Wednesday, April 18, 2007
PA Ranks Second in Total Dollars Paid in Malpractice Claims
-
Printer Friendly|#| Trackback
At the same website mentioned in the preceding post one can find information on total dollars paid in malpractice cases in 2006. Pennsylvania ranked second with $308,781,000 paid (second only to New York). See for yourself.
Vermont looks pretty good to me right now...
PA Ranks Third in Paid Malpractice Claims
-
Printer Friendly|#| Trackback
The Kaiser Family Foundation maintains StateHealthFacts.org, a site "designed to provide free, up-to-date, and easy-to-use health data on all 50 states". The site just published Number of Paid Medical Malpractice Claims, 2006. Pennsylvania ranks third among all states in number of malpractice claims paid per thousand physicians. See for yourself.
Tuesday, April 17, 2007
Acoustic Respiratory Monitoring: What Is It?
-
Printer Friendly|#| Trackback
An intriguing press release last week from Masimo (known for their motion artifact-resistant pulse oximeters) begins as follows:
"Masimo, the inventor of Pulse CO-Oximetry and Read-Through Motion and Low Perfusion pulse oximetry, reported that three new independent studies, including one presented the recent International Anesthesiology Research Society (IARS) Clinical & Scientific Congress in Orlando, concluded that Masimo Acoustic Respiratory Monitoring technology (ARM) is "at least as accurate as capnometry" and "significantly more reliable" for monitoring respiration in spontaneously breathing patients."
The release then refers to "an adhesive bioacoustic sensor applied to the patient's neck and connected to a breathing frequency monitor prototype" which in turn accurately monitors respiratory rate.
If this device does what I think it does, it will become the standard of care for post-surgical patients very rapidly. We've been looking for a way to reliably monitor respiratory rate on the floors, once patients are discharge from the recovery room. For example, a patient may receive pain medications from multiple sources, with unpredictable onsets. How do we know their maximum respiratory depression won't happen after they've been delivered to their hospital room?
A patient can receive oxycontin and celebrex orally from a surgeon before their knee replacement surgery, then more fentanyl, morphine, and versed from us (anesthesia). The surgeon may then inject bupivicaine and morphine into the joint at the conclusion of surgery (without necessarily telling the anesthesiologist). I might also do a femoral nerve block to further reduce post-op pain. All of us are trying to do right by the patient but, given the right set of circumstances, are setting them up for significant respiratory depression post-op. The ability to reliably monitor respiratory rate with this new Masimo monitor would be a huge patient safety advance.
The Society for Technology in Anesthesia abstract is here.
Monday, April 2, 2007
Skim for OS X
-
Printer Friendly|#| Trackback
A new application called Skim has been released for Mac OS X and I mention it here for readers who stuff their hard disks with pdf files of articles they have heretofore been unable to annotate electronically:
"Skim is a PDF Reader and note-taker for OS X. Skim is designed to help you read and annotate scientific papers in PDF."
[Michael McCracken]
Do Specialty Hospitals Call 911 to Save Their Patients, or Transport Them?
-
Printer Friendly|#| Trackback
The New York Times has an article titled Some Hospitals Call 911 to Save Their Patients which details two cases of patients having surgery at a specialty surgical hospital, experiencing complications, and then being transferred to a medical center (where they ultimately died). The whole article is written, and certainly the title was chosen, to suggest that 911 emergency services were called in order to treat a deteriorating patient as no physicians routinely stay in-house overnight.
Although I am not familiar with the particulars of the two cases mentioned in the New York Times article, it should be known that 911 would be called for any intra-facility transfer and does not necessarily imply they were called to render care in an emergency or that care was unavailable from other professionals already there.
Isn't it interesting, though, that a patient who is has no objection to getting their care from a CRNA, nurse practitioner, physician's assistant, or other 'health care provider' (after all, it's cheaper, right?) suddenly deems it essential to have a doctor there when things start to go south? Of course they do. I would, too!
If you're flying a commercial flight and the landing gear won't deploy, you feel better knowing the pilot is a former military pilot with years of experience in 'heavies.' If your child's safety is threatened by a stranger, you feel better knowing that highly trained and qualified officers are there to protect you. If you're having surgery and things start to go bad, you want an anesthesiologist, a physician, a smart, independent thinker who doesn't get flustered or do whatever the surgeon says to do. You want me. Not someone who is cheaper, less highly trained, less experienced, someone who will do in 99% of cases.
