Maggots Clean Wounds Faster Than Surgeons | Wound Healing | LiveScience

Aah, the French:

The idea of putting maggots into open flesh may sound repulsive, but such a therapy might be a quick way to clean wounds, a new study from France suggests.

via Maggots Clean Wounds Faster Than Surgeons | Wound Healing | LiveScience.

I kid. I think this is a good idea, and it’s natures’ way of saying ‘cleanup on aisle three’. Patients not infrequently will be brought to the ED with awful, non-healing wounds infested with maggots.

We typically kill them off, more because a) the staff is completely grossed out and b) if you’re living at home and have maggots in your wounds, let’s just say your personal hygiene is deeply suspect. Rank, in fact. Needs a decon level bad.

However, there is a legitimate role for biological wound cleaning; I have a WWII surgical book with a chapter in it on growing your own sterile maggots. It’s not an ER thing, but it’s yet another tool in the armamentarium of bad wounds.

Studying alternative medicine with federal dollars – latimes.com

You. Don’t. Say.

Thanks to a $374,000 taxpayer-funded grant, we now know that inhaling lemon and lavender scents doesn’t do a lot for our ability to heal a wound. With $666,000 in federal research money, scientists examined whether distant prayer could heal AIDS. It could not.

The National Center for Complementary and Alternative Medicine, or NCCAM, also helped pay scientists to study whether squirting brewed coffee into someone’s intestines can help treat pancreatic cancer (a $406,000 grant) and whether massage makes people with advanced cancer feel better ($1.25 million). The coffee enemas did not help. The massage did.

“Some of these treatments were just distinctly made up out of people’s imaginations,” said Dr. Wallace Sampson, clinical professor emeritus of medicine at Stanford University. “We don’t take public money and invest it in projects that are just made up out of people’s imaginations.”

via Studying alternative medicine with federal dollars – latimes.com.

For those who are curious about homeopathy:





 

Just Say No: FDA permits marketing of the first hand-held device to aid in the detection of bleeding in the skull

I read that headline and said, “Wow!, finally I won’t need to CT all those patients’ heads!”

FDA permits marketing of the first hand-held device to aid in the detection of bleeding in the skull

Helps to determine if immediate CT scan is needed

The U.S. Food and Drug Administration today allowed marketing of the first hand-held device intended to aid in the detection of life-threatening bleeding in the skull called intracranial hematomas, using near-infrared spectroscopy.

via Press Announcements > FDA permits marketing of the first hand-held device to aid in the detection of bleeding in the skull.

But then, wait, said I, is it any good? Apparently Not:

The FDA granted the de novo petition for the Infrascanner Model 1000 based on a review of data comparing results from 383 CT scans of adult subjects with Infrascanner scan results. The Infrascanner was able to detect nearly 75 percent of the hematomas detected by CT scan. When CT scans detected no hematoma, the Infrascanner detected no hematoma 82 percent of the time. The Infrascanner Model 1000, however, is not a substitute for a CT scan.

Anyone considering purchasing one of these based on those numbers? If so, I’ll sell you a random number generator for 1/2 of what they’re asking.

Stated another way, this device will miss more than 25% of intracranial hematomas that are present, and will tell you it’s there when it’s not 18% of the time.

Not ready for prime time. I feel bad for the detailers who are sent out to see this thing, and worse for the patients it’s used on.

 

Brought to my attention by @EMNews on twitter. (In case you missed it, I’m getting a lot of my bloggable stuff from Twitter. I don’t blog most of what I comment on. Imagine what you’re missing! Get to twitter, and follow me @gruntdoc).

HHS Audits the 1% … and the Rest: First HIPAA Privacy and Security Audits Begin – Davis Wright Tremaine

As the original twitterer ( @NickGenes ) said, “…because there wasn’t enough bureaucracy & expense in healthcare yet”.

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has begun the process of notifying covered entities that they are among the unlucky few who have been selected for the first Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security audits under the Health Information Technology for Economic and Clinical Health (HITECH) Act. …

While the first twenty covered entities have been selected, approximately another 130 remain in this audit round. HHS has indicated that it hopes to continue with proactive audits in the future and expects to become more aggressive in its enforcement of complaints.

via HHS Audits the 1% … and the Rest: First HIPAA Privacy and Security Audits Begin – Davis Wright Tremaine.

