MedWorm: Internists and Doctors of Medicine

Tamsulosin and the floppy iris

Notes from Dr. RW — Wed, 01 Jul 2009 15:44:00 +0100

Research study and editorial in JAMA. (Source: Notes from Dr. RW)

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The confusing terminology of bronchiolitis syndromes

Notes from Dr. RW — Wed, 01 Jul 2009 15:40:00 +0100

Do you know respiratory bronchiolitis-associated interstitial lung disease (RbILD) from bronchiolitis obliterans with organizing pneumonia (BOOP)? This review helps clarify the terminology. (Source: Notes from Dr. RW)

Awesome Presentations from Slideshare

Medicine and Man — Tue, 30 Jun 2009 20:09:54 +0100

These awesome presentations are the winners of the “Slideshare story telling contest.” Grand Prize: Drunkenomics - The Story of Bar Stool Economics Best Story Telling The Story Of H Most Popular Lets Talk Poverty addthis_url = 'http%3A%2F%2Fmedicineandman.com%2Fblog%2F2009%2F06%2F30%2Fawesome-presentations-from-slideshare%2F'; addthis_title = 'Awesome+Presentations+from+Slideshare'; addthis_pub = ''; (Source: Medicine and Man)

Troponin measurement in the ER in patients with PE

Notes from Dr. RW — Tue, 30 Jun 2009 19:21:00 +0100

The positive and negative predictive values for central pulmonary artery obstruction were good in this study: Troponin values were elevated in 20 (19.2%) of 104 patients (95% confidence interval [CI], 11.6-26.8) with a mean cTnI concentration of 0.38 ± 0.44 μg/L. Elevated cTnI value had a significant correlation with main pulmonary arteries involvement using the modified Computed Tomography Obstruction Index score (P = .0001). Elevated ED cTnI value had 53.8% (95% CI, 37.6-66) sensitivity and 92.3% (95% CI, 87-96.4) specificity, 70% (95% CI, 49-86) PPV, and 85.7% (95% CI, 80.7-90) NPV for predicting main pulmonary artery obstruction on CT. Increased cTnI values were highly correlated to intensive care unit admission of patients with PE (RR, 12.83; 95% CI, 3.87-42.4). The evidence in...

Fireworks Injuries TV News Spot

Doctor Anonymous — Tue, 30 Jun 2009 07:01:00 +0100

What you'll see above is my 2nd interview on local TV news talking about health issues. In this spot, it starts out with a news item about fireworks sales and then I talk about some statistics about fireworks injuries along with some tips to follow for the Fourth Of july weekend to be safe. You can also read about my own critique about this interview in another post. If you found this informative, I encourage you to check out my first TV news spot talking about asthma. Enjoy! (Originally posted on June 30, 2009) (Source: Doctor Anonymous)

Interview Critique

Doctor Anonymous — Tue, 30 Jun 2009 01:55:00 +0100

In the video above, you'll see and hear my thoughts on my latest local TV news spot talking about fireworks safety. This interview is following a long seven days of working which included a Joint Commission survey - as I mentioned in this post - was pretty stressful for me. And, in addition to that, I was on call this past weekend.But despite that, and feeling fatigued, I felt that I was ready for this interview. I have been through this before - well once - with my interview about asthma. As you can see in the "before" video above, I felt pretty confident with the material. I practiced to myself more than a few times in the car driving up to the TV station. Did I mention that this was live and there was no "take two" possible?So, I get at the TV station in plenty of time. I check in at th...

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Salmonella infection and mycotic aneurysm

Notes from Dr. RW — Mon, 29 Jun 2009 18:48:00 +0100

Don’t forget the association. It can be an aneurysm or a pseudoaneurysm, can occur as a new aneurysm or infection of a pre-existing one, and is associated with certain predisposing conditions. Species associations, according to the brief review, tend to be enteritidis and typhimurium. The article references several other reviews. (Source: Notes from Dr. RW)

EMRs degrade the quality of clinical documentation

Notes from Dr. RW — Mon, 29 Jun 2009 18:37:00 +0100

This article in the American Journal of Medicine explores some of the reasons. Repeated copying and pasting of other notes and template generated electronic clutter are two. Another underappreciated aspect is loss of the power of clinical narrative:Another more insidious consequence of the copy-and-paste function has been the loss of the narrative. Because charts have become capacious warehouses of disorganized, irrelevant, or erroneous data, the story of the patient and the patient's illness is no longer easy to read or likely to be read. In a most compelling and perhaps unintended way, we are witnessing the “death” of the health record narrative, as many of us have known it. Others also speak of the loss of narrative in electronic health records, and with great concern because narrat...

