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The CMG Voice

Does Sepsis Lead To Seizures After Hospital Discharge?

Posted Thursday, May 25, 2017 by Gene Moen

A recent study showed that those who survive sepsis, especially younger patients, had a substantially increased risk of seizures long after discharge from the hospital. Dr. Michael Reznik of the Columbia University Medical Center did the study. The analysis of 850,000 discharges in three large states, with up to eight years of follow-up, found that there was a five-fold increase in risk of seizures in those who had sepsis.

This increase in risk was noted in the analysis of Medicare records for patients older than 65, but the increase was also found to be more marked in those younger than age 65. The study used data from detailed administrative claims for hospital discharges in California, New York, and Florida. The findings, along with previous medical studies, point to sepsis as a major potential to cause brain damage. According to Dr. Reznik, the results of the study may led to “future research to study the specific pathways and risk factors that lead to seizures following sepsis, and whether protective interventions or strategies could be developed.”

As in many such medical studies, there are limitations to the analysis. It relies on administrative codes, which may be completed differently in different institutions. In addition, there may be possible presence of other neuropathologies not noted in charts. Finally, recent sepsis patients may be monitored more closely than others, and therefore seizures would be more likely to be noted.

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Recent article examines the possibility of bias affecting both doctors and patients in health care.

Posted Monday, May 22, 2017 by Tyler Goldberg-Hoss

We all have some bias, and bias can be helpful and harmful. It can be helpful because it helps us function on a daily basis and helps protect us from harm. It can also be harmful, when it becomes a prejudice against someone who is different than us: the “other.”

In 1998 the implicit association test (IAT) was developed to measure unconscious bias. You can try one of the available tests for yourself here:

Project Implicit

Tests include those on sexuality, gender, religion, various ethnic groups, disability, and weight, to name a few. All of them (aside from those devoted to our current President) are biases that can be found in medical encounters all over the country.

Bias can and does exist in the health care, and it can unfortunately cause different patients to get different treatment. There has been one study using the IAT to determine whether doctors are implicitly biased based on race. The study looked at treatment recommendations for patients with acute coronary syndromes presenting to the emergency department.

The study found that there was implicit preference for the white patients and implicit stereotypes of the black patients as being less cooperative.

In our practice, bias shows up in many formers. Often we are called by potential clients who believe they were treated unfairly because of their race, sexual orientation, or something else. In focus groups we run, we routinely analyze potential juror attitudes towards these issues.

I can recall specifically presenting a case involving my young female client. I described the facts of what happened to her, and one focus group participant volunteered that my client was black, because of the way she was treated.

Another time I wanted input as to whether a potential client’s weight would be an issue for jurors (he weighed over 400 lbs when he presented to the emergency room). On one hand, many of the jurors thought that his weight may have been an issue in the way in which he was treated. However, they also felt like his medical problems were his fault, much more so than anything the health care provider did.

Bias exists in all facets of our society. Although we will likely never be “bias-free”, having an awareness of our biases is a good first step in hopefully working towards those biases not affecting how we treat people, particularly in the medical field.

You can read the full article here:

How Does Bias Affect Physicians, Patients?

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Can Antibiotics Alone Treat Appendicitis?

Posted Thursday, May 18, 2017 by Gene Moen

For more than a century, surgery has been the standard treatment for appendicitis. Conventional medical wisdom has been that an infected or inflamed organ should be surgically removed, especially when the human body seems to do fairly well without an appendix.

The conventional wisdom may be overturned by a clinical study being done at UCLA, where Dr. David Talan (board certified in both emergency medicine and infectious disease medicine) leads a team to address questions about drugs being an alternative to surgery. The importance of the study is that one in 10 people in the U.S. will be diagnosed with appendicitis, and the risks and costs of surgery are multiplied by the 300,000 appendectomies performed each year in the U.S. In fact, this is the most common emergency surgery.

It has been thought that, because appendicitis carries the risk of rupture and death, emergency surgery was always needed. But if caught early, physicians are learning that antibiotic treatment alone may be reasonable and adequate to treat the condition. A number of studies in the U.S. over the past several years have found that, although antibiotics worked for many patients, about 25% required surgery. But the number of patients studied was insufficient to allow broad conclusions to be reached.

The UCLA study will look at the outcomes of more than 1,500 patients at UCLA and other hospitals who are diagnosed with appendicitis. Randomly selected patients will be treated with antibiotics alone or with surgery. Tracked over a period of a year, the study will look at disease recurrence, length of hospital stay, and treatment costs. The hope is that lessons learned will allow patients to be treated with drugs on an outpatient basis, thus reducing the costs associated with hospitalization. The study will be completed in 2021.

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New Study Shows Decrease In Total Medical Malpractice Claims, Increase In Size Of Paid Claims.

Posted Monday, May 15, 2017 by Gene Moen

Researchers at Brigham and Women’s Hospital in Boston found that claims paid by physicians’ insurers have been substantially decreasing over the last two decades. However, the amount paid on each claim has been increasing. These trends will not be surprising to attorneys who represent injured patients. The reason for both trends is relatively simple: the cost of pursuing a malpractice claim has become so great that few attorneys can afford to file a “modest” claim for damages. As a result, there are fewer cases filed, but those that are filed are in cases with large damages, and thus larger amounts are paid on the claims on average.

The study was interesting, also, in breaking down claims paid by various specialties, such as dermatology, neurosurgery, etc. The largest amounts paid were for neurosurgery. Again, most claimants’ attorneys will understand that, because of the higher cost of pursuing such a claim, only the larger damages claims can be justified.

Part of the reason for the high cost of such claims is that neurosurgery experts are very expensive even when one can find a neurosurgeon who is willing to testify against another neurosurgeon. Some of the experts in neurosurgery sub-specialties charge as much as $1,200 an hour to simply review records and consult with an attorney. Contrast that with family practice claims, where it is much easier to find credible experts and charges are usually $500 an hour or less.

The breakdown on types of claims was also interesting. The most common claims involved misdiagnoses, surgical errors, and treatment-related mistakes. Roughly 32 percent of all paid claims involved the patient’s death.

The conclusions of the researchers may not be completely accurate, since they are assuming that the decrease in claims means that they have become more difficult to win at trial. While that may be true (in part because of the anti-lawsuit propaganda campaign by insurers and medical groups – which tends to taint jury verdicts), the reality is cost is a very big driver of decisions about bringing a medical malpractice lawsuit. A typical case that goes to trial may cost the attorney $100,000+ in out-of-pocket costs. To invest that much money, not to mention other resources in time and effort, requires a careful weighing of risks and benefits before filing a lawsuit.

Attorneys for medical malpractice claimants know that this is not a law practice for the faint-of-heart. Almost all such claims are handled on the basis of a contingent-fee, which means a loss not only results in no payment for the attorney’s time, but also means the attorney absorbs the costs that have been advanced.

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Can Virtual Reality Diagnose Concussions?

Posted Thursday, May 11, 2017 by Gene Moen

In a recent blog post, we discussed the ways in which virtual reality (VR) and other electronic devices are being used to help treat patients with various medical problems. Not mentioned in that blog was that several studies have investigated the use of a Nintendo Wii balance board for treating brain-injured patients.

In a new study, VR is now being used to diagnose head injuries. Researchers at the University of Birmingham and the University of East Anglia in England conducted trials to evaluate the use of a VR headset to detect subtle neurological changes that can help assess concussions.

Certainly there is a current emphasis on head injuries in football in the U.S that is comparable to the emphasis in Europe on head injuries in soccer. Collision at the goal and “heading” a soccer ball have been known to cause head injuries. In the study, players wore the headset while standing on a balance board and following directions. The inability to comply with some directions helped detect subtle neurological problems.

This particular study was hampered because of the need to connect the VR device to a computer terminal. It is thought that future research may use a mobile VR headset, such as Google Cardboard or Samsung Gear VR.

The use of immersive VR for concussion diagnosis remains an area that has only had limited research to date. But it is likely that, as preliminary results are reported, more researchers will focus on it. The interaction between medicine and electronics is developing rapidly, and it is likely that many new studies will focus on both the diagnostic and treatment potentials of electronic devices.

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