The Need for Brave Health Reform

A Proposal for Private Health Reform in Australia

Australia’s health system is in need of reform.  A recently published article by Country Doctor on KevinMD.com prompted me to solidify my thoughts on potential solutions which could improve the private health system in Australia.  My apologies to our international readers for whom this will have less relevance, although I believe there are key messages that apply to all of our health systems.

In basic terms, the Federal Government in Australia funds General Practice consultations, Specialist Outpatient consultations and private hospital specialist fees via Medicare.  The Private Health Insurance (PHI) companies fund hospital visits only, and cover a portion of the specialist fees, the theatre fees, bed fees, prosthesis etc and some radiology and pathology fees.  Some PHI policies also cover extras such as dental, optometry and physiotherapy.  PHI premiums are paid by the individual (not usually by employers) and for those above a nominal income bracket attract a partial rebate in the Medicare Levy (a tax on income to pay for Medicare).

Here are my suggestions to improve the Private Health System

  1. Remove Medicare as a funder of private hospital admissions and procedures and standardise PHI payments.
  2. Make private specialist fees more transparent and accessible to patients
  3. Increase Medicare funding for health promotion and practices that keep patients out of hospital
  4. Revise Medicare funding for specialist outpatients to improve access for patients

Remove Medicare as a funder of private hospital admissions and procedures

PHI companies currently negotiate with Private Hospitals to set fees for bed fees, operating theatre fees, procedures etc.  These don’t have a Medicare component and so are a fixed fee once agreed upon.  However, the fee paid to specialists is subject to different kinds of schemes and models.

For example, let’s say you need a cholecystectomy.  Medicare Benefits Scheme (MBS) sets a fee of $740 but only pays 75%, $550.  The PHI pays the other 25% of the set fee.  Most of the time, the specialist will charge more than the MBS fee.  Here’s where it gets interesting.

The specialists can agree on a certain amount of extra fee (the Gap) with the PHI.  As long as they keep the gap under this amount the PHI will also pay that Gap (usually less than $500).   This is Gap Cover or No Gap and translates to no out-of-pocket fee for the patient.

Or, some PHIs offer a “Known Gap” where the specialist agrees to charge a fixed amount more than what is covered by Medicare and PHI, so the patient has a fixed out-of-pocket expense, usually a few hundred dollars.

The PHIs may attempt to “recruit” No Gap or even Known Gap specialists, which means they have to agree to these conditions for all the procedures they perform.

But, if the specialist wants to charge in excess of the above amounts, the PHI will only cover the 25% Medicare rate.  So effectively if the specialist charges more, the PHI pays less and guess who suffers?  The patient pays an even larger out-of-pocket fee.

So, going back to the cholecystectomy, if the surgeon charges $1200, the patient’s PHI will probably pay the gap and they will have the procedure without any out-of-pocket expense.  But, if the surgeon charges $1400, the patient may actually end up paying more than $600 out-of-pocket, even though the surgeon only made $200 more.  Let’s ignore the anaesthetist’s fee for this example but suffice to say their gap can be just as large as the surgeons.

This is probably confusing if it is the first time you’ve read or thought about it.  How do you think the patients feel?

Removing the Medicare fee would take away the concept of a “Gap” and ideally mean that the specialists and PHI will have to negotiate a fixed fee for each procedure.  Ideally it would roughly equate to an existing Gap Cover fee, so in the case of the cholecystectomy, about $1200.  No “if you charge more we pay less” schemes.  If the specialist charges more than $1200, then that is paid out of the patient’s pocket.  This also removes the financial negotiation from the doctors vs government political battlefield.

This will obviously translate to higher insurance premiums, but these can be offset by greater Medicare Levy rebates.  The other step is to minimise the sometimes exorbitant out-of-pocket specialist fees so that using the private health system is cheaper overall, even if the premiums are higher.  That brings me to my next point.

Make private specialist fees more transparent and accessible to patients

Patient ‘self-health’ funding stories are becoming increasingly common. Tracy Ryan’s story outlines the difficulties and pain caused to patients by excessive out-of-pocket costs:

To use the example in the article, if you need to buy a new TV or if you need to put in a swimming pool, you can shop around for prices and quotes.  You may decide to go with the more expensive quote if you think that you will get better service or quality, but ultimately it is your choice.  This is not the case with private specialist fees.

