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Sleep apnea increases stroke risk in men

Conditions and Diseases

April 27, 2010

by Charles Bankhead

Severe obstructive sleep apnea almost tripled stroke risk in men, data from a prospective cohort study showed.

Among men with mild or moderate apnea, each one-unit increase in the obstructive apnea hypopnea index (OAHI) raised stroke risk by 6%. Obstructive sleep apnea did not have a significant association with stroke risk in women, investigators reported online in the American Journal of Respiratory and Critical Care Medicine.

“This study provides compelling …

Aneurysm as a cause of the Bret Michaels brain hemorrhage

Kevin

Conditions and Diseases

April 26, 2010

Bret Michaels continues to be monitored in the intensive care unit after suffering a subarachnoid hemorrhage.

According to his road manager, “further testing this week will help locate the source of the bleeding.”

What exactly does that entail?

As I mentioned previously, aneurysms are responsible for the majority of brain bleeds. Finding that source is critical. Angiography, or …

Texas Medical Association: Stop the Medicare meltdown

Kevin

Health Policy

April 26, 2010

A guest column by the Texas Medical Association, exclusive to KevinMD.com.

by William H. Fleming III, MD

So we have this new health law that’s intended to provide better health care access for most Americans. Many of the reforms rely upon the sustainability and effectiveness of Medicare.

Medicare, however, is doomed to failure unless Congress fixes a fundamental problem existing within the current program — the Sustainable Growth Rate (SGR) formula. The …

Undocumented individuals make hospital discharge difficult

John Schumann, MD

Physician

April 26, 2010

Working in the hospital this month, my team has been caring for Mr. M. He was here when we started on service at the beginning of the month, and unless his planned transfer to another facility goes through, he’ll be here when we sign off to the next team at the end of the month.

Mr. M is in his fifties. He speaks Spanish. He is an undocumented immigrant from Central …

Quality care requires open clinical transparency

Paul Levy

Physician

April 26, 2010

Let’s face it. Health care is an odd field. Costs are unknown or indecipherable. Prices for the services offered are hidden from consumers. Likewise, the value (efficacy, quality, safety) of the services received is hidden from consumers. In no sense does it represent other markets, in which transparency of these elements reigns and which therefore have a better chance of reaching the “efficient market” described by economists.

In such an environment, …

Alternative medicine isn’t taught to doctors in medical school

Crystal Phend

Medications

April 26, 2010

by Crystal Phend

Physicians don’t know much more about complementary and alternative medicine than their patients do, according to a new survey.

Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).

And almost half of respondents rated their own knowledge about herbal medicines as “quite” or “very” poor (36.2% and 10.4%, …

Health reform won’t help the ER

Chris Rangel, MD

Health Policy

April 26, 2010

Contrary to popular belief, those without health insurance are not flooding emergency rooms as a consequence of being cut off from routine and preventive care. Actually, frequent visitors to the local ER are far more likely to have insurance according to a new review of 25 studies on ER use published since 1990.

Frequent users account for about 8% of ED patients but 28% of visits. Although frequent …

Read more…

Health reform won’t help the ER

ADHD needs more than drugs to appropriately treat

Claudia M. Gold, MD

Conditions and Diseases

April 25, 2010

I consider my most successful cases to be the ones that do not seem me any more. Not that they are “better”, but they and their families have come to realize the full complexity of the problems they are struggling with, and are getting appropriate help.

I inherited my “ADHD practice” from another pediatrician. He was wonderful man, a larger than life, toss babies in the air pediatrician with a hearty …

Don Berwick and whether he can change Medicare and Medicaid

Kevin

Health Policy

April 25, 2010

by Marianne Mattera

President Obama is planning to appoint Don Berwick — the Harvard pediatrician, recognized health policy expert, and head of the Institute for Healthcare Improvement (IHI) — as the new head of CMS.

Berwick’s nomination has been heralded by many as a terrific choice.

Our own health policy columnist, David Nash, said that “Berwick’s global following is a powerful political force …

C-section rates and its association with lawsuits

Amy Tuteur, MD

Physician

April 25, 2010

The National Center for Health Statistics recently released a new report, Recent Trends in Cesarean Delivery in the United States. The report is most notable for a startling statistic; the C-section rate has reached the astronomical level of 32%, an increase of more than 50% since 1996. This is disturbing news.

Why is the C-section rate sky high?

The pervasive nature of the increase may hold some clues. The increase has …

St. Vincent’s Hospital closes, but who’s to blame?

