...
Source: Life in the Fast Lane - January 11, 2017 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Education Emergency Medicine Intensive Care Neurology Neurosurgery Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation recommendations research and reviews Source Type: blogs

Medical Technology: What Changing Venture Capital Investments Signal
The market for medical devices historically has been dominated by big-ticket “physician preference items” such as artificial joints, spinal implants, and cardiac pacemakers. Venture capital and private equity investors have been eager to fund new firms in this expanding and lucrative domain. Changes in physician payment and organization are reducing the demand for these cost-increasing innovations, however, and redirecting the flow of investment capital. For the past decade we have been studying medical device innovation (startup firms) and adoption (hospital organizations), starting from different angles but a...
Source: Health Affairs Blog - January 9, 2017 Category: Health Management Authors: Josh Baltzel and James C. Robinson Tags: Costs and Spending Drugs and Medical Technology Featured Health IT Health Professionals Hospitals medical devices venture capitalism Source Type: blogs

Calorie Restriction as a Means to Improve Surgical Outcomes
The long-term response to calorie restriction has long been of interest to the aging research community, and particularly in the past few decades as the tools of biotechnology allowed for a more detailed analysis of the metabolic changes that accompany a reduced calorie intake. A restricted diet extends healthy life spans in near all species tested to date, though to a much greater extent in short-lived species than in long-lived species such as our own. Considerable effort is presently devoted to the development of drugs that can replicate some fraction of calorie restriction - more effort than is merited in my opinion, g...
Source: Fight Aging! - January 7, 2017 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

Reliefband Neurowave: Wearable Device Offers Drug-free Relief from Nausea and Vomiting
Reliefband Technologies, a company based in Horsham, PA, revealed their new Reliefband Neurowave during the 2017 Consumer Electronics Show (CES) in Las Vegas this week. The Reliefband Neurowave is a smart-band that offers a drug-free treatment for nausea and vomiting associated with motion sickness, morning sickness, post-surgery, and even with virtual reality gaming. The Reliefband Neurowave employs FDA-cleared and patented technology that delivers electric pulses of a specific waveform, frequency, and intensity to the median nerve on the underside of the user’s wrist. Through stimulating the median nerve, the Relie...
Source: Medgadget - January 4, 2017 Category: Medical Equipment Authors: Kenan Raddawi Tags: Anesthesiology Medicine Oncology OTC Source Type: blogs

Echocardiography Videos: The Latest from EchoJournal
We are very proud of EchoJournal, our echocardiography video website. If you are a cardiologist, anesthesiologist, radiologist, medical student, or just a person interested in cardiac ultrasounds, EchoJournal is the place for you. To learn and discuss, you can review new cardiac videos that are added on a regular basis, or you can browse through our video archives. To store or share, you can upload your own clips. The site has a growing membership base and your expertise benefit greatly by joining. The site offers many user choices: keep videos private for storage or post them for discussions, embed videos on your own page...
Source: Medgadget - January 4, 2017 Category: Medical Equipment Authors: Editors Tags: News Source Type: blogs

Deadlier than Heroin: How Fentanyl is Becoming Public Health Enemy No. 1
For the first time in the city’s recorded history, more than 1,000 New Yorkers are expected to die from a fatal drug overdose in 2017. Key to this record-breaking statistic is the increased abuse of fentanyl, a cheap synthetic opioid up to 100 times more powerful than heroin. Relatively unknown to the general public until recently, this drug’s astounding lethality is tearing across the country as deaths related to fentanyl and other synthetic opioids surged more than 70% from 2014 to 2015. So where did this drug come from, and why are so many people dying because of it? Fentanyl has been utilized in medical se...
Source: Cliffside Malibu - January 3, 2017 Category: Addiction Authors: Richard Taite Tags: Richard Taite Source Type: blogs

Masimo ’s TFA-1 Forehead Pulse Oximeter Cleared by FDA
The FDA has given Masimo clearance to introduce the TFA-1 disposable forehead sensor that lets clinicians get pulse oximetry readings from the forehead instead of the fingertip. The device uses Masimo’s proprietary SET Measure-through Motion and Low Perfusion technology to provide accurate readings that rival traditional pulse oximeters. It can measure oxygen saturation (SpO2), pulse rate (PR), perfusion index (PI), and PVI, changes in the perfusion index that occur due to breathing. Measuring oxygen saturation at the forehead may help avoid local inconsistencies caused by taking readings at the t...
Source: Medgadget - January 3, 2017 Category: Medical Equipment Authors: Editors Tags: Anesthesiology Cardiology Critical Care Emergency Medicine Pediatrics Source Type: blogs

Does racial bias compromise patient care?
This study is not unique. A recent study from the University of Virginia demonstrated that nearly 14 percent of sampled medical students endorsed beliefs that black people feel less pain than white people. Students citing this belief were also less likely to prescribe pain medication to black patients. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - December 29, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/dowin-boatright" rel="tag" > Dowin Boatright, MD, MBA < /a > Tags: Physician Emergency Source Type: blogs