The specialist can basically charge whatever they want for a procedure.  There are some guidelines produced by the AMA which state the fee should be reasonable.  This description is obviously subjective and open to interpretation.  The AMA also produces a set of recommended fees for all procedures which is usually considerably in excess of the MBS fee and above what PHI will cover.  Specialists will often use these as a guide – “I charge AMA rates” or “AMA rates + 10%” etc.  These rates, it could be argued, are skewed towards certain historically higher fee charging specialties.  More importantly, they are not freely available to the public.

Some of the out-of-pocket fees can reach tens of thousands of dollars, and some specialists even offer payment plans for their patients.  These do not always correlate with complexity, and many procedures lasting less than an hour will attract out-of-pocket fees of thousands of dollars.  And I’m not talking about cosmetic surgery.  Is this reasonable? I guess it is open to interpretation.  But what is not open to interpretation is that these fees are driving people away from private health insurance.  People who can afford the insurance but just can’t pay the out-of-pocket fees are being forced into the already overworked public system.

Most specialists won’t tell you their fees until you have been seen in their rooms.  Some freely admit that this is a marketing tool.   Seeing the specialist may cost $200 – 300 and you may be expected to consent, etc at the same consult.  This makes it difficult for a patient to “shop around”.  The specialists defend this practice of keeping their fees secret by saying they need to see the patient before they know which procedure they need.  As our AMA President says in the article.

This is true, but most specialists perform 4 or 5 common procedures, so they could easily provide their fee for these.  For example, an upper GI general surgeon may have the cost for a cholecystectomy, inguinal hernia, oesophagectomy, gastroscopy and laparoscopic fundoplication on their website.

Other arguments are that the GPs refer the patients, so it is their responsibility to choose one that is value for money for their patient.  This may happen occasionally, but most of the time patients don’t  feel they can complain about a specialist’s fees to their GP.  GPs also often have no idea of the fees a specialist charges – another example of lack of transparency.

Particularly in capital cities where there are many specialists to choose from,  market forces will set the “reasonable” price.  If the market can see the price in the first place.  So, the AMA fees must be freely available to the public with an explanation as to how they have been derived.  And, specialists must be compelled to provide their fees to patients and GPs, either over the phone or on their websites.   And perhaps each specialist should also provide an explanation as to how they have been derived.  An itemised quote, shall we say.

A single website would be best of all, although one could argue this is not a requirement for any other industry.  The specialists’ websites would be a good start.

Increase Medicare funding for health promotion

The savings made removing Medicare from the private hospital system needs to be redirected to efforts to keep patients out of hospital.  This means a focus on promoting health in the younger population and managing the elderly and sick in their homes or nursing homes wherever possible.

This public health focus needs to remunerate those who are managing patients in nursing homes, educating the ageing population about future choices and advanced health directives, providing palliative care in the home, hospital in the home initiatives etc.

Health promotion needs to be rewarded.  This is not my area of expertise, but the obvious public health challenges such as obesity, lack of exercise, alcohol, prescription drugs and illicit drug addiction, promoting mental health etc need funding to keep these people out of the acute health system.

Revise Medicare funding for specialist outpatients to improve access

My focus has mostly been on surgical specialties but I believe there are other areas that can be improved.  There are a few specialties that feel the need to “close their books”.  These are specialists, trained by the public purse, who basically provide a service for a brief period of time, build up a cohort of patients who require regular review, then stop seeing new patients.  I’m not talking about specialists winding down for retirement.  Examples where this happens are in dermatology and neurology.

I know of a good dermatologist who sees a patient with a complex or unusual condition, makes the diagnosis and then sets out a detailed plan for treatment for the GP.  The patient is only to return if the plan fails.  This seems a sensible approach to managing patients with chronic conditions, rather than clogging up a specialist books forever with 3 or 6 monthly reviews for the rest of the patient’s life.

The Medicare fees (which should still apply to outpatient visits in my new model) should be modified  so that they are only paid if a specialist has a certain proportion of new patients every month.  This will motivate the specialist to continue to provide acute access for patients and avoid the ridiculous waiting times, even to see private specialists.  It may even reduce the number of caveats such as “no rashes seen by this dermatologist” (I’m not kidding).

Improving the private health system by making it more transparent, more affordable and more accessible will increase the uptake of PHI in the Australian market.  This will ultimately improve the public health system by diverting those who can afford it into the private health system.  This would be another step towards a sustainable, quality system.

