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This page shows you the most recent publications within this specialty of the MedWorm directory. This is page number 3.

Funtabulously Frivolous Friday Five 119
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 119 Question 1 Which surgeon had a mortality rate of 300% during a single operation? How did this happen? + Reveal the Funtabulous Answer expand(document.getElementById('ddet109074172'));expand(document.getElementById('ddetlink109074172')) Robert Liston (1794-1847) Liston operated in a time before anaesthesia. It was recognised that a speedy operation could significantly improve the outcomes for a patient, and Mr Liston w...
Source: Life in the Fast Lane - October 2, 2015 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five capecitabine ciguatera FFFF louis pasteur Oncology rabies robert liston virchow Source Type: blogs

Tap that Knee! Basics of Arthrocentesis
Part 2 of a Series   Our series on joint care has given you a basic overview on knee arthrocentesis. Typically, it is not necessary to have an orthopedic consultant come to the bedside in the emergency department to do this procedure. Arthrocentesis is a procedure you can do well and feel confident about your technique.   Take a moment to review our last blog post on knee pain before reading this post and watching the accompanying video. (http://bit.ly/1Q7dG4h.) As always, review the anatomy; it plays a key part in successful bedside technique. Ultrasound-guided arthrocentesis is always a favored approach.   Although em...
Source: The Procedural Pause - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research & Reviews in the Fastlane 102
This study reviewed data from over 30,000 OHCA and found that the initiation of early CPR (prior to EMS arrival) was associated with increased 30-day survival (10.5% vs. 4.0%). Unfortunately, the database has only limited information on neurologic function and thus, improved functional status cannot be assessed from this data set. However, this study further supports the need for increased lay person training as well as methods of bringing those lay providers to the patient (i.e. GoodSam application, mobile phone programs etc). Recommended by Anand Swaminathan Trauma Reith G et al. Injury pattern, outcome and characteri...
Source: Life in the Fast Lane - October 1, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Education Emergency Medicine Emergency Medicine Update Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Review Toxicology Trauma critical care literature research and reviews Source Type: blogs

America’s Nursing Crisis
By SUSAN DENTZER Many of the nation’s nurses understandably erupted in anger when the co-hosts of ABC’s The View mocked Miss America contestant Kelley Johnson for her pageant-night monologue about being a nurse — and for wearing scrubs and a “doctor’s stethoscope” (their words) in the talent competition. The co-hosts, Joy Behar and Michelle Collins, have since apologized, especially for implying that only doctors use stethoscopes. “I didn’t know what the hell I was talking about,” Behar later said. It would be easy to attribute this episode solely to the ignorance of some TV pers...
Source: The Health Care Blog - September 26, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB National Academy of Medicine Nursing Practice Programs Professional Rivalries Robert Wood Johnson Foundation Susan Dentzer Source Type: blogs

The 21st Century Cures Act: More Homework To Do
In July, the US House of Representatives approved the 21st Century Cures Act, which heads to the Senate for a vote this fall. While no one can complain about the Act’s purported goal of “bring[ing] our health care innovation infrastructure into the 21st Century,” or increasing funding for the National Institutes of Health, the optimism surrounding the legislation obscures measures buried within that many agree will make newly approved drugs and medical devices less safe and effective, increase the cost of medical products, and discourage innovation in biomedical research. Long-term value to the public’s health is b...
Source: Health Affairs Blog - September 24, 2015 Category: Health Management Authors: Susan Molchan, James Rickert and John Powers Tags: Costs and Spending Drugs and Medical Technology Featured Health Professionals Hospitals Public Health Quality 21st Century Cures Act Big Pharma Drug approval Fred Upton Research funding Thurgood Marshall Source Type: blogs

