June 25th, 2011 by AnneHansonMD in Health Policy, Opinion
1 Comment »
From the New York Times today we have a story entitled, “A Schizophrenic, A Slain Worker, Troubling Questions,” a horrible story about a mentally ill man who killed a social worker in his group home. The story highlights the defendant’s longstanding history of violence with several assaults in his past. He once fractured his stepfather’s skull and his first criminal offense involved slashing and robbing a homeless man. (On another post on this blog Rob wondered why the charges were dismissed in that case; from experience I can tell you it’s probably because the victim and only witness was homeless and couldn’t be located several months later when the defendant came to trial.) The defendant, Deshawn Chappell, also used drugs while suffering from schizophrenia. Before the murder he reportedly stopped taking his depot neuroleptic and was symptomatic. The news story also suggested that he knew he was committing a crime: he got rid of the body, disposed of the car and changed out of his bloody clothes. Nevertheless, he was sufficiently symptomatic to be found incompetent to stand trial and was committed to a forensic hospital for treatment and restoration. At his competency hearing the victim’s family thought that the defendant was malingering his symptoms, while the victim’s fiance was distraught enough that he tried to attack Chappell in the courtroom. The point of the Times article appears to be an effort to link the crime to cuts in the Massachusetts mental health budget.
So what do I think about this story? Read more »
*This blog post was originally published at Shrink Rap*
June 24th, 2011 by DrRich in Health Policy, Opinion
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Podcast:
In an article appearing last week in the American Heart Journal, investigators concluded that if American doctors would prescribe for their patients with heart failure each of the six therapies which are most strongly recommended in current heart failure guidelines, 68,000 lives per year could be saved.
The following (for the interest of the reader, and for the convenience of any attorneys who may follow DrRich’s offerings), is an ordered list of these six proven, life-saving heart failure therapies, along with the number of American lives that could be saved each year if only American doctors would stop grossly under-utilizing them in violation of published guidelines:
- aldosterone antagonist therapy – 21,407 lives
- beta blockers – 12,922 lives
- implantable defibrillators (ICDs) – 12,179 lives
- cardiac resynchronization therapy (CRT) – 8317 lives
- hydralazine plus isosorbide – 6655 lives
- ACE inhibitors or angiotensin receptor blockers (ARBs) – 6516 lives
The authors, of course, are careful to point out that their analysis is based on statistical methods, and thus must be counted as merely estimates of the magnitude of the benefit that would actually occur should American doctors suddenly begin managing their heart failure patients appropriately. (Their presentation of these estimates to five significant figures implies a level of precision far in excess of what can be justified, and therefore must be an oversight not only by the authors, but also by the reviewers and the editors. But still, one gets the idea. A lot of preventable deaths are being left on the table.)
Several studies have reported, over and over again, that fewer than half of American patients with heart failure Read more »
*This blog post was originally published at The Covert Rationing Blog*
June 24th, 2011 by Linda Burke-Galloway, M.D. in Research, Video
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One of the most dreaded complications in obstetrics is a stillbirth that is defined as the absence of life upon delivery of the baby. There are approximately 3million stillbirths that occur each year globally and one-half million in the U.S. In developing countries, the most common reasons of stillbirths were prolonged labor, pre-eclampsia and infections whereas in the U.S., the most common causes are abnormal genes, abnormal growth (aka growth restriction) and maternal diseases. According to medical studies, unexplained fetal loss is the most common reason for stillbirths that occur after 28 weeks. Risk factors for stillbirth include women who have infections, abnormal chromosomes, genetic disorders and umbilical cord complications. Race and socioeconomics also play a role. Black women have twice the risk of having a stillbirth as Caucasian women. Smoking and advanced maternal age also poses an increased risk.
Until recently, there are no screening tests available to see if a woman was carrying a baby at risk for stillbirth. However, a medical study presented at a conference reported that stillbirths can now be predicted using Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
June 24th, 2011 by John Mandrola, M.D. in Health Tips, Opinion
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Not every Friday brings doctoring bliss. Sorry.
Some Fridays, the wrongness of our healthcare approach squeezes you like a vice-grip.
The medical news of the week can hit you hard.
–This highly tweeted report on how Overweight is the new normal speaks to the futility of asking people to help themselves. That our strong, vibrant, and proud citizenry is succumbing to fatness saddens me deeply. Building wider doors, heavier toilets and restaurant seats without armrests is the wrong approach to fighting obesity.
–We also learned this week that the advancing fury of medical therapeutics cannot counter high rates of obesity, smoking and inactivity. The WSJ health blog reports life expectancy in some Southern US counties trails that of El Salvador and Latvia.
–The nation’s chief doctor prescribes prevention over treatment, and no one retweets her. Silence.
–And the final egg on the face of wellness was this warning from the FDA: Read more »
*This blog post was originally published at Dr John M*
June 24th, 2011 by MotherJonesRN in Opinion
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Check out this nurse’s erect posture and direct eye contact. Just one look tells you that she was in charge of HER unit. I bet patients never argued with her about taking their prescribed dose of Anacin. I remember when nurses wore pure white uniforms, starched caps, and white leather nursing shoes. Those nurses looked regal. They walked up and down the halls of the hospital with an air of confidence in their step. They looked professional and they especially looked striking when they topped off their white uniform with a navy blue cape.
Taking a cue from the past, I’ve started wearing a white uniform when I’m supposed to work as the unit charge nurse. I’ve noticed how people respond to a white uniform. People know that I’m a nurse when they see my white uniform and they assume that I’m in charge when I sit behind the nurses station. The white uniform gives me an air of authority and says, “She’s the boss.” My new dress code has not gone unnoticed by the young medical interns and residences on my unit. They started calling me an old school nurse. I get tickled when they say that a white uniform looks more formal than colored scrubs with prints slashed all over them. One resident told me that she had a hard time taking anyone seriously when they wear Scooby-Doo scrubs to work.
Anacin Nurse knew the secret of running a tight ship. Maybe I should freak everyone out and start wearing a nurse’s cap.
*This blog post was originally published at Nurse Ratched's Place*
From the New York Times today we have a story entitled, “A Schizophrenic, A Slain Worker, Troubling Questions,” a horrible story about a mentally ill man who killed a social worker in his group home. The story highlights the defendant’s longstanding history of violence with several assaults in his past. He once fractured his stepfather’s skull and his first criminal offense involved slashing and robbing a homeless man. (On another post on this blog Rob wondered why the charges were dismissed in that case; from experience I can tell you it’s probably because the victim and only witness was homeless and couldn’t be located several months later when the defendant came to trial.) The defendant, Deshawn Chappell, also used drugs while suffering from schizophrenia. Before the murder he reportedly stopped taking his depot neuroleptic and was symptomatic. The news story also suggested that he knew he was committing a crime: he got rid of the body, disposed of the car and changed out of his bloody clothes. Nevertheless, he was sufficiently symptomatic to be found incompetent to stand trial and was committed to a forensic hospital for treatment and restoration. At his competency hearing the victim’s family thought that the defendant was malingering his symptoms, while the victim’s fiance was distraught enough that he tried to attack Chappell in the courtroom. The point of the Times article appears to be an effort to link the crime to cuts in the Massachusetts mental health budget.
