Doctor is going on sabbatical to think about the pending nullification of Obamacare…here’s why

Doctor, Did You Wash Your Hands?™  was created to explore healthcare transformation with the advent of the ACA.

Now that it will be likely be nullified we need to figure out what that might mean and what will happen.

Foundations of the ACA for providers included: Population Health management and Investment in ambulatory care centers; preparation for Pay for Value replacing fee-for-service reimbursement; Medicaid expansion; and a steep and fast trajectory in employing physicians particularly primary care physicians and hospitalists. And much more!

This triggered consolidation of hospitals into becoming regional hospital systems quickly transitioning into integrated health care delivery systems, then to mega systems focusing on geographic reach, then to super-size systems which have started or taken over medical schools, now functioning  like insurance companies and investment banks.

Billions of dollars were invested nationally to build and support this newly created infrastructure, often paid for by issuing bonds, using lines of credit and perhaps even dipping into endowment funds.

Months ago I suggested “stress tests” for super-sized hospital systems. Now we will find out if there are contingency plans or a “bubble.” Will we have an orderly unwinding or “toxic derivatives”? What will be the impact if 20 million people lose insurance and providers lose the payments associated with them?

So I am starting over by studying Nullification 101 and may be back if I have any insights.

DOCTOR appreciates our valued readers. It’s a challenge being an “orphan” blog so we will take a break and look for a host organization or web site. Please send any comments or suggestions to jonathanmetsch@gmail.com

Thanx! for being my treasured readers.

Jonathan

 

Jonathan M. Metsch, Dr.P.H.

Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai

Adjunct Professor, Management, Zicklin School of Business, Baruch College, C.U.N.Y.

Adjunct Professor, Rutgers School of Public Affairs and Administration & Rutgers School of Public Health

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“There’s a growing movement in the United States to install video cameras in operating rooms…”

Video surveillance has become increasingly pervasive. It is being used to prevent shoplifting, for homeland security at public events, police officers wearing cameras, in airplane cockpits and train locomotives, and for “instant replay” in college and professional sports.

Which led to me research a bit about the use of video surveillance cameras in hospitals.

There was an article this year about “Operating room staff are heard on the recording making rude comments about Ms. Easter while she is sedated. A surgeon calls Ms. Easter “a handful” and is heard laughing about how upset Ms. Easter was when she was told how long she would have to wait to schedule her surgery. The surgeon also comments that he feels sorry for Ms. Easter’s husband. OR staff also made derogatory comments about Ms. Easter’s body. Laughter is recorded in the OR after a female voice, which Ms. Easter claims is that of an OR nurse, is heard saying, “Did you see her belly button?” (A)

And I remember the 2002 episode where” “Massachusetts… indefinitely suspended a surgeon’s medical license because he left a patient anesthetized on an operating table with an open incision in his back while he went to a bank several blocks away.” (B)

A classic situation is Munchausen syndrome by proxy. “…a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.” (C) “Beatrice Crofts Yorker, RN, JD,… writes that she has personally observed a videotape (of a hospitalized child) that showed a mother rinsing a thermometer under running water and then calling in the nurse to read an elevated temperature (covert video surveillance). Indeed, some hospitals have employed covert videotaping to observe the alleged perpetrator’s (mother’s) behavior with the child.” (D)

Some of the articulated benefits that video surveillance provides include: “Keeps patients’ records and identities safe; Ensures staff are meeting health and safety standards; Allows for remote monitoring from a smartphone or tablet; Prevents intruders from gaining access to restricted areas; Deters vandalism and other criminal acts; Increases safety for patients and staff.” (E)

And much has been written about using video surveillance to monitor hand washing and improve compliance. “For example, Summerville Medical Center, a 94-bed acute-care hospital in South Carolina, is having employees wear sensor tags to determine who is washing their hands before and after coming into contact with patients. The technology was first rolled out in the medical center’s intensive care unit in the spring of 2012 and then expanded to its surgery units and the emergency room. Each hospital caregiver wears a badge-like sensor tag that counts room entries and exits as well as the use of soap or sanitizer dispensers. The data collected from the system is used to model and characterize clinician-patient interactions, providing detailed data to help monitor and modify behavior. (F)

