ACEP Now still silent on EM President interviews.

Which is terrible, yet predictable.
ACEP Now | The Official Voice of Emergency Medicine.

Yeah, it’s completely devoid of interviews or conversations with the purported future leaders of Emergency Medicine.

What a surprise.

Again, if you’re running for President of ACEP but abide by the Gag Order, you aren’t worthy, and we (as a specialty) shouldn’t support them.

Emergency Medicine Literature of Note: The tPA Cochrane Review Takes Us For Fools

 

Posted by Ryan Radecki

It’s been 5 years since the last Cochrane Review synthesizing the evidence regarding tPA in acute ischemic stroke.  Clearly, given such a time span, in an area of active clinical controversy, a great deal of new, important, randomized evidence has been generated!Or, sadly, the only new evidence available to inform practice is IST-3 – a study failing to demonstrate benefit, despite its pro-tPA flaws and biases.  So, it ought not be a very exciting update, considering the 2009 version included 26 trials, and the 2014 update now includes only 27 trials.  Their summary conclusion, with only additional evidence of regression to the mean, ought remain essentially the same, or even less optimistic, right?

Of course not:

via Emergency Medicine Literature of Note: The tPA Cochrane Review Takes Us For Fools.

Read, and enjoy. Excellent analysis.

My professional college beclowns itself

A fisking of a paranoid, ill-considered and frankly stupid idea a 9th grader would be ashamed to put forth. From the American College of Emergency Physicians ‘leadership’.

ACEP Clarifies Campaign Rules

By James M. Cusick, MD, FACEP

Chair, Candidate Forum Subcommittee of the ACEP Council

ACEP is a member-driven organization with a representative body of our peers – the ACEP Council – chosen through component bodies, including our chapters (1 representative per 100 members), our Sections of Membership, and other aligned organizations.

There follows some boilerplate language designed to get you to tune out.

None of this is aimed at the author, BTW, I have no doubt he was asked to write this and didn’t make this decision. This is about the College and a terrible decision that reflects poorly on it.

In addition, protections were incorporated into the rules to keep candidate interviews in ACEP publications. Our goal is to avoid candidates being put in the position of commenting on College policy without adequate preparation and to ensure that the campaign process is fair and equal for all candidates.

Wait, what? Candidate interviews for ACEP positions can only be in ACEP house organs? Is Stalin in charge? And for the rationale of “…being put in the position of commenting on College policy without adequate preparation and to ensure that the campaign process is fair and equal for all candidates” means ‘we intend to cover up for the candidates we really want to win, and the gaffes from the unworthy will be published in bold print, but rest assured if you’re our selection it’ll totally be glossed or even left out’.

Count on that. And that’s bollocks.

It’s the biggest horse shit this college has dumped in quite a while, and that isn’t how I want my college to represent itself because that’s how it represents me. Really, if you’re running for President of ACEP, you should be able to handle a non-coddled interview. Seriously, you’re going to say they’re too fragile to be interviewed ‘without adequate preparation…’ and then expect them to deal with legislators and their staffs who are dealing with skilled negotiators and people who know what they are there for? No thanks, I’d rather know the warts and all right up front, not filtered through the ACEP info-seive.

Certain candidates may unfairly benefit from coverage in non-ACEP publications, while some may be disadvantaged. In order to ensure a fair election, campaign questions and the vetting of candidates is the responsibility of ACEP, its Council and its Council Committees.

Umm, no, it’s the right of all of ACEP to know who’s running for office, what their unfiltered views are, and how they handle themselves with tough questions from tough questioners. It’s called campaigning, it’s not the pinewood derby. The very idea that ACEP can make an election totes fair by limiting the questions and answers to their own publications is laughable, were it not so tragically and pathetically sad. If you’re worried someone has an unfair advantage, Editorialize in ACEP Now, and their 150 avid readers can spread the word. But this entire approach is insulting to the intelligence and spirit of ER docs in our great nation.

(Any of you ER docs want to make sure your patients are only presented one at a time, with discreet illnesses and injuries, with a pre-selected choice card of correct diagnoses? No? It’s because we live and work in the real world, and that’s an absurd proposition, like this).

Also, and some may not be aware, but this is most likely a reaction to the excellent challenge by Dr. Greg Henry, ACEP Past-President and fixture asking for a robust questioning in his April 28, 2014 article ACEP, let’s set a real agenda. Read that article, and the kind of questions he wanted to ask, then you’ll see this in-house gag order for what it is: cover for their chosen.

If you’re a candidate for president and you buy into these rules, I know you’re not ready for the job.

If there are specific questions you would like asked of the candidates prior to the election, please send them to communications@acep.org. The Candidate Forum Subcommittee will consider them, the selected questions will be posed to candidates and their responses will be made public.

