MedWorm: Internists and Doctors of Medicine

Dr. A Show 127: Thursday Night - Nov 13,2009

Doctor Anonymous Live — Fri, 06 Nov 2009 16:30:00 +0100

Looking for somewhere to relax on a Thursday night, why not come on into The Doctor Anonymous Show as we talk about the serious and not-so-serious news stories of the week including the areas of medicine/health, entertainment, pop culture, and whatever else comes up.Doctor | Anonymous | Medblogger | New Media | Medicine (Source: Doctor Anonymous Live)

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CDC Stroke Registry Suggests Ways to Improve Care

APCblogit — Fri, 06 Nov 2009 16:21:18 +0100

In treating stroke, both physicians and the public can improve their roles, according to a 3-year analysis of results published in MMWR.Data on some 60,000 patients with stroke from Georgia, Illinois, Massachusetts, and North Carolina were entered into the federally sponsored Paul Coverdell National Acute Stroke Registry between 2005 and 2007. Stroke types were as follows: hemorrhagic, 14%; ischemic, 56%; transient ischemic attack, 22%; and "ill-defined," 7%.Researchers examined 10 treatment performance measures and their use among eligible patients. Among the results: Over a third of patients used private transportation rather than emergency medical services to get to the hospital. Only about 20% arrived at the hospital within 2 hours of symptom onset. Almost all got antithrombo...

Reader Poll: Should House Health Care Bill Pass?

Dr. Wes — Fri, 06 Nov 2009 14:50:00 +0100

With the US House of Representatives set to vote on the ‘‘Affordable Health Care for America Act’’ (H.R. Bill 3962) this weekend, should the bill pass?Vote in the sidebar and feel free to leave any comments you'd like to make below.-WesP.S. I'm not tracking URL's nor marketing - promise - just interested what others who read this blog think.Musings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Six Sigma and Lean

Notes from Dr. RW — Fri, 06 Nov 2009 12:15:00 +0100

---are process improvement methodologies originated by industry (Motorola and Toyota, respectively) increasingly employed by health care systems. They are coming to be viewed as more robust than the traditional quality improvement methods used by hospitals. Joint Commission is getting interested. Expect to hear more about this. Here is a paper describing the experience of four hospital emergency departments using Lean to improve throughput and patient satisfaction. (Source: Notes from Dr. RW)

Renal injury after sodium phosphate bowel prep

Notes from Dr. RW — Fri, 06 Nov 2009 12:00:00 +0100

Phosphate nephropathy, which can lead to not only AKI but also CKD, is an emerging concern as more and more case reports appear. Here is an in depth review. (Source: Notes from Dr. RW)

Dr. A Show 126 Wrap-up: Crzegrl

Doctor Anonymous — Fri, 06 Nov 2009 05:09:00 +0100

Thanks so much to Emily from Crzegrl.net for being my special guest on Show 126. To be honest, with her very busy schedule these days, I wasn't sure if she would be available to be on the show. That's why I didn't mention it beforehand. The show was orignially titled "Guy Fawkes" and that's what you hear at the beginning of the show (don't be alarmed). Anyway, Emily called in from her car, and we had a great interview.In case you hadn't heard yet, Crzegrl will be hosting next week - not only Grand Rounds, but also Change of Shift - sheesh! With next week being Veteran's Day, she's thinking of that type of theme for GR and CoS next week. We also talked about other things as well: Her mother was recently diagnosed with breast cancer, Emily was promoted to Army Reserves Commander of her Medic...

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Cancer's Miracle

Dr. Wes — Fri, 06 Nov 2009 05:04:00 +0100

It's a strange thing, cancer.It renders the greatest intellect impotent.Families coalesce, grapple, then muster their courage to confront the reality, their angst cloaked in platitudes and favors. Certainly there must be something we can do!Slow. Gradual. Relentless. And yet it's moving too fast.I wake at night to my wife's restlessness, the thoughts of her mother circulating. Why her? Why now?A sniffle, a sigh. There is little I can do.The relentless march goes on, the cadence quickening.We realize now what's important; her mother's gifts to us a gem.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Influenza update

Notes from Dr. RW — Fri, 06 Nov 2009 04:21:00 +0100

Recent coverage of influenza in the professional media has consisted of a dizzying flurry of disjointed sound bites. I have set out to put together the essentials here. We continue to struggle to find an appropriate name for the pandemic strain. The latest is “2009 H1N1” (formerly novel influenza A H1N1, to be distinguished from any ordinary seasonal H1N1 strains). Who should receive antiviral treatment? This Medscape Medical News piece summarizes the latest revision (October 16) of the CDC recommendations. In short, the treatment is recommended for individuals with suspected influenza considered to be at high risk. This will include 70% of hospitalized patients. From the news piece: High-risk groups include children younger than 2 years, adults 65 years or older, and pregnant women an...

One Special Operation

Dr. Wes — Fri, 06 Nov 2009 03:02:00 +0100

Real life is so much better than Grey's Anatomy.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

A Cardiology Fellow Saves a Life on the Subway

Dr. Wes — Fri, 06 Nov 2009 02:02:00 +0100

Dr. Sonia Tolani, 32, a first-year cardiology fellow at NewYork-Presbyterian/Columbia, notches her belt with another save after 20 minutes of CPR on the subway..."Stayin alive, stayin' alive, ah ah ah ah..."Nice work!-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Dr. A Show 126: Crzegrl - Nov 06,2009

Doctor Anonymous Live — Fri, 06 Nov 2009 02:00:00 +0100

Thanks to much to Emily from Crzegrl.net for stopping by the show tonight to talk about her hosting the medblog carnivals Grand Rounds and Change of Shift - in the same week! We also talked about the tragedy that occurred today at Fort Hood Army base in Texas. We also talked about her mom's battle with breast cancer, Emily's promotion to Army Reserve Commander of the 334th Medical Group in Michigan, and the upcoming Veteran's Day next week. Following the interview, I talked about some recent stories in the news. Thanks to those who listened live and to those who will listen on the archives. I very much appreciate it!Doctor | Anonymous | Crzegrl | Emily McGee | Fort Hood (Source: Doctor Anonymous Live)

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Is the American Medical Student Association contributing to the infiltration of non-evidence based woo in academic medicine?

Notes from Dr. RW — Thu, 05 Nov 2009 18:47:00 +0100

Multiple factors have contributed to the rising promotion and teaching of quackery in mainstream academic medical centers, something I've called quackademic medicine. Financial incentives, such as funding from the National Center for Complementary and Alternative Medicine (NCCAM) and the Bravewell Collaborative, are well known. Add to this the fact that more and more consumers demand quackery and are willing to pay for it out of pocket. Yes, it is to a large extent about money. Medical educators and health system administrators have sold out.But it's not all about money. There's a deeper cultural change at work at the medical student level, driven by the American Medical Student Association (AMSA). As the largest and most influential organization of medical students, AMSA is not only groo...

Do the Ends Justify the Means?

Dr. Wes — Thu, 05 Nov 2009 18:32:00 +0100

John Cassidy of the New Yorker thinks so:So what does it all add up to? The U.S. government is making a costly and open-ended commitment to help provide health coverage for the vast majority of its citizens. I support this commitment, and I think the federal government’s spending priorities should be altered to make it happen. But let’s not pretend that it isn’t a big deal, or that it will be self-financing, or that it will work out exactly as planned. It won’t. Many Democratic insiders know all this, or most of it. What is really unfolding, I suspect, is the scenario that many conservatives feared. The Obama Administration, like the Bush Administration before it (and many other Administrations before that) is creating a new entitlement program, which, once established, will be vir...

Will the copyright treaty take us back to Web 1.0?

Notes from Dr. RW — Thu, 05 Nov 2009 14:43:00 +0100

Here's some of what's leaked from secret negotiations to hammer out the treaty, according to Boing Boing:That ISPs have to proactively police copyright on user-contributed material. This means that it will be impossible to run a service like Flickr or YouTube or Blogger, since hiring enough lawyers to ensure that the mountain of material uploaded every second isn't infringing will exceed any hope of profitability. I have no idea what this really means. Read the rest of the post and the large comment thread. (Source: Notes from Dr. RW)

Tygecycline for refractory C diff?

Notes from Dr. RW — Thu, 05 Nov 2009 12:15:00 +0100

This is not something worthy of a change in practice yet. File it away in the “stay tuned” category. (Source: Notes from Dr. RW)

Natriuretic peptide levels to guide heart failure therapy

Notes from Dr. RW — Thu, 05 Nov 2009 12:00:00 +0100

Although this has been a swinging pendulum the latest meta-analysis suggests that using BNP or proBNP to guide treatment improves mortality. (Source: Notes from Dr. RW)

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Dr. A Show 126 Tonight

Doctor Anonymous — Thu, 05 Nov 2009 10:48:00 +0100

Thursday, November 5th, 2009 at 9pm ETI hope that you can join us tonight for the show. There is no scheduled guest, but there may be an "unscheduled" guest. You'll just have to tune in to find out. There's a lot going on in the news and current events to talk about as well on the show this week. I was happy to participate to day in what is called "BlogBlast For Peace" in which a group of bloggers place what is called a "peace globe" on their blog. You can read my post here, and you'll notice I don't have much of a peace globe, but I wanted to write something for today.I also wanted to point out that our good friend Crzegrl has chosen - has volunteered - host not one but two blog carnivals - Grand Rounds and Change of Shift - in the same week. Why? Who knows? I thought that I was crazy for...

Blogblast For Peace 2009

Doctor Anonymous — Thu, 05 Nov 2009 01:01:00 +0100

I know this post is early, but it's already November 5th in some parts of the world. I wanted to thank Mimi for all of your hard work in putting this together. The Peace Globe Movement has been very inspiring to watch over the past couple of years. The video above pretty much sums it up. I invite you to read my posts from 2007 and 2008 for Blogblast For Peace.But, if you would like to learn more from the founder herself - Mimi Lenox. I invite you to check out two interviews I had with her. The first interview was Doctor Anonymous Show number 11 on October 25, 2007. And, the second interview was during Doctor Anonymous Show number 56 on November 6, 2008. I'm sorry that I was unable to bring Mimi back on the show in time for BlogBlast 2009, but I hope to have Mimi back on the show soon. Enjo...

Latest Kidney News: Post ASN Round Up.

All Kidney News — Wed, 04 Nov 2009 20:19:18 +0100

This report is based on a study done 314 dialysis patients in Finland published online in the journal nephrology dialysis and transplantation. The reason for improved survival is believed to be due to improvement in diabetes care over the years studied, which were 1995 to 2005. Elements of improved care which have been cited include better blood pressure control with newer drugs as well as adherence to modern protocols concerning the control of blood glucose in diabetes. Medpage is reporting that the use of EPO has been trending upwards for the last few years, supporting data has been recently published in abstract and presented at the ASN this year. However the data captured did not include years after the outcome of several negative trials for the use of EPO in the treatment of anemia in...