The Crisis in Children’s Mental Healthcare

APCblogit — Mon, 29 Jun 2009 13:00:00 +0100

An in-depth look at the breakdown in the mental health care system, featuring five families who share personal stories of frustration, anguish, and loss. (Source: APCblogit)

Twitter Weekly Updates for 2009-06-28

Medicine and Man — Sun, 28 Jun 2009 21:00:00 +0100

Living near major traffic roads associated with increased risk of deep vein thrombosis due to higher air pollution http://bit.ly/1arjxA # Cardiac rehabilitation lowers mortality by 21-34% in older patients with heart disease http://bit.ly/ayrlr # Measuring Copeptin (C-terminal part of vasopressin) with troponin more accurately rules out heart attack in the ER http://bit.ly/1qdXot # Lancet Review: Bite-related and septic syndromes caused by cats and dogs http://bit.ly/sbIwk # PLOS Medicine: What Is the Optimal Therapy for Patients with H5N1 Influenza? (and application to H1N1 flu) http://bit.ly/16ppeW #swineflu # PROSPER trial: inflammatory markers (IL-6, CRP) strongly assoc with risk of fatal vascular events than nonfatal events http://bit.ly/QWstQ # Nice graphics on growth of twitter http...

Podcamp Ohio 2: Pre-Lunch

Doctor Anonymous — Sun, 28 Jun 2009 18:28:00 +0100

This is the next random video from the Podcamp Ohio registration desk including discsussions about wedding rings, Devo, doing the cabbage patch dance, a quick interview with Brandice about how the morning was going, and a view of the lunch food line. Exciting, isn't it? Enjoy! (Source: Doctor Anonymous)

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The Joint Commission Experience

Doctor Anonymous — Sun, 28 Jun 2009 18:19:00 +0100

Some people have asked me what I did last week and what this "Joint Commission" thing is. Especially if you see patients in the hospital on a daily basis, hearing the words "The Joint Commission" (TJC) should make you a little tense.For lack of a better term, TJC is a regulatory agency who inspects hospitals every three years or so to review hospital policies and procedures to maximize patient safety. Unfortunately, what is covered in the news a lot are patients sometimes accidentally harmed when they come to the hospital. How can this happen you ask? Most times, it is the breakdown of processes that occur in the hospital - in addition to human error.Anyway, TJC comes to hospital unannounced to conduct their survey. So, for the past year or so, the hospital has been preparing (by reviewing...

Podcamp Ohio 2: Registration Desk

Doctor Anonymous — Sun, 28 Jun 2009 10:28:00 +0100

In this video from Podcamp Ohio 2, who is rockin the registration desk again this year? That's right! It's me - and some of my closest #pco09 friends. I finally got to meet drew who has been a fan of my show for a long time. We had a great discussion about the type of work that he does - specifically wound care. I'm going to have him on the show to talk about this and other topics. The rest of this video, you'll see what happens behind the scenes of the Podcamp Ohio 2 registration desk. Don't worry, more videos to come soon. Enjoy! (Source: Doctor Anonymous)

Fact checking for Atul Gawande

Notes from Dr. RW — Sat, 27 Jun 2009 05:45:00 +0100

As much as I liked Gawande's New Yorker article I'm having increasing reservations about the accuracy of his assertions, as I suggested here. I think the comment thread from Thursday's post deserves reposting:Clinton said... Just some fact-checking.St. Louis County's Medicare $/beneficiary = 8,306.Not sure if Wikipedia is a great reference, especially lacking an independent citation, but St. Louis does not show up as #3 (that spot belongs to Starr County, TX.)Hidalgo County hits the list at #22, while St. Louis doesn't even hit the lowest 100 list. Something isn't quite right with Gawande's statistics. Maybe he is going off of a different set of measures than lowest income per capita or median household income?http://www.dartmouthatlas.org/interactive_map.shtmhttp://en.wikipedia.org/wiki/L...

