Patient-centered Medical Home Fails to Deliver Quality Improvement

In what is sure to be a setback to the PCMH movement, a new study showed that the PCMH model failed to deliver promised quality improvements.

One of the first, largest, and longest-running multipayer trials of patient-centered medical home medical practices in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department, or ambulatory care services or total costs of care over three years, according to a study. The patient-centered medical home is a team-based model of primary care practice intended to improve the quality, efficiency, and patient experience of care. Professional associations, payers, policy makers, and other stakeholders have advocated for the patient-centered medical home model.”

http://www.sciencedaily.com/releases/2014/02/140225162702.htm

Today’s MRI: Posterior Reversible encephalopathy syndrome (PRES)

Posterior reversible encephalopathy syndrome (PRES) (also known as hypertensive encephalopathy) is a neurotoxic state that occurs secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. Hyperperfusion with resultant disruption of the blood brain barrier results in vasogenic oedema, but no infarction, most commonly in the parieto-occipital regions.

It should not be confused with chronic hypertensive encephalopathy (aka hypertensive microangiopathy) which results in microhemorrhages in the basal ganglia, pons and cerebellum.

Learn more at http://radiopaedia.org/articles/posterior-reversible-encephalopathy-syndrome-1

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Imaging Signs – The Continuous Diaphragm Sign

The CXR below shows central sub-diaphragmatic lucency (continuous diaphragm sign) in keeping with pneumoperitoneum.

Continuous Diaphragm Sign

Robin Williams Tribute

The Primary Care Clinic at Stony Brook held a tribute lunch to Robin Williams on 8/12/2014. Robin Williams committed suicide on 8/11/2014 after a long battle with depression. He brought joy to millions through his acting, comedy, and generosity, and he was “one of a kind” as President Obama put it.

Remember that depression can strike anyone. Someone may be depressed and yet never show it or talk about it. They can seem to have everything, and yet feel they have nothing.

“Richard Cory” by Edwin Arlington Robinson

Whenever Richard Cory went down town,
We people on the pavement looked at him:
He was a gentleman from sole to crown,
Clean favored, and imperially slim.

And he was always quietly arrayed,
And he was always human when he talked;
But still he fluttered pulses when he said,
‘Good-morning,’ and he glittered when he walked.

And he was rich – yes, richer than a king –
And admirably schooled in every grace:
In fine, we thought that he was everything
To make us wish that we were in his place.

So on we worked, and waited for the light,
And went without the meat, and cursed the bread;
And Richard Cory, one calm summer night,
Went home and put a bullet through his head.

2014-08-12

Robin Williams Tribute

IBM’s new chip – a silicon brain

While not strictly medicine, this technology has vast implications for health care. Real-time artificial intelligence analysis of lab and clinical data will become a reality.

“The chip, or processor, is named TrueNorth and was developed by researchers at IBM and detailed in an article published on Thursday in the journal Science. It tries to mimic the way brains recognize patterns, relying on densely interconnected webs of transistors similar to the brain’s neural networks.

“The TrueNorth chip is like the first transistor,” said Terrence J. Sejnowski, director of the Salk Institute’s Computational Neurobiology Laboratory.

http://www.sciencemag.org/content/345/6197/668

Approaching the End

While doctors primarily pursue medicine with the intention of healing people and curing disease, little do they realize how much death and dying becomes part of the conversation with patients and families. Throughout my internship year in internal medicine, I was faced with many discussions regarding palliative care. Discussing the end of life is not an easy task at any stage of a physician’s career, from seasoned physicians to novice interns

Check out the full article:

Journal of Medical Education Perspectives
Vol 3, No 1 (2014)
Table of
Contents
http://www.jmeps.com/issue/view/1084

Brooklyn Half Marathon Medical Team Volunteering

Hey guys,

Stony Brook Medicine will be participating in the Brooklyn Half Marathon on May 17, 2014 as medical volunteers. Let me know if you are interested in volunteering as a medical personnel.

Email Christine.garcia@stonybrookmedicine.edu

Also, keep a look out for more details for the NYC Marathon in November 2014!

For more information on the Brooklyn Half Marathon: http://www.nyrr.org/races-and-events/2014/brooklyn-half

Global Supply of Health Professionals

Global Supply of Health Professionals

The world’s need for and supply of health professionals is in flux. The latest article in the Global Health Series reviews the supply of and demand for physicians and nurses around the world. An interactive graphic shows the density of health workers in each country.

There is a global crisis of severe shortages and marked maldistribution of health professionals that is exacerbated by three great global transitions — demographic changes, epidemiologic shifts, and redistribution of the disability burden.

Shared from the New England Journal of Medicine

Culture Shock: Web-Based Hep C Tx Guidelines

Practice guidelines are a fact of life in modern medicine. They provide clinicians with the best data and the latest consensus on what the data mean for the care of patients.

But they are — or have been — rather slow to react to changes.

Enter HCVguidelines.org, a website that aims to keep up with one of the fastest-moving fields in medicine today — the treatment of hepatitis C virus (HCV) with what are called direct-acting agents.

The website was developed and will be run jointly by the American Association for the Study of Liver Diseases, the Infectious Diseases Society of America, and the International Antiviral Society-USA.

Read more at MedPage Today

Study Dispels “Obesity Paradox” in Diabetes

A study in the New England Journal of Medicine finds no evidence of a so-called “obesity paradox” in type 2 diabetes — that is, the suggestion that mortality is lower among diabetics who are overweight or obese than among those who are normal weight.

Researchers studied over 11,000 healthcare professionals who were free of cardiovascular disease or cancer at the time of diabetes diagnosis. During 16 years’ follow-up, roughly 3000 participants died.

Overall, the association between baseline BMI and all-cause mortality was J-shaped: Compared with normal-weight participants, underweight participants and those with BMIs of 30 or above had significantly increased mortality risks, with the highest risk at BMIs of 35 or higher (hazard ratio, 1.33).

Previous studies that suggested an obesity paradox were limited by short follow-ups and few deaths, the authors write. They conclude that maintaining a healthy weight “should remain the cornerstone of diabetes management.”

– See more at: http://www.nejm.org/doi/full/10.1056/NEJMoa1304501

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