Friday, March 30, 2007
P4P: Are Vested Interests Pushing the Agenda?
-
Printer Friendly|#| Trackback
New Data, More Doubts About Pay-for-Performance (P4P)
"Again, as we have noted before, developing performance measures that will truly benefit patients will require detailed understanding of the clinical context, keen skeptical analysis of the available relevant research data, and careful balancing of benefits, harms and costs. All this would be very hard under the best of circumstances. But the continual attempts by those with vested ideological and financial interests to influence performance measures to advance their own interests make it unlikely that the whole P4P movement will have any good effects on patients.
The first improvement needed in the P4P movement is clear, detailed disclosure of all conflicts of interest affecting those involved in the movement at any stage.
At this point, patients and physicians should be very skeptical about who is likely to benefit from any new performance measure, particularly measures that are lavishly promoted."
This nicely sums up my suspicions about P4P beyond just the fact that it rewards task completion over the exercise of medical judgement...
[Health Care Renewal]
March 30, 1842: The First Ether Anesthetic
-
Printer Friendly|#| Trackback
Wikipedia
"Although William T.G. Morton is well-known for performing his historic anesthesia on October 18, 1846 in Boston, Massachusetts, C.W. Long is now known to be the first to have used an ether-based anesthesia.
After observing the same effects with ether that were already described by Humphry Davy in 1800 with nitrous oxide, C.W. Long used ether the first time on March 30, 1842 to remove a tumor from the neck of his patient, Mr. James M. Venable. Long subsequently removed a second tumor from Venable and used ether anesthesia in amputations and childbirth. The results of these trials were published several years later (in 1849) after Morton's publication. "
Counterinsurgency in Congress
-
Printer Friendly|#| Trackback
Professor Arthur Herman
"I think in some ways here, what you are really seeing is that we’ve got a general who finally understands and gets it about the counterinsurgency in Iraq. What we need is an administration that’s going to deal with the counterinsurgency at home, which is taking root in the Democratic Congress."
[Hugh Hewitt]
Thursday, March 29, 2007
Which is more important? Iraq or Afghanistan?
-
Printer Friendly|#| Trackback
Charles Krauthammer: The wars against radical Islamic insurgents
"Thought experiment: Bring in a completely neutral observer -- a Martian -- and point out to him that the United States is involved in two hot wars against radical Islamic insurgents. One is in Afghanistan, a geographically marginal backwater with no resources, no industrial and no technological infrastructure. The other is in Iraq, one of the three principal Arab states, with untold oil wealth, an educated population, an advanced military and technological infrastructure which, though suffering decay in the later Saddam years, could easily be revived if it falls into the right (i.e. wrong) hands. Add to that the fact that its strategic location would give its rulers inordinate influence over the entire Persian Gulf region, including Saudi Arabia, Kuwait and the Gulf states. Then ask your Martian: Which is the more important battle? He would not even understand why you are asking the question. "
Resolved: C. diff enterocolitis should be a reportable disease
-
Printer Friendly|#| Trackback
The CDC just published their Summary of Notifiable Diseases --- United States, 2005
I wonder why C. diff enterocolitis isn't on the list? I've seen this illness cause more morbidity and mortality in the United States than the big long list they do track...
MMWR: Percentage of Children with Selected Allergies
-
Printer Friendly|#| Trackback
"During 2003--2005, the percentage of children with hay fever increased with age; children aged 10--17 years were nearly three times as likely to have hay fever than children aged 0--4 years. In contrast, the percentage of children with skin allergies decreased with age, and the percentage of children with food allergies did not vary with age."
Tuesday, March 27, 2007
New Study on Malpractice Costs
-
Printer Friendly|#| Trackback
Pacific Research Institute:
JACKPOT JUSTICE: The True Cost of America's Tort System
Processing....
Thursday, March 15, 2007
CDC: Insurance Affects New Patient Acceptance
-
Printer Friendly|#| Trackback
Percentage of Office-Based Primary-Care Physicians Who Did Not Accept New Patients, by Expected Payment Source --- National Ambulatory Medical Care Survey, United States, 2003--2004
"Although 94.2% of primary-care physicians reported in 2003--2004 that they were accepting new patients, acceptance varied by the patient's expected payment source. Among the physicians, 43.0% did not accept new charity cases, 29.3% did not accept new Medicaid patients, and 20.3% did not accept new Medicare patients. Only 7.0% did not accept new patients who self-paid."
