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Physician Payments Sunshine Act: Organizations Respond to CMS
  September 2nd marked the last day for comments on CMS’ proposed rule to eliminate the accredited continuing medical education (CME) exemption from Sunshine Act reporting.  In an overwhelming display of support for the exemption, over 800 comments were submitted encouraging the agency to either maintain or expand the current exclusion. -Total comments supporting maintenance or expansion of the CME exemption:  820 -Total comments supporting elimination of the CME exemption:  approximately 20 -Percentage of comments supporting the CME exemption: 98% We have followed this issue closely, and recentl...
Source: Policy and Medicine - September 8, 2014 Category: American Health Authors: Thomas Sullivan 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

CCC Update 011
Updates to the LITFL Critical Care Compendium are coming thick and fast at the moment. Here’s a quick summary as these entries don’t appear in the LITFL blog feed, and you otherwise need to search for them using search keywords in the CCC table, by googling “litfl ccc searchterm” or by searching GoogleFOAM. Remember, constructive feedback is the fuel that LITFL runs on, hit us with it! Here’s what is new in the CCC since CCC Update 010: Cerebral venous thrombosis This condition reared its head in the last round of FCICM exam vivas I believe — and it wouldn’t surprise me if it...
Source: Life in the Fast Lane - August 15, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Critical Care Compendium Education Emergency Medicine Intensive Care CCC cerebral venous thrombosis early mobilistation extremity trauma ICU acquired weakness MODS Source Type: blogs

Research & Reviews in the Fastlane 105
This study looked at the rate of central line-associated bloodstream infections (CLABSI) in ED placed lines and found the rate (2.0/1000 catheter days) to be the same as that in ICU placed lines (2.3/1000 catheter days). Additionally, they found that the introduction of a central line bundle aimed at standardizing practice was associated with a reduction in CLABSI in the ED (3.0/1000 before the bundle to 0.5/1000 after the bundle). Recommended by Anand Swaminathan Critical care Reitsma S et al. The endothelial glycocalyx: composition, functions, and visualization. Pflugers Arch 2007; 454(3): 345-59. PMID 17256154 We are...
Source: Life in the Fast Lane - October 21, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Emergency Medicine Update Intensive Care Pre-hospital / Retrieval Psychiatry and Mental Health Resuscitation Trauma critical care R&R in the FASTLANE recommendations research and r Source Type: blogs

Research and Reviews in the Fastlane 091
Welcome to the 91st 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 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out t...
Source: Life in the Fast Lane - July 15, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Emergency Medicine Haematology Intensive Care R&R in the FASTLANE Resuscitation critical care EBM literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 101
This article reviews the evidence and concludes that the harms of prophylactic antibiotics likely outweighs the benefits and that withholding antibiotics may be very reasonable. Recommended by: Anand Swaminathan Pediatrics Cohen-Silver JH et al. Autism in the emergency department. Clin Pediatr 2014; 53(12): 1134-8. PMID: 25031320 Sometimes we need adjust our approach to a patient’s management in order to avoid exacerbating the problem. There are many clinical scenarios when this is true, but is especially important to consider when dealing with patients who have autism. Recommended by: Sean Fox Ultrasound and Im...
Source: Life in the Fast Lane - September 23, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine Emergency Medicine Update General Surgery Infectious Disease Intensive Care Pediatrics R&R in the FASTLANE Radiology Urology critical care literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 137
Welcome to the 137th 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 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R ...
Source: Life in the Fast Lane - June 1, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Education LITFL Neurology R&R in the FASTLANE Trauma critical care emergency Emergency Medicine Intensive Care literature recommendations research and reviews Resuscitation Source Type: blogs

More on uncoupling clinicians from EHR clerical oppression
At my August 6, 2016 post (link) I wrote of my belief that " best practices " for EHR evolution call for:... a return to paper (specialized forms depending on the setting) for clinical data capture by busy doctors and nurses, and data entry into a computer via clerical personnel.I presented a late 1990 ' s real-world experiment in creating such a system for invasive cardiology in the Delaware hospital system, Christiana Care Health System, where I was CMIO at that time.As at the links http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story and https://web.archive.org/web/20140...
Source: Health Care Renewal - August 9, 2016 Category: Health Management Tags: Christiana Care Health System healthcare IT difficulties ICCD invasive cardiology paperless Source Type: blogs

Pediatric In-Hospital Cardiac Arrest Secondary to Acute Pulmonary Embolism
Conclusions: Pulmonary embolism was recognized as the etiology of multiple adolescent cardiac arrests in this single-center series and may be more common than previously reported. Recognition, high-quality cardiopulmonary resuscitation, and treatment with thrombolytic therapy resulted in survival in four of five patients.
Source: Critical Care Medicine - February 23, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Acute procedural interventions after pediatric blunt abdominal trauma: A prospective multicenter evaluation
CONCLUSION: Acute procedural interventions for children with IAI from BAT are rare, predominantly for HVI, are performed early in the hospital course and have excellent clinical outcomes. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; therapeutic study, level IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - September 22, 2017 Category: Orthopaedics Tags: Original Articles Source Type: research

Outpatient Vascular Care: Good, bad or ugly?
BY ANISH KOKA Filling in the holes of recent stories in the New York Times, and Propublica on the outpatient care of patients with peripheral arterial disease Most have gotten used to egregiously bad coverage of current events that fills the pages of today’s New York Times, but even by their now very low standards a recent telling of a story about peripheral artery disease was very bad. The scintillating allegation by Katie Thomas, Jessica Silver-Greenberg and Robert Gebeloff is that “medical device makers are bankrolling doctors to perform artery clearing procedures that can lead to amputationsâ€...
Source: The Health Care Blog - July 24, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Anish Koka Medical Devices Outpatient vascular care Source Type: blogs

Physician Payments Sunshine Act: Over 100 Medical Associations and Societies Urge CMS To Reconsider CME Exemption and Open Payments Timeline
Medial associations and specialty societies have been understandably frustrated with the way the Physician Payments Sunshine Act has rolled out so far. Yesterday, over 100 medical societies including the American Medical Assocation--49 state medical societies and 64 medical specality societies--sent a letter to Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services (CMS) asking for redress over three problematic issues: (1) the expansion of reporting requirements for educational activities, (2) Open Payments’ condensed timeframe for physician registration, and (3) the complicated r...
Source: Policy and Medicine - August 6, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Current tools have low accuracy for predicting delayed ischemia after aneurysmal subarachnoid hemorrhage
(Wolters Kluwer Health) Both CT angiography and transcranial Doppler have limited accuracy in detecting cerebral vasospasm and predicting delayed cerebral ischemia (DCI) in patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm, reports a study in the inaugural edition of Critical Care Explorations, the official open-access journal of the Society of Critical Care Medicine (SCCM). The journal is published in the Lippincott portfolio by Wolters Kluwer.
Source: EurekAlert! - Medicine and Health - February 21, 2019 Category: International Medicine & Public Health Source Type: news

Evolution of neurological recovery during the first year after subarachnoid haemorrhage in a French university centre
Conclusion: Neurological complications in the following of SAH should be actively treated in order to improve outcome. The early neuro-ICU phase remains a key determinant of long-term recovery.
Source: Anaesthesia, Critical Care and Pain Medicine - October 26, 2018 Category: Anesthesiology Source Type: research