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Guidelines for family-centered care in the neonatal, pediatric, and adult ICU

by jmiller on January 11, 2017

These guidelines (Crit Care Med, Jan) “identify the evidence base for best practices for family-centered care in the ICU.”  The original guidelines published in 2007 have been one of the most widely cited documents on family-centered care.  However, the prior guidelines were developed using what is now an outdated evidence analysis. The new guidelines described in this work are not an update of the prior guidelines, but instead are the result of a completely new and more rigorous analysis.  These new guidelines represent the current state of international science in family-centered care and family support for family members of critically ill patients across the lifespan. “  Click here to read full text.

Your health care in 2017: what you must know

by jmiller on December 29, 2016

Frank Lalli, once a long serving editor of Money Magazine, wrote this piece for last Sunday’s (Dec 25th) newspapers.  He gives a very analytical picture of what the future will likely be in respect to Obamacare; purchasing health insurance across state lines; drug prices; changes to Medicare and Medicaid; insurance changes through employers; etc.  It’s a fascinating read with thoughtful analysis.  To read full text, click here.

Higher mortality in weekend admissions to the hospital: true, false, or uncertain?

by jmiller on December 28, 2016

This “Viewpoint” article (JAMA, Dec 27) concludes, “recent studies suggest that patients admitted during weekends are at no greater risk of dying than those admitted during the week.  Policy makers need to avoid unjustified claims about an increased risk of death among patients admitted during weekends because doing so only serves to undermine public confidentce and trust in hospitals and damage staff morale.  Neither of these are in the interest of patients or the public.”   To read full text, click here.

Cardiovascular safety of Celecoxib, Naproxen, or Ibuprofen for arthritis

by jmiller on December 27, 2016

Both  the NEJM  (Nov 13, epub) and The Medical Letter (Dec. 19) reported on the cardiovascular safety of Celebrex.  The NEJM publication  concludes:  “At moderate doses, celecoxib was found to be noninferior to ibuprofen or naproxen with regard to cardiovascular safety.  In summary, the PRECISION trial also showed that celecoxib treatment also resulted in lower rates of gastrointestinal events than did either comparator drug and in lower rates of renal adverse events than did ibuprofen.”  Click here to read full text.  The Medical Letter (Dec. 19) reported that “the average dosage of the COX-2 selective NSAID celecoxib (Celebrex) used in the PRECISION trial was too low to support the determination that celecoxib is noninferior to ibruprofen and naproxen with regard to cardiovascular safety.  Cox-2 selective NSAIDS cause less gastrointestinal toxicity and bleeding than nonselective NSAIDS, but they may have a prothromobotic effect, and all NSAIDS are nephrotoxic.  Elderly patients, who are most at risk, should exercise caution in taking any NSAID, including celecoxib.  To read Medical Letter piece, click here.

Partnering with nurses to transform primary care – JAMA forum

by jmiller on December 27, 2016

This is a very interesting piece about developing skill mix with registered nurses to transform primary care.  The author cites the many challenges to making it work, but as one physician explains t “I’m able to actually see more patients and spend more time with them on issues that matter and require my expertise.  Click here to read this forum (JAMA, Dec. 20)

Teens of the week: Where are they now? Featuring Helen Selonick, daughter of Dr. Stu Selonick and wife of AAMC’s emergency room doc, James Prevas

by jmiller on December 27, 2016

This is a beautiful piece, published December 26th in the Capital,  revisiting a 2003 Teen of the week:  Helen Selonick, daughter of Dr. Stu Selonick, who also became (and married) a physician.  This is a delightful piece to share.  To read full article, click here.

Meaning and the nature of physicians’ work by Abraham Verghese, M.D.

by jmiller on December 8, 2016

This excellent Perspective from the Nov.10th issue of NEJM, written by Dr. Abraham Verghese, author of Cutting For Stone, is a very insightful piece on the timeline of where we are now in medicine, versus where we were.  He poignantly comments that “patient centered care”, despite all the rhetoric, is not the center of things.  His vision of the future is that “the U.S. medical community will have to rethink the human-computer interface and more thoughtfully merge the real patient with the ipatient.”  Click here to read full-text.

Mindfulness Meditation-Based Intervention is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

by jmiller on November 3, 2016

“Findings of this study indicate that the targeted mindful meditation-based intervention is feasible and safe in patients with opioid-treated chronic low back pain.  Mindful meditation-based interventions are particularly attractive for the treatment of chronic disabling conditions because they promote an acceptance-based, self-reflective process, which can encourage a patient-empowering and personalized approach addressing the whole patient.  This approach extends beyond the traditional, disease-focused treatment model of chronic pain and passive nature of pharmacotherapy, offering a valuable therapeutic option for those with refractory chronic low back pain requiring daily opioid therapy.”  (Journal of Alternative and Complementary Medicine, August)  Click here to read full-text.

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