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4303. Petition to retire the surviving sepsis campaign guidelines. A #FOAMed Movement.

because of a suboptimal rating system and industry sponsorship (1). The IDSA has enormous experience in treating infection and creating guidelines. Septic patients deserve a set of guidelines that meet the IDSA standards. Guidelines should summarize evidence and provide recommendations to clinicians. Unfortunately, the SSC doesn’t seem to trust clinicians to exercise judgement. The guidelines infantilize clinicians by prescribing a rigid set of bundles which mandate specific interventions within fixed (...) . Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Medicine. Electronic publication ahead of print, PMID 29675566. Kanwar M, Brar N, Khatib R, Fakih MG. Misdiagnosis of community-acquired pneumonia and inappropriate utilization of antibiotics: side effects of the 4-h antibiotic administration rule. Chest 2007; 131: 1865-1869. Share this: Like this: Like Loading... Related Post navigation 2 thoughts on “ Petition to retire the surviving sepsis campaign

2018 Thinking critical care blog

4304. Stranger Things are happening in health care

their lobbying efforts, hoping to extend patents and loosen industry regulations, rather than make generics readily available for people who can’t afford high-priced prescriptions. The mood in D.C. felt like a far cry from the socially-conscious, problem-solving optimism I found on the campus of Claremont. In contrast to the students’ energizing, inspirational and refreshing points of view, Washington’s elected officials are focused on how to cut back – not expand – health insurance. Many of them believe (...) , strokes and cancer. And the best way to do that is through highly effective prevention measures, which include controlling blood-pressure, reducing blood lipids and screening for colon cancer. 4. Technology holds massive promise. Technology drives today’s consumer culture. But if you look behind the reception desk of your local doctor’s office, there’s a good chance you’ll see an electronic health record system that fails to make your information available to other doctors and hospitals in the area

2018 KevinMD blog

4305. Poor communication between EHRs is unacceptable. Let’s fix it.

a dormant infection; if our patient was unknowingly infected with tuberculosis (TB), giving our first-line therapies could lead to a disseminated infection — even death. The other hospital had already performed the necessary tests, including a TB culture from the patient’s lung fluid. Unfortunately, because the other hospital used a different electronic health record (EHR) system, it could not send us the patient’s updated digital health record. Instead, it sent us an 80-page printout with the TB result (...) in enabling information exchange, regulatory bodies must be proactive about mandating compliance. Mandating standards for EHR interoperability by a specific time point–akin to the Environmental Protection Agency’s requirement for automotive manufacturers increase fuel economy standard to 54.5 mpg by 2025 — will light the fire under companies’ feet to ensure that their systems meet the prescribed goal. Another solution would be to create a single, unified EHR system contracted, ideally, to a private

2018 KevinMD blog

4306. The patient-physician relationship is in critical condition

. The cost of running a small practice is not feasible for many now due to ever-changing regulations, electronic medical record requirements and lower reimbursement for services. There are certainly benefits to larger health care organizations, such as more collaboration opportunities and convenience-of-care coordination for patients. However, physicians must continue to do what is right medically and lead rather than follow when it comes to delivering health care. Despite shifting practice demographics (...) , the larger problem we face collectively is a lack of unity. All too often, we are competing rather than collaborating. The turf battles between specialists and protecting our territory hurt physicians. Yet, we fall in line with regulations imposed on all of us which we know are illogical. We have become customer service specialists, held to the most stringent patient satisfaction expectations, even when doing the right thing medically opposes this. For example, if prescribing an opioid is clearly

2018 KevinMD blog

4307. Unintended consequences of health policies – heeding HL Mencken and Gary Klein

; there is always a well-known solution to every human problem—neat, plausible, and wrong.” ( When policy wonks and legislators and rule makers seek to solve problems in medicine they seemingly forget this admonition. Here are 3 examples of poorly considered solutions: Electronic health records – in the abstract this seems like an obvious idea. But the problem they address is very complex and we had to adopt them before they were really ready to make practice (...) . Myriad rules restricting physician prescribed opioids. My colleague Stephan Kertesz (and his national associates) have written extensively on this topic. Here is one example article – How does one avoid these problems? I have written previously about Gary Klein’s pre-mortem exam process. The concept is rather straightforward. Before one starts a project (and each of the examples I cite are actually projects meant to improve health), you bring in front line people (in health, physicians, nurses