Oh, those greedy cardiologists

Notes from Dr. RW — Sat, 27 Jun 2009 05:23:00 +0100

ConclusionsThe COURAGE trial immediately impacted the management of stable angina. Catheterization referral volume decreased, medication use increased, and the use of medical therapy rather than revascularization increased among patients with coronary disease. And, there was this from Heartwire: Use of coronary stents, including drug-eluting stents (DES), "dropped sharply" in April, the Wall Street Journal reports, citing a marketplace report conducted by Millennium Research Group in 140 US hospitals [1]. According to Journal reporter Keith J Winstein, doctors did roughly 71 200 stenting procedures in April: 10% less than in March and 15% less than the previous year. Physicians believe that drop, writes Winstein, is "an unusually quick response" to the COURAGE trial, presented at the ACC...

Pre-Podcamp Ohio 2 Video

Doctor Anonymous — Sat, 27 Jun 2009 01:53:00 +0100

I know I haven't had a chance to talk about it yet, but I had a great time at Podcamp Ohio 2 last weekend in Columbus. In these next few posts, I will share some video and come comments about the video and about the conference. In this video, it is the night before Podcamp and we had a little gathering at a local mexican restaurant.It's kind of interesting, especially since this was the first time that I saw some of these people in a year - since the last Podcamp Ohio. It was kind of funny seeing everybody with their smartphones, taking video, taking pictures, and other geeky, techy stuff. So enjoy this and there will be more Podcamp Ohio 2 video to come! (Source: Doctor Anonymous)

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Antithrombotic agents and the risk of cerebral microbleeds

Notes from Dr. RW — Sat, 27 Jun 2009 01:05:00 +0100

Antiplatelet agents, but not anticoagulants, were associated with cerebral microbleeds in this study. While that may seem surprising at first glance it actually makes sense. Intracranial microbleed is a disease of the elderly, and is related to amyloid angiopathy in the case of lobar bleeds and hypertensive or atherosclerotic small vessel disease in the case of subtentorial bleeds. Following a tiny break in a blood vessel your first defense against such hemorrhage is the platelet plug, not the coagulation proteins. Although warfarin is known to be associated with spontaneous intracranial hemorrhage this study challenges our thinking about antithrombotic therapy in the elderly. Amyloid angiopathy and associated hemorrhage are related in a complex way to the APO E genotype. Medscape CME here...

PhDream

FtM Doctor — Fri, 26 Jun 2009 23:11:29 +0100

I want to do a PhD. I’m not so fussed about the qualification, but I do want to do a PhD. I want to spend 3 years devoting my life to answering one question. I want to persue my intellectual interests, and torture, er, teach medical students. I really enjoy the science behind medicine. And lets face it having a PhD never did anyone’s career any harm. The grand master plan is to get a few more things published and apply for a Welcome Trust/MRC fellowship. They are the most prestigious sources of funding. So when I got an e mail from a friend about a funding PhD that was available down in the South of England I was excited. I didn’t think I’d have enough experience but there was no harm at all in ringing up was there? So I rang up, and had a chat, he thought I did h...

Pulmonary Roundtable — Fri, 26 Jun 2009 16:04:00 +0100

Please see facebook group (pulmonary roundtable) for details of the case (Source: Pulmonary Roundtable)

Dr. A Show - Aug 14,2009

Doctor Anonymous Live — Fri, 26 Jun 2009 15:45:00 +0100

To be announcedDoctor | Anonymous | Medblogger | New Media | Medicine (Source: Doctor Anonymous Live)

Atul Gawande answers objections

Notes from Dr. RW — Fri, 26 Jun 2009 01:52:00 +0100

H/T to DB for pointing me to this follow up article by Atul Gawande concerning his earlier New Yorker piece on health care costs. Here he elaborates and provides more data in response to objections and questions concerning his original article. He also re-emphasizes that it’s all about organization and leadership and gives another example, Scott and White Hospital in Temple, Texas which is part of an integrated medical group in many ways like Mayo Clinic. Despite having, purportedly, more physicians per capita than any other community in the U.S., Temple Texas has high quality scores and low costs. One quibble. In answering the point about McAllen’s poverty as a possible driver of utilization he says: By any measure, McAllen’s poverty and poor health fails to account for its differe...

