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Assessing Appropriate Use of Vascular Access Devices

Assessing Appropriate Use of Vascular Access Devices

Safe and reliable venous access is paramount when administering medications in critically ill and ICU patients. “Central venous access devices (CVADs) are commonly used in ICUs and pose significant infectious and thrombotic risk to patients,” explains Vineet Chopra, MD, MSc. Underlying disease, immobility, sedation, and the number, type, and duration of catheters used are just some of the risk factors associated with catheter-related complications in ICU patients. Studies show that the risk for complications associated with central venous catheters (CVCs) is higher in ICUs when compared with other hospital departments. “It’s important to balance the clinical needs of patients with risks associated with any vascular device,” says Dr. Chopra. “This requires having processes in place for selecting devices, inserting the devices aseptically, and caring for, managing, and removing devices when they’re no longer necessary.” He adds that the association between thrombosis, infections and devices highlights why use of devices, such as peripherally inserted central catheters (PICCs), should be considered carefully. Despite this knowledge, some PICCs may not be placed for clinically valid reasons. “Defining appropriate indications for PICC use is important an important patient safety issue,” Dr. Chopra says. A New Approach Several professional organizations have issued recommendations to help guide the selection of CVADs. For example, the Society of Healthcare Epidemiology of America recommends providing clinicians an evidence-based list of indications for CVCs prior to placement. The Infusion Nursing Standards recommend using the least invasive device to meet patients’ specific needs. The CDC’s central line-associated bloodstream guidelines recommend reserving PICCs when duration of IV therapy is projected to last 7 or more days. While helpful, none of these...
#PWChat Recap: The Future of Medicaid Funding

#PWChat Recap: The Future of Medicaid Funding

The Physician’s Weekly #PWChat series continued with another informative discussion focusing on healthcare and, more specifically, medicaid funding. It was co-hosted by Dr. Linda Girgis, MD, FAAFP. You can view our upcoming schedule, or read our other #PWChat recaps here. Below are the highlights from the chat. You can read the full transcript here.   Question 1 Q1: What do we know about proposals to cut #Medicaid funding, lower coverage, & increase premiums?#PWChat — Physician’s Weekly (@physicianswkly) July 20, 2017 A1. The proposed plan aims to cut federal funding to Medicaid significantly. #PWChat https://t.co/PGtwbpnfmL — Linda Girgis, MD (@DrLindaMD) July 20, 2017 We know that if enacted, any such proposal will kill people. Maybe me. Despite @Avik‘s inability to assess evidence #pwchat https://t.co/GMtzEm73wD — #MedicaidMatt (@mattbc) July 20, 2017 Question 2 Q2: Why do you think the Senate bill with major cuts to Medicaid appears to have died?#PWChat — Physician’s Weekly (@physicianswkly) July 20, 2017 A2. We have already seen increased premiums and less coverage w/ the #ACA. It can be expected to be worse under the new plan. #PWchat https://t.co/PGtwbpnfmL — Linda Girgis, MD (@DrLindaMD) July 20, 2017 A2. It was too draconian in the cuts it was proposing. #PWchat https://t.co/IczO9ins8r — Linda Girgis, MD (@DrLindaMD) July 20, 2017 This just doesn’t comport with reality. #PWchat See, e.g. https://t.co/QLUGpl09EZ https://t.co/YfDmXRl5qC — #MedicaidMatt (@mattbc) July 20, 2017 Question 3 Q3: What are the potential benefits of #Medicaid cuts?#PWChat — Physician’s Weekly (@physicianswkly) July 20, 2017 A3. Reduces costs and funds can be spent in other places. #PWchat https://t.co/1AIchfEpSc — Linda Girgis, MD (@DrLindaMD) July 20, 2017 A3: .@NRO &...
Physicians Practice: 7 Ways to Break Bad News to Patients

