Survey: More than half of Iowans unfamiliar with virtual health care services

From the Journal:

Virtual care is a growing trend in health care, but few Iowans know about it, according to a University of Iowa Health Care survey conducted this year.

The survey of 528 Iowans from both urban and rural areas found that 54 percent of respondents were unfamiliar with the concept of care delivered via computer or smartphone.

NP average hourly wage & salary for all 50 states

From Becker’s:

Nurse practitioners in California earn the highest average annual salary of NPs in the U.S. at $120,930, according to the Bureau of Labor Statistics. Alaska came in second at $117,080, and Hawaii, Massachusetts and Oregon rounding out the top five.

Nationally, the mean annual wage for NPs is $101,260, but wages vary state to state. Here are the average hourly and annual wage for NPs in all 50 states, based on the BLS data gathered in May 2015, listed in alphabetical order.


Hourly: $43.57
Annual wage: $90,620
Median annual household income: $60,413


Hourly: $46.65
Annual wage: $97,030
Median annual household income: $51,983


Hourly: $45.34
Annual wage: $94,310
Median annual household income: $60,855


Hourly: $44.23
Annual wage: $91,990
Median annual household income: $54,865

Special ambulances will scan, treat stroke victims in western Chicago suburbs

From the Tribune:

New types of ambulances will likely speed through the western suburbs soon, in hopes of delivering lifesaving care to stroke victims sooner.

Unlike typical ambulances, the new mobile stroke treatment units of Rush University Medical Center and Northwestern Medicine Central DuPage Hospital will carry CT scanners, cameras for communicating with stroke neurologists from afar and medication that can begin to dissolve clots and restore blood flow to the brain.

Emergency Physicians Can Help Curb Gun-Related Injuries

From Medscape:

Clinicians working in the emergency department can play an active role in counseling patients about the safe storage of firearms, which could help reduce the number of gun-related injuries and deaths, according to experts here at the American College of Emergency Physicians 2016 Scientific Assembly.

Emergency physicians might not “prevent every mass shooting, and we’re not going to prevent every suicide or every homicide, but we can make a dent” in these occurrences, said Megan Ranney, MD, associate professor of emergency medicine at Brown University in Providence, Rhode Island.

“Two-thirds of firearm deaths are suicide, and the vast majority of those are preventable,” Dr Ranney told Medscape Medical News.

Emergency room clinicians are well placed to counsel patients and their families about safe gun storage, said session codiscussant Marian Betz, MD, from the University of Colorado Denver.

Increase in visits to emergency departments persists following Medicaid expansion

Press Release:

Visits to hospital emergency departments (EDs) not only jumped by 40% in Oregon after Medicaid coverage was expanded there in 2008–but the increase persisted for at least two years, according to a new study led by health economists at Harvard T.H. Chan School of Public Health and the Massachusetts Institute of Technology.

The study also found no evidence that the newly insured are more likely to substitute doctor’s office visits for trips to the ED; rather, it found that Medicaid makes it more likely that individuals will use both types of care.

The study will appear in the October 20, 2016 issue of the New England Journal of Medicine.

“Our finding that Medicaid increased ED visits generated a lot of debate about whether this might just be a temporary spike; now we know that the increase in ED visits persisted for at least the first two years of Medicaid coverage,” said Amy Finkelstein, the John and Jennie S. MacDonald professor of economics and co-Scientific Director of J-PAL North America at MIT, who led the study with Katherine Baicker, C. Boyden Gray Professor of Health Economics at Harvard Chan School.

The researchers examined new evidence from the Oregon Health Insurance Experiment, a unique, randomized controlled evaluation of the effects of Medicaid expansion. Oregon’s lottery provided an unprecedented opportunity to separate out the effects of Medicaid from confounding factors to assess the impact of coverage on a wide range of outcomes, from health care use to financial security to mental and physical health.

Prior results from the Oregon Health Insurance Experiment showed that extending Medicaid coverage led to increased health care use across a range of settings–there were more doctors’ office visits, prescription drugs used, and hospitalizations. There was also a 40% increase in ED use in the first 15 months after people gained coverage. The results also showed that Medicaid substantially improved financial security and reduced depression, but had no detectable effect on physical health or on employment.

Many observers thought that the higher rate of ED use would decrease over time as more newly insured patients gained access to primary care doctors. But the new study found otherwise. Not only did the rise in emergency department visits among the newly insured persist for two years, but those people were also more likely to use a combination of office and ED visits.

“For policymakers thinking about expansions, our results suggest that a typical Medicaid program will increase health care use across settings — including the ED — for at least two years, and that it won’t lead people to go to the doctor instead of the ED,” said Baicker.


Funding for the Oregon Health Insurance Experiment came from the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, the California HealthCare Foundation, the John D. and Catherine T. MacArthur Foundation, the National Institute on Aging (P30AG012810, RC2AGO36631 and R01AG0345151), the Robert Wood Johnson Foundation, the Sloan Foundation, the Smith Richardson Foundation, and the U.S. Social Security Administration (through grant 5 RRC 08098400-03-00 to the National Bureau of Economic Research as part of the SSA Retirement Research Consortium). The Centers for Medicare and Medicaid Services’ provided matching funds for the original evaluation.

“Effect of Medicaid Coverage on ED Use–Further Evidence from Oregon’s Experiment,” Amy N. Finkelstein, Sarah L. Taubman, Heidi L. Allen, Bill J. Wright, and Katherine Baicker, New England Journal of Medicine, October 20, 2016, doi: 10.1056/NEJMp1609533

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Glucose tablets likely better for easing low blood sugar symptoms

From Reuters:

When people with diabetes experience a dangerous drop in blood sugar, glucose tablets might be a better option than a sugary food or drink, a study suggests.

For a new study, researchers pooled data from four papers in the medical literature that compared the effect of dietary sugars and glucose tablets on relieving low blood sugar symptoms, including three randomized trials, which are generally the most reliable kind of medical study.

When results from all four studies were combined, neither dietary sugars nor glucose tablets reliably returned blood sugar levels to normal within 10 to 15 minutes, according to the research team.

“Regardless of the oral (method) used to treat hypoglycemia, time is required for absorption before the measured blood returns to the normal range and the patient’s symptoms improve,” the authors wrote.

However, people who used glucose tablets seemed to feel better faster. Patients who used sugary foods were 11 percent less likely to feel relief from their symptoms within 15 minutes.

Elder abuse under-identified in U.S. emergency departments

From Science Daily:

In a new study published this week in the Journal of the American Geriatrics Society, a team of researchers from the University of North Carolina at Chapel Hill, University of California San Diego, and Weil Cornell Medicine used a nationally-representative dataset to estimate the frequency with which emergency providers make a formal diagnosis of elder abuse. The answer: 1 in 7,700 visits.

“These findings indicate that the vast majority of victims of elder abuse pass through the emergency department without the problem being identified,” said, Timothy Platts-Mills, MD, assistant professor of emergency medicine and co-director of the division of geriatric emergency medicine at the UNC School of Medicine and senior author of the study. Given the burden of this problem, this is a major missed opportunity. “Emergency physicians strive to make sure that for each patient who comes through the door, all serious and life-threatening conditions are identified and addressed. For elder abuse, EDs across the country are falling short.”