Oxygen therapy brings ‘remarkable’ turnaround for toddler who fell in pool

From WENY:

Eden Carlson’s story might be one in a million.

The toddler, who suffered brain damage after falling into a swimming pool at 23 months old, has begun to rebuild her brain function after treatment with hyperbaric oxygen therapy, according to a case study published last month in the journal Medical Gas Research.

“We’re stimulating growth of tissue and inhibiting inflammation and stopping cell death,” said Dr. Paul G. Harch, clinical professor and director of hyperbaric medicine at LSU Health New Orleans School of Medicine.

Hyperbaric oxygen therapy introduces a greater-than-usual amount of oxygen to patients within a special chamber. The special chamber allows a doctor to control both the pressure and the level of vital gas, explained Harch, who treated the child and is lead author of the case study.

After months of oxygen treatments, Eden is a “typical 3-year old,” said her mother, Kristal Carlson of Fayetteville, Arkansas.

Kaiser Permanente Emergency Department Intervention for Adult Head Trauma Reduces CT Use

Press Release:

Implementing a decision support tool for the use of computed tomography for adult head injuries resulted in reduced CT use and allowed for better identification of injuries, according to a new Kaiser Permanente study published today in the Annals of Emergency Medicine.

This study examined the use of the Canadian CT Head Rule (known as CCHR) in U.S. emergency departments. CCHR was developed to help physicians determine which minor head injury patients needed head CT imagingAccording to the study’s authors, this tool has the potential to be replicated in other health systems.

The intervention included clinical leadership endorsement of CCHR; physician education through an e-learning module; and a clinical decision support tool embedded into the electronic health record, which prompted emergency department physicians to avoid CT imaging based on the CCHR recommendations.“Our aim with this study was twofold: to decrease unnecessary CT scans that may harm patients and increase costs, while ensuring patients receive the highest quality, recommended care,” said lead author and emergency department physician Adam L. Sharp, MD, MS, Kaiser Permanente Southern California Department of Research & Evaluation. “This effort also demonstrates the feasibility and positive impact the implementation of a clinical decision rule has on CT use in community emergency departments.”

The study included 43,053 adult trauma patients from January 2014 to December 2015 in 13 Kaiser Permanente community emergency departments in Southern California. Patients had a mean age of 59, were 53.6 percent female and racially diverse. Overall, 14,018 (31.1 percent) of all adult trauma patients received a head CT. Researchers noted a 5.3 percent reduction in CT use and an increase in CT-identified injuries. Nearly all (12 of 13) of the emergency departments reduced head CT following the implementation of the intervention.

This analysis reflects real-world examination of a simple intervention that many emergency departments should be able to replicate. It also adds to previous Kaiser Permanente research published earlier this year by Dr. Sharp, which found approximately 33 percent of CT scans performed for head injury could be avoided.

Additional study authors include: Brian Z. Huang, MPH, Tania Tang, PhD, MPH, Ernest Shen, PhD, and senior author Michael K. Gould, MD, MS, all with the Kaiser Permanente Department of Research & Evaluation; Michael H. Kanter, MD, regional medical director of Quality and Clinical Analysis at Kaiser Permanente in Southern California; and Edward R. Melnick, MD, MHS, and Arjun K. Venkatesh, MD, MPH, from the Department of Emergency Medicine, Yale University.

This study was supported by Kaiser Permanente Southern California’s Care Improvement Research Team internal funds, which support operational research to improve patient care.

About the Kaiser Permanente Southern California Department of Research & Evaluation
The Department of Research & Evaluation conducts high-quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiologic research, health services research, biostatistics research, and behavioral research as well as clinical trials. Major areas of study include chronic disease, infectious disease, cancer, drug safety and effectiveness, and maternal and child health. Headquartered in Pasadena, California, the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general public. Visit kp.org/research.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 11.8 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

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.