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 …
Aneurysm as a cause of the Bret Michaels brain hemorrhage
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 …
Undocumented individuals make hospital discharge difficult
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, …
Quality care requires open clinical transparency
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 …
Health reform won’t help the ER
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 …
St. Vincent’s Hospital closes, but who’s to blame?
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 …
Bret Michaels has a subarachnoid hemorrhage, and what that means
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 …
Palliative care physicians confronting their own mortality
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 …
Psychiatric patients detained in the ER
I was consulted recently about an elderly woman who refused surgery for a large bowel obstruction from a colonic mass, likely cancer. The inpatient team asked me to help with the transition to hospice and to help make her comfortable.
I went to see her. She had a nasogastric tube sucking up brown material from her stomach. Her abdomen was swollen and uncomfortable. Her primary goal was to return to walking …
Palliative care needs a simple and consistent message
by Michael Smith
It’s possible to reduce the burden of drug-resistant pathogens in hard-hit hospitals — all it takes is consistent effort over time, French researchers say.
That’s the conclusion after a 15-year, intensive program aimed at reducing the impact of methicillin-resistant Staphylococcus aureus (MRSA) on Parisian hospitals reported in the March 22 Archives of Internal Medicine.
The program started in 1993 in the 38-hospital, 23,000-bed Assistance Publique-Hôpitaux de Paris, the largest …
MRSA control takes consistent time and effort
by Michael Kirsch, MD
Does anyone out there know why President Obama underwent a virtual ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?
In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …
President Obama should have had colonoscopy without sedation
by Michael Smith
The use of treatment checklists for 13 common diagnoses was associated with a dramatic reduction in patient deaths at three London hospitals, researchers said.
The year the checklists were introduced, the three facilities in the North West London Hospitals NHS Trust registered 255 fewer deaths than the previous year, according to Brian Jarman, PhD, of Imperial College London, and colleagues.
The targeted diagnoses accounted for 174 fewer deaths than the …
Checklists help reduce hospital deaths
by Michael Smith
Healthcare workers in a New York City emergency department had the highest rate of infection among employees of an urban hospital system during the first wave of the H1N1 pandemic flu, researchers said.
In a single-institution study using medical and administrative records, the adult emergency department had an H1N1 infection rate of 28.8% during April, May, and June of 2009, according to Robert Bristow, MD, and colleagues at New …
Healthcare workers in the ER hit hard by H1N1
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The iPad has finally been released and we’ve got our hands on one so we can provide the medical community a healthcare perspective of the device. Here are my initial impressions.
The iPad should fit comfortably your white coat. If you continue on to the rest of the review you’ll see pictures of the device easily settling into …
iPad review for doctors: A hands on guide for medicine
by Dr. Whoo, MD
Q. I just found out last week that I’ll be a new mom in November, making me an official mother in medicine! I’ve been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here’s my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?
— From a future mom and …
Medicine residency survival tips during pregnancy
by Crystal Phend
Advance planning improves end-of-life care for elderly patients and helps families cope with the loss, researchers found.
In a randomized trial, hospitalized patients over age 80 who were formally assisted with documenting their end-of-life treatment wishes and with designating a surrogate were almost three times more likely to have those wishes followed (86% versus 30% in usual care, P<0.001).
Family members of patients in the advance planning intervention reported significantly …
Advance planning helps families cope with loss
When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’
Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code status is the medical term that describes what a patient’s wishes are should his or her heart stop or lungs fail. While code status is not a topic that typically …
Patient advance directives are critical in the ICU
A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.
But her history was concerning to me, and it was concerning to …
Hospital admissions may require watching and waiting
In 1927, Francis Peabody remarked that, “The secret of the care of the patient is in caring for the patient.”
Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in today’s era, perhaps the group that best personifies this central …
Social work is key to quality patient care
by Joseph Lombardi, MD
You probably remember the tragic death of actor John Ritter in 2003.
Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection.
In addition to TAD Coalition’s “Ritter Rules,” which focus on recognizing, treating and preventing the condition, the American Heart Association and American College of Cardiology also released new guidelines designed to prevent unnecessary …
Aortic dissection symptoms and current treatment options
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