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Sensing Savvy

Resident Work Hour Limits: Should They Be Extended?

Posted by Thomas Gole, DO, FAAFP on May 22, 2017 7:00:00 AM

An 18-year-old woman was taken to the ER of New York Hospital on March 4, 1984. Suspecting she had a viral syndrome after presenting with a fever and jerking movements, physicians admitted her for observation and hydration.

As the night wore on, however, the woman became more and more agitated, leading her doctors — a first- and second-year resident and an attending — to order additional medications and restraints. A few hours later the woman was dead. This was the infamous case of Libby Zion, and it forced the medical establishment to take a hard look at resident work hours and supervision due to errors made during her care.

Before work hour restrictions were implemented, it wasn’t uncommon for residents to stay awake for upward of 36 hours. In 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited resident shifts to 16 hours, but the ACGME proposed in late 2016 that the shifts be extended to 28 hours.

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Topics: Clinical Trends

Temporary Doctors are Gaining Popularity: 5 Things to Know

Posted by Thomas Gole, DO, FAAFP on May 10, 2017 6:30:00 AM

For the past 10 years, Dr. Louise Henson has been working as locum tenens physician. Because she’s a temporary doctor, Henson can avoid long hours and being on call, and can set her own hours and doesn’t have to worry about taking time off for family or personal commitments.

Until recently, locum tenens physicians traditionally filled in for colleagues who were ill, traveling or otherwise unable to work. Now, the opportunity to work as a temporary doctor is becoming an attractive option for physicians who feel burned out. Healthcare facilities are also seeing the benefits of employing more locum tenens staff members.

A recent report from locum tenens staffing agency Staff Care found temporary doctors are on the rise. Here are five things to know about the increase in locum tenens physicians.

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Topics: Clinical Trends

French President’s Assassination Leads to Development of Suturing Techniques Used to Reconnect Blood Vessels

Posted by Susan Eymann, MS on Mar 22, 2017 7:00:00 AM

When a major blood vessel is severed, death will occur if the bleeding isn't stopped and circulation restored. This was the case in 1894, when the fifth president of the Third Republic of France, Sadi Carnot, was attacked with a knife in the abdomen that left his portal vein severed. The surgeons who treated the president felt that the vein was too large to be successfully reconnected. Consequently, the vein bled out and the president died as a result of his wounds. This left a deep impression on a young French medical student at the University of Lyon, Alexis Carrel (1873-1944).

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Topics: Clinical Trends

Life Expectancy in the US

Posted by Thomas Gole, DO, FAAFP on Mar 20, 2017 6:30:00 AM

The statistics alarm. Despite being one of the world's wealthiest nations and one which spends more than any other country on healthcare, the United States trails most other industrialized countries and even Cuba in life expectancy. According to the UN's World Population Prospects of 2015, the US, with an average life expectancy of 78.88 years, ranks 43rd in life expectancy at birth. American males are expected to live to 76.47 and females to 81.25 years.

"Some people need health care some of the time, but all people need health and wellness all the time."

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Topics: Clinical Trends

What to Know about the CDC's Safer Dialysis Initiative

Posted by Deborah Brouwer-Maier RN, CNN on Dec 5, 2016 7:00:00 AM

Behind cardiovascular disease, bloodstream infections are the second highest killer of hemodialysis patients. The death rates from infection could be halved if dialysis facilities implemented the CDC’s Core Interventions for Dialysis Bloodstream Infection Prevention, the health agency notes.

To make dialysis professionals more aware of these interventions, the Centers for Disease Control and Prevention has launched a “Making Dialysis Safer for Patients” initiative.

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Topics: Hemodialysis, Clinical Trends

Pediatric Vascular Access Surveillance Examined at Boston Children's Hospital

Posted by Deborah Brouwer-Maier RN, CNN on Nov 23, 2016 6:30:00 AM

Pediatric nephrologists at Boston's prestigious Children's Hospital recognized that an arteriovenous (AV) access is the preferred vascular access for dialysis delivery in children and adolescents requiring chronic hemodialysis (HD). They also understood that, because of the small size of the accesses, maintenance of an access after it is created becomes all the more important and difficult.

Ultrasound dilution (UD) monitoring of AV access flow is widely used in adult HD units for early stenosis detection, but its experience in pediatrics is limited. Therefore, the Boston group they undertook a study to examine its usefulness in children and adolescents.

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Topics: Hemodialysis, Clinical Trends

The Cardiovascular Effects of Arteriovenous Fistulas: A Cause for Concern?

Posted by Deborah Brouwer-Maier RN, CNN on Nov 16, 2016 6:30:00 AM

Jennifer MacRae and her colleagues from the University of Calgary, Calgary, Alberta, Canada, reviewed the hemodynamic and cardiovascular consequences of arteriovenous fistulas. Their findings were published in a 2006 paper in Seminars in Dialysis.

MacRae identified three periods when the presence of an AV fistula influences a patient's hemodynamics.

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Topics: Hemodialysis, Clinical Trends

The Maytag and Nose-Cone Artificial Kidneys

Posted by Susan Eymann, MS on Nov 7, 2016 7:00:00 AM

During the early days of dialysis, in the 1960s, only a few patients could be treated, and even then at great cost. This was unacceptable to W.J. Kolff, the inventor of the first artificial kidney.

As head of the Department of Artificial Organs at the Cleveland Clinic, Kolff wanted to make dialysis so reasonable that anyone could afford it. In his biography, Inventor for Life, The Story of W.J. Kolff, Father of Artificial Organs, Herman Broers relates how Kolff went in search of a way to allow kidney patients to dialyze at home to relieve the pressure of limited beds in dialysis centers. In 1966, Kolff and his team arrived at a solution.

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Topics: Hemodialysis, Clinical Trends

Beating Surgeon Burnout: Advice From Your Peers

Posted by Thomas Gole, DO, FAAFP on Oct 10, 2016 6:30:00 AM

“Doctors and other health workers pay dearly for the relentless stress of patient care, a plight compounded by mounting bureaucracy and accelerating change in the healthcare industry,” Dr. Mark Greenawald concluded after tragically losing one of his ob-gyn patients during childbirth, and being unable to successfully process the grief from the experience.

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Topics: Clinical Trends, CABG Surgery

How Do You Rate the Affordable Care Act (ACA)? These Docs Gave it an F

Posted by Thomas Gole, DO, FAAFP on Sep 26, 2016 7:00:00 AM

Since its inception six years ago, the Affordable Care Act (ACA) has received lots of feedback. Regardless of political opinions, physicians have voiced their thoughts on the law, praising it for improving access to healthcare but saying it has negatively affected their practices.

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Topics: Clinical Trends, Hospital Administration

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