Open access endoscopy raises potential ethical issues
Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance.
Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring physician doesn’t need our consultative advice for his 50-year-old patient with rectal bleeding. He just needs us to do a colonoscopy. We have a strict screening process in place to verify that these patients are appropriate for o...
Source: Kevin, M.D. - Medical Weblog - July 2, 2016 Category: Journals (General) Authors: Michael Kirsch, MD Tags: Conditions GI Source Type: blogs
No Pea'ce in the Pods
Discussion of Recent Literature. Pediatr Emerg Care 2013;29(6):743.Davis MG, Casavant MJ, et al. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014. Pediatrics 2016;137(5):e20154529.Russell JL, Wiles DA, et al. Significant Chemical Burns Associated with Dermal Exposure to Laundry Pod Detergent. J Med Toxicol 2014;10(3):292.Tags: detergent pod, laundry detergent, vomiting, poisoning, erythema, decontaminationPublished: 7/2/2016 10:06:00 AM (Source: The Tox Cave)
Source: The Tox Cave - July 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
MKSAP: 68-year-old woman with dyspepsia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman undergoes upper endoscopy for evaluation of dyspepsia. She has a history of pernicious anemia. She has no other medical problems and her only medication is oral vitamin B12.
On physical examination, vital signs are normal, as is the remainder of the physical examination.
Upper endoscopy discloses a 6-mm polyp in the body of the stomach, which is removed by polypectomy. Other endoscopic findings, including biopsy of the duodenum to evaluate for celiac disease, are normal. Pathologic examinatio...
Source: Kevin, M.D. - Medical Weblog - June 18, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Cancer GI Source Type: blogs
Top 10 Most Prestigious Medical Centers in the World (2016)
The world is full of excellent medical centers all competing to make the newest medical discovery, perform the latest procedure and be a top-performing hospital with the best reputation. These renowned medical centers model excellent clinical practice and dedicated patient care that you just can’t find anywhere. Out of all the prestigious medical centers in the world, these 10 lead the way:
Texas Medical Center: The Texas Medical Center in Houston, Texas, is the largest of its kind. Not only does the TMC have one of the highest volumes of clinical facilities for patient care, basic science and research, but it also has ...
Source: Unbounded Medicine - May 24, 2016 Category: Surgery Authors: Jon Mikel I ñarritu Tags: News Source Type: blogs
CMS Proposed Patient Relationship Categories for MACRA
Patient engagement and patient satisfaction have been a core principle of healthcare reform under ACA and MACRA. The Centers for Medicare and Medicaid Services (CMS) recently released for public comment its proposed physician-patient relationship categories, a first step toward a Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirement that the agency establish classification code sets for such physician-patient relationships. The patient relationship categories and codes are intended to help CMS more effectively measure resource use, a major performance category under the Merit-based Incentive Payment Syst...
Source: Policy and Medicine - May 18, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
The white coat doesn’t mean much anymore
I’ll just start this off by saying that I am not exactly sure where I stand on the white coat thing. One part of me loves the white coat as a symbol, a shield against disease, and a place with pockets to put my things; and then there are other days when I just want to throw that germ-ridden cotton barrier to the doctor-patient relationship in the trash, roll up my sleeves, and just do my job without all the pomp and circumstance of an impractically-long white coat. Yes, I can opine on the history and merits of the long white coat, and then turn around and make a perfectly valid argument for why we should ditch the thi...
Source: Kevin, M.D. - Medical Weblog - May 6, 2016 Category: Journals (General) Authors: Frederick Gandolfo, MD Tags: Education Medical school Source Type: blogs
NICU Practice: Swallow Studies and Vocal Cord Impairment
I received this question from a speech-language pathologist who read my blog posts on working in the Neonatal Intensive Care Unit (NICU), and I answer it here.
Question: What are current recommendations on timing of instrumental evaluation following diagnosis of vocal fold impairment with neonates?
