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Latest Posts

Hand-Held Device To Aid In The Detection Of Intracranial Hematomas: Ready For Prime Time?

I read this 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? Read more »

*This blog post was originally published at GruntDoc*

E. Coli Outbreak Is Traced Back To Ready-To-Bake Cookie Dough

The investigation of a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (STEC) that sickened 77 people and hospitalized 35 was traced back to ready-to-bake cookie dough, prompting infectious disease specialists to ask for stronger pasteurization and more consumer warnings.

like smack by Robert S. Donovan via Flickr and a Creative Commons licenseA report in Clinical Infectious Diseases outlined the outbreak and the work done by national and local health officials to track down the source.

No single source could be identified for certain for the outbreak. But one brand of dough was present in 94% of cases, and three nonoutbreak STEC strains were isolated from it, leading to a recall of 3.6 million packages of the cookie dough.

The detective work began with May 19, 2009, through PulseNet, the network of public health and food regulatory agency laboratories coordinated by the CDC. It identified Read more »

*This blog post was originally published at ACP Internist*

Making Discoveries About Type 1 Diabetes From Long-Term Survivors

It’s hard to imagine what it was like to live with type 1 diabetes 80 years ago. Insulin was a brand new and relatively untested drug, the only way to check blood sugar levels was by testing boiled urine, syringes had to be sterilized, and needles sharpened by hand. Couple those challenges with the common complications of diabetes—heart disease, kidney failure, nerve damage, blindness, and more—and life expectancy for someone with type 1 diabetes wasn’t that long.

Spencer M. Wallace, Jr., was diagnosed with type 1 diabetes in 1931, at age 7. He’s now an active 87-year-old who plays golf several times a week. He isn’t alone as a long-term survivor. Since 1970, almost 3,500 men and women who have lived with the disease for a half century have been recognized by the Joslin Diabetes Center in Boston with bronze 50-year medals. Forty-five of them Read more »

*This blog post was originally published at Harvard Health Blog*

Majority Of California Children’s Hospitals Found To Offer Unhealthy Meals

A study published in the journal Academic Pediatrics reveals that 93% of California children’s hospitals offered unhealthy food to outpatients, visitors and staff in the cafeteria and snack bars.  Said another way, only 7% offered healthy food.  What did these foods consist of to be called “unhealthy”?  Try fried food, sweetened beverages, burgers and lots of sugary sweets.

The study found that 81% of the cafeterias placed high-calorie, high-sugar items like ice cream right by the cash register, a well known marketing plan to tantalize and increase selection.  Forty four percent didn’t even offer low calorie salad dressing and fewer than 1/3 had no nutrition information.

Health care workers, like the rest of America, suffer from increasing obesity.  One study showed over 54% of Read more »

*This blog post was originally published at EverythingHealth*

Study Explores New Method Of Fluorescing Cancer Cells In Tumors

00299er743jf73u Two months ago we reported on the first ovarian cancer surgeries performed with fluorescence guidance. As described in the Nature Medicine paper, the international team of researchers from The Netherlands, Germany, and Indiana used folate coupled to fluorescein isothiocyanate (FITC) to make ovarian cancer cells glow so they could be easily identified.

Now, in this week’s issue of Science Translational Medicine, another international team from Japan and Maryland reports their development of a spray-on probe that may provide even better sensitivity and fluorescent contrast than the folate-FITC counterpart. The editors of STM summarize this work well in the following note: Read more »

*This blog post was originally published at Medgadget*

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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