Sensible Medicine

DECEMBER 18, 2023

Good morning all. This Monday, I take a day off. For the study of the week, Vinay Prasad contrasts the different recommendations on the treatment of childhood obesity. The USPSTF or United States Preventive Services Task Force is an independent volunteer panel of experts in disease prevention and evidence-based medicine. They are as close to neutral judges of medical evidence as it gets.

Documentation 363

Documentation Medication 363

Scrubs

APRIL 5, 2023

Professionals in virtually every industry have been buzzing about Chat-GPT ever since it debuted in November of last year. The AI-powered chatbot can generate all kinds of text from stories and poems to computer code. It uses language models to produce text that mimics the style of human beings. And now doctors are using it to answer routine clinical questions.

Documentation 355

Documentation Follow-Up Medication Hospital 355

Sensible Medicine

NOVEMBER 30, 2023

Three recent events tell us that US healthcare is doomed. First, health care premiums have risen to new heights. Second, Medicare has agreed to pay for GRAIL cancer screening as part of coverage with evidence development and third, many doctors protested Cigna’s denial of coverage for a double lung transplant for stage IV lung cancer, leading the insurer to agree to cover it.

Insurance 363

Insurance Tests Hospital 363

Sensible Medicine

NOVEMBER 10, 2023

The CDC has just reported that more parents than ever are getting vaccine exemptions for their children entering Kindergarten. For many of us who have witnessed the CDC’s repeated blunders with kids COVID19 vaccines, this result is entirely predictable. The CDC has lost the trust of the American people, and it will keep getting worse. First, let me say, I warned them.

Scheduling 364

Scheduling Hospital 364

Sensible Medicine

DECEMBER 30, 2023

I started it all by claiming on Twitter that the FDA was a rubber stamp. From boosters for 6 month old babies (no data), to postpartum depression drugs that are basically Xanax , to bad cancer drug approvals, in my mind, the FDA is failing the American people. In a recent post, John Mandrola reviewed 5 cardiology devices approved by the FDA with questionable data.

Tests 337

Tests 337

Sensible Medicine

NOVEMBER 6, 2023

Many doctors believe that closing the left atrial appendage (with a device) will help reduce stroke and bleeding. The idea behind stroke reduction is that occluding the appendage takes away a common area where clots form. The reason for less bleeding is that patients with proper occlusion can often be taken off anticoagulant drugs. These are nice ideas.

Medication 335

Medication 335

Sensible Medicine

NOVEMBER 20, 2023

I received a text message from a colleague last night during dinner that a trial we were part of, called OCEANIC AF , was being terminated early by the data safety monitoring board. This morning, the makers of asundexian had a press release up on its site. This is huge news in cardiology. But it is also worthy of a column here because we at Sensible Medicine are interested in how new therapies are tested.

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Tests Medication 323

Sensible Medicine

DECEMBER 21, 2023

Over the last week, a debate has simmered between the pages of my Substack , Sensible Medicine, and the Sensible Medicine podcast, which you can watch here. Sensible Medicine Mandrola and Prasad are back Listen now 4 days ago · 60 likes · 18 comments · Vinay Prasad and John Mandrola Briefly put the argument is: Yes, of course, medicine would benefit from more large, well done randomized studies, and better epidemiologic evidence, but this is expensive, costly, requires coordinatio

Tests 309

Tests Medication 309

Sensible Medicine

DECEMBER 29, 2023

Here is an odd take on a Friday Reflection but hey, it’s the holidays, and I have been on vacation. A few pithy images (if images can be pithy). It is a bit of a reprise from last year but with a bunch of new ones. For those who read from the email, you might not be able to see them all — just view them on the Substack site. Sensible Medicine is a reader-supported publication.

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299

Scrubs

MARCH 28, 2023

Student nurses need to complete at least 400 hours of clinical training before they can take the National Council Licensure Exam, but more states are allowing students to practice their skills in simulated labs instead of on real patients. A new bill in New York State would allow nursing students to substitute up to 30% of their clinical training with “high-quality simulation education.

Billing 303

Billing Hospital Patient Experience Medication 303

Sensible Medicine

DECEMBER 11, 2023

This one hits at the heart of my field—the ablation of atrial fibrillation. Current thinking holds that the way to ablate AF is to electrically isolate the muscle bundles going in and out of the pulmonary veins. Think of it as building an electric fence around the pulmonary veins. We use different energy sources to ablate the tissue. This is a picture I made in 2012.

Follow-Up 294

Follow-Up Medication Hospital 294

Scrubs

MARCH 9, 2023

Angel McCullough is the director of nursing at Thomas Jefferson University Hospital in Philadelphia, but she recently got a new assignment. Every Tuesday, she visits around a dozen elementary schools in the city to give a lesson on nursing and basic human medicine. It’s part of a new program called the “Mini Nurse Academy,” which is designed to get young students interested in nursing.

Hospital 299

Hospital 299

Sensible Medicine

SEPTEMBER 25, 2023

You had two choices in the lottery for senior science class. Mr. Flexner taught science in the old way. As a reductionist, he had his students learn basic physiology as that would explain human disease. If you did the work, which was hard, you got a good grade. Mrs. Onderdonk focused on the mechanics of science. Her students actually did science. They thought about questions; designed experiments to answer these questions, and assessed the results.

Discharges 294

Discharges Admissions Hospital Collaboration 294

Sensible Medicine

SEPTEMBER 28, 2023

I’ve been hearing a lot about intermittent fasting as an approach to weight loss lately. This comes from physicians, patients, and celebrities. I never pay attention to this kind of chatter because, as I have written , I think weight loss advice (outside of GLP-1s and bariatric surgery) arises from a data free zone. However, I’ve realized that intermittent fasting serves as a good example from which to discuss the complexities of actually practicing medicine according to evidence-bas

Medication 288

Medication Tests 288

Scrubs

MARCH 30, 2023

Some one million nurses with active RN licenses are not working due to unsafe working conditions, according to National Nurses United, the largest nursing union in the country. Nurses have been organizing to get federal lawmakers to pass a bill that would set minimum nurse-patient ratios for every department in every hospital in the country. The bill, known as The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, was authored by Sen.

Billing 290

Billing Hospital Huddles/Rounds Patient Safety 290

Scrubs

MARCH 7, 2023

Shariya Small wasn’t ready to be a single mom when she gave birth to triplets earlier this year. The 14-year-old resented having to wake up at all hours of the night to change diapers and feed her babies. It was all a little too much for a teenager to handle. All three of her children were born prematurely at 26 weeks, which only complicated the situation.

Discharges 290

Discharges Hospital Huddles/Rounds Scheduling 290

Scrubs

FEBRUARY 21, 2023

Nurses and law enforcement professionals often have trouble identifying bruises on individuals with black or brown skin. This can prevent them from dealing with situations of domestic abuse or detecting underlying health issues, such as internal bleeding. So, Dr. Katherine Scafide decided to do something about it. She’s a forensic nurse and associate professor at George Mason University who has worked with trauma patients for years.

Documentation 288

Documentation Medication 288

Scrubs

FEBRUARY 9, 2023

A new study suggests that hating your commute to work might actually improve your mental health. Researchers from Wayne State and Rutgers University found that commuting creates a liminal space that allows your brain to switch off and recharge. The COVID-19 pandemic deprived millions of Americans of their daily commutes, which could explain the increase in burnout, anxiety, and depression. “We believe the loss of this space helps explain why many people missed their commutes,” the au

Hospital 281

Hospital 281

Scrubs

FEBRUARY 7, 2023

Passing the National Council Licensure Exam (NCLEX) isn’t easy. Just ask any licensed registered nurse. But more and more students are having trouble passing the exam, which is only compounding the ongoing nurse shortage. Experts believe the COVID-19 pandemic is largely to blame. The health crisis forced nursing schools to conduct their operations online, depriving thousands of aspiring nurses the chance to learn and practice their skills in person.

Critical Thinking 279

Critical Thinking Tests Collaboration 279

Scrubs

FEBRUARY 6, 2023

Stephanee Beggs, 28, made a name for herself long before becoming a nurse. She originally earned a degree in business management but soon decided to go back to school to pursue her dream of helping others. Beggs was in the middle of an accelerated nursing program, which she says packs three years’ worth of education into one year, when the pandemic shut everything down, forcing her to continue her education online.

Follow-Up 278

Follow-Up Scheduling Documentation Collaboration 278

Scrubs

FEBRUARY 10, 2023

Tylar Krause, a school nurse at Kleberg Elementary in Dallas, TX, is used to treating kids for all kinds of aches and pains. And helping women give birth isn’t exactly in her job description. But that didn’t stop her from jumping into action when the mother of one of her students went into labor. Loren Carcamo was pregnant with her third child when she got a call from her kids’ school.