Answer:
I’ll offer some general guidelines, although SLPs should consider the question in context of each infant’s unique co-morbidities—especially respiratory, airway and neurological—as well as feeding history. Also, we can problem-solve most effectively when knowing the likely—or determined—cause for the voca...
Source: American Speech-Language-Hearing Association (ASHA) Press Releases - May 5, 2016 Category: Speech Therapy Authors: Shelley D. Hutchins Tags: Speech-Language Pathology Health Care NICU Swallowing Disorders 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
TBT: Which is More Uncomfortable – The Colonoscopy or Treatment for Colon Cancer?
March is Colon Cancer Awareness Month, today’s TBT post provides some helpful information on colorectal cancer.
Michelle was a healthy, active 47 year old. She tried to eat right and she exercised. It looked like the hard work was paying off: no health issues and lots of energy. Her work in the healthcare field motivated her to see her doctors regularly for checkups, to get mammograms and to have her blood work done annually. She knew she was getting close to the magical age of 50 and that soon she would need to get a colonoscopy to screen for colorectal cancer. Since she had no family history of the disease she wa...
Source: Disruptive Women in Health Care - March 10, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Cancer TBT Source Type: blogs
Gastroenterologists are the tattoo artists of medicine
Everywhere you go, you can see people from all walks of life sporting some pretty cool tattoos. Tattoos are so popular nowadays that they’re almost conformist. I consider myself really hip since I don’t have any tattoos; how avant-garde! However, that doesn’t mean I don’t appreciate good ink when I see it. As a matter of fact, I even dabble as a tattooist sometimes.
It is common practice to leave a permanent tattoo at the site of significant pathology (such as a large polyp or tumor) inside the GI tract. We typically use a substance called SPOT, which consists of microscopic carbon particles in a suspension. Whe...
Source: Kevin, M.D. - Medical Weblog - January 26, 2016 Category: Journals (General) Authors: Frederick Gandolfo, MD Tags: Conditions GI Source Type: blogs
MKSAP: 50-year-old man with a large bleeding gastric ulcer
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated in follow-up after hospitalization 6 months ago for a large bleeding gastric ulcer. Tests performed for Helicobacter pylori infection at that time were negative. However, for the 3 months before hospitalization he had been taking ibuprofen for chronic back pain. He was discharged from the hospital on omeprazole, and his ibuprofen was discontinued. Owing to the large size of the ulcer and increased suspicion for underlying malignancy, follow-up upper endoscopy was performed 3 month...
Source: Kevin, M.D. - Medical Weblog - January 16, 2016 Category: Journals (General) Authors: mksap Tags: Conditions GI Source Type: blogs
Freedom of information (FOI) request: endoscopy services working group papers
Monitor - This request was for papers relating to the endoscopy services working group Monitor runs with the NHS Trust Development Authority and NHS England to co-ordinate the improvement of access to endoscopy services.
FOI request
Monitor publications (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - November 17, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Integrated care Quality of care and clinical outcomes Source Type: blogs
The Payment Reform Landscape: Which Quality Measures Matter?
Over the past 15 years there have been major changes in the measures we have at our disposal to assess the quality of care. We have gone from decentralized disorganization to measures that have been “standardized” through various multi-stakeholder consensus processes, including that of the National Quality Forum. And where there was a dearth of standard quality measures, some now argue we have too many (600-plus and counting), but not the right ones.
This has led to initiatives like the Measure Applications Partnership, the Institute of Medicine’s report “Vital Signs: Core Metrics for Health and Health Care Progres...
Source: Health Affairs Blog - October 15, 2015 Category: Health Management Authors: Suzanne Delbanco, François de Brantes and Tom Valuck Tags: Costs and Spending Featured Insurance and Coverage Organization and Delivery Payment Policy Quality AHIP Core Measures Collaborative employers IOM report National Quality Forum Payment Reform Landscape quality measures Suzanne Delb Source Type: blogs
