My lede:

The Centers for Medicare & Medicaid Services has estimated that rules that took effect in October 2008 and denied payment for “reasonably preventable” hospital-associated conditions would save the government $21 million and encourage patient safety improvement.

But the savings probably will be much lower, according to a study in the September/October Health Affairs.

The nonpayment rules are likely to cost hospitals about $2.7 million — $368 per facility — raising the question of whether the no-pay policy will achieve Medicare’s cost and safety objectives. Hospitals and physician organizations, including the American Medical Association, have objected to some of the conditions included in the no-pay list, saying prevention is not always possible.

The whole shebang.

My lede:

All adults should be screened for depression, and primary care physicians should do the screening, according to a position statement issued in October by the American College of Preventive Medicine.

With 6.7% of American adults — about 15 million people — experiencing depression in any given year, the prevalence of the disabling and potentially deadly condition makes it imperative that primary care doctors regularly screen their patients, the college’s statement said. The college consists of 2,000 physicians who specialize in preventive medicine practice or research.

Primary care physicians are the principal health care contacts for most patients with mental illnesses, according to the paper, published in the October Journal of Family Practice. More than a third of primary care patients experience some form of depression, and 10% of patients have major depression. But, the college’s position statement said, most depressed patients seeing primary care doctors go undiagnosed.

The whole shebang.

My lede:

Two New England physicians are taking on a state law they argue interferes with their ability to prescribe life-ending doses of medication to terminally ill patients who request it.

Gary Blick, MD, an HIV/AIDS specialist in Norwalk, Conn., and Ronald M. Levine, MD, an internist in Greenwich, Conn., in October filed a legal challenge to the state’s assisted-suicide statute, saying the threat of punishment prevents them from prescribing lethal doses of medication.

Dr. Blick said that since he started practicing in 1987, he has received numerous requests for lethal prescriptions from terminally ill patients with “agonizing pain” and poor quality of life. “I always tell them I can’t do that — I could be tried for manslaughter.”

The whole shebang.

My lede:

GlaxoSmithKline plc, the world’s No. 2 selling drugmaker, said in September it will stop taking continuing medical education grant applications from medical education and communication companies.

The world’s top-selling drugmaker, Pfizer Inc., in July 2008, became the first company to steer its money away from these for-profit CME companies, often called MECCs. Critics argue that commercial CME providers are more likely than nonprofit providers to let bias slip into their offerings.

“A MECC can’t say to a drug company grant, ‘I can take this or leave this,’ whereas a medical center can say that, because they derive income from so many other sources,” said Daniel J. Carlat, MD, a prominent critic of industry support for CME and assistant clinical professor of psychiatry at the Tufts University School of Medicine in Massachusetts. “The incentives to create obviously promotional CME are much greater with MECCs than with other organizations.”

The whole shebang.

My lede:

Sporting a pair of stylish aviator sunglasses as a hip-hop beat swells on the soundtrack, John D. Clarke, MD, seems at home in the rap video for which he won a national contest to find the best flu-prevention public service announcement.

But the first giveaway that the lyrics to this rap will stray far from typical Jay-Z fare is a close-up of Dr. Clarke’s name in script over the pocket on his white coat. Then he dishes out the rhyme: “Hand sanitizer, I advise you get it — why? It makes germs die when you rub and let it dry.”

The minute-long music video also advises patients to seek medical care if they believe they are infected with influenza A(H1N1), stay home when sick, use tissues when sneezing, wash their hands for 20 seconds, and avoid touching the nose, eyes and mouth.

The whole shebang.

The video:

My lede:

“Oh, I forgot all about that,” Monal Joshi, MD, responded to a question from a senior resident during morning report. The internal medicine intern, entering the 25th hour of a 30-hour shift at Rush University Medical Center in Chicago, had overlooked a patient’s test result.

The slip was quickly caught by a supervisor, and no harm was done. But was the resident’s momentary lapse due to fatigue?

Dr. Joshi had at least two hours of sleep the night before — pretty good for when she’s on call.

Some other members of the five-person Rush internal medicine residency team looked worse for wear as their shifts neared the end one day last spring. Third-year medical student Shikha Wadhwani rested her hand on her head, blinking slowly and yawning widely, as the others went through their reports.

But Yoojin Kim, MD, an intern who slept from 3:30 a.m. to 6 a.m., looked bright as a fluorescent light as she sped through her patient reports.

Sleep scientists say staying awake for more than 16 hours decreases the ability to concentrate, impairs memory and hinders the ability to do tasks such as tracking test results on a monitor.

Yet sleep deprivation does not affect everyone the same way. Such is the enigma of the debate on whether resident duty-hour limits have helped patients.

Six years have passed since the Accreditation Council for Graduate Medical Education cut resident workweeks to 80 hours. The council also restricted shifts to 24 hours of call plus six hours of patient transition and educational activities.

Some health leaders said cutting back the weekend-long shifts and 120-hour workweeks that were common before the 2003 rules would yield a safety benefit — fewer patient deaths and fewer complications. But it is hard to make a definitive, evidence-based argument that the work-hour limits have improved patient outcomes, experts said.

The whole shebang.