Doctors control emotions with patients

From UPI, via GruntDoc:

A U.S. study suggests physicians shut off the portion of their brain that helps them appreciate the pain their patients are experiencing.

Instead, the University of Chicago research indicates physicians activate a portion of the brain connected with controlling emotions during such patient encounters.

Because doctors sometimes have to inflict pain on patients as part of the healing process, they also must develop the ability not to be distracted by the suffering, said Jean Decety, a professor of psychology and psychiatry and co-author of the study.

"They have learned through their training and practice to keep a detached perspective; without such a mechanism, performing their practice could be overwhelming or distressing, and as a consequence impair their ability to be of assistance for their patients" said Decety.

Obesity Threatens Emergency Services: Report

ABC News' take on the effect of obese (and "super-obese") patients in EMS and the ED.

Extra wide beds, stronger toilets and special patient lifting devices are becoming more and more common in emergency rooms. The reason for such new equipment? Hospitals across the United States are struggling to handle increasing numbers of extra-large patients.

And as the country's rates of obesity and "superobesity" continue to climb, many worry that such accommodations will put an increasingly heavy toll on an already strained emergency services system.

Hospitalists Shorten Patient Stays

From the Washington Post:

Being cared for by hospital-based general physicians -- also known as "hospitalists" -- can shorten patients' hospital stays, a U.S. study finds.

The study looked at more than 9,000 patients discharged from an academic medical center between July 2002 and June 2004.

The 2,913 patients cared for by hospitalists had an average hospital stay of just over 5 days, compared to nearly 6 days for the 6,124 patients cared for by non-hospitalists, reported researchers at Montefiore Medical Center in New York City.

"Hospitalist care had the strongest association with length of stay in patients with specific diagnoses, including cerebrovascular accidents (strokes), congestive heart failure, pneumonia, sepsis, urinary tract infections and asthma/chronic obstructive pulmonary disease," the researchers wrote. "The close monitoring and continuous presence offered by hospitalists may allow for earlier discharge, because hospitalists are more likely to detect clinical improvement in real time and to make appropriate adjustments in treatment regimens."

Tamper-Proof Prescriptions

From the Wall Street Journal Health Blog:

It looks like doctors and pharmacies will get a reprieve from a new rule requiring tamper-proof prescriptions for Medicaid patients.

Congress created the rule earlier this year, and it’s set to go into effect on October 1. But the Senate last night passed a bill that would push that back another six months, and a similar bill is moving through the House this week.

The shift is supposed to make it harder for patients to forge prescriptions. But doctors and pharmacies have said the quick implementation wouldn’t give them enough time to get ready and could result in patients not being able to get the medicine they need.

Obese and Super Obese Patients Challenge Emergency Medical Care Providers

From ACEP:

Obese patients are presenting new challenges in emergency care, from burdening patient transport systems to complicating diagnosis and treatment. As rates of obesity and super obesity accelerate, emergency departments struggle to cope (“Emergency Departments Shoulder Challenges of Providing Care, Preserving Dignity for the ‘Super Obese’”).

“Higher levels of obesity will lead to more people getting sick with heart disease, hypertension or diabetes and coming to the emergency department,” said Dr. Theodore Delbridge, chief of emergency medicine at Pitt County Memorial Hospital in Greenville, North Carolina. “Clearly the obesity epidemic is having an effect on emergency department care. The steady increase in obese and super obese patients creates pressures across the entire spectrum of patient care, from ambulance capacity to proper drug dosing.”

A survey cited in the article finds that the emergency department has been the most affected area in hospitals by the growing population of obese patients.

Super obese patients present the greatest difficulties to emergency medical care providers, from pre-hospital care through hospital admission. Patients who weigh more than 400 pounds may require bariatric ambulances, which are rare due to their high cost. In addition, EMS workers typically only lift 100 pounds, meaning a larger patient will require extra personnel. Nearly half of surveyed EMS workers reported back injuries related to lifting extremely heavy patients. Global sales in bariatric stretchers and lift systems are expected to soar in the next five years.

In addition, super obesity may create complications in diagnosis and treatment because of difficulties with blood draws, lumbar punctures or imaging machines such as CT scanners. Drug dosing poses additional dilemmas since, for most drugs, there are few clinical studies on proper dosing for very large patients.

Between 1986 and 2000, the prevalence of super obese patients has increased by a factor of five, from one in 2,000 to one in 400. Seventy-eight percent of hospitals reported an increase in the admission of severely obese patients in the last year, a trend that seems likely to continue.

“The bottom line is that this trend is not going away and emergency care providers will have to find ways to optimize care,” said Dr. Delbridge. “Emergency physicians adapt to all kinds of changes in our patient population and this is no different.”

WSJ: "Chatty Neatnik Docs Ace Malpractice Insurance Tests"

Love that title. From the Wall Street Journal Health Blog.

Paying premiums isn’t enough to get malpractice insurance for some docs these days. Some insurers now require an online personality test, reports American Medical News.

The test gauges a doctor’s “interpersonal communication skills,” “attention to detail” and “propensity for risk-taking behavior,” according to the Web site of United Medical Liability. The online test takes 15 to 20 minutes, according to the company. Insurers may send doctors who are sloppy, thrill-seeking clods to training to reduce their risk of being sued.

U of I med school eyes expansion in DM

From the Des Moines Register:

The University of Iowa Hospitals and the Des Moines Area Medical Consortium is looking at a new downtown location in order to double the number of medical students receiving training in the city.

"It will improve the medical education of our students and hopefully entice more of these students to stay in Des Moines and surrounding areas," said Jean Robillard, vice president for medical affairs at the U of I.

Twenty-five to 35 U of I medical students now spend rotations each year at Iowa Methodist Medical Center, Iowa Lutheran Hospital, Blank Children's Hospital, Veterans Affairs Medical Center and Broadlawns Medical Center, said Dr. Steven Craig, the consortium's executive director.

Education space in the consortium's offices at 1415 Woodland St. is already tight and would not be adequate if the consortium agrees to increase the number of U of I medical students to 50 to 55 each year, Craig said.

"We recognize that taking in more students means we need more classrooms, conference rooms and patient simulation rooms," Craig said. "We've been exploring what type of facility we would need."

The consortium would likely develop a new facility close to its offices just south of Methodist, Craig said. Consortium leaders are now trying to figure out how much it would cost, how they would raise the money and where the building would be located, he said.

"No timeline has been set," he said. "We're now in the exploratory stage."

Hypothermia Treatment

From Medgadget:

Life Recovery Systems, HD, LLC, of Alexandria, LA was just issued the CE Mark of approval by the EU to market their ThermoSuit system, indicated for emergency cooling of patients to "preserve cardiac and brain function in victims of cardiac arrest, stroke, heart attack, traumatic brain injury and hyperthermic patients."

The ThermoSuit System uses innovative technology to rapidly cool a patient's core temperature. It consists of a disposable body suit and a means to pump coolant within the suit over the skin of the patient. It is the first device for patient temperature management that conveniently provides a thin layer of rapidly flowing liquid coolant in direct contact with the skin. This approach gives the ThermoSuit System outstanding capabilities to rapidly and non-invasively change patient temperature. It has been designed for ease of use for clinicians who treat patients indicated for cooling therapy, and has the potential to quickly cool these patients conveniently and rapidly.

Mayo Clinic Calls for Universal Coverage

From the (excellent) Wall Street Journal Health Blog

Make everybody in America buy health insurance, and give subsidies to help the poor afford it. Force insurance companies to offer some coverage to everyone, regardless of health status. And have everybody buy their insurance directly, rather than getting it through their employer.

Those are the broad outlines of a plan (described here) created by the Mayo Clinic’s Health Policy Center after consulting with hundreds of academics, patient activists and health-care providers in the last year and a half. The group also got input from executives at companies such as Wal-Mart and Verizon that are not part of the health-care industry.

Newsweek article about eICU's

From Newsweek:

Here's the sub-heading: Small hospitals use technology to run remote ICUs.

Swedish Medical is one of a growing number of hospitals opting for a radical form of outsourcing by using technology and doctors stationed off-site to monitor the well-being of critically ill patients. Instead of listening through a stethoscope, a single doctor can track multiple patients at all three hospitals from a remote facility by watching monitors and Webcams, working from a post that looks a lot like an air-traffic controller's station.

ER Kiosks Let Patients Avoid Long Lines

From ABC News

An emergency room might be the last place you'd think would have do-it-yourself check-in. But Parkland Memorial Hospital has three self-service computer kiosks, similar to those used by airport passengers and hotel guests. And so do a handful of other hospital ERs, where the long wait in line to register and explain symptoms can be grueling.

Multitasking (and why migraine patients wait)

From Scalpel or Sword (a great blog)

At any given moment during the typical shift in the ER, here is what is happening:

There are 10-20 patients in the waiting room. Some have been waiting 6 hours. A couple of them have ankle sprains and were already X-rayed, and their X-rays were already read by the Radiologist as "no bony abnormality, soft tissue swelling." They would like to leave without being seen. We don't argue too much.

I'm waiting on a callback from a specialist, and I have two more calls to make after that one. If I paged them all at once, they would all call back at the same time, then two of them would hang up before I was finished talking with the first one. They would be understandably angry when they were repaged, and they would take an hour to call back the second time. So I page them one at a time. As soon as I introduce myself to the next patient I see, the first one will call back...

continues...

Nurse fired for not aiding death probe

From the Des Moines (IA) Register:

A nurse at the Perry Health Care Center has been fired for failing to cooperate with an investigation into a resident's death at the nursing home.

The home was recently fined $7,000 amid allegations that workers there were unable to perform basic CPR on residents.

Communication test predicts problem doctors

From Reuters:

Physicians coming out of medical school with lousy communication skills end up getting more complaints down the road from patients, and tests can find the doctors with problems, according to a study published on Tuesday.

The study confirmed that tests like one given during the medical-licensing process in Canada can predict which doctors would run into trouble and underscored the importance of a doctor's ability to communicate well with patients.

