There are multiple definitions for a mass shooting. Some definitions require a certain number of people be killed. Some definitions require a certain number of people be shot. Some definitions do not include gang violence. Regardless of the definition used, the number of mass shootings in the United States is increasing.
There are also multiple definitions of what qualifies as a medical disaster. These definitions can be summarized with the statement that a medical disaster is an event that produces a number of casualties that overwhelms the local health system.
Most mass shootings fit the definition of a medical disaster. When a mass shooting occurs, medical resources are diverted from current patients to those injured in the shooting. Patients with acute medical problems unrelated to the shooting must endure a prolonged wait for medical care.
The CHEST Disaster Response NetWork feels that it is necessary to take action to reduce the number of mass shootings. Unlike natural disasters, mass shootings are man-made. As such, we should proactively work to prevent them. Prevention is a large part of medicine. Working together with community leaders, law enforcement, and government officials, we can and should work to eliminate mass shootings so that we can minimize gun-related injury and death.
MACRA: Reincarnation of Medicare physician reimbursement model
In April 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) eradicating the detested sustainable growth rate (SGR) formula. If this is your first dive into MACRA as an eligible professional (EP), it may be a bit baffling trying to understand its impact on your practice.
Under MIPS, rules are divided into four categories. During the first year, each category will make up a certain percentage to the physician’s overall score, which will result in a penalty or payment as a lump sum in 2019. If you are an Advanced APM in 2017 and receive 25% of Medicare payments or see 20% of your Medicare patients through this model, you can earn up to a 5% incentive payment in 2019.
The performance period started on January 1, 2017. Submission of performance data is due by March 31, 2018. MACRA is complicated and here to stay. Learn and educate yourself to avoid downward payment adjustment. For full details, please visit.
2. CMS MACRA Executive Summary. https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf
3. American Medical Association. http://bit.ly/1miEtBD
Frailty in lung transplantation
Two of the greatest challenges in lung transplantation are to identify optimal transplant candidates and to help those transplant recipients thrive in the years following surgery. Frailty is emerging as a marker of increased posttransplant morbidity and may represent an area where both the recipient selection process and posttransplant outcomes can be optimized. Described by some as “biologic age” rather than “chronologic age,” frailty is a syndrome of functional impairment and weakness that predisposes to adverse health outcomes. The adverse effects of frailty have been described in multiple clinical scenarios, including the ICU, chronic lung diseases, heart failure, liver transplant, kidney transplant, geriatrics, and others.
Remaining challenges include determining which clinical assessments best define frailty in the lung transplant population, documenting the adverse effects of frailty in well-designed multicenter prospective studies, and developing interventions to mitigate the adverse effects of frailty.
Asthma treatment during pregnancy
Asthma is common in pregnancy, occurring in 3% to 8% of pregnant women. While the course of asthma during pregnancy is variable, the objectives of asthma treatment do not change and aim to prevent acute exacerbations and optimize management. Uncontrolled asthma is associated with an increased risk of perinatal morbidity. Published guidelines on pharmacologic therapies during pregnancy recommend the same step-wise approach as in nonpregnant women.
The diagnosis of asthma, the use of other concurrent medications, and medication compliance may all be potential confounders. ICS use in pregnancy was associated with endocrine and metabolic disturbances in the offspring in a national cohort (Tegethoff M et al. Am J Respir Crit Care Med. 2012;185:557-63). However, this study did not report on systemic steroid use, asthma severity, or details of these disturbances.