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The CMG Voice

Fireworks injuries expected to keep local ERs busy tomorrow

Posted Monday, July 3, 2017 by Tyler Goldberg-Hoss

The 4th of July is about as American as you can get. Along with it comes the tradition of fireworks. While some choose to watch large displays from a safe distance, others favor a more “hands on” approach.

Washington State, like most other states, allows the sale of some fireworks (Massachusetts and New Jersey ban sales entirely). And as you might expect, people can and do get hurt using and being near fireworks.

National data shows that children are much more likely than adults to get hurt – teenagers in particular. And no surprise, males are much more likely to be injured than females.

The most likely injuries sustained include thermal burns, contusions, lacerations, fractures, and foreign bodies. While injuries from fireworks occur at other times of year (particularly around New Year’s), the lion’s share of such mayhem occurs in early July.

For more information, this article includes some interactive graphs that illustrate the harms caused by fireworks.

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July 1 is almost here. Don’t get sick.

Posted Thursday, June 29, 2017 by Tyler Goldberg-Hoss

As June turns to July and summer begins in earnest, hundreds of medical school graduates around the country begin their residencies. These residents typically practice medicine under the direct or indirect supervision of an attending physician.

These residencies are part of graduate medical training and a necessary step in producing competent health care providers.

It also means that, across the board, the medical providers treating you in July are more likely to be less experienced than those who may have treated you in June. Associated with this is a perceived increased risk of medical errors: the so called “July effect”. While that may sound relatively benign, in the United Kingdom it is called the “killing season.”

Studies have been done investigating whether there is in fact a July effect – whether medical errors increase during this month. The studies have been equivocal – some found no difference in the rates of complications, particularly when the study focused on a particular disease process such as appendicitis or acute cardiovascular conditions.

Other studies, including a 2010 study from the Journal of General Internal Medicine, found that medication errors increased 10% in July in teaching hospitals from 1979 to 2006. Interestingly, the study did not find a similar error increase in nearby non-teaching hospitals. This suggests an increase due to medical students beginning their residencies, and in particular the new responsibility of prescribing drugs independently.

One criticism of the study suggested that the supervision of residents has improved over time, so that this 10% number is skewed by earlier data.

In a situation where a new resident commits an error and causes harm – even death – to her patient, it’s important to examine the entire situation when coming to any conclusions about fault and responsibility. When teaching hospitals have to balance the need to teach its residents with the safety of its patients, it may be more likely that ultimate responsibility is on the system itself for failing to properly do so.

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New study finds that we can boost cancer survival rates by letting patients more easily report side effects

Posted Monday, June 26, 2017 by Tyler Goldberg-Hoss

In the past, patients on chemotherapy and other cancer fighting treatments had to make an appointment to see their doctor to discuss complications and side effects from their treatment. This led to patients toughing it out through symptoms until their next appointment, and unfortunately leading a lower quality of life.

Given the results of a new study, it appears that these patients also sacrificed months of survival on average.

A new study gave cancer patients the opportunity to report side effects over the computer instead of waiting for an appointment. Nursing staff was often very responsive (80% of the time they responded immediately) with medications for the symptoms.

Those patients who participated in the study and took advantage of calling their providers for help with symptoms saw their quality of life improve. In addition, because patients were more comfortable they were able to stay on chemotherapy longer, and live longer.

You can read an article on this study here:

Quickly reporting cancer complications may boost survival

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Quantifying pain with science – how new technologies may be able to show jurors the pain an injured person is experiencing

Posted Thursday, June 22, 2017 by Tyler Goldberg-Hoss

Every one of our clients has suffered some harm giving rise to a claim. Some harm is easier to quantify than others. In particular, if one can show that the injured person cannot do the work that she used to do because of the negligence of the defendant, she may be entitled to money to replace the wages she has lost. Similarly, if medical and other bills have been paid or likely will need to be paid in the future, money can pay those bills.

However, most of my clients also have “pain and suffering” damages, harm that cannot easily be quantified by calculating wages lost or medical bills to be incurred. This often includes harm in the form of actual, day-to-day, pain. Pain is a difficult thing for many people to understand sufficient to feel comfortable translating it into a figure that will adequately compensate the person for having to endure it.

Recently, there is an emerging trend in personal injury litigation to make more concrete this pain by using neuroscience. In particular, some doctors and researchers are using fMRI technology (“Functional magnetic resonance imaging”) to actually show the locations in the brain that become active with pain. The thought is that, by standardizing the pain a person has (as opposed to amorphous and subjective 1-10 scales), juries will be more likely to understand, accept, and more easily allow for money damages to compensate for the pain.

An article describing these new efforts can be found here:

Personal injury lawyers turn to neuroscience to back claims of chronic pain

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Is Medicine Based On Science? The Example of Cardiac Stenting

Posted Monday, June 19, 2017 by Gene Moen

Over the centuries, medicine has evolved from a “black art” to one that is based on provable scientific principles. Or at least that is the assumption. An essay in The Atlantic magazine questions how far medicine has actually advanced (“When Evidence Say No, But Doctors Say Yes”). A key example in the article is the practice of stenting cardiac vessels to prevent heart attacks.

As the article points out, interventional cardiologists participate in a major industry focused on opening up a blocked cardiac artery without surgery. This is done by inserting a thin device up through the vessel to the narrowed area and stretching it open. Sometimes the area is then kept open by placing a stent inside the vessel. It all seems intuitive to anyone who thinks of the body as, in part, a vascular plumbing system. If the pipe is narrowed, open it up, and then prop it open.

Studies have shown, however, that few patients who are otherwise stable benefit from this procedure. Putting a piece of metal in an artery carries the risk of major complications, even death. Despite this knowledge and the evidence upon which it is based, invasive cardiologists continue to make this a mainstay of their medical practices. Apart from the obvious fact that this makes a lot of money for such cardiologists, a major reason may be social and cultural, rather than scientific.

“Evidence-based medicine” has become a slogan for the “new” scientific medicine. Yet there is a dearth of solid proof of benefit for many of the medical practices that make up much of what a doctor does. The remedies are often a result of habit and custom. Other doctors do them, and they are talked about at medical meetings, so this must be what should be done.

But evidence-based medicine only works for things for which we have solid evidence. A review of the article in The Atlantic contained the following: “But for those things for which we only have intuition and sometimes guesswork it is often best to remember the famous formulation of Loeb’s laws. Many times it is best to go by this dictum when tempted for forge ahead into the mist: ‘Don’t just do something, stand there.’”

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