MedWorm: Respiratory Medicine Blogs

New Coronavirus Sickens Healthcare Workers

Inside Surgery — Wed, 15 May 2013 20:31:23 +0100

A new coronavirus has caused serious illness in two healthcare workers in Saudi Arabia who were exposed to patients carry the virus. A man is is critical condition and a 43 year old woman is in stable but serious condition after suffering respiratory distress from the SARS-like illness. The post New Coronavirus Sickens Healthcare Workers appeared first on InsideSurgery Medical Information Blog. (Source: Inside Surgery)

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Post #38 The Common Cold

A Pediatrician's Blog — Wed, 15 May 2013 15:13:00 +0100

It's been around for centuries, and there is no cure. Millions of people every year are miserable because of it, but there is no vaccine. It is the common cold.Back in the 16th century, folks dubbed it a "cold" because symptoms seemed to pop up in conjunction with exposure to cold weather.Today, science has identified more than 200 different types of cold viruses that are specific to humans.Most children will catch six to 12 colds per year, typically in rapid succession and usually in the wintertime – and this is actually quite normal.Kids with colds can be quite miserable, leaving parents desperate for relief and pediatricians quite frustrated at their inability to treat it. Since doctors can't treat the virus, parents are often eager to treat the symptoms.Unfortunately cough and cold m...

Body of Proof Star Dana Delany Uses Incorrect CPR Technique and Protocol

Inside Surgery — Wed, 15 May 2013 03:39:53 +0100

In the opening scenes in the last episode of Body of Proof, a television series starring Dana Delany as medical examiner Dr. Megan Hunt, a patient was given CPR after being shot in the back. While the writers of Body of Proof, no doubt, will claim dramatic license in the depiction of the scene to further the episode’s story line, the technique and protocol used by Dr. Hunt does not fit with the standard diagnosis and treatment steps as described in the 2010 guidelines for cardiopulmonary resuscitation and practiced in real-life resuscitations by trauma surgeons, intensive care physicians, emergency medicine physicians, and prehospital educators. In the scene, Dr. Hunt examines a shooting victim and realizes through undescribed clinical clues that the patient is still alive. She then...

To Many Anti-Smoking Advocates, Nicotine is the Problem, Rather than Disease and Death

The Rest of the Story: Tobacco News Analysis and Commentary — Tue, 14 May 2013 11:36:00 +0100

According to an article in the Toledo Blade, electronic cigarettes have helped many smokers to quit, producing profound health benefits among patients with COPD and cancer who were unable to quit using traditional methods.While this seems like something to applaud, the article notes that health officials are frowning upon, rather than praising, the tremendous health benefits that smokers have achieved from quitting or cutting down on tobacco cigarettes.According to the article:"Health officials argue the long-term effects of the unregulated products are unknown and require more research. “There are fewer chemicals in e-cigarettes and no carbon dioxide is emitted. Those certainly would be a reduction in harmful inhalants,” said Holly Kowalczk, a registered respiratory therapist at Prome...

The Fog of Science

Stayin' Alive — Mon, 13 May 2013 17:10:00 +0100

As you may recall, in our last episode, Abraham Flexner has persuaded the world -- or at least the space between the North Atlantic and the North Pacific -- to put medicine on a scientific basis. But, it turns out that is very easy to say and very hard to do.Back in 1910, people knew more about human biology than they did in 1850 or 500 BC, to be sure. But the usefulness of that knowledge for making or keeping people healthy -- whatever that means, and remember we still haven't figured that out -- was very limited. To take stock briefly of our relevant knowledge at the time, we knew something about pathogenic microbes and the importance of sterilizing surgical instruments and wounds. We didn't have any antibiotics, however. There were some empirical remedies, such as opioid analgesics, and...

Pulmonologist Unsure that Smoking is Any More Hazardous than Quitting Smoking via Electronic Cigarettes

The Rest of the Story: Tobacco News Analysis and Commentary — Mon, 13 May 2013 10:48:00 +0100

It doesn't take a rocket toxicologist to understand that smoking burning tobacco, which contains more than 10,000 chemicals including 60 known human carcinogens - and which has already been demonstrated to cause more than 400,000 deaths each year in the U.S. - is much more harmful than vaping from a non-tobacco solution containing little more than nicotine and glycerin or propylene glycol.If any tobacco company even hinted that smoking is as benign as inhaling vapor from a solution of propylene glycol with nicotine, that company would find itself in a courtroom the next day, defending itself against charges of fraud.Apparently, however, a physician can make precisely the same claim with impunity.Last week, a Stanford pulmonologist claimed that it is unclear that smoking is any more harmful...

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A good death…

Life in the Fast Lane — Sat, 11 May 2013 06:54:51 +0100

The 4th International Advanced Care Planning and End of Life Care Conference has just been held in Melbourne, run by the ACPEL Society. A keynote speaker was Professor Robin Taylor, Respiratory Physician from Dunedin Hospital, New Zealand. His team produced this video, entitled “A Good Death”, featuring a real patient, who is dying from COPD, and the efforts made to improve his care in the last stages of his life. In the words of Professor Taylor: “We wanted to make this film because we realized that the care we were providing to patients with respiratory disease at the end of life was missing the mark, and I don’t think we are alone. Two families expressed their appreciation but also their frustration at the way their loved ones had been looked after in Dunedin Ho...

What to do after the patient is made comfort measures only (CMO)

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 08 May 2013 04:00:00 +0100

Discussion: Deciding to focus only on comfort is a major transition point for patients, families and health care providers. After making this decision, most families are not sure what comes next. They look to health care providers to reassure them that they are doing the right thing and to ensure that their loved one does not suffer and that they are prepared for the next few days. The following questions should guide one’s action after a patient is made CMO: 1. Are the patient’s symptoms adequately treated/prevented? A standardized comfort measures only order sheet can optimize symptom management in CMO patients. It reminds clinicians that: a. All medications and laboratory tests that do not promote comfort should be discontinued. b. &n...

The LITFL Review 103

Life in the Fast Lane — Tue, 07 May 2013 12:32:10 +0100

Welcome to the 103rd edition! The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around. The Most Fair Dinkum Ripper Beaut of the Week The Sono Cave For those of you that love ultrasound or just learning – The Sono Cave is the ultimate EM blog for you. Check out these two awesome FOAMed cases from James over the past few weeks: Appendicitis with appendicolith Ultrasound of Acute Angle-Closure Glaucoma The ...