Follow-Up 278

Follow-Up Hospital 278

Scrubs

FEBRUARY 28, 2023

It’s been a busy two days for thousands of nurses in Austin, Texas. They turned out on Monday and Tuesday as part of Texas Nurse Day at the Capitol, an event organized by the Texas Nurses Association. It’s more than a protest. Instead, the union is taking over sections of the state capitol to meet with lawmakers to develop policies that will curtail the state’s ongoing staffing shortage.

Hospital 278

Hospital Billing Medication 278

Sensible Medicine

DECEMBER 20, 2023

I am not an artificial intelligence skeptic or pessimist. I am confident that AI will improve healthcare, and I look forward to seeing how. I’ve been following the general conversations and have been particularly interested in AI’s potential to improve diagnostic performance. Two good reads are here and here. I do not think that we can yet really imagine how we will incorporate AI into our practice in five or ten years.

Appointments 271

Appointments Diagnostics Scheduling Follow-Up 271

Scrubs

APRIL 10, 2023

As a refugee awaiting her husband in the U.S., Eliza Shabire was overwhelmed when she found out she was pregnant with her first child. She lives with her extended family in Boise, Idaho but she needed help raising her child in a new environment, so her doctor referred her to the Nurse-Family Partnership program, which is currently operating in three of the state’s seven public health districts.

Hospital 272

Hospital Appointments 272

Scrubs

MAY 3, 2023

Nurses all over the country are going on strike or walking away from the bedside due to low pay and stressful working conditions. But your life as a nurse can vary dramatically based on where you choose to live and work. WalletHub recently conducted a nationwide study of the best and worst states to be a nurse. The findings are based on data in two key categories: “Opportunity & Competition” and “Work Environment.

Hospital 264

Hospital 264

Scrubs

APRIL 19, 2023

As the building nurse at Wilson Vance Intermediate School, Nancy Rook spends a lot of time with Gunner Hartley, a fourth grader with spina bifida. The two can often be seen roaming the halls together as Rook helps Hartley manage his condition at school. Hartley uses a wheelchair, and the other children often have questions about his condition, so Rook decided to write a children’s book to show them that his disability doesn’t make him different.

Medication 264

Medication 264

Scrubs

MAY 6, 2023

Think back to your days on the playground. Were you that kid in school who always got hurt? Chances are you were cared for by a school nurse. But these professionals do more than just hand out Pepto Bismol and Band-Aids, they play a vital role in promoting the health and well-being of the communities in which they serve. School nurses develop care plans for the entire campus by giving staff and faculty the support they need to care for themselves and their students.

Care Plan 264

Care Plan Hospital Medication 264

Scrubs

APRIL 4, 2023

Lori Martinek was fired from Regional Health Services of Howard County in Iowa last year after being assaulted by a combative patient. She was denied unemployment benefits for months because her former employer challenged her claim, but a state court recently ruled in her favor. Records show Martinek worked at the facility from January 2018 to September of last year when the incident occurred.

Discharges 264

Discharges Hospital 264

Scrubs

MARCH 25, 2023

Christy Fliss isn’t used to seeing much daylight as the charge nurse on the night shift at Sanford Health Sylvan Court in Canby, Minnesota where she’s worked for nearly nine years. Her colleagues know and love her for her attention to detail and stabilizing presence in the ICU, so they decided to surprise her with the DAISY Award to show her how much they appreciate having her around.

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264

Scrubs

MARCH 24, 2023

“Patient in room 709 didn’t sleep all night and thinks his call light is to get the cops to come and arrest us,” said the night shift nurse as she packed her things. How can nursing be so predictable and unpredictable at the same time? As soon as I walked into his room and tried to introduce myself, he exclaimed, “Oh great, another woman; if they really think they can keep me here, they should at least bring a man to do the job!

Huddles/Rounds 264

Huddles/Rounds Hospital Communication Medication 264

Scrubs

MARCH 21, 2023

Doctors spend a lot of time entering clinical notes into patient charts at the end of the day. But a new artificial intelligence program could do away with this practice for good. MaineHealth recently announced it is using AI to automatically record conversations between doctors and their patients during a check-up or follow-up visit. The software then transcribes the information and enters the most important details into the patient’s chart, so doctors don’t have to spend as much time entering

Hospital 264

Hospital Follow-Up Appointments Documentation 264