Yes, this is HITECH, the Son of HIPAA, but it all started with HIPAA.

Is it worth pointing out that HIPAA exempted itself from the unfunded mandate and paperwork reduction rules when it was enacted? I pointed out then that their assertion that it wouldn’t cause an increase in paperwork, nor was it an unfunded mandate was really unlikely.

How many Millions of dollars and man-hours are we pouring down these regulatory holes?

 

amednews: Law enforcement can access data bank without doctors’ knowledge :: Dec. 13, 2011 … American Medical News

Well, this is good news. Remember that we were assured the information in the NPDB would be protected? Yeah, me too.

And, I don’t understand this move at all.

Law enforcement can access data bank without doctors’ knowledge

The rule, a response to the expansion of the National Practitioner Data Bank, is intended to help prevent evidence tampering.

By Carolyne Krupa, amednews staff. Posted Dec. 13, 2011.

Physicians and other health professionals no longer will be notified if someone accesses information about them through the National Practitioner Data Bank for an investigation, according to a federal rule that takes effect Dec. 23.

The rule, an exemption to the Privacy Act, is meant to prevent tampering with evidence and is limited to law enforcement agencies, said David Bowman, a spokesman for the Dept. of Health and Human Services’ Health Resources and Services Administration, which administers the data bank.

Umm, prevent tampering with WHAT evidence? by the time something’s being put in the NPDB, it’s know about by a lot of folks, and there isn’t any realy opportunity to ‘tamper with evidence’. This sounds exceptionally fishy to me. I need a better explanation than this. (I know I won’t get it).

Oh, and spot the problem with this logic (which I’ll point out after the quote):

Law enforcement agencies are authorized to see information on adverse actions against physicians such as medical board disciplinary actions and peer review sanctions. Such queries make up less than 1% of NPDB queries, with an average of 20 by law enforcement annually, according to the rule (www.gpo.gov/fdsys/pkg/FR-2011-11-23/pdf/2011-30292.pdf).

via amednews: Law enforcement can access data bank without doctors’ knowledge :: Dec. 13, 2011 … American Medical News.

When Law Enforcement was required to notify people they’d had a look at their records, their query rate was less than 1%. Now that they can do it secretly, what will that rate be? We’ll never know.

Fear of Regulation can limit a company

And, it’s not a tiny company with very limited resources, either…

He can’t talk to us because Apple fires employees who talk with the press without permission, but also because the company must walk a fine line in the medical arena. Right now, the U.S. Food and Drug Administration seems set on regulating the software that runs on the iPad, not the device itself, but if the FDA were to decide that Apple is marketing the iPad for regulated medical uses, it could unleash a regulatory nightmare on the company.

Apple has to carefully watch what it says when it talks about the iPad in medicine, says Bradley Thompson, a partner with the law firm Epstein Becker Green and an expert on FDA regulations. As long as they promote it as a general-use computing device, Apple should be fine. But “if they were promoting it for specific medical device uses,” he says, “they would cross a line.”

via Apple’s Secret Plan to Steal Your Doctor’s Heart | Wired Enterprise | Wired.com.

For those who wonder why many of us are against the regulate-everything environment…

Exposing the Cost of Health Care – Technology Review

I really like this idea, but …  well, see after the quote.

It’s easy to compare prices on cameras, vacations, and homes. But in the United States, patients fly blind when paying for health care. People typically don’t find out how much any given medical procedure costs until well after they receive treatment, be it a blood draw or major surgery.

This lack of transparency has contributed to huge disparities in the cost of procedures. According to Castlight Health, a startup based in San Francisco, a colonoscopy costs anywhere from $563 to $3,967 within a single zip code. EKGs can range from $27 to $143, while the price for a set of three spinal x-rays varies from as little as $38 to as high as $162.

When someone else is picking up the tab, mystery pricing is not much of a problem. But these days, even the 59.5 million Americans who get health benefits through large self-insured employers are increasingly expected to pay a percentage of the costs for their medical care.