Really. You’re not only going to vet the answers and decide what goes out you’re going to control the questions, too? Here are a couple for you: a) boxers or briefs, and b) puppies or kittens?

I for one would like to have someone bathed in the knowledge of fights won and lost ask our presidential candidates hard questions about the tough choices facing ACEP, but we will absolutely not get it with this format. On purpose.

Hell, we’ll be lucky to find out if they like puppies.

 

via ACEP Clarifies Campaign Rules « The Central Line.

Another reason I like my job

Colleagues I can call on and count on.

Recently I was the 11p doc in my ED (the overnight shift), and I knew what my evening had in store when Colleague/suspect1 said “It’s been slow all day”. Oy.

At 11:03P the charge nurse (who deserves a Medal for her actions that night) said ‘you’re getting a level 1 medical and two level 1 trauma transfers in the next five minutes’, and that was in addition to the waterfall of regular patients who heard the word ‘slow’ and ran like very sick possessed zombies to our ED.

The medical was a great case I would have loved had I had no other duties: CHB, external pacer dependent, and I did the right thing for this patient: I called the procedure doc, and turned that patient’s care over to him (the one who caused this, Colleague1). (I knew what this patient needed, it’s an intubation/cordis/float the pacer/etc, and that’s 20 minutes straight of terrific procedures while letting the department drown). He did as well as you’d think. Maybe better than I would have done.

The other colleague star was Golleague2, the 9P, who never peeped that I wasn’t sending him home, or really even taking his workups. In fact, toward the end of the night he did a lac or two for me, and I kept Colleague1 busy until 3 with procedures. Terrific to have people you can count on.

This isn’t about me, or even these two great colleagues (though I thank both of you profusely), it’s really about all of us. Giving means getting, and I and our mutual patients got the best that night, and get it when we work and play well together.

It’s a great place to work. Thanks to you all.

ED patient: word to the wise

If your driver has a personality disorder, it will reflect on you. It’s unavoidable.

please ask them to wait for you in the waiting room. Or in the car. Or on Venus.

(EMS not included).

Definition of cold: Killing a Patient to Save His Life – NYTimes.com

For the record, I’m all for this, providing it pans out in trials…

PITTSBURGH — Trauma patients arriving at an emergency room here after sustaining a gunshot or knife wound may find themselves enrolled in a startling medical experiment.

Surgeons will drain their blood and replace it with freezing saltwater. Without heartbeat and brain activity, the patients will be clinically dead.

And then the surgeons will try to save their lives.

Researchers at the University of Pittsburgh Medical Center have begun a clinical trial that pushes the boundaries of conventional surgery — and, some say, medical ethics.

By inducing hypothermia and slowing metabolism in dying patients, doctors hope to buy valuable time in which to mend the victims’ wounds.

via Killing a Patient to Save His Life – NYTimes.com.

You Can’t Yelp Your Doctor – The Daily Beast

Some of the country’s best doctors have the worst patient satisfaction scores. Here’s why.Part of being a doctor is learning to suppress your feelings. You get good at being what people need you to be. But it slowly transforms you into something you couldn’t have foreseen—a sort of Stepford doctor—pleasing everyone with your perfect smile and agreeable demeanor, hoping that your patient satisfaction survey will be favorable, no matter the cost.

Press Ganey is one of the top providers of patient satisfaction surveys, according to the Forbes article, Why Rating Your Doctor Is Bad For Your Health.The government has bet big on these surveys, as a recent article in Forbesnotes. Armed with the idea that “patient is always right,” Washington figured that more customer satisfaction data “will improve quality of care and reduce costs.”

That turns out to have been a bad bet.

via The Mask Your Doctor Hides Behind – The Daily Beast.

Read the whole thing, but it’s what your doctors, especially the hospital based ones, have been saying since day 1.

Healthcare Reform Update: Doc employment won’t lead to lower healthcare spending, research shows | Modern Healthcare

You don’t say.

Market share and prices tend to climb among hospitals that employ doctors but not for hospitals with looser contracts with independent physicians, according to newly published research. The findings, the authors say, suggest that integration itself does not produce the savings that many health system executives and policymakers promise from closer coordination between hospitals and doctors.

Hospital prices, according to the study, increased 2% to 3% each time physician-employing hospitals’ market share increased by one standard-deviation. The results were drawn from an analysis of roughly 2 million hospital bills submitted to private insurers between 2001 and 2007. Overall spending on services at the hospitals that employed physicians grew, while the utilization of services at those hospitals didn’t change.

via Healthcare Reform Update: Doc employment won’t lead to lower healthcare spending, research shows | Modern Healthcare.