“At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.” (G)

But there are skeptics. “Another potential issue with the video observation is a false accusation of failure to wash. Patient rooms and patients themselves are not being watched. Let’s say a nurse went into a patient’s room to tell him something and didn’t touch anything. A person in India watching a video from a camera focused on a door or sink would not be able to tell that. If the nurse doesn’t wash her hands when she leaves the room, is she going to be cross-examined? (H)

“Operating rooms have long been equipped with cameras for security and training purposes. But video technology has rarely been used to improve patient care. ……… staff check in with the videos once every two minutes, and follow a checklist to look out for errors that could creep into surgery when staff skip steps in safety protocols. The data they collect on the performance of each team is then streamed real-time to the frontlines of the operating room; the medical teams and staff in charge can view the information on their smartphones.” (I)

“An eICU support center can provide care to patients in multiple hospitals. The goal of an eICU initiative is to optimize clinical expertise and facilitate 24-hour-a-day care by ICU caregivers, whether the caregivers are down the hall from the patient that’s being monitored or in another city. Two-way cameras, video monitors, microphones and smart alarms connected by high speed data lines provide eICU caregivers, who are called intensivists, with real-time patient data around the clock. Intensivists can also communicate with on-site caregivers through dedicated telephone lines. “ (J)

Some examples are useful “Chris Nowakowski’s wife died in Wisconsin during what should have been a routine procedure on her pacemaker. Danny Long’s wife in North Carolina suffered catastrophic neurological injury during a surgery to relieve numbness in her extremities. A doctor perforated the colon and esophagus of Deirdre Gilbert’s daughter in Texas, then operated on her after she was dead. In each case, the families still don’t know the full story of what happened to their loved ones because of a lack of documentation and an inability to pursue a costly lawsuit. They are relatives of an estimated 400,000 a year people who die in the United States of preventable medical errors, the third-leading cause of death after heart disease and cancer. But the families say they could have known much more if cameras had been installed in the operating rooms, recording the actions and movements of the doctors and staffers involved.” (K)

“There’s a growing movement in the United States to install video cameras in operating rooms (ORs)….. The idea is to document possible adverse events and thereby prevent similar ones from occurring in the future, but critics worry that recording devices in the OR would not only compromise patient and doctor privacy but lead to a wave of new malpractice lawsuits.

The camera-in-the-OR movement has taken off because of a number of high-profile medical mistakes. A woman named Julie Ayer Rubenzer died after breast-enhancement surgery done in Florida, after she was given excessive amounts of propofol, the same anesthetic that led to the 2009 death of pop star Michael Jackson.” (L)

“However the benefits of having video evidence in the operating rooms could be enormous. Think of the abusive surgeon who terrorizes the entire OR staff. Finally there will be evidence for disciplinary action, instead of just another he said/she said in front of some hospital committee. Wrong site surgery can be analyzed so that others can see what went wrong instead of reading through vague medical records which pretty much parrot the hospital’s time out protocol and doesn’t give any insight into how the mistake was made. Lap sponges left in the patient? The unblinking eye of the camera can show why the sponge was not counted properly at the end of the case. Were the nurses distracted by a shift change? Was the music too loud causing people not to be able to hear each other clearly? Was the count wrong at the beginning of the case and nobody noticed? All these could be answered by a simple video.” (M)

But not everyone agrees. “What scares me is the intent of such a policy. What exactly would a videotaped be used for? So the patient can watch it? Surely the patient will have no clue what he or she is watching. If the videotape is going to be used for malpractice, then I think patients will be the ones who suffer. Everybody in medicine knows that although surgical technique is standard, it varies widely. You will always find someone who is willing to say that your technique is not the standard of care. How they operate in Boston is not necessarily how they operate in San Francisco. Thus I don’t really think their (sic) is much utility because the nature of medicine and surgery is constant criticism to improve practice. This however is different from critique in the form of malpractice.” (N)