Kevin

Physician

April 24, 2010

by Marie Cooper

St. Vincent’s Medical Center in Greenwich Village was founded in 1849, making it the third oldest hospital in New York City. It has been an occasional scene of notoriety but mostly it has witnessed countless episodes of anonymous compassion and care. My two sons were born there. As a major teaching hospital, it has over 1000 affiliated physicians. It is where generations of …

Colorectal cancer in blacks is affected by healthcare utilization

MedPage Today

Conditions and Diseases

April 24, 2010

by Todd Neale

The greater burden of colorectal cancer in the black community appears to be related to healthcare utilization, and not biology, researchers found.

Similar proportions of black and white patients had polyps or masses detected by flexible sigmoidoscopy, but black patients were less likely than whites to have the recommended follow-up colonoscopy (62.6% versus 72.4%), according to Adeyinka Laiyemo, MD, MPH, of Howard University in Washington, and colleagues.

After adjustment for …

Op-ed: Health insurance doesn’t mean doctors will be available

Kevin

Health Policy

April 24, 2010

The following op-ed was published on March 30th, 2010 in AOL News.

Health reform has passed, and the United States is poised to join the rest of the industrialized world in providing most of its citizens with affordable health coverage.

But having health insurance doesn’t necessarily mean it will be easy to find a doctor. Even before reform, reports projected a shortfall of 40,000 primary care physicians over the …

Bret Michaels has a subarachnoid hemorrhage, and what that means

Kevin

Conditions and Diseases

April 23, 2010

Bret Michaels is in critical condition from a subarachnoid hemorrhage.

I’ve been watching Celebrity Apprentice recently, and he comes across as a genuine person who, of course, has been raising awareness for Type 1 diabetes. As most people know, he has battled various diabetic complications on the show, and recently underwent an emergency appendectomy.

What’s his prognosis like?

Not good, I’m …

Palliative care physicians confronting their own mortality

Lyle Fettig, MD

Conditions and Diseases

April 23, 2010

Dr. Desiree Pardi was the palliative care medical director at Weill Cornell Medical Center in New York. She died of metastatic breast cancer in 2009 at the age of 41.

Her story provides palliative care clinicians an opportunity to reflect on how our own personal mortality interacts with our professional lives.

I did not personally know Dr. Pardi. I write this post knowing that many readers did indeed know her, some …

Medicaid physician payment rates hurts primary care doctors

David B. Nash, MD, MBA

Health Policy

April 23, 2010

Across the country, state Medicaid health insurance programs serving low-income children and families, people with disabilities, and older adults are struggling in an environment of chronic underfunding.

Consider that, nationwide, at least one child in four relies on Medicaid for health coverage. Medicaid funds healthcare services for two out of every five births and fills in gaps in Medicare coverage for the elderly and disabled.

But inadequate payments and outmoded methods of …

Patient adherence to drugs is low and what doctors can do

Shantanu Nundy, MD

Medications

April 22, 2010

Frequently in preventive health we ask patients to take medications that will reduce the risk of a certain bad medical outcome years down the road: cholesterol-lowering agents that lower the risk of a heart attack, blood pressure-lowering agents that reduce the risk of kidney disease, glucose-lowering medications that reduce the risk of diabetes-related complications.

Sometimes these medications make patients feel better — for example, insulin in patients with symptomatic diabetes or …

Psychiatric patients detained in the ER

Edwin Leap, MD

Physician

April 22, 2010

Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care.

The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage …

Read more…

Psychiatric patients detained in the ER

Dementia affects the entire family

Emily P. Walker

Conditions and Diseases

April 22, 2010

by Emily P. Walker

My grandfather recently died of pancreatic cancer.

My grandpa was a WWII veteran, a nature enthusiast, an animal-lover, a chiropractor until the 1980s, and a firm believer in natural medicine. He helped my grandmother give birth to five children in her bed, and neither of them had ever taken any drugs except when both were hospitalized one winter with pneumonia.

As someone with a major respect for medical doctors …

Read more…

Dementia affects the entire family

Patient satisfaction scores improve when doctors sit

Kevin

Physician

April 22, 2010

Patient satisfaction, as I wrote previously, is being increasingly focused upon.

Doctors are often pressed for time, and appear rushed — which can potentially lead to unhappy patients.

I saw this small study showing that the simple act of sitting down while talking to patients can have a profound effect. Many doctors I know already do this, but now there’s some data to support sitting.

According to the study, performed at …

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