New Prehospital 12-Lead

From Medgadget

The popular HeartStart line of defibrillators from Philips is getting a nice addition to its lineup. The company is now profiling its HeartStart MRx Monitor/Defibrillator that sports the ability for paramedics to transmit patient data from the ambulance to the hospital's ER en route.

New CPR Technique

From Purdue University:

New CPR promises better results by compressing abdomen, not chest

A biomedical engineer at Purdue University has developed a new method to perform cardiopulmonary resuscitation that promises to be more effective than standard CPR because it increases nourishing blood flow through the heart by 25 percent over the current method.

A new technique is desperately needed because conventional CPR has a success rate of 5 percent to 10 percent, depending on how fast rescuers are able to respond and how well the procedure is performed. For every one minute of delay, the resuscitation rate decreases by 10 percent.


"In other words, at 10 minutes, the resuscitation is absolutely ineffective," said Leslie Geddes, Showalter Distinguished Professor Emeritus in Purdue's Weldon School of Biomedical Engineering. "Any medical procedure that had that low a success rate would be abandoned right away. But the alternative is not very good, either: Don't do CPR and the person is going to die."

Geddes has developed the first new CPR alternative, called "only rhythmic abdominal compression," or OAC-CPR, which works by pushing on the abdomen instead of the chest.

"There are major problems with standard CPR," Geddes said. "One is the risk of breaking ribs if you push too hard, but if you don't push hard you won't save the person. Another problem is the risk of transferring infection with mouth-to-mouth breathing."

The new CPR method eliminates both risks, Geddes said.

"Bogus doctor trapped by misspelt letter to court after speeding let-off"

From the London Times

A bogus doctor who escaped a speeding fine by claiming he was on an emergency call was rumbled only after writing a badly spelt letter in an attempt to claim expenses for attending court.

Omid Chiang equipped his car with a flashing green light, a defibrillator and a “doctor-on-call” sign so he could break the speed limit at will and park anywhere he fancied.

New Oral Airway

BusinessWeek reported on the device, as it recently won a design award.
Interesting name...

Tonguesucker

The Tongue Sucker is an oropharyngeal airway device specifically developed to be used by untrained persons on unconscious casualties. Located in first aid boxes, it is designed to prevent the obstruction of the oropharynx, or throat, by the tongue and may also assist in compression only cardiopulmonary resuscitation (CPR).

Cutting docs’ hours doesn’t reduce death rates

From MSNBC (emphasis added)

Cutting the grueling work hours of doctors-in-training had little effect on reducing patient deaths, according to two large studies.

Death rates dropped in one group of patients in veterans’ hospitals but not in three other groups, the researchers reported.

The results come from what the authors describe as the largest and most comprehensive national look at work-hour restrictions, which were implemented four years ago in an effort to reduce medical errors by tired physicians.

For the groups with no change, Volpp said one possible explanation is that more patient handoffs by residents offset the benefits of reduced fatigue. He also noted the work-hour limits may not be strictly enforced at every hospital.

Picture Boards Speak In Health Crisis

From CBS News:

With more ill and injured people needing emergency care but do not speak English, hospitals, clinics and rescue squads are turning to picture boards to bridge the communication gap with easily understood images.

The large, double-sided panels let patients point to icons showing their problem _ such as pain, a burn, breathing trouble or a fall _ as well as the part of the body that is affected. They also can point to their native language in a list so an appropriate interpreter can be located.

"They ought to be in every ambulance, in every hospital, in every clinic," said Dr. Fred M. Jacobs, head of New Jersey's health department. "Communication barriers lead to adverse impacts on (care) quality, misunderstandings and even medical errors."

His department is partnering with the state's hospital association to distribute thousands of the boards to all New Jersey hospitals, rescue squads and public health clinics.

New, small portable ultrasound

From a press release:

Siemens introduces the world's smallest ultrasound device for initial diagnosis in emergency situations

The first few minutes are instrumental in emergency situations. A new portable ultrasound device from Siemens Medical Systems supports medical personnel in these efforts. The device, known as Acuson P10, is a hand-held device intended for complementary initial diagnostic care and triage, particularly in cardiology, emergency care and obstetrics. It is poised to change the physical exam by providing immediate information to health care providers at the earliest possible patient intervention points, such as intensive care units, ambulances and medical helicopters. The advantages of the new system are its portability, easy handling as well as its fast and consistent availability to the physician. The device is barely larger than a Blackberry and weighs just a little more than 700 grams.

I’ll Drive, I’m Just Having a Heart Attack

From the Wall Street Journal's Health Blog:

Hey, tough guy: It’s OK to call 911 if you think you’re having a heart attack. In fact, it can help you save precious heart muscle and lower your chances of death.

But, as the WSJ’s Ron Winslow points out in this morning’s paper, a recent study in Minnesota found that only 37% of rural men who were having heart attacks arrived at the hospital in an ambulance. The rest drove themselves or got a ride from a friend or family member. Women with heart attacks did slightly better but still not great– 49% of them came by ambulance.