First, a pitch for the latest Health Wonk Review, the biweekly blog post digest.
First, a pitch for the latest Health Wonk Review, the biweekly blog post digest.
A new study looks at how well IM docs can judge the severity of sepsis, an immune response to infection that can be mild and can be fatal.
Internists can discriminate well between septic patients with good, intermediate, and bad prognosis. Key messages Many patients suffering from sepsis are treated at general medical departments. Good estimation of the severity of disease upon admission is critical for decision-making regarding treatment. Internists including junior staff could discriminate well between patients with different degrees of disease severity of sepsis.
Three recent columns explain why this is important. Aimed at a hospital audience, they are of interest to all.
A lot of people—both inside and outside of hospitals—don’t know what is it, how to recognize it, or even how to define it.
And not only, as the CDC acknowledges, is the condition life-threatening, costly, “difficult to predict, diagnose, and treat,” but no one sector of the health system owns it.
That makes sepsis exceptionally challenging.
“Whereas stroke is province of a neurologist and trauma is the province of a surgeon and asthma is the province of an pulmonologist, sepsis involves the emergency room, the acute patient floor, the infectious diseases practitioner, the ICU, and the surgeon,” says Martin Doerfler, MD, senior vice president of clinical strategy and development at North Shore-LIJ Health System (soon to be renamed Northwell Health) in New York.” [Sepsis] really falls through the cracks, and that is part of the problem.”
Kay Lazar of the Globe had this yesterday:
State regulators are citing more than four dozen Massachusetts nursing homes for advertising dementia care services when they don’t actually offer the kind of care required to make such a claim, according to the Department of Public Health.
Massachusetts regulators revoked or suspended the professional licenses of 13 nurses after discovering recently that the health care workers lied about having nursing degrees or being licensed in other states, health department documents show.
The action sparked questions about the background checks state regulators rely on to issue licenses to thousands of nurses and applicants in 10 other health fields, including pharmacists, psychologists, podiatrists, and optometrists.
A long post on CommonHealth about suicide last week. There, two docs from MGH offer this conclusion:
...(I)f we devote the time and resources to be personally available, the rate of suicide goes down even in difficult social circumstances. This has been found in settings as varied as high schools and military gatherings.
So, we can, it turns out, do a lot. Moreover, much of what we can do is what we ought to be doing anyhow. Screening for preexisting risk factors early in life is essential.
We need to detect and treat psychiatric illnesses more effectively and earlier in life. We need a better approach to the social factors that haunt us and put us at risk for suicide. We need to understand and spread the word more effectively about the risk factors for all suicides.
And, most importantly, we need each other. Every single study of suicide and its causes shows that through open, personal and informed communication, the rate of suicide can be decreased. We’re pack animals. We need each other.
On the other side of the river Matthew K. Nock, the director of Harvard University’s Laboratory for Clinical and Developmental Research, was the subject of a 2013 profile in the NYTimes Magazine.
Our understanding of how suicidal thinking progresses, or how to spot and halt it, is little better now than it was two and a half centuries ago, when we first began to consider suicide a medical rather than philosophical problem and physicians prescribed, to ward it off, buckets of cold water thrown at the head.
“We’ve never gone out and observed, as an ecologist would or a biologist would go out and observe the thing you’re interested in for hours and hours and hours and then understand its basic properties and then work from that,” Matthew K. Nock, the director of Harvard University’s Laboratory for Clinical and Developmental Research, told me. “We’ve never done it.”
In an August paper in the Journal of Affective Disorders, he and his team looked at STB — suicidal thoughts and behaviors — looked at risk factors for 2,400 people. They found a strong link between suicide and “mental disorders” but note that “actors like childhood adversities or trauma also play a considerable role in the new onset of STB, especially in the transition from suicide ideation to suicide attempt.”
His lab has been busy. He’s co-author on 15 studies so far in 2015, ranging from suicide in the military to college freshman to depressed adolescent.
Plenty of Boston health care workers are involved with the Lasker award-winning Doctors without Borders, including US president Dr. Deane Marchbein, an anesthesiologist at Cambridge Health Alliance. They were cited for their work during the Ebola outbreak in Africa.
They are holding a recruitment meeting on Sept 21 at the Boston Public Library Commonwealth Salon
230 Dartmouth St.
Every day, Doctors Without Borders aid workers from around the world provide assistance to people whose survival is threatened by violence, neglect, or catastrophe—treating those most in need regardless of political, religious, or economic interest. Whether an emergency involves armed conflicts or epidemics, malnutrition or natural disasters, Doctors Without Borders is committed to bringing quality medical care to people caught in crisis.
