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

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

New books received this week
Local anesthesia for dental professionals / Kathy B. Bassett. 2nd ed, Pearson: Boston, 2014. For courses in Pain Control, Local Anesthesia in Dentistry, and Nitrous Oxide Sedation (minimal sedation) in Dentistry. Local Anesthesia for Dental Professionals, 2/e provides a user-friendly, primary resource for instructors and students of pain control. This text is appropriate for both dental and dental hygiene students and provides step-by-step instructions that are also useful to practicing clinicians seeking to improve their skills or learn new injection techniques. In addition to the superb illustrations, step-by-step appro...
Source: DentistryLibrary@Sydney - September 12, 2014 Category: Dentists Tags: New books Source Type: blogs

Research and Reviews in the Fastlane 047
In this study, the research team collected pooled urine (read many people used the urinal they collected from) from a popular nightclub area in London and analyzed the specimens for the presence of illicit drug compounds. The goal was to determine whether this method could be used to track patterns and monitor trends in recreational drug use.  Recommended by: Anand Swaminathan Emergency Medicine, Critical Care, Anaesthetics Hindman BJ et al. Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation with Macintosh and Airtraq Laryngoscopes. Anesthesiology. 2014; 121(2):260-71. PMID...
Source: Life in the Fast Lane - September 9, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Clinical Research Education Emergency Medicine R&R in the FASTLANE critical care Intensive Care literature recommendations Research and Review Source Type: blogs

What Killed Joan Rivers? Piecing Together a Medical Mystery
KAREN SIBERT, MD 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 yesterday, September 7.  Like so many of her fans, I appreciated her quick wit as […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 8, 2014 Category: Consumer Health News Tags: THCB Demerol Hypotension Joan Rivers Midazolam outpatient care Propofol Wellness Yorkville Endoscopy Source Type: blogs

Physician Payments Sunshine Act: Organizations Respond to CMS
  September 2nd marked the last day for comments on CMS’ proposed rule to eliminate the accredited continuing medical education (CME) exemption from Sunshine Act reporting.  In an overwhelming display of support for the exemption, over 800 comments were submitted encouraging the agency to either maintain or expand the current exclusion. -Total comments supporting maintenance or expansion of the CME exemption:  820 -Total comments supporting elimination of the CME exemption:  approximately 20 -Percentage of comments supporting the CME exemption: 98% We have followed this issue closely, and recentl...
Source: Policy and Medicine - September 8, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Anesthesia outside the operating room: A growing trend
I opened my obligatory late-afternoon email to find my work schedule for the next morning: three general anesthetics for MRIs. My heart sank. A week before, I had been assigned to the new neurosciences MRI suite for a 6-hour interventional radiology procedure, followed by another intervention in the CT scanner. My first thought: Who is trying to punish 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 - September 7, 2014 Category: Journals (General) Authors: Tags: Physician Radiology Surgery Source Type: blogs

Joan Rivers Out of ICU and “Comfortable” Likely Ominous
Although we are not participating in the care of comedy legend Joan Rivers, we have noted news reports that her daughter Melissa has said her mother is out of the ICU and being kept comfortable. Rivers was hospitalized six days ago after suffering cardiac arrest and a prolonged anoxic period (brain without oxygen.) She was placed in a hypothermic coma (lowered body temperature) as is standard for the first 24-48 hours after arrest in an attempt to salvage brain and cardiac function. However, reading between the lines of this recent statement, this is likely an ominous development and could signal the start of a comfort car...
Source: Inside Surgery - September 4, 2014 Category: Surgery Authors: Editor Tags: Anesthesia Medical News Wire Uncategorized ativan comfort care dying ICU Joan Rivers morphine Source Type: blogs

Contrasting American EDs with the World’s Largest Hospital
By Zubair Chao, MD   Dr. Thomas Cook and I escaped the dry heat of South Carolina to land in Chengdu, China, home of West China Hospital, in July 2012. He was set to teach an emergency ultrasound class, and I was on a global mission as part of my emergency medicine residency.   Some say it is the largest hospital in the world, boasting 5,000 beds, nearly 100 operating suites, and a large outpatient center, which, on any given day, has about 10,000 patients.     West China Hospital   The ED at West China Hospital recently moved to its new home in a larger, more modern facility. It sees about 160,000 patients a year, wh...
Source: Going Global - September 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Go Mental: Head and Neck Anesthesia
As we approach the end of summer, we pay tribute to a special nerve block. This particular block is crucial for treating lower lip lacerations that may be related to slips and falls at the pool or skateboarding. We are going to ask you to go mental, as in blocking the mental nerve of the face.   The mental nerve is an extension of the inferior alveolar nerve, which branches primarily off the trigeminal nerve. It is a sensory nerve that provides sensation to the lower chin and lip. It does not supply sensory innervation to the lower teeth, although some patients report mild anesthesia to their teeth. Three branches come ou...
Source: The Procedural Pause - September 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Crack the Case
Conclusion The patient received antibiotics, steroids, and nebulized albuterol during his hospital admission. His symptoms and chest x-ray findings improved within 24 hours. Blood cultures were negative, and antibiotics were discontinued. He was discharged home with instructions to discontinue use of crack cocaine and given a prescription for oral steroids and an albuterol inhaler.Tags: tachycardia, scattered rhonchi, wheezing, emergency medicine, crack, cocainePublished: 9/2/2014 11:24:00 AM (Source: The Tox Cave)
Source: The Tox Cave - September 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Mini-Sims for Critical Care
Conclusion The bottom line is clear: a copy of this book should be in every ICU. We need to ‘make sim happen’ in the workplace and this book is a great entry point. However, nothing replaces the need for clear learning objectives and a skilled teacher, so I encourage clinicians to seek further training in simulation education… Books and mannequins don’t teach themselves. Disclosures The authors of the book provided LITFL with a review copy free-of-charge. The post Mini-Sims for Critical Care appeared first on LITFL. (Source: Life in the Fast Lane)
Source: Life in the Fast Lane - August 31, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Book Review amuth samuel Charlie Corke in situ simulation mini-sims for critical care nick simpson Source Type: blogs

Kids and Cutting to Air
This is a guest post written by Dr Mike Cameron FACEM, a Queensland-based emergency physician. It was the mid-1980s and I was almost at the end of my third year as a doctor. I was working in England, about an hour’s motorcycle ride North of London, in a district hospital of a few hundred beds. I remember it was cold. That night I was the Anaesthetic Senior House Officer (SHO) on call. I had done a few cases in Theatre but I had got out before midnight and things were looking pretty good sleep-wise. Labour Ward had a couple in early labour but no epidurals required. I was on a 1:2 roster, but my Registrar and I alternated...
Source: Life in the Fast Lane - August 30, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Anaesthetics Emergency Medicine child cricothyroidotomy mike cameron paediatric surgical airway trick of the trade Source Type: blogs

Balloon mitral valvotomy – the modern treatment for mitral stenosis
Inflated balloon across the mitral valve Long back, mitral stenosis (narrowing of the valve between the left atrium and left ventricle) used to be treated by a surgery known as closed mitral valvotomy in which the surgeon used to open the chest and introduce a mechanical device to enlarge the narrowed valve through the tip of the left ventricle. Currently this procedure has become obsolete and almost extinct with the development of balloon mitral valvotomy (BMV). In this procedure, balloon at the tip a long tube (balloon catheter) is used to enlarge the narrowed valve. The balloon catheter for this procedure is introduced ...
Source: Cardiophile MD - August 30, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Heart Disease FAQ Source Type: blogs

Masimo rainbow DCI-mini Hemoglobin Spot-Check Sensor Cleared in Europe, Japan
Masimo has received European and Japanese regulatory approvals to introduce the rainbow DCI-mini non-invasive hemoglobin (SpHb) sensor. Intended for infants and small kids weighing 3 to 30 kg (6.6 lbs to 66 lbs), the sensor connects to Masimo’s Pronto monitor that displays the readings. Finger sensors for hemoglobin have only been available for patients 10 kg (22 lbs) and larger, making catching anemia difficult in small kids without the drama of drawing blood. The DCI-mini is clipped onto to a child’s finger, or a toe on smaller kids, and provides spot-check readings at any time. Masimo hopes that the new dev...
Source: Medgadget - August 29, 2014 Category: Technology Consultants Authors: Editors Tags: Anesthesiology Cardiology Critical Care Pediatrics Source Type: blogs

Technology, Lower Reimbursements Reduce Number of Radiology Positions
I have blogged before about the shrinking residency and job opportunities in radiology (see: Job Prospects Dimming for Residents in Radiology; Defining the Underlying Problems; Radiology Jobs Trend Downward; Blame Technology and Reimbursement). Also see this: Job Prospects Are Dimming for Radiology Trainees. This seems to be the result of a number of factors including: (1) incumbent radiologists are able to work more efficiently due to RIS/PACS support; (2) some radiologists have reportedly postponed their retirement due to the financial downturn in 2008; (3) teleradiology enabled some radiologists to find part-time ...
Source: Lab Soft News - August 29, 2014 Category: Pathologists Authors: Bruce Friedman Tags: Healthcare Delivery Healthcare Information Technology Source Type: blogs

The RUC. "an Independent Group of Physicians?" - But It Includes Executives and Board Members of For-Profit Health Care Corporations and Large Hospital Systems
Introduction We just discussed how a major story in Politico has once again drawn attention to the opaque RUC (Resource Based Relative Value System Update Committee) and its important role in determining what physicians are paid for different kinds of services, and hence the incentives that have helped make the US health care system so procedurally oriented.  (See the end of our last post for a summary of the complex issues that swirl around the RUC.)The Politico article covered most of the bases, but notably omitted how the RUC may be tied to various large health care organizations, especially for-profit, and how the...
Source: Health Care Renewal - August 28, 2014 Category: Health Management Tags: AMA boards of directors conflicts of interest health care prices healthcare executive hospital systems perverse incentives regulatory capture RUC Source Type: blogs

My University of Michigan Experience
By: Ethel Osei-Tutu, medical student, University of Cape Coast, School of Medical Sciences, Ghana Editor’s Note: For more information on the Ghana–Michigan medical student exchange program, see “Perceptions of Ghanaian Medical Students Completing a Clinical Elective at the University of Michigan Medical School” by Abedini, Danso-Bamfo, and colleagues, published in the July issue.  The University of Cape Coast, School of Medical Sciences (UCCSMS) began a yearly exchange program with the University of Michigan (UMich) in 2012. Four final-year students from UCCSMS are selected each year based on merit ...
Source: Academic Medicine Blog - August 28, 2014 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Trainee Perspective international exchange program international medical education patient centered care University of Cape Coast School of Medical Sciences University of Michigan Medical School Source Type: blogs

How Much Is My Colonoscopy Going to Cost? $600? $5,400?
By JEANNE PINDER How much does a colonoscopy cost? Well, that depends. If you’re uninsured, this is a big question. We’ve learned that cash or self-pay prices can range from $600 to over $5,400, so it pays to ask. If you’re insured, you may think it doesn’t matter. Routine, preventive screening colonoscopies are to be […] (Source: The Health Care Blog)
Source: The Health Care Blog - August 27, 2014 Category: Consumer Health News Tags: THCB Anesthesia Billing Colonoscopy Facility fee Gastroenterology Labs pricing Source Type: blogs

The Smallest Drugs
Here is the updated version of the "smallest drugs" collection that I did the other day. Here are the criteria I used: the molecular weight cutoff was set, arbitrarily, at aspirin's 180. I excluded the inhaled anaesthetics, only allowing things that are oils or solids in their form of use. As a small-molecule organic chemist, I only allowed organic compounds - lithium and so on are for another category. And the hardest one was "Must be in current use across several countries". That's another arbitrary cutoff, but it excludes pemoline (176), for example, which has basically been removed from the market. It also gets rid of ...
Source: In the Pipeline - August 27, 2014 Category: Chemists Tags: Chemical News Source Type: blogs

This is what lifelong learning in medicine should look like
He left a little early to stop by the cath lab to see his patient before her procedure.  Cordial “hellos,” “good mornings,” and “any last questions?” were mentioned before she signed her consent.  The team was working feverishly to prepare her for her procedure.  “Have you met the anesthesiologist yet?” was next, and almost on cue, the anesthesiologist arrived and took over for a bit. 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 - August 27, 2014 Category: Journals (General) Authors: Tags: Physician Heart Source Type: blogs

Will dermal rolling get rid of acne scars? The Beauty Brains Show episode 45
What is dermal rolling? Does it really get rid of acne scars? And most importantly, is it safe and effective to do it to yourself at home?  Click below to play Episode 45 or click “download” to save the MP3 file to your computer. Show notes The Cosmetic Categories Game Tune in as I try to stump Randy in a new game that features beauty products, beauty brands and beauty ingredients. Question of the week: Will dermal rollers get rid of acne scars? Chris asks…Does dermal rolling really work to remove acne scars and can you do it at home? How does dermal rolling/micro needling work? A dermal roller is one of the device...
Source: thebeautybrains.com - August 26, 2014 Category: Physicians With Health Advice Authors: Perry RomanowskiThe Beauty Brains Tags: Claims Podcast Problems Safety Source Type: blogs

Small Molecules - Really, Really Small
Mentioning such a small compound as pirfenidone prompts me to put up the graphic shown below: these are the smallest commonly used drugs that I can think of. (OK, there's cocaine as a nasal anaesthetic - no, really - but that's where I draw the line at "commonly used". Nominations for ones that I've missed are welcome, and I'll update the list as needed. Note: four more have been added since the initial post, with more to come. This sort of thing really makes a chemist think, though - some of these compounds are very good indeed at what they do, and have been wildly successful. We need to keep an open mind about small mole...
Source: In the Pipeline - August 25, 2014 Category: Chemists Tags: Drug Industry History Source Type: blogs

Dealing with physicians who have lost empathy and compassion
I am a regular reader of patient blogs, and I find myself frequently gasping at the mistreatment they experience at the hands of my peers. I recently had the “pleasure” of being a patient myself, and found that my professional ties did not protect me from outrageously poor bedside manners. I suppose I’m writing this partly to vent, but also to remind health care professionals what not to do to patients waking up from anesthesia. I also think my experience may serve as a reminder that it’s ok to fire your doctor when conditions warrant. Continue reading ... Your patients are rating you online: How to respond. Mana...
Source: Kevin, M.D. - Medical Weblog - August 22, 2014 Category: Journals (General) Authors: Tags: Physician GI Source Type: blogs

Peri-op Cardiac Evaluation Guidelines Updated
The ACC/AHA have just released updated guidelines on perioperative cardiac evaluation and management for non-cardiac surgery patients. …recommendations in the updated guideline address elective non-cardiac surgery, which should be delayed 14 days after balloon angioplasty, 30 days after bare-metal stent implantation, and optimally 365 days after drug-eluting stent implantation The post Peri-op Cardiac Evaluation Guidelines Updated appeared first on Waking Up Costs. (Source: Waking Up Costs)
Source: Waking Up Costs - August 20, 2014 Category: Anesthesiology Authors: Clark Tags: Anesthesia Medicine Source Type: blogs

Does anesthesia cause memory loss?
A reader searching Google using the following keywordsdoes anesthesia cause memory losswas directed to this article in the Alzheimer's Reading Room.Does anesthesia increase the odds of developing dementia later in life?Does anesthesia increase the odds of developing dementia later in life? Does anesthesia hasten memory loss in persons already living with Alzheimer's and dementia?Does Anesthesia Cause Dementia or Memory Loss in the Elderly?Bob De Marco Alzheimer's Reading RoomTo learn more about Alzheimer's and Dementia care visit the Alzheimer's Reading Room (Source: CareGiver, The)
Source: CareGiver, The - August 20, 2014 Category: Dementia Authors: Bob DeMarco Source Type: blogs

Life with chronic pain
I was very intrigued to read this article on a man's advice on living with a wife in chronic pain. I admit I might be guilty of some of the first ten myself. My husband does pick up on when I am overdoing things and cues me to take it easier.I also know sometimes when I want to do things and feel like I should do them but just don't have it in me. I try to work around it. I'll lie down for a while and then try later on. Or I'll put it off until the next day. Sometimes I ask my husband to do things for me - like making dinner - because the idea of standing in the kitchen for ten minutes just isn't a good idea.If you read hi...
Source: Caroline's Breast Cancer Blog - August 19, 2014 Category: Cancer Tags: pain levels Source Type: blogs

Top stories in health and medicine, August 19, 2014
From MedPage Today: Hospitals Question Charity for Some Patients. As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t. Antibiotics Early in Life May Boost Obesity Risk. Exposure to antibiotics early in life may permanently alter gut microbes in a way that could increase obesity risk years later. Huge Variations in Blood Test Charges ‘Irrational’. One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test ch...
Source: Kevin, M.D. - Medical Weblog - August 19, 2014 Category: Journals (General) Authors: Tags: News Hospital Obesity Source Type: blogs

Are American doctors paid too much or too little?
A version of column was published in USA Today on July 2, 2014. There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs.  I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, while those of specialists like radiologists or anesthesiologists approach $300,000.  It seems like a lot of money. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out h...
Source: Kevin, M.D. - Medical Weblog - August 15, 2014 Category: Journals (General) Authors: Tags: Kevin's Take Health reform Primary care Source Type: blogs

