Stories from Texas Medicine, February 2013

The Journal of Texas Medicine: February 2013 - 05/13/2016

Locked-in syndrome is a rare neuropsychological disorder. Its primary features are quadriplegia and paralysis of the cranial nerves except for those responsible for vertical eye movements. The differential diagnosis includes persistent vegetative state, brain death, minimally conscious states, C3 transection of the spinal cord, and conversion locked-in syndrome. Etiologies of locked-in syndrome include hemorrhagic and thrombotic events, tumors affecting the ventral pons, infectious agents, iatrogenic causes, trauma, metabolic abnormalities, and other miscellaneous causes. The clinical manifestations, differential diagnosis, neuropsychological assessment, rehabilitation, and prognosis of patients with locked-in syndrome are discussed.

Making Strides - 05/13/2016

Texas' health information exchanges (HIEs) are closer to being able to connect to one another locally and across state lines.

Healthy Priorities - 05/13/2016

The Texas Public Health Coalition consists of more than 20 organizations dedicated to advancing core public health principles at the state and community levels. The Texas Medical Association is a charter member. In December, the group unveiled its legislative priorities on immunizations, tobacco use, obesity, and cancer prevention for the 2013 session. Member organizations are focusing on some familiar territory – increasing the amount of required physical activity in Texas schools and supporting comprehensive statewide legislation that eliminates exposure to secondhand smoke in all indoor workplaces throughout Texas, for example.

Difficult Choices - 05/13/2016

Different circumstances bring different levels of complexity to end-of-life care decisions. Physicians must act in the best interest of the patient, but with the ethical responsibility of not doing any intentional harm. As end-of-life issues heat up again in Capitol debates, protecting physicians' ability to carry out that duty under the 1999 Texas Advance Directives Act is a key feature of legislation the Texas Medical Association developed in collaboration with the Texas Hospital Association, the Texas Catholic Conference, the Texas Alliance for Life, and other faith-based groups. The groups are also pushing for reforms they believe will improve transparency and communication for all parties affected by these decisions.

Closed Formulary, Part Two - 05/13/2016

Legislation to reduce overuse of pain medications and other addictive and expensive drugs within the workers' compensation program appears to be achieving that goal through stepped implementation of a closed formulary. With phase two of the process set to take effect this September, leaders at the Texas Medical Association and the Texas Department of Insurance Division of Workers' Compensation say physicians should prepare now for what could be the more challenging part of the transition. Under the closed formulary, mandated by the legislature in 2005, physicians must obtain preauthorization from workers' compensation insurance carriers before prescribing roughly 90 different medications. The so-called "N drugs" not in the formulary include mostly opioids, analgesics, muscle relaxants, and antidepressants. Until now, the preapproval process applied only to patients injured on or after Sept. 1, 2011. Starting on Sept. 1 this year, physicians also must obtain N-drug preauthorization for ...

Big Decision - 05/13/2016

During that Many young doctors begin their professional lives as employed physicians, then transition into full or part owners of a practice. Deciding between employment and solo practice is a big decision. Whatever the choice, it has to be done right.