Which raises a number of medical ethics challenges, e.g. “Should a patient be able to refuse video surveillance? If so, shouldn’t the hospital be allowed to refuse medical care to patients that do not consent? Kind of like walking into an airport and refusing to be video recorded. If you don’t want to be videotaped, find another means of travel. For now, smile … if you enter a hospital, you’re going to be on camera. Ethics committee approval notwithstanding.” (O)

“Healthcare can benefit from the power of cameras to improve accountability,” Makary, Pawlik and Xu conclude. “In an era where 86% of nurses report having recently witnessed disruptive behavior at work, hand washing compliance remains highly variable, and many physicians do not use evidence based medicine, recorded video can be an invaluable quality improvement tool. If concerns about consent, privacy, and data security are dealt with carefully, video data can tell a story that simply cannot be matched by written documentation.” (P))

The use of technology in medical care is a reality “to improve clinical care and slash error rates, and to reduce patient stress, encouraging healing.” (Q)

Advanced patient safety technology should be embraced!

 

(A) http://www.beckershospitalreview.com/news-analysis/texas-hospital-or-staff-recorded-mocking-sedated-patient.html

(B) http://www.nytimes.com/2002/08/09/us/surgeon-who-left-an-operation-to-run-an-errand-is-suspended.html?_r=0

(C) https://medlineplus.gov/ency/article/001555.htm

(D) http://www.camorrison.com/articles/fourth_amendment.htm

(E) https://www.videosurveillance.com/healthcare.asp

(F) http://www.computerworld.com/article/2497225/healthcare-it/hospitals-use-cameras–sensor-tags-to-track-hand-washing.html

(G) http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?_r=0

(H) http://www.physiciansweekly.com/hand-washing-hospital-monitoring/

(I) http://www.newsweek.com/video-auditing-hospital-surgery-safety-medical-errors-479107

(J) http://searchhealthit.techtarget.com/definition/Electronic-Intensive-Care-Unit-eICU

(K) https://www.washingtonpost.com/local/could-cameras-in-operating-rooms-reduce-preventable-medical-deaths/2015/08/25/fc2696c4-3ae2-11e5-b3ac-8a79bc44e5e2_story.html

(L) http://www.medscape.com/viewarticle/851426

(M) http://www.blog.greatzs.com/2014/04/cameras-in-operating-room-is-it-time.html

(N) http://brainblogger.com/2007/05/09/do-you-want-your-surgery-to-be-videotaped/

(O) http://drwhitecoat.com/hospital-video-surveillance/

(P) https://www.minnpost.com/second-opinion/2015/10/its-time-start-videotaping-surgical-procedures-doctors-argue

(Q) http://health.usnews.com/health-news/best-hospitals/articles/2009/07/15/the-high-tech-hospital-of-the-future

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A Medicare Conundrum: Observation status – Readmission penalties – Hospitalist handoff to primary care physician.

You may have wondered how Obamacare pays for medical care for the 20 million+ newly insured. If you don’t understand the incentives and disincentives to hospitals and physicians and get caught in the regulatory quagmire, then you will be the payor!

Using Medicare, here’s an example of how three related concepts determine whether or not Medicare will pay for a hospital admission.

Observation Status.

“When you’re put in the hospital, you’re assigned either inpatient status or observation status. You’re assigned inpatient status if you have severe problems that require highly technical, skilled care.

You’re assigned observation status if you’re not sick enough to require inpatient admission, but are too sick to get your care at your doctor’s office. Or, you might be assigned to observation status when the doctors aren’t sure exactly how sick you are. They can observe you in the hospital and make you an inpatient if you become sicker, or let you go home if you get better.

Since observation patients are a type of outpatient, some hospitals have a special observation area or wing of the hospital for their observation patients. But, many hospitals put their observation patients in the same rooms as their inpatients.

If you’re an inpatient, but Medicare or your health insurance company determines that you should have been assigned observation status, it can refuse to pay for the entire inpatient hospital stay. You probably won’t discover this until the hospital has submitted the claim and had it denied by the insurance company weeks or even months after your hospitalization.” (A)

Medicare Readmission Penalties.

“The ACA requires that inpatient prospective payment system hospitals with higher-than-expected readmissions rates will experience decreased Medicare payments for all Medicare discharges.