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Wound care for elderly patients

APCblogit — Thu, 25 Jun 2009 13:00:00 +0100

As your patients age, they become more susceptible to chronic conditions that compromise skin integrity. How would you treat an older patient with skin break down due to ulcer and chronic wound formation? Read this recent article from Clinical Interventions in Aging and let us know what you think! (Source: APCblogit)

Reasons for practice variation

Notes from Dr. RW — Thu, 25 Jun 2009 02:21:00 +0100

In view of the reaction to Atul Gawande’s recent New Yorker article I thought it would be interesting to explore some of the many reasons for practice variation. A popular perception is that it’s a lot about greed, and Gawande provided some extreme anecdotes which suggest, on first glance, that this is the case. Objective evidence, however, suggests otherwise. Here’s a run down. Physicians with risk averse personality profiles order more tests. Malpractice fear drives referrals to specialists. Internists have higher utilization than FPs according to multiple studies, attributable to being more risk averse. I have found no study looking at greed as a driver of utilization. (Source: Notes from Dr. RW)

QT prolongation in hospitalized patients

Notes from Dr. RW — Thu, 25 Jun 2009 02:20:00 +0100

The horribly ill patients who are typically admitted to the hospital often have electrolyte disturbances or other conditions that may prolong the QT interval. This calls for special vigilance in drug therapy, as the list of QT prolonging drugs is daunting. This brief article from The Hospitalist has some pointers. You could just about make the case for doing an electrocardiogram on all hospitalized patients. (Source: Notes from Dr. RW)

The electrocardiogram in pulmonary embolism

Notes from Dr. RW — Thu, 25 Jun 2009 02:18:00 +0100

---has very poor sensitivity and only fair specificity. A new study shows that positive electrocardiographic findings indicative of right ventricular strain are additive to the prognostic information gained from echocardiography. The two techniques are complementary. (Source: Notes from Dr. RW)

More on the over use of telemetry monitoring

Notes from Dr. RW — Wed, 24 Jun 2009 05:23:00 +0100

This topic seems to be enjoying a resurgence of attention in the literature, perhaps as a result of its importance in bed control and the role of telemetry over use in emergency department congestion. It’s clear that telemetry use far exceeds indications deemed appropriate in the guidelines. The latest review is here. My previous post on this topic is here. An American Heart Association Scientific Statement which updates the 1991 ACC guidelines is linked here. (Source: Notes from Dr. RW)

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Cardiac auscultation resources from the Texas Heart Institute

Notes from Dr. RW — Wed, 24 Jun 2009 05:21:00 +0100

There are several web based reproductions of heart sounds, most of which are of poor quality. This resource from the Texas Heart Institute is the best educational site for auscultation I’ve seen yet. (Source: Notes from Dr. RW)

Obesity linked to pancreatic cancer

Medicine and Man — Wed, 24 Jun 2009 04:42:33 +0100

Pancreatic cancer is the fourth leading cause of death in United States. Once diagnosed, patients have a very poor prognosis with median survival between 3 to 6 months. A new study published in the Journal of American Medical Association has found a link between being obese in early adulthood and the risk of developing pancreatic cancer. Individuals who were overweight (BMI of 25-29.9) from the ages of 14 to 39 years or obese (BMI > 30) from the ages of 20 to 49 years were at about twice the risk of developing pancreatic cancer (OR 1.67 & 2.58 respectively), independent of diabetes status. Also obesity at older age was associated with lower overall survival in patients with this malignancy. The main drawback of the study is that this is a case control study, therefore the 2 fact...

Help your patients sleep better

APCblogit — Tue, 23 Jun 2009 13:00:00 +0100

A recent article in the Journal of Advanced Nursing has suggested that music-assisted relaxation can improve the quality of your patients’ sleep. What techniques do you recommend to help your patients get a good night’s sleep? (Source: APCblogit)

Neuro-imaging tips for hospitalists

Notes from Dr. RW — Tue, 23 Jun 2009 05:07:00 +0100

Here's a summary of one of the neuro talks at Bob Wachter's Hospital Medicine course last fall. It contains a lot of pearls. (Source: Notes from Dr. RW)

Should TPN be started and stopped gradually?

