‘Therapeutic Hypothermia’ Can Protect the Brain in the Aftermath of Cardiac Arrest

From the Wall Street Journal:

For decades, conventional wisdom in treating patients with cardiac arrest was that if the heart stopped beating for longer than six to 10 minutes, the brain would be dead. Now a new treatment being embraced by a growing number of U.S. hospitals suggests that patients can be brought back to a healthy life even if their heart is stopped for 20 minutes, perhaps longer.

The difference is profound. In recent months around the U.S., doctors and nurses say, cardiac-arrest patients who would previously have been given up for dead have been revived and discharged to return to their families and jobs with all or nearly all of their cognitive abilities intact.

The treatment is called therapeutic hypothermia and at its core is the simplest of technologies: ice. Once a patient’s heartbeat is restored, emergency-room doctors, cardiologists and rescue squads are quickly applying ice and other coolants to moderately lower a patient’s body temperature by about six degrees. Then the patient is put in a drug-induced coma in intensive care for 24 hours before gradually being warmed back up to normal temperature.

ER Visits Soared After Actress Richardson’s Death

Cool! A study presented at the ACEP Scientific Symposium. That’s where I am…

From ABC:

Do well-publicized medical cases drive people to seek care? In at least one case, the answer is yes: Publicity surrounding the death of actress Natasha Richardson after a head injury triggered a 73% increase in emergency room visits for head trauma, according to research presented Monday at the American College of Emergency Physicians’ annual meeting in Boston.

Brian Walsh and colleagues at Morristown Memorial Hospital in New Jersey looked at the number of patients seen by doctors in 19 urban, suburban, and rural emergency rooms in New York and New Jersey in March 2009. During that month, more than 2,500 of nearly 87,000 visits were for head trauma.

They compared the daily visits for head injury in the 10 days before and after March 18, the day Richardson died following a skiing accident. Although the visits for head trauma increased significantly after March 18, only “a very small proportion of patients–in the two to three percent range–really had anything to worry about,” Walsh told Reuters Health.

By March 31, the number of visits returned to the pre-March 18 range.

“The study quantified what we already knew: when the media make people more aware of a disease process, they get scared and come to the emergency room,” Walsh said. In this case, “the media played up the ‘sudden death syndrome’ aspect–the idea that you can have a minor fall, look great afterwards, and suddenly die.”

Physician Assistants and Nurse Practitioners as a Usual Source of Care

From Wiley InterScience:

Purpose: To identify characteristics and outcomes of patients who use physician assistants and nurse practitioners (PA/NPs) as a usual source of care.

Methods: Cross sectional analysis using the telephone and mail surveys of the Wisconsin Longitudinal Study (WLS), a prospective cohort study of Wisconsin high school graduates and selected siblings (n = 6,803).

Findings: Individuals from metropolitan (OR = 0.40, 95% CI = 0.29-0.54) and micropolitan (OR = 0.65, 95% CI = 0.44-0.95) areas were less likely to utilize PA/NPs than participants from rural locations. Participants without insurance or with public insurance other than Medicare were more likely than those with private insurance to utilize PA/NPs (OR = 1.71, 95% CI = 1.02-2.86). Patients of PA/NPs were more likely to be women (OR = 1.77, 95% CI = 1.34-2.34), younger (OR = 0.95, 95% CI = 0.92-0.98) and have lower extroversion scores (OR = 0.81, 95% CI = 0.68-0.96). Participants utilizing PA/NPs reported lower perceived access (β=−0.22, 95% CI =−0.35-0.09) than those utilizing doctors. PA/NP utilization was associated with an increased likelihood of chiropractor visits (OR = 1.57, 95% CI = 1.15-2.15) and decreased likelihood of a complete health exams (OR = 0.74, 95% CI = 0.55-0.99) or mammograms (OR = 0.65, 95% CI = 0.45-0.93). There were no significant differences in self-rated health or difficulties/delays in receiving care.

Conclusions: Populations served by PA/NPs and doctors differ demographically but not in complexity. Though perceived access to care was lower for patients of PA/NPs, there were few differences in utilization and no differences in difficulties/delays in care or outcomes. This suggests that PA/NPs are acting as primary care providers to underserved patients with a range of disease severity, findings which have important implications for policy, including clinician workforce and reimbursement issues.

Designated Medical Directors for Emergency Medical Services: Recruitment and Roles

From Wiley InterScience:

Context: Emergency medical services (EMS) agencies rely on medical oversight to support Emergency Medical Technicians (EMTs) in the provision of prehospital care. Most states require EMS agencies to have a designated medical director (DMD), who typically is responsible for the many activities of medical oversight. Purpose: To assess rural-urban differences in obtaining a DMD and in their responsibilities.

Methods: A national survey of 1,425 local EMS directors, conducted in 2007. Findings: Rural EMS directors were more likely than urban ones to report DMD recruitment problems, but recruitment barriers were similar, with the most commonly reported barrier being an unwillingness of local physicians to serve. Rural EMS directors reported that their DMDs were less likely to be trained in Emergency Medicine, and were less likely to provide educational support functions such as continuing education. Rural agencies were more likely to get on-line medical direction from their DMD, but were less likely to always get the on-line support they needed. Common barriers to on-line support were typical of rural communication barriers.

Conclusions: Existing recommendations for DMD qualifications may be difficult to attain in rural communities. To develop programs that will support medical direction for rural EMS agencies, it is important to learn what physicians identify as the barriers to serving as DMDs, and whether there are alternative and innovative ways to provide an optimal level of medical oversight. Solutions will likely be multi-faceted, as EMS activities and organizational structures are diverse and the responsibilities of the DMD are broad.

Improving length-based weight estimates by adding a body habitus (obesity) icon

From Science Direct:

Background

Length-based dosing systems reduce errors associated with resuscitation drug dosing. Obese and thin children of the same length are dosed the same despite their different weights.

Methods

Length (height) and weight were measured in children after a body habitus icon assignment. Within each body habitus group, regression analysis was performed to generate a weight-estimation formula using body habitus and length (BHL). This BHL method was compared to the Broselow tape (BT).

Results

Height and weight data were plotted to obtain visual scattergrams. Logarithmic regression yielded higher correlation coefficients than standard linear regression. Within body habitus groups, BHL epinephrine dose estimates were more accurate than BT dose estimates using 0.01 mg/kg as a dosing standard.

Conclusions

Adding body habitus information to the patient’s length results in a more accurate weight estimate than length alone in children. The accuracy improvement is greater in children 3 years and older as compared to younger children.

Wisconsin Suspends Enrollment for BadgerCare Plus

From Modern Healthcare:

Less than four months after launching a health insurance plan for low-income residents during one the worst recessions in decades, Wisconsin Gov. Jim Doyle is suspending enrollment in the program because demand was higher than expected.

Since launching the BadgerCare Plus Core Plan on June 15, state officials have received more than 500 applications per day from low-income adults. Program organizers say the plan can afford to cover about 54,000 people, but 60,000 applications have already been received, prompting a decision to place anyone who applies after Oct. 9 on a waiting list

The program is open to adults who do not have dependent children living with them and who earn less than $21,660 for an individual or $29,139 for a couple. Participants cannot have had access to employer-subsidized insurance for at least 12 months prior.

Are surgical masks as effective as N95 respirators to prevent influenza?

From KevinMD:

Nurses are as well protected from influenza with a standard surgical mask as with an N95 respirator while caring for febrile patients, according to a randomized trial published in the November 4 issue of the Journal of the American Medical Association.

Here are some guidelines for infection control among hospital patients with confirmed or suspected H1N1 influenza, from the Centers for Disease Control and Prevention:

• Respiratory hygiene/cough etiquette infection control measures should be implemented at the first point of contact with a potentially infected person

• Any patients who have a confirmed, probable, or suspected case of novel H1N1 and present for care at a healthcare facilities should be placed directly into individual rooms and the door should be kept closed.

• For procedures that are likely to generate aerosols, an airborne infection isolation room (AIIR) with negative pressure air handling with 6 to 12 air changes per hour can be used.

Researchers out of McMaster University in Hamilton randomized 446 nurses from eight Ontario hospitals to use of surgical masks or N95 respirators for the prevention of influenza. The nurses were instructed to use the masks or respirators while caring for febrile patients between September and December 2008.

During the study period, laboratory-confirmed influenza occurred among 23.6% of nurses assigned surgical masks and 22.9% of those assigned N95 respirators. Non-inferiority of surgical masks was maintained even among nurses with an increased level of the circulating pandemic 2009 H1N1 influenza strain.

Today’s research indicates that surgical masks are as effective as N95 respirators for preventing the spread of influenza, at least in a typical nursing setting.

Flu and H1N1 influenza vaccine recommendations for doctors and health care workers

From KevinMD:

The recommendations of the Advisory Committee on Immunization Practices (ACIP), which is an advisory committee to the Centers for Disease Control (CDC), are quite clear:

* Re seasonal influenza: All health care personnel and persons in training for health-care professions should be vaccinated annually against influenza. Persons working in health care settings who should be vaccinated include physicians, nurses, and other workers in both hospital and outpatient care settings, medical emergency response workers (e.g., paramedics and emergency medical technicians), employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.

* Re H1N1: Similarly, health care personnel are considered a high priority group for receiving the H1N1 vaccine. When vaccine is first available, ACIP recommends that programs and providers administer vaccine to health care and emergency medical services personnel.

Here are the CDC’s detailed recommendations regarding seasonal influenza vaccination and vaccination against H1N1.

The ACIP also recommends both that facilities employing health care personnel should provide vaccine to workers, and that the level of vaccination among health care personnel should be considered as a measure of a patient safety program.

What are the recommendations for health care personnel with flu-like symptoms staying at home?

Although the general CDC recommendation states that “people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]) or signs of a fever without the use of fever-reducing medications,” there is a different recommendation for health care personnel. Specifically, the CDC states that, for health care personnel, the “exclusion period should be continued for 7 days from symptom onset or until the resolution of symptoms, whichever is longer.”

Tiny Portable Ultrasound from SonoSite Gets US OK

From Medgadget:

SonoSite (Bothell, Washington) just announced that the company received FDA approval to market the firm’s tiny NanoMaxx ultrasound system throughout the United States. Weighing in at only 6 pounds (2.7 kilo) and with a battery life of 2 operational hours, the system is truly portable for busy clinics, ambulances, emergency rooms, and elsewhere that ultrasound is needed.

AHIMA announces Health Information Bill of Rights

From Modern Healthcare:

Privacy and security are among the top points outlined in a new Health Information Bill of Rights for patients being promoted by the Chicago-based American Health Information Management Association. The seven-point platform is offered as a model to encourage providers to give strict protections to personal health information and to assuage patients’ fears about information security by increasing transparency.

The Health Information Bill of Rights, which is designed to be posted in hospitals and carried in wallet-sized cards, seeks to advance several ideas: patients ought to have free access to their records, even during treatment, including knowing who has accessed their records; health records should be accurate and protected by a national standard for data security; providers should be held accountable for violating privacy and security laws and policies; and patients ought to have a private right of action to bring lawsuits if a security breach of their health information causes harm.