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

Yale Medicine: "Straddling medicine and journalism, a former resident keeps an eye on the science press"
As a Yale medical school alumnus (post doctoral fellowship in Medical Informatics 1992-4, faculty in Medical Informatics 1994-6), I receive their literary magazine "Yale Medicine."In the current issue I just received is a story about another Yale medical school graduate who through writing, both professionally and via blogs, is a gadfly against bad medicine - and bad media about bad medicine - like myself and the other bloggers at Healthcare Renewal, at http://yalemedicine.yale.edu/autumn2014/people/alumni/204173.His name is Ivan Oransky, MD.... After his internship, Oransky chose journalism over the practice of medicine. ...
Source: Health Care Renewal - December 14, 2014 Category: Health Management Tags: Embargo Watch Ivan Oransky Medpage TODAY Retraction Watch Yale Yale Medicine Source Type: blogs

How To Be A Successful Patient: Young Doctors Offer Some Advice
I am proud to be a part of the American Resident Project, an initiative that promotes the writing of medical students, residents, and new physicians as they explore ideas for transforming American health care delivery.  I recently had the opportunity to interview three of the writing fellows about how to help patients take control of their health. Dr. Marissa Camilon (MC) is an emergency medicine resident at LA County USC Medical Center, Dr. Craig Chen (CC) is an anesthesiology resident at Stanford Hospitals and Clinics, and Dr. Elaine Khoong (EK) is a resident in internal medicine at San Francisco General Hospital. Here&...
Source: Better Health - December 12, 2014 Category: American Health Authors: Dr. Val Jones Tags: Expert Interviews Health Tips Apps Empowered Patients EMR Health Outcomes Mobile Health Poverty Texting The American Resident Project Source Type: blogs

The Innovation Conundrum In Health Care
Editor’s note: This post is part of a series of several posts related to the 4th European Forum on Health Policy and Management: Innovation & Implementation, to be held in Berlin, Germany on January 29 and 30, 2015. For more information or to request your personal invitation contact the Center for Healthcare Management. It is never too early for new technology in health care. In contrast to the innovator’s dilemma in other industries where the adoption can be sluggish because current customers may not be able to use the future’s toolbox, in medicine innovators always can be assured of an audience when announcing ...
Source: Health Affairs Blog - December 12, 2014 Category: Health Management Authors: Katharina Janus Tags: All Categories Europe Health Care Delivery Innovation Pharma Policy Quality Research Technology Source Type: blogs

Research and Reviews in the Fastlane 061
Welcome to the 61st edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the...
Source: Life in the Fast Lane - December 10, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE airway critical care emergency Emergency Medicine Intensive Care recommendations Review Trauma Source Type: blogs

Fridericia formula for QT interval correction
Measurement of QT interval is very important because of the potential for life threatening torsade de pointes in the presence of QT interval prolongation. QT interval measurement is very important in the evaluation of any new drug because several drugs have been withdrawn in the past due to QT prolongation and life threatening cardiac arrhythmias. QT interval varies with heart rate, shortening with increase in heart rate. Hence it is usual practice to correct the QT interval for a heart rate of 60 per minute. The most commonly used is the Bazett formula while the others are Fridericia, Hodges, and Framingham formulas. Whi...
Source: Cardiophile MD - December 7, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs

MKSAP: 38-year-old man with a mass in his right neck
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated for a mass in his right neck that he first noticed 2 weeks ago while shaving. The patient also reports experiencing a pressure sensation when swallowing solid foods for the past year and daily diarrhea for the past 2 months. His personal medical history is unremarkable. His younger brother has nephrolithiasis, and his father died of a hypertensive crisis and cardiac arrest at age 62 years while undergoing anesthesia induction to repair a hip fracture. On physical examination, vital...
Source: Kevin, M.D. - Medical Weblog - December 6, 2014 Category: Journals (General) Authors: Tags: Conditions Endocrinology Source Type: blogs

