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The January, 2013 special issue of the Southern Medical Journal addresses "Disaster Medicine and Physician Preparedness." One of the key articles in this special issue addresses lessons learned in the aftermath of medical care during Hurricane Katrina by Dr. Anna Pou, Professor, LSU Health Science Center. Dr. Pou was one of the few physicians trapped in a major hospital in New Orleans who had to care for ill patients in the face of physical isolation of the hospital, limited and dwindling medical supplies, and in the face of heat and lack of physical resources. This interview with Dr. Pou explores some of the medical, ethical, and legal issues that physicians might face in responding to a disaster situation in their community, and how physicians can better prepare themselves because of the lessons learned from this physician's experiences.
US consumers spend more than $20 billion/year on overthe-counter (OTC) drugs. Although generic and brand name OTC drugs share the same active ingredients and undergo the same rigorous Food and Drug Administration approval process, brand name formulations continue to lead the OTC drug market with a higher market share. There is a limited amount of publicly available information regarding consumer perceptions and awareness about generic and brand nameOTC drugs. The main objective of this research was to understand what factors influence US consumers to purchase generic versus brand name OTC drugs. Although economic factors play an important role in influencing consumers to choose generic formulations, a variety of other factors including advertisements, duration of the OTC effectiveness, severity of sickness, preferable form of OTC medication, safety of the OTC, relief of multiple symptoms, and preferred company will persuade others to pay more for brand name drugs. Ultimately, increased awareness and use of generic OTC drugs may result in substantial cost savings for consumers.
The lessons learned from Hurricane Katrina for medical providers have challenged hospitals to revisit disaster response plans and to be more involved in state and local disaster planning and response. Mississippi is endeavoring to design and operate an efficient daily emergency communication, coordination, and transfer system that is well rehearsed when disaster strikes. This philosophy has been validated in the state’s medical response to disasters since Katrina in 2005. Physicians and medical providers should play a key role in disaster planning and response at the local, state, and regional levels. Healthcare facilities and providers should assess and improve communications interoperability with local emergency management and public safety officials, and should apply new assumptions to medical surge plans. Medical evacuations plans that mirror daily transfer patterns and procedures should be coordinated.
The lack of disaster training, which is apparent among physicians, nurses, hospital staff, volunteers, public health and safety personnel, and others, poses a considerable yet modifiable risk to patients, care providers, and healthcare facilities. In an era of declining budgets for emergency preparedness training, collaborative approaches to emergency preparedness training such as that developed by the Center for Health Professional Training and Emergency Response may enhance and improve provider preparedness. This article will detail the development of the Center for Health Professional Training and Emergency Response (CHPTER) including its innovative, competency-based emergency preparedness training (EPT) curriculum, and the results of a regional preparedness workforce assessment.
Disasters can occur at any moment and can be any size or type. It is a physician’s obligation to provide urgent care during disasters, assist in policy making relevant to disaster preparedness, and become educated in disaster preparedness and management. Numerous courses offered through the Federal Emergency Management Agency can help educate and prepare physicians in assuming an active response role. In addition, there are numerous disaster medical assistance teams that physicians may join. An axiom in disaster preparedness is that a successful response to a disaster is directly related to management of preparedness before the event and response after it. Physicians are leaders within their families, offices and communities, and it is vital that they become actively engaged in the processes involving disaster preparedness and response.
More than 1 million people in the United States have Parkinson disease
(PD), more than are diagnosed as having multiplesclerosis, amyotrophic lateral
sclerosis, muscular dystrophy, and myasthenia gravis combined. PD affects
approximately 1 in 100 Americans older than 60 years. It burdens patients,
their care partners, and the overall healthcare system. This article reviews
the epidemiology, clinical features, putative environmental risk and protective
factors, neuropathological aspects, heterogeneity, medical management, and recent
studies regarding genetics and PD. The article suggests that based on new
research, the prevalence of PD varies in different regions of the United
States. Some progress has been made in identifying the risk and protective
factors of PD, and a newly emphasized area of study in PD is genetics. Patient
care recommendations, based on American Academy of Neurology practice
guidelines, are outlined to show the state of contemporary medical management
of PD and related disorders.Proton pump inhibitors (PPIs) are one of the most commonly prescribed classes of medications in the United States. By inhibiting gastric H+/K+ adenosine triphosphatase via covalent binding to the cysteine residues of the proton pump, they provide the most potent acid suppression available. Long-term PPI use accounts for the majority of total PPI use. Absolute indications include peptic ulcer disease, chronic nonsteroidal anti-inflammatory drugs use, treatment of Helicobacter pylori, and erosive esophagitis. Although PPIs are generally considered safe, numerous adverse effects, particularly associated with long-term use have been reported. Many patients receiving chronic PPI therapy do not have clear indications for their use, prompting consideration for reduction or discontinuation of their use. This article reviews the indications for PPI use, the adverse effects/risks involved with their use, and conditions in which their use is controversial. Physicians who treat patients with PPIs for various disorders should fully understand the wide range of indications, contraindications, adverse actions, and risks so that they may not only obtain informed consent/compliance but also maximize the drug positive effects while minimizing the negative effects--essentially providing a positive benefit/risk ratio. Additionally, the patient should be well educated regarding side effects and what to do if they experience them.
Acute pulmonary embolism (PE) is a common clinical condition with presentations that may vary from asymptomatic subsegmental emboli to massive vascular obstruction and shock with high risk of death. Identifying patients at highest risk for death is critical to select those who would benefit most from thrombolytic therapy. New and evolving clinical prediction models, serum tests, and imaging modalities are being used to improve our ability to identify potential thrombolytic candidates. Although thrombolysis is the treatment of choice in patients at high risk, its role is debatable in patients at intermediate risk. The decision to initiate thrombolysis in a given patient should be based on their risk classification as well as any co-morbidities present which might influence that decision.
The term osteodystrophy describes the pathological changes in bone structure in chronic kideny disease (CKD); however, this term fails to describe adequately the adverse changes in mineral and hormonal metabolism in CKD that have grave consequences for patient survival. CKD-mineral and bone disorder (CKD-MBD) is a broader, newly defined term that should be used instead of renal osteodystrophy to define the mineral, bone, hormonal, and calcific cardiovascular abnormalities that are seen in CKD. The new paradigm in the management of renal bone disease is to “think beyond the bones” and strive to improve cardiovascular outcomes and survival. This means treating other aspects of the disease process that go beyond merely controlling parathyroid hormone levels. Primary physicians need to take a proactive approach to the management of CKD-MBD because the disorder begins early in the course of CKD, well before a patient is referred to a nephrologist. It is important to appreciate that when untreated, abnormalities of mineral metabolism lead to cardiovascular calcifications, which are a major cause of morbidity and mortality in patients with CKD. This review outlines the evidence behind the understanding of CKD-MBD, its implications for overall mortality, and the latest recommendations for management of CKD-MBD in patients with predialysis CKD.
Cardiovascular disease (CVD), the leading cause of death in the world, is largely preventable. An increasing amount of evidence suggests that annual vaccination with inactivated influenza vaccine reduces morbidity and mortality associated with CVD; however, immunization rates in patients with CVD fall consistently below the goals established by Healthy People 2020. Several national guidelines recommend annual influenza vaccination in people with a history of CVD. An annual influenza vaccination is a simple intervention aimed at decreasing cardiovascular morbidity and mortality, and practitioners should be mindful of ensuring that patients are protected.
Each year in the United States, more than 15,000 elderly adults experience a fatal fall, although little is known about the circumstances surrounding such falls. Most fatal falls in elderly adults are experienced by individuals residing in the community at their homes, indoors, and while walking and tend to affect the oldest elderly adults. A significant number of fatal falls also occur in public locations, outdoors, and during more vigorous activities and tend to affect elderly individuals not living with family. Although Hispanic ethnicity is associated with a decreased risk of fatal falls, it does not appear to be associated with the circumstances surrounding such falls. Fatal fall prevention should target the oldest elderly adults living at home while also helping to ensure individuals that living without family have the appropriate support.