2018 db's Medical Rants blog

4308. Doctors overcorrect too often

mg of warfarin. The doctor orders 7.5 mg daily without seeing that two months ago when the patient was given that dose, the INR shot up to 3.9. Even electronic medical records sometimes display the current value (and/or the place to order and “sign off” on it) in a whole different area from where we see historical values and dosing (Any reference to Greenway or eClinicalWorks here is purely coincidental). This causes a risk for overcorrection very much like my winter driving example. The same (...) been incidents of high potassium, causing physician worry and subsequent emergency prescriptions for the diarrhea-causing rescue medication. Looking back and forth in time, I realized that the patient’s kidney numbers had fluctuated in the same range two years before and two years after the stopping of the fluid pill. I restarted it and didn’t expect to have to fuss with high potassiums again. I believe this was another case of myopic laboratory analysis. Some amount of testing is necessary

2018 KevinMD blog

4309. The Painful EHR Transition

The Painful EHR Transition The Painful EHR Transition | The Skeptical Cardiologist Primary Menu Search for: The Painful EHR Transition For the past 6 weeks I and the several hundred other ambulatory physicians who belong to the St. Luke’s Medical Group have been going through a difficult transition; we’ve changed the software that we use to manage patient information. Seven years ago we made the painful transition from paper patient charts to an electronic health record (EHR) called eClinical (...) Works. This process required lots of scanning but by 2015 when i wrote “ ” I had become very facile and comfortable with the software. During this current transition to an EHR called Cerner, we had to drastically reduce the number of patients seen per day in the office as we learned how to streamline workflow and as bugs were worked out of the system. We have struggled mightily with the simplest of tasks such as renewing patient prescriptions, scheduling tests, or reviewing test results. Stress

2018 The Skeptical Cardiologist

4310. For mild hypertension in low-risk adults, harms of drug therapy outweigh benefits

. A recently published in JAMA Internal Medicine sought to clarify the benefits and harms of drug therapy in low-risk adults with mild hypertension using data from 40,000 patients in an electronic health records database in the United Kingdom. The authors compared the outcomes of persons aged 18 to 74 with mild hypertension who were prescribed anti-hypertensive medications within 12 months of diagnosis to those in similar untreated persons. Persons with a history of CVD, left ventricular hypertrophy

2018 The AFP Community Blog

4311. We need to make better use of the health team and technology

can do Perhaps there is something in the patient-centered medical home that can help move these things forward. Maybe it would help if a patient’s visit to the doctor’s office actually began before they arrive, with the electronic health record reminding them of health care maintenance items that need attention, testing they are due for, and then a way to think in advance about any prescriptions they need, any referrals they need, any forms that need to be filled out, and then a way to list out (...) in the electronic health record portal, wearable devices that nudge you to do what’s right, beeps and whistles on your cellphone, even financial penalties or rewards, seemed to do little to move our patients away from unhealthy behaviors towards what we think are the best things for their health. Doing the right thing now for the reward of health many decades in the future, is clearly a barrier built into our human nature, and one which we as a health care team are challenged to try to overcome. What the team

2018 KevinMD blog

4312. A conversation with a Rigvir flack

existing registration, but unfortunately your analysis is used to doubt the registration. Which is off course strange, because nowhere in the world rules and regulations (in our case standards for clinical trials) are used with backward date. Yes for new registrations - we know the rules – we will provide proper RCT data, but as for now, please respect that the medicine is prescription medicine that is prescribed only in national clinics and by certified doctors for last 13 years. They have (...) trials and most of the evidences is not published. Doctors and clinics in Latvia use this medicine for majority of melanoma patients in Latvia for many years. In Latvia medicine is prescribed only in national clinics and by certified doctors and they have also other alternatives, so probably they know what they do. 2 years ago we started EMA (centralised EU) commercialisation process and even obtained EU commission support from Horizon2020 grant, we also obtained EMA regulatory advice

2017 Respectful Insolence

4313. We have to deal with the trauma in veterans early on

elsewhere. They got admitted, I took the best care of them that circumstances would allow for whatever I thought they needed. In the community hospitals and in the office, I shared patients with the VA. And people came by who just happened to have been in the army as young adults but were pretty mainstream after that, going to college, joining a union or seeking jobs as they became available. As prescriptions became more expensive, the VA would often supply medicines to veterans like my father who saw (...) the doctor or nurse practitioner as a precondition for having the prescription supplied but regarded physicians external to the VA as their doctors. With systems, particularly governmental ones, process often becomes excessive. This being an important medical center initiative, the VA’s physician representative for this project presented our academic year’s first grand rounds. He extensively outlined process. Every patient admitted to the hospital would have a complete military history, where they served