Lumbar Puncture: Golden Rules
We feel it is extremely important to highlight some golden rules and additional pearls after our recent lumbar puncture series. (Read the first two articles about positioning and technique at http://bit.ly/1zRSOdC and http://bit.ly/1wY8MiJ.) These tips will help you ensure the best outcome for your patients.   Be Prepared §  Be aware that patients will be anxious. □   Spend dedicated time reviewing the procedure and informed consent. □   Make sure that they feel only the lidocaine injection. □   Most patients will do better with Versed as long as there are no contraindications. §  Be prepared for patients ...
Source: The Procedural Pause - December 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research and Reviews in the Fastlane 060
This study enrolled 2500+ from whom 362 had a DVT, among them 6.3% have proximal DVT not located in common femoral or popliteal locations. This study shows a significant number of patients with proximal DVTs that a 2-point scan would miss.Recommended by: Daniel CabreraEmergency Medicine, Adminstration Gupta, M. Happy Meals for Everyone? Ann Emerg Med 2014; 64(6): 609 – 611. PMID: 25454564This excellent editorial points out the positive and negative aspects of an accompanying study (PMID: 25182541) which examined the patient and ED characteristics associated with patient satisfaction scores. Obviously, a growing ...
Source: Life in the Fast Lane - December 4, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE critical care emergency Emergency Medicine Intensive Care Press Ganey recommendations Review Source Type: blogs

TechTool Thursday 059 PediPain
TechTool review PediPain by The Hospital For Sick Children on iOSPediPain is an app to provide you with correct paediatric dosing guidelines for administering effective pain management for children. It’s been developed by the Department of Anaesthesia at the Hospital for Sick Kids in TorontoWebsite: – iTunes – WebsiteDesignThe design looks ok, but I wouldn’t say they’ve pushed the boat out on the graphics. It works smoothly and doesn’t crash. The only irritating part of the user interface is when you are asked to add the weight and age – this part isn’t intuitive and no matter how many times I u...
Source: Life in the Fast Lane - November 27, 2014 Category: Emergency Medicine Authors: Tessa Davis Tags: Review Tech Tool PediPain Source Type: blogs

When The Doctor Says This Won’t Hurt A Bit — And Incredibly, It’s True | CommonHealth
In May, my six-year-old daughter, Julia, smashed into our front door handle and got a deep, bloody gash in her forehead.We rushed her, head wrapped like a tiny mummy, to the medical center at MIT, where we generally go for pediatric care. Julia wept while the nurse cleaned and examined her lacerated skin. After a short exam, she sent us to the emergency department at Children's Hospital Boston for stitches. "How bad is that, generally?" I asked, having never experienced suturing either for myself or my cautious, risk-averse, older daughter."It can be traumatic," the nurse said.Julia cried, "I don't want stitches."It's a la...
Source: Psychology of Pain - November 25, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

Research and Reviews in the Fastlane 058
This study (n=60) randomized patients in the ED getting IV opioids to morphine (0.1 mg/kg) + placebo or morphine (0.1 mg/kg) + ketamine (group 1 0.15 or group 2 0.30 mg/kg). Patients in the ketamine arm had significantly decreased pain without significant adverse effects, although the group with the higher dose of ketamine had a seeming increase in side effects without added analgesic benefit. The literature is mounting that low dose ketamine has utility in the acute analgesia armamentarium but selecting the right population will likely be key (and more is not better). Recommended by: Lauren Westafer Further Listening: Cli...
Source: Life in the Fast Lane - November 20, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education R&R in the FASTLANE Review Source Type: blogs

Anesthesiologists have to start to truly care for patients
Anesthesiology used to be a job that was attractive for people who don’t like patients very much.  The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done.  Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the night with a fever. Continue reading ... 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 - November 12, 2014 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

