Policy, Ethics, Education Archives - Page 4 of 9 - PulmCCM
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Policy, Ethics, Education Articles

Jun 222012
 
Palliative care exploding in U.S. hospitals (AP)

Hospitals added palliative care services at a feverish pace throughout the 2000s, the Associated Press reported in a piece picked up by news outlets across the U.S. in June. While 658 hospitals reported having palliative care programs in 2000, 1,568 reported they offered palliative care services in 2009 — that’s over 60% of the hospitals [… read more]

Jun 142012
 
Most clinical trials are too small, often underpowered

The past decade has seen an explosion in the number of clinical trials; there are now more than 10,000 new trials registered each year. Although clinical trials’ quality is improving somewhat, most are still small and single-center and a large proportion do not adhere with reporting requirements, raising serious questions as to what we are [… read more]

Jun 092012
 
COPD self-care program fail; unexplained deaths at VA hospitals (RCT)

Chronic diseases like chronic obstructive pulmonary disease (COPD) account for at least 2/3 of medical care spending in the U.S. Policy makers, payers, and many physicians recognize that the outpatient clinic-based model is poorly suited to provide support in between physician visits, when most complications or exacerbations occur. Many hospitalizations and decline in function could [… read more]

May 242012
 
U.S. Gov't purse strings may be tightening on GME programs

(image: arstechnica) The Centers for Medicare and Medicaid Services fund graduate medical education (GME) in the U.S. through payroll taxes — to the tune of $9.5 billion per year. Only a portion of that actually goes to paying house staff salaries, though. The rest, academic medical centers have traditionally been free to spend more or [… read more]

May 232012
 
For some LTAC patients, pessimism is the new kindness

(image: flickrCC) Half of patients transferred to long-term acute care facilities (LTACs) on prolonged mechanical ventilation will die within a year, according to a 2010 review. Only a small minority will ever go home without needing significant caregiver assistance. For those over age 65, the prognosis is even worse. It seems rude, or even cruel, [… read more]

May 172012
 
Where's the respect (and $$) for critical care research?

(image: Suburban Wino) Craig Coopersmith of Emory is an amazing guy and a prolific investigator in critical care — and it looks like he’s fed up with having his grants rejected. After some epic bean-counting, his group concludes that critical care research gets short shrift in federal research funding, compared to the huge amounts spent [… read more]

May 162012
 
Tattletales rain on private cardiologists' cash-grabbing parade

Did you know that about half of cardiologists’ $400,000+ average income comes from self-referring patients to undergo imaging studies on scanners owned in part or in whole by the physicians themselves? This type of arrangement violates the spirit but not the letter of the Stark Law, created in 1992 to address the inevitable economic and medical inequities that result when physicians are permitted [… read more]

May 102012
 
How to bill for palliative care in the ICU ... legally (Chest)

Reimbursement for Palliative Care in the ICU By Intensivists To an intensivist, providing palliative care often means having multiple time-consuming and emotionally challenging interactions with families struggling to cope with the impending loss of their loved one. The emotional content of these interactions can be strongly positive, negative, or somewhere in between, but frequently it’s [… read more]

May 052012
 
Fellows: This is your brain on protocols (JAMA)

(image: flickrCC) Do protocols make trainees’ brains go soft? That’s the assertion of more than a few crusty hard-liners who miss the good old days — when you got 2-liter tidal volumes for your ARDS and liked it, dad-gum-it!! Prasad et al can’t say whether critical care fellows can actually run ventilators in the post-protocol [… read more]

May 022012
 
Cost shifting of asthma meds to patients had little effect on adherence, outcomes (JAMA)

(image: flickrCC) Health insurance plans are shifting an increasing portion of costs for prescription medications onto patients. A recent study in JAMA concluded that such cost shifting decreased asthma medication use and increased hospitalization rates in U.S. children. But the effect, if real, was small. What They Did Pinar Karaca-Mandic et al looked back at [… read more]

Apr 242012
 
How to make $25,000 on each EBUS (Chest)

(image: flickrCC) Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), when performed by skilled physicians, reduces the need for mediastinoscopy and unnecessary thoracotomies with their associated morbidity, and is poised to permanently alter the landscape of lung cancer diagnosis and staging. Prior to 2008, Medicare seemed to recognize the potential value of EBUS by paying hospitals [… read more]

Apr 202012
 
Texting resident fails to stop warfarin; hemopericardium ensues

Texting while doctoring is a newly hyped threat to patient safety. Multitasking and the constant flow of new distracting information in the form of alarms, interruptions, pages, etc. have always been inherent to the practice of medicine. But some are wondering if the ubiquitous temptations of personal social media-enabled smartphones and tablets in the medical [… read more]

Apr 172012
 
Most oncologists dump end-of-life talks on other MDs (Ann Intern Med)

(image: Plioz.com) Ever cared for that patient with metastatic cancer in your ICU, intubated for acute respiratory failure and surrounded by a bewildered and stressed family who cope by emotionally blaming you, the intensivist, because “He just saw his oncologist last week, and he said everything was OK!”? Forcing you to begin painful end-of-life discussions [… read more]

Apr 122012
 
Release the data on Relenza and Tamiflu, Cochrane implores Pharma (NYT)

Antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) made big bucks for Roche and GSK respectively during the H1N1 influenza pandemic: Roche reportedly sold  about $3 billion of Tamiflu in 2009. Although sales have dropped off precipitously, the drugs are still recommended by CDC for serious cases of seasonal influenza. But do Relenza and Tamiflu even [… read more]

Apr 112012
 
Lack of ICU beds has no effect on mortality ... in Canada? (Arch Intern Med)

What happens when the “Rapid Response Team” is called for an acutely deteriorating patient, but there’s no ICU bed available to send her to? In Alberta, Canada, not much, apparently. Henry Stelfox, Brenda Hemmelgarn, and Braden Manns analyzed 3,494 consecutive patients with “Code MET (medical emergency team)” rapid-response activations in Calgary between 2007 and 2009. [… read more]

Apr 052012
 

A large proportion of primary care doctors were easily fooled by numbers that seemed to support cancer screening, but were actually irrelevant. Just as bad, they ignored data supporting screening that would genuinely save lives, in a questionnaire simulation published in the March 6 Annals of Internal Medicine. 412 primary care docs were given surveys testing [… read more]

Apr 052012
 

The Joint Commission (previously called “JCAHO”) launched its new “Tobacco Cessation Performance Measure Set” on January 1, 2012. Like most New Years’ resolutions, we all promptly ignored it. But it’s time to pay attention — your hospital might be. Wasn’t there already a smoking cessation performance measure? Yes, in 2004 hospitals were required to report the proportion [… read more]

Apr 022012
 

This post was featured on KevinMD.com; an excerpt follows. “Full code” is the universal default status for patients who haven’t chosen otherwise. Yet I suspect most physicians believe this policy is wrong. We feel in our hearts we’re doing harm when we perform CPR on poor souls whose bodies are trying to naturally end their [… read more]

Apr 012012
 

You might think you’re just writing a prescription and signing your name. But the innocent ink (or pixels) you leave behind in your daily routine turns into liquid gold for an entire industry that makes big profits from understanding and interpreting your behavior to pharmaceutical and insurance companies. As Lawrence Gostin points out in a [… read more]

Mar 252012
 

“The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care,” writes Ezekiel Emanuel, Obama’s former health care advisor who’s now back at University of Pennsylvania in a big-thinker job spanning ethics, economics and medicine. In a JAMA essay with co-author Viktor Fuchs, they opine that [… read more]