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

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

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

Opening narrowed heart valves without surgery
Opening narrowed heart valves without surgery is by dilating them with balloons introduced into the heart through blood vessels. The procedure is known as balloon dilatation or balloon valvotomy. Four Valves in the Heart There are four valves for a normal heart. The mitral valve or bicuspid valve separates the left atrium (upper chamber) from the left ventricle (lower chamber). The aortic valve separates the left ventricle from the aorta, the largest artery of the body carrying oxygenated blood. The tricuspid valve separates the right atrium from the right ventricle and the pulmonary valve separates the right ventricle fr...
Source: Cardiophile MD - August 2, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Source Type: blogs

Funtabulously Frivolous Friday Five 101
It is 393 days since the last instalment of Funtabulously Frivolous Friday Five (FFFF episode 100) and since the last posting we have been inundated with a steady trickle of email protestation. The arbitrary threshold for re-instatement was forcibly fixed for Fifty, and thus the 50th email became the straw that broke the authors back and we return once again to the arcane world of the Who, What, Where, Why and When of medical trivia. Bring back Funtabulously Frivolous Friday!! I, and my colleagues miss it!! …from a cardiology nurse, who enjoys more than cardiology! – madeupquote.com Question 1 What was the...
Source: Life in the Fast Lane - August 1, 2014 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five FFFF medial quiz Medical Trivia Mrs. Winslow's Soothing Syrup Source Type: blogs

Unusual calls in cardiology : A Pacemaker lead and a clavicle fracture !
A tense anesthetist  calls for help ! I had an unusual cardiac consult last week .A middle aged man who was to undergo routine ortho surgery wanted  a cardiac clearance. It was  a through and through fracture of clavicle , why do they need a cardiology opinion , it seemed a  simple  procedure I asked over phone The anesthetic  fellow who was  in charge of the patient told me ,”There is a wire just going parallel to the clavicle sir .I  believe it is pacemaker lead” I agreed to see the patient immediately This was the X-ray It was obvious why they got tensed up  as the pacemaker wire criss -crossed sur...
Source: Dr.S.Venkatesan MD - July 31, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Unity Farm Journal - 5th Week of July 2014
The great thing about running a farm is that every day is filled with the unexpected.Sunny, our new baby alpaca did not consume her first meal of mother’s milk in time to receive the antibodies that are necessary to keep her healthy.   She was not gaining weight.   We had only one choice - a transfusion of alpaca plasma containing IgG (about $150).     We drove to Tufts Veterinary School and picked up 500cc of plasma.   There are two ways to transfuse a baby alpaca - jugular vein IV or peritoneal infusion.   Inserting an IV in a baby alpaca is like wrestling an alligator.  We chose the ...
Source: Life as a Healthcare CIO - July 31, 2014 Category: Technology Consultants Source Type: blogs

Fire!
Earlier this month, Modern Healthcare published a story about the slow movement by hospitals to prevent operating room fires. An excerpt:Despite a slew of news accounts about patients being set on fire in operating rooms across the country, adoption of precautionary measures has been slow, often implemented only after a hospital experiences an accident. Advocates say it's not clear how many hospitals have instituted the available protocols, and no national safety authority tracks the frequency of surgical fires, which are thought to injure patients in one of every three incidents. About 240 surgical fires occur every year,...
Source: Running a hospital - July 30, 2014 Category: Health Managers Source Type: blogs

Evidence from UK Casts Doubt on Assertion that Electronic Cigarettes are a Gateway to Youth Smoking Addiction
The Centers for Disease Control has asserted that electronic cigarette use among youth is a gateway to a lifetime of addiction to smoking. This assertion, which has been picked up by politicians and health groups throughout the country, is being used to justify extreme proposals, such as those to ban e-cigarette advertising and to ban all e-cigarette flavorings.But is there any truth to the assertion that electronic cigarettes are a gateway to youth smoking? New evidence from the UK suggests not. Despite the widespread proliferation of electronic cigarettes throughout England during the past few years, and a concomitant in...
Source: The Rest of the Story: Tobacco News Analysis and Commentary - July 28, 2014 Category: Addiction Source Type: blogs