What does the Shadow Know?
Recently I had the chance to interview and conduct a day long orientation to a potential candidate to a Nurse Anesthetist Residency Program.  Good candidates are hard to find ala May West.  Some of you may know the reference. There are SRNA programs out there that like young blond inexperienced […] (Source: Nurse Anesthetist)
Source: Nurse Anesthetist - November 12, 2014 Category: Nurses Authors: David Roy Tags: Anesthesia Student Life Source Type: blogs

The demoralizing care women veterans receive…I have solutions
Out here, the sunrises and sunsets are breath taking. You can feel the calm and quiet, perfected by the chirping of birds and the rhythm of insects.  Reflection is mandatory.  Rural life is slower.  The night skies are darker, shimmering brightly with millions of stars.  The few sirens we hear sound for a few seconds in the morning, midday and early evening… a sort of alarm clock for farmers. The isolation is peaceful, centering, inviting…. and dangerous for aging disabled veterans far removed from their Community Based Outpatient Centers (CBOC’s) and VA hospitals and lacking community services. The average perso...
Source: Disruptive Women in Health Care - November 11, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Access Advocacy Women's Health Source Type: blogs

Electronic Health Records: AMA Offers Blueprint to Improve Meaningful Use Program
Conclusion  The AMA’s blueprint comes on the heels of growing stakeholder concern about the Meaningful Use program, especially as it progresses beyond the initial stages. The AMA is frustrated by physicians’ struggles to meet the requirements and the blueprint is an opportunity to modify possible roadblocks facing EHR adoption in the United States. By offering additional flexibilities for physicians, the AMA believes the ultimate goal of Meaningful Use—improving patient care—will be realized. We will monitor EHRs and Meaningful Use as it continues to impact medical practices around the country.   ...
Source: Policy and Medicine - November 11, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

My First Patient Was A Mouse
I didn't think much of it at the time.Most physicians can trace back and recall their first patient.  For some, it is a clinical encounter the third or fourth year of medical school.  The more creative may point to their cadaver during first year anatomy and nod knowingly.  My first patient was a mouse.   Or shall I say a group of them?My freshman year of college, I volunteered in the lab of a prominent endocrinologist and studied a new drug to reverse the course of type 1 diabetes.  We monitored genetically bred, non obese, diabetic mice.  Every day we would reach into their cage and grab the...
Source: In My Humble Opinion - November 11, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs

Attention Matters in Anesthesiology
Different fields in medicine rely on different cognitive abilities. One might posit that a successful internist would be good at integrating information; a surgeon, three-dimensional representations of anatomy; an anesthesiologist, being vigilant to events that will harm the patient. The American Society of Anesthesiologists defines our mindset as ‘Vigilance’ and maintaining it is the Holy Grail of our profession. Google give the definition of vigilance as: The action or state of keeping careful watch for possible danger or difficulties. to which I would add ‘over an extended period of time.’ In...
Source: Waking Up Costs - November 8, 2014 Category: Anesthesiology Authors: J. Clark Venable, M.D. Tags: Anesthesia Medical Software Source Type: blogs

Your electronic health record may lack vital information
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. When you walk into any physician’s office or hospital, computers are everywhere.  By 2013, nearly 70 percent of hospitals had moved away from paper charts and toward electronic health records, or EHRs, and more are making the change every day. From the patient’s point of view, it’s reasonable to think that the EHR will know everything about you.  But you might be surprised to know how many pieces of paper your hospital chart may still contain.  And we should all be aware — even alarmed — about all the gaps in criti...
Source: Kevin, M.D. - Medical Weblog - November 8, 2014 Category: Journals (General) Authors: Tags: Tech Health IT Source Type: blogs

The people treating Ebola patients should be volunteers
I was recently injecting anesthetic into a boil for incision and drainage. The abscess swelled and returned an arcing spray of lidocaine laden with blood and pus, soaking the thigh of my cotton scrub pants. A cheap plastic gown would have protected me — I usually wear one. But I couldn’t find one and had other tasks waiting. My mind went to Ebola and exposed nurse necks. What if this were my hospital’s first Ebola patient, who also happened to have an abscess in need of treatment? Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find ...
Source: Kevin, M.D. - Medical Weblog - November 7, 2014 Category: Journals (General) Authors: Tags: Conditions Infectious disease Source Type: blogs