How to Clean you AC Ducts at Home

Addiction Recovery Blog — Mon, 06 May 2013 20:08:06 +0100

Frequent AC duct washing is suggested in any family with air-conditioning techniques. This should be done especially in hot locations like Dubai where citizens invest 90% of the day in the house. The dirt and dirt may acquire in the channels extra time. This accumulation motivates pattern and microbe development which presents health hazards. Only a certified Dubai A/C duct cleaners is capable of doing thorough A/C washing. This is because only an experienced can do duct washing more than two legs into the duct. A certified Dubai AC cleaners also has technology to sterilize the tubes. However, you can still fresh the air channels yourself to reduce dirt build up especially if there is still no pattern development on the tubes. Here is how: 1. Collect resources. You will need resourc...

Which Prescription Drugs Do Americans Abuse Most?

PharmaGossip — Fri, 03 May 2013 04:00:00 +0100

By: Laura Sciuto According to a 2010 study by the National Institute on Drug Abuse, approximately 7 million people in the United States -- or 2.7 percent of the population -- annually abuse prescription drugs. This abuse primarily occurs when people take medication not prescribed to them or take their own prescription drugs at a higher dosage than recommended by their doctor. The most commonly abused prescription drugs fall into three categories: Opioids (pain relievers), depressants and stimulants. Below is a breakdown of each category, compiled using the latest statistics from the National Institute on Drug Abuse: OPIOIDS Medical use: Prescribed to provide pain relief unattainable through over-the-counter pain killers. Frequency of Abuse: 5.1 million (out of 7 million Americans wh...

HHS OIG Provider Self Disclosure Protocol

Policy and Medicine — Tue, 30 Apr 2013 04:00:00 +0100

The Office of Inspector General (OIG) for the U.S. Department of Health & Human Services (HHS) recently updated OIG’s Provider Self-Disclosure Protocol (SDP). The revised protocol now supersedes and replaces the 1998 Federal Register Notice and the Open Letters, as described below (summarized from the new SDP). In addition to the new protocol, OIG also posted a new video podcast about the SDP, given by a lawyer from OIG’s counsel. These videos are part of OIG’s Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. We previously reported in July of 2012 that OIG was soliciting comments to change the SDP, which was first established back in 1998, to give health care providers a process to disclose potential fraud involving...

ResMed VPAP COPD Now Available in U.S.

Medgadget — Thu, 25 Apr 2013 17:38:14 +0100

ResMed out of San Diego, California won FDA clearance and is releasing its VPAP COPD device. A bilevel PAP (positive air pressure) device, it should help people with severe respiratory conditions breathe better at home and stay out of the hospital.The device is used during sleep when assisted breathing is most needed. It applies rapid pressure during inhalation and allows for slow release of the exhaled breath, hopefully improving the lung’s own ability to exchange gas.Read More (Source: Medgadget)

Money From Mistakes

Diabetes Self-Management — Wed, 24 Apr 2013 15:30:23 +0100

By Quinn Phillips Medical errors during hospitalization are strikingly common in the United States. One study of ten hospitals, published in 2010 in The New England Journal of Medicine, found that out of 2,341 admissions, 588 incidents of harm were identified — a rate of 25.1 cases of harm per 100 admissions. According to one source, around 98,000 Americans die as a result of preventable medical errors each year. To put this number in perspective, diabetes contributes to about 75,000 deaths each year in the United States and ranks sixth among all causes of death (after heart disease, cancer, stroke, lower respiratory disease, and accidents). Perhaps most disturbingly, as the 2010 study noted, awareness of the dangers posed by medical errors has been rising, yet the frequency of preve...

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PhRMA Report: Over 5400 Medicines in Development and 70% are First in Class

Policy and Medicine — Wed, 24 Apr 2013 04:00:00 +0100

According to report released by PhRMA, companies have more than 5,400 medicines in development globally, and more than 70% of therapies in the pipeline are potentially first-in-class and could offer patients new treatment options, and a notable number of potential therapies target diseases with limited treatment options such as ALS and rare diseases. A breakdown of their report offers insight into the various medicines in development for different diseases and populations. Older Americans America’s biopharmaceutical research companies are developing 465 new medicines that target the 10 leading chronic conditions affecting seniors. These medicines – all in human clinical trials or under review the U.S. Food and Drug Administration (FDA) – are diverse in scope. They inc...

The Surgery - I Could Never Have Expected This

bipolar.and.me — Sun, 21 Apr 2013 13:55:00 +0100

Mark is freakishly OCD about being on time or early everywhere we go, so when we left to go to the hospital for my surgery, the traffic was bad, it was lightly snowing (yes, I know, on April 19!!), and it appeared we were going to be a bit late. I kept trying to calm him down, telling him they give people huge windows of two to three hours before their surgery even begins to get there. Everyone has their buttons, though. His is traffic, another one of his is finding a parking spot in a parking lot. NOT a good pet peeve living in Chicago. Now *that* I totally dread. I can go from being so excited to being somewhere to telling him to just take me home because it's all been ruined, and it may have all happened in five minutes. It's just that bad. ...

Burt’s Bees Res-Q Ointment: Look at the label

thebeautybrains.com — Sun, 21 Apr 2013 06:13:44 +0100

Res-Q Ointment is the 15th best selling beauty product on Amazon.com this week. It sounds sort of like a drug product because it promises to “comfort life’s bumps and bruises.” Let’s look at the label to see what makes it so rescue-y. Prunus amygdalus dulcis (sweet almond) oil, olea europaea (olive) fruit oil Emollients with some moisturizing properties. Beeswax The “backbone” of the formula that gives it body and texture. Symphytum officinale (comfrey) root extract A natural source of allantoin, a skin healing agent. Theobroma cacao (cocoa) seed butter Natural moisturizer. Triticum vulgare (wheat) germ oil Lavandula hybrida (lavandin) oil That’s right, lavandin NOT lavender. This is a hybrid of two lavender plants that is supposedly beneficial f...

Boston Bomber Possible Suicide Attempt

Inside Surgery — Sun, 21 Apr 2013 04:45:21 +0100

The news reports of the wounds suffered by the Boston bomber suspect being treated at Beth Israel Deaconess Medical Center grow more interesting by the hour. ABC News is now reporting that the suspect has a wound in the back of the neck, which is leading investigators to conjecture that the wound may be the result of an self-inflicted wound in an unsuccessful suicide attempt. One scenario being discussed is that the suspect may have placed the end of the gun barrel in his mouth and pulled the trigger but failed to kill himself. From a purely clinical point of view and assuming the suspect did not flinch and give himself an off center shot through the cheekbone, this would be a very rare outcome. Almost always, when a person swallows a gun barrel and pulls the trigger, massive tissue damag...