2018 KevinMD blog

4314. Why physicians should embrace fitness trackers

Why physicians should embrace fitness trackers Why physicians should embrace fitness trackers Why physicians should embrace fitness trackers | | October 18, 2018 10 Shares I mused while staring blankly towards the electronic tracking board, where I foresee reading the triage call “My tracker said, I have AFib.” I delved into what is in my armamentarium to handle this crisis of the digital age. The stethoscope around my neck suddenly seemed archaic. We the physicians have resigned (...) to the redundant clicks on the electronic medical records (EMR). While still recovering from this inescapable occupational hazard of the new digital documentation, a technological surge of broadband-enabled technology has inundated us. These have surfaced as ingestible, wearable and embeddable based on the route of placement. Are, we physicians, labeling the data provided by them as patient health information (PHI)? The consumer benefits from the tracking devices in making healthy lifestyle changes and goal

2018 KevinMD blog

4315. EHRs are killing medical innovation

against diseases and optimized preventive, medical, surgical and palliative care outcomes. The gift of giving clinicians time to gaze, dream and work together to apply the art and sciences of medicine towards the advancement of health care innovation has been stolen by electronic health records (EHR) and insurance company prior authorization (PA) rationing industries. When EHRs were first introduced, health information technology seemed like a sound idea. Patient personal medical health information (...) and clinical experience to optimize preventive, medical, surgical and palliative outcomes and costs for their patients and their families. Physicians perform histories and physical examinations often resulting in prescriptions for medications, diagnostic orders, specialist referrals or recommended treatments to optimize prevention, medical, surgical and palliative outcomes for patients and their families. This science of the physician-patient interaction combined with the art of empathy is the essence

2018 KevinMD blog

4316. What is the perfect fee-for-service system?

of the treatments patients receive) accounts for 50 percent of the spending increase, followed by the increase in the size of the U.S. population (23.1 percent), and the aging of the population (11.6 percent). “Changes in service utilization were not associated with a statistically significant change in spending.” The takeaway from this study is that to lower U.S. health care expenditures, we must combat out-of-control pricing for prescription medications, medical testing, and hospital stays, and, dare I say (...) on today’s clunky electronic medical record systems to collect such data, further shifts a doctor’s focus towards compliance and away from patient care. The result is rampant burnout in the medical community, not better care. The first step towards better care in the U.S. is the removal of the excessive administrative burdens created by the U.S. government (E&M payment coding, HIPAA, MACRA, etc.), and insurance companies (prior authorizations, excessive denials). The next step is to develop usable

2018 KevinMD blog

4318. Doctors: Don’t forget to take care of yourselves

record, we oftentimes look at some action that we’re ordering for them and say, “Hey, don’t I need to do that?” When was the last time that you, a health care provider who knows best, saw your own primary care provider? Are you prescribing medicines for yourself, or having one of your partners send in prescriptions for you? Ordering your own labs, and reviewing them yourself? I guess all I really want to say is, to take care of everyone else we do need to take care of ourselves, especially as we try (...) , heal thyself” and William Osler’s quote, “The doctor who treats himself has a fool for a patient,” you probably have a recipe for disaster, or at least poor care. I can imagine that as each of us sits with our patients and struggles with them to get their health care maintenance items “up-to-date”, while we are simultaneously managing their acute and chronic medical conditions, trying to deal with our daily administrative and regulatory requirements, and navigating the lumbering electronic health

2018 KevinMD blog

4319. Should You Take An Antioxidant (Supplement or Vitamin) To Prevent Or Treat Heart Disease

in the 1950s suggested that excess free radicals generated by oxidative processes could be responsible for the chronic degenerative diseases of aging. Oxygen, which is essential to animal life, undergoes processing in cells which creates unstable free radicals. Free radicals are short an electron and seek other molecules which can donate an electron and make them more stable. This process is termed oxidation. The molecules produced by oxidation play an important role in a a number of biological processes (...) such as the killing of bacteria and in cell signaling. These same unstable molecules, however, have been implicated in a number of deleterious processes as they can participate in unwanted side reactions and create cell damage. Thus, too many free radicals have been implicated as potentially causal in diseases ranging from cancer to cardiovascular disease to dementia. Antioxidants can reduce damage from free radical reactions because they can donate electrons to neutralize free radicals or their offspring without

2018 The Skeptical Cardiologist

4320. I didn’t become a physician to do data entry

I didn’t become a physician to do data entry I didn't become a physician to do data entry I didn’t become a physician to do data entry | | August 18, 2018 6K Shares The trouble began when I needed to open the electronic health record (EHR) system for the tenth time that day. EHRs have significantly changed the way we practice medicine. They have completely eliminated the need for storage and transport of paper charts, reduced prescription errors secondary to illegible handwritings of physicians (...) clinical information without having bloated notes and cluttered screens that are catered for easy billing and coding. Clinicians together with hospital administrators and information technology professionals should be actively involved in the development, testing and optimization of new electronic features to streamline the workflow. For me, there will be no joy in the practice of medicine until my frustrating rendezvous with EHRs end. The names used in essay have been modified to maintain anonymity

2018 KevinMD blog

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