The Law Of Medicare And Medicaid At Fifty
Editor’s note: This is the first of several periodic posts stemming from presentations to be given at “The Law of Medicare and Medicaid at Fifty,” a conference that will be held at Yale Law School on November 6 and 7. This post introduces an online symposium in connection with The Law of Medicare and Medicaid at 50, an upcoming interdisciplinary conference at Yale Law School.  Many thanks to Health Affairs for its co-sponsorship of the conference and for this opportunity to preview some of the work to be presented. Why focus on the law of Medicare and Medicaid?  These two programs are almost always anal...
Source: Health Affairs Blog - November 4, 2014 Category: Health Management Authors: Abbe Gluck Tags: All Categories Health Law Health Reform Innovation Medicaid Medicare Payment Policy Politics Source Type: blogs

Healthcare Update Satellite — 11-04-2014
Back with more of the Ebola Chronicles … Ebola fears causing discrimination problems all over the US. Thomas Duncan died from Ebola. Now his fiancee is having difficulty finding a place to live as landlords are refusing to rent to her. People of African descent are facing discrimination just because they are from Africa. Mothers of some school children told one African cafeteria worker to leave the school because she “might have Ebola.” In Liberia, bleeding patients are often refused medical care due to Ebola fears. The picture at the link shows a picture of a woman who was bleeding heavily from a miscarr...
Source: WhiteCoat's Call Room - November 4, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Lumbar Puncture Made Simple
Part 2 of a Three-Part Mini-Series on Lumbar Puncture   This month we are back (no pun intended) with the second part of our mini-series focused on perfect patient positioning and lumbar puncture (LP). Part one can be found at http://bit.ly/ProceduralPause.   Now that you have the proper skills to position your patient for an LP, the procedure should be pretty simple, right? The answer is yes! We want you all to be experts. We know that you can and will master an LP after reading these short and sweet LP guidelines and clinical pearls.   Lumbar puncture in the emergency department. Manual of Clinical Anesthesiology;...
Source: The Procedural Pause - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Do EMRs improve patient safety? A debate.
“I’m here to say ‘Yes, they can,’ which is different from ‘Yes, they always do,’” says James Moore, MD, president-elect of the California Society of Anesthesiologists (CSA). To the contrary, enthusiasm for electronic medical records (EHRs) is part of a “syndrome of inappropriate overconfidence in computing,” argues Christine Doyle, MD, the CSA’s Speaker of the House. Continue reading ... 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 - October 30, 2014 Category: Journals (General) Authors: Tags: Tech Health IT Source Type: blogs

The LITFL Review 154
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. Welcome to the 154th edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR] Kane Guthrie [KG] Mat Goebel [MG] Segun Olusany...
Source: Life in the Fast Lane - October 28, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL R/V Source Type: blogs

Research and Reviews in the Fastlane 055
This study demonstrates a higher success rate (100% vs. 88%) and lower pneumothorax rate (0% vs. 5%) in comparing ultrasound guided versus landmark technique for placement. Although the ultrasound guided method may be technically difficult to learn and take some time investment, that time is repayed in the shorter time to accessing the vessel and lower complication rate. Recommended by: Anand Swaminathan Emergency medicineRosen P. The biology of emergency medicine. JACEP. 1979 Jul;8(7):280-3. PubMed PMID 449164 Peter Rosen has called this ‘the only good article I have ever written’. This is Rosen’s rati...
Source: Life in the Fast Lane - October 28, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Clinical Research Emergency Medicine Intensive Care Neurology Resuscitation Trauma critical care Education literature R&R in the FASTLANE recommendations Research and Review Source Type: blogs