The post The Need for Brave Health Reform appeared first on LITFL.

Research and Reviews in the Fastlane 040

Research and Reviews in the Fastlane

Welcome to the 40th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 10 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors

This Edition’s R&R Hall of Famer

Critical Care, Hematology

R&R Hall of Famer Blue

Alikhan R et al. The acute management of haemorrhage, surgery and overdose in patients receiving dabigatran. Emerg Med J. 2014 Feb;31(2):163-8. PMID 23435652

  • With its more predictable pharmacokinetics and a reduced risk of intracranial haemorrhage dabigatran is an attractive alternative to Warfarin. But unlike warfarin, there is no reversal agent and measurement of the anticoagulant effect is not ‘routine’ leading to nihilistic beliefs that bleeding patients overdosed on dabigatran are in dire straits. This great review on dabigatran emergencies reviews treatment options and suggested a treatment algorithm.
  • Recommended by Soren Steemann Rudolph

The Best of the Rest

Critical care, Emergency medicine, Trauma

R&R Eureka

LeRoux P. Haemoglobin management in acute brain injury. LeRoux, P. Curr Opin Crit Care. 2013 Apr;19(2):83-91. PMID 23385374

  • Nice review summarising the debate on chosing the best haemoglobin transfusion trigger for acute neurocritical care (focus on TBI, SAH and acute ischaemic stroke. Bit repetitive in the middle segment. Discusses threshold numbers, outcomes, context and risks.
  • Recommended by Matthew Mac Partlin

Critical Care, Pulmonary

R&R Landmark

Sharifi M et al - “MOPETT” Investigators. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). the  Am J Cardiol. 2013 Jan 15;111(2):273-7. PMID 23102885

  • Consider 1/2 dose tPA in submassive PE ?
  • In this study the role of a “1/2 dose” thrombolysis was evaluated for the reduction of pulmonary artery pressure in moderate PE. A total of 121 patients with moderate PE received either tissue plasminogen activator plus anticoagulation or anticoagulation alone with the primary end points of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. The results suggested that the ½ dose or “safe dose” thrombolysis was safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months.
  • Recommended by Salim R. Rezaie, MD

Retrieval, prehospital and disaster

R&R Hot Stuff

 Goto Y et al. Neurological outcomes in patients transported to hospital without prehospital return of spontaneous circulation after cardiac arrest. Critical Care 2013; 17:R274 PMID 24252433

  • If there’s no ROSC in the field, the chance of achieving good neurologic status is minimal. Survivors were 3-4 times more likely to have a poor neurologic outcome (i.e. severe cerebral disability, coma or brain death) than a good one (1.89% vs. 0.49%).
  • Recommended by Anand Swaminathan

Airway

R&R Game Changer? Might change your clinical practice

Carlson JN, Brown CA. Does the Use of Video Laryngoscopy Improve Intubation Outcomes? Ann Emerg Med. 2014 Mar 10. PMID: 24635989

  • Video laryngoscopy provides superior views of the glottic opening compared with direct laryngoscopy but does not improve the overall rate of intubation success. For difficult airways, video laryngoscopy decreases the time required for intubation.
  • Recommended by Jeremy Fried

Critical Care, Cardiology

R&R Hot Stuff

R&R Game Changer? Might change your clinical practice

Warren SA et al. Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: a retrospective review of prospectively collected data. Resuscitation 2014; 85: 350-8. PMID: 24252225

  • The effects of different dosing periods of adrenaline (epinephrine) remain unclear. In this retrospective review of prospectively collected data investigators sought to evaluate the association between epinephrine average dosing period and survival to hospital discharge in adults with an in-hospital cardiac arrest.  A less frequent adrenaline dosing (6 to <7 min/dose vs 4 to <5 min per dose) was associated with improved survival to discharge. This is more indirect evidence that adrenaline, at least as recommended by current the current ACLS guidelines, is harmful in cardiac arrest patients.
  • Recommended by Anand Swaminathan

Ultrasound

R&R Hot Stuff

Teismann NA et al. The Ultrasound-guided “Peripheral IJ”: Internal Jugular Vein Catheterization using a Standard Intravenous Catheter. J Emerg Med. 2013 Jan;44(1):150-4. PubMed PMID: 22579025

