MedWorm: Internists and Doctors of Medicine

SuperBowl XLIV Commercials

Doctor Anonymous — Mon, 08 Feb 2010 02:33:00 +0100

I really had no loyalties going into the game - meaning I really didn't care who won - other than it was a competitive game. While following twitter during the game, I would occasionally glance up and see the SuperBowl commercials. As predicted before the game by tech pundits, Google for the first time had an ad which most people on twitter liked, but I did not. Oh well. And ad which really snuck under the radar, and will probably get a lot of discussion on the day after the superbowl will be the Letterman/Leno/Oprah awkward looking but entertaining 15 second ad.During the first half of the game, there were two ads which I thought were very funny. One was from career builder and the other was from dockers. Maybe it's just my silly mind, but I thought it was very funny that the theme of the...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Show 144 Wrap-up

Doctor Anonymous — Mon, 08 Feb 2010 00:13:00 +0100

Thanks to everyone who checked out Doctor Anonymous Show 144 either live or on the archives. I talked a little bit about this week's health/medicine news stories, including this one, and also covered some not-so-serious news stories. Thanks so much to our buddy Enrico who called into the show. It's was nice to talk with him again after a long absence - welcome back!As always, you can listen to the show on the player above. Or, if you like, you can download the show and listen anytime by clicking here. Would like to listen and download other Dr. A Shows, we'll just click DoctorAnonymous.org and that takes you to my iTunes page where you have access to all my past shows. Thanks for your continued support of the website and of the show! (Source: Doctor Anonymous)

Dr. A Show 145: Drew Griffin - Feb 12,2010

Doctor Anonymous Live — Sun, 07 Feb 2010 16:45:00 +0100

Our guest will be Drew Griffin from the Wound Care Education Institute (wcei.net). We met in person and had a great conversation at Podcamp Ohio 09. We'll be talking about how it is to be a Clinical Wound Care Specialist and how he uses social media for both work and to relax. Hope you can join us for the show!Doctor | Anonymous | Drew Griffin | Wound Care Education Institute | Medicine (Source: Doctor Anonymous Live)

Changing sex at Medical School

FtM Doctor — Sun, 07 Feb 2010 11:45:39 +0100

It’s nearly 10 years since I changed sex, it seems like a different world now. When I changed you couldn’t change your birth certificate, legally you were your birth sex. This meant you couldn’t get married, if your partner had children through fertility treatment then you couldn’t legally be the father. You could change your passport and driving license with your deed poll and a letter from your psychiatrist. This meant I could change my passport only a month after I transitioned, but now I’d have to wait for 2 years. The law against discrimination was different then as well. Then some transsexuals had managed to use the sex discrimination act to act against employers who discriminated against them. Now it’s clearly worded in the statue that you canno...

How Technology Is Straining the Doctor-Patient Relationship

Dr. Wes — Sun, 07 Feb 2010 11:39:00 +0100

Technology is an incredible thing.Technology is expensive.Technology saves lives.Technology can bankrupt.When there's no technology, are you a "bad" doctor for not following guidelines?When technology's used, are you a "bad" doctor because the patient has multiple comorbidities and the benefit for the implanted technology is questionable? It's become the yin and yang of medicine. An inconvenient truth.Medicine's technology is incredibly expensive, but incredibly valuable.But if the struggle isn't enough, along comes the press to skew the debate by "raising awareness" with our patients.Doctor, you need to "Get with the Guidelines." The subtitle with such an industry-sponsored trial and press report should be, "Oh, and business is off."The journal article at the heart of the Chicago Tribune ...

Anatomically Correct Gifts for Everyone on Valentine's Day

Dr. Wes — Sun, 07 Feb 2010 04:12:00 +0100

For your ex-, consider this giant bleeding gummy heart candy or maybe some of these chocolate hearts from "Pushin' Daisies." For your sweetheart, though, it's probably better to stick with this heart locket that opens to reveal the heart's four chambers.Me? Well, the abstract has appeal and for that, I'm leaning toward getting one of these t-shirts. The only problem is, the shirt's probably better for those interventional cardiology "plumber" types.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Dr. A Show 144: Snowed In - Feb 07,2010

Doctor Anonymous Live — Sun, 07 Feb 2010 02:00:00 +0100

For the first weekend of the BlogTalkRadio sweeps rating period (I'll explain during the show), I have a question for you: Are you snowed in like me and 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 Media | Medicine (Source: Doctor Anonymous Live)

Dr. A Show 144: Snowed In - Feb 07,2010

Doctor Anonymous Live — Sat, 06 Feb 2010 18:00:00 +0100

Is The US Swine Flu Epidemic Over?

Doctor Anonymous — Sat, 06 Feb 2010 13:16:00 +0100

I remember in this area, back in October 2009, when everyone just was not believing that H1N1 was around - or the "epidemic" was not real. Then, for about a 2-3 week span locally - BAM - it seemed like there were cases every where. When I walked throug the waiting room at the hospital, there were folding chairs out, and it was standing room only. Almost every day at the office, the phone was ringing off the hook. Then, as November came, everything calmed down...A report yesterday from the Associated press asks the question, "Is The US Swine Flu Epidemic Over." In the article, you see the graphic above which showed a spike in cases nationally to be in October as well - then a rapid drop off. It seems that just recently, federal health officials have begun to downplay the virus. However, the...

Show 143 Wrapup: Dean Brandon

Doctor Anonymous — Fri, 05 Feb 2010 21:53:00 +0100

Thanks so much to Dr. Dean Brandon for being my guest on Doctor Anonymous Show 143. We had a great conversation about his early influences which guided him toward his career as a pediatric dentist. I had no idea that his parents were NASA scientists. We also talked about the training process behind becoming a pediatric dentist. (Why the picture of Steve Martin above from Little Shop of Horrors? Check out the opening song of Show 143 and you'll know why)His website is called "Pediatric Dentistry" and we talked about how his posts are a reflection of what he tells parents and patients all the time about certain dental conditions. One of his posts called "My Child Tooth Is Turning Dark" has garnered over 100 comments.Finally, we discussed some of the experiences he has had in the social media...

European Health Care Ingenuity

Dr. Wes — Fri, 05 Feb 2010 19:13:00 +0100

You gotta love those Brits:An oil worker who was flown to Lerwick from an offshore platform after suffering a heart attack had to be taken the final mile to hospital in a rented van because no ambulances were available.The man was flown by the Sumburgh-based coastguard helicopter from the Heather Alpha platform, 92 miles north-east of Sumburgh, at around 6am on Tuesday morning. However, the helicopter crew waited half an hour for an ambulance which failed to arrive at the scene.The patient was eventually transferred to the Gilbert Bain Hospital in the back of a Star-Rent-A-Car van, which arrived with a doctor behind the wheel.A paramedic, who had been flying in the helicopter, went with the patient to the hospital where his condition was said to be stable and comfortable.No wonder their he...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Dr. A Show 144: Saturday Night - Feb 07,2010

Doctor Anonymous Live — Fri, 05 Feb 2010 17:15:00 +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 Media | Medicine (Source: Doctor Anonymous Live)

Going to HIMSS 2010

Doctor Anonymous — Fri, 05 Feb 2010 16:51:00 +0100

I'm taking more of an active interest in the electonic medical/health record - especially with the transition that we're going through in our office and at the hospital. In doing some reading and research, a lot of people out there have pointed to a group called HIMSS - which stands for Healthcare Information and Management Systems Society. They have a pretty good website over there that I have been reading a lot.I took a bold step by actually taking the time to go to their annual meeting next month - which will be in Atlanta. Since I have registered for the conference, I've been getting e-mail messages about the many events that will be taking place out there. I will only be able to stay for a couple of days or so, but I'm pretty excited about it. My goals will be to try to connect with o...

When Kids Have Skin in the Game

Dr. Wes — Fri, 05 Feb 2010 14:35:00 +0100

Somehow, I like the message for Jump Rope for Heart much more than Go Red for Women campaign:“I’m very proud of everyone who has collected and helped save lives,” McLaughlin said. Forty-five students, the most ever, collected donations. Although there were prizes for raising money, many students told their teacher they wanted to help people. “I had students say, ‘I’m not doing this for the prizes. I’m doing it to help people,’” he said. “I told them, that is a great attitude. “I couldn’t be more proud of them in these tough economic times.”To me,that's what it's all about.Nice job, kids!-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Adverse events after hospital discharge of geriatric patients

Notes from Dr. RW — Fri, 05 Feb 2010 05:36:00 +0100

ConclusionsDespite a seemingly well-organised system for transition of patients from the GEMU to their homes, one or more unwanted incidents occurred in most patients during discharge or four weeks post discharge. The study has revealed areas of importance for improving transitional care of geriatric patients. (Source: Notes from Dr. RW)

Management of severe asthma in the ICU

Notes from Dr. RW — Fri, 05 Feb 2010 05:25:00 +0100

This is one of the best reviews I've encountered. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Dr. A Show 143: Dean Brandon - Feb 05,2010

Doctor Anonymous Live — Fri, 05 Feb 2010 02:00:00 +0100

Our guest will be Dean Brandon, DMD, author of the blog Pediatric Dentistry. We met at BlogWorldExpo 2009. Among our topics will be how he started blogging, how he uses new media for his business, and how he got to meet internet celebrity Gary Vaynerchuk from WineLibraryTV. Hope you can join us for the show!Doctor | Anonymous | Dean Brandon | Cyber Dentist | Medicine (Source: Doctor Anonymous Live)

When Doctors Play Sherlock Holmes

Dr. Wes — Thu, 04 Feb 2010 22:14:00 +0100

"Could you tell me which medications you're taking?""Um, I'm not sure doctor, but I brought all of them with me.""Great! Can I see the bottles?""Um. Here they are:""Thanks," (said without blinking an eye), "Now, what do you take these for?...."-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Illinois Supreme Court Strikes Down Medical Malpractice Caps

Dr. Wes — Thu, 04 Feb 2010 15:43:00 +0100

From Crain's Chicago Business: The Illinois Supreme Court on Thursday struck down limits on jury awards in medical malpractice cases passed by the Legislature four years ago amid spiking liability costs for medical providers. The court ruled that the caps on pain and suffering and other non-economic damages — $500,000 per case for doctors and $1 million for hospitals — are unconstitutional. The court’s opinion upholds a 2007 ruling by a Cook County Circuit Court judge determining that the law violated the Illinois Constitution’s “separation of powers” clause, essentially finding that lawmakers interfered with the right of juries to determine fair damages. It’s the third time the state’s high court has quashed limits on medical malpractice awards, having tossed out similar l...