Heart Failure is a growing problem in our patient population. Earlier referral to a heart failure specialist results in better outcomes. Both systolic dysfunction and heart failure with a preserved ejection fraction are common problems that are likely to increase as our population ages. Treatment options vary and will likely continue to grow. This activity will address the vast array of new treatment and device options, the importance of lifestyle modification, and CHF guidelines related to these therapies.
There is continued debate on early intervention versus watchful waiting for patients with valvular insufficiency. Through case-based examples, this activity will highlight the evidence for the dangers of delaying surgery, the risks and benefits of early surgery, and percutaneous treatment in our current armamentarium.
The ATP III update in 2004 provided lipid goals for the prevention of cardiovascular disease. Since then, new clinical trials of lipid treatments have provided additional data and new biomarkers have become available for identifying primary prevention subjects who may benefit from a treatment plan. This activity will review these new trials and biomarkers and as a result, provide insight as to potential changes to the new guidelines (ATPIV), scheduled to be released in 2012.
Gout is a common arthritic affliction; however, patients are not well-managed resulting in continued flares and gouty attacks. The importance of identifying patients needing treatment, plus clinical approaches to gout and hyperuricemia will be discussed.
Case presentations will be presented to highlight lecture discussion points. There will be selected cases only, one each on thyroid, diabetes and osteoporosis.
Thyroid dysfunction is present in up to 10% of the population, and thyroid nodules are present in up to 60% of the population. Thyroid dysfunction is typically not diagnosed as screening indications are unclear for the PCP. The PCP needs to understand how and when to screen for thyroid disease based on up to date recommendations. This gap will be addressed with current thoughts on approach to diagnosing and treating thyroid dysfunction and the thyroid nodule.
Physicians, in general, are not fully aware of the impact of the Patient Protection and Affordability Care Act (PPACA) on the practice of medicine. This presentation will cover the impact of PPACA on the practice of medicine including important aspects such as, Accountable Care Organizations (ACOs), Medicare physician reimbursement (SGR), health information technology and the upcoming U.S. Supreme court arguments and opinion concerning the constitutionality of PPACA.
ERISA (federal statute) provides the governing framework for welfare benefit plans, including group health insurance plans. ERISA gives members, and providers, with sufficient assignments, rights. Providers should not pursue their rights without knowledge of False Claims Act pitfalls. The gap will be addressed by highlighting typical roadblocks to reimbursement. Information will be provided to help providers avoid roadblocks. Providers will learn about potential pitfalls with False Claims Act violations and how to avoid them.
The PPACA 2010 (Patient Protection and Affordability Care Act) will change the practice of medicine. It will alter physician reimbursement and the conditions of practice. It will expand reporting and compliance requirements for Medicare and private coverage.
This lecture will review the regular order of the legislative process, how the health care bill did not follow that order and some suggestions to address the real issue in health care – the absence of affordable care for over 50 million Americans.
The healthcare delivery system is changing. Physicians need to understand those changes so that they change with them and so that they can maximize their revenues and minimize their losses as these changes occur. This lecture discusses various changes in healthcare such as out of network, consumer driven healthcare, and Medicare Advantage. Examples of these changes and provider responses to these changes will be discussed so that the physician can develop their own strategies for dealing with these changes.
Examination of the regulations that address hospital outpatient’s
departments will identify the requirements that a hospital must follow in order
to provide safe care and bill for the care.
The regulations require the hospital in certain circumstances to have
physician’s oversight, verification of physician credentials and location of
the outpatient departments in relationship to the main hospital campus. There are also specific billing requirements
that must be followed for Medicare
patients and failure to follow may result in a false claim.Current recommendations by the National Osteoporosis Foundation to diagnose and manage osteoporosis are not well known. These recommendations will be reviewed at length. Treatment options based on an understanding of bone turnover physiology will be discussed as well as long term and potential treatment options.
This presentation offers an overview of the experience of clinical integration at Memorial Hermann, rationale for clinical integration, relevance and applicability in health care reform.