  • We can put a peripheral IV in the internal jugular – but should we?
  • Some patients just have no IV access – no superficial peripherals, no deep peripherals, no external jugular veins.  In a critical emergency, this is the perfect time for an intraosseous line.  But, what about the situation where IV access is simply necessary, but not urgent?  Placing a central line is the last thing we’re interested in doing – draping, opening a costly central line kit, billing for an expensive procedure, exposing them to risks of over-the-wire techniques in the central circulation.This technique, described formally here by folks from Highland Hospital, involves placing a standard, peripheral catheter into the internal jugular vein under ultrasound guidance.  While I think this is a fantastic idea – much faster and less expensive than a full multi-lumen central line set-up – I wouldn’t characterize it as “risk-free”, either.  The nine cases in this year-long review all demonstrated a lack of complications, but more data would help refine the procedural risks.
  • Recommended by Ryan Radecki

Critical care,  Emergency Medicine

Fröhlich S et al. Acute respiratory distress syndrome: current concepts and future directions.  Anaesth Intensive Care. 2013 Jul;41(4):463-72. PMID 23808504

  • Where are we up to on ARDS interventions? Sit back, relax and let the Irish intensivists paint you a picture. A handy review if you are about to sit some exams.
  • Recommended by Matthew Mac Partlin

Emergency Medicine, Neurology

R&R Hot Stuff

R&R Game Changer? Might change your clinical practice

Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. The INTERACT Investigators. Engl J Med. 2013 Jun 20;368(25):2355-65. PubMed PMID: 23713578

  • Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage remains elusive. In this study 2839 patients with spontaneous intracerebral hemorrhage and elevated systolic blood pressure received treatment to either a target systolic level of <140 mm Hg or <180 mm Hg within 1 hour with the use of agents of the physician’s choosing. The Authors did not find the hoped improvements in mortality or severe disability with intensive BP lowering, but did see an improvement in functional outcomes, and no increased harm. So lower away!
  • Recommended by Zach Repanshek

Emergency Medicine, Gastroenterology

R&R Eureka

Biondo S et al. Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial).  Ann Surg. 2014 Jan;259(1):38-44. PMID 23732265

  • The DIVER trial is a prospective randomized clinical control trial validating what we already do in common clinical practice in sending home uncomplicated diverticulitis. 132 individuals underwent randomization in a 1:1 fashion to either inpatient treatment with parenteral antibiotics or sent home on oral antibiotics. Patients had to be uncomplicated (radiographically defined + symptoms relief, no abscess, no breastfeeding or pregnancy, no cognitive/social impairment, no persistent vomiting, no previous antibiotic usage for diverticulitis) in order to meet inclusion criteria. The primary outcome was treatment failure rates whereas the secondary outcomes were quality of life measures. At the end of the study there were no differences between the two groups. The study confirms that our current practice of not admitting uncomplicated diverticulitis presuming the patient has good outpatient follow-up is a safe and cost-effective practice. Interestingly the antibiotic of choice for outpatients was Augmentin alone as opposed to the reflexively given dual therapy (cipro/flagyl) that many choose to use.
  • Recommended by William Paolo

The R&R iconoclastic sneak peek icon key

Research and Reviews The list of contributors R&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE Hall of Famer R&R Hall of famer You simply MUST READ this! R&R Hot Stuff 64 R&R Hot stuff! Everyone’s going to be talking about this
R&R in the FASTLANELandmark Paper R&R Landmark paper A paper that made a difference R&R Game Changer 64 R&R Game Changer? Might change your clinical practice
R&R Eureka 64 R&R Eureka! Revolutionary idea or concept R&R in the FASTLANE RR Mona Lisa R&R Mona Lisa Brilliant writing or explanation
R&R in the FASTLANE RR Boffin 64 R&R Boffintastic High quality research R&R in the FASTLANE RR Trash 64 R&R Trash Must read, because it is so wrong!
R&R in the FASTLANE 009 RR WTF 64 R&R WTF! Weird, transcendent or funtabulous!

That’s it for this week…

That should keep you busy for a week at least! Thanks to our wonderful group of editors and contributors Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

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Gravatar

Have you ever wondered why so many people have an awesome profile photo (avatar) on their blog posts and comments – whilst you remain an anonymous silhouette?

Anonymous John

What is an avatar?

