News

Last 50 Imaging Postings

 (Click on title to be directed to posting, most recent listed first)

University of Arizona-Phoenix Receives Full Accreditation
Limited Choice of Obamacare Insurers in Some Parts of the Southwest
Gottlieb, the FDA and Dumbing Down Medicine
Salary Surveys Report Declines in Pulmonologist, Allergist and Nurse 
   Incomes
CDC Releases Ventilator-Associated Events Criteria
Medicare Bundled Payment Initiative Did Not Reduce COPD Readmissions
Younger Smokers Continue to Smoke as Adults: Implications for Raising the
   Smoking Age to 21
Most Drug Overdose Deaths from Nonprescription Opioids
Lawsuits Allege Price Fixing by Generic Drug Makers
Knox Named Phoenix Associate Dean of Faculty Affairs
Rating the VA Hospitals
Garcia Resigns as Arizona University VP
Combination Influenza Therapy with Clarithromycin-Naproxen-Oseltamivir
   Superior to Oseltamivir Alone
VAP Rates Unchanged
ABIM Overhauling MOC
Substitution of Assistants for Nurses Increases Mortality, Decreases Quality
CMS Releases Data on Drug Spending
Trump Proposes Initial Healthcare Agenda
Election Results of Southwest Ballot Measures Affecting Healthcare
Southwest Ballot Measures Affecting Healthcare
ACGME Proposes Dropping the 16 Hour Resident Shift Limit
Non-Small Cell Lung Cancer: RT Out, Pembrolizumab In, and Vaccine
   Hope or Hype
Dental Visits May Prevent Pneumonia
Hospital Employment of Physicians Does Not Improve Quality
Clinton's and Trump's Positions on Major Healthcare Issues
IDSA Releases Updated Coccidioidomycosis Guidelines
Withdraw of Insurers from ACA Markets Leaving Many Southwest 
   Patients with Few or No Choices
Another Phoenix VA Director Leaves
Hospital Executive Compensation Act Dropped from Ballot
Banner Hacked-3.7 Million at Risk
Top Medical News Stories 2015
Banner Plans to Issue New Bonds to Cover University of Arizona Medical
   Center Purchase
HealthCare.gov Shares Personal Data with Third Parties
2014's Top Southwest Medical Stories
Troubles Continue for the Phoenix VA
Whistle-Blower Accuses VA Inspector General of a "Whitewash" 
VA Office of Inspector General Releases Scathing Report of Phoenix VA
Banner Health, University of Arizona Health Network to Merge
Searchable Database for Physician CMS Payments
Smoking Rates Low in Southwest
Patient Deaths Blamed on Long Waits at the Phoenix VA
Banner Prints Social Security Numbers
Many Southwest Hospitals Will Receive Decreased CMS 
   Reimbursement
Bipartisan Proposal Calls for SGR Repeal
Helman Defends Decision to Pull VA Sponsorship of 
   Veterans Day Parade

 

For an excel file with complete news listings click here.

A report from Heartwire described a letter written by Peter Wilmshurst to the AHA asking for full disclosure of conflicts of interest in the MIST trial. Wilmshurst was portrayed in SWJPCC on April 27, 2012 in our Profiles of Medical Courage series. We felt the report of the letter might be of interest to the readership of SWJPCC but there was no good section to pass along the Heartwire article. For this reason, a new Section entitled “News” has been started to report developments outside the usual medical journal purview or from other sources which might interest our readers. We encourage bringing news-worthy articles to our attention and would welcome submission of written reports of such articles.

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Thursday
Jun152017

University of Arizona-Phoenix Receives Full Accreditation

University of Arizona (UA) officials announced yesterday that the UA College of Medicine-Phoenix, which was originally a branch of the UA-Tucson medical school, was granted full accreditation by the Liaison Committee on Medical Education (LCME) (1). The College of Medicine-Phoenix was created 10 years ago. In 2012, the UA College of Medicine-Phoenix received “preliminary” accreditation with the LCME, then “provisional” accreditation in 2015 and now full accreditation.

To date, the UA College of Medicine-Phoenix has graduated 354 physicians, with classes of about 80 students per year. One year ago this month, the Arizona Medical Association asked for an investigation after a half-dozen of the Phoenix medical school’s top leaders left for positions out of state. Among those departures was the school’s dean, Dr. Stuart D. Flynn. Dr. Kenneth Ramos served as interim dean and helped lead the Phoenix medical school through the accreditation. Dr. Guy Reed from Tennessee was recently hired as the school’s new dean and assumes his duties in July.

There are now five medical schools in Arizona: the two UA medical schools; the Mayo Clinic School of Medicine, which is opening its Arizona campus in Scottsdale this summer; and Midwestern University and A.T. Still University, which both operate osteopathic medical schools in the Phoenix area. A sixth medical school, Omaha-based Creighton University School of Medicine, has medical students doing third- and fourth-year rotations in Arizona.

Richard A. Robbins, MD

Editor, SWJPCC

Reference

  1. Innes S. University of Arizona's Phoenix medical school receives full accreditation. Arizona Star. June 14, 2017. Available at: http://tucson.com/news/local/education/college/university-of-arizona-s-phoenix-medical-school-receives-full-accreditation/article_64a1da80-1866-5a51-a062-7cc04ecd261d.html (accessed 6/15/17).

Cite as: Robbins RA. University of Arizona-Phoenix receives full accreditation. Southwest J Pulm Crit Care. 2017;14(6):311. doi: https://doi.org/10.13175/swjpcc077-17 PDF 

Monday
Jun122017

Limited Choice of Obamacare Insurers in Some Parts of the Southwest

The New York Times is reporting that all of Arizona, much of Nevada, and portions of Utah and Colorado will have only one insurer available under the Affordable Care Act (ACA, Obamacare) marketplace (Figure 1) (1).

 

Figure 1. New York Times compilation of insurance company announcements for providing coverage under the ACA or Obamacare.

 

About 35,000 people buying insurance in Affordable Care Act marketplaces in 45 counties could have no choice in carriers in Ohio and Missouri (Figure 1), This would be the first time that has happened since the marketplaces were opened in 2014.

Some insurance companies are still deciding what they will do in 2018, and others may reverse course, so these numbers could go up or down.

Most Americans get health insurance from a job or government program, but about 22 million people buy individual policies under Obamacare. More than half of them use Obamacare marketplaces, where most of them get a federal tax credit to help pay for coverage. The rest buy directly from an insurer or broker, outside the Obamacare marketplaces. A recent New York Times analysis showed that many insurers are now choosing to sell exclusively outside the marketplaces, where their customers are not eligible for federal subsidies. Because customers cannot use subsidies for these plans, many may not be able to afford coverage.

Richard A. Robbins, MD

Editor, SWJPCC

Reference

  1. Park H, Carlsen A. For the first time, 45 counties could have no insurer in the Obamacare marketplaces. New York Times. June 9, 2017. Available at: https://www.nytimes.com/interactive/2017/06/09/us/counties-with-one-or-no-obamacare-insurer.html (accessed 6/12/17).

Cite as: Robbins RA. Limited choice of healthcare insurers in some parts of the southwest. Southwest J Pulm Crit Care. 2017;14(6):295. doi: https://doi.org/10.13175/swjpcc074-17 PDF 

Friday
Apr142017

Gottlieb, the FDA and Dumbing Down Medicine

Gottlieb, the FDA and Dumbing Down Medicine

In the last few weeks several events have occurred that might impact drug approval in the US. President Donald Trump's pick for FDA commissioner, Dr. Scott Gottlieb. Gottlieb, like many of Trump’s picks for administration healthcare positions, is a physician. He also has experience as deputy FDA commissioner from 2005-7.  However, his confirmation hearing before the Senate Committee on Health, Education, Labor and Pensions alarmed some who say his deep ties to the pharmaceutical industry will cause a conflict of interest (1). Others praised Gottlieb as the right man to lead the FDA.

As opposed to Trump, Gottlieb denied any connection between vaccines and autism (1,2). Dr. Gottlieb called the issue "one of the most exhaustively studied questions in medical history," before saying, "There is no plausible link between vaccines and autism. At some point, we have to accept 'no' for an answer." However, Gottlieb did not give a straight answer when asked to share his thoughts on drug importation. While President Donald Trump has supported increased drug importation and is reported to be working with Democratic lawmakers on drug importation legislation, Dr. Gottlieb had previously opposed the measure (1). When asked if he opposes importing cheaper drugs from foreign countries, he said, "I can tell you I have a lot of ideas that I want to work on right away on how I think we can get more product competition onto the market."

Gottlieb stated that the FDA could speed up approval of new drugs and devices (1). However, a letter to the editor published in the New England Journal of Medicine examined compared review times for new therapeutic agents that were approved by the FDA or the European Medicines Agency (EMA), the primary drug regulator in Europe, between 2011 and 2015 (3). The median total review time was 306 days (interquartile range, 239 to 371) at the FDA, as compared with 383 days (interquartile range, 327 to 446) at the EMA.

In welcome news to many physicians, Gottlieb voiced uneasiness over increasing regulation of physicians’ practices (1). “My concern that the agency was losing confidence in physicians and felt it need[ed] …to supplant their judgment for the judgment of doctors,” Gottlieb said. He had previously referred to the FDA’s action on Arcoxia, a pain killer that was rejected in April 2007 because of concern that it could increase the risk of heart attack and stroke with prolonged use despite being meant for short-term pain relief. Gottlieb stated the opioid epidemic would be his "highest and most immediate priority." He added that the epidemic is a "public health emergency on the order of Ebola and Zika" that requires dramatic action from the FDA. "[T]o address it now, the types of actions that we are going to need to take are going to be more dramatic, perhaps, than the types of actions we would have taken 10 years ago."

Gottlieb did not note that some have linked the present opioid crisis to meddling by bureaucrats, administrations and politicians as an unattended consequence of the pain scale, opioid prescribing guidelines and patient satisfaction ratings (4). Furthermore, he did not note that increasing prescribing authority has been given to non-physicians with less education and clinical experience, e.g., unsupervised nurse practitioners in the Department of Veterans Affairs (5). Whether these non-physician clinicians will use drugs any more or less appropriately than physicians is unclear.

Richard A. Robbins, MD

Editor, SWJPCC

References

  1. Dickson V. Gottlieb favors regulations that empower doctors while keeping FDA standards. Modern Healthcare. April 5, 2017. Available at: http://www.modernhealthcare.com/article/20170405/NEWS/170409965 (requires subscription, accessed 4/11/17).
  2. Dodgson L. Trump has suggested vaccines cause autism — an idea that couldn't be more wrong. Business Insider. January 24, 2017. Available at: http://www.businessinsider.com/trump-vaccines-autism-wrong-2017-1 (accessed 4/11/17).
  3. Downing NS, Zhang AD, Ross JS. Regulatory review of new therapeutic agents — FDA versus EMA, 2011–2015. N Engl J Med. 2017Apr 6;376:1386-7. [CrossRef] [PubMed]
  4. Robbins RA. Pain scales and the opioid crisis. Southwest J Pulm Crit Care. 2017;14(3):119-22. [CrossRef]
  5. Department of Veterans Affairs. VA grants full practice authority to advance practice registered nurses. December 14, 2016. Available at: https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847 (accessed 4/11/17).

Cite as: Robbins RA. Gottlieb, the FDA and dumbing down medicine. Southwest J Pulm Crit Care. 2017;14(4):166-7. doi: https://doi.org/10.13175/swjpcc047-17 PDF 

Friday
Feb102017

Salary Surveys Report Declines in Pulmonologist, Allergist and Nurse Incomes

The 2016 Medscape Physician Compensation Report relates that orthopedic surgeons and cardiologists earn on average the most of those physicians surveyed ($443,000 and $410,000 annually) (1). Pulmonologists and critical care physicians fell in the middle of the spectrum of physician incomes ($281,000 and $306,000 respectively). Allergists were at the lower end ($205,000). Physicians in each category earned more or the same in 2016 than in 2015 except pulmonologists and allergists which were down compared to 2015 incomes of $296,000 ($15,000 decline) and $243,000 ($38,000 decline). As in years past, the survey is nonscientific. Physicians were asked to provide their annual compensation for patient care including salary, bonus, and profit sharing if employed, earnings after taxes, and deductible business expenses (but before income tax) if in private practice. 

The reason for the decrease is unclear but self-employed physicians (i.e., private practice) earned substantially more than employed physicians ($64,000 more for men, $44,000 more for women) (1). If more pulmonary physicians are becoming employed, this could be one reason for the decline in income. In 2016, the Medscape survey reported 59% of men and 72% of women were employed (1).

Nurses also made less on average in 2016. Incomes decreased from $79,000 annually for RNs in 2015 to $78,000 in 2016 (2). LPNs had a more substantial decrease from $46,000 to $43,000. RN’s not employed full time made the same hourly wage as those employed full time ($37/hour) and LPNs not employed full time actually made more per hour than those employed full time ($23 compared to $21/hour). The two most common reasons that nurses gave for decreased income was switching jobs or working less overtime.

Richard A. Robbins, MD

Editor, SWJPCC

References

  1. Peckham C.  Medscape Physician Compensation Report 2016. Medscape. April 1, 2016. Available at: http://www.medscape.com/features/slideshow/compensation/2016/public/overview#page=1 (accessed 2/9/17).
  2. Yox SB, Stokowski LA, McBride M, Berry E.  Medscape RN/LPN Salary Report 2016. Medscape. November 2, 2016. Available at: http://www.medscape.com/features/slideshow/nurse-salary-report-2016?src=WNL_specrep_nursesalary_170209_MSCPEDIT_usmds&uac=9273DT&impID=1286926&faf=1#page=1 (accessed 2/9/17).

Cite as: Robbins RA. Salary surveys report declines in pulmonologist, allergist and nurse incomes. Southwest J Pulm Crit Care. 2017;14(2):68. doi: https://doi.org/10.13175/swjpcc018-17 PDF 

Saturday
Jan282017

CDC Releases Ventilator-Associated Events Criteria

A new term has been coined by the CDC, ventilator-associated events (VAEs) (1). In 2011, the CDC convened a working group composed of members of several stakeholder organizations to address the limitations of the definition of ventilator-associated pneumonia (VAP) definition (2). The organizations represented in the Working Group include: the Critical Care Societies Collaborative (the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society for Critical Care Medicine); the American Association for Respiratory Care; the Association of Professionals in Infection Control and Epidemiology; the Council of State and Territorial Epidemiologists; the Healthcare Infection Control Practices Advisory Committee’s Surveillance Working Group; the Infectious Diseases Society of America; and the Society for Healthcare Epidemiology of America.

VAEs are defined by an increase oxygen (>0.2 in FiO2) or positive end-expiratory pressure (PEEP) (≥3 cm H2O), after a previous stable baseline of at least 2 days. There are three definition tiers within the VAE algorithm: 1) Ventilator-Associated Condition (VAC); 2) Infection-related Ventilator-Associated Complication (IVAC); and 3) Possible VAP (PVAP) (2). There are also many other criteria to classify a VAE into the CDC’s tiers which are omitted for brevity. These definitions have been implemented in the National Healthcare Safety Network (NHSN) and according to the CDC are easily implemented, can make use of electronic health record systems to automate event detection, and identify events that are clinically important and associated with outcomes such as ICU and hospital length of stay and mortality. According to the CDC most VACs are due to pneumonia, ARDS, atelectasis, and pulmonary edema which “are significant clinical conditions that may be preventable”.

The CDC says "the VAE definition algorithm is for use in surveillance; it is not a clinical definition algorithm and is not intended for use in the clinical management of patients”. Based on the experience with the hospital acquired infections program this seems unlikely. What seems more likely is that hospitals will be measured on VAE rates with financial or public relations consequences shortly to follow.

The best evidence suggests that the VAE concept is not useful for guiding clinical decisions in the moment (1). Its performance characteristics as a screening test appear to be terrible, with poor sensitivity (~32%) for detecting VAP in the one of the only prospective studies. This is because clinically insignificant fluctuations in oxygenation/PEEP status are often recorded as VAEs, diluting signal with noise. Numerous retrospective reviews supporting the VAE concept listed on CDC's website strongly link VAEs with morbidity and mortality. However, these observations could be true of many events and may be very different from showing that a prospective (intervention-based) approach is helpful. Pulmonologist Dr. Richard Wunderink from Northwestern commented that “the central hypothesis of the VAE criteria—that VAP and other potentially preventable complications of mechanical ventilation can consistently be detected by worsening gas exchange—is clearly not true”.

The problems with VAE appear much the same as the problems with VAP. Neither is strongly evidence-based and neither has been shown to be helpful in patient care. Furthermore, it might be possible to “game” the numbers by adjusting PEEP, expiratory time, and FiO2 within the defined limits.

Richard A. Robbins, MD

Editor, SWJPCC

References

  1. Pulm/CCM. What are ventilator-associated events (and why should you care)? Available at: http://pulmccm.org/main/2014/review-articles/ventilator-associated-events-care/?utm_source=Email+Updates+from+PulmCCM&utm_campaign=b1ee59472e-USP_mar_24_2014&utm_medium=email&utm_term=0_e9d9e09c7c-b1ee59472e-312029025 (accessed 1/24/17).
  2. CDC. Ventilator-associated event (VAE). January 2017. Available at: https://www.cdc.gov/nhsn/pdfs/pscManual/10-VAE_FINAL.pdf (accessed 1/24/17).

Cite as: Robbins RA. CDC releases ventilator-associated events criteria. Southwest J Pulm Crit Care. 2017:14(1):40-1. doi: https://doi.org/10.13175/swjpcc009-17 PDF