Inpatient Utilization Rates and Healthcare Expenditure May Be Declining for Medicare Recipients

A recently published article in JAMA reports decreasing all-cause mortality, hospitalization rates, and healthcare expenditures for Medicare beneficiaries. The group of Yale researchers analyzed a cohort of 68, 374, 904 unique beneficiaries between 1999 and 2013. All-cause mortality fell from 5.30% to 4.45% . Among fee-for-service enrollees, the total number of hospitalizations per 100 000 person-years, including those in the last 6 months of life, decreased from 35, 274 to 26, 930. Mean inpatient expenditures per Medicare fee-for-service beneficiary (adjusted for inflation) decreased from  $3,290 to $2,801. Possible explanations for these trends include improvements in lifestyle, lifetime healthcare exposure, medical technology and transitional care. Taken together, it is encouraging to see decreased healthcare utilization/expenditure with improved mortality in spite of the rapidly aging population.

Tiny Meals: Americans are Finally Cutting Back #GetFit

With the obesity rates rising over the past few decades, there has been increased interest in reducing the caloric intake for the average American. Recently, the National Health and Nutrition Examination Survey examined this trend and found that caloric consumption was in its first stage of sustained decline in 40 years when the government first began tracking the subject. Where were these cutbacks made? It appears that full-calorie soda consumption is down 25% since the 1990s. There seems to be increased public awareness of the adverse effects of obesity and overeating. A number of these changes appear to be consumer driven as diet sodas and flavored waters are flying off the shelves. It also seems to be making a difference – obesity rates have stopped rising for adults and children, and the rates are actually declining for the youngest of children. The battle of the bulge is not close to being over, however, as at least a third of Americans are obese and two thirds considered overweight leading to a predisposition for heart disease, diabetes, and cancer. Fruit and vegetable consumption still is considered poor and dessert consumption remains high but overall it appears portion sizes are decreasing.  Continue reading Tiny Meals: Americans are Finally Cutting Back #GetFit

Dr. Carlos Girod Selected for the 2015 Watson Award

Our very own Dr. Carlos Girod has been selected as the 2015 recipient of the Patricia and William L. Watson, Jr., M.D. Award for Excellence in Clinical Medicine. This award was established in 2009 and recognizes a faculty physician who exemplifies excellence in clinical care. Dr. Girod is highly regarded by faculty, housetaff and patients alike. He is well known for his extraordinary clinical expertise, management skills and exemplary commitment to Parkland. Please join me in commending Dr. Girod on this prestigious honor.

Case Challenge #1 Answer


Earlier this week we presented a case of a young healthy woman presenting with acute onset delirium, autonomic instability and CSF pleocytosis.

Here’s how you all answered.


Looks like this was a pretty difficult question! The correct answer is…

Anti-N-methyl-D-aspartate receptor antibodies

That was a tough one! Most of you were thrown off by the freshwater swimming and picked Naegleriasis. Lets examine the answer choices:

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Physician Assistance in Dying: The American Experience

Assistant Program Director and Palliative Care guru Dr. Elizabeth Paulk gave an insightful Grand Rounds Lecture today about the history and ethics of physician assisted death (PAD) in this country. She talked in depth about the 1997 Oregon Death with Dignity Act and showed data about the types of patients who seek physician assistance in dying. She highlighted the case of Brittany Maynard, a 29 year old woman with glioblastoma multiforme who became an outspoken advocate for PAD and died by choice in 2014 after moving to Oregon. The Maynard case thrust the issue of PAD into the national spotlight and a 2015 Gallup poll showed an increasingly favorable public perception of  PAD with 68% of Americans in favor. Physician assisted death is currently legal in Oregon, Washington, Montana, New Mexico and Vermont. Read more about the controversy and data surrounding PAD and about Brittany Maynard here and here. See Dr. Paulk’s slides for more information about this morally and legally complicated issue.


Paulk Grand Rounds slides

 Photo courtesy of

As New Medical Schools Come Online, A Concern Rises About Availability Of Texas Residency Slots

Last week, Dallas Magazine published a well researched article profiling the deficit number of residency slots in Texas. Although this problem is national, Texas’ physician shortage (45th in the nation for physicians per capita) and rapidly expanding medical student population have amplified the issue. As of 2013, there were a total of 1,611 residency slots for 1,587 medical school graduates state wide. To achieve the desired 1.1:1 ratio of residency positions to graduates, recommended by the Liaison Committee on Medical Education, Texas will need to add an estimated 589 residency slots by 2022. With federal GME funding fixed for the last 18 years, the state has legislated $60 million to create approximately 125 new GME positions. With new medical schools opening in Austin, the Rio Grande Valley and Fort Worth, this funding is unlikely to be sufficient but any backing from the state legislature is encouraging. This article poses interesting questions regarding the future of graduate medical education at UT Southwestern and Texas as a whole. It’s certainly worth a read.

Groundbreaking New HIV Studies Encouraging HAART for All

While initiation of  Anti-Retroviral Therapy (ART) in patients with CD4 counts less than 350 has been generally accepted as standard of care for most patients with HIV, there has been little consensus or data on outcomes when therapy is initiated at higher CD4 counts. Two groundbreaking studies in HIV, START and TEMPRANO, were recently presented at the International AIDS Society 2015 meeting and released online at the New England Journal of Medicine. The TEMPRANO study group assessed risk of death and HIV-related illness with early (CD4 >500) vs. deferred ART in sub-Saharan African subjects and found reduction in both endpoints. The INSIGHT START study group also found that the initiation of ART in HIV+ adults with a CD4+ count > 500 provided net benefit. The results from these two studies will change the game in terms of recommending ART for all HIV + persons regardless of CD4 count across the world.

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Case Challenge #1


A 27-year-old woman presents with sudden onset agitation and delirium. In the emergency department, she has incoherent speech and lashes out violently at staff. She is initially febrile (38.7ºC). She is admitted to the ICU for observation and after two days is intubated for deteriorating mental status. Prior to intubation, she is noted to have labile blood pressure alternating between hypertension and hypotension.

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Demystifying ILD #AMreport

This morning we discussed a case of Hypersensitivity Pneumonitis which spurred a review of the oft-confusing spectrum of interstitial lung diseases. During our discussion, Dr. Kazi referred to an excellent review of radiographic and clinical features entitled, “What Every Radiologist Should Know about Idiopathic Interstitial Pneumonias.” This article offers an easy to visualize review of distinguishing clinical features of the various forms of ILD as well as predominating radiographic features.

Continue reading Demystifying ILD #AMreport