Testing, Testing: The health-care bill has no master plan for curbing costs. Is that a bad thing?

Dr. Atul Gawande has written an essay in the new issue of The New Yorker concerning the use of pilot programs in the health care reform bill in an effort to contain costs. Dr. Gawande notes that “this has provided a soft target for critics.” However, he writes, “the strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet – here’s the interesting thing – history suggests otherwise.”

http://lists.aamc.org/t/41330/190817/2571/0/

Rebooted Computer Labs Offer Savings for Campuses and Ambiance for Students

In : http://chronicle.com/article/Computer-Labs-Get-Rebooted-as/49323/?sid=at&utm_source=at&utm_medium=en

A work space at the U. of Virginia’s Clemons Library is among the new breed of what used to be thought of as computer labs. “Almost all our students have laptops,” says a UVa official, “so traditional labs have become redundant.”

By Ben Terris

No matter what the future holds for college computer labs, one thing is certain: There will be coffee. But computers? Maybe not.

Colleges are looking for ways to cut costs, and most students now own laptops that they can tote in their backpacks. As a result, many campus technology leaders are taking a hard look at those brightly lit rooms with rows of networked computers, which cost hundreds of thousands of dollars a year to maintain.

The idea of the computer lab has been dying for some time now, says Lev S. Gonick, chief information officer at Case Western Reserve University. “It used to be we would build entire buildings around labs, but that’s all over now,” he says.

More than 11 percent of colleges and universities are either phasing out public computer labs or planning to do so, according to this year’s survey of college technology leaders by the Campus Computing Project, released last month. At colleges that have not pulled the plug on their labs, nearly 20 percent are reviewing the option. This is the first year the Campus Computing Project has asked the question.

Institutions agree that computer labs, much like student centers and libraries before them, are due for an extreme makeover. That is why several technology officials contacted by The Chronicle believe in creating work spaces that hardly resemble the computer labs of the past.

These new spaces might be lounges filled with modular furniture and plasma televisions; virtual labs that give remote laptops access to software; or bigger, better computer rooms with state-of-the-art machines and pleasing architecture that can act as de facto student centers. Fortunately for young caffeine addicts, nearly all officials interviewed said they planned to let students drink and eat while typing away—something that has long been forbidden in traditional computer rooms.

Computer Ownership Way Up

The vast majority of students at four-year-colleges—83 percent—own laptops, according to Student Monitor, a market-research company. That’s up from 36 percent in 2003. Meanwhile, nearly half of the institutions who participated in the Campus Computing Project reported IT budget cuts.

“It’s amazing that labs haven’t died out yet,” says Kenneth C. Green founding director of the Campus Computing Project. “It would seem like an obvious area to save money, but schools keep insisting they are finding value.”

The computer lab is an endangered species on some campuses, though. This year the University of Virginia announced a three-year plan to phase out all of its computer labs.

General computer rooms have already died out at Case Western Reserve, which hasn’t had them in two years, according to Mr. Gonick. Wake Forest University shuttered its general computer labs 10 years ago in favor of a program that lends laptops to every undergraduate.

UVa says its IT department spends about $300,000 a year maintaining the 375 public computers that are on their way out.

“We created labs when we couldn’t reasonably expect students to provide their own computers,” says Michael R. McPherson, the university’s deputy chief information officer. “Almost all our students have laptops, so traditional labs have become redundant.”…

….read entire article in link above.

Northwestern Medical School Discloses Faculty Ties to Industry on New Web Pages

By Katherine Mangan–in the Chronicle of Higher Ed, Dec 8, 2009

Northwestern University’s Feinberg School of Medicine has revamped its Web site’s profile pages for about 2,000 full- and part-time faculty members to include details about their financial ties to industry and professional groups, officials announced on Tuesday.

The online profiles were fleshed out in response to national concerns about financial conflicts of interest by physicians and scientific researchers.

7 Things You Didn’t Know About Senate Health Bill–from NPR

November 30, 2009 by Mary Agnes Carey, Phil Galewitz and Laurie McGinley

Pay attention: The “Patient Protection and Affordable Care Act” — better known as the Senate health care overhaul bill – is chock full of interesting but little publicized provisions affecting consumers. Sure, the bill is mainly a blueprint for overhauling the insurance system. But look closely and you’ll see a variety of items that would affect people from the cradle to old age – from breast pump use to retiree health benefits. It’s a congressional tradition, adding pet interests that otherwise might not pass to a big bill that at least will be put up for a vote.

Yes, there’s plenty of time to change the bill. But political analysts say a final overhaul bill would more likely look like this measure than the version already approved by the House because Senate Democrats barely could agree on sending it to the floor for debate. In short, there’s not much political room for major changes.

Here are some examples of what lies in this 2,074-page bill:

1. Nursing Mothers Get A Break
2. Learning To Be An Adult
3. Retiree Health Benefits
4. Promoting Use Of Bone Density Scans
5. Setting ER Prices
6. Singing The Blues
7. Transparency In Drug Pricing

Read entire post here: http://www.npr.org/templates/story/story.php?storyId=120946217&ft=1&f=1001

Writing Up Your Research Results for Publication–from Chest

by Peter D. Wagner, MD

Peter D. Wagner, MD, Distinguished Professor of Medicine and Bioengineering, Division of Physiology, Department of Medicine, University of California, San Diego, 9500 Gilman Dr, Department 0623A, La Jolla, CA 92093-0623A; e-mail: pdwagner@ucsd.edu

...The brief dissertation that follows is similar but presents in one document all elements of a research paper that may be either basic or clinical. It is also intended to be broadly applicable beyond CHEST. It does not address a variety of important associated issues such as who should be on the author list and in what position, which journal to submit to, or which ethical/conflict-of-interest issues to confront. At the outset, it must be recognized that there are literally thousands of scientific journals in existence. Each has its own list of instructions for authors that may to some extent conflict with, and therefore trump, the stereotypical approach of what now follows….Read entire article here: http://chestjournal.chestpubs.org/content/136/2/639.long

Areas covered:

1. Typical Architecture of a Scientific Report
2. Writing Principles for Each Section of the Report
   1. Title
   2. Abstract
   3. Introduction
   4. Methods
   5. Results
   6. Discussion
   7. References
   8. Summary

From the Hospital to Bankruptcy Court — in today’s NYT

by Kevin Sack

NASHVILLE — Some of the debtors sitting forlornly in this city’s old stone bankruptcy court have lost a job or gotten divorced. Others have been summoned to face their creditors because they spent mindlessly beyond their means. But all too often these days, they are there merely because they, or their children, got sick.

Wes and Katie Covington, from Smyrna, Tenn., were already in debt from a round of fertility treatments when complications with her pregnancy and surgery on his knee left them with unmanageable bills. For Christine L. Phillips of Nashville, it was a $10,000 trip to the emergency room after a car wreck, on the heels of costly operations to remove a cyst and repair a damaged nerve.

Jodie and Charlie Mullins of Dickson, Tenn., were making ends meet on his patrolman’s salary until she developed debilitating back pain that required spinal surgery and forced her to quit nursing school. As with many medical bankruptcies, they had health insurance but their policy had a $3,000 deductible and, to their surprise, covered only 80 percent of their costs.

“I always promised myself that if I ever got in trouble, I’d work two jobs to get out of it,” said Mr. Mullins, a 16-year veteran of the Dickson police force. “But it gets to the point where two or three or four jobs wouldn’t take care of it. The bills just were out of sight.”

Although statistics are elusive, there is a general sense among bankruptcy lawyers and court officials, in Nashville as elsewhere, that the share of personal bankruptcies caused by illness is growing.

In the campaign to broaden support for the overhaul of American health care, few arguments have packed as much rhetorical punch as the there-but-for-the-grace-of-God notion that average families, through no fault of their own, are going bankrupt because of medical debt…. Read entire article here:  http://www.nytimes.com/2009/11/25/health/policy/25bankruptcy.html

AHSL-Phoenix Thanksgiving Closure

The library and campus will be closed Thursday, November 26-Sunday, November 29.  We will open Monday morning at 7:30 and resume regular hours. Happy Thanksgiving!

If you find you require library assistance during the closure please call Jacque at 602-689-5976!!!

NYT Magazine receives letters in response to the Brent James article

Four letters were received by the Magazine commenting on the original article in the Nov. 8 issue…

Writers noted:

What must be kept in mind, however, is the limit of evidence-based medicine: what is good for a group, as a whole, is not equally good for each and every member of the group…Ultimately, medical care always comes down to the individual.

…true malpractice reform would be aided by adoption of Dr. Brent James’s approach of tracking outcomes to determine the course of medical care. Doctors could then be protected from negligence claims by showing they used an empirically proven course of treatment.

Until academic medicine wrests control of medical education and research from corporate influence-peddling, doctors will continue to sort through confusing and conflicting clinical research, and many will ultimately base their treatment decisions on which pharmaceutical representative visited them that week.

Until academic medicine wrests control of medical education and research from corporate influence-peddling, doctors will continue to sort through confusing and conflicting clinical research, and many will ultimately base their treatment decisions on which pharmaceutical representative visited them that week.

Read the letters here:  http://www.nytimes.com/2009/11/22/magazine/22letters-t-DRJAMESWILLM_LETTERS.html

From a colleague at UCSF: Google Tip #24

by Josephine Tan, UCSF, at http://mededlit.blogspot.com/

Every now and again, you may want to find a video describing some topic in which you’re interested. You could do a quick search on Google Video or YouTube.

For example, if I search in Google Video for the phrase h1n1 cdc, I get 3,990 results. That’s too many for me to want to comb through.

Searching YouTube with the same phrase, I get 2,890 results. Still too many to sift through.

Here’s how to get around the results overload when you’re looking for a video on a certain topic.

In a regular Google search, you can type in some specific commands to look for different video formats.

Here’s what the search phrase pictured above is looking for:

+inurl:

whatever follows behind the colon has to be in the URL of the webpage; this is indicated by the + sign

wmv OR avi OR mpg

these are examples of movie filetypes; connecting them with OR will look for any of these filetypes that must occur in the URL of the webpage

site:cdc.gov

this will look for our search exclusively in just the CDC’s website

h1n1

this will look for the topic of h1n1 anywhere on the webpage

When I run this search in Google, I get 101 results. A very manageable set to browse through to find some good videos on the topic.

Checking the Right Boxes, but Failing the Patient … from the NY Times

By DENA RIFKIN, M.D., November 16, 2009

The voice on the phone was authoritative, even brusque. A father was calling our after-hours line to ask about his teenage daughter.

“She’s got another headache,” he said, as I recall. “I’m going to the pharmacy, just wanted your advice on what strength of Tylenol to get her.”

Those opening lines did not admit much room for questions. I knew neither him nor his daughter, but there seemed to be little margin for error in my response. I could almost hear his foot tapping, waiting for the answer.

I hesitated. Who is this young woman? Why is her father calling about a simple headache?

I began to ask questions. Yes, his daughter had headaches every now and then. No, this one seemed a bit worse, that’s all. He wouldn’t even have called, but he wasn’t sure if Tylenol was safe, now that she was breast-feeding.

Breast-feeding?

Yes, yes, there was a new baby, just a few days old. Yes, there had been some problem with the pregnancy and delivery — something about blood pressure — but she had come home just fine. Could I just tell him the right dose?

I sent the young woman and her father to the emergency room, and she was admitted to the hospital with severe pre-eclampsia, a rare but life-threatening postpartum complication.

It has been 10 years since the Institute of Medicine’s seminal report on deaths caused by medical errors (numbering at least 44,000 a year). Since then, there has been tremendous focus on how many mistakes physicians and hospitals make, how much they cost and how to prevent them…..

…But as we bustle from one well-documented chart to the next, no one is counting whether we are still paying attention to the human beings. No one is counting whether we admit that the best source of information, the best protection from medical error, the best opportunity to make a difference — that all of these things have been here all along.

The answers are with the patients, and we must remember the unquantifiable value of asking the right questions. Dr. Dena Rifkin is a physician at the University of California, San Diego.

Read entire post here:  http://www.nytimes.com/2009/11/17/health/17case.html