No Mystery: Arizona Execution Lengthy Due to Drug Choice
By KAREN SIBERT, MD 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. Here’s why. The convicted murderer didn’t receive one component of […] (Source: The Health Care Blog)
Source: The Health Care Blog - July 26, 2014 Category: Consumer Health News Tags: THCB Agonal breathing anesthesiology Benzodiazepines Clayton Locket death penalty Hydromorphine Joseph Wood Lethal injection Source Type: blogs

Comfortably Numb
At the dentist, waiting for the fifth round anesthetic injections to take effect. This should do it. I can chew off my own lower lip now. (Source: Dr. X's Free Associations)
Source: Dr. X's Free Associations - July 25, 2014 Category: Psychiatrists and Psychologists Authors: DrX Tags: Front Page Source Type: blogs

3 ways to master the art of teaming in medicine
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As a physician anesthesiologist in a community hospital setting for more than 25 years, the quest for mastery keeps my practice from getting stale or boring. I relish the technological innovations in the past decade: the video laryngoscopes and ultrasound-guided nerve blocks that allow my skills and competencies to be ever-challenged. There is a magnetic draw to new procedural techniques, such as trancatheter aortic valve replacements (TAVR), which allow us to provide previously untenable options to patients. Continue reading ... Your...
Source: Kevin, M.D. - Medical Weblog - July 24, 2014 Category: Journals (General) Authors: Tags: Physician Hospital Surgery Source Type: blogs

Continuum of Care on WIHI
Madge Kaplan writes:The next WIHI broadcast — From Prehospital to In-Hospital: The Continuum for Time-Sensitive Care — will take place on Thursday, July 24, from 2 to 3 PM ET, and I hope you'll tune in.Our guests will include:Kedar Mate, MD, Vice President, Institute for Healthcare Improvement (IHI)David Williams, PhD, Improvement Advisor and Founder, TrueSimpleJonathan R. Studnek, PhD, NRP, Quality Improvement Manager, Mecklenburg EMS Agency (North Carolina)Kevin Rooney, MBChB, FRCA, FFICM, Consultant in Anaesthesia and Intensive Care Medicine; Professor of Care Improvement, University of the West of Sc...
Source: Running a hospital - July 24, 2014 Category: Health Managers Source Type: blogs

Where does the 10% myth come from?
No one knows exactly.  A nice summary of what we do know is provided in a recent WIRED piece here. William James was thought to play a role, based on a quote from Dale Carnegie's book, How to win friends and influence people, but this may have been a misquote.  Kolb and Wishaw's classic text, Fundamentals of Human Neuropsychology suggests Flourens work in the early 1800s as a likely empirical foundation for the myth.  Flourens of course is famous for his empirical attack on phrenology.  His method involved ablation studies in a variety of animals--chickens, pigeons, frogs, dogs, rabbits--in which h...
Source: Talking Brains - July 24, 2014 Category: Neurologists Authors: Greg Hickok Source Type: blogs

Patient education: Simple solutions are the best solutions
In another entry for the communication category, here’s a little play I wrote: Scene: Pre-op area.  Patient arrives for surgery exactly at the scheduled start time, that is, 90-minutes late. Anesthesiologist (me): Good morning Mrs. Jones.  I’m Dr. so-and-so.  How are you this morning? Patient: Oh, doctor, I have the most terrible headache.  They told me my surgery was at 11 so here I am at 11, and now they tell me I’m late. Me:  It’s OK, Mrs. Jones.  It’s a common mistake.  Now, did you have anything to eat this morning? Patient: Oh, no, doctor.  Just a little toast and coffee. Pause, as the anesthesiolo...
Source: Kevin, M.D. - Medical Weblog - July 22, 2014 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Delete Blood Cancer: What You May Not Know About Bone Marrow Donation
We all know about blood drives and the importance of blood and platelet donations to save lives. And millions of people are registered organ donors (usually when they get their driver’s license). But did you know that there is another renewable, life-saving resource you could give?  It’s your blood stem cells/bone marrow. Only 11 million Americans are registered with the National Marrow Donor Program to help save lives if their blood stem cells match a person fighting any one of 70 blood cancers and diseases. Each year, nearly 20,000 people are in need of blood stem cell/bone marrow transplants as their last hope for ...
Source: Disruptive Women in Health Care - July 22, 2014 Category: Consumer Health News Authors: DW Staff Tags: Access Advocacy Cancer Consumer Health Care Patients Publc Health Source Type: blogs

The Need for Brave Health Reform
A Proposal for Private Health Reform in Australia Australia’s health system is in need of reform.  A recently published article by Country Doctor on KevinMD.com prompted me to solidify my thoughts on potential solutions which could improve the private health system in Australia.  My apologies to our international readers for whom this will have less relevance, although I believe there are key messages that apply to all of our health systems. In basic terms, the Federal Government in Australia funds General Practice consultations, Specialist Outpatient consultations and private hospital specialist fees via Medica...
Source: Life in the Fast Lane - July 22, 2014 Category: Emergency Medicine Authors: Sean Rothwell Tags: Administration Featured Health Reports Politics Australia health reform MBS Medicare Benefits Scheme PHI private health Private Health Insurance Source Type: blogs

Research and Reviews in the Fastlane 040
In this study the role of a “1/2 dose” thrombolysis was evaluated for the reduction of pulmonary artery pressure in moderate PE. A total of 121 patients with moderate PE received either tissue plasminogen activator plus anticoagulation or anticoagulation alone with the primary end points of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. The results suggested that the ½ dose or “safe dose” thrombolysis was safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was ma...
Source: Life in the Fast Lane - July 21, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Gastroenterology Haematology Health Infectious Disease Intensive Care Neurology Pre-hospital / Retrieval Respiratory critical care literature R&R in the FASTLANE Source Type: blogs

Tech Will Transform the Doctor-Patient Relationship
This article was originally published in the Health Service Journal — Jen Hyatt is founder and chief executive of Big White Wall and  a Disruptive Woman to Watch in 2014.  (Source: Disruptive Women in Health Care)
Source: Disruptive Women in Health Care - July 21, 2014 Category: Consumer Health News Authors: DW Staff Tags: Access Advocacy HIT/Health Gaming Innovation Source Type: blogs

The worst word in the English language...
lumpNot Cancer, strangely enough, but 'lump'.You see, Cancer is known. It is a 'thing' a thing which has a protocol, a plan which can be managed.  A lump is none of those things. It is just a lump; something which shouldn't be there and is.  Something which could be utterly benign, something which may just be a comma in the sentence of my breast which will go or it could be cancer, again.It's 2014, nearly 9 years after my diagnosis of Breast cancer 1 in September 2005 and I have another scare.A lump which appeared about three weeks ago in the 'other' breast. It doesn't 'feel' like cancer, if I can be that familia...
Source: A Woman of Many Parts - July 17, 2014 Category: Cancer Authors: Minerva Source Type: blogs

The LITFL Review 144
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around. Welcome to the 144th edition, brought to you by: Kane Guthrie [KG] from LITFL Tessa Davis [TRD] from LITFL and Don’t Forget The Bubbles Brent Thoma [BT] from BoringEM, and ALiEM Chris Ni...
Source: Life in the Fast Lane - July 16, 2014 Category: Emergency Medicine Authors: Kane Guthrie Tags: Education eLearning Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs

Research and Reviews in the Fastlane 039
Welcome to the 39th 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 13 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 f...
Source: Life in the Fast Lane - July 14, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Cardiology Emergency Medicine Emergency Medicine Update Featured Infectious Disease Intensive Care Pre-hospital / Retrieval Resuscitation critical care literature R&R in the FASTLANE recommendations research and revi Source Type: blogs

How to Talk About Pain - NYT
LONDON — IN 1926, Virginia Woolf published an essay on pain, "On Being Ill." Isn't it extraordinary, she observed, that pain does not rank with "love, battle and jealousy" among the most important themes in literature. She lamented the "poverty of the language of pain." Every schoolgirl who falls in love "has Shakespeare, Donne, Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry." Where are the novels or epic poems devoted to typhoid, pneumonia or toothaches, Woolf wondered? Instead, the person in pain is forced to "coin words himself, and, tak...
Source: Psychology of Pain - July 13, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

How To Be A Bad Gastroenterologist
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. Yesterday I 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 healthcare 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. I chose my gastroenterologist based on his credentials and the q...
Source: Better Health - July 10, 2014 Category: American Health Authors: Dr. Val Jones Tags: Opinion True Stories Bad Bedside Manner Bad Doctors Colonoscopy Compassion Empathy Gastroenterologist Lack Lack of Caring Source Type: blogs

Research and Reviews in the Fastlane 038
This study, however, has major flaws and biases that question the validity of their conclusions. Only 19% of centers that were contacted agreed to contribute data to the Consortium. Additionally, the researchers do not assess the quality of the studies included in their meta-analysis. Regardless, observational data should not be used to trump the RCT data included in the recent, Cochrane review. Finally, Roche pharmaceuticals was a major sponsor of this research team. The accompanying editorial is a must-read. Recommended by: Anand Swaminathan Infection Control, Hand hygiene D’Egidio G et al. A study of the ...
Source: Life in the Fast Lane - July 10, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured Infectious Disease Intensive Care Neurology Palliative care R&R in the FASTLANE Radiology Resuscitation Trauma critical care literature recommendations research and reviews Source Type: blogs

Guest blogger Dr. Sana Johnson-Quijada on Freedom and Self Care
I met Dr. Sana Johnson-Quijada at the APA Annual Meeting this year in New York.   Sana has her own blog Friend to Yourself, and I invited her to do a guest blog on Shrink Rap.  In honor of Independence Day, she sent the following post.  Self-Care is Freedom, is Democracy, is Because We Are Accountableauthenticsociety.comSelf-Care Tip #159 – Be accountable for and to yourself.It was about 100 degrees Fahrenheit, which in my part of the world is considered hot.  But in Washington D.C., I considered that temperature general anesthesia.  I was breathing it in and trying hard to remain alert...
Source: Shrink Rap - July 6, 2014 Category: Psychiatrists and Psychologists Authors: Dinah Source Type: blogs

Common Back and Leg Pain Treatment May Not Help Much, Study Says - NYTimes.com
A widely used method of treating a common cause of back and leg pain — steroid injections for spinal stenosis — may provide little benefit for many patients, according to a new study that experts said should make doctors and patients think twice about the treatment.Hundreds of thousands of injections are given for stenosis each year in the United States, experts say, costing hundreds of millions of dollars.But the study, the largest randomized trial evaluating the treatment, found that patients receiving a standard stenosis injection — which combine a steroid and a local anesthetic — had no less pain and virtually ...
Source: Psychology of Pain - July 3, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

Help wanted
You need to have brain surgery. Wouldn't you want a surgeon who had experience in the field (as opposed to, say, removing ingrown toenails)?Me, too.So, this is an interesting job ad. A hospital is looking for an anesthesiologist. That's the person in charge of making sure you're deeply out when they cut you open, watches your vital signs to make sure you're not dying on the table, and then (hopefully) wakes you up after the surgeon has put you back together.So shouldn't they want someone who'd previously done that a few times?Apparently not:Yes folks, you read that correctly. They want an anesthesiologist, but experience u...
Source: Doctor Grumpy in the House - July 3, 2014 Category: Neurologists Authors: Grumpy, M.D. Source Type: blogs

Healthcare Update Satellite — 07-2-2014
Ve have vays of keeping you qviet. Halt den mund! Government-contracted security force who actually call themselves the “Brown Shirts” … threatens to arrest medical providers if they leak any information to media about all of the medical illnesses that are being seen at an illegal alien refugee camp in Lackland Air Force Base. By the way, this story is from FoxNews, so everyone should just ignore it until you or your family members sit next to one of them on a bus or in a movie theater. Combine these kids on playgrounds with anti-vax kids? What could go wrong? Nothing to worry about. Nothing at all. New Y...
Source: WhiteCoat's Call Room - July 2, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

My Difficult Airway
Looks can be deceiving. I was not supposed to have a difficult airway, but we found out the hard way that wasn’t true. I was about to undergo an exploratory laparotomy for suspected appendicitis in 1989, and my wife was adamant that an attending anesthesiologist perform my intubation. The anesthesiology resident at a large Midwest teaching hospital made a claim that I suspect many of us did as we advanced through training and began to feel procedurally invincible. He claimed that the attending anesthesiologist rarely did intubations, and that the residents who performed them daily were more prepared. Unaware of any uniqu...
Source: M2E Too! Mellick's Multimedia EduBlog - July 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research and Reviews in the Fastlane 037
Conclusion: Use of an age-adjusted d-dimer threshold reduces imaging among patients age <50 years with a Revised Geneva Score ≤ 10. While the adoption of an age-adjusted d-dimer threshold is probably safe, the confidence intervals surrounding the additional 1.5% of PE that was missed using an age-adjusted threshold necessitate a prospective study before this practice can be adopted into routine clinical care. Recommended by: Salim R. Rezaie,  Jeremy Fried Read More: The Adventure of the Golden Standard (Rory Spiegel) Resuscitation Wik L et al. Manual vs. integrated automatic load-distributing band CPR with equal ...
Source: Life in the Fast Lane - July 2, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured General Surgery Health Infectious Disease Intensive Care Neurology Neurosurgery Radiology Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations Source Type: blogs

A perfect thank you note to an oncologist
I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery.  The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa deferentia.  In other words, could my patient, a 42-year-old survivor of stage IV Hodgkin’s disease, tolerate a vasectomy? Continue reading ... Your patients are rating you online: How to respond. Manage your online reput...
Source: Kevin, M.D. - Medical Weblog - June 26, 2014 Category: Journals (General) Authors: Tags: Physician Cancer Surgery Source Type: blogs

Research and Reviews in the Fastlane 036
This study found that a high percentage (49%) of patients with serious adverse outcomes after an ED visit for COPD were not initially admitted to the hospital. The authors used logistic regression to derive a decision instrument to aid in determining which patients with COPD exacerbation should be admitted based on risk stratification. The study does not show that admission improves outcomes but the instrument may prove useful for risk stratification if it is prospectively validated. Recommended by: Anand Swaminathan Emergency Medicine, Critical care, Anaesthetics Barends CRM ,Absalom AR. Tied up in science: unknotting ...
Source: Life in the Fast Lane - June 25, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Health Infectious Disease Intensive Care Respiratory Resuscitation critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

I don't feel your pain - Ideas - The Boston Globe
IF YOU STOPPED the average person in an emergency room and asked why she's there—not just her guess at the problem, but what really motivated her to show up—the number one answer would be "pain." For all that modern medicine has learned about disease and treatment, it's alleviating pain that still lies at the heart of the profession. And in recent years, the notion of treating "pain" as its own entity has been rising to the forefront in medicine. Pain management now has its own journals, conferences, clinics, and specialists, and pain relief is sometimes referred to as a human right. The In...
Source: Psychology of Pain - June 18, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

Joint Commission’s Speak Up Program™
The Joint Commission along with the Centers for Medicare & Medicaid Services, launched a program in 2002 called Speak Up™.  It encourages patients to take an active role in preventing health care errors by becoming involved and informed participants on their health care team. The Speak Up™ program features brochures, posters, animated videos and now in 2014 infographics, which can be downloaded for free. Their latest release is Speak Up™ Anesthesia. It was developed to raise awareness of the risks of anesthesia or sedation and precautions that should be taken. The infographic includes a description of types of a...
Source: BHIC - June 18, 2014 Category: Databases & Libraries Authors: Michelle Burda Tags: General Health Information Literacy Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865567 This Cochr...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations resear Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine Featured General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendatio Source Type: blogs

The Neuroscience of the Future
Neural prosthetics, brain-computer interfaces (BCI), “closed-loop” deep brain stimulation (DBS) devices, and a world without human brain disorders. The first three of these are already here... is the last one possible?In the utopian world of The Hedonistic Imperative, an ambitious, admirable (and unlikely) 1995 manifesto by philosopher David Pearce, the goal is to “eradicate suffering in all sentient life” through paradise engineering —  which involves sophisticated applications of nanotechnology, genetic engineering, and psychopharmacology. And going beyond the eradication of suffering, “Life-long happiness ...
Source: The Neurocritic - June 16, 2014 Category: Psychiatrists and Psychologists Authors: The Neurocritic Source Type: blogs