Maintenance of Certification: American Board of Anesthesiology Ends 10-Year Exam; ABIM Considers New Continuous Testing Model As Well
Recently, the American Board of Anesthesiology (ABA) announced it will become the first medical board to restructure its Maintenance of Certification (MOC) program. The Maintenance of Certification in Anesthesiology Program, or MOCA, has required physicians to take a recertification test every 10 years. It will be replaced by a program known as “MOCA 2.0,” which will allow anesthesiologists to continuously assess themselves and identify knowledge gaps through an online portal, including a "MOCA Minute" that allows physicians to answer multiple-choice questions at their own convenience. This shift is noteworthy because ...
Source: Policy and Medicine - September 21, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

The human cost of breast cancer screening
This article originally appeared in Forbes. Image credit: Shutterstock.com Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 19, 2015 Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs

Research and Reviews in the Fastlane 100
This study, using skin tests, found that 0 out of 211 patients demonstrated cross-reactivity between penicillin and aztreonam. The authors recommend skin testing prior to administration and skin testing isn’t a perfect surrogate for a systemic reaction upon IV administration but the best evidence we have shows that cross-reactivity is highly unlikely. Recommended by: Anand Swaminathan Pediatrics Park G et al. Randomized single-blinded clinical trial on effects of nursery songs for infants and young children’s anxiety before and during head computed tomography. Am J Emerg Med. 2015. PMID: 26314215 This RCT randomi...
Source: Life in the Fast Lane - September 17, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Education Emergency Medicine Emergency Medicine Update Haematology Immunology Infectious Disease Intensive Care Palliative care Pediatrics R&R in the FASTLANE critical care literature recommendations research and r Source Type: blogs

Promising news from ABIM
Discussion of Changes to ABIM Certification and MOC Here is the short story: Key recommendations from the report include: Change the MOC exam. The Task Force recommends replacing the 10-year MOC exam with more meaningful, less burdensome assessments. Focus assessments on cognitive and technical skills. Assessment of cognitive skills assures the public that physicians are staying current with the clinical knowledge relevant to patient care. Assessment of technical skills ensures that physicians can apply that knowledge to adequately perform the technical procedures appropriate to the discipline. Recognize specialization. Th...
Source: DB's Medical Rants - September 16, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

8th Annual Pediatric Bioethics Conference
Discussion: Ethical Issues Surrounding Childhood Immunizations  Bruce McIntosh, MD   Co-Interim Statewide Child Protection Team Medical Director  Ray Moseley, PhD Bioethics, Law and Medical Professionalism; Director, CTSI Academy of Research Excellence, University of Florida College of Medicine, Gainesville  Samir Midani, MD  Nemours Children’s Specialty Care, Infectious Disease CME Accreditation Statement (CMEs): (Source: blog.bioethics.net)
Source: blog.bioethics.net - September 16, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

What to say when medical certainty is elusive
Doctors do not know everything. We make mistakes and mistakes in judgment. Sometimes we make the mistake of speaking when we should keep silent. At times, patients ask us questions that we can’t or shouldn’t answer; and yet we do. It shouldn’t be our objective to force certainly into an issue that is amorphous and murky. Here’s a response that I recommend in situations where certainty is elusive. “I don’t know.” I saw a patient for the first time when he was sent to me for a colonoscopy. Prior to the procedure, we interviewed him to be acquainted with his medical history. We are always particularly interested...
Source: Kevin, M.D. - Medical Weblog - September 15, 2015 Category: Journals (General) Authors: Tags: Physician Cancer GI Source Type: blogs