Why Credentials?

Dr. Wes — Thu, 04 Feb 2010 12:16:00 +0100

Today, the ongoing turf war between nurse anesthetists and anesthesiologists was reported in the Wall Street Journal:Gov. Arnold Schwarzenegger decided last year to allow nurse anesthetists in California to work without a supervising physician. Now two doctors’ groups are challenging the move in court, according to HealthLeaders Media.The fight centers over 2001 Medicare rules that usually require a doctor to supervise when nurses administer anesthesia, but allow states to op out of the requirement if a governor sends a letter to the feds. California did that in June.Needless to say, the anesthesiology community was not too happy and filed suit to block the decree.But we must ask ourselves, where are the credentialling bodies in this debate?On an recurring basis, doctors must obtain cont...

The New Health Care Crisis: Dueling Burger Joints

Dr. Wes — Thu, 04 Feb 2010 12:04:00 +0100

Heart Stoppers Sports Bar versus Heart Attack Grill:A bed pan full of Cheese Chest Pain Fries is just one of several medically themed items on the menu here at Heart Stoppers Sports Grill in Delray Beach. Anyone 350 pounds or over gets a free meal. Owner and Paramedic Iggy Lena came up with the idea. The challenge burger is three pounds. And those who fail ... well, there's a special place for them here...the morgue! But not everyone is laughing. The owners of Heart Attack Grill in Chandler, Arizona filed a federal lawsuit. Their lawyer says Heartstoppers is using many of the medical theme elements that heart attack originated. Lena's attorney says the two restaurants have separate concepts. The restaurant in Arizona uses high choloric food as a gimmick and here in Delray Beach, they focus...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Dr. A Show Tonight: Dean Brandon

Doctor Anonymous — Thu, 04 Feb 2010 11:04:00 +0100

Thursday, February 4, 2010 at 9pm ETI hope you can join us for Doctor Anonymous Show 142 when our guest will be Dr. Dean Brandon (pictured above with actor Anthony Edwards). Dean is the author of the blog Pediatric Dentistry. I encourage you to check out the preview post for this show to learn about some of the topics that Dean writes about. I met him at BlogWorld Expo 2009.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 show as it is saved as a podcast so you can listen anytime!For first time Blog Talk Radio listeners:*Although it is not required to listen to the sh...

Video of My Mobile Monday Talk is Online

Ivor Kovic, M.D. — Wed, 03 Feb 2010 18:26:30 +0100

Organizers have published the video of my talk from recently held Mobile Monday Amsterdam event titled Mobile Health. Be sure to watch it and let me know what you think. Mobile Monday Amsterdam now has their own YouTube channel, so you can watch all those brilliant talks from their previous and future events. Tweet This Post (Source: Ivor Kovic, M.D.)

Twitter Interview With Diario Medico

Ivor Kovic, M.D. — Wed, 03 Feb 2010 18:19:19 +0100

Today, journalist Alain Ochoa (@alainochoa) conducted an interview on Twitter with me for Diario Médico (@diariomedico), Spain’s leading medium for health professionals. We mainly talked about mobile technology and its use in medicine. Follow the link to read the whole tweeterview titled Mobile health from Croatia. Tweet This Post (Source: Ivor Kovic, M.D.)

Reaching Out

Doctor Anonymous — Wed, 03 Feb 2010 13:44:00 +0100

"Hello Mrs. Jones," I say as I walk into the exam room. "How many times do I have to tell you that it's ok to call me Dot," this very pleasant 64-year old female says to me. As I look at her chart, I'm always trying to figure out how Dot was shortened from the name of something like Dorothy, Dolores, or Desiree."I haven't seen you in a while," I continue. "Well, doc, I got laid off a few months ago and that's why I haven't been in the office for a while." "I need my refills today, but I have no insurance right now. I hope in the next 7 months that nothing really bad happens, because that's when my Medicare kicks in, and in this economy, I don't anticipate getting another job any time soon.""How have you been doing," I asked. "Well," she said, "it's been rough, since I have a little medical...

American Heart Month

Doctor Anonymous — Wed, 03 Feb 2010 03:12:00 +0100

If you haven't already heard, February is American Heart Month. I've been reading a lot about this in the past few days (you'll see below why). But, one of the statistics that I found interesting was that every 25 seconds, an American will have a coronary event (likely a heart attack). This stat is right from the CDC website.You probably already knew that heart disease is the leading cause of death in the United States and is a major cause of disability. About 2 weeks ago, the American Heart Association started a new educational program called "Life's Simple 7." These are seven factors associated with ideal heart health. The areas they emphasize include Get Active, Eat Better, Lose Weight, Stop Smoking, Control Cholesterol, Manage Blood Pressure, and Reduce Blood Sugar.You can get more det...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Dr. A Show Preview: Dean Brandon

Doctor Anonymous — Wed, 03 Feb 2010 02:49:00 +0100

After a short hiatus, The Doctor Anonymous Thursday night show returns this week with guest Dr. Dean Brandon (pictured on the right above) who is author of the blog Pediatric Dentistry. We met last fall at BlogWorld Expo in Las Vegas. We had a great conversation out there about how social media relates to health/medicine issues.In addition to utilizing social media for fun, Dean also utilizes it for his business. You will see on his blog posts like "What is Pediatric Dentistry," "The Business of Pediatric Dentistry," "White Fillings Vs Silver Fillings," "Orthodontics (Braces)," and "Laughing Gas (Nitrous Oxide)." In the video below, you'll see the opening of the new office.So, I hope you can join us on Thursday, February 4th, 2010 at 9pm Eastern Time for Doctor Anonymous Show 143. In case ...

The Media, Robotics and Atrial Fibrillation Ablation

Dr. Wes — Tue, 02 Feb 2010 23:28:00 +0100

The NBC Today Show aired a segment on the Stereotaxis robotic system for performing catheter ablation of atrial fibrillation using magnetically-steered ablation catheters yesterday (video here). It sure generated a lot of buzz around our hospital. While I share the reporters enthusiasm for all the gadgets and gizmos (what doctor-engineer wouldn't like such neat toys?) the enthusiasm should be tempered with a strong dose of reality regarding this technology and any atrial fibrillation procedure.First is the claim that the patient will be cured with "85-90%" certainty. While these success rates have been reported using this technology for the much simpler atrial flutter ablation, this level of success has not been substantiated in meta analyses of atrial fibrillation ablation studies to date...

Crush It: Gary Vaynerchuk

Doctor Anonymous — Tue, 02 Feb 2010 21:14:00 +0100

Recently, I finished reading the book "Crush It" by Gary Vaynerchuk. You may know this guy from the popular video blog/show called Wine Library Tv. I've always been curious about how people who are considered internet celebrities - how the make it - how they become successful.This book (which I do recommend) outlines steps that Gary did to grow his family's wine business to a multi-million dollar operation. He also emphasizes that all of us are an online brand onto ourselves. If you have a facebook, twitter, or any other social media account somewhere, you are a brand and you have to cultivate and manage that brand. I definitely agree with this. Every so often, I have considered giving up the "Doctor Anonymous" moniker and just branding myself with my "real" name.But, as I found out going ...

Obama's comparative effectiveness agenda: tools versus rules

Notes from Dr. RW — Tue, 02 Feb 2010 06:05:00 +0100

Jerome Groopman's recent piece in the New York Review of Books is a must read for anyone who's serious about health policy. His opening paragraph reveals the President's naiveté about scientific medicine: The administration's stimulus package already devoted more than a billion dollars to "comparative effectiveness research," meaning, in the President's words, evaluating "what works and what doesn't" in the diagnosis and treatment of patients. Reducing the evaluation of medical treatment down to “what works and what doesn't” ignores important questions about individual patient attributes and scientific plausibility. Accordingly, for example, the Obama administration has opened the door to implausible CAM treatments, some of which appear to “work.” Deciding that a treatment “wo...

Grand Rounds is Up (Along With the Groundhogs)

Dr. Wes — Tue, 02 Feb 2010 04:18:00 +0100

... over at Dr. Rob's place at Musings of a Distractible Mind.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Why Canadian Health Care Is So Great

Dr. Wes — Tue, 02 Feb 2010 04:15:00 +0100

... because the Canadian Premier can still come to the US for heart surgery.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Yet another study on the impact of EMRs

Notes from Dr. RW — Tue, 02 Feb 2010 00:21:00 +0100

Early hype about the benefits of the electronic medical record was bolstered by low quality data, unwarranted comparisons with industry and reliance on opinion. Now, despite an increasing body of evidence that such claims are unwarranted, naïve enthusiasm continues. Another large study has been published in the Green Journal. The paper opens with a description of the initial enthusiasm for the EMR:Enthusiasm for health information technology spans the political spectrum, from Barack Obama to Newt Gingrich. Congress is pouring $19 billion into it. Health reformers of many stripes see computerization as a painless solution to the most vexing health policy problems, allowing simultaneous quality improvement and cost reduction.But the study findings, like those of previous research, were that...

