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Latest Posts

What Will Increase Flu Vaccination Rates?

Health care facilities should consider mandatory flu vaccinations for their employees if other attempts don’t increase rates to 90%, a draft statement from a U.S. Department of Health and Human Services (HHS) working group stated.

All public health services, HHS staff and Federally Qualified Health Centers should follow suit, stated the Health Care Personnel Influenza Vaccination Subgroup in draft recommendations.

The working group released five steps to boost vaccination rates:
–Employers should establish comprehensive flu infection prevention programs as recommended by the Centers for Disease Control and Prevention (CDC) to achieve the Healthy People 2020 influenza vaccine coverage goal of 90%.
–Employers should integrate flu vaccination programs into their existing infection prevention programs.
–HHS should encourage CDC and the Centers for Medicare and Medicaid Services to standardize the methodology used to measure Read more »

*This blog post was originally published at ACP Internist*

CDC Works To Eradicate Polio Around The World By The End Of 2012

Men painting billboard for polio vaccination campaign

Polio is a crippling and potentially fatal infectious disease that is completely preventable. Since 1988, members of the Global Polio Eradication Initiative (GPEI), including CDC, the World Health Organization (WHO), Bill and Melinda Gates Foundation, Rotary, and UNICEF, have teamed up to eradicate polio world-wide through large scale vaccination efforts. Global polio cases are down more than 99% since GPEI began. We were able to completely eradicate the disease in the Americas by 1994 and protect our children. By 2006, polio was endemic in only four countries: Read more »

*This blog post was originally published at Public Health Matters Blog*

Free And Convenient Flu Vaccines Increase Vaccination Rates In Healthcare Workers

Far more health care workers got flu vaccines this year than at the same point last year, according to a survey by the Centers for Disease Control and Prevention, although rates are still far less than ideal.

While flu vaccination rates among health care professionals have risen slowly over the past decade, less than half this group were vaccinated until the 2009-10 season, when an estimated 62% of health care workers received seasonal flu vaccines and an additional 2% of workers got only the H1N1 influenza vaccination, the report said. In the 2010-11 season, 63.5% of health care professionals reported flu vaccination.
The Advisory Committee on Immunization Practices recommends that all health care professionals get the flu vaccine every year, and the national Healthy People 2020 objective for health care professionals influenza vaccination is 90%. Read more »

*This blog post was originally published at ACP Hospitalist*

The Importance Of Promoting Good Science And Medicine In Journalism

Sheril Kirshenbaum, research associate at the University of Texas Austin’s Center for International Energy & Environmental Policy, blogged this week under the headline, “Battle Hymn of the Science Journalist.” Excerpt:

There are many excellent science journalists who inhabit the blogosphere and those mainstream news outlets that still feature science sections. These talented individuals want to share your story, your research, and they appreciate and value what you do.

However, there are also a lot of horrible journalists making the rest of us look bad.. Writers who care less about getting it right, and more about trumping up controversy. Journalists whose headlines are notoriously misleading or false. Some Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Vaccine For HPV May Prevent More Than Cervical Cancer

Oropharyngeal cancers caused by the human papillomavirus (HPV) are on the rise in the United States since 1984, as changes in sexual habits further the virus’ spread. But the focus of the HPV vaccine will remain on preventing genital warts and cervical cancer.

Reuters reported one clinician’s opinion that throat cancer linked to HPV will become the dominant cause of the disease, ahead of tobacco use.

To study the issue, researchers determined HPV-positive status among 271 of all 5,755 oropharyngeal cancers collected by the three population-based cancer registries in Hawaii, Iowa and Los Angeles from the Surveillance, Epidemiology, and End Results (SEER) program from 1984 to 2004. Prevalence trends across four calendar periods were estimated by using logistic regression. The study appeared online Oct. 3 in the Journal of Clinical Oncology.

HPV prevalence Read more »

*This blog post was originally published at ACP Internist*

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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