Health Care Insurance Gift Cards

Dr. Wes — Wed, 04 Nov 2009 19:53:00 +0100

... for Florida residents, they're just in time for the holidays!Starting this month you can find these gift cards at any Winn Dixie and in November you can find them at CVS pharmacy stores.There are two types of gift cards available. One is called "the blue health care card" It acts like a temporary health insurance. For $59.00 it gives you health insurance coverage for one to 2 1/2 months based on your age. Here's how it works. You buy the gift card at the store, and the person receiving the card activates it. Then they enroll in a variety of plans offered. After that, you'll receive a package in the mail with a member id card.You can use the temporary insurance gift card to see a doctor, a dentist, at the pharmacy, or for lab work.The other gift card is called the family blue discount c...

Prescription benefit plans in Canada

Notes from Dr. RW — Wed, 04 Nov 2009 12:15:00 +0100

Conclusion— Among HF patients, residing in a province with a more restrictive prescription plan may be associated with lower use of restricted HF medications over and above the expected regional differences in HF drug use across provinces. (Source: Notes from Dr. RW)

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Are Pharmacies Getting Flu Shots Before Doctors?

Dr. Wes — Wed, 04 Nov 2009 12:14:00 +0100

From the Chicago Tribune:"I am a pediatrician in suburban Cook County. We signed up to receive the vaccine, and have yet to get it. I hear it is going to go to local pharmacies before we get it. They only vaccinate children 9 and above. ... Who is going to ensure that infants and asthmatics get vaccinated?"The response from the Illionois Department of Public Health's spokeswoman Kelly Jakubek was telling:"We currently are only placing orders for hospitals and health departments, which we consider the front line of health care," she said.Chicago vaccine providers are under a similar system in which the first shipments go to places that serve the most at risk, said Dr. Julie Morita, medical director of the Chicago Department of Public Health. Her department places the orders and selects the ...

Aortic valve calcification

Notes from Dr. RW — Wed, 04 Nov 2009 12:00:00 +0100

---(calcific aortic sclerosis or stenosis) is an atherosclerotic process and predicts atherosclerosis elsewhere. (Source: Notes from Dr. RW)

A Little Electronic Health Record Satire

Dr. Wes — Wed, 04 Nov 2009 04:48:00 +0100

SEEDIE (The Society of Exhorbitantly Expensive and Difficult to Implement EHR's) (the same organization that certified Extormity) issues it's definition of "meaningful use:""What is meaningful use?" asked executive director Sal Obfuscato at a recent SEEDIE executive retreat in Belize. "We believe the question is the answer, as man has always struggled to find meaning in this world."This insight led SEEDIE to suggest that certified EHR vendors should embed quotes from well known philosophers in their applications. This approach will prompt physicians and other caregivers to actively seek meaning as they document patient encounters. "When I am treating a patient, a thought-provoking quote from Jean Paul Sartre or Voltaire is far more valuable than the ability to e-prescribe or adhere to evid...

Show 126 Preview

Doctor Anonymous — Wed, 04 Nov 2009 03:01:00 +0100

I'd like to invite you to Doctor Anonymous Show 126 this week which will be Thursday, November 5th, 2009 at 9pm Eastern Time. There is no scheduled guest but there may be an "unscheduled" guest - we'll see. But, there are lots that are going on this week to talk about.On November 5th will be the latest observance of what is called the "BlogBlast For Peace." I first heard about this when I first started blogging about 3 years ago. The founder of this movement calls herself Mimi Lenox, and she's been on the show before. It's basically the idea to get as many bloggers to talk about the same thing on the same day. You'll see my post when I put it up - probably late tomorrow or on Thursday.Election Day in the United States also took place this week. I might mention that on the show. Plus, who k...

EP Woo: Electrohypersensitivity Syndrome

Dr. Wes — Tue, 03 Nov 2009 22:03:00 +0100

Do you have headaches, difficulty concentrating, insomnia, heart irregularities and headaches, fatigue, poor short-term memory, difficulty sleeping, skin problems, tinnitus, nausea, and dizziness? You might have electrohypersensitivity syndrome, a variant of "cell-tower blues!" Yep, conclusive data gleaned from a study of twenty-five whole patients out of 100 to be studied has discovered at least one example of a "DECT" (aka Digital Enhanced Cordless Telecommunications in the 1.9-2.4GHz band) cell phone causing increased heart rate and irregularities! Never mind that actual signals are not included in the data, but only a graph of "R-R intervals." (Um, in case you were wondering, noise will cause variations in surface EKG signals and shortening of RR intervals.)But don't pay attention to d...

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What drug is best for initial treatment of rapid atrial fib?

Notes from Dr. RW — Tue, 03 Nov 2009 21:21:00 +0100

According to the results of this study it's good old, tried-and-true diltiazem: Measurements and Main Results: The primary end point was sustained VR control (less than 90 bpm) within 24 hours; the secondary end points included AF symptom improvement and length of hospitalization. At 24 hours, VR control was achieved in 119 of 150 patients (79%). The time to VR control was significantly shorter among patients in the diltiazem group (log-rank test, p less than 0.0001) with the percentage of patients who achieved VR control being higher in the diltiazem group (90%) than the digoxin group (74%) and the amiodarone group (74%). The median time to VR control was significantly shorter in the diltiazem group (3 hours, 1-21 hours) compared with the digoxin (6 hours, 3-15 hours, p less than 0.001) ...

Factors in hospitalist retention

Notes from Dr. RW — Tue, 03 Nov 2009 19:16:00 +0100

Compensation is the obvious one according to this article in ACP Hospitalist, but there are intangibles:Professional development activities can also give hospitalists a chance to bond with their colleagues and build loyalty to a program. “Whether it’s journal clubs or in-service training by specialists, those are all part,” said Dr. Sheff.These activities can also contribute to hospitalists’ sense of identification with their field, which may currently be lacking. “Some physicians are seeing a [hospitalist] career path as being nothing more than a glorified resident,” Dr. Sheff said.Blogging about hospital medicine is one of my remedies for that. It keeps me engaged and interested in the field. (Source: Notes from Dr. RW)

How hospital medicine groups have thrived in troubled economic times

Notes from Dr. RW — Tue, 03 Nov 2009 19:13:00 +0100

Two new themes emerge from this article in The Hospitalist:Hospitalist groups need to align their incentives with hospitals.Hospitals with hospitalists have an easier time recruiting subspecialists. (Source: Notes from Dr. RW)

Easy rule out test for aortic dissection?

Notes from Dr. RW — Tue, 03 Nov 2009 19:02:00 +0100

Conclusion— D-dimer levels may be useful in risk stratifying patients with suspected aortic dissection to rule out aortic dissection if used within the first 24 hours after symptom onset.As with VTE, although the negative predictive power is good, the positive predictive power is poor. (Source: Notes from Dr. RW)

When Hoop-Jumping Becomes Patient Care

Dr. Wes — Tue, 03 Nov 2009 13:31:00 +0100

"Doc, I've got good news and bad news.""What's that?""Well, I've lost six more pounds!" "Wonderful! What's the bad news?""Well, you know that new-fangled drug you gave me that works so well for my atrial fibrillation?""Yes.""We'll, I'm part of that AARP Medicare Advantage Part D drug plan, and I just got the "partial" approved drug list for 2010 in the mail. My drug's not on the list, so I called and found the drug's been moved from a Tier II drug to a Tier III drug. That means it will cost me twice what I paid for it this year. That's gonna be tough, doc. I can't afford it.But I also read that if you call this '800' number and speak to them, they'll allow me to obtain an exemption to keep the drug on Tier II for next year."I called the number as I typed his note. The patient seemed please...

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Election Day 2009

Doctor Anonymous — Tue, 03 Nov 2009 05:18:00 +0100

I think the image above this pretty much sums it up. I know that this is not a presidential election year. But, there are a lot of important issues out there especially on a local and state level. So, do yourself and your fellow citizens a favor and make the time to head on out to the voting place today and make your voice be heard - no matter how you feel about a particular candidate or issue. Happy Election Day! (Source: Doctor Anonymous)

Show 125 Wrap-up

Doctor Anonymous — Tue, 03 Nov 2009 05:10:00 +0100

Thanks again to Gina from CodeBlog for being on Doctor Anonymous Show 125 last week. (I know that this is late getting posted - sorry about that.) I don't know about her, but I had a great time during the interview. And, I know that the people in the chat room had a great time as well. The medbloggers are very fond of CodeBlog, and I can see why.We talked about her origins in nursing and the origins of her in the blog world. Did you know that Code Blog was one of the first medblogs out there? Not only one of the first nursing blogs, but, arguably, one of the first medblogs that was created. We had a great conversation about that and about Grand Rounds and her experience at BlogWorld Expo 2009.As always, you can listen to the show on the player above. Or, if you like, you can download the s...

Darbepoetin alfa is unsafe as well?

All Kidney News — Mon, 02 Nov 2009 23:33:08 +0100

Darbepoetin alfa is a an erythropoesis stimulating agent marketed under the name Aranesp by AMGEN. It is used for the treatment of anemia ( a lower than normal blood count) as a consequence of renal failure or cancer. The use of other similar agents has been questioned over the last 2 to 3 years due to studies in both patients with cancer as well as patients with CKD and on dialysis, which demonstrated an increased risk of mortality, which was due in large part to cardiovascular disease particularly stroke. The debates that occurred due to the outcome of these studies were legendary, due to the counterintuitive findings that suggested treatment to a target normal Hb was dangerous. Yet some learned individuals maintained that the issue was less the target Hb and more the dose of EPO and tim...

Overuse of CTPAgrams for diagnosis of PE

Notes from Dr. RW — Mon, 02 Nov 2009 16:39:00 +0100

According to a poster presentation at a recent conference of the American Thoracic Society:The total number of CTPAs performed for suspected PE stood at 87 in 2000 but jumped to 1,115 in 2005 and to 1,883 in 2008, reported Dr. Chandra, a second-year fellow in the division of pulmonary and critical care at the medical center. In contrast, the percentage of CTPAs that were positive for PE declined during the same period, from 30% in 2000 to 20% in 2005 to 15% in 2008.According to the survey results docs are not applying pretest probability assessment to guide use of CTs.Even more importantly, why not just order a good old fashioned V/Q scan? Test performance in appropriately selected patients is as good as CT.I bet this is keeping the nephrologists busy.Via Hospitalist News. (Source: Notes f...