In fiscal year (FY) 2013, payment penalties were based on hospital readmissions rates within 30 days for heart attack, heart failure and pneumonia. In 2015, CMS will add readmissions for patients undergoing hip or knee replacement, and in 2016, readmissions for patients with chronic obstructive pulmonary disease. CMS is likely to add other measures in the future. (B)

Hospitalists.

“Practically speaking, increasing the number of physicians involved in a patient’s care creates opportunities for miscommunication and discoordination, particularly at admission and discharge. Gaps between community physicians and hospitalists may result in failures to follow up on test results and treatment recommendations. Moreover, the acute care focus of hospital medicine may not match the need of many patients for effective disease prevention and health promotion. Studies are under way to see whether these pitfalls can be mitigated, but I suspect the inherent tensions will remain fundamentally irresolvable.

From the patient’s point of view, it can be highly disconcerting to discover that the physician who knows you best will not even see you at your moment of greatest need — when you are in the hospital, facing serious illness or injury. Who is better equipped to abide by an incapacitated patient’s preferences or offer counseling on end-of-life care: a physician with whom the patient is well acquainted or one the patient has only just met? The patient–physician relationship is built largely on trust, and levels of trust are usually lower among strangers.” (C)

And….

So it’s just not narrow provider networks, out-of-network penalties, restricted drug formularies…

It’s also steps towards inventing health care reimbursement “derivatives” such as:

REFERENCE PRICING. Reference pricing serves as a reverse deductible. Rather than the patient paying up to a defined limit and then the insurer covering the remainder, the insurer pays up to a defined limit and the patient pays the remainder.

VALUE BASED INSURANCE. “The additional cost when patients choose procedures that research shows are unlikely to help their condition is a key element of ….value-based insurance, the premise of which is that a mix of financial carrots and sticks can steer patients toward medical services that will help them and away from ineffective or unnecessary ones.”

Hospitals and their employed physicians, including hospitalists, look to minimize the risk of reimbursement penalties and maximize reimbursement. PATIENT BEWARE!

(A) https://www.verywell.com/an-explanation-of-inpatient-v-observation-status-1738455

(B) http://www.aha.org/content/13/fs-readmissions.pdf

(C) August 10, 2016, at NEJM.org. (Richard Gunderman, M.D., Ph.D.)

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“I am still a family medicine physician and still see my own patients each day. My nurse and I review all messages for the day and all phone calls are returned before we leave.” (A)

Sounds great! But with the transformation of health care more and more physicians are “employed” and not in “private practice.”

The Medical Group Management Association reports that more than 50 percent of physicians are now employed by organizations affiliated with health systems. In some specialties, like cardiology, that is closer to 75 percent.

Discussion of employment tend to focus on the pros and cons for the physician.

Briefly they are:

Pros: The check will clear — The security of knowing that you are not at risk for making payroll may be significant. Both staff and physicians are virtually assured of their incomes. • Administrative headaches disappear — The hospital will worry about issues such as human resources, billing and collecting, rent and overhead, and daily operations. • Incomes are often higher — Many physicians do substantially better in an employment arrangement than they did in private practice.

Cons: You aren’t in charge — Regardless of the assurance that “nothing will change,” it does. Policies are set by the employer. Staff knows who writes their checks. You may end up seeing patients that would not have normally be part of your practice. • Compensation can be changed — Nearly all hospitals pay physicians on some form of production-based compensation formula but that does not mean that can’t change. • You may be judged by new metrics — Hospitals are aggressively adopting quality and patient satisfaction measures that are part of the overall compensation plan. • There may be new technology — Even though you have an EHR it might not be their EHR. You may need to go through another conversion. (B)

But how about the patient?

“One potential downside of the employed model is an increase in physician turnover, which can erode continuity of care. Employed physicians may not have the same financial and emotional stake in their practices as do independent physicians, making it relatively easy for them to move on as practice conditions or other opportunities dictate….

..An additional, more subjective concern is the effect of physician employment on the nature of the medical profession. Will physicians be less likely to take ownership of their patients’ health and be fully engaged patient advocates if they are financially beholden to large, corporate organizations? Will medicine cease being a calling and become in effect a trade?” (C)

“…. hospital-physician partnerships can deteriorate when expectations and accountability on both sides are not well defined up front. A physician may enter into one of these relationships expecting secure compensation and a better lifestyle with more sensible hours while the hospital aims to maintain their volume and/or build their market share with proper control. ….. paying close attention to the metrics of success for both parties, and appropriate consideration of the legal aspects of the contract, including exit clauses for both parties, is essential for long-term success.

Another potential advantage of hospital-physician partnerships is delivering a more integrated care experience for patients. “Many patients do not realize that doctors and hospitals are often separate business entities,” he said. “They assume that everyone is working together to provide them a seamless care experience. Being more closely aligned with the hospital can allow a physician to do that.”

Access to better technology and the ability to streamline care are both major advantages to a partnership,….. but “the overall goal has to be to improve quality and reduce costs of care through a more seamless integrated care experience.” (D)

If you are younger your only experience may be with employed physicians. If you are older perhaps you have already have seen changes in the physician-patient relationship from “back in the day.” So it here are some benchmarks to use:

The core elements comprising patient satisfaction include:

◾Expectations: Providing an opportunity for the patient to tell their story.

◾Communication: patient satisfaction increased when members of the healthcare team took the problem seriously, explained information clearly, and tried to understand the patient’s experience, and provided viable options.

◾Control: Patient satisfaction is improved when patients are encouraged to express their ideas, concerns and expectations.

◾Decision-making: Patient satisfaction increased when the importance of their social and mental functioning as much as their physical functioning was acknowledged.

◾Time spent: Patient satisfaction rates improved as the length of the healthcare visit increases.

◾Clinical team: Although it is clear that the patient first concern is their clinician, they also value the team for which the clinician works.

◾Referrals: Patient satisfaction increases when their healthcare team initiates referrals relieving the patient of this responsibility.

◾Continuity of care: Patient satisfaction increases when they receive continuing care from the same healthcare provider(s).

◾Dignity: As expected, patients who are treated with respect and who are invited to partner in their healthcare decisions report greater satisfaction. (E)

(A) http://www.physicianspractice.com/blog/pros-and-cons-private-practice

(B) http://www.physicianspractice.com/blog/hospital-employment-vs-private-practice-pros-and-cons

(C) http://www.aafp.org/fpm/2015/0700/p11.html

(D) http://www.healio.com/orthopedics/business-of-orthopedics/news/print/orthopedics-today/%7B18032629-f0ad-4b49-94ea-f8f69d614846%7D/private-practice-vs-salaried-employment-a-complicated-decision

(E) http://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/

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ZIKA: The imperative to integrate basic science, epidemiology and case finding, clinical protocols, big data, and more by designating ZIKA/ Emerging Viruses Regional Referral Centers!

what is the federal government waiting for?

 

Congenital Zika Syndrome. Zika causes a unique syndrome of devastating birth defects

Doctors confirmed the link between the Zika virus and microcephaly in April. While the most visible sign of microcephaly is the small size of the head, its actually inside the brain where the most damage occurs. (Whitney Leaming, Julio Negron/The Washington Post)

The birth defects caused by Zika have been described in heartbreaking detail as the virus has spread to more than 45 countries, infecting hundreds of thousands of people, including tens of thousands of pregnant women. Now researchers have concluded that a Zika infection during pregnancy is linked to a distinct pattern of birth defects that they are officially calling congenital Zika syndrome.

In a report released Thursday in JAMA Pediatrics, researchers from the Centers for Disease Control and Prevention describe five types of birth defects that are either unique to Zika or occur rarely with other infections during pregnancy: Severe microcephaly (abnormally small head size) with partly collapsed skull. Decreased brain tissue with a specific pattern of calcium deposits indicating brain damage. Damage to the back of the eye with a specific pattern of scarring and increased pigment. Joints with limited range of motion, such as clubfoot. Too much muscle tone, restricting movement soon after birth.

https://www.washingtonpost.com/news/to-your-health/wp/2016/11/03/congenital-zika-syndrome-is-the-new-name-for-a-group-of-devastating-birth-defects/?postshare=221478184729260&tid=ss_tw

 

 

First Baby in Puerto Rico With Zika-Related Microcephaly Born

The first child in Puerto Rico with Zika-related microcephaly has been born, the territory’s secretary of health announced Friday.

The fetus’s abnormally small head was not detected until the mother was nearly eight months pregnant, according to The Associated Press, even though the mother was probably infected in her second month.

http://www.nytimes.com/2016/10/29/health/zika-microcephaly-puerto-rico.html?_r=0

 

 

Nearly 600 Zika Investigations Force Harris County Public Health to Improvise

Denver, Oct. 31, 2016 — The Harris County Public Health Department — which this past summer confirmed the state of Texas’ first Zika-associated death — has investigated nearly 600 suspected cases this year, 55 percent of which were pregnancy-related, according to new research released today at the American Public Health Association’s 2016 Annual Meeting in Denver.

“And, we believe those case numbers will continue to rise,” said Umair A. Shah, MD, MPH, executive director of Harris County Public Health. “Every day we learn more about Zika. The more we learn, the more we realize that there is not a one-prong approach to combat the spread of the virus, it requires the efforts from all sectors within our health department.”

http://www.newswise.com/articles/nearly-600-zika-investigations-force-harris-county-public-health-to-improvise

 

 

Congenital Zika Virus Syndrome: Beyond Microcephaly

This study shows that congenital Zika virus syndrome is complex and involves many areas of the nervous system. It also indicates that screening for microcephaly alone would be inadequate in newborns with suspected Zika virus syndrome. The details of the clinical and pathological findings of these 11 infants reported in this study can help clinicians assess the offspring of mothers exposed to Zika virus during pregnancy.

http://www.jwatch.org/na42671/2016/10/31/congenital-zika-virus-syndrome-beyond-microcephaly

 

 

Neurologic Complications of Zika Include More Than Microcephaly 

Consequences of neurologic dysfunction in other diseases include problems in hearing, vision, and swallowing, as well as epilepsy. Only longer term follow-up in survivors will establish if this is also true in congenital Zika syndrome. Ocular abnormalities that have been observed in affected infants include anterior and posterior eye anomalies.

http://www.contagionlive.com/news/neurologic-complications-of-zika-include-more-than-microcephaly

 

 

Zika’s million-dollar question: Where are the birth defects?

We created three graphics for a better look at the latest numbers. They offer a glimpse at why researchers are so perplexed by Zika’s uneven impact across the Americas — what University of Texas Zika expert Nikos Vasilakis calls Zika’s “million-dollar question.”

http://www.pri.org/stories/2016-11-01/zika-s-million-dollar-question-where-are-birth-defects

 

 

Here’s What We Could Be Doing to Stop Pandemics Like Zika and Ebola

But while the global health industry and national governments and regulators have made a lot of progress, there’s still much more that these groups can do together to better plan, fund, and organize the battle against emerging pandemics, said a group of experts at Fortune’s Brainstorm Health conference in San Diego, Calif……

http://fortune.com/2016/11/01/zika-ebola-virus-vaccines-pandemics/

 

 

Harmonisation of Zika virus research protocols to address key public health concerns

While the evidence linking Zika virus infection and GBS in adults and separately between microcephaly and other neurological conditions in the fetuses of pregnant women is strong and growing, many key research and public health questions need to be addressed through comprehensive epidemiological studies to better understand the extent of Zika virus infection and the diseases Zika virus causes in humans and their offspring.

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30255-8/fulltext?rss=yes

 

 

Progress on Zika. Yale researchers are active on several fronts.

As the Zika virus epidemic spreads, and Zika’s known risks and dangers multiply—including underdevelopment of fetal brains and transmission of the virus through sexual contact—scientists are racing to catch up. The good news: they’re making progress. At Yale alone, researchers are active on several fronts.

At the School of Medicine, scientists have shown that the Zika virus targets the neural stem cells, which give rise to the developing nervous system in a fetus. ….Researchers at the School of Public Health were part of a team that developed a novel online tool (zika.cidma.us) for evaluating anti-Zika interventions (how cost-effective are mosquito nets?

Another team has shown that Zika travels directly from the vaginal tracts of pregnant mice into the brains of their fetuses.

https://yalealumnimagazine.com/articles/4376-progress-on-zika

 

 

11 things we learned about Zika from a top disease expert

Even a bottle cap full of water can be a mosquito breeding ground.

Our mosquito control found hot spots in surprising places.

An Aedes Aegypti mosquito is really good at biting people.

But it doesn’t go very far.

We did really well fighting Zika in Wynwood. But even doing everything right isn’t enough.

Insecticides, while controversial, are really effective.

But we simply don’t have the technology to totally stop Zika.

It will be several more years before we have a vaccine.

The CDC would be stoked if they could wipe out Aedes Aegypti.

Zika takes a long time to show its worst effects, which makes it hard to get money to fight it.

This is the new normal.

https://thenewtropic.com/11-things-learned-zika-top-disease-expert/

 

 

 

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I went on my morning walk committed to losing the weight I gained over the summer

After turning on my GPS app to monitor my walking time, pace, distance, and calories burned, I started thinking about how technology can change physician/ patient communication for the better, if used thoughtfully.

For example, an article discussing the stethoscope as a historical artifact, raises the question are our physicians’ early or deferred adopters of advanced diagnostic technology.

“The stethoscope, the iconic device representing medical technology for the past two centuries, may be fading from the scene as physicians start to embrace mobile technology in the form of handheld ultrasound devices and smartphone apps. Newer digital stethoscopes enable doctors to not only listen to heart sounds and record them, but handheld devices provide high-resolution ultrasound that can actually “see” what’s wrong with the heart.“ Why do you want to still focus on these heart sounds that provide very indirect information and secondary acoustic events?” (A)

A related question: Do your physicians take full advantage of the scope of uses of their Electronic Medical Record? • Access to patient information, such as diagnoses, allergies, lab results, and medications. •Access to new and past test results among providers in multiple care settings. •Computerized provider order entry. •Computerized decision-support systems to prevent drug interactions and improve compliance with best practices. •Secure electronic communication among providers and patients. •Patient access to health records, disease management tools, and health information resources. •Computerized administration processes, such as scheduling systems. •Standards-based electronic data storage and reporting for patient safety and disease surveillance efforts.” (B)

And next on the horizon: Smart Phones, if used thoughtfully, can facilitate doctor/ patient communication.

“Smartphones already can be used to take blood-pressure readings or even do an electrocardiogram. ECG apps have been approved by the U.S. Food and Drug Administration for consumers and validated in many clinical studies. The apps’ data are immediately analyzed, graphed, displayed on-screen updated with new measurements, stored and (at an individual’s discretion) shared. I thought I’d seen it all in my decades long practice as a cardiologist, but recently, for the first time, I had an ECG emailed to me by a patient, with the subject line, “I’m in atrial fib, now what do I do?” I immediately knew that the world had changed. The patient’s phone hadn’t just recorded the data; it had interpreted it.” (C)

Getting back to weight loss, just-for-fun, here’s an interesting “futuristic” app. (D)

“Our team has created the world’s first handled device able to scan food at a molecular level: the …. Food Sensor. Our technology includes a three-part system: a pocket-sized spectrometer, a cloud-based patented analysis engine, and a mobile app that work together to scan foods, identify calories, macronutrients, allergens, and also provide relevant information such as food fraud, food adulteration and food quality.”

So besides reading these blog posts you can gauge how innovative your physicians in some of the following ways: every Tuesday the New York Times Science section includes health care technology updates; subscribe (usually free) to email newsletters from nationally prominent academic medical centers. “Google” (carefully) about your medical concerns and conditions, and what new diagnostic technology is being used.

My app says I burned 150 calories writing this post!

 

(A) http://www.healthdatamanagement.com/news/handheld-ultrasound-devices-making-stethoscopes-obsolete

(B) https://healthit.ahrq.gov/key-topics/electronic-medical-record-systems

(C) http://www.wsj.com/articles/the-future-of-medicine-is-in-your-smartphone-1420828632

(D) http://tellspec.com/en/

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“To combat this issue, Jackson Memorial Hospital and the University of Miami established a Zika response unit made up of doctors from pediatrics, infectious disease and other specialties to follow these children as they grow up.”

