George Michael, still breathless after pneumonia and tracheotomy, plans a show for his doctors (video)

Video: George Michael: This has been the worst month of my life. ShowBiz411.

A thin and visibly weak George Michael (48) told reporters outside his home in London that he wasn't supposed to speak for very long and was still recovering from a tracheotomy: "I got streptococca-something... It's a form of pneumonia and they spent three weeks keeping me alive basically," Michael said of the doctors in the Austrian hospital where the singer has been receiving treatment since he fell ill in November.

He added that he also wanted to hold a special show for the Austrian doctors who treated him. "I've spent the last 10 days since I woke up literally thanking people for saving my life."

References:

Gaunt George Michael says "fortunate to be here". Reuters, 2011.

iPad App for Education of Heart Patients After Surgery - Mayo Clinic Video

From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."



Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

Every single hour of television watched after the age of 25 reduces the viewer’s life expectancy by 22 minutes

By comparison, smoking a single cigarette reduces life expectancy by about 11 minutes.

An adult who spends an average of six hours a day watching TV over the course of a lifetime can expect to live 4.8 years fewer than a person who does not watch TV.

References:

Get Up. Get Out. Don't Sit. - NYTimes, 2012 http://nyti.ms/10oXBQd

Comments from Twitter and Google Plus:

Humera Naqvi, MD @nayab78: hmmm that means we ppl should be dying early taking the amount of tv watched but life expectancy has increased.

K Dillon, RDMS,CPC-A @comalliwrites: Confounders & confirmation bias not accounted for...

@ShadolooDoll: Misleading. It isn't TV itself, but the lack of activity. A person who is dedicated to exercise can still watch TV, right?

Timothy Cook: Great, since I stopped watching TV.  I can start smoking again!  ;-)

Davíð Þórisson: Phew - no mention of watching Youtube! :-)

Jimena Yosara Aguilar Jimenez: I'll never watch tv again

Dimiter Stanev: Does that mean that disabled people suffer from this too?

Image source: Wikipedia, Creative Commons Attribution ShareAlike 2.5 License.

Neurological and autoimmune disorders after influenza vaccination: no change in risk for Guillain-Barré syndrome, MS, type 1 diabetes, or RA

This Swedish retrospective cohort study, published in BMJ, examined the risk of neurological and autoimmune disorders in people vaccinated against pandemic influenza A (H1N1) with Pandemrix (GlaxoSmithKline) compared with unvaccinated people over 8-10 months.


Image of the H1N1 Influenza Virus, CDC.

One million people were vaccinated against H1N1 and 900,000 remained unvaccinated.

Excess risks among vaccinated people were of low magnitude, but present, for:

- Bell’s palsy (hazard ratio 1.25)
- paresthesia (1.11)
- inflammatory bowel disease (IBD)

Risks for Guillain-Barré syndrome, multiple sclerosis, type 1 diabetes, and rheumatoid arthritis remained unchanged.

The risks of paresthesia and inflammatory bowel disease (IBD) among those vaccinated in the early phase (within 45 days) of the vaccination campaign were significantly increased; the risk being increased within the first 6 weeks after vaccination.

The risks were small but significant among more than one million vaccinated, but only in high risk groups targeted for early vaccination and who were likely to have earlier comorbidity.

The absolute risk of Bell’s palsy was low, 6.4 cases per 100 000 vaccinated population.

References:

Neurological and autoimmune disorders after vaccination against pandemic influenza A (H1N1) with a monovalent adjuvanted vaccine: population based cohort study in Stockholm, Sweden. BMJ 2011; 343:d5956 doi: 10.1136/bmj.d5956 (Published 12 October 2011).

AP Video: Chopstick Pierces Toddler's Brain in China (Recovered After Surgery)

A 14-month-old toddler was playing in the kitchen when he fell, sending a chopstick up his nose. Surgeons were able to remove the chopstick.

Hockey-puck-on-a-rod test checks for concussion after head trauma

From NPR:

The hockey-puck-on-a-rod test was invented by a Michigan high school student.

It works like this: Tester suspends the device while injured athlete sits with forearm on table, fingers loosely circling the stick. Without warning, tester drops stick. Athlete grabs stick as fast as possible. Place where athlete grabs gives an instant readout of reaction time.

It all happens in milliseconds - too fast to measure with a stopwatch. Athletes with concussions had reaction times that were 15% slower.

References:

Teenager's Science Project Leads To Simple Concussion Test. NPR.