Not Seeing the Forest for the Trees

Dr. Wes — Sun, 01 Nov 2009 12:27:00 +0100

Congress, in their efforts to be conciliatory to specialists, is now working to alienate primary care physicians, too:(Medicare payment) Reductions will be made over four years rather than imposed at once in 2010, the U.S. Centers for Medicare and Medicaid Services said yesterday in a statement. In July, the agency said it planned to slice $1.4 billion, or more than 10 percent, in payments for each of the two specialties, triggering what an advocate promised would be a “tooth and nail” battle. The administration argued that the lower reimbursements for specialists would make more dollars available for lower-paid non-specialists who can focus on preventing expensive, chronic illnesses. That would tame the growth in medical costs, one goal of President Barack Obama’s effort to remake t...

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New Treatments For FSGS -ASN Conference

All Kidney News — Sun, 01 Nov 2009 01:11:07 +0100

Idiopathic focal and segmental glomerular sclerosis or FSGS is one of the most common causes of non diabetic kidney disease in the world and also one of the least satisfying to treat due to the difficulty with initiating and maintaining a durable remission. For decades the standard of treatment has been steroid therapy in high doses given either daily or every other day. This results in significant toxicity which includes the development of diabetes mellitus, osteoporosis, personality changes, weight gain, easy bruising etc. Yet these negative effects of steroid therapy are outweighed significantly by the result of not treating FSGS as the disease will usually progress to end stage renal disease (with a requirement for dialysis and transplantation). Even after transplantation there is a ri...

Hospitalists at your beck and call

Notes from Dr. RW — Sat, 31 Oct 2009 01:58:00 +0100

(Source: Notes from Dr. RW)

ASN conference day 2

All Kidney News — Fri, 30 Oct 2009 21:14:34 +0100

The conference has been extremely crowded so far with some talks having to close doors due to inability to accommodate any more people after all sitting and standing room has been exhausted. So I have turned to the poster sessions in attempt to connect with some of the breaking research which is yet to be published. When they are eventually published the data presented in posters may be the source of the next oversubscribed big session at ASN next year. Dr. Mita M shah et. al. sought to answer the question as to whether the immune system in older patients becomes less responsive. If this is true then older patients who receive transplants will need less medication. This would be an important finding because immunosuppressive medications have side effects which worsen lipid profile and may ...

Could Statins Be Protective Against H1N1 Flu?

Dr. Wes — Fri, 30 Oct 2009 19:40:00 +0100

In a retrospective study, it's a definite maybe:Of the patients studied, 801 were taking statins anyway and continued taking them while hospitalized. Seventeen patients who were taking statins died while in the hospital or within a month afterward, compared to 64 who were not taking statins, Vandermeer said.Overall, 2.1 percent of patients taking statins died, compared to 3.2 percent of patients not taking statins. That means patients taking statins were just under 50 percent less likely to die.Turns out this is from a press release regarding reports being presented this weekend at the annual meeting of the Infectious Diseases Society of America (IDSA) in Philadelphia, so while the data are intriguing, they are by no means conclusive.-WesMusings of a cardiologist and cardiac electrophysiol...

Dr. A Show 126: Thursday Night - Nov 06,2009

Doctor Anonymous Live — Fri, 30 Oct 2009 16:30:00 +0100

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Significant Digits

Dr. Wes — Fri, 30 Oct 2009 13:45:00 +0100

I find it interesting that the Congressional Budget Office's House health care bill budget estimate was posted to four significant digits ($1.055 Trillion dollars) even though CBO Director Doug Elmendorf, in a Thursday letter to House Democratic Chairmen, cautioned that his estimates are preliminary and "subject to substantial uncertainty."Why is that so?Could it be that the "estimate" looks better as $1.055 trillion when reported in the press than $1.1 trillion? I guess these days, what's a few hundred billion dollars among friends?-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Hands can do incredible things…

Ivor Kovic, M.D. — Fri, 30 Oct 2009 09:51:00 +0100

…but nothing compares to using them to help save a life American Heart Association is conducting a promotional campaign to motivate and educate people to learn and if necessary perform Hands-Only CPR. They say that…. “When an adult has a sudden cardiac arrest, his or her survival depends greatly on immediately getting CPR from someone nearby. But less than 1/3 of those people get that help. Most bystanders are worried they might do something wrong or make things worse.” Could not agree more. Among other very useful materials, they have created this great interactive web application called Hands Symphony which is so incredibly fun. Try it and share it with other. If you get only one person to learn Hands-Only CPR, that would be a great thing. Tweet This (Source:...

Hospitalists and comanagement---the debate continues

Notes from Dr. RW — Fri, 30 Oct 2009 04:11:00 +0100

But the debate, as illustrated by a point-counterpoint piece in the October issue of The Hospitalist, is not about whether collaboration among hospitalists, surgeons and subspecialists is good for patient care. It's about the importance of dealing with unintended consequences and defining the relationships.There are strong arguments in favor of comanagement as a model which benefits patients. It it's not done carefully, though, the adverse consequences for patient care are many and it is a driver of career dissatisfaction. Eric Siegal, M.D., a co-author of the piece, described a situation all too familiar:In the wee hours of a recent busy call night, the ED called me to admit a patient whose automatic implantable cardioverter cefibrillator (AICD) had fired repeatedly. The patient had no ot...

Dr. A Show 125: Code Blog - Oct 30,2009

Doctor Anonymous Live — Fri, 30 Oct 2009 01:00:00 +0100

Six time Grand Rounds host Code Blog will be our guest on The Doctor Anonymous Show this week. Blogging since 2002, Code Blog is one of the leading nursing bloggers, if not one of the leading medical bloggers out there. We'll talk about her hosting Grand Rounds this week with a Halloween theme, her experience at the Medblog Track at BlogWorld Expo, and we'll talk about her long running blog. Hope you can join us!Doctor | Anonymous | Grand Rounds | Code Blog | Medicine (Source: Doctor Anonymous Live)

Halloween Edition of 'Change of Shift' Is Up

Dr. Wes — Thu, 29 Oct 2009 21:42:00 +0100

Change of Shift, the best each week of the nursing blog-o-sphere, is up this week over at Reality Rounds.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

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Highlights of the American Society of Nephrology Conference Day 1.

All Kidney News — Thu, 29 Oct 2009 20:12:32 +0100

After a whirlwind 12 hours of connecting flights I have finally arrived in San Diego to attend this years American Society of Nephrology conference. The opening session of the 42nd annual conference was kicked off with an engrossing lecture by Nobel Prize winner Dr. Roger Tsien MD. Dr Tsien gave an overview of his prize winning research on labeling of molecules with photo-labile elements and fluorescent techniques which allow direct visualization of processes which could only previously be imagined. The highlight of his presentation was his novel use of color as a tool and guide for surgeons. By injecting molecules that bind to cancer cells or their products, cancer cells can be made to glow any color that he chooses. This allows the operating surgeon to see the extent of the tumor in real...

Coincidence or Foreshadowing?

Dr. Wes — Thu, 29 Oct 2009 17:31:00 +0100

Funny. Nancy Pelosi introduces the 1,990 page health care bill the same day Walmart announces they're going to sell caskets and urns.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

When Hospitals Do Halloween

Dr. Wes — Thu, 29 Oct 2009 17:03:00 +0100

... they can get creative with "pump-kin" decorating:Click image to enlargeHeh. Happy halloween!-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Dr. A Show 125: Code Blog

Doctor Anonymous — Thu, 29 Oct 2009 03:31:00 +0100

Thursday, October 29th, 2009 at 9pm ETI am so happy to welcome Gina from Code Blog to this week's edition of The Doctor Anonymous Show. Code Blog was the host of Grand Rounds this week and it had a Halloween theme. For the first time, I think this year, I made a contribution to Grand Rounds. I know that's pretty pathetic - especially since I have been a past host to the premiere medblog carnival around.Anyway, we'll be talking Grand Rounds this week along with talking about Code Blog which has been around since 2002. Code Blog is one of the leading nursing blogs out there. In addition to all of this, we'll be talking (again) about BlogWorld. I first met Gina in Las Vegas a couple of weeks ago, and we'll get her perspective of the MedBlog Track. So, I hope that you can join us!If you are ne...

Best. Heart Pillows. Ever.

Dr. Wes — Wed, 28 Oct 2009 18:57:00 +0100

Wish I'd seen this earlier (Picture at the link):The girls of Girl Scout troop 6254 will literally and figuratively give away their hearts next weekend.As part of the troop's "stress for less" badge project, the troop's 10 fifth graders have spent about six weeks cutting, stuffing and sewing heart-shaped pillows. But instead of sitting on living room sofas, the throw pillows will land in the arms of heart surgery patients at Scott and White Hospital in Temple.Rachael Clift, one of three co-leaders of the troop, said the project was born when the troop came up with ways to be less stressed."One of them was to give to others because if you can focus on other people, sometimes that's helpful instead of concentrating on what you're stressed about," she said.Each troop member gave individual at...

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Dr. A Show 125: Code Blog - Oct 30,2009

Doctor Anonymous Live — Wed, 28 Oct 2009 16:30:00 +0100

Show 125 Preview

Doctor Anonymous — Wed, 28 Oct 2009 10:51:00 +0100

The Doctor Anonymous Show proudly welcomes six-time Grand Rounds host Gina from Code Blog to the show. For her post this week, she had a Halloween theme which was very well done. I encourage you to check it out if you haven't had a chance yet. Something I really enjoyed this week was that on her twitter account, he took us behind the scenes about what it was like being a GR host. We'll talk about that as well. Even the Grand Rounds founder, got a little nostalgic about that.....We'll also talk about her blog, which according to her archives, goes all the way back to 2002. I could be wrong, but this has to be one of the first medical blogs out there. She and I only met in Las Vegas a couple of weeks ago at the Medblog Track at BlogWorld Expo. And, I admit that I wanted to get to talk with h...

Management of ulcerative colitis in hospitalized patients

Notes from Dr. RW — Wed, 28 Oct 2009 04:40:00 +0100

Steroid therapy is the mainstay in severe cases. How long should you wait for a response before resorting to surgery or rescue medical therapies? What rescue therapies are available? These issues are discussed in a recent review in Expert Review of Gastroenterology and Hepatology. (Source: Notes from Dr. RW)

Mechanical ventilation strategy in ARDS/ALI

Notes from Dr. RW — Wed, 28 Oct 2009 04:37:00 +0100

Conclusion: Available evidence from a limited number of RCTs shows better outcomes with routine use of low VT but not high PEEP ventilation in unselected patients with ARDS or acute lung injury. High PEEP may help to prevent life-threatening hypoxemia in selected patients. (Source: Notes from Dr. RW)

Might Medicare "Bundled Payment" Incentives Influence Patient Care Decisions?

