‘Here It Goes’: Coming Out To Your Doctor In Rural America

From Shots:

Pediatrician Kathryn Hall knows about these concerns all too well. She has been practicing medicine in Tulare County for over a decade, and time and time again, her patients tell her they’re afraid to come out to their other doctors. A few years ago, she got so fed up that she surveyed more than 500 nearby doctors asking them basic questions about being welcoming.

“I made the bar very, very low because we just didn’t get much education on LGBT health in medical school,” says Hall. “That is starting to change.”

Around 120 doctors responded to Hall’s survey, and most of them said they would be happy to serve this group. Hall says there are lots of ways that doctors can make it clear they’re accepting — a little rainbow flag on the door or taking out ad in a local magazine.

The 30 hospitals participating in CMS’ rural hospital payment program

From Becker’s:

CMS named the 30 hospitals that make up the Rural Community Hospital Demonstration Program.

The program was established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. It pays rural hospitals for inpatient hospital services using a cost-based methodology. The program was extended five years under the ACA and was expanded another five years under the 21st Century Cures Act enacted in 2016.

To participate in the program, applicant hospitals must house fewer than 51 acute care inpatient beds, offer 24-hour emergency care services and be ineligible for or not have Critical Access Hospital designation. A maximum of 30 hospitals are allowed to participate in the program.

Emergency department visits for self-inflicted injuries increase among young US females

Press Release:

ottom Line: Emergency department visits for self-inflicted injuries among young females increased significantly in recent years, particularly among girls 10 to 14.

Why The Research Is Interesting: Young people in the United States have high rates of nonfatal self-inflicted injuries that require medical attention; self-inflicted injury is a strong risk factor for suicide.

Who: Children, adolescents and young adults in the United States ages 10 to 24.

When: 2001-2015

What (Study Measures): Rates of emergency department visits for nonfatal self-inflicted injuries using national survey data.

How (Study Design): This is an observational study. Because researchers are not intervening for purposes of the study they cannot control natural differences that could explain study findings.

Authors: Melissa C. Mercado, Ph.D., M.Sc., M.A., of the Centers for Disease Control and Prevention, Atlanta and coauthors



  • 43,138 emergency department visits for self-inflicted injury 2001-2015
  • 5.7 percent annual relative increase in visits after 2008
  • Poisoning the most common method of injury


  • 8.4 percent annual relative increase in visits from 2009-2015
  • 18.8 percent annual relative increase in visits after 2009 among girls 10 to 14


  • Rates of visits stable 2001-2015

Study Limitations: Because the study focused on emergency department cases, rates among all youths ages 10-24 are probably underestimated.

Study Conclusions: Rates of self-injury among females appear to be increasing since 2009, a finding that points to the need for the implementation of suicide and self-harm prevention strategies within health systems and communities.


For more details and to read the full study, please visit the For The Media website.

Cost of opioid epidemic raised to $504 billion

From Axios:

“The White House says the true cost of the opioid drug epidemic in 2015 was $504 billion, or roughly half a trillion dollars,” per AP’s Darlene Superville:

“[T]he Council of Economic Advisers says the figure is more than six times larger than the most recent estimate. The council said a 2016 private study estimated that prescription opioid overdoes, abuse and dependence in the U.S. in 2013 cost $78.5 billion.”

  • “The council said its estimate is significantly larger because the epidemic has worsened, with overdose deaths doubling in the past decade, and that some previous studies didn’t reflect the number of fatalities blamed on opioids, a powerful but addictive category of painkillers.”
  • “The council also said previous studies focused exclusively on prescription opioids, while its study also factors in illicit opioids, including heroin.”

Syncope Outcomes After Emergency Department Discharge

From Cardiology Advisor:

The researchers found that 6.6% of patients were hospitalized and discharged with a primary diagnosis of syncope (cohort 1), 8.7% were hospitalized and discharged with a primary diagnosis other than syncope (cohort 2), and 84.7% were discharged home from the ED with a diagnosis of syncope (cohort 3). There was variation in 30-day ED revisits for syncope from 1.2%  to 2.4% for cohorts 2 and 1, respectively; readmission rates were below 1% among the cohorts.

Short- and long-term mortality rates were highest and lowest for cohorts 2 and 3, respectively (30-day mortality: 1.2%, 5.2%, and 0.4% for cohorts 1, 2, and 3, respectively; 1-year mortality: 9.2%, 17.7%, and 3%, respectively). The total cost of syncope presentation was $534.8 million ($76.7 million, $139.4 million, and $318.7 million for cohorts 1, 2, and 3, respectively).