Follow-up finds clot-grabbing devices offer better stroke outcomes than tPA

From Reuters:

Long-term follow-up of patients in a 2014 study confirms that stroke patients recover better if doctors physically remove a clot from a blocked artery instead of just letting the clot-busting drug tPA try to do the job.

The conclusion is based on 500 Dutch patients treated in a landmark study known as MR CLEAN. The findings, reported in the New England Journal of Medicine, may encourage more hospitals to adopt the technique.

In earlier results from the study, one third of patients whose treatment included using a device to extract a clot from a brain artery achieved functional independence by the 90-day mark after their strokes compared to 19 percent given usual care.

Now, two years of data show functional independence for 37 percent of patients with clot removal versus 24 percent with clot-busting drugs alone.

Physicians can seek licenses in 18 states through new medical licensing compact

Press Release (hat tip: Dr. Menadue):

DES MOINES, IA – Qualified physicians living or practicing in Iowa can begin using a new process to quickly gain licensure in 17 other states that have joined the Interstate Medical Licensure Compact.

To use the expedited licensure process, qualified physicians must designate one of the compact states as their state of principal license and attest that the designated state is their primary residence, or the state where at least 25 percent of their practice of medicine occurs, or is the location of their employer, or the state they use for purposes of federal income tax.

Physicians who designate Iowa as their state of principal licensure will be reviewed by the Iowa Board of Medicine, which will issue a letter of qualification expressing whether or not they are eligible for licensure through the compact. If approved, physicians will select compact states where they want a medical license and the compact will notify those states to issue the license.

The 18 states participating in the compact are Iowa, Alabama, Arizona, Colorado, Idaho, Illinois, Kansas, Minnesota, Mississippi, Montana, Nevada, New Hampshire, Pennsylvania, South Dakota, Utah, West Virginia, Wisconsin, and Wyoming. Compact legislation is being considered in several other states this spring.

To qualify for licensure through the compact a physician must satisfy the following requirements:

 Possess an active, full and unrestricted Iowa medical license.

 Graduate of a medical school accredited by the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation, or a medical school listed in the International Medical Education Directory.

 Passed each component of the U.S. Medical Licensing Examination or the Comprehensive Osteopathic Medical Licensing Examination within three attempts, or any predecessor examinations accepted by the Iowa Board.

 Successfully completed graduate medical education approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association.

 Hold an active, time-limited specialty certification or a lifetime specialty certificate recognized by the American Board of Medical Specialties or the American Osteopathic Association.

 Never been convicted, received adjudication, deferred adjudication, community supervision, or deferred disposition for a felony, gross misdemeanor, or crime of moral turpitude.

 Never held a medical license subjected to discipline by a licensing agency in any state, federal, or foreign jurisdiction, excluding any action related to non-payment of fees related to a medical license.

 Never had a controlled substance license or permit suspended or revoked by a state or the U.S. Drug Enforcement Administration.

 Is not under active investigation by a licensing agency or law enforcement authority in any state, federal, or foreign jurisdiction.

Applicants for licensure through the compact will pay a service fee for the expedited licensure process and the licensure fee for each state medical license issued. To learn more about the compact or to initiate an application for a letter of qualification go to https://www.imlcc.org

 

With same training, insulin pumps no better than injections

From Reuters:

At the start of the study, participants had average A1c readings of 9.1 percent, indicating poorly controlled blood sugar with an increased risk of serious complications.

After two years of follow-up, most patients still had poorly controlled blood sugar. People using the pumps achieved average A1c reductions of 0.85 percentage points, compared with 0.42 percentage points with multiple daily injections, researchers report in the BMJ.

Once researchers accounted for other factors that can influence blood sugar such as age, sex and treatment center, the difference in A1c for pump versus injection patients was too small to rule out the possibility that it was due to chance.

“I think the take-home message for patients is that pumps won’t do the job for you,” Gale said by email. “They are not for everyone, and many people can do just as well on multiple injections.”

Physicians spend 50% of their day on ‘desktop medicine’

From Becker’s:

A study in Health Affairs investigated how physicians split their time between patient visits and computer tasks.

The researchers — led by Ming Tai-Seale, PhD, associate director of the Mountain View, Calif.-based Palo Alto Medical Foundation Research Institute — identified 471 primary care physicians who collectively worked on 31 million EHR transactions between 2011 and 2014. The researchers used the EHRs’ time stamp functionality to examine how physicians allocated their time.

Over time, EHR logs showed a decline in physician time spent on face-to-face visits with patients and an increase in time spent on “desktop medicine,” which includes communicating with patients via patient portal, responding to patients’ online requests, sending staff messages and reviewing test results. On average, physicians spent 3.08 hours on office visits each day and 3.17 hours on desktop medicine each day.

For a trip to the ER, some are opting for Uber over an ambulance

From Stat News:

Millions of Americans take an ambulance trip every year; others get rides from willing friends or, tempting fate, drive themselves.

But in recent years a new trend has arisen: Instead of an ambulance, some sick people are hailing an emergency Uber.

Though firm numbers are hard to come by, drivers for Uber and Lyft say it happens with some regularity. In an online chatroom for Uber drivers, dozens of posters share experiences with passengers who hail a ride with bloody cuts, asthma, anaphylaxis, or broken bones.

As overdoses surge, many R.I. hospitals start testing for fentanyl in ERs

From the Journal:

Rhode Island’s two largest hospital networks for the first time are starting to screen patients for fentanyl, the deadly opioid that is linked to nearly 60 percent of all overdose deaths in 2016.

Hospital industry officials could not say how many emergency rooms nationwide routinely test for fentanyl, a synthetic opioid 50 to 100 times more powerful than morphine.

“It’s probably fewer than half″ of all hospitals, said Dr. Janis Orlowski, chief health care officer of the Association of American Medical Colleges in Washington, D.C. But “it’s sharply on the rise in the last couple of years … because we’re seeing those [overdose] increases.”