The Future is Here: Robots in the Hospital Room

From Iowa Public Radio:

Tele-stroke carts help doctors treat patients remotely, allowing physicians like Dr. Enrique Leira, with the University of Iowa Hospitals and Clinics, to connect with doctors and patients in rural communities. Leira says it is especially important for stoke victims to receive treatment ASAP due to the nature of the condition.

Every minute, two million neurons die when someone is having a stroke, and unfortunately, there’s no expertise in all hospitals throughout the country, especially in rural areas, to know when a [certain] treatment needs to be administered,” Leira says. “Thanks to the tele-stroke technology, we are able to compensate for that disparity in rapid access to expertise by immediately logging into a computer.

“I Finally Found a Doctor Who Uses Modern Technology”

From Lifehacker:

Finding a good doctor is often a crapshoot on its own, so finding one with state-of-the-art tech is even harder. Usually I start my search for an up-to-date doctor by looking at their websites, checking out their office photos and any mentions of the technology they use, but this can be deceiving. I’ve been to dentists who promised that they use “pain free laser treatment” for the comfort of their patients only to find they still use the old torturous scraping tools. I’ve tried reading through doctor reviews on sites like Health Grades and RateMDs, but few ever mention the kind of equipment the doctors use.

Return visits to the Emergency Room more likely for patients with limited English

From Citizen (Reuters):

Patients in the emergency room who don’t speak English well are slightly more likely to return within days, suggesting their care the first time was not as good as it could have been, researchers say.

In a study in one New York hospital, about 4 percent of English speakers made an unplanned return to the ER within three days, compared to 5 percent of people with limited English.

The rural care health access crisis

From the Ledger-Enquirer (editorial):

“Over the past three decades,” notes the sponsoring senators’ news release, “legislative and regulatory changes have combined with broader economic trends to create an uneven playing field that has resulted in hospitals losing out on millions of dollars in Medicare payments annually.”

Probably the cruelest irony of all in this formula is the self-reinforcing damage it does. One of the organizations endorsing the bill is the National Rural Health Association; as its CEO Alan Morgan wrote in a letter to Isakson, the existing reimbursement formula penalizes doctors who practice in underserved communities. One sure way make a rural health crisis self-perpetuating is a built-in reason for medical professionals not to go where they’re needed most.

Every now and then, something comes to Washington’s attention that actually transcends partisan politics. This bill is a welcome result.

Gender Bias in the ED

From Woman’s Day:

Kathi’s story highlights what experts call medical gender bias, which is when women are treated differently than men who have similar symptoms and conditions, or when they’re treated inappropriately for gender-specific conditions. While bias isn’t more likely to happen in the E.R. than in a doctor’s office, it can have devastating effects when decisions must be made quickly.

About one in five adults in the United States go to the emergency room at least once a year, according to a new report from the Centers for Disease Control and Prevention. And women are more likely than men to make an E.R. visit, so it’s imperative that you understand the ins and outs of what might happen so you can protect yourself.

Study finds way to improve patient safety after admission from the emergency department

From Health Canal:

In a landmark study published in European Journal of Emergency Medicine and Journal of Advanced Nursing, researchers with Deakin’s Centre for Quality and Patient Safety Research showed that patients with low blood pressure or abnormally rapid breathing in the emergency department (ED) are at higher risk of their condition deteriorating to the point of needing an emergency response when in the wards. They also found these patients were four times more likely to die in hospital, had 10 times more intensive care admissions and spent three days longer in hospital.

Cool Study: Bystander Cricothyroidotomy w/Pen

From Reuters:

Few movie scenes create more drama than a character saving a dying person’s life by plunging a pen into his neck to open up his airway, but a new study from Germany suggests viewers shouldn’t try that trick at home.

Researchers had 10 people try to push ballpoint pens through the necks of fresh cadavers to create a passage to the airway. While all participants were able to break the skin, only one person was able to get to the airway.

The results show that people shouldn’t try something just because they read it or see it in the media, said Dr. Michael Kamali, chair of emergency medicine at the University of Rochester Medical Center in New York.

Rural white women between 25 and 55 die at spiking rates

From the Washington Post:

White women between 25 and 55 have been dying at accelerating rates over the past decade, a spike in mortality not seen since the AIDS epidemic in the early 1980s. According to recent studies of death certificates, the trend is worse for women in the center of the United States, worse still in rural areas, and worst of all for those in the lower middle class. Drug and alcohol overdose rates for working-age white women have quadrupled. Suicides are up by as much as 50 percent.

Dexamethasone for asthma in the ER: Better compliance, nearly equal effectiveness

ACEP Press Release:

Adults with asthma who were treated with one-dose dexamethasone in the emergency department had only slightly higher relapse than patients who were treated with a 5-day course of prednisone. “Enhanced compliance and convenience may support the use of dexamethasone” is the conclusion of a study that was published online Friday inAnnals of Emergency Medicine (“A Randomized Controlled Noninferiority Trial of Single Dose vs. Five Days of Oral Dexamethasone in Acute Adult Asthma”).

“Any time we can reduce the role of patient compliance with asthma, we have a chance of improving outcomes,” said lead study author Matthew W. Rehrer, MD, of the Department of Emergency Medicine with Kaiser Permanente in Oakland, Calif. “Dexamethasone allows the emergency physician to administer treatment in one dose and doesn’t rely on the patient to remember to take her pills for four more days after leaving the ER. A single dose of medication eliminates prescription adherence barriers such as forgetfulness, cost and dose omission.”

Adult patients with mild to moderate asthma who came to the emergency department were randomly assigned to one of two groups: a single dose of dexamethasone with 4 days of placebo to be taken at home or a 5-day course of oral prednisone. Relapse was defined as an unscheduled return visit to a health care provider for additional treatment for persistent or worsening asthma within 14 days.

Of patients assigned to the dexamethasone group, 12.1 percent relapsed. Of patients assigned to the prednisone group, 9.8 percent relapsed. Rates of hospitalization were about the same: 3.4 percent for dexamethasone and 2.9 percent for prednisone.

“In my personal experience as an emergency physician, I had many asthmatic patients relapsing because they were unable to fill their prednisone prescriptions,” said Dr. Rehrer. “For those patients and others like them, I might prefer to administer dexamethasone because it eliminates for them the burden of having to fill the prescription and remember to take it for the next four days. When it comes to patient compliance, convenience counts.”

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Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

New Tools Help Patients Make Tough Decisions In the ER

From the Wall Street Journal:

Now, to help patients and families weigh the evidence and compare risks and benefits, hospitals are developing so-called shared decision-making aids tailored to emergency situations.

Shared decision-making is common in outpatient visits, where doctors may provide patients with pamphlets, interactive computer programs or risk calculators they can bring home and mull over, on topics such as whether to have an elective procedure or start a new medication. The ER, with its fast and often chaotic pace, has been considered the least-conducive environment for that type of collaboration between patients and doctors, even though there is no evidence it can’t work, says Erik Hess, associate professor and chair of research in the Dept. of Emergency Medicine at Mayo Clinic in Rochester, Minn.