Physicians Practice: 7 Ways to Break Bad News to Patients

The author of this article is Linda Girgis MD, FAAFP, a family physician who practices in New Jersey. Dr. Girgis is also a regular blogger and columnist for Physician’s Weekly, among other publications. One of the hardest tasks a clinician must do is giving patients bad news. Here are some strategies that may help when delivering such news to patients: Be empathetic: Patients need our empathy in all circumstances, not just when they are facing bad outcomes. Be honest: Patients deserve the full and complete truth, no matter how bad it is. Those facing death should know their status so that they can make preparations. Be simple: Ensure that patients understand what you have explained or disclosed. Provide patients websites that offer more information after they go home. Let them ask questions: Make sure patients are fully apprised of their medical situation. If they don’t ask questions, be the lead and ask them if they have any questions. Listen: By listening, physicians can understand what patients are most concerned about and then address these issues. Don’t trivialize: Our words may be easy to say because we’re not the ones suffering. You’re a doctor, not a source for inspirational quotes. Be supportive: Patients need to know you are there for them. You’re there to guide them and help make decisions. Although you may not like or agree with their decisions, remember it is theirs to make. For the complete article, click...
Doctor and Patient Relationships: Empathy & Litigation

Doctor and Patient Relationships: Empathy & Litigation

Research has shown that emergency physicians (EPs) with better interpersonal skills and who spend more time with patients appear to have fewer malpractice claims filed against them. Studies have also shown that empathy from EPs can influence how healthcare providers are viewed and may have a role in patients’ decisions on whether or not they wish to pursue litigation. To investigate this issue further, Dustin D. Smith, MD, Jesse Z. Kellar, MD, and colleagues had a study published in the Emergency Medicine Journal that sought to determine whether the presence or absence of empathetic statements from EPs would alter patient thoughts regarding litigation. For the study, researchers randomized adults in an ED waiting room to watch videos of simulated discharge conversations between physicians and patient actors. Half of the videos differed only by the inclusion of two brief empathetic statements. “These statements included verbalizations that EPs recognized that the patient is concerned about their symptoms and the patient knew their typical state of health better than a physician seeing them for the first time and did the right thing by seeking evaluation,” explains Dr. Smith. After watching the video, participants were asked to rate their thoughts regarding suing this physician in the event of a missed outcome leading to lost work. Questions were also asked about measures of satisfaction with the physician encounter. Demonstrating Empathy Matters According to the results, the addition of brief empathetic statements to ED discharge scenarios appeared to lead to significant reductions in thoughts of litigation. “Adding brief empathetic statements also led patients to have more positive impressions of the physician and a better understanding...
Older Adults Who Eat Yogurt Linked to Better Bone Health

Older Adults Who Eat Yogurt Linked to Better Bone Health

The largest observational study to date of dairy intakes and bone and frailty measurements in older adults has found that increased yogurt consumption was associated with a higher hip bone density and a significantly reduced risk of osteoporosis in older women and men. The study led by Trinity College Dublin, Ireland, in collaboration with St James’s Hospital Dublin and co-investigators from Nutrition at Ulster University, Coleraine investigated participants from the Trinity Ulster Department of Agriculture (TUDA) ageing cohort study (>5000 people). Total hip and femoral neck bone mineral density measures in females were 3.1-3.9% higher among those with the highest yogurt intakes compared to the lowest and improvements were observed in some of the physical function measures (6.7% better). In men, the biomarker of bone breakdown was 9.5% lower in those with the highest yogurt intakes compared to the lowest. This is an indication of reduced bone turnover. Related Articles Review Spotlights Optimal Care of T2DM + Osteoporosis Osteoporosis Tx Ups Survival in Postmenopausal Breast Cancer Older Women Show Limited Understanding of Osteoporosis To determine risk factors for being diagnosed as osteoporotic, the research team analysed a wide range of factors such as BMI, kidney function, physical activity, servings of milk or cheese, and calcium or vitamin D supplements as well as traditional risk factors for bone health (e.g. smoking, inactivity, alcohol etc.). After adjusting for all these factors, each unit increase in yogurt intake in women was associated with a 31% lower risk of osteopenia and a 39% lower risk of osteoporosis. In men, a 52% lower risk of osteoporosis was found. Vitamin D supplements were also associated...
Timing of Menopause Onset May Increase Heart Failure Risk in Women

