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

Pictures Can Be Worth More Than Words
And they stick in the mind much longer.   This elderly patient was sent to the ED after an ultrasound for a pulsatile mass. The CT tells the story better than words can. What’s the diagnosis?             The CT showed an 8.6 cm AAA, and the patient underwent endovascular aortic repair (EVAR).   EVAR is performed by deploying a stent across the aneurysm site. The site is usually accessed through the femoral artery. EVAR has significantly decreased peri-operative mortality and morbidity because the patient is not subjected to open repair with clamping of the aorta. In fact, it has been reported that more than ha...
Source: Lions and Tigers and Bears - January 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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

Maleficent Troponins
We physicians are obsessed with classifying, sorting, and differentiating in a quest for never-ending precision. We gather all manner of “facts” from our patients. Sights, smells, reactions to pushing or pulling. We divine sounds with antiquated stethoscopes or peer underneath the skin with ultrasound. We subject them to tests of blood, urine, and fluids from any place our needles can reach.     All of this is to arrive at an exact diagnosis that is often frustrated by the secondary nature of the data. Our disappointment has driven us mad, but the promise of exactness from biomarkers leaves us giddy. We have convince...
Source: Spontaneous Circulation - January 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Luke and Lesley’s Excellent Samoan Adventure
BY LUKE HUSBY, MD, & AND LESLEY OSBORN, MD   Ten hours of air time and three cities later, we arrived in the Honolulu airport to be greeted by the Samoan travelers who would be guiding us around Samoa.        Once we arrived in Pago Pago in American Samoa, we hit the ground running with a quick trip to the supply cache at a nearby pastor’s house. After a few hours of sorting, we were ready for the week with the pharmaceuticals, bandages, durable medical equipment, and other supplies that we’d need.   Each plane had a weight limit, and there was only one plane with 31 volunteers. The plane made multiple trips ...
Source: Going Global - January 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research and Reviews in the Fastlane 068
Welcome to the 68th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the...
Source: Life in the Fast Lane - January 29, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care LITFL Microbiology Psychiatry and Mental Health critical care examination LITFL R/V R&R in the FASTLANE recommendations Review Source Type: blogs

To the doctors who have lost patients. This is for you.
We all went into medicine to save lives. Deep within even the most cynical of us, is still that pre-med hopeful that believes we can and should restart each non-beating heart, make the non-breathing breathe and fill with blood those who’ve bled, filling them back with life. We expect that a patient’s condition will improve while under our care, or at least not worsen. Intellectually, we know we’ll not be successful every time. 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 28, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Avoid the blame game during inpatient emergencies
Patients admitted to the hospital ward sometimes get sicker instead of getting better right away.  Often this can happen acutely. Depending on the circumstances, ranging from a “rapid response” for unstable vital signs to a cardiac arrest (a “code”), previously uninvolved hospital staff might be called on to help.  Despite the commotion, these events are a period of time for the health care team to shine.  At inpatient emergencies, dead patients are sometimes brought back to life.  A well-run rapid response can prevent a code.  Other times, a patient whose illness has progressed gets the care she n...
Source: Kevin, M.D. - Medical Weblog - January 28, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

The spookiness about sudden death
You live like this, sheltered, in a delicate world, and you believe you are living … And then some shock treatment takes place, a person, a book, a song and it awakens [you] and saves [you] from death. – Anais Nin On June 12, 2013, my driver and I were on our way to Sierpe, Costa Rica from Manuel Antonio when the road entered a palm tree plantation.  About 50 meters in front of us, a blue hatchback circled into view along a bend in the road, then lost control, veered off into the plantation, and hit a palm tree head on, its front bumper popping out along a dramatic arc back onto the highway. Continue reading ....
Source: Kevin, M.D. - Medical Weblog - January 28, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Achieving Shared Decision-Making In Women’s Health
The frustrating labor and delivery experience shared by physician and ethicist Carla Keirns in her Narrative Matters essay, “Watching The Clock: A Mother’s Hope For A Natural Birth In A Cesarean Culture,” published in the January issue of Health Affairs, was unfortunate. That is not debatable. That her outcome was favorable—a healthy baby ultimately delivered in the way that Keirns had hoped—does not excuse the less-than-ideal coordination, and communication, of care that she received. Fortunately, Keirns had the tools at her disposal—such as medical training and solid relationships throughout the p...
Source: Health Affairs Blog - January 28, 2015 Category: Health Management Authors: John Jennings Tags: All Categories Health Care Delivery Narrative Matters Patient Safety Personal Experience Physicians Policy Quality Source Type: blogs

