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

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 15, 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 29, 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

Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management
A young woman presented with intermittent shocks from her implantable defibrillator.  She was intermittently unconscious and unable to give history.   The monitor showed intermittent polymorphic ventricular tachycardia.    The physician was presented with this ECG at the same moment he was observing the repeated syncope:Time zeroIt is a bigeminal rhythm with a very bizarre PVC.  The PVC has an incredibly long QT, but the intervening native rhythms do not.  However, when I saw this (it was texted to me), it immediately reminded me of this case, so I knew by sheer recognition that it was lo...
Source: Dr. Smith's ECG Blog - July 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

The problem with medical TV shows. A surgeon sets the record straight.
I never really watched medical shows, even before and during medical school. I watched maybe one season of ER, a couple of seasons of Grey’s Anatomy and House MD and maybe one episode each of Private Practice, Chicago Hope, Emily Owens MD and other random medical shows. The only medical show I made an exception for was Scrubs, because it was funny and poignant and the closest to replicating what life is actually like in a hospital (but still a long shot I’m afraid!). Oh, and I want to be able to whistle like Dr. Cox. I’m sure like every profession, seeing your own profession on the big or little screen is...
Source: Kevin, M.D. - Medical Weblog - July 7, 2015 Category: Journals (General) Authors: Tags: Physician Mainstream media Surgery Source Type: blogs

There is no shame in honest work, no matter what the job description is
When my sister, Jessica, was a nurse anesthetist student at the University of New England, she had the opportunity to rotate at Johns Hopkins, and she seized it. She was young and fairly new to the medical world and so she did not recognize at first the name of the neurosurgeon with whom she would be working — Dr. Ben Carson. After receiving multiple comments from numerous people about how great it was that she would be working with him, she did what any other 20-something year old would do … she Googled him. Naturally, she found out that he was very accomplished in his field; he was the first neurosurgeon,...
Source: Kevin, M.D. - Medical Weblog - July 6, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Surgery Source Type: blogs

Learning to Take the Heat at #smaccUS
We managed to get an elite team together to run the ‘Learning to Take the Heat’ workshop at SMACC Chicago. Our team consisted of: Anand Swaminathan (@EMSwami) Chris Hicks (@HumanFact0rz) Jason Brooks (@PhenomenalDocs) Jesse Spurr (@Inject_Orange) The “Learning to take the Heat” team as well as myself, with the able assistance of Ali Gould (@intransition2). The focus of the workshop was to develop an understanding of how stress affects the performance of health professionals when caring for the critically ill, and more importantly, how we can teach others to handle stress. Recommended resour...
Source: Life in the Fast Lane - July 2, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Education ali goould anand swaminathan chris hicks Chris Nickson jason brooks jesse spurr SMACC stress inoculation workshop Source Type: blogs

Research and Reviews in the Fastlane 089
This study found that athletes with pathologic TWI (except those in aVR, III, V1) were likely to have underlying cardiac pathology (45% of patients). Hypertrophic cardiomyopathy was the most common finding (81% of cardiac pathology). These authors recommend that all athletes with pathologic TWI be referred for further cardiac testing. Recommeded by Anand Swaminathan The R&R iconoclastic sneak peek icon key The list of contributors The R&R ARCHIVE R&R Hall of famer You simply MUST READ this! R&R Hot stuff! Everyone’s going to be talking about this R&R Landmark paper A paper that ...
Source: Life in the Fast Lane - July 1, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care recommendations research and reviews Source Type: blogs

Should I become an anesthesiologist? Read this first before you decide.
In case you were wondering — robots won’t replace anesthesiologists any time soon, regardless of what the Washington Post may have to say. There will definitely be a place for feedback and closed-loop technology applications in sedation and in general anesthesia, but for the foreseeable future we will still need humans. I’ve been practicing anesthesiology for 30 years now, in the operating rooms of major hospitals. Since 1999, I’ve worked at Cedars-Sinai Medical Center, a large tertiary care private hospital in Los Angeles. So what do I think today’s medical students should know about my field? Continue read...
Source: Kevin, M.D. - Medical Weblog - June 25, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