Notes from Dr. RW — Tue, 23 Jun 2009 03:27:00 +0100

When I was in training TPN was exclusively within the purview of the surgeons. Consequently, internal medicine residents were not trained in its administration. Despite a lack of training and experience hospitalists are increasingly being asked to take over this aspect of hospital care.One of the popular maxims regarding TPN was, because of the risk of severe dysglycemia, never to start or stop abruptly. Myth or fact? This Medscape Ask the Experts piece addresses the question. (Source: Notes from Dr. RW)

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The importance of family history in assessing the risk of first venous thrombosis

Notes from Dr. RW — Tue, 23 Jun 2009 02:59:00 +0100

For a good while we’ve known about the importance of family history in the assessment of patients’ risk for VTE. In many ways the family history is more powerful than all the expensive thrombophilia tests. The more common genetic thrombophilias have low penetrance rates. Thus, when thrombophilia is expressed clinically in families, two or more genetic risks are often present in combination. This helps explain why the family history is often more helpful than laboratory testing.Another factor is the state of the science of thrombophilia testing. Take 100 patients with familial thrombophilia and do an extensive battery of genetic and phenotypic laboratory tests. You’ll find something in only around 60 of them. The other 40 have a genetic disorder waiting to be discovered. Back in the 1...

Swine Flu

Medicine and Man — Tue, 23 Jun 2009 01:46:47 +0100

Since we are still in midst of the swine flu (H1N1) pandemic - here is a quick summary and useful links: “In this video, Dr. Joe Bresee with the CDC Influenza Division describes swine flu - its signs and symptoms, how it’s transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.” Map: Weekly Influenza Activity Estimates Reported by State and Territorial Epidemiologists Swine Flu Cases per million population by country: (Data taken from The Guardian - Data Blog) Useful Links: Center of Disease Control Swine Flu update RSS feed from CDC WHO - Epidemic and Pandemic Alert and Response New England Journal of Medicine H1N1 Influenza Center Lancet - H...

Obama's Health Plan: Ayn Rand speaks

DoctorMental — Mon, 22 Jun 2009 22:31:00 +0100

Doctors have not spoken loudly regarding Obama's health care plan, a Trojan horse of a government health insurance program which will blossom by killing all other insurance programs from the market (who can compete with the Government?) and leave us with a one-payer system (read: VA hospital system). Rationing for the people. But what about the doctors? Here's one:"I quit when medicine was placed under State control...Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege o...

TED Talk: Surgery’s past, present and robotic future

Ivor Kovic, M.D. — Mon, 22 Jun 2009 21:38:10 +0100

Catherine Mohr is quite an incredible women. She is both an engineer and a medical doctor. She combines these two fields with her great inventions which help advance surgery. Take a look at her TED Talk in which she presents the newest robotic tools for surgery, but also remembers the beginnings of this art/craft/science. Tweet This (Source: Ivor Kovic, M.D.)

The absurdity of Medicare's never events policy

Notes from Dr. RW — Mon, 22 Jun 2009 04:23:00 +0100

A commentary in NEJM cites evidence that at best only 20% of hospital falls, a currently designated “never event,” can be prevented. Concerning VTE, under consideration for addition to the list, Aggravated DocSurg provides evidence that some hypercoagulable patients are gonna clot despite appropriate VTE prophylaxis. In its report on patient safety a decade ago the Institute of Medicine emphasized the need to move from a culture of blame to a culture of transparency. Instead, because of the never events initiative we've derailed transparency and taken the culture of blame to a new level. The patient safety movement has backfired. We're worse off than we were 10 years ago. H/T to Retired Doc. (Source: Notes from Dr. RW)

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Atul Gawande on health care costs

Notes from Dr. RW — Mon, 22 Jun 2009 02:59:00 +0100

Bob Wachter, whose blog post first alerted me to Atul Gawande's brilliant New Yorker piece, notes that it is essential reading for anyone concerned with health care policy. Gawande has a unique and fascinating way of explaining health care variations. What he does in the article is explain Dartmouth Atlas data on health care variations by telling stories---stories about the organization (or disorganization) of health care delivery, mainly in McAllen, Texas, but also in places like the Mayo Clinic and Grand Junction Colorado. The strength of Gawande's account is that it is vivid and experiential. (As you read it reflect on what's going on in your own medical community). Its major limitation is not only that it is anecdotal, but that its anecdotes represent the extremes in health care varia...

