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

In the Nalox“ZONE”
A 27-year-old woman with no past medical history presented to the ED by EMS after being found unresponsive at home by her partner. EMS reported that she was unresponsive with a GCS of 3, pinpoint pupils, and sonorous breath sounds. Naloxone 0.4 mg IV was administered, and the patient became responsive. The patient was delirious, agitated, and tachycardic upon arrival to the ED. She was administered lorazepam 2 mg IV without improvement. Her agitation and delirium were so severe that she was intubated, paralyzed with rocuronium, and started on a midazolam infusion.   What is the appropriate dose of IV naloxone? No consensu...
Source: The Tox Cave - January 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Connecticut Transparency Law: Manufacturers Must Only Report Payments to APRNs Practicing Independently
Manufacturers must report quarterly on their transfers of value made to advance practice registered nurses (APRNs) practicing in Connecticut. This group includes nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. APRNs are excluded from the reporting obligations under the Federal Physician Payments Sunshine Act, but Connecticut passed this disclosure requirement as part of a new law allowing APRNs to practice and prescribe independently of physicians.  Proposed Bill No. 257 complicates the reporting obligations in Connecticut by requiring that applicable m...
Source: Policy and Medicine - January 30, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

CMS: Millions of patients across the nation are benefiting from the - um - potential - of Health IT?
I presume this is, in part, a response to the Jan. 21 letter from AMA and the other medical societies as I wrote about two days ago at http://hcrenewal.blogspot.com/2015/01/meaningful-use-not-so-meaningul.html:CMS intends to modify requirements for Meaningful Usehttp://blog.cms.gov/2015/01/29/cms-intends-to-modify-requirements-for-meaningful-use/January 29By Patrick Conway, MDToday, we at the Centers for Medicare & Medicaid Services (CMS) are pleased to announce our intent to engage in rulemaking to update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs beginning in 2015. These intended chan...
Source: Health Care Renewal - January 29, 2015 Category: Health Management Tags: CMS healthcare IT difficulties healthcare IT dissatisfaction healthcare IT myths MD Patrick Conway Source Type: blogs

Research and Reviews in the Fastlane 068
Welcome to the 68th 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 - January 29, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care LITFL Microbiology Psychiatry and Mental Health critical care examination LITFL R/V R&R in the FASTLANE recommendations Review Source Type: blogs

"Meaningful Use" not so meaningul: Multiple medical specialty societies now go on record about hazards of EHR misdirection, mismanagement and sloppy hospital computing
The "Meaningful Use" program for EHRs is a mismanaged boondoggle causing critical issues of patient safety, EHR usability, etc. to be sidestepped.This is on top of the grossly mismanaged and unregulated U.S. boondoggle which should probably be called "the National Programme for IT in the HHS" - in recognition of the now-defunct multi-billion-pound debacle known as the National Programme for IT in the NHS (NPfIT), see my Sept. 2011 post "NPfIT Programme goes PfffT" at http://hcrenewal.blogspot.com/2011/09/npfit-programme-going-pffft.html.The complaints are not just coming from me now.As of January 21, 2015 in a letter to HH...
Source: Health Care Renewal - January 28, 2015 Category: Health Management Tags: AMIA healthcare IT safety Kaizen Event Karen De Salvo management mysticism MAUDE meaningful use Source Type: blogs

Death, Art, Journalism And An "Invisible" Pediatrician In Asheboro, North Carolina
I've not blogged in a long while - and I do not really intend to resume it as a regular activity (especially given the technical problems I had with Blogger getting this post up).  But one of my Mother's best friends died this morning.  I also just got (belated) word of the death of one of my high school teachers - who pushed and prodded me to be someone better than I was at the time.  I wasn't everybody's golden child (that honor belonged to someone else and the rest of us pretty much gave up on trying), but she KNEW I had it in me.Both of these women were great dames - who, in their way, helped make me, ME...
Source: Dr.J's HouseCalls - January 27, 2015 Category: Pediatricians Tags: Cone Healthcare Courier Tribune Edward Cone Invisible Man NHSC Non-profit Pediatrics Physician Whistleblower Randolph Hospital Randolph Medical Associates Robert Morrison Steve Eblin Source Type: blogs

