A call to action: Senators prepare letter on rural health appropriations

From Rural Health Voices:

There are a number of small but vital discretionary programs that help form the rural health safety net.  Especially in hard economic times, these programs play an important role in making sure 62 million rural Americans have access to critical primary, emergency and hospital services.

Senators Kent Conrad and Chuck Grassley are sending a letter to appropriators in support of rural health care program funding in the Labor HHS Appropriations bill and the National Rural Health Association strongly urges individuals to call their Senators and urge them to sign on to this critical letter. A copy of the letter can be viewed here.

The items listed in the letter are PROGRAMMATIC requests and have long enjoyed strong, bipartisan support. Please show your support for the needs of rural health care providers by contacting your Senators today

Prenatal Methamphetamine Exposure and Childhood Behavior Problems at 3 and 5 Years of Age

From Pediatrics:

OBJECTIVE: We evaluated behavior problems in children who were prenatally exposed to methamphetamine (MA) at ages 3 and 5 years.

METHODS: The Infant Development, Environment, and Lifestyle study, a prospective, longitudinal study of prenatal MA exposure and child outcome, enrolled subjects postpartum in Los Angeles, California; Honolulu, Hawaii; Des Moines, Iowa; and Tulsa, Oklahoma. Prenatal exposure was determined by maternal self-report and/or meconium results. Exposed and comparison groups were matched on race, birth weight, public health insurance, and education. Mothers in the comparison group denied use and had a negative meconium screen for amphetamines. Prenatal exposures to tobacco, alcohol, or marijuana occurred in both groups. At ages 3 and 5 years, 330 children (166 exposed and 164 comparison) were assessed for behavior problems by using the caregiver report on the Child Behavior Checklist. General linear mixed models were used to determine the effects of prenatal MA exposure, including heavy exposure (≥3 days per week), age, and the interaction of exposure and age on behavior problems with adjustment for other drugs of abuse and environmental risk factors.

RESULTS: MA exposure was associated with increased emotional reactivity and anxious/depressed problems at both ages and externalizing and attention-deficit/hyperactivity disorder problems by age 5 years. Heavy exposure was related to attention problems and withdrawn behavior at both ages. There were no effects of MA on the internalizing or total behavior problems scales.

CONCLUSIONS: This first report of behavior problems in patients as young as 3 years associated with MA exposure identifies an important public health problem. Continued follow-up can inform the development of preventive intervention programs.

Helicopter Emergency Medical Services Save Lives

From the European Journal of Emergency Medicine:

Background: In many Western countries, Helicopter Emergency Medical Services (HEMS) have become standard in the prehospital care of severely injured patients. Several studies have shown that HEMS have a positive effect on patient’s outcome, although it remains unclear which specific patients benefit most from its care. The aim of this study was to assess the effect of HEMS on the outcome of a large polytraumatized (Injury Severity Score>=16) population.

Methods: All polytraumatized patients treated at the scene of the accident by EMS and/or HEMS and presented in the VU University Medical Center during a period of 6 years were included and retrospectively analyzed. The total population was divided into two groups according to the presence of HEMS on-scene. Prehospital, in-hospital, and outcome parameters were compared. The Trauma Injury Severity Score method was used to calculate the probability of survival.

Results: Almost 60% of all included patients (n=1073) were treated only by an EMS crew on-scene. The remaining 446 patients received additional HEMS care. Significant differences between these two groups were observed in the demographic characteristics, showing that the HEMS group was more severely injured. The predicted survival was calculated using the Trauma Injury Severity Score method, as well as the observed survival, both showing a significantly higher outcome for the EMS group (0.88 vs. 0.66% and 87.7 vs. 71.3%). However, the Z-statistic showed a significant positive difference between the predicted and the observed survival for the HEMS group (P<0.005) and no significant differences for the EMS group (P>0.1), indicating that the chance of surviving in the HEMS group was higher. Per 100 HEMS dispatches, 5.4 additional lives were saved. A correlation of the observed survival with the first measured Revised Trauma Score on-scene showed a positive effect for the HEMS group when the Revised Trauma Score reached a value of 9 or lower.

Conclusion: On-scene HEMS care has a positive effect on the survival of polytraumatized patients, saving 5.4 additional lives per 100 HEMS deployments. This positive effect is especially observed in patients with abnormal vital signs (respiratory and hemodynamically). Research and revision of dispatch criteria are important to reach patients that benefit most from HEMS care.

2012 Medical Malpractice Payout Analysis for Physicians

From Diederich Healthcare via WhiteCoat:

As a service to our clients and all physicians nation-wide, Diederich Healthcare has done an analysis of the medical malpractice payouts in 2011 as recorded by the National Practitioner Data Bank.  Taking the data from the NPDB’s records, statistics were selected that will be both interesting and timely to doctors and all other medical professionals.  Toward the end of the infographic there is also a line graph depicting the total payout amounts from 1992 to 2011.