Steps to Avoid Anesthesia's Complications
Patients undergoing surgery are unlikely to be harmed by anesthesia, but potential complications can be dangerous. Giving drug and health histories is key. Doctors and nurses are ramping up training. (Source: WSJ.com: The Informed Patient)
Source: WSJ.com: The Informed Patient - October 27, 2014 Category: Consumer Health News Tags: FREE Source Type: blogs

New books. No.1 is an eBook, No.3 is print & electronic
Ultrasonic periodontal debridement: theory and technique. / Marie D. George. Ames, Iowa: John Wiley & Sons Inc., 2014. This is the first textbook to focus exclusively on this fundamentally important component of periodontal therapy. George, Donley, and Preshaw provide a comprehensive resource for dental students, dental hygiene and therapy students, and periodontal residents, as well as practicing dental hygienists and dentists who are looking to increase their familiarity and skills with ultrasonic instrumentation. Local anesthesia for dental professionals / Kathy B. Bassett. 2nd ed, Pearson: Boston, 2014. The 2nd editio...
Source: DentistryLibrary@Sydney - October 24, 2014 Category: Dentists Tags: E-books New books Source Type: blogs

What I love about being an anesthesiologist
I wear a lot of hats in my job.  Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table. Many days I spend in an administrative leadership role or conducting research studies.  These functions support the best interests of my patients as well as the science and practice of anesthesiology.  On my clinical days that I spend in hands-on patient care, I provide anesthesia for patients who undergo surgery and other invasive procedures.  I also treat acute pain as a consultant.  Some of my colleagues in anesthesiology specialize in...
Source: Kevin, M.D. - Medical Weblog - October 21, 2014 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Research and Reviews in the Fastlane 054
Conclusions Wrong? (emlitofnote) Critical Care, CardiologyGuyton AC. Regulation of cardiac output. Anesthesiology. 1968; 29(2): 314-26. PMID: 5635884 The modern emphasis on echo might make you think that the heart determines cardiac output. This classic paper by Guyton shows that unless the heart is failing, it has a permissive role in determining cardiac output. The real determinants are (1) the degree of vasodilation of the peripheral vasculature, especially veins, and (2) the filling of the circulatory system, indicated by the mean systemic filling pressure. Gotta love those Guyton curves! Recommended by: Chris Nick...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Clinical Research Education Emergency Medicine Infectious Disease Intensive Care Neurology Neurosurgery Obstetrics / Gynecology Orthopedics Pediatrics Trauma critical care literature R&R in the FASTLANE recommendat Source Type: blogs

Research and Reviews in the Fastlane 053
This study combines the results from the WARFASA and ASPIRE trials looking at aspirin prophylaxis. The results are promising. Aspirin 100 mg reduced the rate of recurrent VTE from 7.5%/year to 5.1%/year (HR = 0.68) without a significant change in bleeding rate (0.5%/year vs 0.4%/year). We often see patients in the ED with a history of unprovoked VTE who are on no long-term prophylaxis. This article argues that we consider aspirin for all these patients. Recommended by: Anand Swaminathan Trauma Stevens AC, Trammell TR, Billows GL, Ladd LM, Olinger ML. Radiation Exposure as a Consequence of Spinal Immobilization and Extri...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Alternative Medicine Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation Toxicology and Toxinology Trauma critical care literature Source Type: blogs

Finding My Purpose through My Wife’s Breast Cancer
In the spring of 2000 Susan, my wife then of 33 years (now of 48), was diagnosed with breast cancer.  It all started with her annual check-up and her internist saying she felt something “funny” in Susan’s right breast.  She suggested Susan see a breast surgeon. While I was surprised, I wasn’t alarmed.  It was going to be Susan’s fourth breast biopsy.  Unlike the three previous ones, this one was done as an out-patient procedure in one of the then relatively new surgical centers now found in shopping centers everywhere.  No frozen section this time, just wait to hear what the surgeon found. He literally skipp...
Source: Disruptive Women in Health Care - October 14, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Cancer Source Type: blogs

LITFL Review 152
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. Welcome to the 152nd edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR] Kane Guthrie [KG] Mat Goebel [MG] Segun Olusany...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Review LITFL R/V Source Type: blogs

Outpatient anesthesia in elderly patients: What to watch for
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. More than 75 percent of operations in the U.S. occur in an outpatient setting. Outpatient, or ambulatory care, can take place in a number of different settings, including physician offices, outpatient surgery centers, or hospital or non-hospital-based outpatient clinics. With more and more elderly patients undergoing outpatient procedures, it’s important to consider the unique risks of geriatric anesthesia care. Not only have the organs in older patients begun their steady decline, but these patients also experience other ailments su...
Source: Kevin, M.D. - Medical Weblog - October 12, 2014 Category: Journals (General) Authors: Tags: Conditions Geriatrics Surgery Source Type: blogs

Why are so many people opposed to epidurals?
To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger. The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In the absence of medical contraindication, maternal request is a sufficient medical indication for pain relief during labor.” Continue reading ... Your patients are rating you...
Source: Kevin, M.D. - Medical Weblog - October 10, 2014 Category: Journals (General) Authors: Tags: Conditions OB/GYN Source Type: blogs

Sleeping on a cloud—advanced clinical anesthesiology solution uses Microsoft Azure as its technological foundation
As a physician, I have a great deal of respect for my colleagues who specialize in anesthesiology. While surgeons may get all the glory for what they do in an operating room, they couldn’t do their job without the anesthesiologist. These specialist doctors...(read more) (Source: HealthBlog)
Source: HealthBlog - October 9, 2014 Category: Technology Consultants Authors: hlthblog Source Type: blogs

Research and Reviews in the Fastlane 052
This study looked at compliance with discharge instructions. Surprisingly (or maybe not so), 39% of pediatric patients returned to play (RTP) on the day of the injury. RTP is widely recognized as a risk for recurrent and more severe concussions as well as significant morbidity. It is the duty of the Emergency Physician to stress the importance of discharge instructions as well as the importance of appropriate follow up. Recommended by: Anand Swaminathan PediatricsSingleton T et al. Emergency department care for patients with hemophilia and von Willebrand disease. J Emerg Med. 2010; 39(2): 158-65. PMID: 18757163 Bleeding...
Source: Life in the Fast Lane - October 9, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Anaesthetics Cardiology Clinical Research Education Emergency Medicine Haematology Infectious Disease Intensive Care International Emergency Medicine Microbiology Neurosurgery Obstetrics / Gynecology Ophthalmology Source Type: blogs

Research and Reviews in the Fastlane 051
Welcome to the 51st edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 10 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out...
Source: Life in the Fast Lane - October 6, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Gastroenterology Infectious Disease Intensive Care Pre-hospital / Retrieval Respiratory Resuscitation critical care literature R&R in the FASTLANE recommendations Research an Source Type: blogs

Positioning is Everything
Part 1 of a Mini-Series on Lumbar Puncture   We love breaking down and simplifying complicated procedures so you can perform them easily and efficiently. The next few blog posts will focus on strengthening your practice.   We want to give appropriate and safe care. We also want to consider patient satisfaction, dignity, and comfort when we complete any procedure. This month, we are focusing on procedures that require perfect patient positioning. Half the battle of any procedure is setting up your stage to perform, no matter how complex or simple the task at hand may be. Successful procedures are all about positioning and...
Source: The Procedural Pause - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Move In Your Seat: Healthy Meeting Tips at MANA Conference
This morning’s Michigan Association of Nurse Anesthetists started off with a line dance and fun. Eliz presented “Move Your Bootie” and shared strategies to move in your seat during meetings to keep the blood flowing and increase attention.  Participants in the 7 am session ended with a line dance and smiles. Later in the day Eliz will share stress management tips in “Juggling Stress“. Were you in the audience? Share a Woo Hoo or “I will because…” statement in a comment below. Thanks! Motivational Women’s Wellness Speaker Eliz Greene works with busy people to improve heart ...
Source: Embrace Your Heart Wellness Initiative - September 27, 2014 Category: Cardiology Authors: Eliz Greene Tags: Award Winning Blog Events & Media Juggling Stress Move Your Bootie Programs for nurses Source Type: blogs

Medicines or Poisons?—Why Cannabinoids Can Both Help and Hurt You
This is the final post of a 3-part series on the science of medical marijuana. Check out Part 1: What’s Wrong with “Medical Marijuana”? and Part 2: Making Medicine from Marijuana. People who write about the health benefits of marijuana sometimes think it’s ironic that a plant containing compounds that could treat disease (like THC or CBD) is banned by the government for being unsafe. But in fact many effective, FDA-approved medicines are closely related to illegal, harmful drugs and are sometimes even made from the same sources. That’s because there’s a fine (and sometimes fuzzy) line between chemicals that are...
Source: NIDA Drugs and Health Blog - September 22, 2014 Category: Addiction Authors: The NIDA Blog Team Source Type: blogs

Pacemaker Panic #2
ECG Exigency 016 A 68-year old woman presents by ambulance to the Emergency Department. Per the ambulance crew, she was brought from home after experiencing 7 out of 10 chest discomfort and weakness. She has a history of hypertension that is well controlled with furosemide, and has a pacemaker because her “heart used to go funny.” The ambulance crew are basic life support only, so the patient has received 324mg of aspirin, and oxygen by nasal cannula. Upon arrival she is seated upright on the stretcher breathing rapidly, with the following vitals: heart rate 107, blood pressure 180/110, respirations 20 and slightly lab...
Source: Life in the Fast Lane - September 19, 2014 Category: Emergency Medicine Authors: Mat Goebel Tags: Cardiology Clinical Case ECG Education Emergency Medicine EKG failure hyperkalaemia hyperkalemia pacemaker pacer pacing ppm Source Type: blogs

Curbing prescription pain medication abuse by working together
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I recently heard a story on the news about a grandmother of eight who had gotten addicted to heroin after being prescribed an opioid painkiller, Oxycontin, for hip pain. It sounds extreme, but unfortunately to those of us in the pain medicine field, it’s all too familiar. Every year in September we acknowledge people struggling with pain during National Pain Awareness Month. It’s an important month dedicated to the roughly 100 million people suffering from chronic pain in the U.S. It’s also important to acknowledge that the abus...
Source: Kevin, M.D. - Medical Weblog - September 18, 2014 Category: Journals (General) Authors: Tags: Physician Pain management Source Type: blogs

Guest post — 10 observations from a 49 year-old falls risk.
It finally happened. After years of sitting at John’s bedside through multiple serious bike crashes, I had one of my own. I’ve had plenty of time to build up a ridiculous amount of smugness about why he crashes and I don’t. “John is reckless; Staci is cautious. John rides like an airplane engine on a shopping cart; Staci uses her head.” I was mountain biking in Cherokee Park. A storm front was moving in so the temperature and humidity were dropping and it was breezy. I felt so good! Like Rose and Jack on the bow of the Titanic. I was queen of my body and that trail. I passed a real mountain bike racer and I said ...
Source: Dr John M - September 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

Observations from being “the family.”
It’s been a trying week for our family. You learn things when your people need healthcare. It’s an entirely different perspective. I am doctor; I’ve been a patient, but this was the first time being “the family.” Without going into details, (see her guest post), my wife Staci came to need the best that American healthcare has to offer. Let’s say it was a non-preference-sensitive decision to proceed with a major surgery. As I write this, things are stable and well here at home. Here are some observations of the experience: People in the business of delivering healthcare are good people. Early on in the course, b...
Source: Dr John M - September 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