To the ABIM: What Real Life-long Learning Should Look Like
He left a little early to stop by the cath lab to see his patient before her procedure.  Cordial "Hello's" and "Good mornings" and "Any last questions?" were mentioned before she signed her consent.  The team was working feverishly to prepare her for her procedure.  "Have you met the anesthesiologist yet?" was next, and almost on cue, the anesthesiologist arrived and took over for a bit. He (Source: Dr. Wes)
Source: Dr. Wes - August 15, 2014 Category: Cardiology Authors: Westby G. Fisher, MD Tags: ABMS American Board of Internal Medicine American Board of Medical Specialties Source Type: blogs

EMA Journal August 2014
Issue 4 (Vol. 26) of EMA Journal for 2014 was published online on 4th August. Editorial overview by Andrew Gosbell & Geoff Hughes Lifers – the loneliest doctors   (#FOAMed) In the latest dispatch from the FOAM Frontier, Spiegel (@EMNerd_), Johnston (@Eleytherius), Ercleve (@Ercleve) and Nickson (@precordialthump) takes us on board the deep space transporter Odysseus where the deep space medics, jovially known as ‘Lifers’, deal with the perils of the induced mental and physiological stasis of passengers who make the centuries long voyages through deep space. The goal of appropriate sedation and ‘quenc...
Source: Life in the Fast Lane - August 15, 2014 Category: Emergency Medicine Authors: Mike Cadogan Tags: Education EMA Journal Emergency Medicine dental emergencies esop tool kit Lifers pediatric fractures Source Type: blogs

To the ABIM: What Real Life-long Learning Should Look Like
He left a little early to stop by the cath lab to see his patient before her procedure.  Cordial "Hello's" and "Good mornings" and "Any last questions?" were mentioned before she signed her consent.  The team was working feverishly to prepare her for her procedure.  "Have you met the anesthesiologist yet?" was next, and almost on cue, the anesthesiologist arrived and took over for a bit. He (Source: Dr. Wes)
Source: Dr. Wes - August 15, 2014 Category: Internists and Doctors of Medicine Authors: DrWes Source Type: blogs

Better Measurement Of Maternity Care Quality
TweetA thought-provoking paper published this month in Health Affairs shows stunning variation in rates of obstetrical complications across U.S. hospitals. This type of research is important and necessary because focusing on averages masks potentially large differences in how patient care is provided and how clinical decisions are made. From a policy perspective, it’s crucial to identify and learn from hospitals that are “positive deviants,” that is – hospitals with better-than-expected quality of care. From a pregnant woman’s perspective, having information on hospital rates of hemorrhage, infection, or lacerati...
Source: Health Affairs Blog - August 12, 2014 Category: Health Management Authors: Katy Kozhimannil Tags: All Categories Health Care Delivery Hospitals Patient Safety Quality Source Type: blogs

Research and Reviews in the Fastlane 043
This study claimed a sensitivity and specificity of 100% in this group of patients questioning the traditional “CT, LP” approach to managing patients with clinical suspicion for SAH. However, the study has flaws and we eagerly await external validation. Recommended by: Salim R. Rezaie Emergency Medicine Williams CM, Maher CG, Latimer J et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014 Jul 23. pii: S0140-6736(14)60805-9. doi: 10.1016/S0140-6736(14)60805-9. PMID 25064594 Should we continue to give paracetamol for lower back pain? In this Austral...
Source: Life in the Fast Lane - August 12, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Anaesthetics Emergency Medicine Infectious Disease Intensive Care Neurology Pediatrics Pre-hospital / Retrieval R&R in the FASTLANE Radiology Toxicology and Toxinology critical care literature recommendations research and reviews Source Type: blogs

A primer on the anesthesia care team model
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Daily, and often several times a day, I am asked by patients about my role as a physician anesthesiologist.  Occasionally the answer involves reiterating to patients that an anesthesiologist is a physician.  Once we get into the discussion, patients are also surprised to learn that as part of an anesthesia care team (ACT), although I am frequently in their operating room and always available, I may not be physically present in their OR throughout the entire procedure.  This is usually when confused or frightened faces appear before...
Source: Kevin, M.D. - Medical Weblog - August 10, 2014 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Online Bidding for Best Price for Orthopedic Surgery with Medibid
I have posted a number of previous notes about so-called medical tourism whereby U.S. consumers seek medical care abroad for a reduced price (see, for example: Two Drivers for Medical Tourism: Public-Private Partnerships and Medical Insurance Participation). A total hip replacement is available at hospitals in India for a fraction of the cost in the U.S. Obviously, the people who seek such services are uninsured or under-insured. A new and interesting option for reduced price surgery at U.S. facilities is available via a web site called Midibid. This was discussed in a recent article (see: Patients Seeking Chea...
Source: Lab Soft News - August 8, 2014 Category: Pathologists Authors: Bruce Friedman Tags: Cost of Healthcare Health Insurance Healthcare Business Healthcare Delivery Medical Consumerism Source Type: blogs