Castlight aims to do as its name suggests: cast light on the actual costs of medical care, so that people can make informed decisions…

via Exposing the Cost of Health Care – Technology Review.

Finally! Some price transparency! Huzzah! I WANT people to recognize that spending money when there’s no clue to the charge (not cost, charge) is directly responsible for a ton of the runaway cost in medicine.

This is better then nothing. It is, and while I don’t begrudge people making money on their great idea, is this the best model?

The company sells its tool to self-insured employers, who pay a fee per covered member per month, and in turn offer employees access so they can become more responsible users of their benefits. It has raised $81 million in venture funding to date. Current customers include Safeway and Life Technologies, a leading maker of genomics tools.

“Castlight is further along than anybody else in helping big employers show their employees that the individual decisions they make on health care actually do have a cost that affects benefits and wages,” says Matthew Holt, co-chairman of Health 2.0, a health-care consultancy firm.

Okay, better than nothing, and a start in the right direction. Good for them.

 

Mayo Clinic drops Medicare- in 2010

Update: this happened 2 years ago. So, I wrote this thinking it was a new development, but it isn’t. Anyone know how this experiment has played out?

 

I’ve wondered for years if hospital organizations (and big organized clinics) had done the math on whether they could do without Medicare, and apparently Mayo has. More after the quote

President Obama last year praised the Mayo Clinic as a “classic example” of how a health-care provider can offer “better outcomes” at lower cost. Then what should Americans think about the famous Minnesota medical center’s decision to take fewer Medicare patients?

Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.

Mayo says it lost $840 million last year treating Medicare patients, the result of the program’s low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers.

via Medicare and the Mayo Clinic – WSJ.com.

First thought: the docs at the Mayo Clinic must have gotten some amazing assurances from the clinic to drop Medicare for 2 years. (If a physician opts out of accepting medicare, and it’s an all or nothing proposition, and under current law they cannot get their medicare billing back for 2 years. No doubt this was done to keep docs from using their opt-out as political leverage, and then get it restored when payments went the way they wanted).

Second thought: Mayo just became a Concierge Clinic. Interesting.

Third: I’m very interested in knowing what administrative advantages would follow dropping Medicare. EMTALA would no longer apply, but this is a clinic, not a hospital/ED, so I’m not sure that would affect them much. (I may misunderstand the role and capabilities of this Arizona Mayo Clinic, so let me know if I’m wrong here).

There are always strings attached with taking Uncle’s money, and they don’t lessen over time, they compound. I think HIPAA is linked to Medicare, too, so that gigantic unfunded mandate could stop.

Interesting…

The ED of the Future

Let’s say, hypothetically, you could design the ED of the Future. I say hypothetically as there may be a new (like New) ED in my future. Maybe; it sounds like a heck of a challenge. Considering we’re a Trauma Center and currently see nearly 100K/year in volume, and have an admission rate that’s between 18-35%,

What would that new ED look like, from the following viewpoints :

  • the patient
  • the triage nurse (is there one?)
  • the treating nurse
  • the ED doc
  • the consultant
  • the hospital admissions team (billing)
  • the OR
  • the Tele units
  • the Floor units
  • ED discharge areas
  • physical plant

I have a few ideas, but am frankly hamstrung by a lack of ‘out there’ imagination. Let’s hope you’re not similarly limited. Don’t feel like you need to answer all of these, but I’m interested in your ‘out of the box’ ideas…which you’ll get full (if ephemeral) credit for.

Xigris Pulled from Market

The irony here is that Eli Lilly has advanced sepsis care (as a prelude to using their drug), and while Xigris hasn’t panned out, aggressive sepsis resuscitation has.

Eli Lilly is withdrawing drotrecogin alfa (Xigris) from all markets worldwide after a major study failed to show a survival benefit for patients taking the drug.

Xigris should be discontinued immediately in patients currently receiving it and should not be started in new patients, the company said.