The New Commodity on E-bay: Used Cardiac Ultrasound Probes

Dr. Wes — Mon, 01 Feb 2010 23:37:00 +0100

At nearly a $500-$1000 a pop when auctioned on E-bay, used phased-array cardiac ultrasound probes have recently become a hot commodity for theft in our local hospitals. This poses big problems when they're needed urgently in the electrophysiology or cardiac catheterization laboratories.Be warned.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Video Blogging Med School

Doctor Anonymous — Mon, 01 Feb 2010 20:24:00 +0100

Here is another example of how/why social media is so cool. This morning someone on twitter, "re-tweeted" my link about today being American Heart Month (btw, thanks to everyone who retweets my stuff. i really appreciate it). When I clicked on his blog, I found out that Bryan Mccolgan is a third year medical student at Columbia and has been video blogging (vlogging) his entire third year of medical school. In the video below, he talks about the very first time he was in the OR. Ah, yes, I remember my first day going into the OR.Anyway, there are more videos on his blog called Becoming A Doctor. I encourage you to check it out (don't forget to tell him Dr. A sent ya - HA!) - also follow him on twitter. I've only been able to check out a few videos this afternoon, but what I've seen is good ...

Happy Heart Month!

Dr. Wes — Mon, 01 Feb 2010 16:28:00 +0100

Yes, folks, February is heart month - you know, Valentine's Day and all. (I love it when a marketing plan comes together!)No doubt you'll be hearing plenty about the American Heart Association's "Go Red for Women" campaign that kicks off Friday, February 5th, but don't forget, just like last year: Go Red's still for men, too. So guys, make sure you wear your red boxer shorts every day this month and get out there and purchase stuff, okay?-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

The Wax In The Ear

Doctor Anonymous — Mon, 01 Feb 2010 14:44:00 +0100

"Hey doc," the patients says, "I think I got wax in my ear." I reply, "Well, that makes it hard to hear me, then, huh?" "WHAT?" - the patient yells. Oh yeah, I say to myself. "I've been having this ever since I was a kid. Every few months, I need my ears cleaned out." So, I look in there, and it's the most amount of wax I've seen in a long time."Sir, do you use q-tips to clean our your ears?" I ask the patient. "Well, yeah, I think I've been doing a good job at keeping things clean, don't you think?" "Well, I wouldn't recommend that because it looks like you've been pushing the wax further in there." "WHAT?"So, we're able to get some of the wax out of there only to find a lot of redness and irritation in the ear canal. "Doc, I still can't hear. Are you sure that you got all the wax out of ...

Homeopathy for fibromyalgia: CV + PB = EBW

Notes from Dr. RW — Mon, 01 Feb 2010 13:27:00 +0100

That stands for chance variation plus publication bias equals evidence based woo. Well illustrated by this paper. (Source: Notes from Dr. RW)

Acute kidney injury in the ICU

Notes from Dr. RW — Mon, 01 Feb 2010 12:17:00 +0100

A review for the non-nephrologist. (Source: Notes from Dr. RW)

Hospital Monopolies Get Pushback

Dr. Wes — Mon, 01 Feb 2010 11:45:00 +0100

From the AMA Medical News:A Peoria, Ill., ambulatory surgery center will get its chance to try to prove allegations that the dominant area hospital improperly manipulated an exclusive contract with an employer health plan to edge the surgicenter out of the market. Without addressing the case's merits, the U.S. District Court for the Central District of Illinois on Dec. 30, 2009, allowed Peoria Day Surgery Center's antitrust lawsuit to proceed to trial. The court said it heard enough evidence that OSF Saint Francis Medical Center's actions could harm local competition and, ultimately, health care access. The trial is expected to begin March 8.It is no secret that monopolies can lead to higher health care costs, but how that occurs is interesting. From a report by the Attorney General of one...

The Ultimate iPhone App?

Dr. Wes — Sun, 31 Jan 2010 17:18:00 +0100

Steve Dahl, from the Chicago Tribune, gives us the run down:I was warned in advance that "Avatar" is a very long and intense movie, and my second-biggest fear Monday afternoon was that my hummingbird-size bladder would dictate the pace of my movie watching. Luckily, I had the iPhone app RunPee (ed. note: video review here) to coordinate my visits to the men's room once the film had started. I was in full command of both the 3-D technology and my 3G technology as I transported myself between Pandora's laboratory and a Pompano Beach lavatory.Run Pee suggests the best times during a movie to make a run to the bathroom or get a snack without missing too much of the plot. "Run Snack" isn't as catchy an app name. The first recommended break was at 56 minutes (I just made it). The app gives you t...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Dr. A Show 143: Dean Brandon - Feb 05,2010

Doctor Anonymous Live — Sun, 31 Jan 2010 16:45:00 +0100

Doctors, The Internet, And Social Media

Doctor Anonymous — Sun, 31 Jan 2010 16:13:00 +0100

As you know, or can probably figure out, I have an interest (or even a passion for) medicine and technology. So, I very much have an interest to see how technology can help me in my job. I have particular interest in seeing how social media (blogs, podcasts, facebook, twitter, etc) can help me communicate the message better.This past week, Dr. Kevin Pho, better known as KevinMD, had an op-ed piece in USA Today online entitled "Doctors Ignore Internet At Their Own Peril." It's no secret that Kevin has used social media and the internet to help get the message out on the unique physician view on medical and health policy issues. In his own Linked In profile, Kevin describes himself as "Social media's leading physician voice," and I very much agree with that. In the USA Today piece he says th...

Clash of the Titans

Dr. Wes — Sun, 31 Jan 2010 12:12:00 +0100

After Northwestern Memorial Healthcare closed its acquisition of Lake Forest Hospital in the posh northern suburbs of Chicago this past Friday, they have officially leapfrogged the geographic stronghold formerly held exclusively by NorthShore University HealthSystem (disclaimer: my employer, so I tread lightly). What this means for the health care market in the north Chicago suburbs remains to be seen, but there is no denying that competition for patients between the large hospital systems will be keen.After all, someone has to pay the bills.So what will the competition look like?First, patients like all things bright and shiny. So look for plenty of new construction. Nothing like a tasteful, brass-laden lobby with plenty of open air space and windows to bring in their distinguished "consu...

Dr. A Show 142: The Return - Jan 31,2010

Doctor Anonymous Live — Sun, 31 Jan 2010 02:00:00 +0100

After an almost two week hiatus, Dr. A returns to the airwaves to talk about what the heck he's been doing all this time. In addition he'll discuss his relevant health/medicine news stories of the week, and also some not-so-serious news stories from this past week.Doctor | Anonymous | Medblogger | Social Media | Medicine (Source: Doctor Anonymous Live)

Which Drug Reps Do Cardiologists Prefer?

Dr. Wes — Sat, 30 Jan 2010 21:06:00 +0100

It seems Pfizer has won the marketing prize:Rating pharma reps for the market researcher SDI (press release here), cardiologists named Pfizer's sales reps No. 1, with Merck's as No. 2. Rounding out the top five were Merck's Schering-Plough, AstraZeneca, and Novartis.So just why did these 300 heart doctors rank the reps as they did? Most graded Pfizer first for several different attributes, including their product know-how, which they considered the most important quality of a good sales rep. Pfizer's sales folks also were No. 1 for the sensitivity to doctors' busy schedules, for their professional conduct, and for their drug-sample offerings. In fact, the only category in which Pfizer didn't rank first was in giving unbiased comparisons with competing products. Schering-Plough's cardiovasc...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

How Hospitals Can Help Invalidate Non-compete Clauses

Dr. Wes — Sat, 30 Jan 2010 19:37:00 +0100

Non-compete clauses are familiar to the business community as a means to prevent a former employee from using corporate trade secrets to compete against the former employer. But when a doctor is forced to leave a practice and three other doctors in that practice join him, that non-compete clause may also impact a hospital in the same geographic area as the non-compete. Hospitals, not wanting to lose admissions, are more than happy come to the aide of the exonerated:A noncompetition clause in the four doctors' employment contracts prohibited them from practicing medicine within 25 miles of the clinic if they left it.All four doctors have continued seeing patients at the clinic because their contracts allow them to work for 90 days after termination or resignation. The clause would have gone...

Facebook/Twitter Break? FAIL!

Doctor Anonymous — Sat, 30 Jan 2010 10:51:00 +0100

Two weeks ago, I set a goal for myself. I told myself that I would "unplug" from both Twitter and Facebook for two weeks. Initially, that meant not even logging into each of the sites and checking what was going on. Well, I'm proud to say that lasted a mere four days. FAIL!After I logged in (four days later), I then told myself that on Facebook, I would not leave any comments or do any of that "thumbs up" thing that is so easy to do. Well, that lasted another two days. FAIL! I mean, hey, it is so easy to hit the "like" button when you see something funny or just agree with something you see. And, I couldn't help, but comment on a thing or two on FB.Finally, I told myself that I would not leave a status update or tweet for the remainder of the two week period. Well, during and after the iPa...

The "Electromagnetogram:" A More Sensitive EKG?

