Published at Fierce Healthcare on March 5, 2010

As a physician who works as a hospitalist and a primary-care doctor, I understand the complexity of discharging a patient from the hospital, and all the moving pieces that must come together to successfully transition a patient back to the outpatient setting. If even one link in the chain fails, a patient often ends up back in the emergency department and/or readmitted to the hospital as, in hospital-speak, a “bounce-back.”

These readmissions are like a canary in a coal mine, alerting us that our hospital-outpatient continuum is seriously disconnected and dysfunctional. And Medicare is now tracking readmissions for several diagnoses while threatening to withhold payment to hospitals for readmissions.

Read more at Fierce Healthcare by clicking here

Sanofi Pasteur has announced that 50 lots of the prefilled syringe form of H1N1 vaccine will expire over a year sooner than their printed expiry dates. Rather than March 4, 2011 they should be disposed of on February 15, 2010 (soon!).

Apparently they have discovered stability issues and can’t guarantee potency. I wonder who pays for all this…?

Google Health and Microsoft HealthVault are vying for their role in the evolving health care landscape. While both offer “Patient Health Records” (PHR) their products differ substantially, and each has limitations. The PHR offers the promise of allowing patients to control their own health information and take charge of their health care, but also presents challenges of data integrity, privacy and security.

I was quoted on this topic in an article in InformationWeek by Mitch Wagner.

See the article here (look on pp. 2 and 3 for my comments)

Travelers to Bali may want to get vaccinated against rabies, or at least consider not eating dog meat, as rabies seems to be uncontained in the canine population. Call us to discuss your options: (415) 963-4431.

–Paul Abramson MD

Source: The Jakarta Post 11/18/09 [edited]
Original article link

* original article follows *

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I was surprised to get a shipment of H1N1 vaccine in last week - among the first shipments nationwide. So far the government is shipping only the nose-spray formulation for ages 2-49 and we’re instructed only to give it to pediatric patients for now.

Children under 10 need two doses separated by 3-4 weeks. Those 10 and over need only one dose. The intranasal vaccine is a live attentuated vaccine and thus cannot be administered to pregnant women or immunocompromised patients - they will have to wait for the injectible form.

The question of exactly who should get the H1N1 vaccine this year is still an open one, in my opinion. There are certain groups for whom I am strongly recommending vaccination with both seasonal and H1N1 influenza vaccines (per the October 16, 2009 CDC recommendations):

I also recommend vaccination for those with asthma or other lung-compromising conditions, and those with immunocompromise of various kinds.

If you don’t fall into one of these groups, then vaccination is a more subjective decision based on your preferences, in consultation with your doctor. It looks like H1N1 influenza vaccine has been produced in a similar manner and with similar manufacturing processes as the seasonal flu vaccine, without adjuvants or thimerosal, so I expect it to be safe.

Please don’t hesitate to call my practice if you would like to receive H1N1 or seasonal influenza vaccination, or if you have specific questions.

(415) 963-4431

Paul Abramson MD

I will be on a panel discussion entitled “Clinical Groupware” on Tuesday 10/6 at 9:15am at the Health 2.0 Conference in San Francisco next week.

I’ll be demonstrating the Hello Health platform as an example of how technology can improve doctor-patient collaboration and provide expanded access to care.

Links:
Health 2.0 Conference Agenda
Hello Health Site

I’ve been using my engineering and programming expertise lately to help organizations develop Health Information Technology that actually meets the needs of doctors and patients. More on this soon!

A nice randomized, controlled, double-blind study of 131 patients, just out in the New England Journal of Medicine, reports that vertebroplasty, a popular (and expensive) treatment for osteoporotic spinal fractures, did no better than placebo. Link to article

A second study from Australia of 78 people found the same: no benefit over placebo. Both treatment and placebo groups showed a reduction in pain. Link to article

Randy Horwitz PhD MD, internist and medical director of the University of Arizona Center for Integrative Medicine, had this to say:

“Another one bites the dust. What’s shocking to me is that there is no mention of this on Quackwatch website. I was sure that they’d be all over this unproven and worthless therapy.”

My take (and I’m sure Dr. Horwitz would agree) is that we should put a lot more research money into finding out why placebos work and how we can utilize the mind-body connection to reliably produce safe, cost-effective clinical improvements. Unnecessary and ineffective surgical procedures aren’t the best way to elicit the placebo response, and are a poor use of our health care dollar(s). But the doctors who make a living doing these procedures won’t tell you that.

UCSF Medical Center’s Chief Medical Officer reported in a campuswide letter today that a spike in admissions and positive tests for H1N1 influenza (”swine flu”) has led to intensified infection control measures.

Recent developments include

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This week’s Annals of Internal Medicine reports on a randomized controlled trial [link to abstract] of a red yeast rice dietary supplement to lower LDL cholesterol in patients who had stopped taking their prescription statin medications because of muscle aches, one of the well-known complications of statins. Read the rest of this entry »

Travel-medicine specialists estimate that less than half of travelers to high-risk countries seek pre-travel medical care. Physicians who aren’t up to date on the latest travel health issues may fail to suggest preventive measures like malaria pills, the proper vaccines for your destination, and the latest strategies for insect bite avoidance, accident prevention, and travel safety. It’s also important to be up to date on routine immunizations for diseases like tetanus and measles.

It’s important to consult a travel doctor early, if possible 4-6 weeks prior to departure. Failure to plan ahead Read the rest of this entry »