Timing of Menopause Onset May Increase Heart Failure Risk in Women

Traditional Chinese medicine might be effective as a complement or alternative to traditional Western medicine for primary and secondary prevention of heart disease, according to a state of the art review paper published today in the Journal of the American College of Cardiology. Heart disease is the No. 1 cause of death worldwide, and despite advances in Western medicine for treating and preventing heart disease, unmet needs remain. As a result, traditional Chinese medicine is being increasingly looked at as a supplement to Western medicine, but to date randomized controlled trials are overall of poor quality and flawed. Western scientists often reject Chinese medicine for specific reasons: the formula consists of dozens of ingredients with many chemical molecules, making it hard to clarify the therapeutic mechanism; the medications available in China do not undergo the same rigorous approval process as Western drugs to guarantee efficacy and safety; and most trials were conducted in China by traditional Chinese medicine physicians with medications largely unavailable in the United States. Related: Evidence-Based Medicine Course Beneficial for Critical Thinking Researchers in this review looked at studies published over the past 10 years on randomized controlled trials of traditional Chinese medicine used for patients with hypertension, dyslipidemia, diabetes/pre-diabetes, atherosclerotic cardiovascular disease and chronic heart failure to assess the efficacy and safety of traditional Chinese medicine. In all, certain Chinese medications showed suggested benefits for each of the cardiovascular health conditions studied. For example, researchers looked at eight randomized controlled trials on traditional Chinese medicine and hypertension. The evidence indicated that Tiankuijiangya, Zhongfujiangya, Qiqilian, Jiangya and Jiangyabao have antihypertensive effects and a good safety profile,...
Kicking the Salt Shaker Habit May Not Be Enough

Kicking the Salt Shaker Habit May Not Be Enough

Restaurant foods and commercially processed foods sold in stores accounted for about 70 percent of dietary sodium intake in a study in three U.S. regions, according to new research in the American Heart Association’s journal Circulation. Sodium is an important contributor to high blood pressure, one of the leading causes of heart attack and stroke. The American Heart Association recommends a maximum of 2,300 milligrams (mg) of sodium a day, which is equivalent to 1 teaspoon of salt. For nearly 70 percent of U.S. adults, the maximum sodium intake recommendation is even lower – 1500 mg/day – based on their age, race or ethnicity, or existing high blood pressure. Sodium can be difficult to avoid, especially when people eat a lot of processed food from grocery stores or restaurants. In fact, the average American adult consumes more than 3,400 mg of sodium per day. To address this serious health threat, in 2010 the Institute of Medicine recommended gradually decreasing sodium levels in commercially processed foods. Related Articles Only 10 Percent of Daily Salt Intake Comes From Shaker Appeals Court Upholds Restaurant Salt Warning Between December 2013 and December 2014, researchers recruited 450 study participants in Palo Alto, California; Birmingham, Alabama; and Minneapolis, Minnesota; divided evenly among each location. Half of participants were female, and equal percentages, overall, were Hispanic, African American, Asian and white. They ranged in age from 18 to 74 years old. Across age groups, the level of dietary sodium was similar, with an average 3,501 mg consumed per day —  over 50 percent more than the recommended 2,300 mg. Researchers found: Sodium added to food outside...
Physicians Practice: How to Engage in Difficult Discussions With Staff

Physicians Practice: How to Engage in Difficult Discussions With Staff

The author of this article is Catherine Hambley, PhD, an organizational psychologist who leverages brain science to promote effectiveness and positive change.  Of the many challenges physicians encounter, one that often stands out is having difficult conversations with staff. All difficult discussions involve different perspectives between individuals, emotional triggers, and high stakes. With these factors in mind, here are four critical strategies for engaging in difficult conversations: Have positive intentions. These intentions need to be communicated positively. Inform the staff member that the conversation is intended to help them learn and grow. Minimize threats for the other person. How dissatisfaction is communicated is critical. Communicate your positive intention but also ask for their perspective on the situation. Do less “telling” and more “asking.”Use open-ended questions to find out how the person views the situation. This can empower them to explore and examine their own ideas and insights and provide clarity as to what might be at stake. Focus more on the solution than the problem. Asking questions and providing feedback that is solution-oriented is less threatening than focusing on the problem.  Solution-oriented communication can help foster a positive learning culture. Successfully managing difficult conversations takes practice and a genuine desire to learn effective communication practices. Using the aforementioned strategies, you may realize that many conversations are not as difficult as you thought they would be. For the complete article, click...
What To Do with Your Leftover Pain Drugs