Wisdom versus knowledge for practicing internists
I have given my Learning How to Think like a Clinician several times recently. Each time physicians in the audience seem to particularly like one line that I use – Wisdom trumps Knowledge. In 2015, we all have rapid access to information. My team regularly uses smartphones, pads or computers to get precise information while on rounds. We cannot remember everything. More important than knowing is knowing what information we need. In our 2014 Annals of Internal Medicine editorial we called for a formative rather than summative process. A formative process describes a process in which the learner gets frequent feedback ...
Source: DB's Medical Rants - September 15, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Penalized for "On-Label" Marketing? In Wake of Amarin, Pacira Files First Amendment Complaint Against FDA
Last week, Pacira Pharmaceuticals, Inc. filed a lawsuit against the Food and Drug Administration (FDA) seeking to establish its right to provide truthful and non-misleading information to doctors about its anesthetic product, Exparel. This case follows last month’s decision in Amarin v. FDA, in which the Southern District of New York held that, under the First Amendment, FDA could not restrict Amarin Pharma’s ability to promote truthful non-misleading off-label information about Vascepa. Pacira's case brings a number of interesting facts to the table that have the potential to further shape how FDA regulates promotion ...
Source: Policy and Medicine - September 14, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Now is the time for acute pain medicine specialists
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Since September is Pain Awareness Month, it’s time to recognize that not all pain is equal. Chronic pain can be alleviated, but “acute” pain (sudden onset, brief in duration, often with an identifiable cause) must be eliminated. This requires a systems-based approach led by physicians dedicated to understanding the physiological processes associated with acute pain and investigating new ways to treat it. The solution is definitely not to give patients more and more opioids. As our understanding of pain mechanisms has ...
Source: Kevin, M.D. - Medical Weblog - September 13, 2015 Category: Journals (General) Authors: Tags: Conditions Pain management Source Type: blogs

The AMA’s Forgotten Fight Against Physician Greed
By MICHAEL MILLENSON Perhaps the most well-known part of the 1965 Medicare creation tale is the opposition by the American Medical Association (AMA) to “socialized medicine.” Yet with financial incentives assuming a new prominence for provider and patient alike, we shouldn’t overlook the AMA’s equally unsuccessful battle against the excesses of capitalistic medicine. The forgotten story of the professionalism’s failure to contain physician greed provides an important policy perspective. The Myth Of Medicine’s ‘Golden Age’ Medical practice pre-1965 is often portrayed as a mythical “Golden Age.” The truth...
Source: The Health Care Blog - September 10, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Medicare, Fair Pay, And The AMA: The Forgotten History
Perhaps the most well-known part of the 1965 Medicare creation tale is the opposition by the American Medical Association (AMA) to “socialized medicine.” Yet with financial incentives assuming a new prominence for provider and patient alike, we shouldn’t overlook the AMA’s equally unsuccessful battle against the excesses of capitalistic medicine. The forgotten story of professionalism’s failure to contain physician greed provides an important policy perspective. The Myth Of Medicine’s ‘Golden Age’ Medical practice pre-1965 is often portrayed as a mythical “Golden Age.” The truth, as I found researching ...
Source: Health Affairs Blog - September 10, 2015 Category: Health Management Authors: Michael Millenson Tags: Costs and Spending Health Professionals Hospitals Medicaid and CHIP Medicare Payment Policy Quality Affordable Care Act American Medical Association George H.W. Bush Kenneth Arrow Physicians Richard Nixon socialized medicine Source Type: blogs

Research and Reviews in the Fastlane 099
This study took a sample from healthy pregnant patients (n=760) at different stages of gestation. They found, unsurprisingly, that d-dimer increases with gestational age, congruent with limited prior literature. They propose a continuous increasing d-dimer in pregnancy. With PE experts such as Dr. Kline proposing gestation adjusted d-dimer, this is a research space to watch. Recommended by: Lauren Westafer Systems and administration Del Portal DA, et al. Impact of an Opioid Prescribing Guideline in the Acute Care Setting. J Emerg Med 2015. PMID: 26281819 As many EDs implement voluntary opioid prescribing guidelines, this...
Source: Life in the Fast Lane - September 9, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Wanted: Pharmacology, Physiology, and Biological Chemistry Division Director
Search Committee Members: Helen Sunshine, National Institute of General Medical Sciences, Chair René Etcheberrigaray, Center for Scientific Review Irene Glowinski, National Institute of Allergy and Infectious Diseases Sherry Mills, Office of Extramural Research, NIH Philip Cole, Johns Hopkins University School of Medicine Judith James, University of Oklahoma Health Sciences Center Scott Miller, Yale University With the recent retirement of Dr. Michael Rogers, the search is now open for an outstanding individual to serve as director of our Division of Pharmacology, Physiology, and Biological Chemistry (PPBC). This positio...
Source: NIGMS Feedback Loop Blog - National Institute of General Medical Sciences - September 8, 2015 Category: Biomedical Science Authors: Monique Hall Tags: Job Announcements Source Type: blogs

