Giving Plasma During Air Transport May Save Trauma Patients

From ReachMD:

Giving blood plasma to seriously injured patients en route by helicopter to the hospital can improve their chances of survival, a new study suggests.

The study, led by the University of Pittsburgh School of Medicine, included 500 trauma patients with severe bleeding.

“These results have the power to significantly alter trauma resuscitation, and their importance to the trauma community cannot be overstated,” co-lead study author Dr. Jason Sperry said in a university news release. He is a professor in the departments of surgery and critical care medicine.

Investigation Sought in Minneapolis Prehospital Ketamine Trials

From MedPage Today:

Following revelations last month about two controlled trials of ketamine for treating severe agitation — with drugs injected by first responders without the patients’ individual consent — the consumer group Public Citizen and dozens of independent physicians are calling for a federal investigation.

The Minneapolis Star Tribune newspaper published a series of stories in June detailing the trials, which were the first quasi-randomized studies comparing ketamine with traditional medications (i.e., haloperidol and midazolam) used to sedate agitated patients in emergency settings. The trials had been approved under a “waiver of consent” process, under which the investigators said risks were minimal; they also consulted beforehand with community groups, including patients in a homeless shelter under treatment for substance abuse.

Rural America needs help solving its growing obesity crisis

From Quartz:

People living in rural America are more likely to suffer from obesity than those living in and near cities. And while there are a number of reasons for this, public health experts in the world’s largest economy say there aren’t enough programs being deployed to help people overcome the problem.

The finding, presented in a pair of newly published studies carried out by researchers at the US Centers for Disease Control and Prevention, raises more questions than it does offer answers. To be sure, these are not the first studies to identify a disparity in obesity rates between people living in cities with more than a million people and more sparsely populated rural areas. They add to a growing body of evidence showing as much, increasing pressure on the public health community to figure out why the disparity exists and how to best go about solving the problem.

Chart: https://www.theatlas.com/charts/H1RvslO-7

 

 

Amid strong second quarter, HCA reports declining emergency department numbers

From Fierce Healthcare:

HCA Healthcare officials had mostly good news to share during Wednesday’s second-quarter earnings call.

Officials for the Nashville-based health system giant were able to point to plenty of positive signs including a 7.4% growth in revenues, net income of $820 million for the quarter and both increasing admissions and surgeries across its facilities.

But one figure that stuck out for HCA—the largest health system in the country—was its emergency department figures. While all other numbers seemed to rise over the same quarter last year, same-facility emergency room visits for the second quarter declined about 1% from the prior year.

Sepsis Guidelines Spark EM Petition

From Emergency Medicine News:

It took all of one day for emergency physicians to organize opposition after an update to the Surviving Sepsis Campaign Bundle was released online.

The day after the new version was released, Scott D. Weingart, MD, the editor-in-chief of EMCrit (https://emcrit.org), and Josh Farkas, MD, the editor-in-chief of PulmCrit (http://bit.ly/PulmCrit), posted a petition calling for its retraction. Their petition was signed by more than 4,000 people as of press time. (emcrit.org/sscpetition.)

Dr. Weingart, who opposes the new bundle, said, “It sounds wonderful. Let’s treat these patients as quickly as possible. [But the authors] have fallen into the trap of many guideline writers who pretend their topic exists in a vacuum.”

The emergency department, however, is not a vacuum, he said, and there is no leeway time. Determining who has sepsis or septic shock and who does not can be complicated, Dr. Weingart noted. “They actually said in some of their materials that they see patients being treated quickly for trauma and heart attack. Why not the same for septic patients? But they are not showing us a septic patient with an extremely low blood pressure, breathing 80 times a minute. That would be comparable with a patient who fell out a four-story window. Then the one-hour bundle would be reasonable,” he said.

Instead, Dr. Weingart said, emergency physicians could be faced with one really sick patient, nine not-so-sick patients, and 40 others who need care. They would have to start treating them all within an hour if they adhered to the bundle, including exposing patients who might not have sepsis to powerful antibiotics just to comply with the bundles. “We won’t be able to wait for cultures to come back,” he said.

The petition outlines these concerns, leveling criticism that the recommendations are based on low to moderate quality of evidence but are made at a strong level. The bundle also ignores clinician judgment about whether the recommendations will help or harm an individual patient and does not consider the effect the guidelines will have on nonseptic patients also receiving care in the emergency department.

Little River, a rural provider with high lab charges, files for bankruptcy

From Modern Healthcare:

A Texas health system whose flagship critical access hospital billed $372 million for outpatient labs in 2016—86% of its total bills that year—has filed for Chapter 11 bankruptcy.

Rockdale, Texas-based Little River Healthcare filed for bankruptcy in the Texas Western Bankruptcy Court on July 24. The two-hospital company and its affiliates have nearly 600 employees and an associated physician practice that employs 63 doctors, but records show it has struggled to keep up with payroll and owes more than $1 million in unpaid wages.

Midwest primary care providers donate money to erase $1.4M in medical debt

From Becker’s:

The Midwest Direct Primary Care Alliance, a group of primary care clinics in Kansas and Missouri, donated more than $10,000 to buy $1.4 million in unpaid medical bills.

By partnering with RIP Medical Debt, which buys medical debt for pennies on the dollar, the alliance helped erase medical expenses of 784 people in the Kansas City metropolitan area.