--- title: October 31, 2024 Customer Newsletter description: Peanut Panic, ER Boarding Costs, Passwords Aren't Working, QUIZ QUESTION, Senators Probe Pharma Telehealth, PEMQBook Live Course image: https://challengercme.com/hs-fs/hubfs/cust%20nl.webp?width=1200&upscale=true&name=cust%20nl.webp --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/october-31-2024-customer-newsletter-0#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) # October 31, 2024 Customer Newsletter Peanut Panic, ER Boarding Costs, Passwords Aren't Working, QUIZ QUESTION, Senators Probe Pharma Telehealth, PEMQBook Live Course [ Challenger Corporation ](https://challengercme.com/blog/author/challenger-corporation) Oct 31, 2024 ### < [All Posts](https://challengercme.com/blog) Try Med-Challenger Start a free trial today and save! 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[BROWSE COURSES](https://fuse.challengercme.com/store) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/october-31-2024-customer-newsletter-0&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/october-31-2024-customer-newsletter-0&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/october-31-2024-customer-newsletter-0&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/october-31-2024-customer-newsletter-0&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![Newsletter 10/24/24](https://challengercme.com/hs-fs/hubfs/cust%20nl.webp?width=1200&upscale=true&name=cust%20nl.webp) - Passwords Aren't Working - Senators Probe Pharma Telehealth - PEMQBook Live Course Begins Soon - Rise of Peanut Panic - Cost of Boarding Patients in ED - QUIZ QUESTION! ![Untitled (63)](https://challengercme.com/hs-fs/hubfs/Untitled%20(63).png?width=4096&height=288&name=Untitled%20(63).png) ## Passwords in Healthcare: A Doctor’s Perspective on Why They Aren’t Working  Password systems are the easiest type of security to implement for programmers. Then, throw in two-factor authentication and an edict from healthcare IT to rotate to new passwords every 30 or 90 days, and you end up with password hell. It’s not all the programmers' fault—you’re plugging dozens of external services and outside databases into hospital systems. Single sign-on (SSO) brings its own problems. The Change Healthcare debacle that cost billions and leaked up to 210 million patient records to the internet occurred when a hacker used stolen credentials, most likely obtained by calling someone and telling them IT needed their password.  The cost is minutes every day, but millions of minutes collectively. However, that cost is spread out across millions of people. We do need better badge-token and biometric security structures for critical systems. [Passwords in Healthcare: A Doctor’s Perspective on Why They aren’t Working](https://www.healthcaredive.com/spons/passwords-in-healthcare-a-doctors-perspective-on-why-they-arent-working/729163/?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--7ytqX7QasLO6Rs-1k5sG0LCi81ADws7-X2AOXEuStUpWJ41Tg7V7EfPNmEw9pGN2sxg-k) - Healthcare Dive | ## [![fall divider](https://challengercme.com/hs-fs/hubfs/fall%20divider.png?upscale=true&upscale=true&width=1120&height=78&name=fall%20divider.png)![It’s not an emergency PEM SM](https://challengercme.com/hs-fs/hubfs/It%E2%80%99s%20not%20an%20emergency%20PEM%20SM.png?width=796&height=667&name=It%E2%80%99s%20not%20an%20emergency%20PEM%20SM.png)](https://challengercme.com/pediatric-emergency-medicine-live-course-3rd-edition?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--7ytqX7QasLO6Rs-1k5sG0LCi81ADws7-X2AOXEuStUpWJ41Tg7V7EfPNmEw9pGN2sxg-k) ![Untitled (40)](https://challengercme.com/hs-fs/hubfs/Newsletter%20-%20Customer%20Newsletter%20Graphics/Untitled%20(40).png?upscale=true&upscale=true&width=1120&height=78&name=Untitled%20(40).png)Lawmakers Seek Answers on Pfizer, Lilly Telehealth Moves The move by pharmaceutical manufacturers into telehealth and direct-to-consumer sales of prescription drugs has attracted the attention of US Senators - Elizabeth Warren, Bernie Sanders, Dick Durbin and Peter Welch.  Pfizer and Lilly are on the hot seat, but pretty much every large manufacturer is working some sort of direct-to-consumer play using telehealth services now.  From the looks of it, not much is going to come out of the inquiries - and they aren’t talking to Amazon, Walmart, Optum, Kroger or the dozens of others entering telehealth specifically for direct-to-consumer prescription sales. [Lawmakers Seek Answers on Pfizer, Lilly Telehealth Moves](https://pharmaphorum.com/news/lawmakers-seek-answers-pfizer-lilly-telehealth-moves?