Public Disclosure Bar Blocks Recovery in Stryker False Claims Act Case
The U.S. Court of Appeals for the Eighth Circuit rejected a whistleblower suit against Stryker Corp. and other pain pump manufacturers because the allegations were based on information that had already been made public. The Court upheld the District Court in ruling that the plaintiff failed to pass the “public disclosure bar” necessary for whistleblowers to recover under the False Claims Act (FCA). Whistleblowers are able to share in the government's recovery when they are integral to the discovery of the fraud.  The Eighth Circuit referenced a frequently cited quote in its opinion, which describes the public dis...
Source: Policy and Medicine - September 16, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

ACO Update: What Challenges Lie Ahead?
In June, we noted that Accountable Care Organizations (ACOs) have proliferated throughout the United States in the past few years, but they are still a comparatively new model for delivering low-cost, high quality care. As of mid-2013, there were over 4 million beneficiaries covered by Medicare ACOs. Additionally, a report identified 537 ACOs, and found that the number of physicians, nurse practitioners, and physician assistants participating in ACOs exceeds 190,000. Currently, there are nearly 289,000 total healthcare providers and business personnel aligned with ACOs. Despite these growing numbers, two interesting articl...
Source: Policy and Medicine - September 16, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Research and Reviews in the Fastlane 048
This study looked at one institution’s discrepancy rate between EP and radiologist plain film reads over 10 years. They found overall an ~3% discrepancy rate on all plain films. This of course does not mean the radiologist was correct in every discrepancy. But it does show we agree most of the time. Most interestingly, the rate of discrepancies requiring emergent change in management was a mere 0.056%! Recommended by: Zack Repanshek Prehospital/Retrieval Braude D et al. Air Transport of Patients with Pneumothorax: Is Tube Thoracostomy Required Before Flight? Air Med J. 2014 Jul-Aug;33(4):152-6. PMID: 25049185 C...
Source: Life in the Fast Lane - September 15, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Education Emergency Medicine Pediatrics Pre-hospital / Retrieval Public Health Respiratory Resuscitation Toxicology and Toxinology critical care Intensive Care literature R&R in the FASTLANE recommendati Source Type: blogs

Anesthesiologist’s Review of the Facts in the Joan Rivers Case
By KAREN SIBERT, MD Since the death of comedian and talk-show host Joan Rivers, more information has surfaced about the events on the morning of August 28 at Yorkville Endoscopy. But key questions remain unanswered. News accounts agree that Ms. Rivers sought medical advice because her famous voice was becoming increasingly raspy. This could be caused […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 15, 2014 Category: Consumer Health News Tags: THCB Airway Laryngospasm Larynx Polyp Propofol Tumor Yorkville Endoscopy Source Type: blogs

Joan Rivers: Pushing the limits of outpatient care
There are minor operations and procedures, but there are no minor anesthetics.  This could turn out to be the one lesson learned from the ongoing investigation into the death of comedian Joan Rivers. Ms. Rivers’ funeral was held on September 7.  Like so many of her fans, I appreciated her quick wit as she entertained us for decades, poking fun at herself and skewering the fashion choices of the rich and famous.  She earned her success with hard work and keen intelligence — she was, after all, a Phi Beta Kappa graduate of Barnard College.  Ms. Rivers was still going strong at 81 when she walked into an outpatie...
Source: Kevin, M.D. - Medical Weblog - September 15, 2014 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Night Three
It’s now night 3 of 6. Six straight days — er, nights — covering the ICU patients here at one of the local county hospitals. Night 1 was great. Occasional calls here and there from nurses for little things that did not require much brain power. I am also working with an intern. He is covering the non-ICU patients. Night 1 went well for him too. I think I saw him watching tv shows on his iPad during the down time. Night 2 was definitely busier for the both of us. For me, there was one patient who pretty much required my attention the entire night. And when I finally failed at placing a functional arterial ...
Source: JeffreyMD.com - September 13, 2014 Category: Medical Students Authors: Dr. Jeff Tags: Residency medicine nightshifts Source Type: blogs