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The CMG Voice

Changes to risk calculator may change your blood pressure medication

Posted Tuesday, June 12, 2018 by Tyler Goldberg-Hoss

Millions of Americans take medication to prevent heart attacks and other cardiovascular disease. These medications include aspirin, statins, and other types of drugs.

Often times, doctors prescribing these medications for their patients use a risk calculator, which estimates the 10 year risk of cardiovascular disease. This calculator (you can find a version here) was based on research done decades ago.

Recently, Stanford researchers have updated the data, and as a result have created a new calculator that purports to be more accurate in their risk estimates.

As a result, an estimated 11 million Americans may benefit from a reassessment of their 10 year risk. Some may find that their risk has been overestimated, and thus should be taking a lower dose of medication. Conversely, some may find that their risk has been underestimated, and should take more or a different medication.

African Americans in particular may benefit from these revised risk assessments, since their population was not well represented in data supporting the previous calculator.

You can read more about this here:

New risk calculator could change the aspirin, statins, and blood pressure medications some people take

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That doctor you saw in the ER? She may not be employed by the hospital. Sometimes that matters.

Posted Tuesday, June 5, 2018 by Tyler Goldberg-Hoss

Most folks I talk with about medical care think that when they go to a hospital, the health care providers treating them are employees of the hospital. And when things go wrong giving rise to a claim of medical negligence, folks think the hospital is on the hook for the bad actions of the doctors, nurses or other providers who were negligent.

Except, that’s not always how it works these.

Typically, nurses, CNAs, techs, therapists, scribes, and administrative personnel are employed by the hospital. The hospital would typically be responsible for their actions because they are employees.

However, many physicians (and mid-level providers like ARNPs and PAs) who practice in a hospital – any many of them only practice in a hospital, and often only in that hospital – are actually not employees.

Rather, often they are either independent contractors, or employed with a group that contracts with the hospital to provide particular physician services to that hospital.

Here are some examples:

When you go to the ER, often these days the physicians and mid-level providers who treat you there are not employees. If that doctor orders imaging to be taken, those images are likely read by another doctor who is similarly not employed by the hospital. If you require inpatient hospitalization, often times the hospitalists – those doctors whose practice is just providing medicine in a hospital – are part of a group of hospitalists that contracts with the hospital to provide such services.

Need surgery? That surgeon may not be an employee of the hospital, and the anesthesiologist likely isn’t as well. Does that surgeon want to send a specimen to have a pathologist look at it? That pathologist may just be an independent contractor as well.

So why does this matter?

For one thing, bringing a claim against one defendant (i.e. the hospital) is typically easier than bringing it against two or three or four. For another, depending on the nature of the injuries, it may be the case that the doctor herself has limited insurance proceeds that are insufficient given the magnitude of the harm.

Fortunately, in Washington there is law that, in certain situations, the hospital may be liable for the actions of non-employee physicians. This is known as ostensible or apparent agency. Although the law itself is a bit confusing, the essence is that if you go to a hospital, and you reasonably believe that the doctor treating you is an employee of the hospital, a jury may find that the hospital is liable for the actions of the doctor. Even though he or she is not an employee.

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Intricate design, unsafe cleaning practices to blame for high rate of infected medical scopes

Posted Monday, April 30, 2018 by Tyler Goldberg-Hoss

In a recent paper published in the American Journal of Infection Control, 71% of reusable medical scopes tested at three major hospitals carried bacteria.

Scopes are medical devices used to look deep into areas of the body, including the colon, lung, and esophagus. Because such a high percentage of these scopes carry bacteria, considerable numbers of patients are harmed: 35 deaths since 2013.

These bacteria, including superbugs such as CRE and MRSA, are responsible for even more harm: around 2 millions Americans are made sick by such bugs, and overall 23,000 die.

Part of the problem is the design, and also the cleaning procedures of hospital staff often lacked. This includes using the same gloves when disinfecting the scopes multiple times, scopes stored in unsanitary conditions, and generally skipping steps in the cleaning process due to the need to rush between procedures.

Higher standards have been proposed to increase patient safety. This includes sterilizing all scopes using gas or chemicals, and concurrently redesigning scopes to withstand the stress of repeated sterilizations (or creating single use scopes).

Scopes – in all their forms – are terrific inventions that have saved countless lives and solved countless medical problems. It appears that, with a little tweaking, they can continue to be promoters of patient safety.

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New transport technology keeps livers warm and alive – not on ice in a cooler

Posted Thursday, April 26, 2018 by Tyler Goldberg-Hoss

As you may know, we as a society have not figured out the best system for organ transplantation. I have already written on the problem of too little organs and at least one solution for it. Additionally, some have advocated for legalizing the ability to sell your organs.

Within that context, medical researchers continue to find ways to make our organs last longer, make transplantation less necessary, and increase the likelihood that an organ will be viable for transplantation.

This includes hearts and now livers. A new study finds that instead of traditionally keeping livers “on ice” during the transport process, livers actually prefer to be warm.

The new technology, called an OrganOx device, replicates a liver’s normal environment, including keeping livers functioning during transport. This resulted, according to the study, in a greater chance the organ will actually be used in transplantation due to less injury to the liver as it “lives” outside the body.

You can read more about the results of the study here:

A ‘breakthrough in organ preservation’: Study shows keeping livers warm helps preserve them for transplant

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Radiologists watch out – Artificial Intelligence is coming

Posted Monday, April 23, 2018 by Tyler Goldberg-Hoss

Recently the FDA approved the marketing of a device that uses Artificial Intelligence (AI) to screen patients for the eye disease diabetic retinopathy.

The software, called IDx-DR, uses AI to analyze images taken of the retina. It is marketed toward health care professionals such as primary care doctors who may not normally be involved in the eye care of their patients.

Someone in the office takes a picture of the retina with a special camera. Then the images are uploaded to a server where the IDx-DR software is installed. Then IDx-DR does it’s thing. First, it determines whether the images are good enough quality to analyze. Next, if the images are good enough, it analyzes them, producing one of two results: either (1) “more than mild diabetic retinopathy detected: refer to an eye care professional” or (2) “negative for more than mild diabetic retinopathy; rescreen in 12 months.”

IDx-DR is not perfect: in the FDA study, it correctly identified more than mild diabetic retinopathy 87.4% of the time, and correctly identified those patients without more than mild diabetic retinopathy 89.5% of the time. However, considering how diabetic is the most common cause of vision loss among diabetics in the US, early detection of disease is important in halting its progress, and about ½ of all diabetics don’t see their eye doctors on a yearly basis. The software promises to improve detection and prevent vision loss for a significant number of people.

As an attorney who handles claims against medical providers, it will be important for any such provider to make sure each patient is appropriate for the screening software (some patients, such as those with underlying eye conditions, should not be screened with IDx-DR). And patients should be aware that the software is not perfect; they should go to their eye doctor if they begin having any vision symptoms.

Although this is a baby step in terms of using AI to screen for abnormalities in medical imaging, it does not take much effort to imagine AI interpreting x-rays and other imaging in the future. How long will it be before we are able to use our smartphones to take pictures of our bodies and allow AI to diagnose us?

You can read the FDA release here to learn more:

FDA permits marketing of artificial intelligence-based device to detect certain diabetes-related eye problems

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