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--7ytqX7QasLO6Rs-1k5sG0LCi81ADws7-X2AOXEuStUpWJ41Tg7V7EfPNmEw9pGN2sxg-k) - Pharmaphorum ![fall divider2](https://challengercme.com/hs-fs/hubfs/fall%20divider2.png?upscale=true&upscale=true&width=1120&height=78&name=fall%20divider2.png) ## Excerpt from ‘Blind Spots’ by Marty Makary *The Harvard Gazette* has bravely stepped into the allergy fray. We salute them (*while hiding behind that tree way over there*). Dr. Marty Makary is a surgeon and professor at Johns Hopkins, with several books on healthcare systems and reform. His latest is *Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health.* This is an excerpt from a chapter on allergies and the history of their development. [Surgeon, Professor Marty Makary Examines Damage Wrought When Medicine Closes Ranks Around Inaccurate Dogma](https://news.harvard.edu/gazette/story/2024/10/excerpt-from-blind-spots-by-marty-makary/?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--7ytqX7QasLO6Rs-1k5sG0LCi81ADws7-X2AOXEuStUpWJ41Tg7V7EfPNmEw9pGN2sxg-k) - Harvard Gazette ![Untitled (13)](https://challengercme.com/hs-fs/hubfs/Newsletter%20-%20Customer%20Newsletter%20Graphics/Untitled%20(13).png?width=796&height=56&name=Untitled%20(13).png) ## Boarding Patients in Emergency Departments Nearly Doubles Daily Cost of Care, Study Finds A study with 25 patients in a stroke center isn’t large, but it aligns with other studies in Annals of Emergency Medicine and Academic Emergency Medicine showing that boarding significantly increases mortality rates, doubles healthcare costs, exacerbates staffing problems, and decreases care availability for all ED patients. Facility closures and patient rerouting, bed reductions as cost-cutting measures in hospitals, increased acuity due to primary care and specialist shortages, discharge delays, and post-acute care placement issues (such as a lack of skilled nursing and rehabilitation beds)—even poor maintenance and CNA staffing that causes delays in clearing rooms—all contribute to the problem. These are well-known issues, but investing in adequate inpatient staffing, infrastructure, equipment, and staff development doesn’t tend toward short-term ROI. The front end is all cost, with rewards only in long-term ROI and brand improvement. So far, most solutions have been limited to suggestions about penalties and additional paperwork to track boarding times. [Boarding Patients in Emergency Departments Nearly Doubles Daily Cost of Care, Study Finds](https://www.hmpgloballearningnetwork.com/site/emsworld/news/boarding-patients-emergency-departments-nearly-doubles-daily-cost-care-study?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--7ytqX7QasLO6Rs-1k5sG0LCi81ADws7-X2AOXEuStUpWJ41Tg7V7EfPNmEw9pGN2sxg-k) - EMS World ![Untitled (10)](https://challengercme.com/hs-fs/hubfs/Newsletter%20-%20Customer%20Newsletter%20Graphics/Untitled%20(10).png?width=2000&height=141&name=Untitled%20(10).png) ## [![quiz ad NL](https://challengercme.com/hs-fs/hubfs/quiz%20ad%20NL.png?width=940&height=788&name=quiz%20ad%20NL.png)](https://challengercme.com/blog/35-year-old-woman-presents-with-edema-stage-1-htn)QUIZ QUESTION ## 35-year-old woman presents with edema, stage 1 HTNA A 35-year-old woman presents with a history of type 2 diabetes and hypertension. Her blood pressure is 135/86 mm Hg. You note the presence of trace edema on both extremities. Urinalysis is positive for 2+ protein and no blood. You obtain urinalysis for a spot protein/creatinine ratio, which is 0.3 g/g (normal < 0.2 g/g). Her serum creatinine level is 0.6 mg/dL (normal range, 0.6-1.2).   Which of the following statements is correct? - She has stage 2 kidney disease. - She has stage 3 kidney disease. - She has stage 1 kidney disease. - She does not have kidney disease [![click here for answer](https://challengercme.com/hs-fs/hubfs/click%20here%20for%20answer.jpg?upscale=true&upscale=true&width=572&height=71&name=click%20here%20for%20answer.jpg)](https://challengercme.com/blog/35-year-old-woman-presents-with-edema-stage-1-htn?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--7ytqX7QasLO6Rs-1k5sG0LCi81ADws7-X2AOXEuStUpWJ41Tg7V7EfPNmEw9pGN2sxg-k) | | --- | [ Subscribe to Our Blog & Save 15% ](https://challengercme.com/blog) ## Similar posts Pediatric Medicine ### [#1 Missed in Pediatric Review - Idiopathic Intracranial Hypertension](https://challengercme.com/blog/1-missed-in-pediatric-review-idiopathic-intracranial-hypertension) Pediatric IIH: recognize papilledema, diagnostic clues, and ED management for children — concise review and practice question. Challenger Corporation Nov 12, 2025 emergency medicine ### [The Most Missed Question in EM Certification Prep This Week](https://challengercme.com/blog/the-most-missed-question-in-em-certification-prep-this-week021125) Most missed question in Emergency Medicine. Three rapidly life-threatening gynecologic emergencies that should be considered in every female of... Med-Challenger Feb 11, 2025 quick quiz ### [12-year-old boy complains of irritated skin near his auricles](https://challengercme.com/blog/12-year-old-boy-complains-of-irritated-skin-near-his-auricles) It's Dermatitis Quiz Time with Med-Challenger! . 