Truth in advertising: When is a doctor really a doctor?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. In an emergency, the first question people often ask is: “Is there a doctor in the house?” When you have a medical problem, the best advice is, “Ask your doctor.”  Most people automatically assume that “doctor” in this context refers to a physician with a medical degree. Dentists, chiropractors, and podiatrists are well-educated professionals who may also be addressed as “doctor,” but there’s no question that their training and specialization is different. Continue reading ... Your patients are rating you online: Ho...
Source: Kevin, M.D. - Medical Weblog - January 27, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Beyond Law Enforcement: The FTC’s Role In Promoting Health Care Competition And Innovation
By now, the Federal Trade Commission’s (FTC) law enforcement efforts in the health care area are well known. We have successfully challenged several hospital and physician practice mergers in the last few years. We also continue to pursue anticompetitive pharmaceutical patent settlements, following a victory at the Supreme Court in the Actavis case. Speaking of the Court, it is currently reviewing a case we brought against the North Carolina Board of Dental Examiners, alleging that its members conspired to exclude non-dentists from providing teeth whitening services in North Carolina. Perhaps less publicized are the FTC...
Source: Health Affairs Blog - January 26, 2015 Category: Health Management Authors: Maureen Ohlhausen Tags: All Categories Competition Connected Health Consumers Health Care Costs Health Law Innovation Policy States Technology Workforce Source Type: blogs

Perioperative medicine: the pathway to better surgical care
This report presents RCoA's vision for future models of surgical care which aims to deliver more efficient healthcare and better outcomes for patients from contemplation of surgery until full recovery. It argues that multi-disciplinary perioperative care helps to provide a solution to the high demand for hospital beds in helping to enable faster recovery and prevent hospital re-admissions. The accompanying case studies highlight examples of good practice in this field.  Report Case studies RCoA resources (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - January 26, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Integrated care Source Type: blogs

Research and Reviews in the Fastlane 067
This study looks into the question and finds that medical students randomized to having their simulated patient die report increased cognitive load and had poorer learning outcomes. The authors caution that this doesn’t mean we shouldn’t have simulated patients die but that we need to plan for this outcome intelligently.Recommended by: Anand SwaminathanPediatricsMaffei FA et al. Duration of mechanical ventilation in life-threatening pediatric asthma: description of an acute asphyxial subgroup. Pediatrics 2004; 114(3):762-7. PMID: 15342851Interestingly, while we often preach to not intubate the asthmatic…...
Source: Life in the Fast Lane - January 21, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Resuscitation critical care examination recommendations Review Source Type: blogs

LITFL Review #165
Welcome to the 165th LITFL Review. 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.The Most Fair Dinkum Ripper Beauts of the WeekDo you re-spike IV fluid bags? The case of Ruby Chen from gravelessons.com should make us all re-think this. [SO] The Best of #FOAMed Emergency MedicineExcellent discussion of everything you need to know about AFib from EM Cases featuring Ian St...
Source: Life in the Fast Lane - January 19, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

LITFL Review 165
Welcome to the 165th LITFL Review. 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.The Most Fair Dinkum Ripper Beauts of the WeekDo you re-spike IV fluid bags? The case of Ruby Chen from gravelessons.com should make us all re-think this. [SO]The Best of #FOAMed Emergency MedicineExcellent discussion of everything you need to know about AFib from EM Cases featuring Ian Stiell. ...
Source: Life in the Fast Lane - January 19, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