The trial with the bad news on Xigris was called PROWESS-SHOCK, a placebo-controlled study with 28-day mortality as the primary outcome and planned enrollment of nearly 1,700 patients.

via Medical News: Sepsis Drug Pulled from Market – in Product Alert, Prescriptions from MedPage Today.

At ACEP the reviewers of this study said it favored placebo over Xigris. Tough to market a very very expensive drug when not using it is better…

Guest Column: Better Care, Thanks to Tort Reform — Health Reform and Texas | The Texas Tribune

Wait, I was told this would Never Work.

Thanks to the passage of lawsuit reforms, medical care is now more readily available in many Texas communities. For many patients, this change has been life-altering; for some, life-saving.

via Guest Column: Better Care, Thanks to Tort Reform — Health Reform and Texas | The Texas Tribune.

Libertarians, Medical Malpractice and Contract | Cato @ Liberty

Interesting think piece on pre-arranged medmal arrangements, and why they won’t currently work…


The one signal fact about the American court system is that, paternalistically, it generally refuses to enforce contractual arrangements of this sort. No matter how well spelled out in advance, courts will not enforce the disclaimer of liability or apply the agreed-on damage limit. You will instead get the malpractice coverage that courts and lawmakers deign to prescribe for you, not the coverage you and your medical provider might have chosen yourselves.

via Libertarians, Medical Malpractice and Contract | Cato @ Liberty.

Best of my ACEP 2011 Twitter feed

If you don’t follow me on twitter, you missed my play by play of the recent ACEP 2011 Scientific Assembly from San Francisco. Several of us attending twittered (and it was terrifically entertaining to meet them and socialize)!

These are trimmed from my tweets ( http://twitter.com/#!/gruntdoc ) and should you be interested, all the Scientific Assembly tweeters were using the hashtag #sa11.

My rough count for the ones I included here is 95. Some are more interesting than others. Enjoy.

Asplin says its harder to collect from high deductible/HSA pts than from self pay. Seems odd. Asplin

1% of population accounts for 30% of all spending in a given year, 5% account for HALF. 20% spend nothing. There’s your problem.Asplin

Understatement: there’s a gap between the vision and the reality of the Medical Home. Asplin

ER docs make the most expensive routine decision in healthcare: admit or home? We have little to no control over readmissions. Asplin

[Read more...]

Army seeking troops bitten by stray animals following rabies death – Army – Stripes

Wow, that is awful beyond belief.

Army seeking troops bitten by stray animals following rabies death – Army – Stripes.

SEOUL – The Army is redoubling its search for anyone who might have been bitten by a wild animal in Iraq or Afghanistan following the Aug. 31 death of a soldier from rabies, the service’s public health command stated Wednesday.

“The death of this soldier is very tragic, and we are taking actions to ensure something like this does not happen again,” Lt. Col. Steven Cersovsky, director of epidemiology and disease surveillance at the Army’s Public Health Command, said in the release.

Spc. Kevin Shumaker, 24, became the first soldier to die from rabies since 1967 after he was bitten by a stray dog in Afghanistan.

Shumaker told his parents that he received three of six necessary rabies shots in Afghanistan, but did not receive the final shots because they were expired, according to a Contra Costa Times report. Shumaker, a 10th Mountain Division soldier, died at Fort Drum, N.Y., eight months after the bite.

“I would not be without my son if the proper treatment was given to Kevin,” his mother, Elaine Taylor, told the newspaper in September.

Prayers for his family.

World’s first malaria vaccine works in major trial | Reuters

Okay, like all of us I want an effective and safe malaria vaccine, and the tone of the article is hopeful. But…

The trial is still going on, but researchers who analyzed data from the first 6,000 children found that after 12 months of follow-up, three doses of RTS,S reduced the risk of children experiencing clinical malaria and severe malaria by 56 percent and 47 percent, respectively.

Loucq said widespread use of insecticide-treated bednets in the trial — by 75 percent of people taking part — showed that RTS,S can provide significant protection on top of other existing malaria control methods.

via World’s first malaria vaccine works in major trial | Reuters.

We’ll have to read the study, but if you’re mixing a change in bednet use AND a new vaccine, well, let’s hope they were measuring what they thought they were.