Persian Wisdom

DoctorMental — Mon, 22 Jun 2009 01:29:00 +0100

On September 29, 2006, I blogged about a lecture given by a U.S. political science professor, in which he discussed freedom in Iran in the context of rule under the mullahs. I received a reply that day traced to central Iran, apparently to a medical institution or school. The response was mysterious, but less so after this weekend: "I wish people in the world really knew how we feel here."We know now how these young people feel. Without taking sides (what good would that do other than polarizing the Iranian people against America?), we can stand with the people and against violence, against corrupt election process, and for justice, for freedom, and for the future for Iran. We can also pray for the Iranian people. (Source: DoctorMental)

Twitter Weekly Updates for 2009-06-21

Medicine and Man — Sun, 21 Jun 2009 21:00:00 +0100

Text of Obama’s Speech on Health Care Reform to the American Medical Association http://bit.ly/u9Nei # CSF analysis of Abeta42 and tau protein helpful in diagnosing early cases of Alzheimer’s dementia http://bit.ly/1u8YH # 10 Ways to Protect Your Kidneys http://bit.ly/oytP5 # American Medical Association’s response to Obama’s speech (http://bit.ly/u9Nei) on health care reform http://bit.ly/a51wz # FDA Warns Web Sites against Marketing Fraudulent H1N1 Flu Virus (swine flu) Claims http://bit.ly/ZYSg1 # UPSTF: Screen for hepatitis B virus infection in pregnant women at their first prenatal visit (Grade A recommendation) http://bit.ly/cfoQY # Being physically active associated with better profile of inflammatory factors and reduced risk of metabolic syndrome http://bit.ly/2...

Roy Poses on EBM and CER

Notes from Dr. RW — Fri, 19 Jun 2009 19:21:00 +0100

Discussions. Although we sometimes disagree on areas of public policy in medicine, particularly the role of industry, I respect his views. Recently he has written one of several posts on comparative effectiveness research (CER). Like many opinion writers on this subject he conflates CER (which is nothing more than head to head clinical trials, which we've been doing for decades) with an agenda for more government control of research and health care. That conveniently enables him and other writers to accuse skeptics of this advancing agenda of being opposed to CER, a fallacy which I exposed here. Any defense of CER, as Dr. Poses purports to be making, presupposes that somewhere there's opposition. But, as I said in that post, there is no serious opposition to the pure notion of CER. The fir...

Pearls on toxicology

Notes from Dr. RW — Fri, 19 Jun 2009 13:52:00 +0100

---and a vast array of other topics were presented at the American College of Emergency Physicians Scientific Assembly last fall. Leon Gussow, MD, an assistant professor of emergency medicine at Rush Medical College, wrote in Emergency Medicine News:A great many informative and entertaining lectures were presented at the American College of Emergency Physicians' Scientific Assembly, all essential to the practice of emergency medicine, but here I examine some important issues raised in lectures related to medical toxicology.These lectures contain some fascinating content for seasoned clinicians, such as you’re unlikely to find anywhere else. You can access the pdf files of the PowerPoint presentations for the toxicology content and all the other lectures here.Since this CME accredited mee...

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Acute coronary syndrome management

Notes from Dr. RW — Fri, 19 Jun 2009 13:50:00 +0100

Recent review in NEJM. (Source: Notes from Dr. RW)

Pre-Podcamp Show Wrapup

Doctor Anonymous — Fri, 19 Jun 2009 03:44:00 +0100

I have to tell you that I am so happy for the show tonight. It didn't start off how I'd like. What do I mean by that? Well, I had a hospital meeting right before the show. About halfway through the meeting, I thought things were going ok and that I'd be on time at home for the live show. Then, there was that one agenda item which brought everything down. I ended up being about 5-10 minutes late for the show.One of the great things about twitter is that as soon as I put a twitter post up - boom - there were about 5-7 people popping up in the chat room - incredible. So, you need to know that the show really didn't start going until about 13 minutes into the show. So, feel free to fast forward to that part to listen. (You can listen on the player above or download the show here)Thanks so much...

