State’s privately run Medicaid system should be dropped, 47% of Iowans say

From the Des Moines Register:

Iowa’s shift to a privately managed Medicaid system continues to draw more detractors than fans, a new Des Moines Register/Mediacom Iowa Poll shows.

Forty-seven percent of Iowa adults think the state should go back to having a state-run Medicaid system, according to the poll. Thirty-seven percent think the state should continue to have private companies run the program. Sixteen percent are unsure.

Controversial Treatment Appears to Reverse Brain Damage in Drowned Toddler

From Gizmodo:

The girl fell into her family’s pool in February 2016, according to Newsweek, and showed up nearly comatose at the hospital in Arkansas with a body temperature of 85.1. After 35 days in the hospital, she was still unresponsive, immobile, and showed injury to her brain’s gray and white matter, the outer and inner parts. So Dr. Paul G. Harch from the Louisiana State University School of Medicine gave her pure oxygen gas to breathe, both at regular pressure and in a higher-pressure chamber.

After 162 days and 40 sessions in the high-pressure hyperbaric oxygen treatment (HBOT) chamber, Harch reported that Carlson could walk and that much of the brain damage had reversed. The case report does not mention follow up studies

This is just a single case report, published in the journal Medical Gas Research by an advocate for HBOT therapy—so there’s reason to be skeptical. It is not a clinical comparison of many cases, and it does not compare HBOT to an alternative or to existing treatments. But it would appear that in this case, the therapy could have indeed led to a reversal of the girl’s brain damage.

Connecticut union deal includes increased copay for “unnecessary” emergency room visits

From the Yankee Institute:

Tucked inside the concessions package negotiated between union leadership and Gov. Dannel Malloy is a provision which would implement a $250 copay for “unnecessary” emergency room visits.

The provision would not affect retirees and was included in the section labelled “Design Changes to Save Money and Improve Health.”

The 2011 concessions deal instituted a $35 copay for a trip to the emergency room. That fee is waived if the patient is admitted to the hospital or if there were no reasonable medical alternatives.

The same waiver will apply for the increased amount of $250 but the copay may actually violate state insurance regulations.

The Connecticut Insurance Department limits the copay amount an insurance company can charge for medical services. For a visit to the emergency room, the maximum allowable copay is $200.

It is unknown at this time, how the concessions deal would bypass the copay cap imposed by the Insurance Department but union contracts often contain supercedence provisions which override state law.

Using Google Glass to support teletoxicology consults in the emergency department

From iMedicalApps:

Poison centers are typically staffed by pharmacists and physicians specialized in toxicology. They use telephone calls to collect information for their medical recommendations. This is free of charge, because of federal funding, and is one of the few medical specialties that do not bill for services. Advances in wearable technology may change the landscape for medical specialties that perform consults like toxicology.

The article “Teletoxicology: Patient Assessment Using Wearable Audiovisual Streaming Technology” in The Journal of Medical Toxicology is an interesting study on the accuracy of remote consultants using Google Glass ® to evaluate patients.

Be prepared for ambulance wait times

From Reuters:

Bystanders should be prepared to give first aid during an emergency until responders arrive on the scene, experts say.

On average in the U.S., the length of time between a call for help and the arrival of emergency medical services is about eight minutes – but that rose to 14 minutes in rural areas (where about 10 percent of patients waited nearly 30 minutes), researchers found.

“It’s long enough that if CPR isn’t done before the ambulance gets there, it’s not going to turn out well for the patient,” said lead author Dr. Howard Mell, of CEP-America and Presence Mercy Medical Center in Aurora, Illinois.

More hospital closings in rural America add risk for pregnant women

From Reuters:

Hospitals are scaling back services, shutting their maternity wards or closing altogether, according to data from hospitals, state health departments, the federal government and rural health organizations.

Nationally, 119 rural hospitals that have shut since 2005, with 80 of those closures having occurred since 2010, according to the most recent data from the North Carolina Rural Health Research Program.

To save on insurance and staffing costs, maternity departments are often among the first to get shuttered inside financially stressed rural hospitals, according medical professionals and healthcare experts.

Computers helping emergency doctors make better choices

From Science Daily:

Clinical decision support (CDS) embedded directly into the patient’s electronic medical record is associated with decreased overall utilization of high cost imaging, especially among higher utilizers. That is the main finding of a study published in the July 2017 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine.