Putting it on the board

A back-page section in CAP TODAY that I’ve been working to beef up is called “Put it on the Board.” I usually contribute a fairly well reported lead news item of a few hundred words.

Back in January, I examined the need for faster, simpler tests to diagnose infectious diseases. In February, the story looked at explosive growth in the field of genomics and how difficult it is to translate benchside discoveries into bedside treatments. And last month I reported on how labs will be affected by a new federal regulation giving patients the right to their test reports.

And, yes, it appears that Ken “Hawk” Harrelson’s home-run call did inspire the section’s name.

How high-tech approach may reshape the autopsy

Boosters of so-called virtual autopsy say it has the potential to revolutionize the practice of forensic pathology and could help increase the share of U.S. deaths subject to medical autopsy.

The technique involves the use of computed tomography, magnetic resonance imaging, and three-dimensional surface scanning technology to help resolve tricky forensic questions such as whether a woman was killed with a hammer or a bicycle wrench. The 3D scanning can help provide a “morphological footprint” to gauge against any kind of instrument that could have inflicted the damage, said Michael J. Thali, MD, chair of the Institute of Forensic Medicine at the University of Zurich in Switzerland. About 500 virtual autopsies have been conducted at the institute, Dr. Thali said in a June 8, 2013 lecture before the Royal Society of Medicine in London.

Postmortem imaging using CT and MRI—the former is better for evaluating skeletal injuries, while the latter excels with soft-tissue evaluation—can help give a 3D visualization of these blunt-force injuries, Dr. Thali said. He and his colleagues also have used the virtual autopsy approach in cases of strangulation, knife wounds, and more.

My latest in CAP TODAY. Read the whole shebang.

Guidance aims for safer use of lab data in EHRs

A wide-ranging set of recommended health information technology safety practices recently issued by the Department of Health and Human Services is likely to accentuate the essential role that pathologists and laboratory leaders play in minimizing the adverse consequences of health IT.

Pathologists and lab experts involved with developing the guidance say it could serve as a North Star for how health care organizations can improve IT safety, especially with regard to better test tracking and results display. But some of the functionalities the recommendations call for are not yet widely available, and the recommended practices could represent a big implementation challenge for laboratories.

My latest in CAP TODAY. Read the whole shebang.

Saving time on HLA testing’s final compatibility check

What would you give for a little more time? Take a vital task that you do every day, every week, or every month, and do it about three times faster—with no effect on the quality of the outcome. No, this is not another comfort-food recipe from Rachael Ray’s best-selling series of “30-Minute Meals” cookbooks. This is the story of how a growing number of histocompatibility laboratories are optimizing a test that can detect low concentrations of donor-specific human leukocyte antigen antibodies and help avoid post-transplant organ graft failure.

My latest in CAP TODAY. Read the whole shebang.

Clinician-friendly tactics slash unwarranted testing

A child born recently at Broward Health Medical Center was definitively diagnosed, without testing, as having a significant genetic abnormality. A medical resident eager to put his education into practice ordered genetic testing for the newborn, two normal siblings, and the child’s parents.

The tests would have cost the hospital up to $10,000—each.

My first bylined story in CAP TODAY. Read the whole shebang.

Painkiller problem hits hard in workers comp

The dramatic increase in overdose deaths and emergency department visits related to the class of narcotic painkillers known as opioids has drawn national attention to the rise in abuse of the drugs as well as inappropriate prescribing by physicians.

But the problem, dubbed an “epidemic” by the Centers for Disease Control and Prevention Director Dr. Tom Frieden, is not limited to teens looking for a cheap high by raiding their parents’ medicine cabinets. Rather, it is being felt in a big way by employers. Companies are seeing their workers compensation costs rise by $1.4 billion annually as a result of injured workers taking prescription opioids such as OxyContin and subsequently experiencing a pronounced delay in return to work.

Experts say that a coordinated effort among all the stakeholders—politicians, regulators, medical authorities and the general public—is needed to comprehensively address the opioid epidemic. But they note that there are some steps that employers and their insurers can take to discourage improper prescribing, help injured workers return to work more quickly and help rein in workers compensation costs.