More on the cardiotoxic effects of methadone

Notes from Dr. RW — Fri, 19 Jun 2009 00:21:00 +0100

There has been some controversy about methadone’s cardiac risk along with vigorous objections to the ACP guidelines for cardiac safety monitoring, coming mostly from advocates for methadone maintenance treatment for opiate addiction. My last post on the subject drew a blistering reply. The commenter is the author of this blog. She wrote:Your broad assumption about methadone's cardio toxicity has yet to be proven and your talking about it like it's a given? It never fails to surprise me how easily even DOCTORS can leave their rationality and objectiveness behind, when they hear the word "methadone".YOur writing this entry as if your assumptions about methadone are a "known fact" and it's simply not true.Although there is widespread ignorance concerning methadone’s cardiac toxicity no in...

Problems with IE 8 and Blogger

Notes from Dr. RW — Thu, 18 Jun 2009 16:37:00 +0100

Microsoft has recently pushed out IE 8 as an update for WinXP users. I did the “upgrade” this week from IE 6 to IE 8. The browser has that nice new look and seemed to work great---until I tried to paste something into Blogger’s post editor. No can do! Firefox is my work around for now. Here’s a discussion of the problem in Google’s help forum. (Source: Notes from Dr. RW)

Acid suppression and nosocomial pneumonia

Notes from Dr. RW — Thu, 18 Jun 2009 16:03:00 +0100

Conclusions In this large, hospital-based pharmacoepidemiologic cohort, acid-suppressive medication use was associated with 30% increased odds of hospital-acquired pneumonia. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use. The recent emphasis on the ventilator bundle has created widespread confusion on this point. The bundle (sometimes known as the VAP bundle) has been touted as a process improvement to decrease the incidence of ventilator associated pneumonia, despite the fact that acid suppressive medication is one of the bundle components, and such treatment has long been known to increase pneumonia.(Elsewhere I pointed out the lack of evidence in support of the bundle as a means to decrease pneumonia).Many hospitalized patients ar...

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Surgery’s past, present and robotic future

Medicine and Man — Thu, 18 Jun 2009 15:22:54 +0100

Another excellent talk at TED: “Surgeon and inventor Catherine Mohr tours the history of surgery (and its pre-painkiller, pre-antiseptic past), then demos some of the newest tools for surgery through tiny incisions, performed using nimble robot hands. Fascinating — but not for the squeamish.” addthis_url = 'http%3A%2F%2Fmedicineandman.com%2Fblog%2F2009%2F06%2F18%2Fsurgerys-past-present-and-robotic-future%2F'; addthis_title = 'Surgery%26%238217%3Bs+past%2C+present+and+robotic+future'; addthis_pub = ''; (Source: Medicine and Man)

AAPA’s Town Hall

APCblogit — Thu, 18 Jun 2009 13:00:00 +0100

This is the 13th installment of the series, in which Bill Leinweber, President Cindy Lord, and President-Elect Stephen Hanson discuss heath care reform in this segment of the AAPA Town Hall. Find other installments in the related videos column. (Source: APCblogit)

Dr. A Show 105: Blogiversary

Doctor Anonymous — Thu, 18 Jun 2009 10:10:00 +0100

Thursday, June 18th, 2009 at 9pm Eastern TimeEven though the official blogiversary date is tomorrow (My first blog post was June 19, 2006), we're gonna be celebrating my three years in the medical blogisphere tonight on The Doctor Anonymous Show. It's hard to believe that it has been this long already. Lots of blogs and come and gone in this time - and, to be honest, I thought this one would be one that would not quite be around that long. But, hey, hooray! Three years a still plugging along!In addition to that, show 105 will also be the unofficial online kickoff party for Podcamp Ohio 2 which will be taking place in just two days in Columbus. Angelo, the Lead Organizer for #PCO2, had his final planning podcast last night, and will be joining us live for the show tonight. I hope that other...

Blogging has suffered lately

Notes from Dr. RW — Thu, 18 Jun 2009 04:51:00 +0100

---due to a very punishing work load last week. Like many hospitalist programs these days ours has a 7 on 7 off schedule. I try and store some posts in the can during my week off for posting later. Were it not for Blogger's auto-post the Notes would have shut down last week. Can't blog at work and too tired to blog when I get home. Although auto-posting continued apace I had too little time to devote much attention to some exceptional posts elsewhere in the blogosphere. Although it will seem late I intend to comment in some detail on these topics over the next few days: Atul Gawande’s important New Yorker article as discussed by Bob Wachter and DB. Dr. Wes's Open Letter to Patients Regarding Health Reform. (Well, I may not need to comment. This masterpiece needs no elaboration. But...