All Trials | All Trials Registered. All Results Reported

Many thanks to Steve in the comments on the last post for alerting me to this movement:

It’s time all clinical trial results are reported.

Patients, researchers, pharmacists, doctors and regulators everywhere will benefit from publication of clinical trial results. Wherever you are in the world please sign the petition:

Thousands of clinical trials have not reported their results; some have not even been registered.

Information on what was done and what was found in these trials could be lost forever to doctors and researchers, leading to bad treatment decisions, missed opportunities for good medicine, and trials being repeated.

All trials past and present should be registered, and the full methods and the results reported.

We call on governments, regulators and research bodies to implement measures to achieve this.

via All Trials | All Trials Registered. All Results Reported.

I signed the petition, and hope others will as well.

Realistically, this will require either a mindboggling scandal (even worse than the ones we know about) leading to group self-regulation, or more likely, intrusive and poorly thought out legislation.

I know what I’d bet on.

What the Tamiflu saga tells us about drug trials and big pharma | Business | The Guardian

Hint: Roche stinks, and the Cochrane Collaboration has done all of us a huge favor. Time to stop prescribing Tamiflu.

What the Tamiflu saga tells us about drug trials and big pharmaWe now know the government’s Tamiflu stockpile wouldn’t have done us much good in the event of a flu epidemic. But the secrecy surrounding clinical trials means there’s a lot we don’t know about other medicines we take

via What the Tamiflu saga tells us about drug trials and big pharma | Business | The Guardian.

Navy Matters: A-10 Scrapping Justification Exposed

Please click through and read the whole thing. Something I hadn’t considered.

This is a Navy blog but I just can’t pass on the following Air Force item especially since it indirectly impacts Marine and Navy CAS.

DoD Buzz website quotes Air Force Gen. Mark Welsh as saying that scrapping the A-10 will save $4.2B over five years (1).  This apparently is the Air Force’s justification for letting the A-10 go.  Of course, the real justification is preserving the Air Force’s buy of F-35’s.  Be that as it may …

Let’s check that cost savings number out, shall we?

via Navy Matters: A-10 Scrapping Justification Exposed.

Stolen laptops lead to important HIPAA settlements

In case you wondered why your IT department isn’t reasonable about security, it’s because the penalties aren’t reasonable.

Stolen laptops lead to important HIPAA settlements

Two entities have paid the U.S. Department of Health and Human Services Office for Civil Rights (OCR) $1,975,220 collectively to resolve potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.  These major enforcement actions underscore the significant risk to the security of patient information posed by unencrypted laptop computers and other mobile devices.

via Stolen laptops lead to important HIPAA settlements.

1.7 Million dollar fine.

Bug can cause deadly failures when anesthesia device is connected to cell phones | Ars Technica

I can think of at least one reason phones are being plugged into USB’s…

Federal safety officials have issued an urgent warning about software defects in an anesthesia delivery system that can cause life-threatening failures at unexpected times, including when a cellphone or other device is plugged into one of its USB ports.The ARKON anesthesia delivery system is used in hospitals to deliver oxygen, anesthetic vapor, and nitrous oxide to patients during surgical procedures. It is manufactured by UK-based Spacelabs Healthcare Ltd., which issued a recall in March. A bug in Version 2.0 of the software running on the device is so serious that it could cause severe injury or death, the US Food and Drug Administration warned last week in what’s known as a Class I recall. In part, the FDA advisory read:

via Bug can cause deadly failures when anesthesia device is connected to cell phones | Ars Technica.

In my practice in the ER, there are two types of patients: those who travel with their phone chargers and plug them in, and those who don’t and whose phones are dying. The former will plug into any power port, the latter are the ones asking if anyone has a charger they can borrow.

So, your loved one is in the ICU on the vent, you’ve been calling and texting for what seems like forever, and you get to sit at the bedside. You’d never think twice about charging your phone off the nearest USB port; it’s never been a problem before, why would it be now?

Why that would shut down a ventilator is terrible planning on the part of the manufacturer, and it’ll get fixed. For you, though, don’t plug your pone into medical gear, as apparently some of it isn’t hardened against real life.

 

Top 5 Reasons Why ‘The Customer Is Always Right’ Is Wrong | Alexander Kjerulf

Top 5 Reasons Why ‘The Customer Is Always Right’ Is Wrong | Alexander Kjerulf.

Correct!

Medicare Payments to Providers in 2012 – WSJ.com

Medicare Payments to Providers in 2012
Newly released Medicare billing data show total payments to more than 880,000 medical providers in 2012, totaling $77 billion.
Search the database by provider name, specialty and location to see the types and number of procedures performed and the amounts paid to each provider by Medicare. Related article.

via Medicare Payments to Providers in 2012 – WSJ.com.

Use your new powers for Good.