March 1st, 2011 by RyanDuBosar in Health Policy, Research
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Bacterial contamination of physicians’ newly laundered uniforms occurs within three hours of putting them on, making them no more or less dirty than the traditional white coats, researchers reported.
Researchers sought to compare bacterial and methicillin-resistant Staphylococcus aureus contamination of physicians’ white coats to freshly laundered short-sleeved uniforms, and to determine the rate at which bacterial contamination happens. They reported results in the Journal of Hospital Medicine.
ACP Internist‘s blog recently took up the debate as well. The issue has cropped up over the years, assessing not only the cleanliness but the professionalism inherent in the white lab coat.
Researchers conducted a prospective, randomized, controlled trial among 100 residents and hospitalists on an internal medicine service at Denver Health, a university-affiliated public safety-net hospital. Subjects wore a white coat or a laundered, short-sleeved uniform.
At the end of an eight-hour workday, no significant differences were found between the extent of bacterial or MRSA contamination of infrequently-washed white coats compared to the laundered uniforms. Sleeve cuffs of white coats were slightly but significantly more contaminated than the pockets or the midsleeves, “but interestingly, we found no difference in colony count from cultures taken from the skin at the wrists of the subjects wearing either garment,” researchers wrote.
And, there was no association found between the extent of bacterial or MRSA contamination and the frequency with which white coats were washed or changed. Colony counts of newly laundered uniforms were essentially zero, but after three hours they were nearly 50 percent of those counted at eight hours.
*This blog post was originally published at ACP Internist*
February 27th, 2011 by RyanDuBosar in Better Health Network, Research
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The top five therapeutic classes ranked by total expense are metabolic, central nervous system, cardiovascular, gastrointestinal, and psychotherapeutic, altogether totaling $155.7 billion, or two-thirds of prescription drug expenses by U.S. adults in 2008.
Two-thirds of American adults use a prescription drug, totaling the $232.6 billion in expenses. The Agency for Healthcare Research and Quality compiled a statistical brief showing that drug classes varied widely in how they made the top five list. While 46 percent of adults with a prescribed drug expense bought a central nervous system agent, they are relatively cheaper on average. Gastrointestinal agents had the highest average expense per prescription ($133), or more than three times the average expense of the cheapest class, which was cardiovascular agents ($39). But 46 percent of adults who take a prescription drug use a central nervous system agent, while 17.7 percent take a gastroenterological one.
Metabolic agents had the highest total expenses ($52.2 billion), or more than one-fifth of all prescription drug expenses. The rest of the list by total expenditures were central nervous system agents ($35.1 billion), cardiovascular agents ($28.6 billion), gastrointestinal agents ($20.2 billion), and psychotherapeutic agents ($19.6 billion).
The estimates presented are derived from the Household and Pharmacy Components of the 2008 Medical Expenditure Panel Survey (MEPS). Expenditures include payments from all sources including out of pocket, private and public insurance sources for outpatient prescription drug purchases during 2008. Over-the-counter medicines are excluded, as are prescription medicines administered in an inpatient setting, clinic, or physician’s office.
*This blog post was originally published at ACP Internist*
February 23rd, 2011 by RyanDuBosar in Better Health Network, Research
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Add coronary stent thrombosis to the list of cardiac events influenced by circadian rhythms, with more events occurring during the early morning hours and in a summertime window of late July and early August.
Coronary stent thrombosis joins several other adverse cardiac events that also follow a circadian pattern, such as stroke, unstable angina pectoris, acute myocardial infarction and sudden cardiac death, according to researcher published in JACC: Cardiovascular Interventions.
Most studies that addressed circadian variations in cardiovascular disease were done before the advent of stents, so, researcher from Mayo Clinic-Rochester conducted a retrospective analysis of medical records and the clinic’s registry, finding 124 patients who presented with coronary stent thrombosis between February 1995 and August 2009.
Researchers determined the time of day, day of week, and season of year that the stent thrombosis occurred and recorded when potential triggers were present. In addition, the team categorized each stent thrombosis based on the number of days since the initial stenting procedure: early=0 to 30, late=31 to 360 days, very late=more than 360 days.
The association between the onset of stent thrombosis was lowest at 8 p.m. and highest at 7 a.m. (P=0.006). However, when the team divided the analysis into early, late, and very late stent thrombosis, only the association between early stent thrombosis and time of day remained significant (P=0.030, P=0.537, P=0.096, respectively). Day of week wasn’t associated, but stent thrombosis rates peaked between the end of July and the beginning of August (P=0.036). Read more »
*This blog post was originally published at ACP Internist*
February 21st, 2011 by RyanDuBosar in Better Health Network, Research
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The use of temporary physicians is rising, filling in until permanent physicians can be hired amid the ongoing shortage of doctors nationwide, a locum tenens firm has found. The company estimates between 30,000 and 40,000 physicians worked on a locum tenens basis in 2010.
The survey, by Staff Care, polled hospital and medical group managers about their use of locum tenens. Eighty-five percent said their facilities had used temporary physicians sometime in 2010, up from 72 percent in 2009.
Psychiatrists and other behavioral health specialists were the most sought-after specialty (22 percent of all requests), followed by primary care physicians, defined as family physicians, general internists and pediatricians (20 percent) and internal medicine subspecialists (12 percent). Hospitalists were 9 percent.
According to the survey, the primary reason cited by 63 percent of healthcare facilities was to fill a position until a permanent physician could be found. Forty-six percent of healthcare facilities now use locum tenens physicians to fill in for physicians who have left the area, compared to 22 percent in 2009. Fourteen percent use locum tenens doctors to either help meet rising patient demand for medical services or to fill in during peak times, such as flu season. Fifty-three percent use locum tenens physicians to fill in for physicians who are on vacation, ill or for other absences.
Most locum tenens physicians plan to stick with temporary practice in the short-term, the company noted. Sixty percent said they plan to practice on a locum tenens basis for more than three years, 28 percent for one to three years and 12 percent for less than a year.
Freedom trumps pay, the company noted, as 82 percent cited flexibility as a benefit, compared to 16 percent who identified pay as a benefit. Other reasons cited for working as a locum tenens include absence of medical politics (48 percent), travel (44 percent), professional development (21 percent) and searching for permanent practice (20 percent).
The locum tenens option is important to maintaining physician supply, the company concluded, because during a time of physician shortages it allows doctors who might be considering full retirement to remain active in medicine.
*This blog post was originally published at ACP Internist*
February 17th, 2011 by RyanDuBosar in Health Policy, Research
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Less than one in three primary care practices offer all 10 recommended adult vaccines, citing a variety of financial and logistical reasons.
Researchers sponsored by the Centers for Disease Control and Prevention sampled 993 family physicians and 997 general internists. Of the respondents, 27 percent (31 percent of family practitioners and 20 percent of internists) stocked all 10. Results appear in the Feb. 17 issue of the journal Vaccine.
The 10 vaccines were hepatitis A; hepatitis B; human papillomavirus vaccine (HPV); combined measles, mumps, and rubella (MMR); meningococcal conjugate vaccine (MCV4); pneumococcal polysaccharide (PPSV23); tetanus diphtheria (Td); combined tetanus, diphtheria, and pertussis (Tdap); varicella; and zoster.
Of the responding practices, two percent plan to stop vaccine purchases, 12 percent plan to increase them and the rest had no plans to change their vaccination stocking habits. But physicians who identified themselves as their respective practices’ decision makers for stocking vaccines were more likely to decrease the number of different vaccines stocked for adults (11 percent vs. three percent; P=.0001).
The National Vaccine Advisory Committee, a group that advises the various federal agencies involved in vaccines and immunizations, arrived at even bleaker figures in 2009, reported the April 2009 issue of ACP Internist. For example, 62 percent of decision makers in practices said they had delayed purchase of a vaccine at some time in the prior three years due to financial concerns. And in the prior year, 16 percent of practice decision makers had seriously considered stopping vaccinations for privately-insured patients due to the cost and reimbursement issues. Read more »
*This blog post was originally published at ACP Internist*
Bacterial contamination of physicians’ newly laundered uniforms occurs within three hours of putting them on, making them no more or less dirty than the traditional white coats, researchers reported.