Comments:

Nicholas Genes - Neat idea. I like how it's free of stopwatches and all the variability they introduce. But it seems that athletes would need to have a baseline measurement pre-trauma to really compare (maybe they can do it when they're signing waivers at the start of the season...)

Hospitalist evolution? "Extensivist" = hospitalist who prevents readmissions by seeing patients after discharge

"On a typical morning, Sandip Patel, MD, a hospitalist employed by a health plan in Southern California, rounds on patients at the hospital, then meets with case managers and a medical director to review care plans and decide which patients will stay or go.

In the afternoon, Dr. Patel may see recently discharged patients—those coded "red" or "yellow," based on medical complexity—at an integrated-care center, which is also owned and run by the health plan. Then he might head to a nursing home to check on patients discharged a week ago.

Dr. Patel considers himself an "extensivist" with a goal to reduce readmissions. "Lowering readmission rates is within the purview of the hospitalists."

References:
Health-plan hospitalists cut readmissions—by sometimes leaving the hospital. Today's Hospitalist, 2010.
Median adult hospitalist compensation up slightly to $220,619 in 2010 http://goo.gl/D9rHp

Image source: sxc.hu

Oral factor Xa inhibitor apixaban - more effective than enoxaparin for thromboprophylaxis after knee replacement

Low-molecular-weight heparins such as enoxaparin are preferred for prevention of venous thromboembolism after major joint replacement. Apixaban, an orally active factor Xa inhibitor, might be as effective, have lower bleeding risk, and be easier to use than is enoxaparin.

The primary outcome in this Lancet study was the composite of asymptomatic and symptomatic deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and all-cause death during treatment. The primary outcome was reported in 15% of apixaban patients and 24% of enoxaparin patients (relative risk 0·62), absolute risk reduction 9·3%.

Major or clinically relevant non-major bleeding occurred in 4% of patients receiving apixaban and 5% of treated with enoxaparin.

The authors concluded that apixaban 2·5 mg twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.

References:

Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. The Lancet, Volume 375, Issue 9717, Pages 807 - 815, 6 March 2010.

Image source: Apixaban, Wikipedia, public domain.

SHAKE may be common in hospitals: Supplement-associated Hyperammonemia After Cachectic Episode

High-protein dietary supplements were started for 2 patients, who had a period of anorexia before hospital admission but no history of liver disease. Subsequent altered mental status with ataxia developed in both patients.

Hyperammonemia was noted, while liver function test results remained normal.

Removal of the high-protein dietary supplements led to reversal of symptoms and normalization of the ammonia level.

With the ubiquity of nutrition supplement use, SHAKE (supplement-associated hyperammonemia after c[k]achetic episode) syndrome may be common in modern hospitals.

References:
Iatrogenic Hyperammonemia After Anorexia. Emily Welsh, BA; Jan Kucera, MD; Michael D. Perloff, MD, PhD. Arch Intern Med. 2010;170(5):486-488.
Image source: sxc.hu.

28% of Vermont doctors "to stop practicing medicine" after single payer reform - doctors on Twitter disagree

According to BMJ, Vermont moves closer to becoming first US state to provide “socialised medicine”.

Vermont is set to become the first US state to launch a single payer healthcare plan after a bill passed both houses of the state’s legislature.

The plan is expected to be signed by Governor who originally proposed the idea that would abolish most insurance plans and would instead provide healthcare to all residents through public funding - a “single payer” scheme and is fiercely opposed by many conservative politicians as “socialised medicine.”

Some doctors in Vermont are unhappy about the proposed changes. In an online poll of 600 doctors conducted by a state representative and an ObGyn doctor, 28% said that they will stop practising medicine in the state if the plan is adopted.

Comments from Twitter:

@a_singledrop (Emily Lu): Seriously?

@movinmeat: calling their bluff.

@gruntdoc (GruntDoc): States as exp labs.

@backpackerchick (Hartley): In another era, doctors ****** about Medicare and found themselves richer than ever when it was enacted! What's good for the doctor (profits) is not necessarily good for the patient!

@RN_ing (Mary v. Seattle RN): Change is difficult... to be expected, but continue to want #singlepayor.

@irfandhalla (Irfan Dhalla): Single payer turned out to be well liked by docs in Canada. Will same happen in Vermont?

What do you think? Feel free to comment below, or post on Twitter.

References:

Vermont moves closer to becoming first US state to provide “socialised medicine”. BMJ 2011; 342:d2921.

Image source: OpenClipArt.org, public domain.