High Prescribing Connecticut APRN Charged With Accepting Kickbacks; Comes On Heels Of Connecticut Sunshine Law Targeting APRNs
The U.S. Attorney’s Office of the District of Connecticut has announced that an Advanced Practice Registered Nurse (APRN) practicing in the state has admitted to receiving $83,000 in kickbacks—mostly as a speaker at dinner programs—by an unnamed drug manufacturer. The press release states that Heather Alfonso was a “heavy prescriber” of a drug used to treat cancer pain. They noted that a review of Medicare Part D prescription drug events for prescribers of the drug showed that Alfonso was responsible for more than $1 million in claims and was the highest prescriber of the drug in Connecticut. However, the governm...
Source: Policy and Medicine - June 25, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

A patient secretly records his colonoscopy. It cost this doctor her job.
A patient undergoing a colonoscopy pressed “record” on his smartphone before being sedated, hoping to capture instructions from his physicians after the procedure.  What he heard instead was shocking: “In addition to their vicious commentary, the doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart.” The incident cost his anesthesiologist $500,000 in the ensuing malpractice and defamation trial. The recording has to be heard to be believed. Your patients are rating you online: How to respond. Manage your...
Source: Kevin, M.D. - Medical Weblog - June 24, 2015 Category: Journals (General) Authors: Tags: Video GI Malpractice Source Type: blogs

HIT Newser: Prison time for HITECH fraud
By MICHELLE RONAN NOTEBOOM CVS Health acquires Target’s healthcare biz CVS Health will pay $1.9 billion to acquire Target’s healthcare businesses, including 1,600 pharmacies and 80 MinuteClinic health clinics. CVS Health also just opened its Boston-based Digital Innovation Lab, which will focus on developing cutting-edge digital services and personalized capabilities that offer an accessible and integrated personal pharmacy and health experience. CVS is making big strides to position itself as both a digital innovator and major provider of primary care services. Look for them to continue to build on existing ...
Source: The Health Care Blog - June 22, 2015 Category: Consumer Health News Authors: michelle Tags: THCB Uncategorized HIT Newser Meaningful Use Source Type: blogs

Questioning the commitment today’s physicians have to medicine
Dr. Margaret Wood, who chairs the Department of Anesthesiology at Columbia University Medical Center, has published a wonderful article titled “Women in Medicine:  Then and Now,” in the journal Anesthesia and Analgesia. I think I speak for many of us in admitting that Anesthesia and Analgesia doesn’t occupy a prominent place on my bedside table. Many readers may have missed Dr. Wood’s article. That’s a shame, because it isn’t just about anesthesiology, and speaks to issues in medicine independent of specialty or gender. Continue reading ... Your patients are rating you online: How to respond. Manag...
Source: Kevin, M.D. - Medical Weblog - June 21, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Super Docs
Guest post by Tane Eunson – A student of the game (5th year M.B.B.S.) As a typical kiwi bloke, I’m a dyed-in-the-wool rugby fanatic (pardon the sheep reference). So when opportunities with two Super Rugby franchises arose for me in the past year, I picked the ball up and sprinted for the posts. As an ‘intern’ with the franchises, I was part of the ‘athletic performance’ teams. The hierarchical structures differed subtly within each team, but they both comprised the team doctor, two physiotherapists, two strength and conditioning coaches and a number of other interns in the varying disciplines. With regards ...
Source: Life in the Fast Lane - June 19, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Medical Specialty Sports Medicine rugby Super Docs Super XV Tane Eunson Source Type: blogs