Dr. Wes — Tue, 27 Oct 2009 22:12:00 +0100

One wonders, might this be construed as a bribe?Under the pilot project, Medicare is saving 4.4% on the base rates for heart and joint surgeries at Hillcrest because the hospital is offering a discount. For Morrow's knee replacement, for example, the government is paying $13,211, about $450 less than it normally would.Meanwhile, Morrow, who is eager to get back to playing basketball, gets a portion of the savings from Medicare — $271 as an incentive for going to a hospital that participates in the program.The three-year experiment, which began in May, is taking place at five hospitals identified by Medicare for high-quality, cost-efficient care. All competed to get into the program by offering discounts to Medicare.Besides Hillcrest, Baptist Health System in San Antonio is taking part, w...

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What Congress Missed in the Health Care Reform Debate

Dr. Wes — Tue, 27 Oct 2009 22:06:00 +0100

I mean, how are we going to pay for this?-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Defibrillators and Video Pill Endoscopies Can Mix

Dr. Wes — Tue, 27 Oct 2009 21:24:00 +0100

A radiofrequency interference myth debunked:A new Mayo Clinic study suggests that video capsule endoscopy (CE), a procedure that uses wireless technology in diagnosing intestinal disease, is safe for patients with heart devices. Wireless electrical gadgets, such as cell phones, have been shown to interfere with implanted heart devices, including pacemakers and defibrillators. This risk has led medical experts to speculate that capsule endoscopy could similarly cause heart devices to fail. As a result, the noninvasive procedure has been contraindicated by the U.S. Food and Drug Administration (FDA) for patients with cardiac devices. Contraindication means an increased risk may be involved.Generally, the topic has remained in the subject of speculation, although several small studies have fo...

When New York Health Care Moves to Tennesee

Dr. Wes — Tue, 27 Oct 2009 16:06:00 +0100

From the mail bag:Market forces today are causing more hospital systems to "affilitate" so they can share (pdf) management expertise to improve staffing efficiencies and purchasing power with lucrative medical device contracts. I find it interesting that hospital systems and their administrators can move across state lines at will, but patients can't get similar leverage across state lines for their health insurance purchases.Always good to see whose driving the bus in health care reform.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

For Cardiology Fellows: One Tough Job Market

Dr. Wes — Tue, 27 Oct 2009 03:15:00 +0100

The e-mails from fellows are coming from far and wide. Faced with the uncertainty over health care reform, the slumping economy, and the looming pay cuts to cardiologists, cardiology fellows are seeing one of the most challenging job markets in years. As a result, the number of e-mails we've received from fellows probing for potential job openings has accelerated to unprecedented levels. For those who fear health care reform, fear not.Before any bill has made it to the Congressional floor, certain aspects of health care reform are already here.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

The Shortage of Primary Care Services: Utilizing Nurse Practitioners and Physician Assistants to Relieve the Crisis

APCblogit — Mon, 26 Oct 2009 14:54:07 +0100

From Bob Blumm, MA, PA-C, DFAAPA:t is evident that the American system of health care is in need of an overhaul. Current figures indicate that there are over 46 million people who are uninsured. This equates to 15% of our nation's citizens who may not be able to access health care. The American College of Clinicians submits that Physician Assistants (PAs) and Nurse Practitioners (NPs) already significantly improve access to primary care services, but are underutilized in our current health care delivery system. While fewer physicians are choosing primary care, a new paradigm exists. But there has been a systemic failure to recognize that the skills and knowledge of PAs and NPs makes them well qualified to fill the role of primary care provider. Even though these individuals demonstrate...

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Paved by Good Intentions

Dr. Wes — Mon, 26 Oct 2009 11:13:00 +0100

"After this shift, I will have worked 105 hours this week.""Why is that?" I asked."Because unlike the emergency room, where care is transfered easily to guys arriving at the next shift, hospitalists don't have that luxury. We have to stick with our patients once they're ours. Let's say it's quarter to five. The nocturnist comes on at six. The call comes from the ER and you get a guy that's sick as hell: something like an aortic dissection with crappy renal function that's too sick for surgery. He's never been in our system. No history. No real physical. The family doesn't know his medications. The ER only provides a listing - no doses - I have to call their home and get the list or wait for them to bring in the bottles, review the labs, order a slew more tests. I can't just offload the cas...

My Take on H1N1

Doctor Anonymous — Mon, 26 Oct 2009 04:01:00 +0100

A lot of people have been asking me what I think of the H1N1 virus and the vaccine that will eventually be made available to the public. Here are some facts to start out with - these come right from the CDC website. More than 9000 hospitalizations and nearly 600 deaths have been reported to CDC associated with H1N1 - of these deaths, approximately 95 have been in children (as of this post 10/26/09).Now granted, annually, approximately 36,000 deaths occur with regular seasonal flu. This fact alone should at least make you think about getting your seasonal flu shot, if you haven't already done so.I also agree that the press has been hyping the situation up for the past six months with the H1N1 story - prior to that months and months of stories about the bird flu (remember bird flu?). Plus, w...

Insulin Resistance and Kidney Disease, some thoughts.

All Kidney News — Sun, 25 Oct 2009 01:21:56 +0100

Insulin resistance Insulin resistance is a term many doctors and scientists are already familiar with. However not that many patients have a concept of exactly what is meant by resistance to insulin. Other than its role in the causation of type 2 diabetes, Ginsberg considers insulin resistance a major underlying abnormality driving cardiovascular disease, the major cause of morbidity and mortality in much of the world. Although most of the research produced thus far focused on the role of insulin resistance in diabetics, it is now apparent that insulin resistance is important in its own right. Insulin resistance is a syndrome that has been linked to increased risk for cardiovascular disease. However its effect is believed to act via promoting dyslipidemia, hypertension, hypercoagulability,...

Type 2 diabetes cures

Notes from Dr. RW — Sat, 24 Oct 2009 17:32:00 +0100

Generally I don’t like to be anecdotal but today I will. The testimonials in this LA Times piece are so compelling I’ll even overlook the Yoga references. These were obese folks with “bad” type 2 diabetes who used lifestyle changes to dispense with insulin and completely reverse their disease processes. It drives home the point that you treat insulin resistance with exercise and caloric reduction. These patients’ doctors were treating overeating with more and more insulin. Predictably, they got worse. Of course these were exceptionally motivated people. For folks who can’t seem to diet and exercise we sometimes have to treat their overeating with insulin just to decrease microvascular disease, but it’s not physiologic. Read the whole article but ignore the parts about Yoga. (...

The Senate Finance Committee’s proposed device tax

Notes from Dr. RW — Sat, 24 Oct 2009 15:42:00 +0100

---is part of the Senate health care bill. After explaining how it works Dick Morris notes: The result will be that virtually every piece of advanced surgical equipment will be subject to a price increase to meet the levy from Washington. No matter that these devices often make the difference between life and death and that, in effect, taxing them raises the cost of vital treatments. The vengeful White House will have its pound of flesh from the medical device industry for daring to be independent and to refuse to knuckle down to administration pressure.This tax, imposed in a spirit of haughty arrogance, falls on totally inappropriate objects. Valves, prosthetic limbs, pacemakers, hearing aids and such are essential therapies that make life longer, better and less painful. To tax them make...

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The Pacemaker Tax

Dr. Wes — Sat, 24 Oct 2009 13:33:00 +0100

... or is it really just an "assessment?"The legislation does not work like a sales or excise tax. Rather, it follows the model of the punitive tobacco settlement imposed on cigarette companies in the '90s. It assesses an industry-wide payment that firms must make in proportion to their market share. It bars the them from passing along the cost of the assessment by charging more for certain basic products, but allows them to raise the price of others to raise the funds for the fee.The result will be that virtually every piece of advanced surgical equipment will be subject to a price increase to meet the levy from Washington. No matter that these devices often make the difference between life and death and that, in effect, taxing them raises the cost of vital treatments. The vengeful White ...

Dr. A Show 125: Thursday Night - Oct 30,2009

Doctor Anonymous Live — Fri, 23 Oct 2009 15:45:00 +0100

Think You Know Government Health Care?

Dr. Wes — Fri, 23 Oct 2009 12:01:00 +0100

Now you can prove it.Bring friends and family together to tackle this crossword comprised of only five complete words and twenty common government health care-related acronyms. Only the uniquely tolerant will survive:Click image to enlargeHave fun! -WesGive up? Answers here.Musings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Pulmonary embolism review

Notes from Dr. RW — Fri, 23 Oct 2009 10:55:00 +0100

One glaring flaw in this review: the claim that CTA is the imaging modality of choice without evidence to back it up. Otherwise it's pretty good. (Source: Notes from Dr. RW)

WPW syndrome

Notes from Dr. RW — Fri, 23 Oct 2009 10:48:00 +0100

Review in American Journal of Emergency Medicine. (Source: Notes from Dr. RW)

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Pneumothorax for hospitalists

Notes from Dr. RW — Fri, 23 Oct 2009 10:46:00 +0100

Here are the nuts and bolts. (Source: Notes from Dr. RW)

Peritoneal Dialysis and Encapsulating Peritonitis

All Kidney News — Fri, 23 Oct 2009 04:04:23 +0100

Sclerosing Encapsulating Peritonitis affects alters the normal Peritoneum Image Source (http://us.i1.yimg.com/us.yimg.com/i/edu/ref/ga/l/1035.gif) Peritoneal dialysis relies on the peritoneal lining as a surface for the exchange of substances during dialysis. However the peritoneal membrane was never intended to be used for this purpose. The goal of peritoneal dialysis research is to find the least traumatic and disruptive method of ensuring efficient dialysis occurs for as long as possible before the peritoneal lining is “worn out”. The greatest advance in this area would entail some method that allows the membrane to continue to function indefinitely. One of the unsolved problems remains the absence of any clear way to predict the peritoneal membrane will react under the same...

Dr. A Show 124: MedBlogWorld09 Wrapup - Oct 23,2009

Doctor Anonymous Live — Fri, 23 Oct 2009 01:00:00 +0100

Do you wanna know what really happened behind the scenes of the first ever MedBlogger Track at BlogWorld Expo 2009? Well, this is the show that will give you that and also my first impressions of your favorite medbloggers in Las Vegas. Hope to see you to for the show!Doctor | Anonymous | Medblogger | New Media | Medicine (Source: Doctor Anonymous Live)

BWE 09: The Nick Genes Exclusive

Doctor Anonymous — Thu, 22 Oct 2009 22:17:00 +0100

Now, you're not gonna here or read this from any other medblog "post BlogWorld" post. So, this is definitely an exclusive. I talked with our good friend and Grand Rounds founder Nick Genes. And, he told me of an adventure he had with the iPod of noted medical blogger Dr. Rob.Apparently, Dr. Rob is prone to leave technology around, like his iPod. In fact, during the BlogWorld conference, Dr. Rob forgot his laptop cord in the lecture room and it had to be brought to him later (at the bar). Anyway, in the video above, Nick gives us an exclusive look inside the mind of Dr. Rob and the electonic contents of his iPod.If you enjoyed this silliness, then I Invite you to check out an extended interview I had with Nick Genes back with Doctor Anonymous Show number 13 (beware of the technical glitch a...

