Hospital Delirium

Hospitals Combat an Insidious Complication | WSJ
| 10.17.07

Delirium was once thought to be an unavoidable complication without lasting effects, but a growing body of evidence indicates that the condition can have devastating long-term consequences — and that it is preventable with simple changes in care. Researchers are exploring the links between delirium and long-term mental impairment, including whether hallucinations and delusions that happen during delirium can cause a form of posttraumatic stress disorder. Studies also show that delirium prolongs hospital stays, increases treatment costs and poses a threefold risk of death within six months for patients in the ICU, compared with patients without delirium.

Micturitions of a Dinosaur

“…if we’re going to start a series of whines about inappropriate calls and silly treatments I’ve got a box full…”

Think much bigger — a dinosaur’s carsass full…

Browser Analytics

I’ve been using Google Analytics and I was surprised to see how far Internet Explorer has fallen in browser standing. Equally surprised to see Safari in a double-digit standing:

Citation Styles

Citation styles — not exhaustive…

NLM style:

Pho K. How to cite a blog in a paper [Internet]. Nashua, New Hampshire: Kevin Pho. 2004 May - [cited 2007 Oct 12]. Available from: http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html.

ALWD (Rule 40.3) style:

Kevin Pho, Kevin, M.D. Medical Weblog, How to cite a blog in a paper, http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html (Oct. 12, 2007).

Bluebook (Rule 18.2.3) style:

Kevin Pho, How to cite a blog in a paper, Kevin, M.D. Medical Weblog, Oct. 12, 2007, http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html.

Aside, with the legal profession’s recent interest in medical weblogs, it is more likely that formal citations will be in the ALWD or Bluebook style…

Kidney Notes, Kevin, M.D., medGadget

Technological Imperative Bites Again

New device brings fast help to a failing heart | USAT | 10.11.07

For more than 30 years, paramedics have been saving the lives of these patients by inserting, through the vocal cords, a breathing tube about the width of a small garden hose and then pushing air into the lungs with an inflatable bag.… But the aggressive treatment is very uncomfortable for those on the receiving end, and it carries the risk of dangerous infection. So a device more commonly found in the hospital is making its way into the nation’s ambulances, including Harper’s rig in Houston.

As one that is highly skeptical of most of what the technological imperative has done to EMS — the cost of CPAP over the cost of intubation seems reasonable.

ED is Not Emergency Dentistry

Boom Times for Dentists, but Not for Teeth | NYT | 10.11.07

With dentists’ fees rising far faster than inflation and more than 100 million people lacking dental insurance, the percentage of Americans with untreated cavities began rising this decade, reversing a half-century trend of improvement in dental health.

“Most dentists consider themselves to be in the business of dentistry rather than the practice of dentistry,” said Dr. David A. Nash, a professor of pediatric dentistry at the University of Kentucky. “I’m a cynic about my profession, but the data are there. It’s embarrassing.”

Dentists, of course, are no more obligated to serve the poor than are lawyers or accountants. But the issue from a public health standpoint, the critics say, is that even as so many patients go untreated, business is booming for most dentists. They are making more money while working shorter hours, on average, even as the nation’s number of dentists, per person, has declined.

Dentists’ incomes have grown faster than that of the typical American and the incomes of medical doctors. Formerly poor relations to physicians, American dentists in general practice made an average salary of $185,000 in 2004, the most recent data available. That figure is similar to what non-specialist doctors make, but dentists work far fewer hours. Dental surgeons and orthodontists average more than $300,000 annually.

I’m always amazed at how many dentists and oral surgeons seeing (or taking a call on) dental pain due to a dental abscess send them to the Emergency Department for the antibiotic and pain medicine prescriptions. We are not dentist — see the patient and treat the patient — the patient needs a dentist not a delay. Sorry, we’re already taking all those disenfranchised from medicine, we can’t do those disenfranchised from dentistry as well. Ranks right up there with “I just had my chiropractor do a manipulation and now I really hurt.”

Physician Herding

Lawyers To Docs: Lump It. Insurers Can Rate You | WSJ Health Blog | 10.9.07

[T]hree George Washington University public-health professors and attorneys have put together a legal analysis of the practice. Their conclusion: Get used to the rating game, docs. Nothing in the law prevents insurers from publicly ranking doctors — provided they do it right, the three say. That means applying clear criteria transparently, with an established process for fixing any problems that crop up.

[I]t is not classification based on quality that is illegal,” the George Washington lawyers write, “nor is it publication of information regarding health care quality that is illegal: it is undertaking these efforts in an opaque manner that tends to lead to legal backlash.

An Assessment of Legal Issues Raised in “High Performing” Health Plan Quality and Efficiency Tiering Arrangements | RWJF | 10.9.07

A legal analysis released by The George Washington University School of Public Health and Health Services and the Robert Wood Johnson Foundation affirms the legality under federal and state law of physician ranking systems used by health plan provider networks.

Key findings:

• Successful transparency efforts include an open process>that outlines clear development of standards and methods to identify and correct errors.
• All affected groups should be involved in developing the transparency process from the start and weigh in on key governance issues, including approved uses and access to data, disclosure issues and due process rights to challenge data, and performance evaluations.
• Government entities (i.e., state insurance regulators, the Centers for Medicare and Medicaid Services or the United States Department of Labor) could assist the process by developing common standards to establish scientific methodology of tiering.

How are physicians to be herded? Ratings, tierings, “best practices,” reimbursements, satisfactions, etc. — ah yes, performances — the other-side of the P4P coin…. And lawyers are grousing over Avvo.

911 VoIP

House bill aims to modernize 911 system | Washington Technology | 10.08.07

The 911 Modernization and Public Safety Act of 2007 (H.R. 3403), sponsored by Rep. Barton Gordon (D-Tenn.), seeks to facilitate rapid deployment of IP-enabled 911 services and IP-enabled enhanced wireless 911. It would extend enhanced 911 services to IP-based telephone services. The goal is to migrate today’s 911 systems to new technologies.

“Modern communication capabilities offer an opportunity to improve the system as we know it, but they also offer challenges,” Jason Barbour, president of NENA, said in a news release. “The 911 community must embrace and react to change quickly, to better serve the American public, industry and the mobile consumer in all emergencies. We need help from Congress to do so.”

Negligent Credentialing

http://www.ama-assn.org/amednews/2007/10/15/prsa1015.htm | AMN | 10.15.07

Physicians fear that a recent Minnesota Supreme Court decision could compromise statutory peer review protections and taint physicians in medical liability cases that are tied to negligent credentialing claims.

For the first time, the high court recognized that patients can sue hospitals for allegedly granting privileges to doctors with questionable credentials. The unanimous decision adds Minnesota to a list of at least 25 other states that recognize negligent credentialing claims.

Meanwhile, doctors worry that such claims will chip away at peer review confidentiality because hospitals will find it difficult to fight back without disclosing the details that go into credentialing decisions.

In any consideration of “universal” tort reform, should we first clean our own house? Is negligent credentialing any different from negligent hiring — and is it not a reasonable alternate legal theory for negligent outcome?

Slights and Injuries

Nurses’ Reality: Enduring Slights, Injuries While Caring for Patients | WSJ | 10.9.07

Nurses and doctors in the emergency department are the most likely to encounter workplace violence.

A 2005 study of Michigan ER doctors showed that 75% were verbally threatened, 28% were physically assaulted and 3.5% were stalked in the previous year. (Read the abstract)

Sounds about right, I consider it a good shift if I’m not yelled and cursed at…of course “hey doc” is getting pretty close to a harassing phrase.

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