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

A doctor quits. Before doing the same, consider these 5 things.
This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift. Fresh out of residency, I had accepted a job in the ER of a community hospital which — though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview — had turned into exactly the opposite when I was slugging through the night shifts alone and disgruntled a few months later. The consultants refused to come in. The triage process was a disaster. The waiting room churned with angry patients who would occasionally erupt past the security doors to...
Source: Kevin, M.D. - Medical Weblog - January 28, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

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

CriticaLink Helps Countries Lacking EMS
Jennifer Farrell, a Fulbright scholar and fourth-year medical student at Tulane University, founded CriticaLink, a nonprofit mobile app company, to more quickly help first responders get to accidents in countries where emergency medical services are inconsistent or, in some cases, nonexistent.   Calls made through the app will be dispatched through a call center, or app users can send photos and submit geo-tagged information. When accidents are reported, nearby trained first responders will receive a ping and a pop-up notification on their phones. The number for the call center is a long one for now (096 7878 7878), but ...
Source: Technology & Inventions - January 27, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Resilience, Speaking Up, Reframing: Reflections On Recovery
In October 2014—nearly three years after an auto-pedestrian accident that left me unable to walk—I embarked on a six-day bicycle trip through the Sicilian countryside. An account of the earlier accident and my uneven care experience appeared in the June 2014 issue of Health Affairs (‘Nothing is Broken’: For an Injured Doctor, Quality-Focused Care Misses the Mark), and excerpted in The Washington Post. Despite major improvements in my gait at the two-year mark of physical therapy, I am still cane-dependent, and my orthopedist noted to me that I would never be able to bike again. Surely, this was on my mind ...
Source: Health Affairs Blog - January 27, 2015 Category: Health Management Authors: Charlotte Yeh Tags: All Categories Disabilities Long-Term Care Narrative Matters Personal Experience Source Type: blogs

On Camshafts and Communication
“It’s a really loud rumble as I’m driving along and it sounds like it’s coming from the back axle. I’ve spoken to my mate Dave (he used to rebuild old bikes you know) and he thinks it’s the wheel bearing. Not trying to tell you your job, you understand… You’re the expert…. Have a look and see what you think…”I trail off into a slightly awkward silence that the mechanic cheerfully fills. I realise that what I’ve done is akin to what my patients frequently do; I’ve come into the car emergency department (well, my local garage) with a preconceived idea of what’s wrong because I’ve “spoken t...
Source: Life in the Fast Lane - January 27, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Arcanum Veritas Literary Medicine LITFL Andrew Tabner camshaft communication empathy Source Type: blogs

Moving Beyond Wellness ROI Toward Employment-Based Cultures Of Health: Part I
With their recent post declaring that employment-based wellness initiatives “increase rather than decrease employer spending on health care with no net health benefit,” Al Lewis and coauthors are continuing to exert a clarifying presence in a field with a history of unsubstantiated claims and suspect methods. This conclusion is not supported by the work with which we and others have been associated and is thus not one with which we agree. Nevertheless, Lewis et al. are to be acknowledged for fueling the need for a sharper focus on the core challenge at hand for employers: how best to improve the value of their health...
Source: Health Affairs Blog - January 26, 2015 Category: Health Management Authors: Harris Allen and Raymond Fabius Tags: All Categories Employer-Sponsored Insurance Health Care Costs Nonmedical Determinants Policy Prevention Public Health Research Source Type: blogs

Dear health IT: Please understand our frustrations
Dear health IT staff, I know that, on many levels, physicians must be the absolute banes of your existence.  We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems.  We call you because we forgot our passwords, then because we forgot the new passwords.  We call because the system crashes, and we call because the voice recognition doesn’t work, and we curse the screen and shake our collective fists at things that slow us every day.   I get it. Continue reading ... Your patients are rating you online: How to respond. Manage your onli...
Source: Kevin, M.D. - Medical Weblog - January 26, 2015 Category: Journals (General) Authors: Tags: Tech Emergency Health IT Hospital Source Type: blogs

LITFL Review 166
Welcome to the 166th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.The Most Fair Dinkum Ripper Beauts of the WeekIt’s Junior Doc changeover time in sunny blighty.  Point your new Juniors to this fantastic series from the team in Virchester.  This podcast talks over the basics of Problems in Early Pregnancy. [CC] Helping to get around the difficulty of ...
Source: Life in the Fast Lane - January 25, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Performance measurement has major problems
I started writing about performance measurement and associated problems for 10 years. For the first few years, we in the blogosphere seemed to be shouting in the wilderness. When I first joined the ACP Board of Regents, the general consensus favored P4P. We who questioned the value of performance measures were told that “the train has left the station”. Over the past 7 years, many leaders in medicine have seen what the blogs saw first, we have too many bad measures, and too often performance measurement has significant unintended consequences. Now even MedPac has major concerns about the proliferation of per...
Source: DB's Medical Rants - January 25, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Anatomy of a Missed LAD Occlusion (classified as a NonSTEMI)
A male in his 50's called 911 for constant 8/10 midsternal chest pressure.  Here was his prehospital ECG:Computerized QTc is 423 ms.  The ST elevation at the J-point was measured by the computer (see right side), and is less than the "criteria" for anterior STEMI (2 mm in males over age 40).  There is also almost a saddleback morphology in V2.  I say "almost" because the R' wave is not tall enough to be a typical saddleback. By the subtle LAD occlusion vs. Early Repol formula, this is clearly LAD occlusion: STE60V3 = 2, RAV4 = about 7, value = 25.07 (greater than 23.4 indicates probable LAD occlusion)He...
Source: Dr. Smith's ECG Blog - January 24, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Additional Requirements For Charitable Hospitals: Final Rules On Community Health Needs Assessments And Financial Assistance
On December 29, the Department of the Treasury and the Internal Revenue Service released long-awaited final regulations implementing Affordable Care Act provisions that impose additional obligations on charitable hospital organizations covered by §501(c)(3) of the Internal Revenue Code.  Published in the Federal Register on December 31 2014, the regulations are massive, consolidating a series of prior proposals into a single final body of regulatory law.  The regulations affect more than 80 percent of U.S. hospitals, both the 60 percent that operate as private nonprofit entities and the 23 percent that operate as gover...
Source: Health Affairs Blog - January 23, 2015 Category: Health Management Authors: Sara Rosenbaum Tags: All Categories Consumers Disparities Health Reform Hospitals Nonmedical Determinants Policy Prevention Public Health Source Type: blogs

The marriage between technology and medicine: An interview with John Halamka
Of the nearly 100 people I interviewed for my upcoming book, John Halmaka was one of the most fascinating. Halamka is CIO of Beth Israel Deaconess Medical Center and a national leader in health IT policy. He also runs a family farm, on which he raises ducks, alpacas and llamas. His penchant for black mock turtlenecks, along with his brilliance and quirkiness, raise inevitable comparisons to Steve Jobs. I interviewed him in Boston on August 12, 2014. *** Our conversation was very wide ranging, but I was particularly struck by what Halamka had to say about federal privacy regulations and HIPAA and their impact on his job...
Source: Kevin, M.D. - Medical Weblog - January 22, 2015 Category: Journals (General) Authors: Tags: Tech Emergency Health IT Mobile health Source Type: blogs

Return of Bedlam?
I think you'll only be able to read the first 100 words, but that's okay, I'll tell you what Dominic Sisti and friends have to say in the new JAMA.When I was a youth, we had a wonderful, progressive movement. We were going to end the warehousing of mentally ill people in grim, abusive, totalitarian "hospitals" that were more like dungeons. Instead, we were going to provide them with community based services and housing in the least restrictive possible environment. They were going to be reintegrated and treated like human beings.So the states emptied out their mental hospitals and then closed them down. In 1955, there were...
Source: Stayin' Alive - January 22, 2015 Category: American Health Source Type: blogs

Lowering health care costs is more than cost awareness
I wish lowering health care costs was as easy as “cost awareness,” but as one patient put it, “I never pay the first few bills, because the amount changes every time a new bill is sent.”  The payment system is so fragmented that it’s hard to know what will become an expense with any given illness.  Even the savviest of consumers of health care have difficulty with hospital payment systems.  Most consumers of health care are not savvy consumers.  Comparing the cost of apples and oranges in one grocery store to another is not like comparing a hip replacement from one hospital to another.  Often in emergency si...
Source: Kevin, M.D. - Medical Weblog - January 22, 2015 Category: Journals (General) Authors: Tags: Patient Health reform Source Type: blogs

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

Warm summer nights
It was summer 2006, the days long and the nights warm, and I was an intern, living by the beach and working a rotation in emergency. My memories of this time are like those of childhood holidays, a jumble of sensation and moments, rounded out and glossed by time and nostalgia, but I can say with certainty that it was a golden period.I was beginning to find my feet within the world of medicine, finally feeling like a real doctor. We were still in the old department in those days, poorly designed and hopelessly undersized for our growing patient load, yet warm and friendly, the glass walled doctor station affectionately know...
Source: Life in the Fast Lane - January 20, 2015 Category: Emergency Medicine Authors: Kristin Boyle Tags: Literary Medicine LITFL Warm summer nights Source Type: blogs

The strain of the influenza epidemic on emergency departments
Influenza has arrived refusing to be ignored or be the ugly step-virus to Ebola any longer. This influenza season is officially an epidemic. The Washington Post’s Wonkblog reported earlier this month that December 2014 was “one of the worst flu months in years.”  In fact, they found that it was “the worst December since the polling organization started tracking flu season in 2008.” 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 19, 2015 Category: Journals (General) Authors: Tags: Conditions Emergency Infectious disease Source Type: blogs

Healthcare Update Satellite — 01-19-2015
Penicillin allergy? It’s associated with increased bad outcomes, but not for the reasons you think. The allergies themselves are mostly not allergies. And no, “my mother said I had a rash when I was a baby” isn’t an allergy. However, when compared with patients who don’t have penicillin “allergies”, patients with penicillin allergies have longer hospital stays and are between 14% and 30% more likely to get resistant infections while in the hospitals – possibly because the penicillin “allergic” patients are being treated with much stronger antibiotics that kill of...
Source: WhiteCoat's Call Room - January 19, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

LITFL Review #165
Welcome to the 165th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.The Most Fair Dinkum Ripper Beauts of the WeekDo you re-spike IV fluid bags? The case of Ruby Chen from gravelessons.com should make us all re-think this. [SO] The Best of #FOAMed Emergency MedicineExcellent discussion of everything you need to know about AFib from EM Cases featuring Ian St...
Source: Life in the Fast Lane - January 19, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

LITFL Review 165
Welcome to the 165th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.The Most Fair Dinkum Ripper Beauts of the WeekDo you re-spike IV fluid bags? The case of Ruby Chen from gravelessons.com should make us all re-think this. [SO]The Best of #FOAMed Emergency MedicineExcellent discussion of everything you need to know about AFib from EM Cases featuring Ian Stiell. ...
Source: Life in the Fast Lane - January 19, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Do drug seekers in the ER make you burst out in song? It did here.
Between 1991 and 2010, opioid drug prescriptions increased from 75.5 million to 209.5 million.  How can we stop prescription drug abuse? Let’s start in the ER. 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 19, 2015 Category: Journals (General) Authors: Tags: Video Emergency Medications Source Type: blogs

You Must Read the ECG in Clinical Context....
An elderly male presented with cough and dyspnea, progressive for several days.  He had no chest pain.  Among his many tests, the ECG was done first, and was handed to me before I ever saw the patient:There is minimal ST elevation in inferior leads, with reciprocal ST depression in aVL and marked ST depression in V2-V5.This is consistent with inferior and posterior MI (posterior STEMI), but also with subendocardial ischemia.  The clinical context is critical.  Although a patient with acute chest pain and this ECG is likely to have a posterior MI, a complex medical patient may have reasons for supply/dem...
Source: Dr. Smith's ECG Blog - January 18, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Are CT scans ordered too often? Well, consider the leaf blower.
To critics who admonish emergency physicians like myself for our excessive use of CT scans, I’ll ask them to consider the leaf blower. I’m sipping my morning coffee on our front porch, a bright, idyllic autumn day in New England, the tranquility ripped apart by the landscapers across the street. For many jobs, a powerful leaf blower might prove superior to a rake or broom. But in my neighborhood known for smaller yards, the humble rake and broom would work as well, if not better. 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 - January 17, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Radiology Source Type: blogs

MKSAP: 74-year-old man with fever and chills
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 74-year-old man is evaluated in the emergency department for a 3-day history of fever and chills as well as confusion. He has a 5-week history of a nonhealing ulcer on the plantar surface of his left foot. He has diabetes mellitus, hypertension, and peripheral vascular disease for which he takes metformin, glyburide, lisinopril, chlorthalidone, and aspirin. He has no known medication allergies. On physical examination, temperature is 39.0 °C (102.2 °F), blood pressure is 92/60 mm Hg, pulse rate is 108/min, a...
Source: Kevin, M.D. - Medical Weblog - January 17, 2015 Category: Journals (General) Authors: Tags: Conditions Diabetes Infectious disease Source Type: blogs

If Emergency Medicine Physicians Told Hospitalists The Truth…
(Source: Better Health)
Source: Better Health - January 16, 2015 Category: American Health Authors: Dr. Val Jones Tags: Friday Funny cartoon Diagnosis Emergency Medicine Hospitalists Original Truth Val Jones Source Type: blogs

A and E crisis
This article is part of a series - go to the end of this page to see links to others.A report in the BMJ about a recent report from the Health Foundation and the Nuffield Trust, which finds that most reasons for the problems do not explain the whole story.  You will need a subscription to read this article.Rather older, dating from July 2013, a Lancet article by John House (I know, I thought that, but not him!), asking experts about the causes of the crisis.  You will need a subscription to read this too. An Observer article about operations being cancelled because of the crisis.Finally for now, the work of the K...
Source: Browsing - January 15, 2015 Category: Databases & Libraries Tags: A and E NHS Source Type: blogs

A and E crisis - amended 20th January
This article is part of a series - go to the end of this page to see links to others.A report in the BMJ about a recent report from the Health Foundation and the Nuffield Trust, which finds that most reasons for the problems do not explain the whole story.  You will need a subscription to read this article.Rather older, dating from July 2013, a Lancet article by John House (I know, I thought that, but not him!), asking experts about the causes of the crisis.  You will need a subscription to read this too. An Observer article about operations being cancelled because of the crisis.The work of the King's Fund on urg...
Source: Browsing - January 15, 2015 Category: Databases & Libraries Tags: A and E NHS Source Type: blogs

Thoughts on diagnostic errors
A colleague recently asked me to opine on the diagnostic error problem. As you might imagine, once I start, it is difficult for me to slow down. Here are some of my somewhat disjointed thoughts. 1. Diagnostic accuracy, while the most important quality measure for internists (and many other physicians), likely will not occupy the primary focus of performance measurement. The problem stems from our inability to accurately identify diagnostic errors. Some have likened the diagnostic error problem to Potter Stewart’s famous quote about pornography – “But I know it when I see it” 2. We have systems that ...
Source: DB's Medical Rants - January 15, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

How much will my ostomy pouch cost?
Last year, I underwent a colectomy, a surgery that removed my entire colon. Afterwards, I had to wear a temporary waste-collecting pouch attached to my abdomen known as an ostomy. Until my next surgery, I was now an “ostomate.” One of the early side-effects of the surgery was that I was prone to bouts of severe dehydration that left me hospitalized for a few days. During one of my dehydration-related hospitalizations, the nursing staff wheeled in my new roommate, Randy, an elderly man who had emergency surgery to remove his colon. Without knowing it, Randy had joined the club that I was in: He was now an ostomate. Con...
Source: Kevin, M.D. - Medical Weblog - January 15, 2015 Category: Journals (General) Authors: Tags: Patient GI Surgery Source Type: blogs

Big Brother Wants to Watch You Drive
Randal O'Toole In 2008, the Washington legislature passed a law mandating a 50 percent reduction in per capita driving by 2050. California and Oregon laws or regulations have similar but somewhat less draconian targets. The Obama administration wants to mandate that all new cars come equipped with vehicle-to-infrastructure communications, so the car can send signals to and receive messages from street lights and other infrastructure. Now the California Air Resources Board is considering regulations requiring that all cars monitor their owners’ driving habits, including but not limited to how many miles they drive, how m...
Source: Cato-at-liberty - January 15, 2015 Category: American Health Authors: Randal O'Toole Source Type: blogs

Patient satisfaction in the ER. Oh yes, this doctor went there.
As more doctors work for hospitals and large conglomerates, patient satisfaction rules.  And these physicians are saying, “My boss is CEO!” 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 14, 2015 Category: Journals (General) Authors: Tags: Video Emergency Source Type: blogs

Research and Reviews in the Fastlane 066
Welcome to the 66th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the...
Source: Life in the Fast Lane - January 14, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine General Surgery Intensive Care Pediatrics Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation critical care recommendations Review Source Type: blogs

The Dream Drive
Autonomous vehicle technology is already here: Cars park themselves, alert drivers to impending dangers, and even apply the brakes in emergencies. But what will it take to unlock its potential for major societal benefits? (Source: The RAND Blog)
Source: The RAND Blog - January 14, 2015 Category: Health Management Authors: RAND Corporation Source Type: blogs

Filming in the ER: A Policymaker Perspective
This post is the second of two posts, the first ran yesterday and can be read here. Some say ‘there oughtta be a law’ against ER filming. In my role as a policy advisor, including to U.S. Presidents and global company CEOs, getting assignments to assess policy issues to determine if ‘there oughtta be a law’ happened weekly. That assignment would have launched discussions with my team to conduct comprehensive, fair-balanced analyses of the issues. Our own personal views would not have mattered. To those we advised, we promised thoughtful analyses that considered as many different perspectives as we could identify. W...
Source: Disruptive Women in Health Care - January 13, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Access Advocacy Champions Consumer Health Care Patients Patients' Rights Source Type: blogs

Is Metro Fixable? If So, Why Doesn't Our Political Class Fix It?
Walter Olson Yesterday’s lethal smoke episode in a tunnel near the L’Enfant Plaza station of Washington’s Metro system was like one of the disaster scenes in Atlas Shrugged, from the controllers’ instructions (eventually disobeyed) to riders not to evacuate the eight-car Yellow Line train even as it rapidly filled with smoke, to a spokesperson’s insistence that there were “no casualties in the traditional sense” even as workers above ground were seen hustling unconscious persons on stretchers into emergency vehicles. One person was killed and more than eighty taken to hospitals; the...
Source: Cato-at-liberty - January 13, 2015 Category: American Health Authors: Walter Olson Source Type: blogs