That's "informed" consent
My friend and colleague, Doug Hanto (a world class transplant surgeon) reports on Facebook about the birth of his grandson at St. Vincent Carmel Hospital in Indiana:Interesting. Lindsay is about to have a C-section this morning, and we will welcome John Douglas into the world. The nurse handed Lindsay informed consent for C-section, anesthesia, blood transfusion, circumcision, and HBV vaccine with no explanation. Like signing the agreement you have to sign when updating your OSX or windows software. They all say "Your physician has explained ..." No one has explained anything. Trust is alive and well in the real world. Thi...
Source: Running a hospital - August 8, 2014 Category: Health Managers Source Type: blogs

Back Pain Doctor Sarasota Fl
Failed back syndrome, or lumbar post-laminectomy syndrome, is the term given to patients who have had back surgery for back pain, but continue to have pain after surgery. Even worse, their back pain can be worse after the surgery. The main problem is the fact that low back pain is not an indication for back surgery – any more than neck pain is an indication for neck surgery (failed neck surgery: cervical post-laminectomy syndrome). Surgery done for the sole purpose of relieving neck or back pain is doomed to failure. Many spine surgeons make the false assumption that if a patient has back pain and there is a spine MR...
Source: Sarasota Neurology - August 7, 2014 Category: Neurologists Authors: Dan Kassicieh, D.O. Tags: Back Pain Platelet Rich Plasma Back Pain Doctors Back Pain Specialist joint pain Sarasota Neurology Surgery Source Type: blogs

Physician Payments Sunshine Act: Over 100 Medical Associations and Societies Urge CMS To Reconsider CME Exemption and Open Payments Timeline
Medial associations and specialty societies have been understandably frustrated with the way the Physician Payments Sunshine Act has rolled out so far. Yesterday, over 100 medical societies including the American Medical Assocation--49 state medical societies and 64 medical specality societies--sent a letter to Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services (CMS) asking for redress over three problematic issues: (1) the expansion of reporting requirements for educational activities, (2) Open Payments’ condensed timeframe for physician registration, and (3) the complicated r...
Source: Policy and Medicine - August 6, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Interview with Jim Welch, EVP, Sotera Wireless
This interview is with a long established thought leader in patient monitoring and alarm notification, Jim Welch. Jim has demonstrated a knack for bringing a fresh approach to long-term persistent problems in monitoring, nursing vigilance and patient care. At Sotera Wireless, Jim’s had a chance to re-imagine patient monitoring in low acuity settings with predictably innovative results. At the AAMI 2014 conference, I had the opportunity to attend the breakfast symposium where Jim presented, Transforming Care in Non-ICU Settings through Disruptive Continuous Monitoring Technology. The following discussion centers on patien...
Source: Medical Connectivity Consulting - August 4, 2014 Category: Technology Consultants Authors: Tim Gee Tags: Clinical Alarms Company Profiles Patient Safety alarm notification Source Type: blogs

Twenty Twitter Rules
We present one side (the coherent one) of a tête-à-tête between Gregory Miller, MD and Matt/Mike Dawson, recorded sometime between sudoku-smackdown and coffee-time… …I applaud you for taking on the huge field of Social Media. Blogs are easy to figure out. Most people don’t want to start a blog or write an ebook. What I think is lacking (or at least *I* haven’t seen it) is “How to use Twitter to improve your medical practice.” I agree that Twitter is extremely useful in medicine as the speed-dating version of blogs. It has the advantage of being easily digested...
Source: Life in the Fast Lane - August 4, 2014 Category: Emergency Medicine Authors: Mike Cadogan Tags: FOAM Social Media Web Culture Greg Miller MD Gregory Miller matt dawson Rules Twitter Twitter rules Source Type: blogs

The execution in Arizona: There’s no mystery why it took so long.
There’s no mystery about why the July 23 execution of Joseph Wood in Arizona took so long. From the anesthesiologist’s point of view, it doesn’t seem surprising that the combination of drugs used — midazolam and hydromorphone — might take nearly two hours to cause death. 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 - August 2, 2014 Category: Journals (General) Authors: Tags: Meds Medications Source Type: blogs