My latest appears in the January issue of Rough Notes, a final holdover from my freelancing interregnum. Read the whole shebang.

A blast from the past

In a July 2 editorial, the Tribune’s editorial board spoke out against Indiana’s more liberal fireworks laws, calling them a “farce.” I find it extremely ironic that when the 4th of July comes around, adults in Illinois aren’t allowed to freely celebrate what little liberty they have left.

So began my 1999 letter to the Chicago Tribune, which it recently occurred to me to dig up. Read the whole shebang.

The next patient safety target: misdiagnosis

A 36-year-old woman recently presented with flu-like symptoms at Shonan Kamakura General Hospital in Kamakura, Japan. Just a week earlier, her son had been diagnosed with influenza, leading her doctors to think that might be the cause of her fever, fatigue, sore throat and dry cough.

But she tested negative for flu, so she was diagnosed with an upper respiratory infection, prescribed 1,200 mg of acetaminophen daily and sent home. The woman returned the next day, reporting symptoms of vertigo. Testing showed she had suddenly become anemic. Within days she was dead, felled by acute promyelocytic leukemia, which has a 5-year survival rate surpassing 70% when correctly diagnosed and treated.

The tragic case of delayed diagnosis, presented at the Diagnostic Error in Medicine 6th International Conference in Chicago in September, was one of those extremely rare “white zebras” that every physician dreads, expert diagnosticians said.

“These are tough cases at every level,” said David E. Newman-Toker, MD, PhD, associate professor of neurology and otolaryngology at Johns Hopkins University School of Medicine in Baltimore.

But new research shows that it’s not just the one-in-a-million diagnoses that get missed, Dr. Newman-Toker noted. Diagnostic errors are responsible for more patient deaths, disabilities and medical liability costs than any other kind of medical mishap.

My latest is in the December issue of ACP Hospitalist, a holdover from when I was still freelancing. Read the whole shebang.

Outreach to Latinos on health coverage faces obstacles

Valentin Torres is the kind of resident Illinois officials know they need to reach if their effort to vastly expand health insurance coverage under the Affordable Care Act is going to succeed.

Torres, a truck driver and the sole provider for his wife and three children under 18, said his family has gone uninsured since 2005 when he lost the coverage he had through an employer.

At a state-organized outreach event he heard about on Spanish-language radio, Torres learned the family would be eligible for Medicaid under the health law’s expanded income rules. He planned to complete his application from home through abe.illinois.gov, a site for Medicaid applicants separate from the troubled federal website where private insurance plans are sold.

“I came here to get health coverage for me and my family,” said Torres, 44, who is bilingual but spoke to a counselor in Spanish. “Without insurance, you can’t afford to get sick.”

Federal health officials estimate that Latinos make up nearly a quarter of Illinois’ uninsured population, inspiring a special effort by state officials to spread the word about options available under the health law. To help raise awareness, Illinois is partnering with nearly 50 community-based organizations with close ties to immigrant populations.

My latest is in the Chicago Tribune. Read the whole shebang.

Here is my new cubicle …

2013-11-04 10.00.29 … at the College of American Pathologists, where I started a position Monday as senior editor for a monthly magazine the college publishes, CAP TODAY. The publication focuses principally on clinical issues in pathology, laboratory medicine and laboratory management. So, I have a lot to learn. The job is out in the suburb of Northfield, so I had to buy a car to make the daily commute. It’s interesting work so far and, hey, free coffee! I will, as I’ve done with all my previous jobs, post links to my articles. Given the audience at which the publication is aimed, however, these stories may be less accessible to the general reader than most of my previous work.

FDA Refuses to Set Dosage, Duration Limits on Opioid Labels

After more than a year of research, public hearings, and consideration of nearly 3,000 comments filed by physician organizations, patients, and others, the U.S. Food and Drug Administration in September altered the labeling of extended-release and long-acting opioid analgesics to place a greater emphasis on the medications’ safety risks. The action falls far short of the strict limits on the dosage and duration of opioid therapy for patients’ noncancer pain that were proposed by advocacy groups last year.

My latest, published in the American Academy of Pain Medicine’s Pain Medicine Network newsletter. Read the whole shebang.