BWE 09: The Mother Jones, RN Interview

Doctor Anonymous — Thu, 22 Oct 2009 21:32:00 +0100

Yes, that's right. My mother, of sorts, also attended the first ever MedBlog Track at last week's BlogWorld and New Media Expo in Las Vegas. Mother Jones, RN (MJRN) who runs the Nurse Ratched's Place blog, has always been a strong supporter of me, my blog, and my internet radio show. And for all of that, I am very much grateful.We had a some great conversations about the past, present, and future of medical/healthcare blogging. However, in the video above, we got a little silly, as we usually do. And, it was actually a fun interview to do. If you like that, then, you'll enjoy a more in-depth conversation all the way back on Doctor Anonymous Show number 6. MJRN even called into show number one when I really didn't know what I was doing.As always, you can listen to show number six in the pla...

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BWE 09: Why Bongi Blogs

Doctor Anonymous — Thu, 22 Oct 2009 15:36:00 +0100

Probably one of the most mysterious medbloggers who everyone wanted to meet (other than me - HA!) was the medblogger we know as "Bongi." We all learned that he actually does have a real name and is actually a real person - duh. Bongi was on one of the panels at the first ever MedBlog Track at BlogWorld Expo last week in Las Vegas. Thanks to MedPage Today and Johnson & Johnson for sponsoring the event.In the video above, Bongi tells us why he blogs. Simply put, he is a storyteller. That sounds like a great reason to me. If you enjoyed this little clip, I encourage you to check out my extended conversation with Bongi on The Doctor Anonymous Show number 30. As I was listening to this again, our good friend Kerri from SixUntilMe is also on this show - at the show beginning. And, I totally ...

Options for nutritional support in acute pancreatitis

Notes from Dr. RW — Thu, 22 Oct 2009 14:41:00 +0100

Enteral, parenteral, or none at all? According to this systematic review:Enteral nutrition, when compared with no supplementary nutrition, was associated with no significant change in infectious complications: ratio of relative risks (RR) 0.56, 95% confidence interval (CI) 0.07–4.32, P=0.58, but a significant reduction in mortality: ratio of RR 0.22, 95% CI 0.07–0.70, P=0.01. Parenteral nutrition, when compared with no supplementary nutrition, was associated with no significant change in infectious complications: RR 1.36, 95% CI 0.18–10.40; P=0.77, but a significant reduction in mortality: RR 0.36, 95% CI 0.13–0.97, P=0.04. Enteral nutrition, when compared with parenteral nutrition, was associated with a significant reduction in infectious complications: RR 0.41, 95% CI 0.30–0.57...

Prosthetic Aortic Valve? There's an App For That!

Dr. Wes — Thu, 22 Oct 2009 14:07:00 +0100

Meet iAorticValve produced by iMobileHealthCare, available now for upload to your iPhone.In an era where the medical device industry is increasingly concerned about health care reform, innovation, and the implications for providing their products to patients, it's nice to know there are helpful companies sprouting up that can place company literature about mechanical, biologic, or percutaneous prosthetic aortic valves, both approved and experimental, on your iPhone free of charge. Further, if you want to go ahead and calculate your own STS (Society of Thoracic Surgery) Risk Calculator for placement of a heart valve, heck, you can do that also. Do not, however, look for objective criticism of the various valve types since most device literature there fails to include warnings, containdicati...

BWE09: Podmedic Interviews Dr. A

Doctor Anonymous — Thu, 22 Oct 2009 11:27:00 +0100

One of the people I was looking forward to meeting in person was Jaime Davis who is the founder of the ProMedNetwork of podcasts, of which I am a proud member. If you're looking for new medicine and science related podcasts to check out, I encourage you to check out ProMedNetwork.comIf you enjoyed this little banter in the video above, I encourage you to check out where I turn the tables and interview Jaime on The Doctor Anonymous show number 67. We talked about ProMedNetwork and other topics as well. As always, you can listen on the player above. Or, even download the show by clicking here and listen anytime. Enjoy! (Source: Doctor Anonymous)

Dr. A Show 124 Tonight!

Doctor Anonymous — Thu, 22 Oct 2009 10:13:00 +0100

Thursday, October 22nd, 2009 at 9pm ETI hope you can join me tonight as I do a wrap-up show on the first ever MedBlog Track at BlogWorld and New Media Expo in Las Vegas last week. Thanks to MedPage Today and Johnson & Johnson for sponsoring the event. You may have been reading a lot about this from my fellow medbloggers. You may have also been watching some vids from the event. But, tonight, I will also be sharing some "behind the scenes" stories where you not here anywhere else! (Image Credit: Nurse Ratched's Place)If you are new to the show, I encourage you to catch us live. There is a great chat room that also goes on. You can even see my shining face on the webcam. In addition, you can call into the show to say hello. Can't catch us live? That's ok. You can listen anytime after the sho...

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Cannulation Technique may Improve Fistula Survival

All Kidney News — Wed, 21 Oct 2009 23:31:44 +0100

AV fistula complications Image by RoundboyzPhotography An AV fistula is the access of choice in patients starting dialysis. The use of AV fistula first is associated with less risk of infection which is a significant cause of morbidity and reduced survival in dialysis patients. The technique used to cannulate a fistula is essentially the method used by the HD nurse to insert the venous and arterial needle into the fistula so that an adequate blood flow for the process of dialysis can occur. However as noted by Van Loon et. al. “Little is known about cannulation of the vascular access (VA), such as the number of successful cannulation procedures, frequency of complications caused by cannulation, and VA failure.” The above investigators then went on to publish the results of a st...

CSI Chicago: Murder Victims Identified by Pacemaker Information

Dr. Wes — Wed, 21 Oct 2009 18:17:00 +0100

In a sad case here in Chicago, it is interesting to note that a person's pacemaker can help identify them if no other means of identification exists following a homicide:Ruby and Milton McClendon's bodies were discovered about 12:30 p.m. Monday in the Wentworth Woods of the Cook County Forest Preserve off Campbell Road between Pulaski and Michigan City Roads. An autopsy performed Tuesday determined that Milton McClendon died from a gunshot wound to the head and Ruby McClendon died from multiple gunshot wounds. Milton McClendon, who was identified through his heart pacemaker, was 78, and his wife was 76, records show.This is not the first time pacemakers have been used to determine critical identifying information or details (subscription) about the time of death. All patients implanted wit...

Spontaneous bacterial peritonitis: what's new?

Notes from Dr. RW — Wed, 21 Oct 2009 15:38:00 +0100

Although the long term prognosis of SBP is guarded the short term prognosis is no longer considered dismal, as it was when the condition was first reported. A recent review in the World Journal of Gastroenterology (available as free full text here) makes the following points:Suspect SBP in patients with large volume ascites due to liver disease. It seldom occurs in patients with small volume ascites or in those with ascites unrelated to liver disease.Clinical manifestations may be vague and indolent. Thirteen percent of patients have no direct symptoms. So, paracentesis is recommended for all cirrhotic patients admitted to the hospital with large volume ascites.In patients diagnosed with peritonitis as defined as a peritoneal fluid PMN count of 250 or above additional peritoneal fluid test...

On the AMA and Prostitutes

Dr. Wes — Wed, 21 Oct 2009 10:29:00 +0100

Wow, some choice words on the Senate floor from Tennessee Republican Senator Bob Corker yesterday on the Hill:We all know that the selling of one’s body is one of the oldest businesses that has existed in the history of the world. And so the AMA now is engaged in basically selling the support of its body by throwing future generations under the bus by in essence urging that we as Congress pass this week a quarter of a trillion spending bill, unpaid for. And if we would do that we might get their support in health care reform.Heh. One wonders if he's been reading this blog.In all seriousness, the mashinations going on the Hill often leave me perplexed. Fortunately, all one has to do in such a situation is turn to a fellow cardiac electrophysiologist to help explain things, and no one does...

Paul Levy Phones It In - Literally!

Doctor Anonymous — Wed, 21 Oct 2009 05:16:00 +0100

I know you have already saw pictures over on the Running A Hospital Blog by Mr. Levy. But here, kids, is the companion video to go along with those pics. I recorded this video at the MedBlog Track at BlogWorld Expo 2009. Thanks to MedPage Today and Johnson & Johnson for sponsoring the track.In the four minute video above, Paul was asked about his blog - especially why he blogs. He responds by saying, "Why wouldn't you do it" (meaning blog). Another interesting quote was this, "Folks have gotten used to the idea that when they send me an e-mail on a particular topic, it may show up on the blog."If you enjoyed this little short video, I invite you to check out my extended conversation with Paul on Doctor Anonymous Show number 29. You can listen on the player above. Or, if you like, you c...

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Dr. A Show 124 Preview

Doctor Anonymous — Wed, 21 Oct 2009 03:49:00 +0100

I'd like to invite you to the show this week as we wrap-up the first ever MedBlog Track at BlogWorld Expo 2009 - or, as I am affectionally calling it - MedBlogWorld 2009. You'll see in the video above some of the stuff that I'm scheduled to talk about including some behind the scenes stories which you're not gonna find on any other post-BWE blog post!So, check us out on Thursday, October 22nd, 2009 at 9pm Eastern Time. As always we're gonna be live on BlogTalkRadio.com with a chat room, you're ability to call into the show to say hello, and even you're ability to see me do the show live on my webcam. Isn't that exciting? See you for the show! (Source: Doctor Anonymous)

Shows 122 & 123 Wrap-up

Doctor Anonymous — Wed, 21 Oct 2009 03:39:00 +0100

With my busy schedule before BlogWorld Expo, I haven't had a chance to post up these archived shows. I have to admit that show 122 was not my best effort. I was on call that night, and just walked into the door following doing an admission at the hospital. In addition, before doing the hospital admission, I was at a soccer game where it was cold, windy, and rainy. So, I was exhausted and tired and frustrated. In addition, I was having some technical difficulties during the show. If I wasn't so tired, I would have been very angry. But, it was only a 30 minute show, so the pain of me doing a show was relatively short. (As always you can listen to the show in the player above. Or, you can click here and listen to the show anytime)Show Number 123, however, has an interesting story behind it. B...