On Monday, Sept. 21 medical and non-medical professionals are invited to join us for an evening presentation to learn more about how you can join Doctors Without Borders’ pool of dedicated aid workers.
An aid worker and Field Human Resources Officer will discuss requirements and the application process, and you’ll meet experienced Doctors Without Borders aid workers from the Boston area and hear their firsthand stories of “life in the field.”
Dr Marchbein spoke to the Globe when she was chosen for the post in 2012.
Q. Tell me about a dangerous spot where you have worked.
A. I spent this winter in Lebanon, working on getting medical supplies into Syria. Health facilities, doctors, and nurses were targeted. Since we were not sure we could keep the team safe, we had to abandon the idea of putting them in the field. So I Skyped with medical counterparts to understand what they needed and I taught a trauma course in Lebanon for those who might be going to Syria. And we were finding ways to get medical supplies in there.
Q. How did you do that?
A. Basically it’s about consorting with smugglers. There are thousands of years’ worth of well-worn smuggling routes from bordering countries. So instead of flatscreen TVs, they were smuggling in medical supplies.
Here are a few more Boston docs involved with the group.
In Boston, the students are back and so is the long list of health-related events, including the already sold-out IgNobels. Fold up some of your own paper airplanes and watch it via webcast next week. Saturday lectures are first come, first served.
7p. “Thinking about Flavor.” A Science and Cooking Public Lecture. Harold McGee and Dave Arnold. Harvard: Science Center C. Details. More science than health, but fun and sometimes nutritious. Click here for the full schedule and arrive early for a seat.
September 10 – 11. “Population Health Equity.” HMS: Joseph B. Martin Conference Center. Details, RSVP.
8:30a – 4p. “The Role of Universities in Addressing Global Health Challenges.” A symposium. Harvard: Knafel Gymnasium, 18 Mason St. Details, Registration.
Noon. “Fast-Acting Treatments for Depression: Intravenous Injections and Electromagnetic Fields.” Michael Rohan and Arkadiy Stolyar. McLean Hospital: Belmont campus – Service building, Pierce Hall. Details.
4:30p. “The Ethics of Innovative Neurosurgery.” A panel discussion. HMS: Armenise Building D, Amphitheater, 210 Longwood Ave. This event will be webcast. Webcast URL TBA. &nbsol Details, RSVP.*
8:30 – 5:30p. “MindEx 2015.” Keynotes: “What I Learned from Being Labelled Mentally Ill and My Views on Some Challenges Facing Cyberconscious Minds,” by Martine Rothblatt, and “The Current State of Personal Genomics,” by George Church. Harvard: Sanders Theater. Details. More Ex stuff.
UPDATE: Props to Beta Boston, another source of Globe health reporting.
Since the Globe currently has no full-time health and science editor, no science writer and a hard-to-find, often dated health site, we turn to the business section for news on health, or at least health finance and pharma. Perhaps things will pick up in the fall.
In terms of Globe-ish health-sci-ish reporting, we see STAT continuing to pop up in the paper and the paper’s website but not the STAT website. The business section of the print version of today’s paper premieres a weekly column called Kendall Squared. Today, Andrew Joseph reports on the rebranding of the square-less square, the sale of dishes at the closed Hungry Mother restaurant, a Forsyth Institute dentist who runs a children’s clinic in Kuwait and a non-profit dispute resolution group that is being prices out of the Square.
In the meantime, best to follow individual members of the Globe‘s shrinking but solid Metro sci-health team:
The state’s biggest hospitals were the most profitable in 2014, with Massachusetts General Hospital, the largest academic medical center, earning $200 million, up 34 percent from the previous year, and Brigham and Women’s Hospital earning $152 million, up 9 percent. Both are owned by Partners HealthCare of Boston.
Other big earners were Baystate Medical Center of Springfield, Lahey Hospital and Medical Center in Burlington, Saint Vincent Hospital in Worcester, and Beth Israel Deaconess Medical Center in Boston. The results are for fiscal year 2014, which for most hospitals ended last September.
The profits overall, however, mask some of the struggles in the changing field. Quincy Medical Center lost $39 million last year, the most in the state. Its owner, Steward Health Care System, closed the hospital at the end of the year. North Adams Regional Hospital in the Berkshires closed several months earlier. The push to cut costs has, in part, prompted several hospitals to consider mergers or acquisitions.
Earlier this week, the paper reported that the advent of ACOs has cut Medicare spending at five major health systems in the state
New figures show five Massachusetts health systems saved a combined $141 million during that period as part of the program, which aims to rein in costs by better coordinating care for Medicare patients and cutting unnecessary hospital stays and medical services. Doctors manage care for these patients in pools known as Pioneer accountable care organizations.