Monday, March 12, 2007
CDC: Quadrivalent Human Papillomavirus Vaccine
-
Printer Friendly|#| Trackback
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
"Routine Vaccination of Females Aged 11--12 Years
ACIP recommends routine vaccination of females aged 11--12 years with 3 doses of quadrivalent HPV vaccine. The vaccination series can be started as young as age 9 years.
Catch-Up Vaccination of Females Aged 13--26 Years
Vaccination also is recommended for females aged 13--26 years who have not been previously vaccinated or who have not completed the full series. Ideally, vaccine should be administered before potential exposure to HPV through sexual contact; however, females who might have already been exposed to HPV should be vaccinated. Sexually active females who have not been infected with any of the HPV vaccine types would receive full benefit from vaccination. Vaccination would provide less benefit to females if they have already been infected with one or more of the four vaccine HPV types. However, it is not possible for a clinician to assess the extent to which sexually active persons would benefit from vaccination, and the risk for HPV infection might continue as long as persons are sexually active. Pap testing and screening for HPV DNA or HPV antibody are not needed before vaccination at any age. "
Sunday, March 11, 2007
Barbecued Ribs
-
Printer Friendly|#| Trackback
I love barbecued ribs. I never tried to make them at home because I thought it must be too time intensive. Barbecued ribs have to be made on a barbecue, right? Wrong. Barbecued ribs can be made in a crock pot. I think these ribs are as good if not better than any you'll find in a restaurant (even a Texas barbecue restaurant). I'm posting it here because I've promised several nurses I'd bring in the recipe, always forget, so now I can just point them here.
Ingredients:
- 3.5 pounds baby back ribs
- 0.25 c brown sugar
- 0.5 tsp black pepper
- 3 tbsp liquid smoke
- 2 cloves garlic, finely chopped
- 1 tsp salt
- 1 medium onion, sliced
- 0.5 cup Coke (not diet!)
- 1.5 c. barbecue sauce (I like Cattleman's)
1. Remove inner skin from ribs (I use pliers to make this easier). Mix brown sugar, pepper, liquid smoke, garlic, and salt. Rub mixture onto ribs and cut them into 4 inch pieces. Layer ribs and onion in crock pot.
2. Cover and cook on low setting for 6-9 hours (depending on how your crock pot interprets 'low').
3. Remove ribs from pot. Drain and discard liquid.
4. Dip ribs into barbecue sauce, place ribs back into crock pot and pour any remaining sauce over ribs. Cook on low for an additional hour.
This recipe makes enough for 2-4 adults, depending on their appetite. For our family of 4, I make a double recipe (7 lbs of ribs) so there are sure to leftovers. I have tried this recipe with spare ribs instead of baby-back ribs and found it much too greasy for my liking.
Own Your Own Cable Modem? Check The Speed!
-
Printer Friendly|#| Trackback
I have cable modem service to my home via Comcast. I bought my own modem, the Motorola 4100, about three years ago so I wouldn't have to pay the cable modem rental fees. Since the modem only cost about $50, I've saved about one hundred dollars over that time period.
I had Comcast come install two CableCards in my new Tivo Series 3 and the installers commented on what an old modem I had. They went on to explain that one advantage of renting a modem is that, when the modem limits download speed, Comcast will replace it with a faster one. Having just installed a new Airport Extreme Pre-N wireless router, this seemed like something to check out.
After reading the spec. sheets on both modems it looks to me like their download speed is the same (38 Mbps). However, the Motorola 5101 I just installed is faster in my tests. Maybe it's the DOCSIS 2.0 support. Well, I'm just an unfrozen caveman anesthesiologist but I know speed when I see it...16 Mbps:
If you bought your own modem several years ago, consider upgrading it. The results might surprise you.
Friday, March 9, 2007
Lifehacker: Gmail Manager
-
Printer Friendly|#| Trackback
Download of the Day: Gmail Manager (Firefox) - Lifehacker
" The Gmail Manager Firefox add-on obviates the need to keep your Gmail open in a tab all the time by displaying your email info in a statusbar pop-up, as shown."
A must-have for a Firefox Gmail user
| 1 |
2
|
3 |
4 |
5 |
6 |
7 |
| 8 |
9 |
10 |
11 |
12 |
13 |
14 |
| 15 |
16 |
17
|
18 |
19 |
20 |
21 |
| 22 |
23 |
24 |
25 |
26 |
27
|
28 |
| 29 |
30 |
|
|
Mar May
|