Erratum

Dr. Wes — Wed, 21 Oct 2009 02:51:00 +0100

Click to enlargeWhat's wrong with the cover from this week's Heart Rhythm journal. (Hint: arrow).This is why I don't think I'd ever like to be a copy editor because some smart a** will point out things like this.-Wesh/t: A fellow colleague in crimeMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Dr. A Show 124: MedBlogWorld09 Wrapup - Oct 23,2009

Doctor Anonymous Live — Tue, 20 Oct 2009 15:45:00 +0100

Citation bias and unfounded authority

Notes from Dr. RW — Tue, 20 Oct 2009 12:36:00 +0100

Bias is omnipresent and operates at many levels. We're all familiar with publication bias but there's a less will appreciated form: citation distortion. This can occur by several means such as selectively citing papers that support a claim while ignoring those that refute it, or by citing papers in support of a claim but which have no original research data.H/T to Secondhand Smoke. (Source: Notes from Dr. RW)

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MedBlogWorld In A Nutshell

Doctor Anonymous — Tue, 20 Oct 2009 03:12:00 +0100

As my good friend Kim has written in the past, "Doctor Anonymous will be going full-out techie on us and bringing his video camera, so what happens in Vegas may or may not stay in Vegas! You have been warned!" Well, my friends, the day has come - hehe.In the video above, is a compilation of the video that I recorded at the first ever MedBlog Track at BlogWorld Expo 2009. Thanks again to MedPage Today and Johnson & Johnson for sponsoring this MedBlog Track. What I'm gonna do (when I get some more time from my "real" job - HA) is place on this blog, more of the parts of the video that you see above.I hope you enjoy this video. And, feel free to leave comments. Especially for those who did not attend last week's meeting, this may be the first time you're actually seeing your favorite medblogg...

Reasons it’s crap being a woman.

FtM Doctor — Mon, 19 Oct 2009 22:24:36 +0100

The other day one of my school friends contacted me on Facebook and asked why I choose to change sex. I think I muttered the usual cliche about being ‘trapped in the wrong body’ or something. But as far as I can see the real question is ‘Why on earth are you still a woman?’ Because life as a woman was seriously weird. Things that were rubbish about being a woman. Make up. I tend to cultivate stubble when I’m not at work, but it gets hopelessly itchy after a week. Anyway if you think shaving is bad, try having to slather some weird powdery stuff over your face every day. And get this – it’s for no apparent purpose. Periods. Urgh. Why ? Dying in childbirth. Sorry but any species where 1 in 5 females die in childbirth unless they have medica...

Stem Cells Provide Hope In Alport Syndrome.

All Kidney News — Mon, 19 Oct 2009 21:52:02 +0100

Stem Cells For Alport Syndrome Alport syndrome is a genetic defect of type 4 collagen, a major structural component of the glomerular basement membrane. Which is in turn the major structural component that defines the function of the filtration apparatus of the kidney. Defects of this important component of glomerular function results in various abnormalities. In Alport syndrome patients progressively lose renal function due to inflammation of the kidney. There is currently no known cure for this condition. Researchers in Boston however have published a paper that seeks to lay the foundation of a possible future treatment. Their research focuses on a lab induced variant of Alport syndrome in rats and its subsequent treatment with stem cells derived from the bone marrow of healthy rats. Th...

Health Reform: $1.03 Trillion And Counting

Dr. Wes — Mon, 19 Oct 2009 16:02:00 +0100

Let's be honest, shall we? It seems the Congressional Budget Office's prediction of the cost of the Baucus bill, some $829 billion dollars, was only achieved by removing Congress's pledge to abolish the "sustainable growth rate" adjustment for physician pay, saving the bill some $200-240 billion dollars in costs over 10 years. Instead, this portion of the health care legislation was carved out and placed under a separate bill, S. 1776 as an "accounting trick."Lord knows how many other pieces of legislation have been similarly extracted from the original health reform bill for budgetary expediency.Interesting that the press never seems to mention this.So, by my most optimistic calculations so far, the Health Care Reform package will cost U.S. taxpayers about $829 Billion (Baucus Bill) + $20...

When med students post unprofessional content on social networking sites

Notes from Dr. RW — Mon, 19 Oct 2009 14:33:00 +0100

From a survey in the JAMA issue on medical education: Results Sixty percent of US medical schools responded (78/130). Of these schools, 60% (47/78) reported incidents of students posting unprofessional online content. Violations of patient confidentiality were reported by 13% (6/46). Student use of profanity (52%; 22/42), frankly discriminatory language (48%; 19/40), depiction of intoxication (39%; 17/44), and sexually suggestive material (38%; 16/42) were commonly reported. Of 45 schools that reported an incident and responded to the question about disciplinary actions, 30 gave informal warning (67%) and 3 reported student dismissal (7%). Policies that cover student-posted online content were reported by 38% (28/73) of deans. Of schools without such policies, 11% (5/46) were actively deve...

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Twitter Weekly Updates for 2009-10-18

Medicine and Man — Sun, 18 Oct 2009 21:00:00 +0100

Dietary modifications to prevent kidney stones http://j.mp/tfpzk # Elevated pre-op BNP is a predictor of cardiovascular events in first 30 days after non-cardiac surgery http://bit.ly/NxTjr # McDonald's has online math program for kids in Australia with the ad- "proudly provided by your local McDonald’s" http://bit.ly/8aHK0 # Google introduces search options for mobile browsers http://bit.ly/YUFnY #iphone #android #palm # The New Yorker: How different are dogfighting and football? http://bit.ly/1THpqS # The New Yorker Slideshow: This Is Your Brain On Football http://bit.ly/nFeiG # For doctors, less sleep is linked with more mistakes http://bit.ly/1TqGpL # In surgeries, mistakes were made nearly twice as often when the doctor had slept fewer than 6 hours http://bit.ly/1TqGpL...

No Good Options for Specialists

Dr. Wes — Sun, 18 Oct 2009 20:37:00 +0100

I just received this e-mail from the Heart Rhythm Society:On Wednesday, the Alliance of Specialty Medicine (the Society is an active member of the Alliance), as well as the American Medical Association and nine other medical societies attended a meeting with the following officials: Senate Majority Leader Harry Reid (D-NV), Senate Finance Committee Chairman Max Baucus (D-MT), Senate Health Committee Member Chris Dodd (D-CT), White House Chief of Staff Rahm Emanuel and Office of Health Reform Director Nancy-Ann DeParle. During the meeting it was announced that S.1776 will serve as the Senate vehicle for eliminating the SGR formula and lay the foundation for establishing a new Medicare physician payment system. This new proposal will be incorporated into broader health care reform legislatio...

Dr. A Show 125: Thursday Night - Oct 23,2009

Doctor Anonymous Live — Sun, 18 Oct 2009 15:00:00 +0100

Our Upside Down Medical Liability Crisis

Dr. Wes — Sun, 18 Oct 2009 13:32:00 +0100

I had an interesting visit with the husband of my niece last evening. He works as an ER doctor that is self-insured group of 60 physicians that cover the ER needs of four hospitals in Clark County near Las Vegas. What is interesting is they are self-insured to save costs. As a group, then, they know how much per patient they must collect to assure liability care for every patient that comes to their emergency rooms.That amount is $17 per patient per visit.Guess how much their group receives for care they render to a Medicaid patient for a "level two" visit (minor problem: ear ache, sore throat, etc.)Fourteen dollars per visit.(Note: Medicare level two patients pay considerably better (about four times as much)).When liability costs exceed the payments received for the care provided to thos...

Show Cancelled - Oct 17,2009

Doctor Anonymous Live — Sat, 17 Oct 2009 23:25:04 +0100

I apologize for cancelling the show tonight. I think I had just a little too much fun at BlogWorld Expo - just got back this morning and haven't been feeling good all day. I'll give my BWE update on the next show. Sorry for the inconvenience....... (Source: Doctor Anonymous Live)

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The State of Our Current Health Care Reform Efforts

Dr. Wes — Sat, 17 Oct 2009 15:09:00 +0100

If you read nothing else this morning, please read Margaret Polaneczky, MD's (aka "TBTAM") excellent post that vividly summarizes our current health care reform efforts underway while offering insights as to what real reform should look like:Real reform won't happen until the American people take their seat at the head of the table and invite doctors, ethicists and healthcare experts (not industry lobbyists) to bring their best knowledge about what interventions are most important, most effective and most cost efficient. Then we can sort out our priorities (you can call it rationing if you want) and create a budget.Only then we can begin to negotiate with third parties (insurers, Big Pharma, etc) to sell us what we need at the best price. That's called competition, and it's what American c...

Dr. A Show 124: Saturday Night - Oct 18,2009

Doctor Anonymous Live — Sat, 17 Oct 2009 15:00:00 +0100

Looking for somewhere to relax on a Saturday night, why not come on into The Doctor Anonymous Show as we talk about the serious and not-so-serious news stories of the week including the areas of medicine/health, entertainment, pop culture, and whatever else comes up.Doctor | Anonymous | Medblogger | Social Networking | Medicine (Source: Doctor Anonymous Live)

Muscle Cramps In Dialysis Treated By Vitamin E

All Kidney News — Sat, 17 Oct 2009 03:18:57 +0100

cramp photo Credit:happeningfish Cramping of the muscles while undergoing dialysis is one of the most frequent complaints of dialysis patients. It occurs in up to 20% of dialysis sessions. Risk factors for cramping includes high weight gain in between dialysis sessions. Having low serum calcium or derangement of sodium and potassium. Intradialytic hypotension may also present with cramping of the muscles. While many corrective actions may taken during the treatment to treat the cramps, it may be found that this interrupts treatment time and can reduce clearances and achieved ultrafiltration especially if sodium chloride is used repeatedly to treat the episodes of cramping. Recently an article published in the American Journal of Therapeutics has shown that vitamin E maybe effective at pr...

Large Kidneys What Do They Mean?

All Kidney News — Sat, 17 Oct 2009 02:30:19 +0100

Usually kidney disease is associated with small kidneys. The process that shrinks the kidney is scarring otherwise known as fibrosis which is the end point of any damage to the kidney. However from time to time a disease process will come along that causes enlargement of the kidney as it proceeds to damage the kidney. Some of the diseases that may cause this are as follows. Infiltrative diseases such as sarcoidosis and amyloidosis both cause this. Amyloidosis is a disease of the blood which bears certain similarities with multiple myeloma and may coexist with this condition. There is deposition of large quantities of abnormal protein in amyloidosis which are laid down around the blood vessels and other structures of the kidney leading to abnormal function. HIV kidney disease is associated...