Dr. Wes — Fri, 29 Jan 2010 23:25:00 +0100

Could magnetometers replace EKGs?The portable magnetometer, invented by scientists at the University of Leeds, England, measures minute fluctuations in the heart's magnetic field so sensitively that it can detect heart problems in fetuses, as well as spot problems in adult hearts far earlier than an ultrasound or ECG. And the device is far cheaper than any of those other devices, too.All well and good, but getting people to understand the information produced will remain the largest challenge of this technology, not to mention the artifact created by things that create electrical interference, like pacemakers.Weren't vectorcardiograms supposed to supplant EKG's, too?-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Reiki at Baltimore Shock Trauma Center

Notes from Dr. RW — Fri, 29 Jan 2010 20:45:00 +0100

The chief of anesthesiology explains the institution's scientific standard: “From what they tell us, we think they get better quicker.” (Source: Notes from Dr. RW)

AHA policy statement on regional systems of care for out of hospital cardiac arrest

Notes from Dr. RW — Fri, 29 Jan 2010 14:23:00 +0100

Stroke, trauma and STEMI all have their regional centers of care. Now that we have a post resuscitation bundle, why not for out of hospital cardiac arrest? It’s time. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Mobile Monday Amsterdam impressions

Ivor Kovic, M.D. — Fri, 29 Jan 2010 13:06:40 +0100

Several day ago I came back home after presenting at the Mobile Monday Amsterdam event titled Mobile Health. That is me on the left I am still impressed by the whole thing. First of all I have to congratulate the organizers (Marc, Yuri, Maarten, Sam, and Martijn) for doing a great job. They fully supported all the speakers from the first contact to the end of the event. The venue where the event took place was an actual church, De Duif, and it was a spectacular choice. From the moment I entered it, I was just blown away. Beautiful light, colors, art, atmosphere. Everything was ready for a great event. I was the first speaker to present after a short break in the middle of the program, and I had so much fun doing it. Mostly because of the crowd which was very educated and full of interesti...

Antimalarial use in SLE

Notes from Dr. RW — Fri, 29 Jan 2010 12:19:00 +0100

For years the thinking regarding SLE was that one treats manifestations and complications but that there was no basic treatment for the disease itself. Over time that perception has changed with accumulating evidence that antimalarials might alter the natural history of the disease and maybe even improve survival. A new study posted ahead of print in Arthritis and Rheumatism indicates a protective effect of hydroxychloroquine against thrombovascular events: Fifty-four cases were identified and matched to 108 controls. Univariate analyses identified age (OR, 95%CI = 1.04, 1.01-1.07) or being older than 50 years old (3.5, 1.4-8.6) and hypertension (2.5, 1.0-5.8) as being associated with an increased risk of TE while use of antimalarials (0.31, 0.13-0.71) was associated with a decreased risk ...

Drug induced acute liver injury

Notes from Dr. RW — Fri, 29 Jan 2010 11:08:00 +0100

An excellent review was recently published in Seminars in Liver Disease. Free full text access is available via Medscape. Points of interest: Prognosis is largely determined by the presence or absence of coagulopathy and encephalopathy. Transplant free survival is poor if these are present. Acetaminophen is the most frequent culprit. N-acetylcysteine therapy may benefit some patients with non-acetaminophen induced injury. (Source: Notes from Dr. RW)

iPad For Medicine Is About The Software

Doctor Anonymous — Thu, 28 Jan 2010 23:39:00 +0100

In kind of browsing around today, it seems that almost every industry - including education, aviation, business, and medicine - is excited about the latest Apple piece of hardware called the iPad. It's so entertaining reading the apple haters and those in the tech industry complain about the iPad - sheesh!Anyway, focusing back on the medicine and health care industry, there have been a number of posts that I have read talking about the potential of the Apple iPad device. On KevinMD, Steve Woodruff has a good piece touting the awesome hardware potential of the device and the ideal end point of its use in the medical setting.A heavily referenced article is from Venture Beat called "Apple tablet reps spotted at LA hospital" which talks about how Apple reps were there "three or four times" in ...

Hyperkalemia and the electrocardiogram

Notes from Dr. RW — Thu, 28 Jan 2010 22:04:00 +0100

Another in the series by James Roberts, M.D., on at-a-glance electrocardiographic patterns that portend disaster. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

MIBG imaging and heart failure prognosis

Notes from Dr. RW — Thu, 28 Jan 2010 13:00:00 +0100

I first mentioned imaging of heart failure patients with metiodobenzylguanidine (AdreView) here. Now JACC has published a review summarizing the state of the art of MIBG imaging: Cardiac sympathetic imaging with meta-iodobenzylguanidine (mIBG) is a noninvasive tool to risk stratify patients with heart failure (HF). In patients with ischemic and nonischemic cardiomyopathy, cardiac mIBG activity is a very powerful predictor of survival. Cardiac sympathetic imaging can help in understanding how sympathetic overactivity exerts its deleterious actions, which may result in better therapy and outcome for patients with HF. (Source: Notes from Dr. RW)

If rapid response teams improve outcomes it takes time

Notes from Dr. RW — Thu, 28 Jan 2010 12:59:00 +0100

In this new before and after study it took 4 years to see a reduction in mortality. Although the data were severity adjusted they did not take into account other hospital improvements that may have taken place over time. (It really gets complicated when one considers that other process improvements may have been driven by the rapid response system itself). (Source: Notes from Dr. RW)

Internal Medicine News on You Tube

Notes from Dr. RW — Thu, 28 Jan 2010 11:58:00 +0100

Internal Medicine News is now posting videos on You Tube which you can view here. (Source: Notes from Dr. RW)

Microscopic colitis

Notes from Dr. RW — Thu, 28 Jan 2010 11:55:00 +0100

An underappreciated cause of chronic diarrhea in older adults. Review in Age and Ageing. (Source: Notes from Dr. RW)

Double standard for DTC advertising

Notes from Dr. RW — Wed, 27 Jan 2010 21:52:00 +0100

Academic medical centers don’t have to (and seldom do) adhere to the same standards drug companies do. H/T to Erik DeLue. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Marketing campaign “disguised as evidence based medicine” saved lives! Who'da thunk it?

Notes from Dr. RW — Wed, 27 Jan 2010 18:43:00 +0100

For over a decade the pharmascolds have been preaching that industry marketing is harmful to patients even though there's not a shred of evidence that it's true. Arguably the most maligned of all industry supported promotions is the Surviving Sepsis Campaign, widely criticized as being little more than marketing disguised as evidence based medicine:Seeing in these bundles a potentially powerful vehicle for promoting their products, pharmaceutical and medical-device companies have begun to invest in influencing the adoption of guidelines that serve their own financial goals. A case in point is the development of guidelines for the treatment of sepsis, which was orchestrated as an extension of a pharmaceutical marketing campaign.1,2 Although its advocates viewed this effort as an important a...

A hospitalist’s wish list

Notes from Dr. RW — Wed, 27 Jan 2010 14:50:00 +0100

From Robert Harrington, Jr., MD. Funny. And true. (Source: Notes from Dr. RW)

Is Health Care Too Big to Fix?

Dr. Wes — Wed, 27 Jan 2010 13:27:00 +0100

Now that the health care bill has been soundly defeated by the election of a single individual to the Senate, the Democratic party is fleeing the House and Senate health care overhaul bills like rats from a burning ship. Sadly Republicans, too, are staying silent with (so far) few rushing forth with their alternative solution to counteract the impasse:Senator Dianne Feinstein, Democrat of California, said Democrats were assessing their options on health care. “It’s a timeout,” she said. “The leadership is re-evaluating. They asked us to keep our powder dry.”Mrs. Feinstein said Congressional leaders should simplify the gigantic health care bill and try to pass parts of it that would be understandable to the public. But she also acknowledged that the odds were long for a far-reachi...

Updated international consensus recommendations for management of patients with nonvariceal UGI bleeding

Notes from Dr. RW — Wed, 27 Jan 2010 12:47:00 +0100

Via Annals Intermal Medicine. (Source: Notes from Dr. RW)

Pulmonary involvement in patients with inflammatory bowel disease

Notes from Dr. RW — Wed, 27 Jan 2010 11:48:00 +0100

Pulmonary complications of several types are emerging as important extra intestinal manifestations of Crohn’s disease and ulcerative colitis. Free full text review here. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Review of corticosteroid induced psychiatric symptoms

Notes from Dr. RW — Wed, 27 Jan 2010 11:45:00 +0100

This may be more common we think. Via Psychiatry Online. (Source: Notes from Dr. RW)

Apple Tablet?

Doctor Anonymous — Wed, 27 Jan 2010 01:55:00 +0100

I don't know about you, but I'm more interested in what Steve is going to say tomorrow verses the State of the Union address from Washington. What many people fear (me included) is the possibility that instead of the awesomeness of an iPhone type announcement - what we'll get instead is along the lines of the "mac cube" which flopped a year after it was triumphantly brought out by Steve. We'll see what happens tomorrow.... (Source: Doctor Anonymous)

Alpha 1: the forgotten etiology

Notes from Dr. RW — Tue, 26 Jan 2010 21:37:00 +0100

Here’s another review of alpha 1 antitrypsin deficiency, again making the point that this disorder is widely under diagnosed. Screening is recommended on all individuals with emphysema, unremitting asthma and in certain other circumstances. (Source: Notes from Dr. RW)

The future of quackademic medicine is secure

Notes from Dr. RW — Tue, 26 Jan 2010 12:32:00 +0100

---if this, the largest survey of its kind, is any indication: In the largest national survey of its kind, researchers from UCLA and UC San Diego measured medical students' attitudes and beliefs about complementary and alternative medicine (CAM) and found that three-quarters of them felt conventional Western medicine would benefit by integrating more CAM therapies and ideas. The findings will be published in the online issue of Evidence-based Complementary and Alternative Medicine (eCAM) on January 20, 2010. "Complementary and alternative medicine is receiving increased attention in light of the global health crisis and the significant role of traditional medicine in meeting public health needs in developing countries," said study author Ryan Abbott, a researcher at the UCLA Center for Eas...