Risk to the medical practice is increased significantly without proper planning. An effective Coding Compliance Plan is the key to recognizing coding and documentation practices that could increase organizational risk. Many benefits of a well-made compliance plan exist including minimized billing errors, reduced chance of audits, diminished malpractice odds, and increased financial return. This presentation will highlight ways to recognize these practices and offer suggestions for creating a Coding Compliance Plan. A formal plan is a necessity for every practice to reduce risks and improve compliance in their organization.
Many cases of cervicitis go untreated because there are often no obvious symptoms; therefore women who have the infection do not know they have it. Physicians have little laboratory support to differentiate cervicitis from vaginitis. Undiagnosed cervicitis is a potentially serious condition where cervical pathogens may be introduced into the upper genital tract with procedures. This activity will focus on practical aspects to procedures and diagnostic criteria, as well as provide appropriate approaches to treatment.
This education session will review the standard guidelines for the use of cerclage and progesterone. Given multiple gestations and expensive preterm delivery at a markedly high rate, options to reduce preterm delivery will be discussed.
New contraceptives with a variety of new hormone combinations and non-traditional regimens have become available in 2010-2011. Clinicians should understand how new indications effect management of an increasingly heavier and aging patient population, and should be able to effectively and efficiently discuss these options, their risks and benefits with patients. This activity will provide an overview of the new options as well as a discussion of their mechanism of action.
New testing methodologies for Ob/Gyn office microbiologic diagnostic tests have demonstrated a significant improvement over tests previously available. This activity will address the different sensitivities of the variety of tests offered by insurance companies and their preferred laboratories. An overview of these tests offered by insurance companies and their preferred laboratories. An overview of these tests and patient benefit will be provided.
Diagnosing and managing difficult vaginal infections is challenging, due to limited literature and lack of guidelines. In addition, reimbursement for managing these chronic infections is poor. This activity will describe how to diagnose and manage patients in a managed care climate of cheap or limited testing methods and protocols, based on available lab information, exams and history.
Since ovarian cancer is a heterogeneous disease, little progress has been made in identifying a screening methodology that will improve early detection resulting in an improvement in survival. CA125 and transvaginal ultrasonography has been the mainstay of ovarian cancer screening and of primary importance in the evaluation of an adnexal mass. Despite advances in our understanding of proteomics, there have been limited advancements in the identification of biomarkers that would improve the early detection of ovarian cancer. The approval of Ova1 and HE4 has expanded our ability to help predict if a mass is benign or malignant, and how these tests should be incorporated into treatment algorithms has not been fully elucidated. Attendees of this lecture will gain awareness of how these new methodologies can be integrated with our current understanding of ovarian carcinogenesis and practice guidelines leading toward an improvement in the early detection of ovarian cancer.
Since the results were announced from the Women’s Health Initiative there has been a significant decline in the usage of hormone replacement therapy (HRT) despite our limited knowledge of the intricate relationship between the two. While the Women’s Health Initiative identified an association between breast cancer and hormone replacement therapy (HRT) there are many variables that can influence this risk including the interval between the initiation of therapy and the climacteric and method of drug delivery. HRT has been shown to influence histology and treatment responses in women diagnosed with breast cancer. Attendees of this lecture will understand the relationship between HRT and breast cancer enabling them to identify women who perhaps may benefit from treatment and those who would be harmed.
Numerous sources of data, including The Surgeon General’s Report on Osteoporosis, indicate that osteoporosis remains seriously under-diagnosed and undertreated. As a result, US women experience hundreds of thousands of preventable hip and other serious fractures often leading to pain, disability, deformity and premature death. Simultaneously, patient and physician concerns about the safety of medications have increased. New guidelines for therapy stress the importance of identifying those women at high risk of fracture for whom the benefits of treatment far outweigh the risks of therapy as well as identifying women at very low risk for fracture for whom medication should not be prescribed. Clinicians, therefore, must become competent in the use of FRAX, a new tool provided by the World Health Organization to quantitate fracture risk for individual patients and use current clinical guidelines to make informed treatment decisions and to help patients accurately weigh the risks and benefits of treatment.