hospitals
kkrisberg | July 1, 2016Dr. Jodi Sherman wants to expand the medical profession’s understanding of patient safety far beyond the exam room and hospital bed. For Sherman, the oft-heard medical mantra of “first do no harm” should also push the health care system to do more to reduce its harmful air emissions and their impact on people’s health.
“Traditionally, our duty has been to the patient in front of us,” Sherman told me. “But we have a duty to protect society as well.”
Sherman, an assistant professor of anesthesiology at Yale School of Medicine, recently co-authored a new study on harmful air pollutants coming…
lborkowski | June 24, 2015Innovation in healthcare doesn't just mean new drugs and devices; sometimes, studying and updating procedures can result in big improvements for patients' health. In the New York Times, Gina Kolata reports on procedure changes hospitals have made to improve care for heart-attack patients:
With no new medical discoveries, no new technologies, no payment incentives — and little public notice — hospitals in recent years have slashed the time it takes to clear a blockage in a patient’s arteries and get blood flowing again to the heart.
The changes have been driven by a detailed analysis of the…
lborkowski | June 8, 2015A 68-year-old South Korean man recently returned from a multi-country trip to the Middle East developed a cough and fever. He visited four health facilities before being diagnosed with MERS (Middle East Respiratory Syndrome), and in the process spread the virus to several more people. Now, 50 people in South Korea have been diagnosed with MERS, and four have died. Two of the patients are healthcare workers.
MERS is a viral respiratory illness caused by a coronavirus (MERS-CoV) and characterized by fever, cough, and shortness of breath; it was first reported in Saudi Arabia in 2012. It has…
lborkowski | April 18, 2013The New Yorker's News Desk blog features an excellent piece by Atul Gawande called "Why Boston's Hospitals Were Ready." It's a riveting read about how emergency medical teams, the city's emergency command center, and hospital staff all responded immediately and with admirable coordination to the needs of those injured in the bomb blast at the Boston Marathon:
The explosions took place at 2:50 P.M., twelve seconds apart. Medical personnel manning the runners’ first-aid tent swiftly converted it into a mass-casualty triage unit. Emergency medical teams mobilized en masse from around the city,…
lborkowski | March 14, 2013Last week, CDC Director Thomas Frieden opened a press briefing by saying, "It's not often that our scientists come to me to say that we have a very serious problem, and we need to sound an alarm." What scientists found, and reported in CDC's Morbidity and Mortality Weekly Report, is that a growing proportion of Enterobacteriaceae (a family of bacteria known for causing hospital-acquired infections) are resistant to carbapenems, a type of antibiotics that's typically been the last line of attack against stubborn infections. Frieden explained why these carbapenem-resistant Enterobacteriaceae (…
lborkowski | October 3, 2011One thing that drove me nuts during the healthcare reform debate was the scare tactic of claiming that proposed legislation would result in rationing of healthcare. The problem with making such a claim is that healthcare is already rationed in the US. We ration healthcare based on insurance status and ability to pay. And, as a story from NPR's Richard Knox points out, we ration when there are supply shortages -- as there are now with several important drugs. Here's Knox's overview of the problem:
The shortages involve a wide range of medications: cancer chemotherapy agents, anesthetics,…
lborkowski | July 20, 2010Last year, Atul Gawande wrote an interesting New Yorker piece that compares present-day efforts to control healthcare costs with early 20th-century efforts to increase US farming productivity. The quest for more farming productivity succeeded not because of any grand, sweeping reform, he explains, but because the government, through the USDA, invested in pilot programs, scientific extensions, and provision of information to farmers. Gawande summarizes the recipe for success:
The government never took over agriculture, but the government didn't leave it alone, either. It shaped a feedback loop…
lborkowski | May 27, 2010A New York Times article by Jane Gross highlights a costly healthcare problem: avoidable hospital readmissions, which affect one in five patients and account for $17.4 billion of the current $102.6 billion Medicare budget. (When people talk about readmissions, they're generally referring to an admission within 30 days of the previous admission for the same condition.)
