The impact of diabetes on the pathogenesis of sepsis

Diabetes is associated with an increased susceptibility to infection and sepsis. Conflicting data exist on whether the mortality of patients with sepsis is influenced by the presence of diabetes, fuelling the ongoing debate on the benefit of tight glucose regulation in patients with sepsis. The main reason for which diabetes predisposes to infection appears to be abnormalities of the host response, particularly in neutrophil chemotaxis, adhesion and intracellular killing, defects that have been attributed to the effect of hyperglycaemia. There is also evidence for defects in humoral immunity, and this may play a larger role than previously recognised. We review the literature on the immune response in diabetes and its potential contribution to the pathogenesis of sepsis. In addition, the effect of diabetes treatment on the immune response is discussed, with specific reference to insulin, metformin, sulphonylureas and thiazolidinediones

Health Information Technology and Electronic Health Records in Neurologic Practice

The Tipping Point for Electronic Health Records (EHR) Has Been Reached and Universal Adoption in the United States is Now Inevitable. Neurologists Will Want to Choose their Electronic Health Record Prudently. Careful Selection, Contracting, Planning, and Training Are Essential to Successful Implementation. Neurologists Need to Examine their Workflow Carefully and Make Adjustments to Ensure that Efficiency is Increased. Neurologists Will Want to Achieve a Significant Return on Investment and Qualify for All Applicable Financial Incentives from Payers, Including CMS. EHRs Are Not Just Record-Keeping Tools But Play an Important Role in Quality Improvement, Evidence-Based Medicine, Pay for Performance, Patient Education, Bio-Surveillance, Data Warehousing, and Data Exchange. © 2010 Elsevier Inc. All Rights Reserved

How neurologists are paid: Part 3: Hospital support, Veterans Administration, and neurohospitalists

Part 1 of this series focused on factors influencing payment for patient care services and Part 2 described compensation plans for neurologists in private practice and in academic medicine. In Part 3, we review how hospital salary support and appointments to Veterans Administration hospitals contribute to the salary structure of neurologists. We also discuss neurohospitalist care and ways neurologists can potentially increase compensation from on-call pay, telemedicine, and the use of new transitional care and complex chronic care codes. We conclude with an emphasis on the important role of neurologists as team players in a health care system that will rely on efficient coordination of care among many health care workers

How neurologists are paid: Part 2: Private practice, research grants, academic and nonclinical activities

Part 1 of this series focused on factors influencing payment for patient care services. In Part 2, we review compensation models for nonpatient activity such as medical legal reviews, committee participation, and collaboration with the pharmaceutical industry. Compensation to neurologists in private practice is commonly in the form of guaranteed salary and bonuses. Salary for neurologists in academic medicine has changed considerably over the past 3 decades, from small departments with faculty supported by grants and volunteer faculty, to large departments with faculty split between those with research grant support and those focusing on patient care and teaching. Compensation models in academic medicine range from straight salary without bonus to straight salary with personal or shared bonus and salary based on relative value units

How neurologists are paid: Part 1: The Medicare payment system

Neurologists are facing yearly reductions in reimbursement for rendered services. These reductions arise from changes by Medicare, Medicaid, and third-party payers to achieve cost savings. In Part 1, we discuss reimbursement for office visits and procedures, the relative value scale, the conversion factor used by Medicare to transform work into payments, and the recently repealed sustainable growth rate. The establishment of new codes for transitional care and chronic care management may augment the salaries of neurologists who care for patients with chronic conditions. Medicare\u27s recent elimination of payment for consultations and the bundling of nerve conduction studies have dramatically affected reimbursement. Large discrepancies remain between compensation for procedures and office visits