Excited delirium syndrome

Notes from Dr. RW — Tue, 26 Jan 2010 12:24:00 +0100

Now recognized as a distinct entity. More here. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Quackademic medicine leaders head to India

Notes from Dr. RW — Tue, 26 Jan 2010 11:35:00 +0100

---to learn more about Ayurveda: The purpose of the U.S. delegation’s visit is to explore the possibilities of introduction of evidence-based Ayurveda, Yoga, meditation, and oil massage treatment in the United States medical education, research, and patient care areas, and also to study the possibilities of joint Indo-U.S. research under NIH funding. (Source: Notes from Dr. RW)

Estimation of creatinine clearance in morbid obesity

Notes from Dr. RW — Tue, 26 Jan 2010 11:27:00 +0100

American Journal of Health-System Pharmacy via Medscape. (Source: Notes from Dr. RW)

Doctor Salaries? E-bay Pays Better

Dr. Wes — Tue, 26 Jan 2010 05:16:00 +0100

... at least for one doctor:Lickteig runs a clothing store on eBay, where she's a "Gold PowerSeller," ranking among the top 1½ percent of merchants on the online marketplace.The 35-year-old family practitioner says she earned $120,000 last year on eBay, more than she did practicing medicine.And we wonder why primary care is having such a problem...-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

2009 Medgadget Weblog Award Finalists

Doctor Anonymous — Tue, 26 Jan 2010 03:29:00 +0100

Yes kids, it's that time of year again when we vote for our favorite medical weblogs for the previous year. This is of course from our friends at Medgadget. And, you can take a look at all the finalists here. In 2008, I had the honor of having Dr. Nick Genes on Doctor Anonymous Show number 19 to talk all about the Medgadget Medblog Awards. You can listen on the player below. Or, you can download the show here and listen anytime.Later that month in Jan 2008, Nick returned to the show with the other Medgadget guys to make a final push for voting that year. I believe even Mr. Paul Levy himself called into the show trying to get himself some votes. Listen in the player below or download Dr. A Show 21 right here.Now, the category that is near and dear to my heart is the Best New Medical Weblog ...

DIC correlates with lactate levels in sepsis

Notes from Dr. RW — Mon, 25 Jan 2010 19:52:00 +0100

---at least when the balance is shifted toward microthrombosis:Our observations show that, in the course of human septic shock, activation of coagulation and, particularly, inhibition of activated fibrinolysis are independently associated with hyperlactatemia. This suggests a contribution of DIC resulting from a coagulation/fibrinolysis imbalance to microvascular obstruction, tissue hypoxygenation and thereby to ultimate demise. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Hospice: Some Misconceptions

Dr. Wes — Mon, 25 Jan 2010 16:15:00 +0100

The Los Angeles Times had an earlier starter piece on hospice care recently with some remarkable figures:Over the last 25 years, the number of Americans turning to hospice for end-of-life care has climbed dramatically -- from 25,000 in 1982 to 1.45 million in 2008, as more and more people choose to spend their final days in the comfort of home or a patient facility with a home-like environment rather than in a hospital pursuing aggressive treatments.I have been involved with hospice twice now - once with my father several years ago, and recently with my mother-in-law who just died of pancreatic cancer. There are many references out there about hospice, and for a general overview for those thinking about hospice for themselves or a loved one, I'd steer you toward this introduction (pdf), pr...

Momo Amsterdam will start soon

Ivor Kovic, M.D. — Mon, 25 Jan 2010 13:41:15 +0100

In less than one and a half hour MoMo #14 will start at the beautiful location - De Duif. Watch the video below. Tweet This (Source: Ivor Kovic, M.D.)

The preoperative medical evaluation: consult, don't insult

Notes from Dr. RW — Mon, 25 Jan 2010 12:49:00 +0100

Tips form the Perioperative Medicine Summit. (Source: Notes from Dr. RW)

Medical textbooks available on Google Books

Notes from Dr. RW — Mon, 25 Jan 2010 11:47:00 +0100

You can't access the entire content, but large portions. Via Clinical Cases and Images. (Source: Notes from Dr. RW)

USMLE You Tube videos

Notes from Dr. RW — Mon, 25 Jan 2010 11:43:00 +0100

It never hurts to review the basics even if you're long past USMLE.Via Clinical Cases and Images. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Mobile Monday Amsterdam Livestream

Ivor Kovic, M.D. — Mon, 25 Jan 2010 00:16:46 +0100

I have an update on Mobile Monday event which will take place in Amsterdam, 15 hours from now. The whole event will be streamed live for you enjoyment. It starts at 4 pm and ends at 7 pm (CET). My presentation should begin at 5:55 pm. Be sure to tune in, and even post questions to presenters via Twitter. Tweet This (Source: Ivor Kovic, M.D.)

The USNS Comfort in Haiti

Dr. Wes — Sun, 24 Jan 2010 22:01:00 +0100

A must-read from the USNS Comfort, the US Navy's hospital ship based in Baltimore and now in Haiti:We don’t have our Marine combat cargo Gunnery Sergeant yet so a Navy chief filled in today. We had 147 helicopters land on the Comfort. Only 81 patients so you can see there were a lot of politicians trying to show the world how important they are. Plus media was all over CASREC today.Captain Sharpe, one of my roommates, just came in all pumped up about the day. He said, “This is what it’s all about. Helping people.” We talked about how much busier things are going to get. Last night he and I talked about amputations. You chop the limb off clean _ they call it a guillotine amputation _ cover it with gauze, and put the patient in the ward for a couple days. Then you have to bring him b...

Now, It Seems Like Yesterday

Dr. Wes — Sun, 24 Jan 2010 18:02:00 +0100

... that she was holding my wife (on the right) in her arms:Barbara Geary Goulet5 October 1924 - 24 Jan 2010"And ever has it been known that love knows not its own depth until the hour of separation."- Kabil Gibran-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Dr. A Show 142: Dean Brandon - Feb 05,2010

Doctor Anonymous Live — Sun, 24 Jan 2010 16:30:00 +0100

Radical environmentalism

Notes from Dr. RW — Fri, 22 Jan 2010 19:40:00 +0100

The new religion?Instead of religious sins plaguing our conscience, we now have the transgressions of leaving the water running, leaving the lights on, failing to recycle, and using plastic grocery bags instead of paper. In addition, the righteous pleasures of being more orthodox than your neighbor (in this case being more green) can still be had—Read the rest at Secondhand Smoke. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Quit Smoking & Survive Lung Cancer

Doctor Anonymous — Fri, 22 Jan 2010 12:36:00 +0100

Yes, you read that title right. Intuitively, it makes sense. Quit smoking and you can decrease your chance of lung cancer. But, now, there is data out there that patients with early lung cancer - who quit smoking - not only increase their rate of survival - they can double their chances of survival. The article talking about they study is from the Associated Press entitled, "Smokers With Cancer Could Quit And Double Survival."People with lung cancer who continued smoking had a 29 to 33 percent chance of surviving five years. But those who kicked the habit had a 63 to 70 percent chance of being alive after five years. The research was published Friday in the BMJ, formerly known as the British Medical Journal. Lung cancer is the top cancer worldwide, and the prognosis is usually poor. Only a...

New study on rapid response teams

Notes from Dr. RW — Fri, 22 Jan 2010 12:35:00 +0100

Conclusion Although RRTs have broad appeal, robust evidence to support their effectiveness in reducing hospital mortality is lacking.One curious finding was that although RRTs didn't impact mortality they reduced the number of arrests outside the ICU, which may merely mean that RRTs get people to the ICU before they code with no resulting impact on mortality.As I said before, results such as this don't mean RRTs are useless. Your hospital may benefit if you use the process for all it's worth. Results such as this DO mean that RRTs should not be a performance standard, and no one can make the claim that RRTs save lives.Related editorial. (Source: Notes from Dr. RW)

Variation in interpretation of CT scans to evaluate for PE

Notes from Dr. RW — Fri, 22 Jan 2010 11:32:00 +0100

From the American Journal of Emergency Medicine:We found a very good interobserver agreement in MDCT evaluation for the diagnosis of massive PE, whereas we observed a lower concordance in regard to segmentarian and subsegmentarian PE. In the case of negative or nonmassive PE diagnosis, a second evaluation of the CT performed by an expert CT radiologist would probably be effective to decrease the CT evaluation error.The present degree of confidence in CT angiography over ventilation perfusion lung scanning for the diagnosis of PE is unwarranted. (Source: Notes from Dr. RW)

Massachusetts election upset a sentinel event for democrats

Notes from Dr. RW — Thu, 21 Jan 2010 21:05:00 +0100

Maybe they should do a root cause analysis. Two Medscape articles offer a perspective on how this will affect health care reform. (Source: Notes from Dr. RW)

New York Times review of The Checklist Manifesto

Notes from Dr. RW — Thu, 21 Jan 2010 13:29:00 +0100

From the review:A hospital, as the saying goes, is no place for sick people. It’s filled with hazards to your health, not least of which are the myriad infections, missed diagnoses, dosage mistakes and other complications that arise from human error. And in a hospital, human error seems all but inevitable. How can any one individual, or even any one team of individuals, keep all the tasks straight and anticipate all eventualities 100 percent of the time?You can't, but checklists may help, and that's apparently what the book is about. Why not make your own checklist to cover the areas most likely to bite you? Did you address DVT prophylaxis? Did you continue the home meds that need to be given and hold the ones that need to be held? Have you looked at today's labs and ordered tomorrow's? ...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Warning: Sitting Can Kill You

Doctor Anonymous — Thu, 21 Jan 2010 12:19:00 +0100

You think I'm kidding about this, dont you? Well I'm not (hehe). There was a study just published this week which says exactly this. I got the story from the Associated Press in their article entitied, "Experts: Sitting Too Much Could Be Deadly."Research is preliminary, but several studies suggest people who spend most of their days sitting are more likely to be fat, have a heart attack or even die. In an editorial published this week in the British Journal of Sports Medicine, Elin Ekblom-Bak of the Swedish School of Sport and Health Sciences suggested that authorities rethink how they define physical activity to highlight the dangers of sitting."After four hours of sitting, the body starts to send harmful signals," Ekblom-Bak said. She explained that genes regulating the amount of glucose...