When patients end up back in the hospital, it's often because their care didn't continue appropriately when they were first discharged. Patients leaving the hospital should receive detailed instructions about what they need to…
revere | May 14, 2010When I was young (high school, college) I had a variety of jobs, including golf caddy (cured me of golf for the rest of my life; there were no carts, just an 11 year old lugging two bags with 16 clubs over 18 holes) and paper boy (4 am on Sundays hauling 80 huge Sunday papers in a wagon; took about 2 hours. Weekdays were smaller papers but the same wagon, and after school. I know, I know. Soon you'll expect me to talk about how I had to walk 5 miles to school, barefoot in the winter, but it wouldn't be true. It was only 4 miles). Then I started working in hospitals and basically I've been…
revere | April 1, 2010The AMA just took over a journal called Disaster Medicine and Public Health Preparedness. In fact they proudly announced they were the exclusive publisher and distributor of the journal, formerly published by Lippincott, Williams and Wilkins. I wouldn't even know about it except it was in connection with a press release of an article likely to be of interest any health care worker: ":Which Health Care Workers Were Most Affected During the Spring 2009 H1N1 Pandemic?" by Santos, Bristow and Vorenkamp of Weill-Cornell Medical School in New York. And the AMA even said it was redesigning the…
revere | November 10, 2009Nursing homes (Long Term Care Facilities, LTCFs) are a favorite hunting ground for respiratory viruses, including flu. They are open to the general community, where visitors and employees mingle freely with the residents. The residents are usually of an advanced age, have other sicknesses that make them vulnerable and often have less active immune defenses. So when the swine flu pandemic began at the end of April, the Public Health Laboratory at Ontario's Agency for Health Protection and Promotion ramped up their respiratory infection outbreak registration system with the prospect that LCTFs…
revere | November 9, 2009We only just got to the surgical/N95 mask article in the Journal of the American Medical Association (JAMA). We've been traveling and haven't been able to keep up with what others were saying, but we're sure it's been well covered by the usual suspects. So we'll just add our take here, for what it's worth.
As most readers here know, what kind of mask (if any) will best protect a health care worker or anyone else at high risk of exposure to people infected with influenza virus is a difficult question. We still remain unsure whether flu is transmitted mainly by large or small droplets. If most…
revere | November 4, 2009It's being described as a "dramatic settlement" that will set a pattern for the nation. Let's hope so, because the agreement reached yesterday by the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) and hospital player Catholic Healthcare West (CHW) sounds like just what the doctor ordered. It covers 32 CHW facilities in California and Nevada, where CNA/NNOC represents 13,000 registered nurses.
Some details:
A centerpiece of the agreement is the creation of a new system-wide emergency task force, comprised of CNA/NNOC RNs and hospital representatives following…
revere | October 5, 2009In an earlier post I said I opposed mandatory vaccination for adults (but not for children), the one exception being for health care workers because they come in contact with people at high risk. My view then was that if you work in a health care institution and won't get vaccinated against flu, then you shouldn't come to work. Now I am re-evaluating my position as a result of some cogent and pragmatic comments from lawyer-bioethicist George Annas, professor of health law, bioethics and human rights at Boston University School of Public Health, and author of "The Rights of Patients." I know…
revere | July 26, 2009The Reveres have been around a long time and we know a lot of public health people in different states. Recently we were talking with a colleague about the problem of hospital surge capacity -- the ability to handle a sudden demand for services -- and she described her first job working for a state health department in the early 1980s. Her job was to compile a health resources report, essentially a yearly compilation of licensed and operating beds for all manner of health facilities, including hospitals, nursing homes, psychiatric facilities, outpatient clinics, rest homes, group homes and…
revere | May 28, 2009Influenza surveillance in the US has at least five component parts (depending on how you count it is as many as seven). We discussed the virologic surveillance system in another post. CDC has two surveillance sub-systems that look at hospitalized cases with laboratory confirmed influenza, the New Vaccine Surveillance Network (NVSN) and the Emerging Infections Program (EIP). The NVSN is confined to cases in children less than five years old, while the EIP covers all ages. Let's take a look at the most recent EIP data.
EIP doesn't cover the entire country. Instead it collects data from 60…
revere | April 12, 2009Fomites are inanimate objects that act as modes of transmission for infectious agents. You know. The doorknob or airplane armrest handled by someone who coughs on his hand or blows her nose. We know that some agents, like influenza viral particles, can remain viable (i.e., retain their ability to replicate in a host cell) for days or weeks. This doesn't automatically mean that fomites are an important mode of transmission, however. There is evidence those same viral particles lose their ability to replicate after only a few minutes on your hand. The apparent paradox is probably related to the…
revere | April 4, 2009If you know your bugs you know that Blattella germanica and Periplaneta americana are cockroaches. They aren't the only cockroach species. In fact there are an estimated 4000 different kinds of cockroach, many of them living in fields, forests or jungles. Unless they are living in your hospital's Intensive Care Unit:
Ectobius vittiventris (Costa) is a field-dwelling cockroach and 1 of 4,000 species worldwide. We describe a cockroach infestation of an intensive care unit (ICU).
[snip]
The University of Geneva Hospitals are a 2,200-bed tertiary healthcare center. The 18-bed medical ICU is…
grrlscientist | July 6, 2008tags: emergency pet care, hospitals, companion pet issues
Elektra is one of the survivors.
My companion female Solomon Islands eclectus parrot, Eclectus roratus solomonensis.
Image: GrrlScientist, 2 April 2008 [larger view].
I want to talk about something that has bothered me ever since I spent nearly five months in the hospital: what happens to your companion animals when you are suddenly not there to take care of them? If you live alone and don't have a local support system, as is true for me, then this is a very real problem, as I became painfully aware of nearly two years ago.…