Perfect Job, perfect specialty??
I remember how difficult it was for me to choose a specialty. Initially (as in before medical school), I wanted to be a dermatologist. I loved cosmetics and hair products, and as a college student I thought I'd go into some sort of 'beautifying' medical specialty.Once in medical school they forced upon us that primary care crap tried to encourage us to consider careers in primary care. And I did...seriously. I really, really liked the idea of family practice. The doctor that sees the entire family, and watch the kids grow up, and have continuity of care, and keep the family healthy, yadda yadda yadda.Then, I started having...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs

You can easily become the physician that you judge
A recent paper in the Annals of Internal Medicine has sparked a large media response. In it, two incidents are described: In one, a male OB/GYN is prepping a patient’s vaginal area for surgery, which involves running a brush soaked in Betadine or ChloraPrep solution over the labia, mons pubis, perineum, and inner thighs when the patient is already put to sleep by anesthesia.  He makes an appalling joke, “I bet she is enjoying this.” In the second, another male OB/GYN resident runs into a room with a patient bleeding to death from her vagina.  He controls the bleeding with manual pressure, putting his ...
Source: Kevin, M.D. - Medical Weblog - September 8, 2015 Category: Journals (General) Authors: Tags: Physician OB/GYN Source Type: blogs

Infant Dies Following 5 Vaccine Doses
Life after losing a loved one to vaccines is very painful. With a heavy heart, we share Sebastian Ryan Morley’s story. He was a healthy boy whose life ended after routine vaccinations. Sebastian’s mother and grandmother have worked many years in both the veterinary and human healthcare fields. What they were taught in school led them to believe vaccines were safe, but now they will never vaccinate again. We thank his family for coming forward and sharing very important information the public isn’t usually made aware of. Sebastian’s grandmother, Valerie Murfin, shared: “On December 11, 2002, when my grandson Sebas...
Source: vactruth.com - September 5, 2015 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Augustina Ursino Human Top Stories adverse reactions dtap Hepatitis B vaccine Sebastian Ryan Morley truth about vaccines Vaccine Death vaccine injury VAERS Valerie Murfin Source Type: blogs

“Our Family Secrets” Exposed — The Ethics of Whistleblowing
This week the Annals of Internal Medicine published an article so controversial they felt the need to publish an accompanying editorial, explaining their decision to publish the anonymous article. The article, “Our Family Secrets” describes two experiences where a health care provider has acted inappropriately while patients were under anesthesia. The editorial describes the acts with poignant alarm: “The first incident reeked of misogyny and... // Read More » (Source: blog.bioethics.net)
Source: blog.bioethics.net - August 29, 2015 Category: Medical Ethics Authors: Sarah Sawicki Tags: Health Care bioethics Culture / Ethnicity / Gender / Disability Ethical Method / Grounding Health Care Practice syndicated Source Type: blogs

What Should Public Health Officials Be Doing About E-Cigarettes?
Are electronic cigarettes a safer alternative to combustible cigarettes, or are they a new gateway to a lifetime of nicotine addiction? In the past month, the editors of The New York Times noted the opposite conclusions from the British agency Public Health England that reported e-cigarettes can reduce the health risks of smoking by 95 percent, compared to a study in the Journal of the American Medical Association, which showed that ninth graders who tried e-cigarettes were far more likely to then use regular combustible tobacco within a year. In a step that may help resolve this controversy, the Food and Drug Administrati...
Source: Health Affairs Blog - August 27, 2015 Category: Health Management Authors: John Maa Tags: Costs and Spending Drugs and Medical Technology Featured Global Health Population Health Public Health Children e-cigarettes FAA FDA Prevention Smoking tobacco vaping Source Type: blogs

The Real Dark Side of Health Care: Health Care Corruption
The editors of the prestigious Annals of Internal Medicine just stated they they were shocked, shocked to find out that physicians occasionally express disrespect for patients when the patients cannot hear or see them.  The occasion was an editorial signed by three editors whose title included the phrase, "shining a light on the dark side of health care."(1)  The editorial referred to an anonymous narrative that recounted two incidents from the past.(2)Two Alleged Incidents of Physicians' Expression of Disrespect for Patients The first incident, discussed second hand, was of a obstetrician who made a sexist comme...
Source: Health Care Renewal - August 25, 2015 Category: Health Management Tags: anechoic effect Annals of Internal Medicine health care corruption medical journals professionalism Source Type: blogs

Maybe health costs should be a quality measure
How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for good care: How much is the bill? 15 years ago, I took care of Melissa for gallbladder cancer. She received surgery, radiation and has been in remission ever since. In fact, because she has no need of a grouchy oncologist, I have not seen her in years. Melissa works full ...
Source: Kevin, M.D. - Medical Weblog - August 25, 2015 Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs

The "Dark Side" of Medical Education?
It is rare that a medical journal would publish an essay by a physician anonymously which describes the "dark side of medicine" and perhaps including the "dark side" of medical education.  The article is in the August 18 2015 issue of the Annals of Internal Medicine and in an editorial  in the same issue, the following:We hope that medical educators and others will use this essay as a jumping-off point for discussions that explore the reasons why physicians sometimes behave badly and brainstorm strategies for handling these ugly situations in real time. By shining a light on this dark side of the profes...
Source: blog.bioethics.net - August 24, 2015 Category: Medical Ethics Authors: Maurice Bernstein, M.D. Tags: Health Care syndicated Source Type: blogs

How Stanford Med Got “Work-Life Balance” Wrong
By KAREN SIBERT, MD Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”? Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white? Every day, I go to work and see the example of the nurses and technicians who work right alongside me in tough thoracic surgery cases. Zanetta, for instance, is the single mother of five children. She leaves her 12-hour shift at 7 p.m. and then faces...
Source: The Health Care Blog - August 24, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Karen Sibert Stanford Medicine Workplace Wellness Source Type: blogs

Research and Reviews in the Fastlane 096
This study assessed the speed and accuracy of medication administration in simulated pediatric resuscitations. 10 teams consisting of physicians and nurses participated in a cross over study, so that they did one simulation with the new syringes and one without. Time to delivery of medications was quicker with the new syringes (47 versus 19 seconds, a difference of 27 seconds; 95%CI 21-33 seconds). Teams were also more accurate using the new color-coded syringes, with dosing errors occurring 17% of the time with the conventional approach and 0% of the time with the new syringes (absolute difference 17%; 95% CI 4-30%). Obvi...
Source: Life in the Fast Lane - August 20, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma EBM Intensive Care literature R&R in the FASTLANE recommendations research and reviews Respiratory urology Wilderness Medicine Tagg Source Type: blogs

The most feared medical specialty? It’s actually one of the safest.
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I often hear patients say, “I am not afraid of the surgery, just the anesthesia.” But should patients worry?   Physician anesthesiologists suffered a crisis in confidence in 1982 when the ABC television program 20/20 aired, “The Deep Sleep:  6,000 Will Die or Suffer Brain Damage,” about anesthesia complications, brain injury, and death.  At that time, physician anesthesiologists were having difficulty obtaining malpractice insurance because, although anesthesia claims were not the most frequent, they were the most costly du...
Source: Kevin, M.D. - Medical Weblog - August 18, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Patients can spot the fake: They need the authentic
“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” – Albert Einstein “Miracles happen every day; change your perception of what a miracle is, and you’ll see them all around you.” — Jon Bon Jovi “The miracle is this: The more we share, the more we have.” — Leonard Nimoy It is amazing when things in medicine work just the way they are supposed to —  it’s like a miracle. When I take an antihistamine, I can breathe, and all the itching and sneezing stops. When I get an injection of local anesthetic, I can touch a...
Source: Kevin, M.D. - Medical Weblog - August 16, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Harnessing Big Data – MedTech Innovation that Segments Patients According to Need
A recent interview with Battelle researchers David Giles and Stephanie Kute proves that big data is here to stay. An incredible amount of innovation is happening in the world of medical devices as technology improves, growing increasingly smarter and recording more information about its users. This innovation raises a few new questions: how can we utilize new technology to be most effective, and how can we ensure that private information is kept secure? Stephanie Kute, platform lead for the Battelle analytics and health research team, spoke to MassDevice about Battelle’s strategies in the rapidly-changing world of big da...
Source: Disruptive Women in Health Care - August 5, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Innovation Patients Source Type: blogs

Report on Incorrect DNR Order from Veterans Affairs Inspector General
In October 2014, I blogged about the case of Roland Mayo.  A California VA facility had erroneously placed a DNR order on him. A few days ago, the Department of Veterans Affairs Office of Inspector General released a new report titled "Healthcare Inspection: Delay in Emergency Airway Management and Concerns about Support for Nurses VA Northern California Health Care System Mather, California." The OIG found:Facility staff did not follow through on the patient’s request upon admission to discuss advance directives. We found no evidence of advance care planning discussion during the patient’s hospital s...
Source: blog.bioethics.net - August 4, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

Evaluation of a continuous monitoring and feedback initiative to improve quality of anaesthetic care: a mixed-methods quasi-experimental study
This study evaluated the impact of a continuous quality monitoring and feedback initiative in anaesthesia. The results support the potential of quality monitoring and feedback interventions as quality improvement mechanisms and provide insight into the positive response of clinicians to this type of initiative, including documentation of the experiences of anaesthetists that participated as users and codesigners of the feedback. Report Summary Abstract (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - August 4, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Patient involvement, experience and feedback Quality of care and clinical outcomes Source Type: blogs

Solving the Problem of Delivering Oxygen during Needle Cricothyroidotomy
BY RICAURTE A. SOLIS, DO   When faced with a "can't intubate, can't oxygenate" crisis, the decision to move to a surgical airway must be made rapidly and deliberately. A surgical cricothyroidotomy is debatably the better approach in these situations, but a needle cricothyroidotomy may sometimes be indicated. It may be easier to perform in a very small child, for example, and although it is probably less than ideal in an adult, a rapid needle cricothyroidotomy may provide an oxygenation bridge that will prevent a critically hypoxic patient from arresting until a more definitive airway is secured.   Cricothyroido...
Source: M2E Too! Mellick's Multimedia EduBlog - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Procedure’s Impact on Patient Comfort, Care, and Outcome
This blog teaches procedures, with its case studies and videos intended to help you perfect your technique and strengthen your confidence. This month we explore issues related to procedural patient impact. How will your intervention positively or negatively affect patient outcome? What happens when we decide to step in and complete a procedure?   A risk is always inherent when a provider undertakes a procedure, no matter how insignificant. Carefully, we weigh the pros and cons of the potential procedure with our patients. Will our intervention cause a positive effect or outcome? Our goals are to repair, resolve, or restor...
Source: The Procedural Pause - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Young physicians must take a leadership role. Here’s why.
My young patient was dying as a blood clot under the cover of her brain accumulated and began compressing the fragile tissue within her skull. She needed surgery to remove the clot that would save her life. As the team pushed her from CT scanner to the operating room, it was soon realized labs were missing and were needed before opening her cranium. “There’s no order in the computer!” someone shouted out.  As I pushed the patient into the operating room, what was I supposed to do at that critical moment? Drop what I was doing and find a computer to enter the order or continue in trying to save her life? The world of...
Source: Kevin, M.D. - Medical Weblog - August 2, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Rise of the Machines
By SHIRIE LENG, MD “We are convinced the machine can do better than human anesthesiologists.” This statement was made by a doctor. Not only a doctor but an anesthesiologist. Not just an anesthesiologist but a pediatric anesthesiologist. Not just any old pediatric anesthesiologist but one in charge of pediatric anesthesia research at the University of British Columbia medical school in Vancouver. One can only assume that this guy has a pretty low estimation of what his colleagues can do. Must make for great break room conversation. The doctor making this statement, one JM Ansermino, is co-creator of a new automated ...
Source: The Health Care Blog - July 31, 2015 Category: Consumer Health News Authors: suchandan roy Tags: THCB Shirie Leng Source Type: blogs

Research and Reviews in the Fastlane 093
This study of 50 volunteers suggests that three commonly taught methods for finding the cricothyroid membrane (general palpation, four-finger, skin crease) are relatively inaccurate, using ultrasonography as the gold standard. I conclude:1. The landmark techniques are inaccurate for finding the CTM *and that’s okay.* Make your best guess using general palpation and if you feel nothing, use four-finger or skin crease **and then make a long vertical incision.** Once you get through the skin you are very likely to be able to feel the CTM, and even if you still can’t at that point, that’s fine too, cut to air...
Source: Life in the Fast Lane - July 30, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Education Emergency Medicine Intensive Care R&R in the FASTLANE Trauma critical care EBM literature recommendations research and reviews Source Type: blogs

Surviving an EHR launch: The trauma of Go Live
An excerpt from The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age (McGraw-Hill, 2015). The YouTube video opens to show a balding middle-aged man sitting on a stool, strumming a guitar. In a gentle, twangy croon, the man, Robert Schwab, chief quality officer for Texas Health Presbyterian Hospital in Denton, Texas, sings “The Ballad of Go-Live,” a week-by-week chronicle of what happened when his hospital turned on its electronic health record system in 2012. He set his lyrics to the melody of the Simon and Garfunkel folk ballad “Homeward Bound.” I’m sitting at the nurses’ station, ...
Source: Kevin, M.D. - Medical Weblog - July 25, 2015 Category: Journals (General) Authors: Tags: Tech Health IT Source Type: blogs

Research and Reviews in the Fastlane 092
This study, on the other hand, was a well done, RDCT comparing tamsulosin to nifedipine to placebo in 1136 patients and showed no statistically significant difference for the primary outcome (need for further intervention at 4 weeks). Subgroup analysis showed a slight benefit for lower tract stones and the issue of utility in larger stones (> 5 mm) remains unanswered. However, with the move to reduce CT use in renal colic, we won’t know stone location or size on many patients making this drug far less useful in the real world. Recommended by Anand Swaminathan Read More: The Adventure of the Impassible Stone (EM...
Source: Life in the Fast Lane - July 23, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Emergency Medicine Intensive Care R&R in the FASTLANE Renal Resuscitation Trauma Urology critical care EBM Education recommendations research and reviews Source Type: blogs

Summer is a busy season for trauma anesthesiologists
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Summer is immortalized in popular culture for good reasons — no other season can match it for the variety of fun and exciting activities it brings. Unfortunately, that variety of activities and the large volume of people enjoying them inevitably lead to accidents and mishaps of all kinds. The summer months (May through August) show a significant increase in unintentional injury and deaths, particularly for those aged 0 to 14 years. Thankfully, there are many skilled people always at the ready to treat the injured. Trauma anesthesio...
Source: Kevin, M.D. - Medical Weblog - July 15, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Surgery Source Type: blogs

Surgical Complication Rates just got Simple: MedicineBall Is the New MoneyBall
By JORDAN SHLAIN, MD In an age where the importance of data, statistics and predictive modeling can win games for baseball teams and make money for high-frequency traders, the last bastion of opacity is in the midst of getting a whopping dose of sunshine. Every modern industry uses detailed information, mostly via the Internet, to lie out their foundational strategies for gaining market share and building their brands.  Fortress medicine has received a shot over the bow regarding the power of data and how they will need to craft a strategy that includes the bright light of outcomes into their institutions.  Propublica, i...
Source: The Health Care Blog - July 15, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Surgical Complication Rates and the New Data Perspective
By JORDAN SHLAIN, MD  + (UPDATED) In an age where the importance of data, statistics and predictive modeling win big games for baseball teams and make fat money for high-frequency traders, we are at the dawn of a new age of transparency in healthcare  It behooves every actor, in every sector, to use this new perspective to constructively illuminate best practices and design an infrastructure for true operational, clinical and logistic efficiencies at large scale and the local level – all in the spirit of getting the patient the best outcome.    Every modern industry uses ‘big data’ to understand ...
Source: The Health Care Blog - July 15, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

In The War on Wheat, this enlightened physician fights back
A University of Toronto physician speaks out about the Fifth Estate production that purports to have debunked the Wheat Belly arguments: To the producers of the above named show. I did not find that you presented the issue fairly to the public. The show was basically about which guru people should follow—Dr. Davis and a host of glamorous hucksters or the skeptical debunkers. A debunking of a popular movement always feeds into people’s cynical nature and makes good, entertaining TV and a smug audience. Unfortunately, the truth took a big hit. So did an opportunity to educate Canadians to some important issues Dr. Davis ...
Source: Wheat Belly Blog - July 14, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle autoimmunity blood sugar grains insulin Source Type: blogs

Bungled Payments
By PAUL KECKLEY The proposal involves a five-year bundled payment model across 75 geographic areas whereby hospitals would be eligible for a bonus if their costs and outcomes were optimal or be penalized if not based on results 90 days post-discharge. The agency noted that in 2013, it spent more than $7 billion on hospitalization for these procedures with the payments for hospitalization and recovery ranging widely from 16,500 to $33,000. Comments about the proposal will be received by CMS through September 8, 2015, aiming for implementation January 1, 2016. Their rationale, according to Secretary of Health and Human Servi...
Source: The Health Care Blog - July 13, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB bundled payments Burwell CMS Paul Keckley Source Type: blogs

Acupuncture tropes on parade
I sometimes catch flak for repeating this, but there was a time when I thought there might be something to acupuncture. I don’t care, because, as a blogger, when I write a post I assume that a significant fraction of people reading it have never seen this blog before and therefore aren’t even the least… (Source: Respectful Insolence)
Source: Respectful Insolence - July 13, 2015 Category: Surgery Authors: Orac Tags: Complementary and alternative medicine Quackery acupuncture acupuncture anesthesisa Elissa Miolene James Reston Nadia Bouhdili pseudoscience traditional Chinese medicine Transformational Acupuncture Washingtonian Magazine Source Type: blogs

Smiling patients and “Stunning” survival rates  with heart transplantation !
Heart transplantation  as a treatment modality was conceptualized  by Christian Barnard in 1967 . Still considered as an  “Act of God” this  surgery is regularly performed worldwide by dedicated  transplant team consisting of cardiac surgeon , physician , Anesthetist , pathologist and others .Unlike other organs , heart transplant cannot have a “live donor” .Though  started  half a century ago, the real  pace has  picked up only in last 2 decades .Currently it is  “globally accepted  standard” intervention in terminal cardiac failure...
Source: Dr.S.Venkatesan MD - July 12, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Heart transplantation longest survivor with heart transplant survival with heart transplantation Source Type: blogs

Post-call accidents – time to revamp the system
(image credit to FMT) In the last few months we have seen couple of young doctors losing their lives in road traffic accidents post call. In May Dr Nurul Wahida Md Noor died in an accident having been on call the day before. Just 2 days ago, a young anaesthetic MO, Dr Afifah Mohd Ghazi tragically died in an accident also post-call, leaving behind her husband a neurosurgical MO and a 1 year old child. Our heartfelt condolences go out to their families and we can’t imagine the grief they are going through. Medical Officers go “on-call” which is different from going on shift duty that House officers and othe...
Source: Malaysian Medical Resources - July 10, 2015 Category: Global & Universal Authors: palmdoc Tags: - Health tips Accident Call doctor MVA Source Type: blogs