When the Hospitalist Service is Capped

Dr. Wes — Thu, 21 Jan 2010 11:30:00 +0100

It's the fastest growing "specialty" service in medicine: hospitalist medicine. These are the doctors who limit their practice to the care and management of patients admitted to the hospital. It has been wildly popular because it adds a shift-like work schedule to medical care for physicians while supposedly preserving their personal life. It also moves patients through the hospital faster, shortening length of stays. As one of our more esteemed hospitalist bloggers likes to boast: it's a "WIN-WIN!"At least until the hospitalist service gets too busy.It seems now that hospitalists services are limiting the number of patients they admit per day in response to their overwhelming "popularity." It's something akin to capping resident medical student ward services - they stop accepting patients...

Catheter based and surgical treatments for massive DVT

Notes from Dr. RW — Thu, 21 Jan 2010 11:21:00 +0100

Medscape has posted some presentations from the 36th Annual VEITH Symposium. This one makes a strong pitch for catheter based and surgical treatments in patients who have extensive (iliofemoral) DVT. Although the speakers appealed to the ACCP guidelines their statement was somewhat stronger than the guideline recommendation, which suggests that in patients with extensive DVT, an anticipated survival of over a year and low bleeding risk such treatments may be used to reduce acute symptoms and post thrombotic syndrome if appropriate expertise is available.On a related note, do the guidelines recommend catheter directed or surgical treatments for upper extremity DVT? Not across the board, but if there are severe symptoms of recent onset and low bleeding risk they make similar recommendations ...

When States Can't Pay Their Medical Bills

Dr. Wes — Wed, 20 Jan 2010 23:28:00 +0100

... medical institutions might not make payroll:"I would describe bankruptcy as the inability to pay one's bills," says Jim Nowlan, senior fellow at the University of Illinois' Institute of Government and Public Affairs. "We're close to de facto bankruptcy, if not de jure bankruptcy."Legal experts say the protections of the federal bankruptcy code are available to cities and counties but not states.While Illinois doesn't have the option of shutting its doors or shedding debts in a bankruptcy reorganization, it seems powerless to avert the practical equivalent. Despite a budget shortfall estimated to be as high as $5.7 billion, state officials haven't shown the political will to either raise taxes or cut spending sufficiently to close the gap.As a result, fiscal paralysis is spreading throu...

Tragedy

Doctor Anonymous — Wed, 20 Jan 2010 22:19:00 +0100

The death of a young person is always a tragedy. Recently in this little town, there was the death of a young person in her/his 20s of a chronic medical condition. It really doesn't matter what the cause is. But, for the sake of this story that was the cause.One of the great things about primary care is at the same time one of the most painful things about primary care - namely the relationships that docs like me experience. I know I haven't done a good job of "disguising" things or "de-identifying" things from a personal standpoint. You could probably infer from my writing that this person was connected in some way with the office.Sometimes there are incidents in life which really make you think of what is important in life. It's not really what's going in in other parts of the country, o...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Speaking at Mobile Monday Amsterdam

Ivor Kovic, M.D. — Wed, 20 Jan 2010 20:56:21 +0100

I will be speaking at the 14th event of the Mobile Monday chapter in Amsterdam titled Mobile Health. This event will take place on 25th of January with doors opening at 3pm and presentations running until 7pm with a half hour break. Even if you cannot be there, be sure to check out the livestream or watch all videos, talks and presentations afterward on MoMo Amsterdam website. You do not want to miss this, because some extraordinary people will take part in this event. I myself will be talking about mobile technology from a doctor’s standpoint, and try to give an overview of how this technology has influenced the way we treat patients today. Here is the complete lineup: Jen S. McCabe @jensmccabe – CEO and founder of Contagion Health (LinkedIn, blog) Ivor Kovic (@ivorkovic) – MD...

Haiti still needs help

Ivor Kovic, M.D. — Wed, 20 Jan 2010 20:30:38 +0100

Help Haiti by supporting the International Medical Corps (IMC), a global, humanitarian, nonprofit organization, founded by volunteer doctors and nurses and dedicated to saving lives and relieving suffering. There are still thousands of patients seeking treatment of which approximately 80% are in need of surgery and are running out of time - especially with the tremendous aftershocks still devastating this country. The IMC team is treating crush injuries, trauma, substantial wound care, shock and other critical cases with the few available supplies - And they’re in it for the long haul. You can help by donating funds, volunteering in Haiti, or just spreading the word (put the above widget on your site). With this organization you can be sure your money is going to the ones that need ...

Pulmonary manifestations of connective tissue diseases

Notes from Dr. RW — Wed, 20 Jan 2010 19:19:00 +0100

This review in Clinical Pulmonary Medicine focuses largely on interstitial lung diseases. (Source: Notes from Dr. RW)

The Massachusetts Aftermath

Dr. Wes — Wed, 20 Jan 2010 14:45:00 +0100

With the stunning election of the Republican Scott Brown from Massachusetts last evening, the pundits are awash in analysis and retrospection. The forces that aligned to elect a Republican to the "people's seat" in Massachusetts are too numerous to expand upon here. Not being from Massachusetts, it would be presumptuous of me to claim I understand all of the issues at stake. I am simply not a political pundit. But from a 50,000 foot perspective, I am amazed that the Commonwealth of Massachusetts, long the shining star upon which our national health care reform efforts were modeled, has effectively stalled (stopped?) the partisan railroading of the current health care legislation hashed out for months in both houses of Congress. Do they know something about their health care program that th...

Schamberg disease

Notes from Dr. RW — Wed, 20 Jan 2010 13:17:00 +0100

Case description and brief review in CMAJ. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

A web based resource on therapeutic drug monitoring

Notes from Dr. RW — Wed, 20 Jan 2010 12:15:00 +0100

---was tested and found to improve participants' knowledge in several areas. The resource itself is here. (Source: Notes from Dr. RW)

Statin drugs are associated with lower risk of gall stones and cholecystectomy

Notes from Dr. RW — Wed, 20 Jan 2010 12:13:00 +0100

---in this study. That's opposite the case for fibrate drugs, which increase the risk. (Source: Notes from Dr. RW)

You tube case presentations

Notes from Dr. RW — Wed, 20 Jan 2010 12:10:00 +0100

Many thanks to Clinical Cases and Images. (Source: Notes from Dr. RW)

California to Regulate Doctor Wait Times

Doctor Anonymous — Wed, 20 Jan 2010 02:05:00 +0100

Ok, here's an idea, have government mandate how long it takes for you to see a doctor. Don't believe it? Well, California, in their infinite wisdom, is doing just that. I read this story and it just made my skin crawl. It is from The Los Angeles Times and it is entitled, "California Limits HMO Wait Times."The regulations by the California Department of Managed Health Care, in the works for much of the last decade, will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15. Patients seeking urgent care that does not require prior authorization must be seen within 48 hours.Telephone calls to doctors' offices will have to be returned within 30 minutes, and physicians or other health professionals will have to be avai...

Brown Versus ...

Dr. Wes — Tue, 19 Jan 2010 23:26:00 +0100

In Brown vs. Board of Education - Brown wonIn Brown vs Missisipi - Brown wonIn Brown vs. Coakley? Hmmm. I'm not sure, but at least he's got the right name and attitude.This race should probably be subtitled as "The People vs. Congress."In that respect, the People have already won. -WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Social Media Suicide?

Doctor Anonymous — Tue, 19 Jan 2010 21:41:00 +0100

Ok, I admit that I got the following article after logging into twitter. This is from Time.com and the title is "How to Disappear from Facebook and Twitter." This kind of goes along with my previous post. But, then again, it does not. The article makes reference to a "suicide machine" which, in essence, scrubs your online identity from social media networks.Since its Dec. 19 launch, Suicide Machine has assisted more than 1,000 virtual deaths, severing more than 80,500 friendships on Facebook and removing some 276,000 tweets from Twitter.Once you hand over your log-in details and click Commit, the program will methodically delete your info — Twitter tweets, MySpace contacts, Facebook friends, LinkedIn connections — much like users could do manually. What remains is a brittle cyberskelet...

Why doesn't the American College of Physicians just merge with AAFP and get it over with?

Notes from Dr. RW — Tue, 19 Jan 2010 21:08:00 +0100

The American College of Physicians has for some time been complicit with an agenda to eliminate Internal Medicine as a unique specialty. Retired Doc offers the latest absurd example. General Internal Medicine is on the way out. It's about pay in part, but it's mainly about loss of professional identity. (Source: Notes from Dr. RW)

Unintentional acetaminophen overdose

Notes from Dr. RW — Tue, 19 Jan 2010 19:08:00 +0100

A review in CCJM. (Source: Notes from Dr. RW)

Experiment

Doctor Anonymous — Tue, 19 Jan 2010 16:46:00 +0100

So, for the last three days, I've been doing this silly experiment with myself (no not anything like that people - hehe). I have tried to unplug from twitter and facebook for a few days. Well, I have failed in one aspect in that I have been continuing to log into FB and twitter. And, I have commented on FB.However, I have not placed an update or tweet for the past few days. And, let me tell you, it has been very difficult NOT to do that. I had been kind of weird, though, in that I have found myself getting back to this blog to write thoughts down - and it's been a good thing. (BTW, thanks for all the feedback as I have tried to get back into blogging).I'm continuing to hold true and not do my live internet radio show for these two weeks. And, I'm doing ok (for now) in not posting any updat...

Another Electrophysiologist Enters the Fray

Dr. Wes — Tue, 19 Jan 2010 13:03:00 +0100

Thought I'd spread the link-love to Dr. John Mandrola, another fellow cardiac electrophysiologist from Louisville, KY who has been brave enough to enter the medical blog-o-sphere over at Dr. John M. Head on over and say "hi."Always good to have another EP's voice in the fray...-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Telomeres and disease

Notes from Dr. RW — Tue, 19 Jan 2010 12:06:00 +0100

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

Therapeutic hypothermia made simple

Notes from Dr. RW — Tue, 19 Jan 2010 12:04:00 +0100

Scott D. Weingart, MD, RDMS really sums up the nuts and bolts. (Source: Notes from Dr. RW)

Management of acute decompensated heart failure

Notes from Dr. RW — Tue, 19 Jan 2010 12:02:00 +0100

Open access review. (Source: Notes from Dr. RW)

More acid base resources

Notes from Dr. RW — Tue, 19 Jan 2010 12:00:00 +0100

This excellent collection from Clinical Cases and Images contains some resources I had not linked to before. (Source: Notes from Dr. RW)

A Tale of Two MRIs

Notes from Dr. RW — Tue, 19 Jan 2010 11:54:00 +0100

Is this what we have to look forward to under Obamacare? (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

The Big Five personality test and medical school success

Notes from Dr. RW — Tue, 19 Jan 2010 00:05:00 +0100

Medical school admission candidates are evaluated for both their cognitive abilities and their personalities. The evaluation of cognitive ability is quantitative (grades, MCATs). Personality evaluation, however, is subjective, based on interviews and letters of recommendation. Is evaluation of the candidate's personality predictive of long term success? Can it be more systematic?A large group of students in Belgium underwent psychological testing using quantitative methodology at beginning of their medical training and were then followed long term. Results were published here:In this longitudinal investigation, an entire European country’s 1997 cohort of medical students was studied throughout their medical school career (Year 1, N = 627; Year 7, N = 306). Over time, extraversion, openne...

Students

Doctor Anonymous — Mon, 18 Jan 2010 20:42:00 +0100

"Dr. A, your student is here," the front desk squawks through the intercom. "Sheesh," I say to myself as I look at my full schedule of patients. Now, don't get me wrong. I really enjoy teaching. Something I do know is that I could not do teaching full time. I thought about possibly joining a residency program or exploring the possibility of teaching full time at the med school. But, at this point in my career, patient care is still my passion.What docs never say (in public) but always think is that students definitely slow down the productivity and efficiency of office hours. I mean, teaching does take a long time - at least being a good teacher or student "mentor." But, we all know that at one point in our medical career, we were that student who didn't know that much and were afraid to a...

Just Call Me "Doctor Snitch"

Dr. Wes — Mon, 18 Jan 2010 14:49:00 +0100

In a continuing effort to drive a stake though the doctor-patient relationship, insurers are now turning to doctors to serve as their investigatory snitch in attempts to deny patients coverage:"To your knowledge, as the patient been seen by any other healthcare professional for the above condition between the dates of 12/01/08 and 03/01/09? ____ YES ____ NOIf yes, please provide the name(s) and address(es) of the other healthcare professional(s):"Like I have nothing better to do than to serve the simultaneous roles of deep throat and directory assistance operator for an insurer...-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Bob Wachter resuscitates USCF medical grand rounds

Notes from Dr. RW — Mon, 18 Jan 2010 12:47:00 +0100

Faced with dwindling attendance and the suggestion that the program be discontinued Bob Wachter decided to save the tradition, noting this:First, in a world in which we can increasingly segment our information (i.e., watch Glenn Beck or Rachel Maddow), making a habit of attending grand rounds is one of the few ways for physicians to be exposed to information and people outside their professional silos. We are all in danger of accruing new information about only those things we already know and like.Second, grand rounds can help build, or promote, community. Think about it: increasingly, texting, email, and Facebook mean that we can get through our days without actual human contact. Grand rounds provides a venue for all the members of a social network (in this case, a department of medicine...

Glorified housestaff?

Notes from Dr. RW — Mon, 18 Jan 2010 12:34:00 +0100

The recent Today's Hospitalist piece on management of patients with intracranial hemorrhage got a lively response from readers:The truth is that neurosurgeons are trained to manage these patients, and the bottom line is that no one wants to get out of bed. What you call a “paradigm shift” in your December 2009 cover story, I call “turf.”I resent this shift, but I think it will be transient. With cost and reimbursement cutbacks, payers are NOT going to continue to pay two doctors when only one is needed. Hospitalists will not be paid to manage hypertension in an ICH patient when the appropriate admitting doctor (the neurosurgeon) has for years been capable of doing so.Another response:We are often seen as little more than glorified housestaff as we admit patients more appropriately ...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Wide Awake Open Heart Surgery

Dr. Wes — Mon, 18 Jan 2010 05:33:00 +0100

Click image to enlargeWhy someone would want to do this, I haven't a clue.Swaroup Anand, 23, from Bangalore, is fully conscious as he undergoes open-heart surgery. An epidural to the neck, administered at the city’s Wockhardt Hospital, has numbed his body. Dr Vivek Jawali pioneered the technique ten years ago and has recently released a tutorial on DVD which gives a step-by-step guide to the procedure – sorry, but you can only get a copy if you’re a surgeon or an anaesthetist.Seems there would be considerable risk of respiratory compromise is the epidural went too high. But according to this video, over 400 cases have been performed, including a bypass with aortic valve replacement!I don't know... I'm not sure I could stomach the sound of the bone saw or, worse, if the surgeon said "...

Struggling

Doctor Anonymous — Mon, 18 Jan 2010 02:53:00 +0100

It's been months since I have written any kind of significant blog post. I'm not really sure why. I could use the excuse that work is getting in the way, or life is getting in the way. But, I know that those are just poor excuses. I also know that if you don't write anything, no one reads the blog. I have seen my readership slowly dwindle over the past few months. Frankly speaking, I'm embarrassed to call my self a "blogger" these days.The only way to get back writing - is to just write. So, that is what this post is about. What I hope to do is to try to find my blogging voice again. I have put so many road blocks in front of me and I have made so many excuses. It's time for me to stop making excuses and just writing something again. The funny thing is that I used to enjoy writing. It used...

Dr. A Show 142: Thursday Night - Feb 05,2010

Doctor Anonymous Live — Sun, 17 Jan 2010 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 | Social Media | Medicine (Source: Doctor Anonymous Live)

Dr. A Show 141: Saturday Night - Jan 17,2010

Doctor Anonymous Live — Sun, 17 Jan 2010 02:00:00 +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. Plus. I will have an Important Announcement during the course of tonight's show.....Doctor | Anonymous | Medblogger | Social Media | Medicine (Source: Doctor Anonymous Live)

An ice age in our lifetime?

Notes from Dr. RW — Sat, 16 Jan 2010 15:19:00 +0100

Well, that's what they were saying in 1978. H/T to Secondhand Smoke. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Photo Gallery: The Heart

Dr. Wes — Sat, 16 Jan 2010 13:03:00 +0100

Click image to enlargeThe above is a retouched photograph of an 82 year old patient's chest x-ray with a pacemaker and pneumonia that hails from the photo gallery from National Geographic.You can download "wallpaper" sized images from their collection at the link above to adorn your computer monitor's background or the wall of your office or lab.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Lady Gaga's Palpitation Differential

Dr. Wes — Fri, 15 Jan 2010 17:10:00 +0100

Okay, medical blog-o-sphere, pressing news has arrived that Lady Gaga had to cancel her concert at Purdue University due to an acute onset of pre-performance palpitations:"Paramedics came to take care of me, and told me my heart-rate was irregular - a result of exhaustion and dehydration."Your job, should you like to accept it, is to consider the differential diagnosis of what might have been the cause.So go ahead... make me proud!I'll start: (1) Premature atrial contractions...-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Dr. A Show 141: Saturday Night - Jan 17,2010

Doctor Anonymous Live — Fri, 15 Jan 2010 16:30:00 +0100

The Institute of Medicine provides ammo for the opponents of tort reform

Notes from Dr. RW — Fri, 15 Jan 2010 13:55:00 +0100

I've been citing evidence for some time that the IOM report on patient safety did little more than create a culture of blame which will propel us into the next malpractice crisis. Here's another example.H/T to Clinical Cases and Images. (Source: Notes from Dr. RW)

More on the elimination of consult codes

Notes from Dr. RW — Fri, 15 Jan 2010 12:51:00 +0100

According to this article no one seems to be able to agree on how it will affect hospitalists. (Source: Notes from Dr. RW)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Haitian Destruction Caught on Video

Dr. Wes — Fri, 15 Jan 2010 12:38:00 +0100

... it only took a little over 16 seconds.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

Where Were the Techs and Nurses?

Dr. Wes — Fri, 15 Jan 2010 12:17:00 +0100

Medicine is a team sport. No single doctor can do what they do without tons of help from nurses, technicians, clerical staff, and yes, even adminstrators.So it was with considerable surprise that I saw this piece from the Baltimore Sun:"An internal review, begun last May at the behest of federal investigators and in response to a patient complaint, has turned up 369 patients with stents that appear to have been implanted in their arteries unnecessarily, CEO Jeffrey K. Norman said in an interview yesterday. Patients began receiving letters alerting them to the finding early last month, and more notifications are expected as the review continues. "We take our interaction and the care of our patients with the utmost seriousness, and so we wanted to alert patients and their physicians to what ...

Show 140 Wrap-up: Chronicles of EMS

Doctor Anonymous — Fri, 15 Jan 2010 04:15:00 +0100

Thanks to Ted Setla from EMS Media for talking on Doctor Anonymous Show 140 about the new reality web series called "Chronicles of EMS." Our discussion started with us talking about Ted's background as a paramedic AND a filmmaker. We then went into the origins of the CoEMS project which started with a bunch of passionate people who wanted to share a point of view which has never been covered like this before. According to their promo material, CoEMS is "a reality web series that travels the world exploring EMS systems, how they operate and the personalities behind them." If you haven't checked out the trailer/preview of the first show, you can check it out here. Our interview also covered how they are getting sponsorship for episodes and how a community really has come together around this...

Dr. A Show 140: Chronicles of EMS - Jan 15,2010

Doctor Anonymous Live — Fri, 15 Jan 2010 02:00:00 +0100

Thaddeus Setla from EMSMedia.TV will be our guest to talk about the upcoming premiere on Feb 12, 2010 of a show called Chronicles of EMS which is a reality web series that travels the world exploring EMS systems, how they operate and the personalities behind them.Doctor | Anonymous | Chronicles of EMS | EMS Media dot TV | Thaddeus Setla (Source: Doctor Anonymous Live)

To Pack or Not to Pack? A dilema for FtMs

FtM Doctor — Thu, 14 Jan 2010 17:20:47 +0100

In my ‘Passing as male without Testosterone post’ Landan commented that I had missed out packing – that’ s putting something down the front of your pants to add a bulge. I’m not entirely convinced by whether it’s a good idea. There is always the big worry that if you don’t have something down your pants then people will notice that their isn’t a bulge, and you have to do everything you can to pass, especially in the early stages. Particularly if you are on a date and get a grope, you need something convincing to prevent her, or him running away screaming. Many trans men would never go swimming without having something down the front of their shorts. I live in a happy world where I don’t think anyone really looks at my crotch, I do...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Do eICUs improve outcomes?

Notes from Dr. RW — Thu, 14 Jan 2010 12:39:00 +0100

A study from 2004 had found that they improved mortality and resource utilization. This newer study did not. Both were before-and-after intervention studies. Given the setting and the conditions of the newer study I have to wonder what the eICU really added, given that most of the study ICUs were “closed” meaning that many patients were cared for by intensivists in the pre-intervention period. Also, utilization of the eICU by individual physicians was limited.I suspect eICUs are like rapid response teams in that, while it is difficult to prove benefit in the aggregate, individual hospitals may benefit if they utilize them for all they're worth. (Source: Notes from Dr. RW)

Dr. A Show Tonight

Doctor Anonymous — Thu, 14 Jan 2010 11:39:00 +0100

Thursday, January 14, 2010 at 9pm ETOn The Doctor Anonymous Show 140 tonight, we will be welcoming Thaddeus Setla from EMS Media. We will be talking about a new series called "Chronicles of EMS" which will make it's premiere on the internet on February 12, 2010. According to the facebook fan page for the show, CoEMS is "a reality web series that travels the world exploring EMS systems, how they operate and the personalities behind them. From San Francisco to the UK tell us what you want to see from these systems."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 show a...

Doctor Paycut Suit Score: HHS 1, ACC 0

Dr. Wes — Thu, 14 Jan 2010 02:19:00 +0100

It's hard to bring a suit against lawyers. As case in point, from ModernHealthCare.com:A U.S. District Court judge in Fort Lauderdale, Fla., has denied the American College of Cardiology's request for a preliminary injunction to block a scheduled Medicare reimbursement cut for cardiology services. The ACC, its Florida chapter and other cardiology organizations filed a lawsuit against HHS Secretary Kathleen Sebelius on Dec. 28, seeking to stop the pay cut on the grounds that is based on the “erroneous and flawed” Physician Practice Information Survey. The ACC said Medicare payment cuts for 37,000 cardiologists are being based on the practice expenses of 55 doctors.In addition to denying the injunction, Judge William Dimitrouleas denied a request for expedited discovery and canceled a sc...

When woo invades hospitals

Notes from Dr. RW — Wed, 13 Jan 2010 21:40:00 +0100

---what will hospitalists do? Can you imagine doing comanagement with this guy? Woo, under the guise of integrative medicine, is rapidly invading hospitals, especially academic medical centers. The Society of Hospital Medicine should take a stand against this assault on scientific medicine in hospitals and provide resources and support to help the individual hospitalist respond in an appropriately critical manner. Unfortunately, if an article in the latest issue of The Hospitalist (an official publication of the Society) is any indication, I'm not optimistic. The article discusses a mixture of a few plausible alternative methods and some of the wooiest woo, towards which it takes a disturbingly uncritical stance. (Source: Notes from Dr. RW)

Dr. A Show 140: Chronicles of EMS - Jan 15,2010

Doctor Anonymous Live — Wed, 13 Jan 2010 16:45:00 +0100

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Primary influenza pneumonia

Notes from Dr. RW — Wed, 13 Jan 2010 15:57:00 +0100

Reviewed in Critical Care:Primary influenza pneumonia has a high mortality rate during pandemics, not only in immunocompromised individuals and patients with underlying comorbid conditions, but also in young, healthy adults. Clinicians should maintain a high index of suspicion for this diagnosis in patients presenting with influenza-like symptoms that progress quickly (2-5 days) to respiratory distress and extensive pulmonary involvement....Ensuring an appropriate oxygenation and ventilation strategy, as well as prompt initiation of antiviral therapy, is essential in management. (Source: Notes from Dr. RW)

Why Doctors Fail to Heed Their Own Advice

Dr. Wes — Wed, 13 Jan 2010 15:51:00 +0100

Recently, I've been recovering from some form of upper respiratory illness - of what form, I have no clue - but it was probably the dreaded H1N1 influenza virus or its equivalent (yes, I took the shots, but to no avail). Last Friday, with surprising reluctance, I conceded defeat and called in sick - something I almost never do. Somehow the thought of spreading contagion while wearing a mask while croaking, sniffling, coughing my way though conversations just didn't seem like the best thing for me or my patients. Gratefully, I'm on the upswing and only now have a slightly hoarse voice and an occasional cough that's improving, but it is interesting to reflect on why, despite knowing better, I felt so inclined to keep seeing patients despite my illness.First, there is the subliminal message t...

Dr. A Show 140 Preview: Chronicles of EMS

Doctor Anonymous — Wed, 13 Jan 2010 06:09:00 +0100

Let me tell you about the power of social media. So, I was just listening to the live podcast called MedicCastLive and one of the panelists mentioned a new reality web series called Chronicles of EMS. Their promo based material calls CoEMS Chronicles "a reality web series that travels the world exploring EMS systems, how they operate and the personalities behind them."This sounds very exciting! Our guest will be Thaddeus Setla from EMSMedia.TV to talk about the new series which will be premiering on Feburary 12, 2010 on EMSMedia.TV. You can see the trailer/preview of the first episode below. Let me tell you, the production value of the preview is top notch (as you'll see below). So, I'm looking forward to checking out this show.I hope that you can join me on Thursday, January 14, 2010 at 9...

Bicarb for prevention of contrast-induced nephropathy

Notes from Dr. RW — Tue, 12 Jan 2010 15:55:00 +0100

The pendulum is swinging back. According to the latest systematic review:The effectiveness of sodium bicarbonate treatment to prevent CIN in high-risk patients remains uncertain. Earlier reports probably overestimated the magnitude of any benefit, whereas larger, more recent trials have had neutral results. Large multicenter trials are required to clarify whether sodium bicarbonate has value for prevention of CIN before routine use can be recommended. (Source: Notes from Dr. RW)

Grand Rounds Is Up

Dr. Wes — Tue, 12 Jan 2010 15:50:00 +0100

... over at Dr. Rich's place, the Covert Rationing blog, with his post-holiday edition:The Holidays may be over, but there’s no rest for Santa or his cute little Congressional elves. So, after a respite that must have seemed all too brief, Santa has herded his diminutive (but ever-cheerful!) drudges right back into their Secret Workshop, to finish building for us kids the Healthcare We Can All Believe In.DrRich, for one, can hardly wait to unwrap it.But unwrap it he does with his usual sharp-witted writing style. Definitely worth a read. Twice. Gotta find out who's been naughty and nice.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Another antiphospholipid syndrome review

Notes from Dr. RW — Tue, 12 Jan 2010 15:50:00 +0100

This one is similar to the one I cited recently, but focuses more on the under appreciated association of thrombocytopenia and its management. (Source: Notes from Dr. RW)

How Hospitals Survive: Making Dust

Dr. Wes — Mon, 11 Jan 2010 20:04:00 +0100

If they don't make dust, they fade (subscription):UIC has spent four years drafting plans for a $450-million patient tower as the centerpiece of a $650-million, five-year-long overhaul of its Near West Side campus. But an inability to finance the project has forced longtime CEO John DeNardo to ice those plans for now.He's settling for a $40-million repair job on the 500-bed hospital, which lost heat two days last month when the campus steam plant gave out.The capital crunch poses a threat to UIC, where the hospital serves as a training ground for the nation's largest medical school — more than 15% of the state's physicians cut their teeth at the place. Rival university hospitals are pouring money into new buildings, including Rush University Medical Center's $1-billion makeover next door...

Can you catch HPV (and cervical cancer) without going near a penis?

FtM Doctor — Mon, 11 Jan 2010 16:58:11 +0100

Cervical cancer is caused by Human Papilloma Virus, HPV is caught through sexual intercourse. So if you haven’t had sex you’re unlikely to get cervical cancer. But does the sex need to be with a man? A recent article in the BMJ revealed that it didn’t, and that you could catch HPV through sex between women. This was actually a report of a systematic review of the literature performed by Julie Fish. The report itself was prepared for the NHS cervical cancer screening service, and wasn’t published. But there’s a link to the PDF. Now most of this document is about the barriers found by lesbians who wish to have a cervical smear, and how embarrassing it is to be assumed to be heterosexual. The other barrier that is mentioned in the report is the fact that women ar...

The Aisles of Walgreens

Dr. Wes — Mon, 11 Jan 2010 15:20:00 +0100

Worn out, her face showed the toll that being a caregiver for her mother dying of pancreatic cancer has taken."You know, there are some aisles in Walgreens I'd rather not frequent, like those for dressing supplies and Depends undergarments.And yet you know something? I'm at peace with that and wouldn't want it any other way."Now you know why I married her.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes)