Freestanding ERs May Freeze Out Poor, Minorities

July 17, 2016

Fierce Healthcare/By Zack Budryk/July 14, 2016

The freestanding emergency room mode is taking healthcare delivery by storm, but concerns linger about their effect on care access, according to a new study published in theAnnals of Emergency Medicine.

These stand-alone facilities are physicially separate from acute care hospitals but are available 24/7 for emergency care, and offer many of the same services as traditional emergency departments, including on-site advanced diagnostic imaging and laboratory testing.

Researchers from Boston’s Brigham and Women’s Hospital assembled a national database of freestanding ERs, determining that 360 existed across 30 states as of spring 2015, up from 222 in 2009. They found growth of the ERs is concentrated in high-income areas with growing populations, more traditional ERs, a higher proportion of privately insured patients and a lower proportion of Medicaid beneficiaries.

Ohio, Texas and Colorado led the other states for number of freestanding ERs, and in Texas and Ohio specifically, freestanding ERs were concentrated in ZIP codes with more privately-insured patients, according to the research. Texas’ freestanding ERs are more likely to be in ZIP codes with fewer Hispanics and higher annual spending.

Therefore, researchers concluded that although the model is on the rise, the facilities grow in areas that need the least help with care access.

“In the states with the most freestanding EDs, it seems less likely that they will expand access to underserved populations,” corresponding author Jeremiah Schuur, M.D., vice chair, Clinical Affairs, Department of Emergency Medicine, Brigham and Women’s Hospital, said in astatement, “as they are preferentially located in areas where people had more available health services, higher rates of private health insurance, lower rates of Medicaid and higher median incomes.”

The findings echo concerns voiced last year by the Medicare Payment Advisory Commission (MedPAC), which noted that two-thirds of Houston’s for-profit freestanding ERs are in ZIP codes with an average income higher than $53,000, FierceHealthcare previously reported.

Battlefield lessons for trauma care: National system could save 200K lives

June 21, 2016

Fierce Healthcare – by Zack Budryk |Jun 20, 2016 10:10am

Improved trauma care could prevent 20 percent of deaths from injuries such as gunshots or car accidents, according to a new report from the National Academies of Sciences, Engineering and Medicine.

The report, co-authored by Donald Berwick, M.D., former administrator for the Centers for Medicare & Medicaid Services, calls for healthcare leaders to set a national goal of zero preventable deaths from injury. As a model for such a strategy, the report cites the U.S. Army’s 75th Ranger Regiment, which managed to nearly eliminate preventable deaths.

Between 2001 and 2011, if all trauma centers nationwide had achieved outcomes on the level of the top-performing centers, 200,000 fewer patients would have died, according to the report. As it stands, however, research shows all trauma providers are not created equal, withtrauma centers serving a predominantly minority population seeing higher mortality rates.

To properly address trauma care, the authors write, healthcare needs a nationwide trauma care system that provides education across the entire continuum of trauma care, from the actual injury scene to rehabilitation and post-rehabilitation. Currently, “we do not have a cogent or well-designed research strategy on trauma care,” Berwick said in a public briefing on the report last week, according to Kaiser Health News.

Trauma care also needs a bigger research budget, according to the report; while trauma is the top cause of death for civilian Americans under 46, its research budget was less than 1 percent of the National Institutes of Health’s 2015 biomedical research budget.

In the wake of mass casualty events such as this month’s mass shooting in Orlando, Florida, which killed 49 people, the presence nearby of emergency personnel with battlefield experience provides a clear advantage.

“The tragedy is that a lot of this likely could be helped by that hard-won knowledge gained on the battlefield,” John B. Holcomb, a retired colonel and chairman of surgery at the University of Texas Health Science Center, who served on the committee, told Stars & Stripes. “No one knows where the next Orlando is going to happen.”

Psoriasis Linked to AAA – —Shared inflammatory mechanisms may explain the association

April 17, 2016

by Nancy Walsh, Senior Staff Writer, MedPage Today

Patients with psoriasis — whether mild or severe — are at increased risk of abdominal aortic aneurysms (AAA), a Danish nationwide cohort study found.

“These findings add importantly to current evidence of psoriasis as a clinically relevant risk factor for cardiovascular disease and may require increased focus on heightened risk of AAA in patients with psoriasis,” the researchers wrote in Atherosclerosis, Thrombosis, and Vascular Biology.

Systemic inflammatory markers such as C-reactive protein and tumor necrosis factor (TNF)-α also are elevated in patients with AAA and in those with psoriasis.

Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner.

Blood Test For Concussion

April 1, 2016

Researchers at Orlando Health detected evidence of concussions in patients up to 7 days after their injury using a simple blood test, according to a new study published in JAMA Neurology. The discovery could greatly expand the window for diagnosing concussions, especially in patients who experience a delayed onset of symptoms.

Science Daily, March 28, 2016.

N.F.L. Great Ken Stabler Had Brain Disease C.T.E.

February 3, 2016

Pro Football by John Branch, February 3, 2016.

Shortly before he died last July, the former N.F.L. quarterback Ken Stablerwas rushed away by doctors, desperate to save him, in a Mississippi hospital. His longtime partner followed the scrum to the elevator, holding his hand. She told him that she loved him. Stabler said that he loved her, too.

“I turned my head to wipe the tears away,” his partner, Kim Bush, said recently. “And when I looked back, he looked me dead in the eye and said, ‘I’m tired.’ ”

They were the last words anyone in Stabler’s family heard him speak.

“I knew that was it,” Bush said. “I knew that he had gone the distance. Because Kenny Stabler was never tired.

The day after Stabler died on July 8, a victim of colon cancer at age 69, his brain was removed during an autopsy and ferried to scientists in Massachusetts. It weighed 1,318 grams, or just under three pounds. Over several months, it was dissected for clues, as Stabler had wished, to help those left behind understand why his mind seemed to slip so precipitously in his final years.

On a scale of 1 to 4, Stabler had high Stage 3 chronic traumaticencephalopathy, or C.T.E., the degenerative brain disease believed to be caused by repeated blows to the head, according to researchers at Boston University. The relationship between blows to the head and brain degeneration is still poorly understood, and some experts caution that other factors, like unrelated mood problems or dementia, might contribute to symptoms experienced by those later found to have had C.T.E.

Drug Overdoses Propel Rise in Mortality Rates of Young Whites

January 22, 2016

The New York Times. By Gina Kolata and Sarah Cohen. January 16, 2016

Drug overdoses are driving up the death rate of young white adults in the United States to levels not seen since the end of the AIDS epidemic more than two decades ago — a turn of fortune that stands in sharp contrast to falling death rates for young blacks, a New York Times analysis of death certificates has found.

The rising death rates for those young white adults, ages 25 to 34, make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it.

The Times analyzed nearly 60 million death certificates collected by the Centers for Disease Control and Prevention from 1990 to 2014. It found death rates for non-Hispanic whites either rising or flattening for all the adult age groups under 65 — a trend that was particularly pronounced in women — even as medical advances sharply reduce deaths from traditional killers like heart disease. Death rates for blacks and most Hispanic groups continued to fall.

Lawsuit Claims Fitbit Heart Rate Monitor Is Inaccurate

January 12, 2016

CBS/January 8, 2016

SAN FRANCISCO (CBS) — The makers of Fitbit are being sued by people who allege that the popular fitness device isn’t accurately keeping track of their heart rate while exercising.

The lawsuit filed in federal court this week claims that the wrist-based activity tracker is consistently misrecording users’ heart rates by a “very significant margin.” It also takes aim at Fitbit commercials with slogans like “Every Beat Counts” and “Know Your Heart.”

‘Flying ICUs’: Medical helicopters provide advanced care for rural patients

November 29, 2015

Medical helicopters so well-equipped that one hospital leader calls them “flying intensive care units” are helping people in the rural upper Midwest get emergency medical care that otherwise would be out of reach, the Duluth (Minnesota) News Tribune reported.

“There’s some debate as to the value of having a helicopter system in New York City or Detroit or Chicago,” Mark Monte, M.D., chief of trauma surgery at St. Luke’s Hospital in Duluth, told the newspaper. “But we cover a large expanse of open territory. So to have a helicopter which can go out and reach a great distance and bring a patient back is a great advantage.”

Duluth News Tribune/John Lundy/November 23, 2015

Cases of Pulmonary Hypertension Grow in Children

September 22, 2015

September 20, 2015 By Andrea K. McDaniels of The Baltimore Sun

At 3 months old, Gabrielle John’s daughter would wake up gasping for air and sweating profusely. Baby Stella’s heart rate was also much higher than normal.

“Her little body was working so hard to do anything,” John said.

After several emergency trips to different hospitals, doctors at Johns Hopkins Hospital finally diagnosed Stella with pulmonary hypertension, a potentially fatal condition in which blood pressure is abnormally elevated in the arteries of the lungs. These pulmonary arteries narrow, causing the heart to work harder to pump blood through the lungs to collect oxygen and possibly leading to heart failure.

People Who Suffer Depression And Anxiety After A Traumatic Brain Injury May Have Damaged White Matter

June 24, 2015

Jun 16, 2015 12:00 AM By  for Medical Daily/The Grapevine

Over the past few years, it’s become widely known among the scientific community that traumatic brain injuries, or concussions as they’re more often called, can result in lasting physical and mental damage for the sufferer — a reality that only entered the public consciousness with the emergence of lawsuits filed against the NFL, alleging that they had ignored the evidence showing this when it came to their own players.

But while we know that a concussion can leave you with more than dizziness and a temporary headache, it’s been harder to understand exactly why. Now, new research published in the Radiological Society of North America claims to have possibly figured out part of the mystery. The study authors say they were able to detect unique brain patterns among people suffering from depression or anxiety as a result of their concussion when compared to the brains of those concussion sufferers with no reported mental problems — in some cases, these patterns resembled the brains of those whose mental illness wasn’t caused by head trauma.

Source: Alhilali, L, Delic J, Gumus S, et al. Evaluation of White Matter Injury Patterns Underlying Neuropsychiatric Symptoms after Mild Traumatic Brain Injury. Radiological Society of North America. 2015.

See Medical Daily/The Grapevine for full report.


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