  • An ‘avatar‘ (translated from Sanskrit as ‘descent’ of a deity in a terrestrial form) is your graphical representation online. It is the little picture that appears next to your name when you publish articles, write comments or interact with websites.
  • In the land of FOAM the avatar is usually referred to as a Gravatar the portmanteau of Globally Recognized Avatar.

What is a Gravatar? Why should I have one?

  • Unlike standard avatars, Gravatars follow you around the web and automatically appear when you publish an article or leave a comment on a blog/website.
  • Gravatar is the most globally recognized form of avatar-content affiliation with approximately 30 billion images being served on website per day.
  • Gravatar affords free, easy, updatable global identification by associating your content with the profile image you want to display.
  • Having a gravatar account saves you having to register an avatar on every site you join or service you register for.
  • You can update the Gravatar you use across multiple sites by uploading a single image in a single place.

How do I create my Gravatar?

  • On the Gravatar home page, click on the ‘Sign In’ button at the top-right of your browser window.

If you have a wordpress.com account you can sign in with your username and password

gavatar with wordpress

If you don’t have a wordpress.com account – click Need an account? to register for a new account.

  • Enter your preferred email address and enter a username and a password.
  • Then click Sign up to submit your registration.

gravatar no wordpress

You can then manage your profile by

  • Users can choose which images they want to show as their primary image.

manage gravatars

verify rel = me

How do I manage Gravatars and hovercards on my website/blog?

  • WordPress.com owners will automatically see gravatars and hovercards
  • WordPress.org owners will have comments and authors enabled, but need to install the Jetpack plugin to enable hovercards.
  • Hovercards appear when you place your mouse over any Gravatar. They provide extra information from your gravatar profile such as social media links, websites and images.
  • You can turn offHovercards with these steps:
    • Go to Settings -> Discussion
    • Scroll down to the Avatar section
    • Uncheck the box “Gravatar Hovercards”. This will disable hovercards on your blog.
precordialthump gravatar

Hovercard example (Chris Nickson)

References:

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The LITFL Review 144

The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.

Welcome to the 144th edition, brought to you by:

The Most Fair Dinkum Ripper Beaut of the Week

The Best of #FOAMed Emergency Medicine

  • Stephen Smith reposts on a Certain Pattern of PseudoSTEMI to remind us that WPW can cause STEMI-like findings on the 12-lead ECG. Patients with chest pain and this finding should be considered for cardiac catherization or thrombolytics but caution is advised. [AS]
  • Audio from NYU/Bellevue Grand Rounds in June 2014 featuring Jerry Hoffman on Over-diagnosis and David Newman on Chest Pain posted this week to the All NYC EM Conference site. Great talks from a couple legends in Emergency Medicine on topics critical to us all. [AS]
  • Richard Body at St Emlyns uses his own research to answer the question How accurate is clincal judgement for acute coronary syndromes? He highlights the relative uselessness of historical features and risk factors – but interestingly the combination of clinician gestalt, normal ECG and negative troponin looks very promising… more studies needed, but a must read all the same. [CN]
  • TTL Podcast 1. Getting to CT in 30 mins is a St. Emlyns podcast examining what aspects of initial trauma managment are really needed before going for a scan, when you have to have the scan done within 30 minutes of arrival. This sparked
  • Hippo EM present a videocast on pus and stones discussing how you can diagnoses UTI in patients with ureteric calculi. Or rather, how you can’t. [CN]
  • Are topical anesthetics dangerous in the treatment of corneal abrasions or is withholding them simply evil? Ken Milne and Salim Rezaie discuss on The Skeptics Guide to Emergency Medicine. Ken even brings in an opthalmologist who says it’s “okay” to give topical anesthetics! [AS]

The Best of #FOAMcc Critical Care

  • Speak up! on INTENSIVE focusses on speaking up, an obligation of all healthcare professionals to ensure that patients are not harmed. It can be difficult, requires skill, and requires courage – but is essential. [CN]
  • Cliff Reid has looked into the options for rewarming when you are faced with profound hypothermia and no ECMO. [CN]
  • PulmCCM highlight a recent meta-analysis showing that Prone positioning reduces ARDS mortality by 26%. Is your ICU proning yet? [CN]

The Best of #FOAMPed Paediatrics

  • In yet another superb smaccGOLD talk, Paediatric INtensivist and Palliative Care physician Greg Kelly tells us what to do when children die. [CN]

