June 28th, 2011 by American Journal of Neuroradiology in Research
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Gray matter (GM) damage, in terms of focal lesions,1 “diffuse” tissue injury, and atrophy is a well-known feature of multiple sclerosis (MS). Recently, T1-hyperintensity on unenhanced T1-weighted sequences has been found in the dentate nuclei of patients with MS with severe disability and high T2 lesion load.2 Such an abnormality has been interpreted as an additional sign of the neurodegenerative processes known to occur in the course of MS. This report describes a patient who, despite being mildly disabled and having a low T2 lesion load and no evident brain atrophy, showed a bilateral dentate nucleus T1 hyperintensity.
The patient was a 44-year-old man who had a diagnosis of relapsing-remitting MS (RRMS) in September 1997, after 3 relapses that occurred in June 1995, March 1997, and September 1997. Brain and cord MR imaging and CSF examination were suggestive of MS. After the diagnosis, he started treatment with interferonβ-1α, with clinical stability until January 2009, when he complained of vertigo, which gradually resolved after 5 days of steroidtreatment (methylprednisolone, 1 g daily intravenously). In September 2010, he entered a research protocol and underwent neurologic and neuropsychologic (Rao Brief Repeatable Neuropsychological Battery) evaluations and brain MR imaging on a 3T scanner. The neurologic examination showed Read more »
*This blog post was originally published at AJNR Blog*
June 26th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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McKinsey Quarterly has reported its survey concluding there will be a radical restructuring of employer-sponsored health benefits (ESI) as a result of President Obama’s following the 2010 passage of the Affordable Care Act.
Healthcare insurance rates have already skyrocketed as a result of anticipating the conditions of Obama care. President Obama has been powerless to do anything about the increases.
Thirty percent (30%) of companies providing ESI to their employees will drop healthcare insurance coverage once Obama care takes effect in 2014.
The survey included 1300 employers providing ESI across industries, geographies, and employer sizes. Other surveys have found that as we get closer to 2014, President Obama’s Healthcare Reform Act will provoke a much greater number of employers to drop employer sponsored healthcare insurance.
The penalty for not providing healthcare insurance coverage is much cheaper than providing healthcare coverage.
McKinsey’s survey suggests that when more employers become aware of the new economic and social incentives embedded in Obamacare the percentage of employers dropping ESI will Read more »
*This blog post was originally published at Repairing the Healthcare System*
June 26th, 2011 by DrWes in Opinion, Research
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Alright doctors, time to give up the cell phones. (Never mind that there has not been a study linking cell phones and hospital acquired infections).
From the American Journal of Infection Control:
A cross-sectional study was conducted to determine bacterial colonization on the mobile phones (MPs) used by patients, patients’ companions, visitors, and health care workers (HCWs). Significantly higher rates of pathogens (39.6% vs 20.6%, respectively; P = .02) were found in MPs of patients’ (n = 48) versus the HCWs’ (n = 12). There were also more multidrug pathogens in the patents’ MPs including methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Escherichia coli, and Klebsiella spp, high-level aminoglycoside-resistant Enterococcus spp, and carabepenem-resistant Acinetobacter baumanii. Our findings suggest that mobile phones of patients, patients’ companions, and visitors represent higher risk for nosocomial pathogen colonization than those of HCWs. Specific infection control measures may be required for this threat.
What specific measures might they consider?
They better be careful what they wish for or they might also have to take away all those dirty EMR computer keyboards, too.
*This blog post was originally published at Dr. Wes*
June 26th, 2011 by Toni Brayer, M.D. in Health Policy, Opinion
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An article by Brian Klepper and Paul Fischer at Health Affairs has me all fired up. Finally these two health experts are calling it like it is. The Wall Street Journal, New York Times and EverythingHealth have written before about the way primary care is undervalued and underpayed in this country and how it is harming the health and economics of the United States.
A secretive, specialist-dominated panel within the American Medical Association called the RUC has been valuing medical services for decades. They divvy up billions of Medicare and Medicaid dollars and all insurance payers base their reimbursement on these values also. The result has been gross overpayment of procedures and medical specialists and underpayment of doctors who practice primary care in internal medicine, family medicine and pediatrics). These payment inequities have led us to a shortage of these doctors and medical costs skyrocket as a result. As Uwe E. Reinhardt says, “Surely there is something absurd when a nation pays a primary care physician poorly relative to other specialists and then wrings its hands over a shortage of primary care physicians.”
Klepper, Fischer and author Kathleen Behan make a bold suggestion. Let’s quit complaining about the RUC and their flawed methodologies. Let’s quit admiring the problem of financial conflicts of interest and the primary care labor shortage. It’s time for the primary care specialty societies, Read more »
*This blog post was originally published at ACP Internist*
June 26th, 2011 by AndrewSchorr in Health Tips, True Stories
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Hi! Greetings from Breckenridge, Colorado. At 10,000 feet, I am told it is the highest resort town in North America. The Rocky Mountain scenery is breathtaking. But there’s a problem for about one in four of us who visit here, especially people like me who live at sea level. We can get hit with high altitude sickness and a few days ago, I was one of the unlucky ones.
What happens is your body isn’t used to the thin air and your blood has difficulty getting enough oxygen to your body. It usually happens at altitudes over 8,500 feet. You get an ongoing headache, you feel tired, you have insomnia (I was sleepless for two nights!), you could have nausea and certainly fatigue. Drinking lots of water and passing up alcohol can help, but even then some people have problems.
When I finally saw a family doctor – Doctor P.J. – he told me it’s genetic. Some people have trouble “acclimatizing” and others don’t, but there’s no easy way to know who will be affected before you make the climb. Now that I know I have difficulty I will take a prescription medicine (Diamox) ahead of coming up here again.
Doctor P.J. says even Read more »
*This blog post was originally published at Andrew's Blog*