What To Do with Your Leftover Pain Drugs

Throughout the United States, the rates of prescription pain drug addiction and death continue to increase, placing a substantial burden on the nation’s healthcare system. This problem persists despite the development of new policy initiatives aimed at limiting access to these medications for both adults and younger patients. Studies show that about one in four high school seniors has used narcotic pain drugs, but parents may downplay the risks of these drugs because they are prescribed by a physician. “For adolescents, a known point of access to pain medication is pills in the home that are left over from a previous prescription,” says Sarah J. Clark, MPH. Recently, Dr. Clark and colleagues at the C.S. Mott Children’s Hospital surveyed a national sample of parents of children aged 5 to 17 about their experiences with pain drug prescriptions for their children as a part of the hospital’s national poll on children’s health. The survey, which was administered to 1,176 randomly selected parents, sought to identify how frequently parents keep leftover pain medications in the home and to assess whether or not parents are receiving guidance on what to do in these situations. A Common Problem According to the poll, prescription pain medications were common in U.S. households with children. “We found that three in 10 parents reported that they had received at least one pain drug prescription for their children in the last 5 years, most commonly for surgery or injury,” says Dr. Clark. “About 60% of those prescriptions were for a narcotic like oxycodone or hydrocodone and 8% were for non-narcotic pain relievers. Narcotics prescriptions were more common among...
Statin & Aspirin Use Post-CABG

Statin & Aspirin Use Post-CABG

If left untreated, about half of bypass vein grafts become occluded within 10 years of surgery. “Both statins and aspirin carry class I indications from the American College of Cardiology and the American Heart Association to be used to keep grafts open over the long term and should be continued indefinitely unless patients have specific contraindications,” says Kevin Curl, MD. Taking a Deeper Look Despite guideline recommendations, few studies have explored the long-term usage of statins and aspirin among patients who have undergone CABG. To address this research gap, Dr. Curl and colleagues had a study published in the American Journal of Cardiology that analyzed utilization rates of statins and aspirin among post-CABG patients who were referred for coronary angiography with the purpose being to identify the long-term trends with medication adherence in this high-risk population. The authors reviewed the electronic health records 381 consecutive patients who received CABG and a cardiac catheterization procedure at Thomas Jefferson University at least 3 years after surgery was performed. Inpatient and outpatient records were analyzed to assess prescribing patterns of these medications and other pertinent clinical and laboratory data. Underutilization Common According to the results, 67% of patients involved in the study were being prescribed a statin, while 75% were prescribed aspirin. “Alarmingly, only 52% were prescribed both of these medications at the time of their catheterization procedure,” says Dr. Curl. CABG recipients who were not taking statins had 22% higher LDL cholesterol levels as well as significantly lower average total cholesterol values. Nearly one-third of study participants (35%) had LDL levels that were 100 mg/dl or higher. Among patients not taking...
#PWChat Recap: Defensive Medicine & Related Costs

#PWChat Recap: Defensive Medicine & Related Costs

The Physician’s Weekly #PWChat series continued last night with an energetic discussion focusing on defensive medicine and related costs. It was co-hosted by Jeff Segal, MD, JD, founder and CEO of Medical Justice, an organization that focuses on medical malpractice issues. The conversation was sparked by one of Segal’s recent articles, Traditional Tort Reform Won’t Reduce Healthcare Costs. You can view our upcoming schedule, or read our other #PWChat recaps here. Below are the highlights from the chat. You can read the full transcript here.     Question 1 Q1: What do we currently know about the negative impacts of defensive medicine?#PWChat — Physician’s Weekly (@physicianswkly) July 13, 2017 A1: It’s expensive. Nobody knows how expensive. > $100 & < 650B/yr. Those $ not value-add. Just to avoid hot seat in court. #PWChat (1/3) — Jeffrey Segal (@jeffsegalmd) July 13, 2017 A1: Everybody does it. One researcher said 91% practice defensively. The other 9% are liars. #PWChat (2/3) — Jeffrey Segal (@jeffsegalmd) July 13, 2017 A1: TRADITIONAL tort reform hasn’t has cut defensive medicine. Why? No MD wants to be sued. Whether for $1 or $1M. #PWChat (3/3) — Jeffrey Segal (@jeffsegalmd) July 13, 2017 Over time #DefensiveMedicine morphs into #StandardOfCare #NaturalSelection #PWchat — Art Fougner (@sonodoc99) July 13, 2017 Question 2 Q2: Pres Trump proposes to cap damages on pain and suffering to $250,000 per claim, limit attorneys’ fees (1/2)#PWChat — Physician’s Weekly (@physicianswkly) July 13, 2017 and limit the period to file lawsuits among other traditional tort reform efforts. Will this approach work? Why/why not? (2/2)#PWChat — Physician’s Weekly (@physicianswkly) July 13, 2017 A2: Will it pass?...
New Blood Test Could Detect Pancreatic Cancer Earlier

