Inhalant abuse remains prevalent in teens

Conditions and Diseases
May 6, 2010

by Todd Neale

Although inhalant abuse has become less prevalent since the early 1990s in all age groups, it remains a source of injury and death, particularly among teenagers, researchers have found.

From 1993 to 2008, intentional exposure to 3,410 different inhalants was reported to U.S. poison control centers, Toby Litovitz, MD, of the National Capital Poison Center in Washington, and colleagues reported in the May issue of Pediatrics.

The highest rate of …

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Inhalant abuse remains prevalent in teens

Social networking impact on patients, doctors, and non-profits

Social Media in Medicine
May 6, 2010

In its current listing of online social networks, Wikipedia presents 156 major, active websites. A neighboring link to view “now-defunct” sites accompanies the listing — a subtle reminder of the Internet’s competitive and volatile environment where promising endeavors rise and fall overnight.

But although the popularity of a specific website may fade with time, the practice of online social networking is here to stay.

In its simplest form, online social networking is …

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Social networking impact on patients, doctors, and non-profits

How Massachusetts can lead health IT modernization

Health Technology
May 6, 2010

Although healthcare reform has its supporters and detractors, healthcare IT reform – the use of technology to improve the quality, safety and efficiency of healthcare throughout the country – has broad support from all stakeholders.

The passage of last year’s $787 billion economic stimulus bill brought with it a healthcare IT modernization program that could inject about $30 billion into the economy. Since Massachusetts is a leader both in the use …

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How Massachusetts can lead health IT modernization

Family comes first for some who have finished residency

Medical Education
May 5, 2010

by Dr. Whoo, MD

I have met several women who have completed residency and maybe even practiced beyond that, but decide to quit and stay at home with kids. I wonder – why would a woman who has gone through all of that training just quit? It would seem like the hard part is behind them and I am perplexed by their decision but, of course, I …

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Family comes first for some who have finished residency

How Massachusetts controls health costs should be closely watched

Health Policy
May 5, 2010

A major criticism leveled at the health reform law is that it doesn’t do enough to control costs. Yet experience with a similar breed of health reform in Massachusetts indicates that the cost control issue will come to the fore sooner rather than later.

Recent stories have reinforced my conviction about this:

Massachusetts health plans have sued the state and stopped issuing new policies to small businesses and individuals after the …

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How Massachusetts controls health costs should be closely watched

Maternal death rates improve but hurts fund raising

Health Policy
May 5, 2010

by Mike Himowitz

When you’re advocating for a health cause, can good news be bad news?

It’s entirely possible — when science threatens fund-raising, and at the worst possible time.

Consider a study of worldwide maternal death rates by a team from the University of Washington that appeared online recently in The Lancet.

The group, led by Christopher Murray, of the school’s Institute for …

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Maternal death rates improve but hurts fund raising

Quality hospital care deserves to be celebrated

Physician
May 5, 2010

Last week my wife and best friend, Elaine, had massive abdominal surgery. We fully expected her to be an inpatient for a week, but she was home in four and half days. To watch her recover was to see what happens when everything converges: the deep knowledge and skills of excellent, humane physicians; a capable, caring clinical staff; wonderful new technologies; and a lifetime of eating right, being fit and …

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Quality hospital care deserves to be celebrated

Health reform may mean meaningful changes for physicians

Health Policy
May 4, 2010

Jim called me late on a fall afternoon to report our mutual friend was in the local emergency room. “It looks like he had a stroke”. I immediately asked to speak to the ER doctor for the results of the CAT scan I knew would have been done. There were two metastatic tumors in the brain.

It has been over two years since my friend died. He was among the millions …

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Health reform may mean meaningful changes for physicians

Problem list problems with electronic medical records

Health Technology
May 4, 2010

In family medicine it has been common to keep a “Problem List” in patients’ paper charts. Usually placed on the left hand side, on top of the Medication List, it has given doctors like me an instant thumbnail sketch before considering the specifics of each patient’s visit for that day.

A typical Problem List would include diagnoses like diabetes, hypertension, high cholesterol or rheumatoid arthritis. It would list prior surgeries, like …

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Problem list problems with electronic medical records

Malpractice fears influence cardiology decisions

Physician
May 4, 2010

by Charles Bankhead

For nearly a quarter of cardiologist respondents, malpractice concerns influenced their decisions to order tests or treatment for hypothetical cases included in a national survey.

Almost 30% of cardiologists acknowledged ordering cardiac catheterization because colleagues did so in the same situation, according to an article published online in Circulation: Cardiovascular Quality Outcomes.

Concerns about malpractice had a significant association with regional use of tests and treatment, Frances Lee Lucas, PhD, …

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Malpractice fears influence cardiology decisions

Avoiding the ER and arranging a direct admit is not easy

Physician
May 4, 2010

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. …

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Avoiding the ER and arranging a direct admit is not easy

Defensive medicine worsens patient care and raises costs

Physician
May 3, 2010

Health care in the United States costs too much, and it doesn’t look like that’s going to change. Recent health care reform legislation doesn’t take any meaningful steps towards reducing or controlling costs. In fact, it explicitly forbids states from trying to curtail the costs of malpractice litigation in any way that would reduce lawyers’ fees.

How does a fear of lawsuits increase costs? The most direct way is …

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Defensive medicine worsens patient care and raises costs

Residency team changes can improve education and patient care

Medical Education
May 3, 2010

In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Education, ACGME) were fairly benign and largely ignored – marquee programs like ours were generally given carte blanche to organize our residents’ experience as we saw fit.

When I took over our residency in 1992, …

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Residency team changes can improve education and patient care

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Money prevents patients from seeking timely heart care

Physician
May 3, 2010

by Crystal Phend

Lack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed.

A delay in getting to the hospital for treatment of acute MI was 38% more likely among the uninsured and 21% more likely among insured patients with financial concerns, reported Paul S. Chan, MD, MSc, Mid America Heart Institute in Kansas City, Mo., and colleagues.

More than two in every …

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Money prevents patients from seeking timely heart care

How health care reform will affect mental health

Health Policy
May 3, 2010

by Diana E. Lee

The cost of therapy and medication for underinsured people are common barriers keeping people from getting treatment for a mental health problem.

Although there are community mental health centers that provide treatment for many people, their resources are stretched far too thin to help everyone who needs treatment on the level someone with a more serious issue may need. One of the most positive changes that will arise …

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How health care reform will affect mental health

Medical device security may be vulnerable to hackers

Conditions and Diseases
May 2, 2010

by Kristina Fiore

Although no such attacks have yet been reported, medical devices could be susceptible to hackers, and a thorough security analysis should be done as part of FDA approval, researchers argue.

Premarket regulatory evaluation should include a risk-based security assessment depending on the nature of the device and the perceived threat of a security compromise, said William H. Maisel, MD, MPH, of Beth Israel Deaconess Medical Center, in Boston, and …

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Medical device security may be vulnerable to hackers

Free prescription drug samples cost patients more money

Medications
May 1, 2010

Free is good, right? If you have to pay out of pocket for medicines, free prescription drug samples from your doctor’s office might seem like a godsend. But nine times out of ten, these free samples end up costing you more money. Here’s how.

First of all, pharmaceutical reps only get paid to give out brand new medicines that their companies are trying to promote. They are giving out these drugs …

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Free prescription drug samples cost patients more money

Medicare reverses a brain tumor drug decision

Health Policy
May 1, 2010

by John Fauber

Paula Oertel’s brain tumor disappeared for nine years while she was on a drug not approved for her condition. The tumor returned when a move to a new home triggered a Medicare review — and subsequent denial of coverage for the experimental treatment.

Now Medicare officials have decided she will be allowed to go back on the drug.

“I am hoping …

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Medicare reverses a brain tumor drug decision

Doctors need more eye contact with patients, not computers

Physician
April 30, 2010

I had an interesting juxtaposition of events. While waiting in Peets, a coffee shop in Lexington Center, I watched the friendly discussions between the baristas and customers.

I then went to a doctor’s appointment, where a nurse stood typing at a laptop asking me a series of questions, including “Are you in pain?” and “Do you feel safe at home?” She didn’t look at me once as she read and typed.

Eye Contact …

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Doctors need more eye contact with patients, not computers

Healthcare reform and the new role of hospitalists

Physician
April 30, 2010

by John Gever

With growing pressures on hospitals from the new healthcare reform law and from the stakeholder community to become more efficient and effective, administrators may find they already have the necessary expertise under their own roofs, a prominent hospitalist said.

“Some organizations with hospitalist programs need look no further than these programs to chart a course toward more effective physician-hospital integration,” wrote Robert M. Wachter, MD, of the University of …

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Healthcare reform and the new role of hospitalists

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