Jury awards $63M to Samantha Reckis, girl who lost skin after taking Motrin - CBS News

PharmaGossip — Sun, 21 Apr 2013 04:00:00 +0100

via cbsnews.com BOSTONA jury has awarded a Massachusetts teenager and her parents $63 million nearly a decade after she suffered a life-threatening drug reaction that caused her to lose most of her skin after taking Johnson & Johnson's children's pain reliever Motrin. Johnson & Johnson and its McNeil-PPC Inc. subsidiary should pay Samantha Reckis and her parents a total of $109 million, including interest, a Plymouth Superior Court jury decided on Wednesday. Samantha was 7 when she was given Motrin brand ibuprofen, family attorney Brad Henry said. She suffered a rare side effect known as toxic epidermal necrolysis (TEN) and lost 90 percent of her skin and was blinded, he said. She suffered brain damage that "thankfully" involved only short-term memory loss, he said, and surgeons had to dri...

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Avian influenza H7N9 viruses isolated from humans: What do the gene sequences mean?

virology blog — Wed, 17 Apr 2013 01:17:14 +0100

There have been over 60 human infections with avian influenza virus H7N9 in China, and cases have been detected outside of Shanghai, including Beijing, Zhejiang, Henan, and Anhui Provinces. Information on the first three cases has now been published, allowing a more detailed consideration of the properties of the viral isolates. The first genome sequences reported were from the initial three H7N9 isolates: A/Shanghai/1/2013, A/Shanghai/2/2013, and A/Anhui/1/2013. These were followed by genome sequences from A/Hongzhou/1/2013 (from a male patient), A/pigeon/Shanghai/S1069/2013), A/chicken/Shanghai/S1053/2013), and A/environment/Shanghai/S1088/2013, the latter three from a Shanghai market. Analysis of the viral genome sequences reveals that all 8 RNA segments of influenza A/Shanghai/1/2...

Fred Schulte: "GOP senators call for overhaul of electronic health records program"

Health Care Renewal — Tue, 16 Apr 2013 19:37:00 +0100

Fred Schulte, investigative reporter at the Center for Public Integrity (link to bio), has authored a new article worth reading in its entirety:GOP senators call for overhaul of electronic health records programLawmakers say Obama's $35 billion initiative pushing health information technology isn't working.Six U.S. Senators are calling for an overhaul of the federal government’s $35 billion plan for doctors and hospitals to switch from paper to electronic medical records, citing concerns from patient privacy to possible Medicare billing fraud.The report issued Tuesday by the half-dozen Republicans concedes that many lawmakers and medical experts believe the digital systems can reduce health care costs and improve the quality of care by reducing duplicative testing and cutting down on med...

Dobbs Newsletter

Malaysian Medical Resources — Mon, 15 Apr 2013 22:12:20 +0100

Dobbs is the exclusive (and free!) forum for Malaysian doctors which we have maintained for 12 years now. This is the latest update/newsletter: Greetings Dobber I trust this email finds you well. Time again for an update on what’s new in Dobbs, your unique Internet based community for Malaysian doctors by Malaysian doctors. Dobbs forum is organised into Groups, each with its individual forum. Since the last new group added,Heartbeat, which caters to Cardiology related matters, we have three new Groups: 1) Pulmonology - for discussion, learning and sharing on things related to Respiratory medicine. The group’s enthusiastic administrator is Dr. Jamalul Azizi who has really sparked much interest with his exciting and informative posts.. 2) HaemOnc - for postings related to ...

Hospital defense maliciousness, aided and abetted by attorneys who ignore the ABA and Pennsylvania's Ethical Rules of Conduct Regarding "Candor Towards the Tribunal"

Health Care Renewal — Thu, 11 Apr 2013 16:58:00 +0100

At Healthcare Renewal we've written of hospitals' deviations from the core mission of compassionate, ethical and safe patient care, towards profiteering at patient's and the community's expense.What we haven't written about is maliciousness.At my Feb. 2013 posts about my late mother's (now my) lawsuit regarding injury and death that involved EHR problems, namely "The lengths a hospital will go to in order to protect their EHR - Motion for Reconsideration of Denial of Motion for Reconsideration of Denial of Objections" and "More on the lengths a hospital will go through to protect their EHR from discovery", I'd opined that the defense's repeated position that individual Certificates of Merit [COMs] were required naming or otherwise "identifying by specialty" every si...

Dental bib clips can harbor oral and skin bacteria even after disinfection

Dental Technology Blog — Mon, 08 Apr 2013 14:18:00 +0100

40 percent of bib clips retained aerobic bacteria; 70 percent retained anaerobic bacteria post-disinfectionResearchers at Tufts University School of Dental Medicine and the Forsyth Institute published a study today, "Comprehensive Analysis of Aerobic and Anaerobic Bacteria Found on Dental Bib Clips at Hygiene Clinic", that found that a significant proportion of dental bib clips harbored bacteria from the patient, dental clinician and the environment even after the clips had undergone standard disinfection procedures in a hygiene clinic. Although the majority of the thousands of bacteria found on the bib clips immediately after treatment were adequately eliminated through the disinfection procedure, the researchers found that 40% of the bib clips tested post-disinfection retained one or mo...

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A critique of the Cochrane Collaboration

Liberating the literature — Sun, 07 Apr 2013 17:47:00 +0100

In this study the authors compared the performance of McMaster Premium LiteratUre Service (PLUS) and Clinical Queries (CQs) to that of the Cochrane Controlled Trials Register, MEDLINE, and EMBASE for locating studies added during an update of reviews. They concluded that PLUS included less than a quarter of the new studies in Cochrane updates, but most reviews appeared unaffected by the omission of these studies. In other words, you do not necessarily need to get all articles to arrive at an accurate effect size (compared to the Cochrane systematic review).3) A pragmatic strategy for the review of clinical evidence [10]. In this paper the authors compared a research strategy based on the review of a selected number of core journals, with that derived by an SR ...

Shifting From Fee-For-Service Medicaid: An Early Review Of Rx Drug Utilization

Health Affairs Blog — Fri, 05 Apr 2013 13:13:44 +0100

The recent moves by states to bring their Medicaid prescription drug benefits under managed Medicaid plans has fully taken root: the percentage of Medicaid prescriptions filled under managed Medicaid plans jumped from 19 percent in September 2011 to 46 percent in June 2012. As yet, the impact this might be having on patient care has not been examined. While it is early days to see the impact on health outcomes and whether better preventive services are being provided at lower cost, any changes in the utilization of prescription drugs can be an early indicator of longer term impact. At the IMS Institute for Healthcare Informatics, we have looked at four states -- Kentucky, New Jersey, New York and Ohio -- and compared changes in the use of anti-psychotic, respiratory and diabetes medicatio...

First human infections with avian influenza H7N9 virus

virology blog — Fri, 05 Apr 2013 02:05:26 +0100

Fourteen people in China have been infected with avian influenza H7N9 virus, leading to five deaths. This avian influenza virus has never been isolated from humans. Influenza A viruses with the H7 hemagglutinin protein circulate among birds, and some, such as H7N2, H7N3, and H7N7, have been previously found to infect humans. It is not known how the individuals in China acquired the H7N9 virus. Some of the infections have occurred in Shanghai, where a similar virus was found in pigeon samples collected at a marketplace in that city. It is not clear what types of pigeon samples tested positive for the virus, nor is it known whether the virus spread from poultry to pigeons or vice versa. In response the city has begun mass slaughter of poultry to stem further spread of the virus. Influenza H...

Another Sign of Resistance? - Doctors Sue Hospital Systems Alleged to Put Money Ahead of Mission

Health Care Renewal — Thu, 04 Apr 2013 18:57:00 +0100

This article also described how money allegedly came before patient care:The court papers include email exchanges between Henderson and the other doctors in the ER group. In a November 2010 email, he discusses ways to punish doctors who do fewer patient transfers and reward those who tally more transfers:'(T)op quarter $1,000, next quarter $500. Bottom quarter up or out talk at annual evaluation.' In other words, according to doctors who received the email, Henderson proposed that doctors would be divided into strata based on who recommended the most transfers, with the top group winning bonus money while those who performed the least would eventually be terminated.Transferring patients was such a priority that doctors were ordered to fill out non-transfer forms, explaining a decision not ...

Searching for Smaug

Life in the Fast Lane — Wed, 03 Apr 2013 23:55:09 +0100

“My armour is like tenfold shields, my teeth are swords, my claws spears, the shock of my tail is a thunderbolt, my wings a hurricane, and my breath death!“ Smaug, the most powerful, the most cunning, and some would even say the greatest, dragon of the Third Age, had a story steeped in mystery. By the time an unexpected journey began, Smaug had not been seen for 150 years, but legend had it that he had laid waste to the Lonely Mountain in Erebor, and was feared as a ruthless killer. The obvious questions that ensue from this frightening tale are: Does Smaug really exist, or is he some terrifying myth? If he does exist, is he a swift and definitive killer, feared by man, dwarf and elven folk alike? Does he have a weak spot, which is amenable to piercing by a single needle-...

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Metals in Electronic Cigarette Vapor are Below USP Standards for Metals in Inhalation Medications

The Rest of the Story: Tobacco News Analysis and Commentary — Wed, 03 Apr 2013 11:13:00 +0100

As I reported on Monday, a study published last week in the online journal PLoS ONE sounded the alarm about potential dangers of electronic cigarettes. The article reported the detection of trace amounts of metals in the aerosol from one brand of electronic cigarette.(See: Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PLos ONE 2013; 8(3): e57987.)The study reported that: "The aerosol contained particles greater than 1 micrometer comprised of tin, silver, iron, nickel, aluminum, and silicate and nanoparticles (less than 100 nanometers) of tin, chromium and nickel. The concentrations of nine of eleven elements in EC aerosol were higher than or equal to the correspon...

New Study Documents Effectiveness of Electronic Cigarettes for Smoking Cessation Among 1,000 Ex-Smokers

The Rest of the Story: Tobacco News Analysis and Commentary — Tue, 02 Apr 2013 11:36:00 +0100

Anti-smoking groups and advocates continue to argue that there is no evidence that electronic cigarettes can be helpful in smoking cessation, but according to a new study published in the journal Addiction, there are at least 1,000 ex-smokers who would beg to differ. The article reports the results of a survey of committed e-cigarette users, recruited from two e-cigarette company web sites, and finds that these devices were highly successful in helping about 75% of these users to quit smoking. (See: Dawkins L, Turner J, Roberts A, Soar K. 'Vaping' profiles and preferences: an online survey of electronic cigarette users. Addiction 2013; doi: 10.1111/add.12150.)There were 1,347 respondents to this online survey. The main finding was that: "Seventy-four percent of participants repo...

New Study Sounds Alarm about Metals Detected in Electronic Cigarettes, But Fails to Inform Readers that Nicotine Inhalers Have Similar Levels of the Same Metals

The Rest of the Story: Tobacco News Analysis and Commentary — Mon, 01 Apr 2013 11:34:00 +0100

This study reported a nickel level of 0.005 micrograms in 10 puffs of the electronic cigarette vapor.The Nicorette nicotine inhaler was found to contain nickel at a level of 0.013 micrograms per 10 puffs.Thus, the level of nickel in the electronic cigarette vapor was 2.6 times lower than in an FDA-approved nicotine inhaler.The study reported a lead level of 0.017 micrograms in 10 puffs of the electronic cigarette vapor.The Nicorette nicotine inhaler was found to contain lead at a level of 0.003 micrograms per 10 puffs.Thus, the level of lead in the electronic cigarette vapor was 5.7 times higher than in an FDA-approved nicotine inhaler.However, it should be noted that only one brand of electronic cigarette was tested in this study, and in the Goniewicz et al. study, 12 brands were tested a...

killing the cardiac arrest mind donk.

impactEDnurse — Mon, 01 Apr 2013 08:13:26 +0100

OK, you have completed your Advanced Life Support (ALS) and Basic Life Support (BLS) education. Perhaps it was a few months back. Or perhaps you are due for a refresher. And then your patient arrests. When you least are expecting it. You immediately experience the arrest response mind donk. Your brain is total beige…. and all your knowledge of the ALS algorithm seems to be folded up into an origami flapping bird that is migrating south to your sphincter. I am going to give you a rough thought-script to simplify the whole thing and get you over any mental donk by moving you to move your nursing team through the things that need to be done. This is NOT a substitute to the ALS pathway you have been taught, it is just a quick script to cover the first few minutes. By that time there sh...

Acute Severe Pulmonary Edema: What is the Diagnosis?

Dr. Smith's ECG Blog — Wed, 27 Mar 2013 04:00:00 +0100

Here is an interesting case just presented in a conference today. Thanks to Dr. Simegn, Asinger, Davies, and Bart for their input.A 69 yo previously healthy woman had very sudden severe dyspnea. The husband at some point reported that they had been physically active that day, and that the patient had complained of some chest pain one week prior for which she did not take his advice to go to the ER. She presented in pulmonary edema, hypoxic on high flow O2, and sats were above 90% on Noninvasive Ventilation. BP was 130/70. Cardiac physical exam was unremarkable except for very coarse breath sounds. ABG was 6.99/44/201/11 on BiPAP. Here is her first ECG:The rate is 143. There are p-waves, but in lead II there are apparently 2 p-waves for every QRS.&n...

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Wheat Belly transforms lives in New Zealand . . . and a bread recipe!

Wheat Belly Blog — Mon, 25 Mar 2013 15:34:19 +0100

Annie posted this story of complete health turnarounds in her formerly ill parents involving diabetes/prediabetes and a condition called Wegener’s Granulomatosis: I live in Christchurch, New Zealand, and saw you briefly on a programme called “60 Minutes” when they were discussing gluten sensitivity. My parents both had many health problems that were talked about, so I read your book and blog thoroughly and started them on the Wheat Belly diet a few months ago. Mum is overweight and has struggled with diets all her life. She was on bendrofluazide and candesartan for blood pressure and about to start diabetes medication. Dad has Wegener’s Granulomatosis and on long-term steroids and azathioprine after completing a course of IV cyclophosphamide. He also developed stero...

Another Study Concludes that Smoking Ban Reduced Heart Attacks While Data Show No Effect

The Rest of the Story: Tobacco News Analysis and Commentary — Mon, 25 Mar 2013 11:09:00 +0100

A study published online in the journal PLoS ONE concludes that a partial smoking ban in Prince Edward Island resulted in a 14%-24% decline in heart attack admissions, while the study data show that the rate of heart attacks actually increased in the five-year period following the smoking ban compared to the five-year period before the ban.(See: Gaudreau K, Sanford CJ, Cheverie C, McClure C. The Effect of a Smoking Ban on Hospitalization Rates for Cardiovascular and Respiratory Conditions in Prince Edward Island, Canada. PLoS ONE 8(3): e56102. doi:10.1371/journal.pone.0056102.)A partial smoking ban went into effect in Prince Edward Island on June 1, 2003. Smoking was banned in all public places and workplaces, but was still allowed in designated smoking rooms. The study compares...

Anaphylaxis Diagnostic Criteria

Inside Surgery — Sun, 24 Mar 2013 22:49:22 +0100

Anaphylaxis should be considered in the differential diagnosis when any one of the three main criteria list below occurs in a patient: 1. Acute onset of an illness (minutes to hours) with involvement of the skin, mucoasal tissue, or both (e.g., generalized hives, pruritus and or flushing, swollen lips/tongue/uvula and at least one of the following: a.) respiratory compromise – dyspnea, wheeze-bronchospasm, stridor, reduced peakflow, hypoxemia b.) reduced blood pressure or associated symptoms of end-organ dysfunction – hypotonia, collapse, syncope, incontinence 2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours) a.) involvement of the skin and/or mucosal tissue b.) respiratory compromise (e.g., dyspn...

nurses f. cancer.

impactEDnurse — Sun, 24 Mar 2013 07:40:17 +0100

I’m sure your have seen the powerful slogan: F. Cancer. Well, I am going to tell you that our profession has the power to not only f. cancer, but to f. cardiovascular disease, f. chronic respiratory diseases and f. diabetes. Between them these four diseases are responsible for 60% of deaths worldwide. In low and middle-income countries they will kill 90% of their victims before the age of 60, and will inflict an added economic burden on those countries surpassing 7 Trillion dollars by 2025. Go back and read that again and think about it a little. As nurses we are immersed in the complex technological, physical, professional and ethical responses that are required to manage the impact (and the collateral damage) that they inflict. This is what we do. But each of us have the capacity t...

Circovirus in Shanghai

virology blog — Tue, 19 Mar 2013 18:22:47 +0100

Recently thousands of dead and decaying pigs were pulled from rivers in Shanghai and Jiaxing, China. Apparently farmers dumped the animals into the water after the pigs became ill. Porcine circovirus has been detected in the in pig carcasses and in the water. Porcine circoviruses are small, icosahedral viruses that were discovered in 1974 as contaminants of a porcine kidney cell line. They were later called circoviruses when their genome was found to be a circular, single-stranded DNA molecule. Upon entry into cells, the viral ssDNA genome enters the nucleus where it is made double-stranded by host enzymes. It is then transcribed by host RNA polymerase II to form mRNAs that are translated into viral proteins. There is some evidence that circoviruses might have evolved from a plant virus t...

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Women and the Treatment of Pain - NYTimes.com

Psychology of Pain — Mon, 18 Mar 2013 16:06:00 +0100

To the list of differences between men and women, we can add one more: the drug-dose gender gap. Doctors and researchers increasingly understand that there can be striking variations in the way men and women respond to drugs, many of which are tested almost exclusively on males. Early this year, for instance, the Food and Drug Administration announced that it was cutting in half theprescribed dose of Ambien for women, who remained drowsy for longer than men after taking the drug.Women have hormonal cycles, smaller organs, higher body fat composition — all of which are thought to play a role in how drugs affect our bodies. We also have basic differences in gene expression, which can make differences in the way we metabolize drugs. For example, men metabolize caffeine more quickl...

Reponses on Test Comparison Medical Journal Apps

DigiCMB — Mon, 18 Mar 2013 04:00:00 +0100

End of last week (March 15th 2013) was the official kick-off of our test and trial period for 4 different Journal Apps. See our LibGuides page on E-Journals. Comparison of (Medical) Journal Apps by Cmb Umcg I will try and post all relevant comments and responses to the test trial and the apps below in this post. In the end I want to create a kind of comparion chart/map/table and list a number of criteria. here are some criteria I am thinking off. If you have suggestions for additional criteria, please do not hesitate to contact me! Registration process User interface Performance Access to full text Pdf view + extra's Share options "Open In" other Apps Notifications Search options Platforms Support Some Responses Am I right that docwise and Read by QxMD do NOT hav...

PCA Morphine Dosage Protocol For Severe Pain Management In the Hospital.

The Happy Hospitalist — Mon, 18 Mar 2013 04:00:00 +0100

PCA morphine is a common method used to achieve pain control in the hospital setting. PCA stands for patient controlled analgesia. This therapy usually involves intravenous opiate therapy. Intravenous opiate management should be taken seriously by hospital nurses and doctors as too much medication can result in a life threatening iatrogenic drug overdose. In most situations, patients will respond rapidly to Narcan, the antidote in opiate overdoses. This complication happens everyday in the hospital, even during optimal monitoring conditions. Many foreseeable and unforeseeable variables are responsible. In fact, IV opiate management is even considered high risk drug management for physicians trying to calculate their medical decision making on their...

