An Interview With George Halvorson: The Kaiser Permanente Renaissance, And Health Reform’s Unfinished Business
For decades, health policymakers considered Kaiser Permanente the lode star of delivery system reform. Yet by the end of 1999, the nation’s oldest and largest group model HMO had experienced almost three years of significant operating losses, the first in the plan’s history. It was struggling to implement a functional electronic health record, and had a reputation for inconsistent customer service. But most seriously, it faced deep divisions between management and the leadership of its powerful Permanente Federation, which represents Kaiser’s more than 17,000 physicians, over both strategic direction and operatio...
Source: Health Affairs Blog - September 30, 2014 Category: Health Management Authors: Jeff Goldsmith Tags: All Categories Business of Health Care Consumers Disparities Health Care Costs Health Care Delivery Health IT Health Reform Innovation Medicaid Medicare Payment Physicians Policy Public Health Quality Source Type: blogs
MKSAP: 72-year-old unconscious woman in the ER
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict glycemic control (average hemoglobin HbA1c level, 6.2%) until last month when she had an infected ulcer between the third and fourth toes of the right foot that resulted in amputation of the middle toe 1 week ago. According...
Source: Kevin, M.D. - Medical Weblog - September 20, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes Emergency Endocrinology Source Type: blogs
Getting the dabigatran (Pradaxa) story right… Correcting four common mistakes.
This purpose of this post is to clarify misstatements made in a recent New York Times article about the anticoagulant drug dabigatran (Pradaxa). The piece had three major inaccuracies, plus one thought-error from a cardiology leader. I write these words because the most valuable tool in the treatment of AF is knowledge. Getting it right is critical. (For readers that persist, I offer a bonus at the end.)
The thrust of the Times’ story concerned editorials in the British Medical Journal that questioned the safety of dabigatran. The first non-warfarin anticoagulant has had plenty of controversy, the most recent of whic...
Source: Dr John M - August 21, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
#Dblog Week: The Mental Stuff
In nursing school, I cared for a patient with a leg ulcer. This person did not have diabetes,but they did have impaired circulation to their feet,as a result of cardiac conditions. And the resulting cascade of unfortunate events(leg gashed on trailer hitch) left a wound to the bone,& a subsequent infection of the worst possible kind.(when I looked at that leg ulcer, it was like staring into a "maybe me" future.The amazing thing to me,is that he felt no pain. This was a wound easily the size of my hand,and redness all around. Inside,there was yellow pus and black eschar(dead tissue) which stuck to the bandage. I had no idea...
Source: The D-Log Cabin - May 14, 2014 Category: Diabetes Authors: HVS Source Type: blogs
Why I Enrolled in a Mindfulness-Based Stress Reduction Program
A Buddhist proverb says that when the student is ready, the teacher will appear.
After five years of trying to learn and practice mindfulness — moment-to-moment awareness, or paying attention to the present moment on my own and ending up, well, different than the bald guys in the ocher and saffron robes, I decided that I was in desperate need of a teacher and some direction.
So I enrolled in the Mindfulness-Based Stress Reduction program (MBSR) at my local hospital.
All MBSR programs are modeled after the one founded by Jon Kabat-Zinn, Ph.D., in 1979 at the University of Massachusetts Medical Center. They aim to he...
Source: World of Psychology - March 20, 2014 Category: Psychiatrists and Psychologists Authors: Therese J. Borchard Tags: General Health-related Mental Health and Wellness Mindfulness Personal Self-Help Stress Bipolar Disorder Elisha Goldstein heart Jon Kabat Zinn Major Depressive Disorder Mbsr Meditation Mindfulness Based Stress Reduction Pain Source Type: blogs
From routine dental visit to oral cancer…
CALIFORNIA MOM OF TWO HAS HALF OF HER TONGUE REMOVED AND A NEW ONE RECONSTRUCTED WITH FOREARMSomeone dies from oral cancer every hour of every day in the United States aloneEarly DETECTION – early cure: Oral Cancer Awareness Month in AprilLos Angeles, CA, February 11, 2014… A routine trip to the dentist saved the life of a California mom of two. The American Dental Association estimates that “60% of the US population visits a dentist every year, however less than 15% of them report having received an oral cancer screening.” Although the number of deaths each year from oral cancer is astoundingly large, it is hi...
Source: Dental Technology Blog - February 17, 2014 Category: Dentists Source Type: blogs
An acerbic opinion versus a sweet solution towards chronic pain
CONCLUSION: Glucose sublingual is and effective analgesic in infants between 1 and 12 months of age Barry E. Levin,1,2 Vanessa H. Routh,3 Ling Kang,2 Nicole M. Sanders,4 and Ambrose A. Dunn-Meynell1,2. Neuronal Glucosensing. What Do We Know After 50 Years? DIABETES, VOL. 53, OCTOBER 2004 Min-tsai Liu1, 2, Susumu Seino3, and Annette L. Kirchgessner1, 2 Identification and Characterization of Glucoresponsive Neurons in the Enteric Nervous System. The Journal of Neuroscience, December 1, 1999, 19(23):10305-10317 J. Antonio Gonzàlez1, Frank Reimann2 and Denis Burdakov1.Dissociation between sensing and metabolism of glucose in ...
Source: HealthSkills Weblog - February 16, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Pain conditions Professional topics Therapeutic approaches Chronic pain healthcare Source Type: blogs
From routine dental visit to oral cancer… california mom of two has half of her tongue removed and a new one reconstructed with forearm
Someone dies from oral cancer every hour of every day in the United States aloneEarly DETECTION – early cure: Oral Cancer Awareness Month in AprilLos Angeles, CA, February 26, 2014… A routine trip to the dentist saved the life of a California mom of two. The American Dental Association estimates that “60% of the US population visits a dentist every year, however less than 15% of them report having received an oral cancer screening.” Although the number of deaths each year from oral cancer is astoundingly large, it is highly curable if diagnosed early. Early detection is a key factor in oral cancer care and a ...
Source: Dental Technology Blog - February 3, 2014 Category: Dentists Source Type: blogs
Neuropathy Common in Young Adults
By Diane Fennell
As many as 70% of people with diabetes are estimated to have some form of neuropathy, or nerve damage. And now, new research published in the journal Diabetes Care suggests that roughly a quarter of young people with Type 2 diabetes have the condition.
As part of the ongoing SEARCH for Diabetes in Youth study, researchers looked at data from 399 youths with diabetes, all of whom had been diagnosed before they turned 20. The 329 participants with Type 1 diabetes had an average age of 15.7, while the 70 participants with Type 2 had an average age of 21.6. Those with Type 2 had a higher body-mass index (a ...
Source: Diabetes Self-Management - December 13, 2013 Category: Diabetes Authors: Diane Fennell Source Type: blogs
Healthcare Update Satellite — 11-20-2013
This report says that mental health patients make up almost half of the emergency department patients at Denver Health every weekend. When you cut funding for psychiatric care by 20% and cut the number of psychiatric beds by 30%, the patients with psychiatric problems don’t just disappear. When they can’t get help, they end up in the emergency department, in jail, or even worse. Could the Columbine or Aurora shootings have been prevented by expanding psychiatric care? Probably not. But one emergency department physician noted that for every “high-profile event that everybody knows about, there’s a hundred that were...
Source: WhiteCoat's Call Room - November 20, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Weird wheat re-exposure reactions
As the world of people who are wheat-free continues to grow, I am witnessing a range of weird re-exposure reactions when people, intentionally or inadvertently, get re-exposed.
Among the peculiar reactions:
Congestive heart failure–A woman with a clear-cut syndrome of wheat intolerance that was evidenced by diabetes, excessive expression of small LDL particles (around 2000 nmol/L at the start), high triglycerides, gastrointestinal distress, widespread joint pain, and a peripheral neuropathy (impaired coordination, reduced sensation to the legs), and negative blood markers for celiac disease, improved substantially a...
Source: Wheat Belly Blog - November 18, 2013 Category: Cardiology Authors: Dr. Davis Tags: Re-exposure syndromes Source Type: blogs
Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care.
Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!).
These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs
Trying to Travel the Road Less Traveled
By Jan Chait
Four blocks west and I'm out of my neighborhood. Two blocks north and I'm at a major east–west road. Another three blocks west and I'll be at the restaurant to meet a friend for lunch. Except…
I'm not walking and I'm not driving. I'm riding a mobility scooter and the major east–west road is being repaved. Which is OK, since I ride my scooter on the sidewalk. Except…
The road crews have moved the barrels and barricades that were blocking the lanes on the road onto the sidewalk so the asphalt machine can do its thing. Carefully, I maneuver around the barricades and barrels, going onto gra...
Source: Diabetes Self-Management - November 5, 2013 Category: Diabetes Authors: Jan Chait Source Type: blogs
EarlySense makes touch-less vital sign monitoring a reality: Transcript
This is the transcript of my recent podcast with EarlySense’s president, Tim O’Malley.
David E. Williams: This is David Williams, president of Health Business Group. I’m speaking with Tim O’Malley, president of EarlySense.
Tim, thanks for joining me today.
Tim O’Malley: Thanks, David, for having me on.
Williams: Tim, can you explain, what is EarlySense? What does the company do in general?
O’Malley: For many years, healthcare providers have tried to find a way to monitor patients in almost all locations of the hospital and even in some subacute care and skilled nursing facilities, to mak...
Source: Health Business Blog - October 24, 2013 Category: Health Managers Authors: dewe67 Tags: Devices Podcast EarlySense Governor Deval Patrick Israel patient care Source Type: blogs
Spiracur’s SNaP Wound Care System Proving Itself in Trials
Positive clinical benefits are continuing to be seen from the SNaP ultraportable negative pressure wound therapy (NPWT) system developed by Spiracur (Sunnyvale, Calif.-based company). NPWT is a therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds (such as diabetic foot ulcers, pressure ulcers and surgical incisions), that can also be used to optimize healing of first and second degree burns.The continued vacuum draws out fluid from the wound area and increases blood flow to the region. The SNaP System is the first FDA cleared non-powered, single use NPWT device. It provides the same...
Source: Medgadget - September 30, 2013 Category: Technology Consultants Authors: Gaurav Krishnamurthy Tags: Military Medicine Plastic Surgery Vascular Surgery Source Type: blogs
