There is little professional guidance to help physicians navigate connections with patients on Faceboook, Twitter and other sites.

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Nurse practitioners and physician assistants account for at least 10% of outpatient visits and increasingly are being used to handle patient care in emergency departments, according to previous research.

But a new survey said 80% of patients expect to see a physician when they come to the ED. Fewer than half would be willing to see an NP or PA for an ankle injury — they would rather wait two more hours to be cared for by a physician.

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Five years after the hurricane devastated New Orleans’ health system, the city’s medical landscape has been transformed.

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A federal jury has found Randeep Mann, MD, guilty on all but one count related to the February 2009 bombing of Arkansas State Medical Board Chair Trent P. Pierce, MD, who nearly died in the blast.

Among other charges, jurors found Dr. Mann, an internist from London, Ark., guilty of using a “weapon of mass destruction” in the bombing that targeted Dr. Pierce. That count alone carries a potential life sentence, said Cherith Beck, public information officer for the Eastern District of Arkansas U.S. Attorney’s Office, which brought the case against Dr. Mann. The verdict was delivered Aug. 9.

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One in three doctors who personally knew of an incompetent or impaired physician colleague failed to report the doctor to a hospital, clinic, professional society or other authority, according to a recent national survey of nearly 2,000 physicians.

A variety of medical professional ethics codes, including the American Medical Association’s, say physicians have a duty to report other doctors whose substance abuse, mental health or other problems could endanger patients. But the survey, whose results were published in the July 14 Journal of the American Medical Association, found that just 64% of physicians completely agreed that they had an obligation to report all impaired or incompetent doctors. The rest of the physicians either “somewhat agreed” that they were obliged to report problem colleagues or disagreed that they had such a responsibility.

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The Iowa Medical Society recently launched what appears to be a first-of-its-kind initiative by a state medical society to help its members recruit new physicians.

Telling potential recruits about the benefits of practicing in the Hawkeye State is the aim of the medical society’s Center for Physician Recruitment. The effort, which started in April, is packaged under the slogan, “Iowa: A Practice Worth Living,” and features a website, coffee-table sized booklet and videos of Iowa doctors from various specialties talking about why they enjoy working and living in the state.

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With newly released data showing that prescription drug misuse now rivals illicit drug use as a cause of emergency department visits, the Food and Drug Administration in June released a long-awaited proposal aimed at curbing recreational use of opioid analgesics.

Physicians and advocates for pain patients hailed the FDA’s proposal for addressing the growing opioid abuse problem while not impeding legitimate access to pain treatment.

Emergency department visits related to misuse of prescription or over-the-counter drugs doubled from 500,000 in 2004 to 1 million in 2008, said the report, based on estimates from the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network. DAWN generated the estimates by reviewing data and medical charts submitted by 231 U.S. emergency departments.

Illegal drugs such as cocaine and heroin were involved in 1 million ED trips annually, a figure that stayed flat over the time period.

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Ambulatory surgical centers’ safety practices are under scrutiny as a study in the Journal of the American Medical Association found that problems in infection control are common at such centers.

The study came on the heels of a 28-count criminal indictment filed June 4 against Las Vegas gastroenterologist Dipak K. Desai, MD, and two of his endoscopy clinic nurse anesthetists. They were charged in connection with unsafe injection practices that led to a 2008 hepatitis C outbreak infecting 115 patients in southern Nevada.

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Two minutes after taking off from New York City’s LaGuardia Airport on a frigid January afternoon in 2009, US Airways Flight 1549 was struck by a flock of geese, instantly disabling the plane’s engines. Capt. Chesley B. “Sully” Sullenberger III radioed air traffic control, seeking an open runway to land the Airbus A320.

As Sullenberger looked for a place to put the plane down, first officer Jeffrey B. Skiles immediately consulted a checklist on how to restart the stalled engines. Skiles’ action showed how ingrained the checklist is in the culture of aviation, where it has been in use for more than 70 years.

Sullenberger successfully ditched the plane in the Hudson River. Then, outstanding application of emergency protocols helped the flight crew successfully evacuate the plane, saving the lives of all 155 people on board — another dramatic example of how aviation’s approach to safety yielded results that winter day.

Long before Sullenberger’s role in “the miracle on the Hudson” landed him on America’s front pages, he had been advising health care organizations on how to apply aviation’s safety lessons in medicine. His consulting group, Safety Reliability Methods Inc., is one of many firms offering aviation-based training to health care organizations eager to achieve the industry’s safety record.

“The risk of accidental death in a jet aircraft from 1967 to 1976 was 1 in 2 million,” Sullenberger noted in a speech in March to health IT professionals. “Today, it is 1 in 10 million. After 75 years, we in aviation have benefited from lessons learned at great cost — literally bought in blood — lessons we now offer up to the medical field for the taking.”

For more than a decade, doctors and hospitals have sought to learn from their counterparts in aviation. Checklists, structured communication techniques, preoperative briefings, error reporting and simulator training are just a few of the aviation safety methods they have tried to implement in the world of medicine.

However, adapting aviation’s techniques to health care has not been easy, patient safety experts say. Inherent differences between the two industries have made it a challenge to learn from aviation’s safety experience.

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My lede:

More than 1,500 hospitals in 17 states reported 18% fewer central-line associated bloodstream infections than projected, according to a first-ever state-specific infection report released in May by the Centers for Disease Control and Prevention.

Infection-control professionals said the CDC data suggest that physicians and nurses at hospitals are using checklists to better implement guideline-based care and prevent bloodstream infections that kill an estimated 31,000 Americans each year.

“This progress is being led by that process of using checklists; I think it deserves a lot of credit,” said Stephen A. Streed, a board member of the Assn. for Professionals in Infection Control and Epidemiology Inc., representing more than 13,000 members who run infection-control programs.

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My lede:

A Food and Drug Administration task force in May unveiled a series of 21 proposals to share publicly more information about pending or rejected drug and device applications, as well as agency enforcement actions. The move, which has drawn objections from companies fearful that greater disclosure will spill trade secrets, is part of a larger transparency drive the FDA launched last year.

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It is legal and ethical to honor patient requests to deactivate implanted cardiac devices, and physicians should take the initiative in talking with terminally ill patients and their families about turning off the devices, according to a new expert panel consensus statement released in May.

Implantable cardioverter-defibrillators, or ICDs, can impose a particularly heavy burden on terminally ill patients, continuing to send electrical shocks as the patient dies.

“His defibrillator kept going off,” one family member of a dying patient told the authors of a study in the Dec. 7, 2004, Annals of Internal Medicine. “It went off 12 times in one night.”

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