12‑yo with periauricular irritated skin , exam-style case for pediatric NP/PA and resident board... Med-Challenger Dec 11, 2024 ## Stay informed. ### Subscribe to our [Medical Education Blog](https://challengercme.com/blog)  Stay informed of new medical education content, certification requirements and deadlines, case-based CME quizzes, and special offers. 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "password security in healthcare", "telehealth and direct-to-consumer prescriptions", "pharmaceutical industry oversight", "peanut allergy debate", "emergency department boarding and costs", "protein/creatinine ratio", "kidney disease screening", "medical education", "exam preparation", "CME", "PEMQBook" ], "articleSection" : "Medical Education Newsletter", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2024-10-31T21:27:52.449Z", "datePublished" : "2024-10-31T21:27:52.000Z", "description" : "Peanut Panic, ER Boarding Costs, Passwords Aren't Working, QUIZ QUESTION, Senators Probe Pharma Telehealth, PEMQBook Live Course", "headline" : "October 31, 2024 Customer Newsletter", "image" : [ { "@type" : "ImageObject", "description" : "cust nl", "url" : "https://challengercme.com/blog/october-31-2024-customer-newsletter-0#image1" }, { "@type" : "ImageObject", "description" : "Med-Challenger Medical Education, a Division of Challenger Corporation", "url" : "https://challengercme.com/blog/october-31-2024-customer-newsletter-0#image2" } ], "inLanguage" : "en-US", "keywords" : [ "Passwords", "telehealth", "Pfizer", "Lilly", "peanut panic", "ED boarding", "emergency department costs", "protein/creatinine ratio", "kidney disease quiz", "PEMQBook", "medical education", "question bank" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/october-31-2024-customer-newsletter-0", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Based on the values reported in the article, the patient’s spot protein/creatinine ratio (0.3 g/g) exceeds the article’s stated normal threshold (< 0.2 g/g), indicating proteinuria, while serum creatinine is within the reported normal range. The article text does not provide a definitive kidney-disease staging answer or chronicity criteria, so a final staging determination is not supplied in the article itself." }, "name" : "35-year-old woman with proteinuria: which statement is correct?", "text" : "A 35-year-old woman with type 2 diabetes and hypertension has blood pressure 135/86 mm Hg, trace bilateral edema, urinalysis positive for 2+ protein and no blood. Spot protein/creatinine ratio is 0.3 g/g (normal < 0.2 g/g). Serum creatinine is 0.6 mg/dL (normal range 0.6-1.2). Which of the following statements is correct? (A) She has stage 2 kidney disease. (B) She has stage 3 kidney disease. (C) She has stage 1 kidney disease. (D) She does not have kidney disease." } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "The article notes that password systems are easy to implement but become problematic when combined with two-factor rules, forced rotation, multiple external services, SSO complexity, and social-engineering attacks; the Change Healthcare breach is cited as an example where stolen credentials likely led to a large data leak." }, "name" : "Why are password systems described as 'not working' in healthcare?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Lawmakers are probing moves by major manufacturers (examples given: Pfizer and Lilly) into telehealth and direct-to-consumer prescription sales, raising oversight questions about how pharmaceutical companies use telehealth channels." }, "name" : "What concern do US Senators have about pharmaceutical companies entering telehealth?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "The article summarizes research showing boarding increases daily cost of care (nearly doubles in the cited study), aligns with other studies linking boarding to increased mortality, worsened staffing problems, reduced care availability, and is driven by factors such as facility closures, bed reductions, discharge delays, and post-acute placement shortages." }, "name" : "What impacts of boarding patients in emergency departments does the article highlight?" }, "position" : 3 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "The patient’s spot protein/creatinine ratio is 0.3 g/g, which the article specifies is above the cited normal threshold (< 0.2 g/g), indicating proteinuria, while serum creatinine is within the reported normal range; the article does not provide a definitive stage assignment." }, "name" : "Interpret the provided spot protein/creatinine ratio for the quiz patient." }, "position" : 4 } ], "name" : "Practice Questions", "numberOfItems" : 4 } ```