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MEASLES: Coming soon to a practice setting near you (Are you ready?)
In case you have been in a news and media blackout recently, Measles is back. I have seen headlines such as “Measles cases rocket toward record level”, “555 Measles cases spread to 20 states,” and “Measles outbreak hits ‘completely avoidable’ 25-year high”…despite being declared eliminated in the United States in 2000. If you are still in current practice, odds are that none of us have seen measles in front of us or thought that we had pretty much eliminated it. Personally, I have only seen one case a few years back and it was in an un-immunized child of a migrant farm worker. To be honest, it could have been very easily overlooked as just another “viral illness” or “viral exanthem”. Sometimes, it pays to be lucky rather than good. The purpose of this blog is to help prepare you in case this walks into your practice setting…making you both lucky and good.
[Read more…] about MEASLES: Coming soon to a practice setting near you (Are you ready?)What’s Your Mission: Part 2
“This is it!”
This was my thought as I am aboard the plane from Phnom Penh, Cambodia on my way back home to Dallas, Texas. I had just spent 2 weeks in Cambodia – my first time after having been lucky to survive the Khmer Rouge. I was both exhausted and emotionally charged after a week of providing anesthesia on the medical mission trip and another travelling through Cambodia.
[Read more…] about What’s Your Mission: Part 2Decoding MIPS in Emergency Medicine – Antibiotic Edition
Revolution in Healthcare
As we all know, we are in the middle of a Revolution of sorts in Health Care. The practice of medicine is becoming less about the art of medicine and more about the business of medicine. Patient Satisfaction is a major concern, and satisfaction ratings along with Quality measures, such as MIPS, are going to play a large role in how we are reimbursed by insurance payors. And when you look at the MIPS guidelines, one of the first questions that comes to mind is ‘How do I satisfy these requirements while keeping my patients happy’? Well, we are going to go over a few of the common MIPS standards here and how you can meet those standards while providing the care that patients want or expect.
Sensitivity, Specificity, Predictive Values, Pre/Post-test Probability, and Likelihood Ratios explained
The purpose of this post is to explain the concept of sensitivity, specificity, predictive values, and likelihood ratios.
Screening Tests
Screening tests (surveillance tests) are tools use to assess the likelihood that a patient may have a certain disease. They are not definitive, but if positive, will heighten suspicion that would warrant use of a gold standard diagnostic test to rule in or rule out a certain diagnosis. The goal of screening tests is to reduce the morbidity and mortality in a population group (Maxim, Niebo, & Utell, 2014). Examples of screening tests include routine EKGs, PSA, PAP smears, and mammograms. For example, a male with an elevated PSA may have prostate cancer, BPH, or prostatitis. Positive results of screening tests need to be compared to the established gold standard test that is regarded as definitive. In this case, a prostate biopsy is considered a definitive test, as it will reveal the etiology of the elevated PSA. Screening tests are less invasive and less costly, whereas the gold standard test may be more invasive, expensive, or too late (discovered during an autopsy). Ideally, gold standard tests, such as coronary angiography, breast biopsy, or colposcopy should have 100% sensitivity and specificity. However, in reality, this may not be the case, as it may be the best test given the clinical picture at the time (Maxim, Niebo, & Utell, 2014).
[Read more…] about Sensitivity, Specificity, Predictive Values, Pre/Post-test Probability, and Likelihood Ratios explainedEuglycemic Diabetic Ketoacidosis: A Case Study
DKA and SGLT-2 inhibitors
One of the greatest aspects of medicine that I enjoy is a continual process of learning. We must continue to grow in our profession, seeking knowledge and experience as much as possible. One such incident occurred recently while on shift… and talk about being a little late to the party! In 2015, the US food and drug administration issued a drug safety communication that warned of an increased risk of DKA with uncharacteristically mild to moderate to glucose elevations (euglycemic DKA). This warning was based on diabetic medications involving SGLT-2 inhibitors. In fact this was based on 20 clinical cases requiring hospitalization captured between March 2013 and June 2014 in the FDA adverse event reporting system database. SGLT-2 inhibitors first came into market in 2013. What are SGLT-2 inhibitor medications?
Influenza: To Swab or Not to Swab
During a recent weekend shift in the Emergency Department, four patients presented with the same chief complaint: “I just want to know if I have the flu.”