New Blood Test Could Detect Pancreatic Cancer Earlier

A new, low-cost blood test may be an effective way to detect pancreatic cancer early, a research team says. The nation’s No. 3 cancer killer, pancreatic cancer often goes undiagnosed until it is too far along to remove. Current screening techniques typically catch it only “after it causes pronounced symptoms, when it has advanced far enough to be lethal,” said study author Kenneth Zaret, director of the University of Pennsylvania’s Institute for Regenerative Medicine. Sometimes it’s found during a body scan for another health issue. But such scans are too costly for routine screening, even for people with a high risk of pancreatic cancer, he said. That includes parents, siblings or children of people who have had pancreatic cancer; those with some gene mutations; and people over 50 who suddenly develop diabetes. Related Articles Traveling to Academic Hospital May Be Best for Pancreatic Cancer ASCO Updates Recs on Potentially Curable Pancreatic Cancer New or Worsening T2DM Could Indicate Pancreatic Cancer Extending Survival After Inoperable Pancreatic Cancer  “A low-cost, noninvasive test, such as we have developed, could be useful for routine screening of individuals who are at high risk for pancreatic cancer,” Zaret said. Current screening focuses on shifting levels of tell-tale blood proteins, according to the American Cancer Society. But such tests are considered unreliable, and the ACS does not recommend routine screening for those who are not known to be at high-risk. Click here to read the full...
Defining Operative Emergency General Surgery

Defining Operative Emergency General Surgery

More than 3 million Americans are admitted to hospitals in the United States each year for emergency general surgery (EGS), and this patient population is a particularly high-risk group of surgery patients. According to clinical trials, patients who undergo an EGS operation are up to six times more likely to die after surgery than are those undergoing the same procedures as an elective surgery. In addition, about half of all patients undergoing EGS will develop a postoperative complication, and up to 15% will be readmitted to the hospital within 30 days of their surgery. EGS patients account for more than $6 billion in annual costs to the U.S. healthcare system. Despite the inordinate burden of EGS, few studies have attempted to create surgical benchmarks for these procedures. In 2013, the American Association for the Surgery of Trauma addressed this issue by publishing a landmark list of 621 ICD-9 diagnosis codes to include any patient requiring an emergency surgical evaluation for diseases within the realm of general surgery as defined by the American Board of Surgery. A follow-up study proposed 149 ICD codes that were identified as procedures that would or could treat any EGS diagnosis. A Retrospective Review To build on this broadly inclusive list of EGS diagnoses, a more focused and nationally representative list of EGS procedures is needed. For a study published in JAMA Surgery, Joaquim M. Havens, MD, and colleagues set out to define a set of procedures that accounted for at least 80% of the national burden of operative EGS. “This data may help simplify efforts to establish EGS benchmarks and guide standardized and focused...
Older Adults Who Take Five or More Medications Walk Slower than Those Who Take Fewer Medications

Older Adults Who Take Five or More Medications Walk Slower than Those Who Take Fewer Medications

