Healthcare Update Satellite — 02-13-2014
More medical news from around the web on my other blog at DrWhiteCoat.com.
No more “putting it on my account.” Due to cuts in payments from Medicare and Medicaid and expenses for treating uninsured patients, Hutchinson Hospital in Kansas will require payment for emergency department services, radiology, and outpatient surgery services before services are rendered.
Emergency department patients will still get screened, but apparently won’t receive non-emergency treatment if a partial payment isn’t made.
Florida Hospital Memorial Medical Center has implemented the same type of system – along wit...
Source: WhiteCoat's Call Room - February 13, 2014 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Notes to myself – 2
Pentobarb coma – BIS should be 10-20 and SR (suppression ratio) should be 70-80
Consider lev albuterol
Should give vaccines after coiling of spleen or before if possible
No calcium channel blockers post MI definitely and post op in general
Toradol inhibits spine healing
Don’t do endoscopes with patients in supine position
don’t ambulate patients with known dvt’s. wait 2-3 days until clots get stuck.
dvt’s even with filter get heparin as much as possible for post phlebitic syndrome and to retard new clot formation
diffuse alveolar hemorrhage – secondary to chemo, goodpasture’s, wege...
Source: Inside Surgery - December 31, 2013 Category: Surgeons Authors: Editor Tags: General Source Type: blogs
ASH 2013 - Maintenance Matters
This study confirms again that they are correct - Rd thoroughly trounces MPT.
For those of us seniors with access to Revlimid, though, this study clearly demonstrates the advantage of Revlimid maintenance after initial therapy. It studied 1,623 newly-diagnosed myeloma patients over age 65 or ineligible for transplant, in three study arms: (A) Rd until disease progression; (B) Rd for 72 weeks or progression; and (C) MPT for 72 weeks or progression.
Some results for patients on continuous Rd versus those on 72-week Rd:
Median progression-free survival: 26 months versus 21 months.
Four-year overall survival: 59% ver...
Source: Myeloma Hope - December 11, 2013 Category: Cancer Source Type: blogs
ASH 2013 - Skip the Transplant
ASH is the American Society of Hematology, which has its annual meeting in early December each year, called the ASH Conference, or just ASH. I will be blogging on several topics, but this one, though it is "just" a poster talk and not an oral presentation, seems extremely important because it suggests a change in the standard of care for newly-diagnosed patients.
Paper 3180: Lenalidomide and Dexamethasone Alone Is Equivalent To Lenalidomide and Dexamethasone With Autologous Stem Cell Transplant In Newly Diagnosed Multiple Myeloma: Interim Study Results Of a Randomized Trial.
The authors are from Columbia University...
Source: Myeloma Hope - December 10, 2013 Category: Cancer Source Type: blogs
Smoldering myeloma requiring treatment: time for a new definition? Introductory notes.
I know I haven’t been posting anything related to myeloma lately…and that has been bothering me a lot. And so I’ve been trying really hard to concentrate.
I began writing this post about ten days ago, but I just haven’t been able to finish it.
So today I decided to write a different sort of post: a post about why I can’t write a post.
It reminds me of the time when I signed up for an American Sign Language course. I was fresh out of college, so that’s QUITE a few years ago…Anyway, I loved my ASL course and was an eager student. Our first assignment was to go shopping in a supermarket and â€...
Source: Margaret's Corner - November 16, 2013 Category: Cancer Authors: Margaret Tags: Blogroll myeloma PETHEMA Source Type: blogs
Cases: "Do you have something stronger than this dilaudid?" The case for opioid rotation
Discussion:
Opioid rotation, or trial of an alternative opioid, is commonly practiced when a patient’s pain responds poorly to one opioid or intolerable side effects develop. These intolerable side effects may include nausea, vomiting, sedation, or even hyperalgesia. Although rotation is a common practice, a Cochrane review in 2004 found that evidence to support the practice for opioid rotation was anecdotal and in non-controlled studies. Randomized trials were suggested. Since that time, several prospective studies have been performed where opioid analgesic effect was inadequate or side effects to the opioid were intol...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 6, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and mus...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Cases: Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and mus...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
The Op-Ed: Off-Label Pregnancy Rx Needs More Regs
With all the talk of off-label promotion and commercial free speech, a vexing issue remains – patient safety. A case in point is the use of dexamethasone, which is sometimes given to pregnant women at risk of having a child with congenital adrenal hyperplasia. Prenatal dexamethasone cannot prevent a child being born with CAH, but it may reduce the odds a girl will be born sex atypical from having CAH. A recent paper in AJOG argued against the use because of safety concerns. We asked Alice Dreger, a professor of Clinical Medical Humanities & Bioethics at Northwestern University, to explain…
In a legal case...
Source: Pharmalot - February 27, 2013 Category: Pharma Commentators Authors: Ed Silverman Tags: Uncategorized Alice Dreger Dexamethasone Medical Ethics Off Label Promotion Source Type: blogs
Meningococcal meningitis and corticosteroids
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); Brust JCM. Meningococcal meningitis, dexamethasone and Class III evidence(editorial) Neurology 2012; 79: 1528-9.The most recent Cochran review shows a benefit of adjunctive dexamthasone to mortality in Streptococcalbut not N meningitidis meningitis with benefits to adults and children in high but not low income countries ( See Brouwer MC et al, 2010). Significantly, however, dexamethasone does no...
Source: neurologyminutiae - February 16, 2013 Category: Neurologists Source Type: blogs
Pomalyst (Pomalidomide) Approved by FDA
Five years ago two different therapies had failed to stop my myeloma's upward climb, and finally a PET scan showed holes in my bones. This was Stage I disease, and time for a treatment that would actually work for me! I went on a trial of CC-4047 (later pomalidomide, now Pomalyst) with dexamethasone, then eventually Pomalyst alone. It brought my numbers down quickly, and now my myeloma remains stable, with an M-spike of about 1.1 mg/dL. More-recent PET scans and X-rays have not found holes in my bones.
My family and I have enjoyed five free years, with a high quality of life. During that time I have been privileged t...
Source: Myeloma Hope - February 8, 2013 Category: Cancer Tags: Pomalyst Source Type: blogs
Dexamethasone To Reduce Hospital Stay
I have to say that the addition of a steroid, to a patient with an active infection often feels like an oxymoron. After all, just when the patient is battling a severe illness, why would we want to shut it down? Of course, I am not talking about those cases of relative adrenal insufficiency, where the steroid becomes a treatment for this, and is not functioning primarily as an immunomodulator. Anyway, in the recent study from the Lancet, the steroid used was dexamethasone which has minimal mineralocorticoid effect anyway.
Meijvis and colleagues randomized 304 patients with community acquired pneumonia (C...
Source: Doc To Doc - September 12, 2011 Category: Health Medicine and Bioethics Commentators Authors: digitaldoc Source Type: blogs
