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Thursday
Feb152018

VA Announces Aggressive New Approach to Produce Rapid Improvements in VA Medical Centers

By: Robbins RA

Abstract: No abstract available. Article truncated at 150 words. The U.S. Department of Veterans Affairs (VA) announced steps that it is taking as part of an aggressive new approach to produce rapid improvements at VA’s low-performing medical facilities nationwide (1). VA defines its low-performing facilities as those medical centers that receive the lowest score in its Strategic Analytics for Improvement and Learning (SAIL) star rating system, or a one-star rating out of five. The SAIL star rating was initiated in 2016 and uses a variety of measures including mortality, length of hospital stay, readmission rates, hospital complications, physician productivity and efficiency. A complete listing of the VA facilities, their star ratings and the metrics used to determine the ratings is available through the end of fiscal year 2017 (2). Based on the latest ratings, the VA currently has 15 one-star facilities including Denver, Loma Linda, and Phoenix in the Southwest (Table 1). 

Table 1. VA facilities with one-star ratings …

URL: http://www.swjpcc.com/news/2018/2/15/va-announces-aggressive-new-approach-to-produce-rapid-improv.html 

Wednesday
Feb142018

Medical Image of the Week: Blue-Green Urine and the Serotonin Syndrome

By: Ateeli H, Azid LA

Abstract: No abstract available. Article truncated after 150 words. A 56-year-old woman was electively admitted for parathyroidectomy for primary hyperparathyroidism with osteoporosis. Five hours post operatively, she developed acute change in mental status. The neurological exam showed inducible clonus, agitation, diaphoresis, ocular clonus, rigidity and hyperreflexia. The patient met Hunter criteria for the diagnosis of serotonin syndrome by being on citalopram and tramadol with the neurological exam findings (1). The patient had been on the same doses of these medications for years with no recent change in kidney or liver functions. The blue-green urine color was strikingly strange. Reviewing the operation room event records showed that she received a high dose of methylene blue to help identify the parathyroid glands.

Serotonin syndrome has been reported with concomitant administration of methylene blue and serotonin reuptake inhibitors (e.g., SSRIs, SNRIs, tricyclic antidepressants). It is recommended to avoid concomitant use and allow a washout period of at least 4-5 half-lives of the …

URL: http://www.swjpcc.com/imaging/2018/2/14/medical-image-of-the-week-blue-green-urine-and-the-serotonin.html 

Tuesday
Feb132018

Healthcare Payments Under the Budget Deal: Mostly Good News for Physicians

By: Robbins RA

Abstract: No abstract available. Article truncated after 150 words. In the early morning hours last Friday (2/9/18) Congress passed and President Trump signed a massive budget agreement (1). The spending package will cost about $320 billion over 10 years, according to the Congressional Budget Office. Payments for healthcare substantially increase under the deal. Most praised the agreement. "Congress made the right choice this morning for patients and communities by voting to halt damaging cuts to hospitals that care for low-income working families and others who face financial challenges," said Dr. Bruce Siegel, CEO of America's Essential Hospitals, which represents the nation's safety-net facilities. Marc Goldwein of the Center for a Responsible Federal Budget called the healthcare provisions the one "beacon of light" in what otherwise is an exorbitantly costly budget bill. Goldwein praised its mix of structural reforms with "reasonable policy” and liked that the bill pays for the increased healthcare spending.

The bill extends Medicare physician fee cuts …

URL: http://www.swjpcc.com/news/2018/2/13/healthcare-payments-under-the-budget-deal-mostly-good-news-f.html 

Wednesday
Feb072018

Medical Image of the Week: Acute Encephalopathy in a Multiple Myeloma Patient

By: Ateeli H, Zaid LA

Abstract: A 45-year-old man with new diagnosis of multiple myeloma waiting to start treatment presented with worsening dizziness, blurred vision that progressed to altered mental status over a week. His physical exam revealed confusion but no focal deficit. His extensive work up showed no abnormality except for mildly elevated serum viscosity. The patient was started immediately on plasmapheresis. He also received dexamethasone, thalidomide and cyclophosphamide. His symptoms resolved completely within a few days of therapy.

Serum viscosity measurements do not correlate well with symptoms or the clinical findings of hypervicosity syndrome. Plasmapheresis promptly relieves the symptoms and should be performed in symptomatic patients regardless of the viscosity level (1,2).

URL: http://www.swjpcc.com/imaging/2018/2/7/medical-image-of-the-week-acute-encephalopathy-in-a-multiple.html 

Tuesday
Feb062018

Brenda Fitzgerald, Conflict of Interest and Physician Leadership

By: Robbins RA

Abstract: No abstract available. Article truncated at 150 words. Barely noticed in the news last week was Brenda Fitzgerald’s resignation as director of the Centers for Disease Control (CDC) after only 6 months on the job (1). Her resignation came one day after Politico reported that she bought shares in a tobacco company one month after assuming the CDC directorship (2). The stock was one of about a dozen new investments that also included Merck and Bayer (3). Fitzgerald had come under criticism by Senator Patty Murray for slow walking divestment from older holdings that government officials said posed potential conflicts of interest (1). While serving as director of the Georgia Department of Health, Fitzgerald owned stock in five other tobacco companies: Reynolds American, British American Tobacco, Imperial Brands, Philip Morris International, and Altria Group (4).

“It gives you a window, I think, into her value system,” said Kathleen Clark, a professor of law focusing on government ethics at …

URL: http://www.swjpcc.com/editorial/2018/2/6/brenda-fitzgerald-conflict-of-interest-and-physician-leaders.html