“Polypharmacy” is the term used when someone takes many (usually five or more) different medications. Experts suggest that, for most older adults, taking that many medications may not be medically necessary. Taking multiple medications also can be linked to problems such as falls, frailty, disability, and even death. Polypharmacy also is a problem for older adults due to side effects or interactions resulting from the use of different medications. Older adults may have difficulties taking the medications properly, and the medications may interfere with a person’s ability to function well. The ability to walk well is a sign of independence and good health for older adults, for example, and it may be affected by the use of multiple medications. Although healthcare providers know that some treatments can slow or hamper an older person’s ability to walk, little is known about the effects of polypharmacy on walking while performing other tasks, like talking. In a new study, researchers examined how polypharmacy affected walking while talking. They published their study in the Journal of the American Geriatrics Society. The researchers examined information from 482 people age 65 and older who were enrolled in the “Central Control of Mobility in Aging” study. That study’s main purpose was to determine how changes to the brain and our central nervous system occur during aging, and how they might impact an older person’s ability to walk. Related Articles Walking Speed Predicts Blood Pressure Risks in the Elderly Prefrontal Brain Activity May Predict Risk of Falls in Elderly Disabling Injury, Illness Less Likely for Elderly Who Exercise Predicting COPD-Related Mortality in the Elderly Researchers confirmed the...
Why Using Antibiotic Eye Drops for Pinkeye is the Wrong Way to Go

Why Using Antibiotic Eye Drops for Pinkeye is the Wrong Way to Go

A new study suggests that most people with acute conjunctivitis, or pinkeye, are getting the wrong treatment. About 60 percent of patients nationwide are prescribed antibiotic eye drops, even though antibiotics are rarely necessary to treat this common eye infection. Of the patients filling antibiotic prescriptions, 20 percent filled prescriptions for antibiotic-steroid eye drops that can prolong or worsen the infection. The study by the University of Michigan Kellogg Eye Center is consistent with a nationwide trend of antibiotic misuse for common viral and mild bacterial conditions. It’s a trend that increases costs to patients and the health care system and may promote antibiotic resistance. Related: One in 4 ER Visits for Eye Problems Aren’t Actually Emergencies “This study opens the lid on overprescribing of antibiotics for a common eye infection,” says lead study author Nakul Shekhawat, M.D., M.P.H., resident physician at Kellogg. Using data from a large managed care network in the United States, researchers identified the number of patients who filled antibiotic eye drop prescriptions for acute conjunctivitis. They then evaluated the characteristics of patients who filled prescriptions compared to those who did not. Among 340,372 people diagnosed with acute conjunctivitis over a 14-year period, 58 percent filled a prescription for antibiotic eye drops. Click here to read the full press...
New Opioid Use in Older Adults with COPD Associated with Increased Risk of Cardiac Death

New Opioid Use in Older Adults with COPD Associated with Increased Risk of Cardiac Death

Older adults with chronic obstructive pulmonary disorder who recently started using opioids have an increased risk of coronary artery disease-related death compared to non-opioid users, researchers at St. Michael’s Hospital have found. Among these patients, new opioid use is associated with a 215 percent increase in coronary artery disease-related death for long-term care residents and an 83 percent increase in coronary artery disease-related death for those who lived at home compared to non-opioid users, according to the study. The study, published today in the European Journal of Clinical Pharmacology, raises concerns about new opioid use among older adults with chronic obstructive pulmonary disease, or COPD, a progressive lung disease that causes breathing difficulty, said Dr. Nicholas Vozoris, a respirologist at St. Michael’s, and lead author of the study. Related Articles At-Risk Pain Patients Can Cut Opioid Use With Psychology Tools Opioid Use Before TKA May Lead to Worse Pain After Surgery ATS: Mortality Down for Patients Hospitalized With COPD in U.S. The COPD-Anxiety Connection Previous research by Dr. Vozoris found older adults with COPD who recently started using opioids are also at an increased risk of dying from respiratory reasons compared to non-opioid users. COPD affects approximately four to 10 per cent of the Canadian population, with the five-year mortality rate from 40 to 70 per cent, depending on the severity. The two-year mortality rate for people with severe COPD is about 50 per cent. Click here to read the full press...
Sleep Problems May be Early Sign of Alzheimer’s

