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

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

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

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

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

Do EMRs improve patient safety? A debate.
“I’m here to say ‘Yes, they can,’ which is different from ‘Yes, they always do,’” says James Moore, MD, president-elect of the California Society of Anesthesiologists (CSA). To the contrary, enthusiasm for electronic medical records (EHRs) is part of a “syndrome of inappropriate overconfidence in computing,” argues Christine Doyle, MD, the CSA’s Speaker of the House. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 30, 2014 Category: Journals (General) Authors: Tags: Tech Health IT Source Type: blogs

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

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

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

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

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

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

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

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

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

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

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

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