Why technology and the Internet may not be good for patients

Potpourri
July 12, 2010

Paro the robot baby harp seal was the final straw.

I had vowed to myself not to think about or write about “the internet makes you smarter, the internet makes you dumber” argument.  Even when some of my favorite authors (Steven B. Johnson, Clay Shirky, Nicholas Carr, and Jonah Lehrer) weighed in, I thought it best not to participate.

And then I read about Paro, either “a disturbing turn in our treatment …

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Why technology and the Internet may not be good for patients

Is health care experience mandatory for a pharmaceutical CEO?

Medications
July 11, 2010

A persistent theme for Health Care Renewal has been how concentration and abuse of power in health care trap patients and heath care professionals in a maze of bureaucracy, perverse incentives, deception, and conflicts of interest.

To anyone who has to make the transition from person to patient, some of these problems become immediately obvious.

Consider, for example, this account of “going into a hospital for a minor procedure”:

The very idea of …

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Is health care experience mandatory for a pharmaceutical CEO?

How H1N1 influenza is similar to the influenza A virus

Conditions and Diseases
July 11, 2010

by Todd Neale

The pandemic H1N1 influenza virus is similar to seasonal influenza A viruses in terms of viral shedding, symptoms, and household transmission, researchers in Hong Kong found.

The researchers prospectively followed 99 patients testing positive in rapid diagnostic tests for influenza A virus and found 45 had the H1N1 pandemic virus and 54 were infected with a seasonal influenza A virus, H3N2, but the two strains did not differ significantly, …

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How H1N1 influenza is similar to the influenza A virus

iPhone, Android or Blackberry? The right smartphone for doctors

Health Technology
July 11, 2010

Lately, I’ve often been asked the question, “What type of smartphone should I get?” by my medical peers.  I’ve been asked this by physicians, residents, medical students, and others. Many of my friends are entering residency and plan on upgrading to a smart phone, while others already entrenched in residency have phone contracts finishing up.

The answer to this question is not easy. Rather, as Facebook nomenclature would demand, “it’s complicated”. …

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iPhone, Android or Blackberry? The right smartphone for doctors

Be skeptical of natural and herbal supplements

Medications
July 10, 2010

A good chunk of every medical visit is spent writing prescriptions.

Before we had an electronic medical record, this was often an arduous task, leading to serious writer’s cramp. Now the computer makes it easier on the doctor, but it doesn’t seem to have much effect on the patient.

A recent article in the Journal of General Internal Medicine highlighted what most doctors have suspected all along, that a good chunk for …

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Be skeptical of natural and herbal supplements

Linezolid resistant Staphylococcus aureus (LRSA) emerging

Medications
July 10, 2010

by Kristina Fiore

The first known outbreak of linezolid and methicillin-resistant Staphylococcus aureus (LRSA) occurred during a 13-week period in 2008 in a hospital in Madrid, researchers say.

The LRSA outbreak, involving 12 patients in the hospital’s intensive care unit (ICU), was also the first with cfr gene-mediated linezolid resistance and was associated with nosocomial transmission and prior administration of linezolid, Miguel Sanchez Garcia, MD, PhD, of Hospital Clinico San Carlos in …

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Linezolid resistant Staphylococcus aureus (LRSA) emerging

Practical barriers for comparative effectiveness studies

Health Policy
July 10, 2010

Writing in the New England Journal of Medicine three authors share their experience in running a head-to-head trial of Avastin (bevacizumab) versus Lucentis (ranibizumab) for wet age-related macular degeneration (AMD).

They describe the barriers they faced and suggest that the barriers will need to be removed for comparative effectiveness research to succeed. They make good points and may well be correct in their policy recommendations.

However the case of Avastin and Lucentis …

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Practical barriers for comparative effectiveness studies

How to treat slouching in children

Conditions and Diseases
July 9, 2010

“I’m worried about my daughter’s posture. What can I do about it other than constantly nagging her to stand up straight?”

You’re probably talking about “kyphosis,” which is the rounded-shoulders, hunched forward kind of posture common in children and many adults. It’s often called “postural kyphosis” because it can be corrected if the child tries to stand straight up. Rarely, there’s a genuine spinal deformity, called Scheuermann’s Kyphosis or Scheuermann’s Disease, …

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How to treat slouching in children

How to implement CPOE successfully at your hospital

Health Technology
July 9, 2010

One in every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes. This has created a new urgency for all hospitals in the state to install computerized physician order entry (CPOE).

At BIDMC, we implemented CPOE in 2001 and have not had a handwritten order in most areas, except for the 2 days of our network outage in 2002. Implementing CPOE is challenging and requires …

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How to implement CPOE successfully at your hospital

Short stature increases heart disease risk

Conditions and Diseases
July 9, 2010

by Todd Neale

People of short stature appear to have a heightened risk of adverse cardiovascular outcomes compared with their taller counterparts, according to a new meta-analysis.

Among 22 studies analyzed, the shortest people had a 1.46-fold greater risk of coronary heart disease or death, Tuula Paajanen, MD, of the University of Tampere in Finland, and colleagues reported online in the European Heart Journal.

A critical height cutoff point for increased risk could …

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Short stature increases heart disease risk

World Cup soccer lessons that doctors can use

Physician
July 9, 2010

Not being much of a soccer aficionado, I have nevertheless been captivated by some of the games in the 2010 World Cup Soccer. Probably has something to do with my being South African!

While I hear many Americans bemoan the slow pace of the televised game (“boring!”), the low scores (“where’s the action?”) and the vuvuzelas (“irritating!”), I have been struck by lessons these matches have offered up for entrepreneurial physician …

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World Cup soccer lessons that doctors can use

Mark Midei and the failure of peer review

Conditions and Diseases
July 8, 2010

A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb.

A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t need them, justifying the procedures by purposely misreading cath films. In several of the cases, Midei allegedly read a 90 percent coronary stenosis when the actual …

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Mark Midei and the failure of peer review

Ambulatory surgical centers may have higher infection rates

Conditions and Diseases
July 8, 2010

by Todd Neale

Failure to follow recommendations to control nosocomial infections appears to be common in ambulatory surgical centers — even during formal inspections, researchers found.

Of 68 centers in three states participating in a pilot inspection program, about two-thirds (67.6%) had a lapse in at least one of five infection control categories, according to Melissa Schaefer, MD, of the CDC’s Division of Healthcare Quality Promotion in Atlanta, and colleagues.

The most common …

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Ambulatory surgical centers may have higher infection rates

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The grief men face when their wives undergo mastectomies

Conditions and Diseases
July 8, 2010

I have given anesthesia for a lot of breast surgery. I don’t think I’ll ever get used to the fog of pain and sorrow surrounding a double mastectomy.

All surgery is invasive in some way. Amputations, in particular, have a horror all their own; the idea that destroying someone – cutting off a body part, violating a coherent whole – should be necessary in order to save a life is almost …

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The grief men face when their wives undergo mastectomies

Emergency room waits grow as more people become insured

Health Policy
July 8, 2010

Remember when I wrote, way back when, that expanding health coverage without a concurrent increase in primary care access will only worsen emergency room waits?

For instance, consider this, from CNN.com:

What good is having health insurance if you can’t find a doctor to see you? …

… The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to …

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Emergency room waits grow as more people become insured

Combo pills do not save patients money

Medications
July 7, 2010

Many prescription medicines are actually two or more medicines combined into one pill or package. True, this packaging is convenient– but you can often save money by buying your medicine as its separate components. Let’s look at some examples:

Lotrel blood pressure pills. This is actually a combination of two blood pressure medicines: amlodipine and benazapril. Lotrel, the combo pill, is available in a generic form, as are it’s two individual …

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Combo pills do not save patients money

MKSAP: 68-year-old woman with difficulty seeing out of her left eye

Conditions and Diseases
July 7, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old woman is evaluated in the emergency department for difficulty seeing out of her left eye.

mksap 15The symptoms were first present upon awakening 45 minutes earlier. She describes her vision as “looking through a dark veil.” Her right eye is unaffected. There is …

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MKSAP: 68-year-old woman with difficulty seeing out of her left eye

Treatment decisions under migraine headache influence

Patient
July 7, 2010

by Diana E. Lee

At an appointment with my local neurologist I showed up feeling bone tired and mentally drained.

Next thing I knew I was going back on a medication I had deliberately chosen to stop taking just because a doctor told me I should be taking something.

When the doctor finally came into my exam room he looked over the list of medications I was taking and declared that Lyrica alone …

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Treatment decisions under migraine headache influence

Best free Android medical apps

Health Technology
July 7, 2010

by Brett Einerson and Iltifat Husain

Health care professionals and students using Android are probably wondering what free Android apps may be helpful in the health care setting.

Android developers continue to add more apps to the Market that relate to health and medical practice. While the field of apps relevant to health care professionals on Android lags far behind the iPhone OS platform, there are several apps worth noting.

Here, we …

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Best free Android medical apps

Tomorrow’s surgeons are today’s video gamers

Physician
July 7, 2010

As a young medical student I remember the arrival of the first video arcade games very clearly: Asteroids, Space Invaders and Pacman.

I spent whatever spare cash I had on them, never playing long enough to be any good, or rich enough to get any better. When I bought my first computer in my late-twenties, I relived my excitement with the newest computer games, spending a disproportionate amount of time long …

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Tomorrow’s surgeons are today’s video gamers

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