Dr. A Show 123: Live at BlogWorld Expo - Oct 16,2009

Doctor Anonymous Live — Fri, 16 Oct 2009 21:00:00 +0100

Couldn't make it to BlogWorld and New Media Expo this year? That's ok, because I will be having a live broadcast from the Exhibit Floor right from the BlogTalkRadio booth 329. I'll be giving a report about the first ever Medblog Track at BWE and also some dirt, uh, stories about your favorite medbloggers in Las Vegas.Doctor | Anonymous | BlogWorldExpo | Medblog Track | Medicine (Source: Doctor Anonymous Live)

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In Case You Were Wondering

Dr. Wes — Fri, 16 Oct 2009 15:28:00 +0100

... Kim has a nice run-down on what I've been up to over at Emergiblog. Yesterday's conference on medical blogging and the impact that social media will play in the future direction of health care was fascinating and well worth the trip. Issues discussed were far-reaching, including the legal issues facing physician and nurse bloggers, what new media means to hospital and the medical device/pharmaceutical industries, and the impact/influence medical bloggers can have upon mainstream media and patient communication.Everyone had a great time and I would encourage anyone out there with an interest in this venue to join us next year!-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Medbloggers at BlogWorld

Doctor Anonymous — Fri, 16 Oct 2009 15:19:00 +0100

What happens in Vegas ends up on YouTube - LOL! In the video above, you'll see what happens when you mix medbloggers, food, drink, Las Vegas, and BlogWorld Expo. I think you'll be able to match up last night's medblogger twitter feed to what is happening above. Kim has already warned you that medblogger karyoke will be posted some time - and this is the time - hehe. Enjoy! (Source: Doctor Anonymous)

Dr. A Show 123 at 2pm PT Today!

Doctor Anonymous — Fri, 16 Oct 2009 14:41:00 +0100

Friday, October 16th, 2009 at 2pmPT/5pmET ETMy first BlogWorld Expo experience has been so much fun! I got to meet a bunch of medbloggers that I have only known online before. This was the first ever MedBlogger Track of programming at this meeting (and hopefully not the last). This experience will be capped off with a live podcast from the floor of the exhibit hall later today.For those of you on site, I will be at the BlogTalkRadio booth (Booth Number 329) at 2pm this afternoon doing a quick 30 minute show talking about my experience yesterday here at BWE09. I picked this time because it is during a break between sessions. If you're not here, that's ok. Just click here and you will be able to listen live as you usually do during other shows.If you are new to the show, I encourage you to c...

BlogWorld 09: HIPAA & Blogging

Doctor Anonymous — Fri, 16 Oct 2009 14:01:00 +0100

Yesterday, was the first ever Medblog Track at BlogWorld Expo. I have to admit that it was a surreal experience to actually meet in person the medbloggers that I have only known online in the past. One of the funny first experiences was that when we were first meeting up yesterday morning, we were actually identifying each other by our twitter IDs.Each of the four panel discussions brought a unique perspective to the area of medicine and social media. The video above is only the first 7-8 minutes of the panel I was a part of called, "Staying on the Good Side of HIPAA: Safe & Ethical Blogging Practices." The entire session went over an hour. So, I probably won't put the entire session up, but I wanted to share with you at least the beginning of this session. When I get home, I'll look throu...

Building a brain in a supercomputer

Medicine and Man — Fri, 16 Oct 2009 13:44:32 +0100

“Henry Markram says the mysteries of the mind can be solved — soon. Mental illness, memory, perception: they’re made of neurons and electric signals, and he plans to find them with a supercomputer that models all the brain’s 100,000,000,000,000 synapses.” addthis_url = 'http%3A%2F%2Fmedicineandman.com%2Fblog%2F2009%2F10%2F16%2Fbuilding-a-brain-in-a-supercomputer%2F'; addthis_title = 'Building+a+brain+in+a+supercomputer'; addthis_pub = ''; (Source: Medicine and Man)

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The Shortage of Primary Care Services: Utilizing Nurse Practitioners and Physician Assistants to Relieve the Crisis

APCblogit — Fri, 16 Oct 2009 13:08:25 +0100

From Bob Blumm, MA, PA-C, DFAAPA: It is evident that the American system of health care is in need of an overhaul. Current figures indicate that there are over 46 million people who are uninsured. This equates to 15% of our nation's citizens who may not be able to access health care. The American College of Clinicians submits that Physician Assistants (PAs) and Nurse Practitioners (NPs) already significantly improve access to primary care services, but are underutilized in our current health care delivery system. While fewer physicians are choosing primary care, a new paradigm exists. But there has been a systemic failure to recognize that the skills and knowledge of PAs and NPs makes them well qualified to fill the role of primary care provider. Even though these individuals demon...

Older Dialysis Patients May Not Derive Benefit from Dialysis

All Kidney News — Thu, 15 Oct 2009 18:17:21 +0100

Dialysis in the Elderly Recently I asked the question can you be too old for dialysis. Then today I noticed a news release based on an article published in the new England Journal of Medicine which suggests that elderly patients living in nursing homes may not be deriving significant benefit from dialysis. I had feedback on my own article, which suggested the very concept of limiting dialysis based on age is repulsive. Let me make it quite clear, that it was never my intention to suggest such a thing. My point remains that in order for a treatment to be offered, it must be shown to be of benefit to the patient. The first rule of medicine is …at least do no harm. In the case of dialysis the elderly population is not as frequently studied survival numbers as well as quality of life da...

Therapeutic hypothermia after cardiac arrest

Notes from Dr. RW — Thu, 15 Oct 2009 11:47:00 +0100

Cost effective in this new analysis. (Source: Notes from Dr. RW)

Exercise may reverse non-alcoholic fatty liver disease

Notes from Dr. RW — Thu, 15 Oct 2009 11:45:00 +0100

---and the effect was independent of weight loss.Medscape CME.Primary source. (Source: Notes from Dr. RW)

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Practical overview of noninvasive ventilation

Notes from Dr. RW — Thu, 15 Oct 2009 11:43:00 +0100

This is the best paper I'm aware of on the subject. It covers a variety of indications. (Source: Notes from Dr. RW)

IV and PO antibiotic options for cellulitis

Notes from Dr. RW — Thu, 15 Oct 2009 11:40:00 +0100

From The Hospitalist. (Source: Notes from Dr. RW)

Treatment Options In Goodpastures.

All Kidney News — Wed, 14 Oct 2009 23:45:01 +0100

kidney Overview of Goodpastures Syndrome. A rapidly progressive form of kidney disease associated with antibodies directed against the structural components of the functional subunits of the kidney and the lung. The disease therefore gives rise to both lung and kidney pathology a situation termed pulmonary renal syndrome. The exact cause is unknown. It is considered an autoimmune disorder (other autoimmune disorder’s that affect the kidney include Lupus Nephritis). The bodies own immune system is responsible for targeting both lung and kidney tissues. The initial immune system activation may occur in response to viral infection or even the inhalation of toxin from the environment such as inhaling gasoline. Smoking increases the risk of the disease it is most likely to occur in men ...

Treatment Options In Goodpastures.

All Kidney News — Wed, 14 Oct 2009 23:45:01 +0100

Dr. A Show 123: Live at BlogWorld Expo - Oct 16,2009

Doctor Anonymous Live — Wed, 14 Oct 2009 15:30:00 +0100

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Guideline concordant treatment of community acquired pneumonia

Notes from Dr. RW — Wed, 14 Oct 2009 11:50:00 +0100

---improved outcomes and reduced resource utilization in this study. (Source: Notes from Dr. RW)

Electrocardiographic findings in arrhythmogenic right ventricular dysplasia

Notes from Dr. RW — Wed, 14 Oct 2009 11:48:00 +0100

Via Circulation. (Source: Notes from Dr. RW)

ER throughput in the U.S.

Notes from Dr. RW — Wed, 14 Oct 2009 11:45:00 +0100

We’re still not doing a very good job. (Source: Notes from Dr. RW)

Cutaneous manifestations of liver disease

Notes from Dr. RW — Wed, 14 Oct 2009 11:40:00 +0100

Some of these apply to liver disease in general while others are associated with specific etiologies (e.g. Hep C, hemochromatosis). Via CCJM. (Source: Notes from Dr. RW)

Mr. Microphone Gets a Stent

Dr. Wes — Wed, 14 Oct 2009 11:05:00 +0100

... I'm not kidding:"The link between erectile dysfunction and coronary artery disease has been well established. Based on this evidence, we are investigating the use of stents in pelvic arteries to determine whether it may provide a new treatment approach and enable better response to drug therapies"...Medical innovation at its finest. -WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

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Dr. A Show 122: BlogWorldExpo Preview - Oct 14,2009

Doctor Anonymous Live — Wed, 14 Oct 2009 02:00:00 +0100

Are you going to the Medblog Track at BlogWorld and New Media Expo in Las Vegas this week? If you will be at this October 15th event, I invite you to join us for the show for the unofficial kickoff party to the Medblogger BlogWorldExpo extravaganza!Doctor | Anonymous | Medblogger | Social Networking | BlogWorldExpo (Source: Doctor Anonymous Live)

Model Health Care System Drops Medicaid Patients

Dr. Wes — Tue, 13 Oct 2009 17:10:00 +0100

Yep, the Mayo clinic is refusing Medicaid patients from two states, citing poor payment rates.So let me get this straight. The government sets the rates for the poor and disadvantaged and one of the President's model health care systems balks? How's this going to work when the government runs more and more of the health care delivery in the US?Maybe this is why Mayo isn't too happy with the current reform plans.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Mail-Order Drugs: Direct to Consumer - from India via Canada

Dr. Wes — Tue, 13 Oct 2009 11:30:00 +0100

It came in the mail to one of my partner's patients, a direct mailing (4 pgs, pdf, 1.2M) promising cheap drugs at significant cost savings from Global Pharmacy Canada. A closer look at the flier, however, discloses the drugs are not from Canada, but rather pharmacies somewhere in India. Call it global direct-to-consumer pharmaceutical advertising. All you have to do is sign a little waiver and send your money:I appoint Global Pharmacy Canada to act as my agent to send my order and prescriptions to a licensed pharmacy in India, so that the pharmacy can send my medications directly to me. I understand that my prescriptions will be filled according to the laws of India, as defined by India's FDA. By completing and signing this form, I understand that I am placing an order for generic medicati...

Dr. A Show 122: Pre-BlogWorld Expo

Doctor Anonymous — Tue, 13 Oct 2009 02:27:00 +0100

Tuesday, October 13th, 2009 at 10pm ETI know what you're saying - What the heck are you doing with a Tuesday night show? Well, with me leaving on Wednesday for Las Vegas for BlogWorld and New Media Expo, I figured, why not? Why not have a show the day before I leave for this huge meeting. I am so nuts, I am on call on show night. And, I'll be coming back from a soccer game before the show starts.What will we be talking about? Well, uh, how about the Medblog Track at Blog World and New Media Expo. Wanna have details on each of the four panel discussions which will take place? Well, click here and you'll get more information. I'm so looking forward to meeting in person people that I've only known electronically through the years. Let me tell you, it's really going to be a surreal experience....