A great example of a ZIKA Regional Referral Center. So, why isn’t the federal government designating ZRRCs? (and an important new finding about on AIDS)

Zika virus ‘not controllable’: CDC director’s grim warning

The director of the Centers for Disease Control and Prevention delivered a grim assessment Tuesday of the government’s ability to contain Zika, saying it’s too late to stop the dangerous virus from spreading throughout the United States.

“Zika and other diseases spread by (the Aedes aegypti mosquito) are really not controllable with current technologies,” CDC Director Thomas Frieden said. “We will see this become endemic in the hemisphere.”

http://www.usatoday.com/story/news/2016/10/25/zika-virus-not-controllable-centers-for-disease-control-and-prevention/92728476/

 

How American Doctors Are Preparing Families for Children With Zika

Doctors in Florida are preparing for the possibility of a few hundred babies born with Zika-related birth defects. While few children have been born in the US with Zika, most pregnant women who became infected in South Florida are due this spring.

To combat this issue, Jackson Memorial Hospital and the University of Miami established a Zika response unit made up of doctors from pediatrics, infectious disease and other specialities to follow these children as they grow up.

“Does the child eventually develop developmental issues? Does the child eventually develop learning issues?” said Dr. Patricia Rodriguez, a pediatric Infectious disease doctor with the zika response team. “We don’t know what’s going to happen when they’re 5 or 6 years old.”

http://motherboard.vice.com/read/how-american-doctors-are-preparing-families-for-children-with-zika

 

Frequent exams only treatment for pregnant woman with Zika

Flores’ experience illustrates the gaps in doctors’ understanding of how Zika affects pregnancy, said Dr. Christine Curry, Flores’ obstetrician-gynecologist and the co-director of the Zika Response Team. For example, doctors don’t currently know why the virus — which is mainly spread by city-dwelling mosquitoes but also can be sexually transmitted — remains detectable in a pregnant woman’s bloodstream far longer than in the bloodstream of a man or a woman who is not pregnant.

“It’s hard to continue to say, ‘I don’t know,’ but it’s not unexpected with a disease that’s really made its mark only in the last few years,” Curry said.

https://www.msn.com/en-us/news/us/frequent-exams-only-treatment-for-pregnant-woman-with-zika/ar-AAjlGTj

 

Why and How Did Zika Turn into Such a Fearsome Virus?

So far, Lyle Petersen, MD of the US Centers for Disease Control and Prevention, told attendees of ID Week in New Orleans, LA, today, the biggest one is why it is causing the severe neurological problems that have made it front page news in the past two years. “This virus has been in Asia for at least 15 years,” Petersen said, without causing microcephaly or other birth anomalies.

http://www.hcplive.com/conference-coverage/idweek-2016/why-and-how-did-zika-turn-into-such-a-fearsome-virus

 

Mythology of ‘Patient Zero’ and how AIDS virus traveled to the United States is all wrong

The story of how “Patient Zero” and AIDS arrived in New York in 1979 and triggered the epidemic in North America has been told so many times in so many different ways that for many people it’s become an accepted truth of our modern history.

It begins with a single man, a young flight attendant named Gaetan Dugas, who presumably became infected abroad and then unwittingly gave it to some of his sexual partners. His sexual partners in turn gave it to their sexual partners and so forth until the whole continent was full of clusters of people dying of the mysterious disease. In journalist Randy Shilt’s 1987 book “And the Band Played On,” and in various media reports, Dugas was described as sexually adventurous and said to have told Centers for Disease Control and Prevention investigators he had approximately 250 sexual partners each year.

It’s a compelling narrative, but it’s not quite right.

https://www.washingtonpost.com/news/to-your-health/wp/2016/10/26/mythology-of-patient-zero-and-how-aids-virus-traveled-to-the-united-states-is-all-wrong/?wpisrc=al_alert-hse

 

 

 

 

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