MDs and CRNAs: Highlighting each other’s expertise
A front page entry in a recent issue of Anesthesiology News: “Physicians Versus CRNAs: Redefining Roles in the Changing Landscape of Health Care.”  Sounds like a prize fight or a gang war: Crips vs. Bloods.  I immediately got my boxing gloves on, readying myself for another bout of vitriol and dislike thinly disguised as concerns for patient safety.  But the author, Michael DeCicca, a second-year anesthesia resident, surprised me. 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 - January 16, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Want to know what Atul Gawande thinks? Read this interview.
Atul Gawande is the preeminent physician-writer of this generation. His new book, Being Mortal, is a runaway bestseller, as have been his three prior books, Complications, Better, and The Checklist Manifesto. One of the joys of my recent sabbatical in Boston was the opportunity to spend some time with Atul, getting to see what an inspirational leader and superb mentor he is, along with being a warm and menschy human being. In my continued series of interviews I conducted for The Digital Doctor, my forthcoming book on health IT, here are excerpts from my conversation with Atul Gawande on July 28, 2014 in Boston. *** I...
Source: Kevin, M.D. - Medical Weblog - January 15, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Surgery Source Type: blogs

Cardiac arrest, severe acidosis, and a bizarre ECG
A middle aged male had an unwitnessed PEA arrest associated with cocaine use.  Whether there was a shockable rhythm prior to PEA is unknown, but he was never defibrillated.  He received chest compressions with LUCAS and 3 doses of epinephrine, and was intubated by prehospital providers.  He had intermittent pulses.  Here is his initial ECG, with a pH of 6.50:The rhythm is uncertain: probably an accelerated junctional rhythm with RBBB and PVCs, but it could be an accelerated rhythm initiated in the left bundle, mimicking RBBB.  It is important to ascertain the end of the QRS, which I attempt to do b...
Source: Dr. Smith's ECG Blog - January 14, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

First time lucky ! An IVF success story at Malpani Infertility Clinic
CONCLUSION AND ADSVISE TO ALL COUPLES WITHOUT CHILDREN PLEASE GO AND SEE MALPANI CLINIC IF YOU ARE NOT ABLE TO CONCEIVE A CHILD WITHIN TWO YEARS OF YOUR MARRIAGE, DO NOT WASTE TIME BY DOING SOME OTHER TREATMENT THINKING THAT YOU WOULD SAVE MONEY.ITS NOT MATTER OF MONEY ITS MATTER OF PRESTIGE AND RESPECT IN SOCIETY WHICH YOU WILL GET ONLY AFTER YOU HAVE A CHILD WHICH YOU WILL GET AT MALPANI CLINICI WAS VERY LUCKY THAT MY WIFE GOT PREGNANT ATHE FIRST CYCLE ITSELF AND NOW SHE IS OF 8 WEEKS OF PREGNANCY AS ON 31 DEC 2014.                    (S...
Source: The Patient's Doctor - January 12, 2015 Category: Obstetricians and Gynecologists Source Type: blogs

Connecticut Transparency Law: Manufacturers Must Submit One Form at a Time Via Email
This reporting obligation is made more cumbersome due to the fact that reporting is due quarterly.  Per the website: Please submit the form below to the email address: DCP.DrugManufacturers@ct.gov.  Email is the only acceptable method for submission of this form. In each form, manufacturers must fill out: Name of manufacturer Recipient information: First and last name, medical license number, Connecticut controlled substance registration (if applicable) Date the expenditure occurred Value/amt of expenditure Nature of expenditure: cash/check/credit educational demo/evaluation unit; other Purpose of th...
Source: Policy and Medicine - January 12, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

The American Society of Anesthesiologists: Deep roots in patient safety
In a hushed surgical theater in Boston in 1846, anesthesia changed medicine forever. The first successful public demonstration of ether anesthesia allowed patients to undergo surgery they would otherwise not have been able to tolerate. Previously, patients who had been subjected to biting down on cloth or looking into a blue light could finally undergo surgery with a real anesthetic, with no pain or recall. 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 - January 10, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

How should a Catholic hospice respond to patients who choose to voluntarily stop eating and drinking in order to hasten death?
This article will analyze the ethical issues from the perspective of the Catholic tradition and suggest strategies for the Catholic hospice to respond to this group if patients." Stanley Terman shared his response to Cavanagh's article:  "The author's position is clear: Life always has value and the intent to die is always wrong. Voluntarily stopping eating and drinking to hasten dying thus violates Catholic principles. It also violates the stated philosophy of hospice—to neither hasten nor postpone death." "She recommends even secular health care professionals on staff at hospices refuse to provide palliative c...
Source: blog.bioethics.net - January 9, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

How to Kill a Doctor
It’s really quite easy to kill a doctor. Here’s a step-by-step process guaranteed to succeed at least 400 times a year: Start early. Be sure to denigrate medical students whenever possible. Even if they’ve come to the profession later in life and have accomplished all kinds of amazing things personally and professionally (which don’t count, of course, since those are other professions) they don’t know squat about medicine and you do. Make sure to emphasize their ignorance and inexperience at every turn, because it’s the only way to prove that you know more than they do, which of course...
Source: Musings of a Dinosaur - January 8, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs

Joan Rivers: What should the anesthesiologist have done?
New York Post reporter Susan Edelman revealed the name of the unfortunate anesthesiologist allegedly present on August 28 at Yorkville Endoscopy, during the throat procedure that led to the death of comedian Joan Rivers. She is reported to be Renuka Reddy Bankulla, MD, 47, a board-certified anesthesiologist from New Rochelle, NY. Having her name made public will be a nightmare for Dr. Bankulla, as investigators will certainly target her role in Ms. Rivers’ sedation and the management — or mismanagement — of her resuscitation. Continue reading ... Your patients are rating you online: How to respond. Manage...
Source: Kevin, M.D. - Medical Weblog - January 8, 2015 Category: Journals (General) Authors: Tags: Physician Malpractice Surgery Source Type: blogs

Hospitalized Woman with New Complaint Everyday Diagnosed with Broken Furnace Syndrome.
Fargo, ND - Bertha Jensen was hospitalized two weeks ago for chest pain rule out, but a new complaint every day has prevented doctors from sending her home during the cold winter months.  That is, until a breakthrough in discharge planning was discovered by her current Hospitalist. Consider Broken Furnace Syndrome for difficult winter discharges."When I was a resident in Minneapolis, I took care of at least a dozen cases of Broken Furnace Syndrome every winter," said Hospitalist Dr. David Penter, who is known for his uncanny ability to spot patients with ulterior motives from a mile away.Broken Furnace Syndrome is any...
Source: The Happy Hospitalist - January 7, 2015 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Cases: Benign Prostatic Hypertrophy (BPH) as a hospice diagnosis?
Conclusion: In this case, a simple condition that is easily treatable in most men became one that we expected to lead to Mr. K’s death. However, the diagnosis that led it to become life-limiting was Mr. K’s dementia, and the heavy burden which BPH treatments would have placed on him. Mr. K’s daughter based her decision on Mr. K’s values, saying that if the father she was raised by was able to see himself in his current condition, he would have wanted both to stay in place and to be allowed to die with dignity. Forced catheterization and antipsychotic treatment might have prolonged his life by years but would have c...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 6, 2015 Category: Palliative Carer Workers Tags: cases childers emergency care hospice medications POLST urology Source Type: blogs

The Anesthesiologist’s Story: New Details Emerge In the Joan Rivers Case
By KAREN SIBERT, MD New York Post reporter Susan Edelman revealed on January 4 the name of the unfortunate anesthesiologist allegedly present on August 28 at Yorkville Endoscopy, during the throat procedure that led to the death of comedian Joan Rivers. She is reported to be Renuka Reddy Bankulla, MD, 47, a board-certified anesthesiologist from New Rochelle, NY. Having […] (Source: The Health Care Blog)
Source: The Health Care Blog - January 4, 2015 Category: Consumer Health News Tags: THCB anesthesiology Joan Rivers Case Oxygen Saturation Propofol Yorkville Endoscopy Source Type: blogs

Survival characteristics of composite restorations in primary teeth
ConclusionsFilling survival was comparably lower to composite restorations observed in prospective clinical studies on permanent teeth and other tooth-colored restoratives used in primary teeth. Due to the very high caries risk and young age of the population, frequent loss due to secondary caries was observed. With respect to the high caries risk, composite restorations can be used to treat carious primary teeth, though a strict caries prevention regimen should be followed to minimize restoration failure.Clinical relevanceFilling loss of composites in the primary dentition is associated with secondary caries on the long t...
Source: Dental Technology Blog - January 2, 2015 Category: Dentists Source Type: blogs