#FOAMTox Toxicology

News from the Fast Lane

LITFL Review EM/CC Educational Social Media Round Up

Emergency Medicine and Critical Care Blogroll — Emergency Medicine and Critical Care Podcasts — 123Sonography.com — Academic Life in Emergency Medicine — A Life at Risk — Bedside Ultrasound - BIJC — Boring EM — Broome Docs — CCM-L — Critical Care Perspectives in EM — Dave on Airways — Dont Forget the Bubbles — Dr Smith’s ECG Blog — ECG Academy — ECG Guru — ECG of the Week — ED ECMO — ED Exam — ED-Nurse — EDTCC — EKG Videos — EM Basic — EMCrit — EM CapeTown — EMCases — EMDocs — EMDutch — EMin5  Emergency Medical Abstracts — EM Journey — EmergencyLondon — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News — Emergency Medicine Ireland — Emergency Medicine Tutorials — Emergency Medicine Updates — EM on the Edge — Emergucate  — EM Journey —  EM IM Doc — EM Literature of Note — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum —EM nerd— EMProcedures — EMRAP — EMRAP: Educators’ Edition — EMRAP.TV — EM REMS — ER CAST — EXPENSIVECARE — Free Emergency Medicine Talks — Gmergency! — Got Resuscitation— Greater Sydney Area HEMS — HQmeded.com — Impactednurse —Injectable Orange  — INTENSIVE — Intensive Care Network — iTeachEM — IVLine — KeeWeeDoc — KI Docs— ER Mentor — MDaware — MD+ CALC — MedEDMasters — Medical Education Videos — Medical Evidence Blog — MedEmIt — Micrognome — Movin’ Meat — Paediatric Emergency Medicine — Pediatric EM Morsels — PEM ED — PEMLit — PEM Cincinnati — PHARM — Practical Evidence — Priceless Electrical Activity — Procedurettes — PulmCCM.org — Radiology Signs — Radiopaedia — REBEL EM - Resus.com.au — Resus.ME — Resus Review — RESUS Room — Resus Room Management — Richard Winters’ Physician Leadership — ruralflyingdoc — SCANCRIT — SCCM Blogs — SEMEP — SinaiEM — SinaiEM Ultrasound — SMART EM — SOCMOB — SonoSpot — StEmylns — Takeokun — thebluntdissection — The Bottom Line — The Central Line — The Ember Project —The Emergency Medicine Resident Blog — The Flipped EM Classroom — thenursepath — The NNT — The Poison Review — The Sharp End — The Short Coat — The Skeptics Guide to Emergency Medicine — The Sono Cave - The Trauma Professional’s Blog — underneathEM.com  — ToxTalk — tjdogma — Twin Cities Toxicology — Ultrarounds — UMEM Educational Pearls —Ultrasound Podcast

LITFL Review

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Google Author Stats

Recently we implemented the rel=”me”, rel=”author” and rel=”publisher” for LITFL and wrote about it at Google Author (Iliad version) and more simplistically at Google Author (Idiots guide)

There are myriad reasons why medical authors are encouraged to implement Google Authorship on their websites and blogs. One such reason is the ability to review author statistics within Google Webmaster tools (because you don’t get enough of that at work, right?)

To see your author statistics:

  • Go to google.com/webmasters and login with same username used for your G+ Profile.
  • On the left hand panel, open the ‘Labs’ section to reveal ‘Author Stats’
  • Author stats will show you analytics for the pages for which you are the verified author

Google Author Stats 2

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Is it really all about the glycocalyx?

Though Jeremy Cohen tried to hide it, I suspect his heart sunk just a little bit when we suggested he give a talk titled ‘Is it really all about the glycocalyx?’ at smaccGOLD.

This talk is the best explanation of the Revised Starling model and the role of the glycocalyx you are ever likely to come across. Furthermore, Jeremy puts these ideas into the context of our specialty’s key randomised control trials — including what we know about fluid resuscitation, ANP, albumin, antithrombin III and steroid administration in the critically ill.

Is this a must listen?

You bet.

Here is the audio (download the mp3 directly here):

To listen to all the smaccGOLD talks as they are released subscribe to the SMACC podcast on iTunes or the SMACC Libsyn feed.

Read Glycocalyx in Critical Illness from the LITFL CCC to learn more about the glycocalyx.

The post Is it really all about the glycocalyx? appeared first on LITFL.