Sleep Problems May be Early Sign of Alzheimer’s

Poor sleep may be a sign that people who are otherwise healthy may be more at risk of developing Alzheimer’s disease later in life than people who do not have sleep problems, according to a study published in the July 5, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology. Researchers have found a link between sleep disturbances and biological markers for Alzheimer’s disease found in the spinal fluid. “Previous evidence has shown that sleep may influence the development or progression of Alzheimer’s disease in various ways,” said study author Barbara B. Bendlin, PhD, of the University of Wisconsin-Madison. “For example, disrupted sleep or lack of sleep may lead to amyloid plaque buildup because the brain’s clearance system kicks into action during sleep. Our study looked not only for amyloid but for other biological markers in the spinal fluid as well.” Amyloid is a protein that can fold and form into plaques. Tau is a protein that forms into tangles. These plaques and tangles are found in the brains of people with Alzheimer’s disease. Related Articles Extra-Virgin Olive Oil Preserves Memory, Protects Brain Against Alzheimer’s PPIs Not Found to Raise Risk of Alzheimer’s Disease CDC: Alzheimer’s Mortality Up 55 Percent From 1999 to 2014 Low Body Mass Index Not Risk Factor for Alzheimer’s Disease For the study, researchers recruited 101 people with an average age of 63 who had normal thinking and memory skills but who were considered at risk of developing Alzheimer’s, either having a parent with the disease or being a carrier of a gene that increases the risk for Alzheimer’s disease...
Dr. MedLaw: Assumption of the Risk

Dr. MedLaw: Assumption of the Risk

This question, often posed by doctors, is actually about a legal doctrine called “assumption of the risk”. This is a defense against a negligence claim based on the plaintiff having actually agreed fully to take on the risk that he or she is now suing about. Assumption of the risk does actually superficially sound a great deal like the informed consent doctrine because  under it someone must be informed of specific risks and agree to go ahead anyway and it does not cover reckless or intentional conduct. Many physicians therefore believe that a patient can, by agreeing to medical care, immunize them against a later claim of malpractice unless they are actually grossly negligent or intentionally improper in providing that care. So, why doesn’t a signed consent just stop a medical malpractice case at the start? Why can’t the defendant doctor plead “assumption of risk” and end the case? After all, patients are informed of the risks as well as the benefits of a treatment and then agree to go ahead anyway. The reason is that the assumption of the risk doctrine actually does not apply to medical care. Let’s look at where it does apply to understand why that is. Defining Assumption of the Risk Express assumption of the risk is usually asserted in cases involving injuries that occurred during inherently dangerous recreational activities, like hang-gliding or bungee-jumping. It is founded on a release that the person who wants to engage in the risky activity signs with the operator, a release that restricts any future claims to injuries due to actually reckless or intentional conduct by the operator. Implied...
Know Your ICD-10 Codes

Know Your ICD-10 Codes

ICD-10, which is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. There are currently 68,000 ICD-10 codes, compared to only 14,000 ICD-9 codes. So many of these new codes, however, can seem obscure when pertaining to medical injuries. Believe it or not, these are actual ICD-10 codes in the newest version. “Swimming-pool of prison as the place of occurrence of the external cause.” “Struck by duck, subsequent encounter.”...
Postoperative Care With Online Portals

Postoperative Care With Online Portals

Research has shown that many patients seek greater accessibility to healthcare, but this can be especially challenging for the surgical community. Studies have suggested that surgeons are facing increasing time constraints due to workforce shortages and higher performance demands. To date, few strategies that have been tested in which clinicians have incorporated new care delivery modalities into general surgical care. It has been suggested that online postoperative care may improve patient access while increasing surgeon efficiency, but few studies have explored this association. “Use of online patient portals may enhance postoperative care by improving efficiency and patient satisfaction,” says Kristy Kummerow Broman, MD, MPH, “but studies are lacking on whether or not patients would want to use these portals.” New Research For a study published in the Journal of the American College of Surgeons, Dr. Kummerow Broman and colleagues evaluated patient and surgeon acceptance of online postoperative care after elective general surgical operations. The prospective pilot study involved 50 patients and compared online and in-person postoperative visits. Study enrollment and activities were completed over a 6 month period. Patients in the analysis underwent elective laparoscopic cholecystectomy, laparoscopic ventral hernia repair, umbilical hernia repair, or inguinal hernia repair, which was carried out by one of five surgeons. “We wanted to determine if all aspects of perioperative care needed to take place in person,” explains Dr. Kummerow Broman. “We thought there might be a role for moving some postoperative care for certain operations to an online environment.” She adds that having patients generate images for patient-to-provider consultation is a relatively new concept. The portal used for the study had been previously...
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