JellyBean 029 with John Hinds
Softly spoken. Well balanced. As an anaesthetist and intensivist you might be forgiven for thinking that Dr John Hinds would be a little risk averse. But not if you’d been to his utterly hilarious talk about madness and mayhem on the very small roads of Ireland. John Hinds is a jack of all trades. I like those kinds of jacks. This is a brilliant example of the sort of extremely cool thing that you can do with a medical, nursing or paramedic qualification. John carries about 25Kg strapped to himself and sends himself along stone walled Irish lanes at eye-watering speeds. John puts his life at risk in order to take a litt...
Source: Life in the Fast Lane - June 16, 2015 Category: Emergency Medicine Authors: Doug Lynch Tags: JellyBean Podcast Web Culture John Hinds Source Type: blogs

LITFL Review 186
Welcome to the 186th 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 Week The importance of grit in medicine can’t be stated enough. Mike Lauria discusses the concept and its import. [AS]   The Best of #FOAMed Emergency Medicine Excellent lecture on the non-utility of backboards and collars via Anton Helman and...
Source: Life in the Fast Lane - June 14, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Research and Reviews in the Fastlane 087
Welcome to the 87th 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...
Source: Life in the Fast Lane - June 10, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care recommendations Review Source Type: blogs

The Hugest of the Huge Hematomas
Welcome to our new series, “Guts and Gore.” That title should serve as a warning that some of the videos we will use as teaching tools may be controversial and not for weak stomachs. We hope, however, that part of why you became an emergency provider was to handle sticky situations like the ones we will present. People like us have the ability to ignore blood and copious discharge, and instead focus on saving and improving the lives of our patients. Rarely are you thanked for this ability, and we hope this series on guts and gore will improve your technique, even when the going gets tough.   The Approach n Proper iden...
Source: The Procedural Pause - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Did Dr. Virginia Apgar worry about work-life balance?
By KAREN SIBERT, MD Dr. Margaret Wood, who chairs the Department of Anesthesiology at Columbia University Medical Center, has published a wonderful article titled “Women in Medicine:  Then and Now“, in the journal Anesthesia and Analgesia. I think I speak for many of us in admitting that Anesthesia and Analgesia doesn’t occupy a prominent place on my bedside table. Many readers may have missed Dr. Wood’s article. That’s a shame, because it isn’t just about anesthesiology, and speaks to issues in medicine independent of specialty or gender. Here are some of my favorite passages about lessons she learned over...
Source: The Health Care Blog - June 1, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Developing Standards ‘Of, By, And For’ Older Adults: Reflections On Patricia Gabow’s Narrative Matters Essay
Imagine three people: a healthy 30-year-old, a 60-year-old with high blood pressure, diabetes and arthritis, and a 90-year-old who is frail and has dementia advanced to the point where her speech often doesn’t make sense. If I lined them up, any doctor could instantly tell me which was which. Ditto if each broke a bone and I showed the physicians only their x-rays. And if I asked the clinicians to predict each patient’s risk of complications and adverse events based on nothing more than the few words above, they would again rapidly and reliably make accurate assessments. Yet, for the most part, our health system lumps ...
Source: Health Affairs Blog - May 29, 2015 Category: Health Management Authors: Louise Aronson Tags: Health Professionals Hospitals Narrative Matters Organization and Delivery Aging End-of-Life Care Health Policy Patricia Gabow standards of care Source Type: blogs

Is your anesthesiology practice poised for success?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Earlier this year, I spoke to an audience of physician anesthesiologists about setting up a basic quality assurance (QA) program within their departments. At the end of the presentation, one physician anesthesiologist stated that his group “will not let anyone out of the operating room (OR) to do QA.” He further described how any activity not related to clinical work takes a back seat to the group’s mandate that the physician anesthesiologists must first “generate revenue in the ORs.” Continue reading ... Your patients are rat...
Source: Kevin, M.D. - Medical Weblog - May 28, 2015 Category: Journals (General) Authors: Tags: Policy Surgery Source Type: blogs

Government backs down on some requirements for digital medical records
EHR utopian dreams have taken some pronounced hits in recent years.In recent months, the hyper-enthusiasts and their government allies have had to eat significant dirt, and scale back their grandiose but risible - to those who actually have the expertise and competence to understand the true challenges of computerization in medicine, and think critically - plans.(At this point I'll give them the benefit of the doubt and not call the utopians and hyper-enthusiasts corrupt, just stupid.) USA Today published this article today outlining the retreat:Government backs down on some requirements for digital medical recordshttp://w...
Source: Health Care Renewal - May 27, 2015 Category: Health Management Tags: Bob Wachter David Blumenthal healthcare IT difficulties healthcare IT dissatisfaction Healthcare IT experiment Jayne O ' Donnell Sally Murphy USA Today Source Type: blogs

Research and Reviews in the Fastlane 085
This study was a retrospective cohort study of 298 patients with confirmed PE. In this population, a 45% were HST negative while 55% were positive. From the HST-negative group, there were no death, CPR or need of thrombolysis compared with 6% of mortality and 9% of CPR or thrombolysis in the HST-positive group. It appears that HST is a good prognosis biomarker in patients with pulmonary embolism. Recommended by: Daniel Cabrera Emergency medicineLin BW. A Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries. J Emerg Med 2015. PMID: 25886984 Fingertip avulsion injuries are typically frustra...
Source: Life in the Fast Lane - May 27, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Cardiology Clinical Research Education Emergency Medicine Intensive Care R&R in the FASTLANE Social Media critical care examination literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 084
This study demonstrated that using a simulation program, EM residents could be brought up to speed on proper sterile technique and that these lessons could be applied clinically. The authors of this study found identical CRBI rates between ED and MICU placed central lines after this educational intervention. Recommended by: Anand Swaminathan Trauma Hildebrand DR et al. Modern management of splenic trauma. BMJ. 2014; 348. PMID: 24696170 Pediatric patients with abdominal trauma can be a challenge to assess. Naturally, we often are concerned for potential splenic injury. What is the most current approach to managing splen...
Source: Life in the Fast Lane - May 21, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Education Emergency Medicine Intensive Care R&R in the FASTLANE Toxicology and Toxinology Trauma critical care examination research and reviews Source Type: blogs

FDA OPDP Issues Fifth Letter of Caution for the Year, Cites Oak Pharmaceuticals For Exhibit Banner
Almost like clockwork, the Food and Drug Administration’s Office of Prescription Drug Promotion (OPDP) has released its fifth enforcement letter of 2015—they have issued one letter in January, February, March, April, and now, as of the past week, one in May. OPDP sent the Untitled Letter to Oak Pharmaceuticals, Inc. (a subsidiary of Akorn, Inc.) regarding the company’s barbiturate anticonvulsant, Nembutal. View the promotional material here. The agency found that Oak’s table exhibit banner was misleading because it omitted “important risk information associated with the use of Nembutal,” and also omitted materi...
Source: Policy and Medicine - May 21, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Research and Reviews in the Fastlane 083
This study looks at intra-arrest cooling in the prehospital setting. No benefit was found for either the surrogate markers or the most important patient centered outcome of survival. Interestingly, the median temperature upon hospital presentationin the group that did not get intra-arrest cooling was 35 degrees (below the 36 degrees recommended in the TTM trial conclusions). Intra-arrest cooling may simply be a lot of money and effort spent without noticeable differences in outcomes.Recommended by: Anand SwaminathanRead More: JC: Getting Chilly Quickly 3. Hypothermia at St.Emlyn’s (St Emlyn’s)Critical CareWalkey...
Source: Life in the Fast Lane - May 14, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Resuscitation Trauma Wilderness Medicine critical care examination literature recommendations research and reviews Source Type: blogs

Implementing Health Reform: Clarifying Requirements For Coverage Of Contraceptives And Other Preventive Services
The Affordable Care Act requires nongrandfathered individual and group insurers and group health plans to cover certain preventive services without cost sharing. Specifically, it requires coverage of: evidence-based items and services given an “A” or “B” rating by the United States Preventive Services Task Force (USPSTF) with respect to the individual involved; immunizations as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control; children’s preventive care and screenings as recommended by Health Resources and Services Administration (HRSA) guidelines; Women’s prev...
Source: Health Affairs Blog - May 12, 2015 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage contraceptives Prevention Source Type: blogs

Why I Hate Secure Email Portals
Many health care enterprises are using secure email ‘portals’ to send, or should I say ‘tell the recipient to come get,’ information and attachments in a way they were told would be ‘HIPAA Compliant’. What I mean by ‘portal’ is a third party to which plain text and any attachment is sent over a secure connection (‘plain text’ is unencrypted information; it can be formatted text that is just not encrypted). The ultimate recipient receives an email inviting them to visit the portal to see the content over a connection that is also encrypted. For example, if the hospital pharmacy director wants to send a ...
Source: Waking Up Costs - May 11, 2015 Category: Anesthesiology Authors: J. Clark Venable, M.D. Tags: Privacy Rant Security Software Source Type: blogs

Stu Marshall on Airway Strategies
Stuart Marshall is an anaesthetist with a PhD in Human Factors and is the Clinical Director of Simulation Education at The Alfred (based at the Australian Centre for Health Innovation). In this FOAM video, created for the Critically Ill Airway (CIA) course, Stu provides an interactive guide to how an airway expert develops a strategies for airway management.CIA airway strategy from Stu Marshall on Vimeo.Feel free to discuss your plans for the scenarios presented in the video. Depending on your context, your plans may be quite different to those described…The next CIA course is December 8th and 9th 2015, registration...
Source: Life in the Fast Lane - May 11, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Airway Anaesthetics Emergency Medicine Intensive Care airway strategies CIA critically ill airway stuart marshall Video Source Type: blogs

A physician anesthesiologist reports in from Afghanistan
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As a physician, you never quite get used to being paged in the middle of the night. The shrill tones emitted via a radio frequency device that seems squarely stuck in the 1980s are almost always the first sign of something gone wrong, especially when serving as a military physician. 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 - May 4, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Cochlear Implants and MRI: Growth Trend Leads to Design Revolution
By Darla Franz, MA, & Rebecca Novak Tibbitt, MPH MED-EL   Cochlear implants (CIs) are an increasingly common option for people with severe to profound hearing loss. Approximately 324,200 people worldwide had received implants as of December 2012, according to the U.S. Food and Drug Administration (FDA). In the United States, an estimated 58,000 adults and 38,000 children have received cochlear implants (National Institute on Deafness and Other Communication Disorders; bit.ly/NIDCD-CI). Recent research has shown that the number of older adults in the United States who are potential candidates for cochlear implantation ...
Source: R&D Blog - May 4, 2015 Category: ENT & OMF Tags: Blog Posts Source Type: blogs

Airway Lessons from the Austere Environment
The Critically Ill Airway course, run by The Alfred ICU and Monash University, is taking place this week. Among the lineup of elite instructors is Dr Brent May (@docbrent), who  has created a 12 minute video lecture on ‘Airway Lessons from the Austere Environment’.Brent is a trauma anaesthetist at The Alfred, a retrieval physician with Adult Retrieval Victoria, and is Chief Medical Officer for the Australian Formula 1 Grand Prix, Motorcycling Australia and Karting Australia. I asked Brent to speak on this topic because I believe that all airway practitioners can benefit from the lessons learned by those wh...
Source: Life in the Fast Lane - May 4, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Airway Anaesthetics Education Emergency Medicine Intensive Care Pre-hospital / Retrieval austere environment brent may critically ill airway course prehospital Source Type: blogs

Cardiac Pacemaker
Cardiac pacemaker is a device meant to give regular electrical pulses to the heart when the normal pacemaker function of the heart is defective. The normal pacemaker of the heart is the sinoatrial node (SA node) situated in the upper part of right atrium. It gives out regular electrical pulses to the heart at a rate between 60 – 100 per minute. These pulses are conducted down the right atrium to the atrioventricular node (AV node), which is the relay station for the pulses. In the AV node the pulses are delayed and sent further down the conduction system known as the bundle of His and bundle branches (right and left)...
Source: Cardiophile MD - May 2, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs