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

How can we take care of patients we have never seen?
Of course, patients are entitled to medical care around the clock.  You would not expect to show up at 2 a.m. at an emergency room to find a “closed” sign.  If you are having chest pain on a weekend, and you call your doctor’s office, you should expect a prompt response from a living and breathing medical doctor.  Patients are aware that when they call the doctor at night, that they are unlikely to reach their own doctor. Similarly, when a patient is admitted to the hospital, they will likely be attended to by a hospitalist, not the primary care physician.  Such is the reality of medical practice today. H...
Source: Kevin, M.D. - Medical Weblog - April 29, 2016 Category: Journals (General) Authors: Tags: Physician GI Source Type: blogs

“You can’t create an addict in the ER.” Yes, you can.
I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs. I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in car crashes, accidentally flushed down toilets and all the rest. People have pleaded with me because their normal doctor was out of the country. One individual (call him Bob) came to me and was denied narcotics, then returned two hou...
Source: Kevin, M.D. - Medical Weblog - April 29, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Eye Wide Shut
"I'm going to get a facial CT on this guy because his eye won't open," the resident said to me as he came out of the patient's room.Suddenly aware that a lateral canthotomy might be in our immediate future, I asked, "What do you mean? You can't get his eye open? What happened?"Changing directions, I entered the room to find a surprisingly cooperative patient with a grossly deformed face. The peri-orbital contusion prevented him from voluntarily opening his eye. So is that pre-septal or retro-orbital? We needed to take a look.Touching the upper lid, the immediate sensation of bubble pop burst forth under...
Source: Lions and Tigers and Bears - April 29, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Baby Got NAC
A 21-year-old woman with no past medical history presented to the emergency department for evaluation of an overdose. She was brought in by ambulance after her boyfriend called the police because she admitted to him that she had ingested a large amount of acetaminophen (APAP). The patient was 21 weeks pregnant and admitted to having ingested half of a bottle of extra-strength Tylenol six hours before arrival. The ED contacted the poison control center, and asked if N-acetylcysteine (NAC) is safe in pregnancy and if the dosing regimen changes for the pregnant patient.NAC's Mechanism of ActionAPAP is primarily metabolized by...
Source: The Tox Cave - April 29, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Ultrasound: Eye Think It’s the Retina
Part 3 in a SeriesThe Problem: Unilateral, painless vision changes and floatersOcular ultrasound is a short and sweet procedure that could change your practice and greatly benefit your patients. It can actually be used to diagnose retinal detachment, which in the past required a referral to an ophthalmologist and often led to delayed therapy. Noninvasive and simple ultrasound techniques can be used on any patient of any age presenting with visual changes. The differential for visual changes with or without complete vision loss or blurry vision encompasses a daunting list. This is for you especially if retinal deta...
Source: The Procedural Pause - April 29, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Treating Priapism in the Emergency Department
It's clear to me that emergency physicians have a number of mental blocks when it comes to managing priapism, which means this penile compartment syndrome is often allowed to languish while we wait for the urologists to come to our rescue.In this video blog, I remove some of the performance anxiety associated with this condition by teaching how to mix up the phenylephrine used for intracavernosal blocks. And, in the second video, I demonstrate how to set up an aspiration and irrigation system, which dramatically simplifies the entire process.Watch the first video here.​​Watch the second video here. Tags: priapism,...
Source: M2E Too! Mellick's Multimedia EduBlog - April 29, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Medicaid Managed Care Final Rule: Examining The Alignment With Qualified Health Plan Requirements
Editor’s note: This post focuses on provisions in the Medicaid and CHIP managed care final rule regarding alignment, and sometimes lack of alignment, between Medicaid managed care requirements and those governing other insurance coverage programs, specifically Qualified Health Plans in the ACA Marketplaces. Watch Health Affairs Blog for more coverage of this final rule. On April 25, 2016, the Centers for Medicare and Medicaid Services released its massive (1425 pages with preface) Medicaid and Children’s Health Insurance Program (CHIP) managed care final rule. CMS also released nine fact sheets highlighting various as...
Source: Health Affairs Blog - April 29, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Medicare Quality external review internal review medical loss ratios network adequacy provider directories States Summary of Benefits And Coverage Source Type: blogs

Medicaid Managed Care Final Rule: Examining The Alignment With Qualified Health Plan Requirements (Updated)
Update: CMS 2017 intentions for standardized plans and quality star ratings. In an April 29 blog post , marketplace CEO Kevin Counihan and Dr. Patrick Conway, principal deputy administrator of CMS, provided a bit more information about the intentions CMS has for standardized plans and quality star ratings for 2017. CMS has rechristened standardized plans as “simple choice plans.”  These are plans with standardized benefit and cost-sharing parameters.  Although CMS has not yet decided how exactly these plan options will be displayed or described, the blog post does say that they will be displayed prominently in Plan...
Source: Health Affairs Blog - April 29, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Medicare Quality external review internal review medical loss ratios network adequacy provider directories States Summary of Benefits And Coverage Source Type: blogs

Global Drug Reference Online – Global DRO
The Global Drug Reference Online (Global DRO) provides athletes and support personnel with information about the prohibited status of specific medications based on the current World Anti-Doping Agency (WADA) Prohibited List. Global DRO does not contain information on, or that applies to, any dietary supplements. The new, updated and readily accessible website for Global DRO is found here: http://www.globaldro.com/Home The Global DRO allows users to search for specific information on products sold in the United Kingdom, Canada, the United States, Japan and Australia. The Global DRO provides the same critical information ...
Source: Life in the Fast Lane - April 29, 2016 Category: Emergency Medicine Authors: Mike Cadogan Tags: Sports Medicine ASADA Global DRO Therapeutic Use Exemption TUE WADA Source Type: blogs

Research and Reviews in the Fastlane 132
This article reviews 10 myths about the UA and UTIs. A common theme that permeates the article is that an abnormal UA is not diagnostic of a UTI: symptoms must be present as well since a significant portion of patients will have chronic colonization. A good lesson to keep in mind the next time you work clinically. Recommended by: Anand Swaminathan Emergency Medicine, Neurology Friedman BW et al. The association between headache and elevated blood pressure among patients presenting to an ED. The American journal of emergency medicine. 32(9):976-81. 2014. PMID: 24993684 More data that BP & HA aren’t related. ...
Source: Life in the Fast Lane - April 29, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine Gastroenterology Neurology Pediatrics Psychiatry and Mental Health R&R in the FASTLANE EBM literature recommendations research and reviews Resuscitation Source Type: blogs

Medicare Access and Chip Reauthorization Act (MACRA) Proposed Rule, MIPS, APM’s and Advanced Care Information
Discussion Welcome news is the elimination of the all or nothing criteria of the meaningful use program. The exclusion of most ACO's under Medicare shared shavings is probably the most controversial part of the proposed rule as health systems have invested millions in the current Medicare shared savings program. That CMS is estimating that 87% of solo practitioners will be paying a penalty will also not be well received. Under MIPS CMS is estimating that non MD providers with the exception of nurse practitioners and physician assistants fare the worst including Chiropractors, Podiatrists and Dentists. Overall the propose...
Source: Policy and Medicine - April 29, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

State Options To Control Health Care Costs And Improve Quality
The recent debate on health care reform has occurred mostly at the national level. The Affordable Care Act, or ACA, was a momentous change for the American health care system. So far, 20 million people have gained health insurance coverage due to the ACA — a historic reduction in the number of uninsured people in the United States. The ACA also contained several tools designed to control health care costs. For example, it created the Center for Medicare and Medicaid Innovation, or CMMI, which is authorized to test new payment and delivery methods to lower costs and improve quality for individuals who receive benefits...
Source: Health Affairs Blog - April 28, 2016 Category: Health Management Authors: Zeke Emanuel, Joshua Sharfstein, Topher Spiro and Meghan O’Toole Tags: Costs and Spending Featured Long-term Services and Supports Medicaid and CHIP Medicare Organization and Delivery Payment Policy Quality ACA APCDs CMMI Gobeille vs. Liberty Mutual Insurance Company Payment Reform state policy St Source Type: blogs

On Zika Preparedness And Response, The US Gets A Failing Grade
There are worrying signs that the United States is unprepared to contain a likely Zika virus outbreak this summer. The critical problems are: insufficient resources for mosquito control, surveillance, and health care; highly variable capabilities and quality of service among public health and mosquito abatement authorities; and weak legal powers to implement critical interventions. The Pan American Health Organization (PAHO) reports that 35 countries and territories in the Americas have confirmed local, vector-borne transmission of Zika since 2015. In the US, local mosquito-borne transmission has been reported in Puerto Ri...
Source: Health Affairs Blog - April 28, 2016 Category: Health Management Authors: Alexandra Phelan and Lawrence O. Gostin Tags: Costs and Spending Equity and Disparities Featured Public Health CDC Congress outbreaks PAHO Prevention WHO Zika Zika virus Source Type: blogs

Chronic Inflammation Harms Hematopoietic Stem Cells
Hematopoietic stem cells reside in bone marrow and are responsible for producing blood cells, including immune cells. Recent research illustrates one way in which chronic inflammation, important in the progression of degenerative aging, can harm this stem cell population. Since chronic inflammation rises due to immune system dysfunction in aging, mechanisms of this nature may be an important component of negative feedback loops that arise in later stages of aging, in which damaged systems interact to further degrade one another. IL-1 is a cytokine long understood to be an essential signal the immune system uses to...
Source: Fight Aging! - April 27, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

PSNC's counter proposal to the government's plans for community pharmacy in 2016/17 and beyond
Pharmaceutical Services Negotiating Committee (PSNC) - This briefing sets out how community pharmacy services, including an emergency supply of medicines service, could be used to generate savings the NHS needs to make through pharmacy, without a cut in funding.  Briefing Press release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - April 26, 2016 Category: UK Health Authors: The King's Fund Information & Knowledge Service Source Type: blogs

New Tools Help Patients Make Tough Decisions In the ER
Patients often let emergency care physicians make important decisions about treatment, medicine or testing. Some hospitals are finding ways to involve patients more in those choices. (Source: WSJ.com: The Informed Patient)
Source: WSJ.com: The Informed Patient - April 25, 2016 Category: Consumer Health News Tags: FREE Source Type: blogs

Choose your own ER adventure
It’s October, and it’s beautiful outside; warm, sunny with a lazy breeze. Colorful. Two hours into my ER shift, I meet Bridgette, a 77 year old who volunteers four days a week. She arrived by ambulance, but walks easily, and feels silly for being here. She sits comfortably on the exam table and tells me her story: Two hours earlier, she was gardening at the seniors’ center when she had a sudden sharp pain in her abdomen. There was no vomiting and no diarrhea. She makes it clear that this happened minutes after eating a soggy cheese sandwich. She rested, and her friends gave her a glass of water. After h...
Source: Kevin, M.D. - Medical Weblog - April 25, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Expedition and Wilderness Medicine
Guest post Dr Edi Albert – Associate Professor, Remote and Polar Medicine at the University of Tasmania. Director, Wilderness Education Group These two nearly synonymous terms refer broadly to the practice of medicine in austere and remote environments. The former term suggests a “journey with a purpose”, whether scientific, humanitarian, or recreational. The latter terms suggests an environment “undisturbed by human activity”. Either way, a pretty cool way to practice medicine. It is within this context that we can identify three broad aspects to expedition and wilderness medicine: pre-departure preparation ...
Source: Life in the Fast Lane - April 25, 2016 Category: Emergency Medicine Authors: Sean Rothwell Tags: Medical Specialty Wilderness Medicine adventure adventure medicine Curriculum Dr Bill Lukin Dr Edi Albert Dr Julian Williams Dr Sean Rothwell remote Source Type: blogs

LITFL Review 228
Welcome to the 227th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Another awesome post on Dr Smith’s ECG blog. A must for anyone who sees patients with chest pain. [CC] The Best of #FOAMed Emergency Medicine An awesome review from Ken Milne and our own Salim Rezaie talking nerdy about a recent paper on HE...
Source: Life in the Fast Lane - April 24, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

This is what a physician wants in an EMR. Please build it.
Adding “electronic” means sortable, searchable, bigger attic, more junk. Unfortunately, no one has the guts to actually clean it. Are urinalyses from the 90s still important, or are we just being sentimental? For everything we do in medicine, there are intended effects and side effects. During my emergency medicine residency there was a mandate that attending physicians had to see each patient cared for by their residents. While a hard transition, I think U.S. emergency medical care became far more consistent as a result. I absolutely benefited in my training, and I’m certain my patients did as well. Then came the si...
Source: Kevin, M.D. - Medical Weblog - April 24, 2016 Category: Journals (General) Authors: Tags: Tech Health IT Source Type: blogs

A Spoonful of Inequality Helps the Medicine go Down
By SAURABH JHA, MD The conventional wisdom in the circles I hang out in – pro-Hillary, morally conscious,happy bunnies who pretend to enjoy French wine and opera – is that the greatest scourgeon humanity after the bubonic plague is inequality of wealth. They worship Pope St. John Paul Piketty and canonize Archbishop Paul Krugman. Not only is inequality bad for its own sake, they say, it makes people ill, like medically ill. Their premise always struck me as specious. I once took them through a thought experiment. Imagine, I said, you time travel to the Bengal famine. There was a lot of equality then – people were...
Source: The Health Care Blog - April 24, 2016 Category: Consumer Health News Authors: Simon Nath Tags: Featured THCB Saurabh Jha Source Type: blogs

John Stossel Discovers Health Care Dysfunction, Blames it on "Socialists" - Like Maurice Greenberg (AIG), John Thain (Merrill Lynch), Sanford Weill (Citigroup), and David H Koch?
In conclusion, I am glad that some of the problems in the dysfunctional US health care system are getting more public attention.  However, now we need to calmly and rationally consider what is causing them and what to do about them without the blinders of ideology or vested interests.  IMHO, true US health care reform would put the operation of US health care organizations more in the hands of people who have knowledge and experience in health care, and are willing to be accountable to support health care professionals' values.  Furthermore, oversight and stewardship of these organizations should represent t...
Source: Health Care Renewal - April 24, 2016 Category: Health Management Tags: boards of trustees bureaucracy finance generic managers managerialism New York - Presbyterian Hospital Source Type: blogs

Ask patients how they feel, along with how they are feeling
“How are you feeling?” It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility.  But, do we ever stop to think: What is really the point of this question?  What information are we trying to glean?  I think for most of us, we’re asking the question with a cognitive bias towards the physical.  How are they “physically” feeling: better, worse, same, new symptoms, associated symptoms, etc.  How will knowing this information then alter our medical decision making, diagnoses and treatment plans — you know, the usual ...
Source: Kevin, M.D. - Medical Weblog - April 23, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

CDC Launches Improved Online Foodborne Outbreak Search Tool
The Centers for Disease Control and Prevention (CDC) released a redesigned online tool making it easier to search data on foodborne disease outbreaks. The updated Foodborne Outbreak Online Database Tool (FOOD Tool) lets users search nearly 20 years of outbreak data by state, food, or germ. An estimated 1 in 6 Americans get sick from foodborne illness every year. Tracking and reporting outbreak information is critical to understanding how foodborne illness affects America’s health. Originally developed in 2009, the FOOD Tool includes national foodborne outbreak data reported to CDC from 1998 to 2014. New interactive featu...
Source: BHIC - April 22, 2016 Category: Databases & Libraries Authors: terri ottosen Tags: Emergency Preparedness Public Health Centers for Disease Control foodborne illness online tools Source Type: blogs

Arguing for Cryonics Providers to Integrate with the Funerary Industry to Spur Growth
Cryonics is the low-temperature vitrified storage of at least the brain on clinical death, with good evidence for it to preserve the fine structures that store the data of the mind. For so long as the mind is maintained, there is a chance that future technologies and societies will become capable of restoration. A small non-profit industry offers cryopreservation services for the few people who choose to avoid the certain oblivion of the grave, but growth into a sizable competitive market has proven elusive. This is important because growth is largely agreed to be necessary for longer-term survival of cryonics organization...
Source: Fight Aging! - April 22, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Stop telling younger generations not to become doctors
This article originally appeared in Medelita. resident.Image credit: Shutterstock.com 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 - April 22, 2016 Category: Journals (General) Authors: Tags: Education Medical school Residency Source Type: blogs

Funtabulously Frivolous Friday Five 142
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 142 Question 1 We’ve all heard of Occam’s Razor but what is Hickam’s Dictum or the Anti-razor? + Reveal the Funtabulous Answer expand(document.getElementById('ddet172338752'));expand(document.getElementById('ddetlink172338752')) A patient can have as many diseases as they damn well please. Occam’s razor can be paraphrased ‘when investigating a patient with multiple symptoms, a single uni...
Source: Life in the Fast Lane - April 22, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five abarognosis anti-razor Crabtree's bludgeon hickam's dictum life expectancy occam's razor Rene Laennec Stethoscope Source Type: blogs

Compromise Prospects Recede In Contraceptive Mandate High Court Litigation
While briefs filed on April 12 by the petitioners and the government in Zubik v. Burwell, the Supreme Court contraceptive mandate case, suggested that there might be room for the Court to impose a compromise, reply briefs filed on April 20, indicated that the parties are still pretty far apart. The petitioners insist that the only acceptable solution would be one in which they did not need to do anything (including self-certification) other than provide coverage to their employees excluding contraception. Insurers could in turn offer separate contraceptive coverage in which their employees would have to enroll independentl...
Source: Health Affairs Blog - April 21, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Mental Health MHPAEA Substance Use Disorders Source Type: blogs

Compromise Prospects Recede In Contraceptive Mandate High Court Litigation (Update)
Implementing Health Reform (April 22 update). On April 21, the Centers for Medicare and Medicaid released drafts of six updated federal standard notices to be used by insurers in the individual market when they discontinue products or renew coverage at the end of a coverage year, or non-renew or terminate coverage because an enrollee has moved out of a product’s service area. CMS update notices released in 2014. For policy years ending before December 31, 2017, insurers may use either the 2014 or updated notices, but for policy years ending on or after that date the updated notices will be required. CMS is requesting co...
Source: Health Affairs Blog - April 21, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Mental Health MHPAEA Substance Use Disorders Source Type: blogs

A death that feels good to a surgeon’s soul
He had loved her with all his being for more than six decades. In the last two years of their 61-year marriage, he had watched helplessly as dementia wrapped its noose around her, slowly tightening its grip on her mind and pulling her away from him. When I met him, I knew the injury was irrecoverable. Her brain was consumed by hemorrhage that had filled the space (cerebral atrophy) left behind by progressive dementia and then some, deflecting the midline between the two hemispheres nearly 12 mm. I asked him what had happened. She had tripped and fallen. For all her mind’s frailty, her body was still strong and agile ...
Source: Kevin, M.D. - Medical Weblog - April 21, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Make The Clinician Burnout Epidemic A National Priority
The health care workforce burnout epidemic is a national crisis. The time to act like it is now. Despite the promise of delivery system reform, especially following passage of the Affordable Care Act (ACA), the risk of burnout among physicians (and other health care professionals) represents a significant threat to system-wide achievement of Triple Aim goals: better patient experience of care, improved population health, and lower costs. In the rush to implement various initiatives, including additional reporting requirements and adoption of new technology such as electronic health records (EHR), and coupled with increasin...
Source: Health Affairs Blog - April 21, 2016 Category: Health Management Authors: Andrew Shin, Tejal Gandhi and Shoshana Herzig Tags: Featured Health Professionals Hospitals Organization and Delivery Quality doctor burnout EHRs physician perspective Physicians triple aim Source Type: blogs

Making Medicine Great Again
By MICHAEL MILLENSON The annual Lown Institute Conference advocates for the “right” kind of patient care, as in “the correct course of action.” But the political meanings of “right” and “left” also echo, sounding like a healthcare version of the recover-lost-glory demands of Donald Trump and the moral crusade of Bernie Sanders. The program for this year’s meeting, held in Chicago, urged attendees to “take back health [care];” you could almost hear a Trumpian, “Make medicine great again!” In an opening address, the institute’s senior vice president, Shannon Brownlee, proclaimed, “We are gathe...
Source: The Health Care Blog - April 21, 2016 Category: Consumer Health News Authors: Simon Nath Tags: Featured THCB Michael Millenson Source Type: blogs

Research and Reviews in the Fastlane 131
This study only shows an association and not causality and will need further prospective studies to elucidate the truth. However, in the absence of better evidence, either agent appears reasonable as the first line but rocuronium has a number of advantages (absence of contraindications, longer paralysis). Recommended by: Anand Swaminathan Read More: Does Succinylcholine Increase Mortality in Severe TBI Patients? (UMEM Education Pearls), Rocuronium vs. Succinycholine (Core EM) The R&R iconoclastic sneak peek icon key The list of contributors The R&R ARCHIVE R&R Hall of famer You simply MUST READ th...
Source: Life in the Fast Lane - April 20, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care LITFL Neurology Pre-hospital / Retrieval Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Medicine is the most emotional profession. This story proves it.
There you are in your father’s arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father’s eyes are full of fear, and the nurse’s tone is worrisome. I look down at you all snuggled up to your father’s chest. You are beautiful. So small and bright-eyed. You don’t recognize how hard your body is working, and you are just taking in all the sights and sounds around you as any baby would. The nurse takes you from your father’s arms, and she places you on the stretcher...
Source: Kevin, M.D. - Medical Weblog - April 19, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

You should want surgery residents for your operation. Here’s why.
A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed the full treatment algorithm.  I answered their questions and concerns. They seemed appreciative and understanding. Ultimately, he signed his consent for surgery. I left the room feeling I had taken good care of this pa...
Source: Kevin, M.D. - Medical Weblog - April 19, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

To Identify Patients For Care Management Interventions, Look Beyond Big Data
Five percent of patients incur nearly 50 percent of United States’ health care costs, and there is growing evidence that investing resources in these individuals can improve care while decreasing costs. In kind, provider organizations are increasingly adopting high-risk care management, a strategy that relies on coordinated outpatient care to reduce costly emergency department (ED) visits and inpatient admissions. However, complex care management programs are costly in themselves, so it is important to select patients who are not only high risk but are also most likely to benefit from such programs. We now have a wea...
Source: Health Affairs Blog - April 19, 2016 Category: Health Management Authors: James Colbert and Ishani Ganguli Tags: Costs and Spending Equity and Disparities Featured Health IT Health Professionals Organization and Delivery Population Health Quality big data chronic disease coordinated care Hospital readmissions patient use of evidence physici Source Type: blogs

How to destroy a great ER: A step by step guide
I took a fantastic emergency medicine (EM) job when I finished residency.  There was no question in my mind that it was the best job within a hundred mile radius, maybe more.  When I first started, my expectations were met.  My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed.  The hospital was independent, locally administrated, and not part of a mega healthcare system.  Its atmosphere was collegial and clinician-friendly. The ER was well-staffed with all-star nurses and techs with experience.  Everyone who worked in th...
Source: Kevin, M.D. - Medical Weblog - April 19, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Hospital Source Type: blogs

LITFL Review 227
Welcome to the 227th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week The old and new titans of critical care Paul Marik and Rob MacSweeney throw down over the futility of predicting fluid responsiveness in resuscitation. [JS] Natalie May provides a thought-provoking post looking at our polarised perspectives in th...
Source: Life in the Fast Lane - April 17, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

A Perfect Resuscitation Saves a Patient with Refractory Ventricular Fibrillation
This was contributed by Dr. Johanna Moore, one of my Hennepin Colleagues who researches CPR, along with Keith Lurie and Demetris Yannopoulos.  She translated her research knowledge into a spectacular resuscitation.Case A 54 year old male presented via ambulance to the Emergency Department (ED) in cardiac arrest. He was found down outside a clinic, where bystander CPR was initiated by clinic staff. The amount of down time was unclear but thought to be minimal as this was a high traffic pedestrian area. He received an estimated 5 minutes of manual CPR, then, after medic arrival, 20 minutes of LUCAS CPR, including u...
Source: Dr. Smith's ECG Blog - April 17, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

The joy of practicing medicine in the frontier
Like many boys born in the 60s, my heroes were often frontiersmen.  I grew up watching the Daniel Boone television series, with Fess Parker.  (I can hear the theme song in my head as I type.)  I watched the Disney production of Davy Crockett, and had a comic book of the same.  I never missed a chance to watch John Wayne die on the walls of the Alamo (also as Davy Crockett).  I could go on and on about my favorite movies, like Jeremiah Johnson or Little Big Man. Later I learned to love the writings of Allan Eckert, a historical novelist who wrote about the Westward expansion, with much of his book The Frontiersman hom...
Source: Kevin, M.D. - Medical Weblog - April 16, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Treat the physical exam with the respect it deserves
I adored the physical exam in medical school. We were taught the exam by sections, and I devoured one after another. No matter how much I had learned about physiology, it was during our physical exam sessions that I finally started to feel like I was learning how to be a doctor. We were getting the tools we needed to really take care of patients. We would have the means to collect our medical data and see the pathophysiology come to life. Sometime in residency, physical exams lost their magic. I wouldn’t say it was on any particular day. It became part of the routine. As an intern, I would be seeing the same patients for...
Source: Kevin, M.D. - Medical Weblog - April 15, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Building Health Care Systems In Post-Earthquake, Post-Constitution Nepal
Nepal finds itself at a critical juncture in its history. On September 20, 2015 a new Constitution was brought into full force, crystallizing the coming of age of the world’s youngest democratic republic. Today, challenges abound in Nepal — recovery from the worst natural disaster in 80 years, a brutal border conflict with India, and entrenched poverty. And as a landlocked nation with limited options for exporting goods, Nepal continues to face economic stagnation. Yet the new Constitution brings us great hope. It is among the world’s most progressive, particularly when it comes to the provision of Univer...
Source: Health Affairs Blog - April 14, 2016 Category: Health Management Authors: Duncan Maru, SP Kalaunee and Shanta Bahadur Shrestha Tags: Costs and Spending Equity and Disparities Featured Global Health Hospitals Organization and Delivery Payment Policy Population Health Public Health Quality ACOs EHRs Nepal Nepal Health System Strategy public-private partnership Source Type: blogs

BONUS VIDEO! Clinical Pearls: Coding and Reimbursement for Bedside Ultrasound
​James R. Roberts, MD, & Martha Roberts, CEN, ACNP, bring you pearls for how to code your use of ultrasound. Watch this video to learn how to make sure you document everything you do and use to receive full reimbursement.​​Published: 4/14/2016 11:53:00 AM (Source: The Procedural Pause)
Source: The Procedural Pause - April 14, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

TBT: Take Your Own Advice! U.S. Should Pay More Attention to STD Prevention Programs Abroad
April is STD Awareness Month. Although the post below originally just ran a little more than a month ago, it is too good not to run in support of STD awareness and for TBT. Most sexually transmitted diseases are preventable. That’s one reason it’s so upsetting that one in four sexually active girls in the United States has one. Out of the 19 million new STD cases annually in the U.S., almost half are among people ages 15 to 24. And those statistics only represent the number of reported cases; many more infections go undocumented. Despite the clear need for STD prevention strategies among young people, current efforts a...
Source: Disruptive Women in Health Care - April 14, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: TBT Source Type: blogs

Research and Reviews in the Fastlane 130
In this study, valproate was less efficient and requiring more rescue medications compared to Ketorolac and Metoclopramide. It appears that valproate is not as helpful as a rescue medication as previously thought. Recommended by: Daniel Cabrera Emergency Medicine, Pre-Hospital/Retrieval Bhalla MC et al. Simple Triage Algorithm and Rapid Treatment and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation mass casualty triage methods for sensitivity, specificity, and predictive values. Am J Emerg Med 2015; 33(11): 1687-91. PMID: 26349777 If you haven’t been exposed to mass casualty triage before, ...
Source: Life in the Fast Lane - April 13, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Emergency Medicine Gastroenterology Intensive Care Pediatrics Pre-hospital / Retrieval EBM Education literature R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

Medicare Help At Home
Nine million community-dwelling Medicare beneficiaries—about one-fifth of all beneficiaries—have serious physical or cognitive limitations and require long-term services and supports (LTSS) that are not covered by Medicare. Nearly all have chronic conditions that require ongoing medical attention, including three-fourths who have three or more chronic conditions and are high-need, high-risk users of Medicare covered services. Gaps in Medicare coverage and the lack of integration of medical care and LTSS have serious consequences. Beneficiaries are exposed to potentially high out-of-pocket expenses. Medicaid cov...
Source: Health Affairs Blog - April 13, 2016 Category: Health Management Authors: Karen Davis, Amber Willink and Cathy Schoen Tags: Costs and Spending Equity and Disparities Health Policy Lab Health Professionals Insurance and Coverage Long-term Services and Supports Medicaid and CHIP Medicare Organization and Delivery Quality ACOs Aging and Health chronic cond Source Type: blogs