Research and Reviews in the Fastlane 064
This study showed a poor specificity (48%) for two tools in identifying stroke patients in the field speaking to the need for better tools and/or better training. A low specificity means lots of patients without disease may be treated.Recommended by: Anand SwaminathanEmergency Medicine, Neurology Hamaekers AE, Henderson JJ. Equipment and strategies for emergency tracheal access in the adult patient. Anaesthesia. 2011 Dec;66 Suppl 2:65-80. PMID: 22074081How to access the cricothyroid membrane….or not! – a great review of the literature for different ways of gaining emergency airway access via the cricothyroid...
Source: Life in the Fast Lane - December 31, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care Neurology Ophthalmology Pediatrics Pre-hospital / Retrieval Resuscitation critical care Press Ganey R&R in the FASTLANE recommendations Review Source Type: blogs

Why you can’t believe all the health articles that you read
I have recently become a card-carrying member of the Association of Health Care Journalists.  Lofty title for a lowly blogger, but I’ll take it.  There are two main advantages to this membership, at least that I can see so far.  The first is access to the full text of online journals, key to actually discussing research intelligently.  The second is the discussion groups, where journalists of all stripes can ask questions about reporting on health issues or point out recent discoveries.  I recently found out just how important both of these perks are, and how they relate. The British Medical Journal (BMJ) recently r...
Source: Kevin, M.D. - Medical Weblog - December 29, 2014 Category: Journals (General) Authors: Tags: Physician Mainstream media Source Type: blogs

Eyebrow Laceration and Repair, If You Dare!
Picture this: It’s Dec. 31 at 11:59 p.m. You’re spending your designated holiday working the overnight. You’re eating some leftover fruitcake in the nurse’s lounge, and you see the following complaint sign into triage: “Drunk/face pain.”   This could mean just about anything when ethanol is on board. You lift your head just slightly over the computer screen and see a young gentleman staggering in the hall. His chart is labeled “SLC” for “streamline care.” Everyone knows that intoxicated patients are never appropriate for your streamline care area, but you decide to take a chance, and hope this guy has ...
Source: The Procedural Pause - December 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Music as Medicine
The following post is written by Lisa Suennen one of our 2015 Women to Watch. It originally ran on her blog Venture Valkyrie. It happens every time. I hear “Bad to the Bone” on the radio and suddenly all is right with the world. I love music and I have learned that if I choose the correct genre and tempo  I can improve a depressed state or calm a hyper one. I have song lists on my iPod called Cranky and Stressed, F the World, and Happiness, all designed around my various moods. Music can have a profound affect on my state of mind. I think this is true for most people, actually. The therapeutic value of music has long ...
Source: Disruptive Women in Health Care - December 23, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Consumer Health Care Innovation Technology Source Type: blogs

Tongue cancer in an elderly patient: Thinking of my grandmother
Old age is no place for sissies. -Bette Davis “I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!” She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had first met. A misunderstanding about stopping medications before surgery had led her to discontinue both her aspirin (a good idea) and her blood pressure pills (not a good idea). She was lying on the c...
Source: Kevin, M.D. - Medical Weblog - December 17, 2014 Category: Journals (General) Authors: Tags: Conditions Surgery Source Type: blogs

Ten things to expect after AF ablation
Here is a list of ten things to say about the experience of having an AF ablation. (Note: This list concerns standard radio frequency catheter ablation for AF.) 1. AF ablation is a big deal: The first thing to say about AF ablation is that it is a big procedure. I tell patients to expect AF ablation to be hard on them. How could it be easy to undergo hours of general anesthesia, insertion of big tubes in the leg veins, 50-75 burns in the atrium and hours of bed rest? Although a minority sail through the recovery without complaints, most patients tell me they were surprised at how hard it was on them. I recommend taking a ...
Source: Dr John M - December 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

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