Ablation or drugs for atrial fibrillation?

Notes from Dr. RW — Tue, 13 Oct 2009 02:18:00 +0100

Ablation is far from perfect but is getting better. Although preliminary data suggest it is more effective than drugs an upcoming large comparative trial may provide better answers.A recent review in CCJM discusses current indications and complications. Complications, particularly pulmonary vein stenosis and atrioesophageal fistula, may appear relatively late and should be recognized by hospitalists.Related editorial here. (Source: Notes from Dr. RW)

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Appropriateness criteria for stress nuclear cardiac imaging

Notes from Dr. RW — Tue, 13 Oct 2009 02:08:00 +0100

A document written by the AHA, the ACC Foundation and other specialty organizations. The tables are good for quick reference, and those portions dealing with acute chest pain will be of particular interest to hospitalists. (Source: Notes from Dr. RW)

A clinical prediction instrument to assess risk of tuberculosis in patients admitted with pneumonia

Notes from Dr. RW — Tue, 13 Oct 2009 02:03:00 +0100

You admit a debilitated patient with pneumonia to the general medical ward. He does not respond well and has a long drawn out hospital course. Weeks later his sputum specimens reveal tuberculosis. Meanwhile several hospital nurses and respiratory therapists have converted their tuberculin skin tests. You're kicking yourself for not having isolated the patient. But how could you have known? You wanted to be a good steward of hospital resources and not utilize isolation rooms unnecessarily. Here's a clinical prediction instrument to help you decide which patients to isolate. (Source: Notes from Dr. RW)

Show 121 Wrap-up

Doctor Anonymous — Tue, 13 Oct 2009 01:58:00 +0100

This show was recorded one week prior to the Medblog Track at the 2009 BlogWorld and New Media Expo in Las Vegas. This was a brief 30 minute show in which I reviewed the panel discussions which are going to take place at this year's Medblog Track (you can find out more information by clicking here).I also reviewed my week which included some comments about my most recent television interview on local TV news. The topic of the interview was October being Breast Cancer Awareness Month. As always, you can listen to the show on the player above. Or, you can download the show by clicking here and listen to the show anytime! (Source: Doctor Anonymous)

Chinese Herbal Medicine and Kidney Stones

All Kidney News — Tue, 13 Oct 2009 01:22:16 +0100

Kidney stone pain or ureteric colic is perhaps the most feared symptom of urolithiasis. People who experience it at its worst will do anything that they have been told will help in the passing kidney stones. Because of this fact there are many questionable products on the market which claim to pass kidney stones or dissolve kidney stones. From time to time I have reviewed some of the more prominent preparations. There is a natural tendency to discount what we don’t understand or were not trained to understand. I am no exception to this rule, having not been trained in traditional herbal medicine in a country where it is practiced. However I do believe the current upsurge in published studies utilizing traditional medicine has allowed for a bridging of knowledge between two worlds whi...

Chinese Herbal Medicine and Kidney Stones

All Kidney News — Tue, 13 Oct 2009 01:22:16 +0100

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BWE & not AAFP CoD

Doctor Anonymous — Mon, 12 Oct 2009 23:23:00 +0100

I have a lot of friends in Boston this week who are attending the annual meeting for the American Academy of Family Physicians (ie - Congress of Delegates or AAFP CoD). And, they may not be too happy with what they read in this post, but here goes.As some of you know, I’m scheduled to present at BlogWorld Expo (BWE) later this week in Las Vegas. I’m going to be moderating a panel about how patient privacy and the HIPPA law can impact blogging, podcasting, and interacting with social networking. When I was offered the moderating spot, I did think to myself, “You know, this is the same week that the AAFP national meeting will be taking place in Boston.” I haven’t seen many of my AAFP friends and colleagues for a while now. Through the summer, I’ve gotten a lot of messages through...

The Rationer

Dr. Wes — Mon, 12 Oct 2009 21:21:00 +0100

Every cardiac electrophysiologist has been there: a relatively young individual in their 50’s presents to the Emergency Room short of breath, sitting bolt upright in bed and is found to be in congestive heart failure. This is not their first admission; several others have come before and each with a common theme: a positive urinary screen for cocaine.The EKG shows left bundle branch block. Catheterizations occur, coronary disease absent or moderate, discussions held, patient recommended for defibrillator or biventricular pacing to improve their heart failure after medications have been ineffective for the past year. The person seems sincere – “No more drugs, doc, really” – a line uttered near the conclusion of every one of the patient’s prior hospitalizations, but this time, re...

Twitter Weekly Updates for 2009-10-11

Medicine and Man — Sun, 11 Oct 2009 21:00:00 +0100

Smoke-free legislation reduces rate of heart attack, and these benefits grow with time http://bit.ly/RRUNI # Can air pollution cause appendicitis? http://bit.ly/3oUp4P Possibly!! # There is insufficient evidence to support evaluating risk of heart disease based on non-traditional risk factors http://bit.ly/kvasD # Non traditional risk factors for heart disease – CRP, homocysteine, lipoprotein(a), ABI, cardiac CT, CIMT http://bit.ly/kvasD # Hand hygiene and face masks may prevent household transmission of influenza virus http://bit.ly/CtO1K # The New Yorker: Swine Flu rumors and fears http://bit.ly/3vmil # Is cystatin C the next creatinine? http://bit.ly/17q2bm # 13 million songs were for sale online last year, 10 million never got a single buyer http://bit.ly/4FiwEk # Last year 80% o...

Green tea and Kidney Cancer News

All Kidney News — Sun, 11 Oct 2009 17:48:32 +0100

An abstract from the Journal Oncology Reports. has brought Green Tea back into the news yet again. EGCG (epigallocatechin gallate), the major antioxidant found in green tea, has been shown to inhibit the growth of many tumor cells even inducing the tumor cells to spontaneously die by a process known as apoptosis. EGCG can inhibit one of the enzymes involved in DNA synthesis and repair and thus cause reactivation of genes that lead to this effect. The gene responsible is known as TFPI-2, a member of the Kunitz-type serine proteinase inhibitor family. Previous studies demonstrated that the expression of TFPI-2 and invasiveness of renal cell carcinoma had a negative correlation. TFPI-2 may induce tumor cell apoptosis in renal cell carcinoma. Lower expression of TFPI-2 in renal cell carcinoma ...

Green tea and Kidney Cancer News

All Kidney News — Sun, 11 Oct 2009 17:48:32 +0100

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Lupus and Kidney disease..What is Lupus Nephritis?

All Kidney News — Sun, 11 Oct 2009 16:41:50 +0100

lupus and kidney disease Lupus nephritis an ominous name for a condition that most people would not have heard of. Chances are if you know the entity to which I am referring you either have this disease or know someone who does. Lupus nephritis is the name given to inflammation of the kidney because of lupus. There are several flavors of Lupus nephritis and they are graded from 1 to 6 based on testing of kidney tissues. The prognosis of lupus nephritis is tied to the class of the disease. With Class I disease having the best prognosis while class 4 and 5 disease and combinations thereof having the worst overall prognosis. Estimates are that up to 50% of patients who have lupus will have some manifestation of lupus nephritis over the course of their illness. To understand Lupus Nephritis we...

Lupus and Kidney disease..What is Lupus Nephritis?

All Kidney News — Sun, 11 Oct 2009 16:41:50 +0100

Iron, EPO Anemia and Kidney Disease

All Kidney News — Sun, 11 Oct 2009 15:06:53 +0100

Anemia in Kidney Disease Spiegel and Chertow in the Clinical Journal of the American Society of Nephrology have taken a look at the direction we are heading in the treatment of anemia in ESRD based on a few recent studies. Their commentary is particularly interesting because it brings to light a new possible threat, the injudicious use of iron in the absence of sufficient safety data. They highlight several clinical controversies still facing patients in the dialysis population. Controversies that stem from recently done studies which have questioned the optimal hemoglobin range for correction of anemia and the absence of any long term safety data for IV iron therapy. It is suggested that economic factors may further complicate the use of such agents based on the reimbursement model, the d...

Iron, EPO Anemia and Kidney Disease

All Kidney News — Sun, 11 Oct 2009 15:06:53 +0100

I’m back, Honestly, no Really.

FtM Doctor — Sun, 11 Oct 2009 10:09:33 +0100

And I’m still not dead. But it’s going ok. I’m enjoying it and feeling that I’ve made the right career decision. But I’m just that much less anonymous than I was as an SHO. There are hundreds of SHOs in the country so I can easily blog in the background. I could be anyone of them. Hell there could even be another transsexual Medical SHO. So if for instance I say ‘Yesterday my Consultant was angry’ my consultant is much more likely to put two and two together that maybe his Registrar is a transsexual. At the moment I love being a Medical Registrar, I’ve got a bit addicted to the adrenaline rush of looking after the very sick, and I can effectively manage a good shift. I’m a bit more unsure about the specalist stuff, I’m ok at the T...

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Dr. A Show 122: BlogWorldExpo Preview - Oct 14,2009

Doctor Anonymous Live — Sat, 10 Oct 2009 18:45:00 +0100

"Body Computing" and the Right to Health Information

Dr. Wes — Sat, 10 Oct 2009 04:32:00 +0100

Fellow cardiac electrophysiologist Leslie Saxon, MD thinks patients should own their medical device information in the era of "body computing:"But there are major obstacles standing in the way of people's rights to access their health care data. There are over 400,000 patients with implanted defibrillators that have networked capability. Up to 20 percent of people with defibrillators will be shocked from the device. While the shock is life-saving and one of the main reasons the device gets placed, patients feel something that is akin to a punch in the chest and it causes great concern and curiosity from the patient. Where does the vital information about the shock go?It is transmitted to a secure server--managed by device manufacturers--and the information is then downloaded to a secure we...

Exercise and Kidney Disease

All Kidney News — Sat, 10 Oct 2009 01:09:45 +0100

Image by raysto. Exercise has proven health benefits in the normal population. These benefits are tied in some instances to weight loss. However the health benefits of exercise exceed that of weight loss alone. In a recent press release the American Society of Nephrology has made the statement “getting off the couch could could lead to a longer life for kidney disease patients.” Based on a study which will be published in the Clinical Journal of the American Society of Nephrology (CJASN). The mortality among patients with CKD is driven unexpectedly by cardiovascular disease implying that the function of these two organs although quite different on paper, are closely related on some more fundamental level that is not readily apparent. Although there are many theories as to how t...

Exercise and Kidney Disease

All Kidney News — Sat, 10 Oct 2009 01:09:45 +0100