Use of medical scribes – unlicensed individuals hired to enter information into the EHR under clinician supervision – has increased substantially. This article addresses the risks engendered by the rise of a medical scribe industry and its potential for becoming integral to US health care delivery. Despite scribes’ reported value, this industry should be viewed as what it is: a workaround or adaptation to the suboptimal state of today’s EHRs. The use of scribes can pose potential risks to patients if they are allowed to enter orders into the EHR. Further, it should not be a substitute for much-needed EHR innovation and transition to more highly effective and more functionally efficient EHR systems. Click here to read full text.
News You Can Use
This article and invited commentary (JAMA Surgery, Dec) concludes: “high-quality evidence shows that bariatric surgical procedures result in greater weight loss than nonsurgical treatments and are more effective at inducing initial type 2 diabetes mellitus remission in obese patients.” Click here to read full-text.
This scientifice statement from the American Hear Association (Circulation, Dec 2014) provides an up-to-date overview of the postthrombotic syndrome (PTS), a frequent, chronic complication of deep venous thrombosis (DVT), and to provide practical recommendations for its optimal prevention, diagnosis, and management. The intended audience for this scientific statement includes clinicians, and other healthcare professionals caring for patients with DVT. Click here to read full text.
This guideline (J Clin Endocrinol Metab, Dec 14) recommends “that plain radiographs be obtained of the pertinent regions of the skeleton in patients with suspected Paget’s disease. If the diagnosis is confirmed, we suggest that a radionucleotide bone scan be done to determine the extent of the disease. After diagnosis of Paget’s disease, we recommend measurement of serum total alkaline phosphatase or, when warranted, a more specific marker of bone formation or bone resorption to assess the response to treatment or evolution of the disease in untreated patients. We suggest treatment with besphosphonate for most patients with active Paget’s disease who are at risk for future complications, Click here to read full text.
The article concludes: “Use of a stringent protocol to treat NAS, regardless of the initial opioid chosen, reduces the duration of opioid exposure and length of hospital stay. Because the major driver of cost is length of hospitalization, the implications for a reduction in cost of care for NAS management could be substantial. (Pediatrics, Aug 2014) Click here to read full-text.
Extending strict rest to 5 days from 1-2 days may not improve symptoms in children with mild concussionby jmiller on January 16, 2015
In an early online (Jan 5th) article from Pediatrics, there may be no benefit to an extended period of strict rest for children after mild traumatic brain injury or concussin. In fact, symptom reporting was increased in children who were recommended extended rest. Strict rest was defined as no school, work or physical activity followed by a stepwise return to normal activities. Children admitted to the hospital were excluded from the analysis. Click here to read full text.
This is an evidence-based review of the diagnosis, staging and treatment of CLL. “Chemoimmunotherapy is the standard first-line option approach for CLL, the most common leukemia observed in adults. Treatment is initiated when the disease becomes symptomatic, and survival is high following treatment.” (JAMA, Dec 3) Click here to read full-text.
This article was Dynamed’s pick for a recent article that would most likely change clinical practice. The article concludes: “Four readily available variables (acute respiratory compromise before admission: bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHT with high sensitivity in young, acutely head-injured children admitted to the PICU. (Pediatrics, Dec) Click here to read full-text.