Don’t have as much time to do it as I used to, but I still post additional updates over at DrWhiteCoat.com if you’re looking for more medical news from around the web.
Enterovirus 68 is confirmed in seven states. Worried parents bring children to emergency departments with “even mild symptoms” to make sure that the children are OK. Now hospitals are at full capacity and wait times increase. When kids do get tested for the disease, many are negative.
North Carolina’s Levine Children’s Hospital emergency department diverts patients and calls in a bomb squad called for … a box outside of the emergency department. According to the article, you may be able to earn money from Crime Stoppers if you call and tell them who left it there.
Speaking about boxes, I just love it when people think outside the box. And I find it fascinating how there is so often the possibility of a chemical or bacterial basis for disease. In this case, a pharmaceutical company Agios created a drug that, instead of killing cancer cells, transforms acute myelogenous leukemia cancer cells back into normal cells. The back-story is what interests me. About 15% of patients with AML have a genetic mutation that affects how molecules are broken down in the Krebs Cycle. Remember that? Instead of isocitrate being broken down into alpha-ketoglutarate, the mutation creates an abnormal enzyme that causes isocitrate to break down into 2-hydroxyglutarate – which inhibits the ability of cell nuclei to mature. Agios’ drug, AG-221, binds to the abnormal enzyme and prevents an accumulation of 2-hydroxyglutarate. Preliminary trials of AG-221 are promising. With traditional treatment, the five year survival in AML is less than 25%. Phase I trials of AG-221 showed a 50% disease remission rate.
Here’s a novel concept. Want to understand why patients return to the emergency department? Just ask them. Study from Thomas Jefferson Hospital in Pennsylvania (.pdf) interviewed 60 patients and discovered that the most common concern prompting a return ED visit was fear or uncertainty about their condition. Patients tended not to follow up with their primary care physicians – even though most had primary care physicians – because the emergency department was more convenient and provided quicker evaluations. A common complaint about the emergency department care was that patients were often unsatisfied with their discharge diagnosis or the explanation of their chief complaint.
This study should be required reading in every emergency medicine residency in this country. In fact, the concepts in the studies should be tested on the emergency medicine board exams.
Now if the study only compared the type of a patient’s insurance with the likelihood of emergency department recidivism.
How else can the media try to tarnish this guy’s reputation? The doctor who oversaw Joan Rivers’ fatal endoscopy was once *sued* 10 years ago. Gasp.
The former patient’s attorneys are really trying to create their 15 minutes of fame. They alleged that 10 years ago the patient received no informed consent prior to a surgery and then vomited during surgery and developed pneumonia because of it. The jury found otherwise and exonerated the doctor. A spokesperson for the endoscopy clinic also noted that the surgical complications in the case 10 years ago occurred because the surgery was performed as an emergency. In one breath, the patient’s lawyers denied that the surgery was emergent, but in the next breath they stated that the patient was “put under before he could tell the doctors he had been fed two meals earlier in the day.”
If the surgery wasn’t an emergency, then why didn’t the patient (who happened to be a retired physician) have time to tell the doctors about his meals?
One way to keep patients from overcrowding the emergency department: Bring the emergency department to them. Colorado ambulance company teaming up with emergency physicians to create mobile emergency departments with supplies to run basic lab tests, insert stitches, and prescribe medications. If patients require higher level of care, they’re transported to the emergency department as with traditional ambulances. Only problem is that the service costs $500 or so per visit and insurance companies aren’t paying for the extra services.
Emergency department nurses call for immediate changes to hospital’s emergency department management to “avoid further harm to patients.” Them’s fighting words. The nurses issued a press release stating that the emergency department is “chronically overcrowded with inadequate levels of appropriate personnel and security” and that management has “refused to take action to rectify the situation.” They’re holding a news conference to describe the unsafe conditions they have been documenting over the past five months.
In other news, there was a law passed so that everyone will have insurance … which we were told would cause the number of patients going to the emergency department to decrease. Phew.
I’m going to regret publishing this. I know it. Study shows that viral infections really can turn into bacterial infections. Well – not really “turn into” bacterial infections, but can make them more likely. When researchers inoculated a child’s nostrils with both influenza and strep pneumonia, they found that the influenza virus inflamed nasal tissue, increased the number of bacteria present and increased the likelihood that the bacteria would travel up the Eustachian tubes into the middle ear.
So when patients come to you and say “this runny nose always turns into pneumonia, I need antibiotics” now there’s at least a tangential basis for that statement.
Kanye West has severe headache after playing basketball before a show in Australia. Gets rushed to the emergency department at Epworth Hospital. Then the fun begins. Kanye’s personal physician, who was called a “diva,” told hospital staff that no one would be “following protocol or filling out forms” in the main area of the hospital. Patients were kicked out of the MRI suite so that Kanye and his entourage could get some privacy. Then Kanye himself was wheeled into the suite on a stretcher playing peek-a-boo with a sheet and guarded by six security guards.
Hours later, Kanye was performing at his concert – where he stopped singing until everyone stood up – and then belittled two people because they remained sitting. He began a chant “stand up” and got the crowd to boo at the people – until learning that both were disabled and one was in a wheelchair.
Or maybe they just had severe headaches after playing basketball … or after listening to Kanye’s “music.”
Fighting MRSA and other drug-resistant infections with … honey? Researchers discover lactic acid-producing microbes in honey that were able to kill MRSA, VRE, pseudomonas, and enterococcus.
If you’re interested in the research behind the studies, there’s a good discussion thread on Reddit with microbiology graduate students who are studying the antimicrobial effects of honey.