Receptor for new coronavirus-EMC identified

virology blog — Fri, 15 Mar 2013 01:42:28 +0100

Viruses are obligate intracellular parasites, which means that they must enter a cell to reproduce. As virions are too large to diffuse passively across the plasma membrane, cellular pathways for uptake of extracellular materials provide entry routes. The first step in entry is adherence of virus particles to the membrane, an interaction mediated by binding to one or more receptor molecules on the cell surface. Identification of cell receptors for viruses is an important objective because their study may lead to information about how the virus enters the cell, how it is targeted to specific tissues, and how it causes disease. The cell receptor for the recently identified coronavirus-EMC, which has so far infected 15 humans with 9 deaths, has been identified as dipeptidyl peptidase 4 (DPP4)...

Guest post from Ashley Bateman on "Full contact microbes" - Roller Derby

The Tree of Life — Tue, 12 Mar 2013 04:00:00 +0100

A special guest post from Ashley Bateman. Roller derby players share their skin microbes during play Single-celled organisms are intimately associated with multicellular organisms across the tree of life, and human beings are no exception. Making up 90% of our cellular composition, these invisible passengers (our microbiome) contribute to our health and well-being in crucial ways, including aiding our digestion, the education of our immune system, and resistance to pathogens. Despite this importance, we still lack a fundamental understanding of where our host-associated microbes actually come from. We know that infants are born practically sterile; early-life events such as birth mode can contribute to the types of microbial species found on an individual, but these events ...

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New Study of Electronic Cigarette Vapor Confirms that E-Cigs are Much Safer than Regular Cigarettes

The Rest of the Story: Tobacco News Analysis and Commentary — Mon, 11 Mar 2013 10:54:00 +0100

A new study of the chemical constituents of the vapor produced by 12 brands of electronic cigarettes reports that these products greatly reduce exposure to the harmful chemicals in tobacco cigarettes and that e-cigarettes therefore show promise as a harm reduction strategy for tobacco control.(See: Goniewicz ML, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control. Published online ahead of print on March 6, 2013. doi: 10.1136/tobaccocontrol-2012-050859.)In the study, levels of selected carbonyl compounds, volatile organic compounds, tobacco-specific nitrosamines, and metals were analyzed in the vapor of 12 brands of electronic cigarettes and compared to levels of the same compounds in a medicinal nicotine inhaler and in regular tobacco ...

It's the Most Horrible Time of the year, and other observations. . .

Head Nurse — Thu, 07 Mar 2013 05:00:00 +0100

The Festival That Cannot Be Pronounced has begun--well, technically is beginning--in Bigton. Littleton, where I live, is not unscathed by this yearly influx of techies, hipsters, and people who haven't seen soap in entirely too long. The traffic is horrible, my favorite beer store is out of my favorite beer, and the highways are full of people who, as they approach both downton Bigton and Sunnydale General, aren't quite sure where they're going. Hilarity, if you mean hilarity-in-a-natural-disaster-sense, often ensues.Luckily, I've been flat on my back since Monday. Why, you ask? Well, let me tell you:This past weekend, I flew to Seattle to attend the Emerald City Comic-Con. With me there were Tashi of Learning to Hope, Mary from The Bright Optimist, Lara of Get Up Swinging, and Nikki, late...

How to recognise paradoxical or reversed split of second heart sound ?

Dr.S.Venkatesan MD — Thu, 28 Feb 2013 16:44:39 +0100

Normal sequence of S2 split is A2 followed by P2. This split is heard only in inspiration . The split is due to pulmonary low vascular impedance and is represented by the hang out interval (40-80ms) . Inspiration transmits the low intra-pleural pressure into pulmonary vasculature and split widens. In expiration the reverse happens and split narrows.Normal human ear does not recognize the normal expiratory split. If the split S2 is well heard in expiration especially in sitting posture it is abnormal . What is paradoxical split of S 2? If split occurs and is well heard only in expiration and becomes single in inspiration , It is classical of paradoxical split. What is the paradox ? In physiological conditions S2 splitting occur during inspiration and become narrow or s...

New Smaller, Cheaper PCR Machine for Disease Diagnosis in Remote Parts of The World

Medgadget — Wed, 27 Feb 2013 18:51:30 +0100

Back in 2006, researchers at Caltech created a relatively small and cheap PCR machine that was commercialized as the Eco device and sold for $13,000. This was a breakthrough, allowing public health professionals to screen people effectively during a viral epidemic like that experienced from H5N1 bird flu.While cheap enough and not too big for diagnostic work at a hospital, the Eco was still too bulky to use in areas where proper clinics don’t exist and the device required a bit of professional expertise to operate. To help tame disease in the world’s remote areas, and allow PCR testing to be performed by just about anyone, the same team that developed the Eco has teamed up with Nobel Laureate David Baltimore to create a new PCR machine that is smaller, lighter, and operates a...

ALung Technologies Hemolung Respiratory Assist Device Cleared in Europe

Medgadget — Tue, 26 Feb 2013 16:45:39 +0100

Pittsburgh based ALung Technologies won the European CE Mark to begin introducing the Hemolung Respiratory Assist System (RAS). The device, intended for people suffering from acute lung failure, performs the essential duties of a lung, removing CO2 from blood and oxygenating it. The partial respiratory support takes the load off the organ and gives it a chance to heal.The procedure is similar to renal dialysis, with a venous catheter used to pass the blood to and from the Hemolung.Read More (Source: Medgadget)

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tests to consider in patients with encephalitis

neurologyminutiae — Sun, 24 Feb 2013 23:59:00 +0100

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EHR and Mobile Health News Around the Country

EMR and HIPAA — Sun, 24 Feb 2013 16:26:07 +0100

It may come as a surprise to some, but according to a study by eClinicalWorks, the majority of physicians like EMR-connected apps, and mHealth apps in general. 2,291 healthcare professionals were surveyed, and 649 were physicians. Over 90 percent of physicians feel it’s valuable to have their EMR connected to an app. The study also revealed other interesting things concerning physicians and medical apps. And EHR vendors may want to consider this when developing and updating their EHR. From the Black Book Rankings, here is a list of top EHR vendors among hospitals. I bet some of these ones definitely have. On a similar topic, there was a recent study about physican EMR use in the United States. Apparently, they are behind other countries. While usage has definitely increased recently...

The Smell of Multiple Sclerosis

Life with MS — Fri, 22 Feb 2013 21:50:08 +0100

Some people with multiple sclerosis smell. Some people with MS smell funny and others with MS don’t smell at all. With last week’s declaration that people living with multiple sclerosis were “crazy”, you might think this blog is to be some kind of an odiferous admonition. On the contrary; when I say that some people with MS “smell funny” or “don’t smell” I’m speaking of the ability to sense smells properly. The loss of smell or inability to smell properly is called anosmia. We know that MS can adversely affect the sense of taste and vision, hearing and all of the rest. It only makes sense that the sense of smell could be mucked-up by MS I have not experienced this sensory distortion I can only imagine how that could mess up one’s life. In fact, one study printed by ...

R&R in the FASTLANE 030

Life in the Fast Lane — Fri, 22 Feb 2013 00:00:26 +0100

The 30th edition of our series of eminence-based eminence is here… However, this one was compiled differently to the others — I challenged over 5,000 Twitter followers to tweet me the best or most useful EM/CC journal article they had read in the past year. Then I went away and read them, and these were the ones worthy of a place in the R&R pantheon (a number of other suggestions had already been included in previous R&Rs — every man and his dog wanted to vote for the Levitan and Weingart preoxygenation paper for instance!). Thanks to all who took part! A free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the pu...

Leaks

Buckeye Surgeon — Wed, 20 Feb 2013 05:00:00 +0100

This study is a retrospective review of over 70,000 low anterior resections, nationwide, from the years 2006-2009. Results The AL rate was 13.68%. The AL group had higher mortality vs the non-AL group (1.78% vs 0.74%). Hospital length of stay and cost were significantly higher in the AL group. Laparoscopic and open resections with a diverting stoma had a higher incidence of AL than those without a stoma (15.97% vs 13.25%). Multivariate analysis revealed that weight loss and malnutrition, fluid and electrolyte disorders, male sex, and stoma placement were associated with a higher risk of AL. The use of laparoscopy was associated with a lower risk of AL. Postoperative ileus, wound infection, respiratory/renal failure, urinary tract infection, pneumonia, deep vein thrombosis,...

The Nose Knows: Smell Disorders

Diabetes Self-Management — Tue, 19 Feb 2013 16:25:57 +0100

By Amy Campbell Some of my favorite smells are a Christmas tree, chocolate chip cookies baking in the oven, and freshly cut pumpkins at Halloween — I can't imagine not being able to smell these delightful things. But according to the National Institutes of Health, between 1% and 2% of people in North America say they have a smell disorder. About 25% of men age 60–69 and 11% of women in this same age range have difficulty being able to smell. Not being able to smell, either somewhat or at all, can be dangerous, as our noses alert us to smells that can signal danger, such as a fire, a gas leak, or spoiled food. It can also be a sign of a serious medical problem. How our sense of smell works We have special cells in our noses called olfactory sensory neurons. These cells are conn...

The LITFL Review 095

Life in the Fast Lane — Mon, 18 Feb 2013 07:21:02 +0100

Welcome to the challenging 95th edition! The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around. The Most Fair Dinkum Ripper Beaut of the Week emimdoc Top spot this week heads over to David at emimdoc with his post on A Note to Conference Organizers Everywhere. David highlights how FOAMed has changed the way we access and engage in conference’s and how conference organisers need to keep up with realms of ...

The Last Patient of a Long Night Shift

WhiteCoat's Call Room — Sun, 17 Feb 2013 16:41:10 +0100

By Birdstrike M.D. My first night shift in a stretch of 7 was almost over. It was 6:15 a.m. and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep. That never makes for a good drive home after a night shift. “Got time to see one more?” asked Jenny the nurse. “Do I have choice? The door-to-doctor time storm-troopers would have it no other way,” I grunted back, eye lids drifting closed. “Febrile seizure,” it said. Good, this should be quick and easy, I think to myself. We’ll give some Tylenol, reassess in 30 minutes and this baby will be happy, smiling and bouncing off the walls. That way I can get out of here at 7 a.m. and be home in bed with my eye blinders on drifting towards sweet REM sl...

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Post #34 Asthma: A Pedi Perspective - Part 2 of 5

A Pediatrician's Blog — Sat, 16 Feb 2013 12:21:00 +0100

Diagnosis is in the details Asthma is a disease that is diagnosed by history. In other words, one cannot make a diagnosis of asthma the very first time a child wheezes. It's like your friend who show up late to your home for dinner; it would be premature to label them "tardy" after one episode, but if they come late multiple dinners in a row, they are likely "tardy" friends. With every subsequent wheezing episode, the more likely these are not one time events but a sign that there is underlying asthma.If asthma is suspected, your child may be referred to a lung specialist for a series of pulmonary function tests - this is typically needed in the more severe cases while the milder cases can be handled by an experienced pediatrician. Not only will this confirm t...

Post #33 Asthma: A Pedi Perspective - Part 1 of 5

A Pediatrician's Blog — Sat, 16 Feb 2013 12:20:00 +0100

It's difficult to diagnose, can attack without warning, and unfortunately we don't know exactly what causes it.It's said to be the most common chronic medical problem in children, fortunately it's manageable with medication.Asthma is a lung disease that causes inflammation and narrowing of the airways, making it hard to breathe.While it affects people of all ages, it most often starts in childhood. According to the American Academy of Pediatrics, between 80 to 90 percent of people with asthma develop symptoms by the age of 4 or 5.Parents tend to worry at the first sign of a cough or wheeze, but in reality, a one-time episode is not indicative of asthma. That would be like labeling a friend of yours "tardy" just because she showed up late one time.Further coloring the diagnosis of asthma in...

R&R in the FASTLANE 029

Life in the Fast Lane — Fri, 15 Feb 2013 06:38:27 +0100

Having been away for a few months due to the distractions of SMACC, moving across a continent and an untold number of other side projects, our series of eminence-based evidence is back with the 29th edition: A free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 8 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world. This edition’s R&R Hall of Famer Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care. 2012 Oct 29;16(5):323. [Epub ahead of print] PubMed PMI...

Journal Alert: DEVELOPMENTAL PSYCHOLOGY

Intelligent Insights on Intelligence Theories and Tests (aka IQ's Corner) — Thu, 14 Feb 2013 17:27:00 +0100

We examined the > validity of the ECERS-R using the multidimensional Rasch partial credit > model (PCM), factor analyses, and regression analyses with data from the > Early Childhood Longitudinal Study Birth Cohort. The PCM identified > rating category disordering, indicating previously unrecognized problems > with the scale's response process validity. Factor analyses identified > neither a single factor nor the ECERS-R six subscales, replicating prior > research regarding the scale's structural validity. Criterion validity > results were mixed, with small effect sizes for regressions predicting > child outcomes and moderate effect sizes for regressions predicting > teacher-reported quality. Our results lend empirical support to recent > critiques ...

Acute Pulmonary Edema, Respiratory Failure, and LBBB

Dr. Smith's ECG Blog — Wed, 13 Feb 2013 05:00:00 +0100

A man in his 70's called 911. When medics arrived, he was in extremis with respiratory failure, able only to say he has a history of CHF. He arrived in the ED and had pink frothy sputum, was intubated, and had the following ECG:There is sinus tach with left bundle branch block (LBBB). There is excessively discordant ST elevation in leads V1 and V2. The highest ST/S ratio is in V1, with a ratio of 8/30 = 0.27, highly suggestive of LAD occlusion. In our study of coronary occlusion in LBBB, we excluded patients with severe hypertension, extreme tachycardia, respiratory failure and pulmonary edema for 2 reasons: 1) they often have false positive ECGs and 2) they need critical care in any case, with or without angiography. So, although this patient h...

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2012: Banner Year for New Drugs

Highlight HEALTH — Wed, 13 Feb 2013 02:36:13 +0100

Fueled by new cancer therapeutics, last year the annual new molecular and biological entity approval count from the U.S. Food and Drug Administration (FDA) saw its highest year since 1997. One-third of the novel products approved by the FDA’s Center for Drug Evaluation and Research (CDER) are used to treat cancers of the blood, breast, colon, prostate, skin and thyroid. As part of the U.S. Food and Drug Administration (FDA), the Center for Drug Evaluation and Research (CDER) promotes and protects the health of Americans by assuring that all prescription and over-the-counter drugs are safe and effective. The CDER evaluates all new over-the-counter and prescription drugs, including biological therapeutics and generic drugs, before they are sold. The 39 novel approvals for 2012 en...

Shire to Forest on Deal List for AstraZeneca: Real M&A - Bloomberg

PharmaGossip — Tue, 12 Feb 2013 05:00:00 +0100

For AstraZeneca Plc to reverse its worst profit slide, the drugmaker needs to make its biggest purchase since at least 2007. AstraZeneca reported a 37 percent drop in 2012 earnings and forecast profit this year will decline “significantly more than revenue” after the $59 billion company suffered setbacks in developing new therapies to replace best-selling drugs that are losing patent protection. While Chief Executive Officer Pascal Soriot said he will focus on internal efforts and purchases of $3 billion to $4 billion to help boost the lowest valuations in the industry, Exane BNP Paribas said only a “transformational deal” can return the company to growth. Enlarge image Shire to Forest Lead Deal List to Salvage AstraZeneca JB Re...

U.S. Military’s BioZen App Helps Monitor Multiple Biofeedback Sensors

Medgadget — Mon, 11 Feb 2013 19:51:49 +0100

The U.S. Department of Defense has released a new free Android app that helps integrate and show live data coming from multiple wireless body sensors. The system works with compatible sensors that perform electroencephalography, electromyography, galvanic skin response, electrocardiography, respiratory rate, and skin temperature monitoring including NeuroSky’s EEG’s, Shimmer2R, BrainAthlete, and BioHarness BT devices. From the app info page:BioZen can display several brain wave bands (Delta, Theta, Alpha, Beta, and Gamma) separately, as well as combinations of several bands using algorithms that may indicate relevant cognitive states, such as meditation and attention. BioZen features a meditation module that represents biometric information with user-selectable graphics that c...

Three New Drugs for Type 2 Diabetes Approved

Diabetes Self-Management — Fri, 08 Feb 2013 19:38:47 +0100

By Diane Fennell On January 26, pharmaceutical manufacturer Takeda announced the approval of its Type 2 diabetes drug, Nesina (generic name alogliptin) by the US Food and Drug Administration (FDA). It is the fourth drug in a class of medicines known as DPP-4 inhibitors, joining Januvia (saxagliptin), Onglyza (sitagliptin), and Tradjenta (linagliptin). Approved simultaneously with Nesina were the drugs Kazano (alogliptin and metformin) and Oseni (alogliptin and pioglitazone [brand name Actos]). DPP-4 inhibitors work to lower blood glucose by blocking the action of an enzyme known as dipeptidyl peptidase 4, or DPP-4. DPP-4 breaks down hormones called incretins, which stimulate the release of insulin, slow stomach emptying, inhibit the release of glucagon (a hormone that signals the liver ...

Evidence based chaos in critical care units !

Dr.S.Venkatesan MD — Fri, 08 Feb 2013 04:53:12 +0100

Critical and intensive medical care is meant for supporting an individual organ (or multiple organs ) at times of extreme distress , till the healing process prevails over .Later , the patient shall be shifted safely out of the unit . Whatever be the modern technology , the single most important factor that determines the success of ICU outcome lies within the patient body ( One estimate says patient factor constitutes almost 85-90% -Dukes medical center ) Ironically , the modern gadgets, drugs , devices threatens . . . rather fights . . . with this inherent patient fighting mechanism . We will ever know how many cellular switches are turned on by our biological high command , that compensates and tries to restore body homeostasis. Here is...

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Gray Days

The D-Log Cabin — Thu, 07 Feb 2013 05:00:00 +0100

It's been a rough 1.2 weeks. Begun,of course, with a sore throat & a mild cough,moved to the runny nose, followed by the 101 degree fevers & the addition of some hard core throat pain, losing my taste on Super Bowl Sunday,(I did not go to the party & how sad is that,when the whole of Baltimore was stark Raven mad?Methinks it may never happen again ) The cough set in & Sunday night I probably got two hours of sleep. Monday I went to the doc & they gave me codeine syrup & an antibiotic for my "sinus infection." Sinus infection-really? Yep,within a day my head felt like a literal bomb & the discharge turned a disgusting color. Fever went away,the cough/pressure/pain continued. I don't know if it's a particular nasty bug,or a side effect of the codeine but then came the retching diaries. Cough...

Most adults vulnerable to vaccine-preventable diseases

Consumer Reports Health Blog — Wed, 30 Jan 2013 19:00:00 +0100

Vaccines aren't just for kids. There are nearly a dozen recommended vaccines besides flu shots for grownups age 19 and older to protect against preventable diseases, such as pneumococcal disease, whooping cough, and shingles. But most adults aren't getting their recommended vaccinations, according to the Centers for Disease Control and Prevention. The CDC analyzed data for select vaccines (excluding influenza) from the National Health Interview Survey. The results indicate there has been little improvement in adult vaccinations in 2011 compared with 2010. There have been only modest gains in women age 19 to 26 getting the human papillomavirus vaccine, and among adults overall getting the Tdap vaccine, which protects against tetanus, diphtheria and pertussis (whooping cough). The findings...

DCD, dicyandiamide, 2-cyanoguanidine

Sciencebase Science Blog — Wed, 30 Jan 2013 08:17:16 +0100

2-Cyanoguanidine, also known as DCD (dicyandiamide) is a nitrile derived from guanidine used as a curative agent for epoxy resins in packaging. Since 2004, it has been used in New Zealand by farmers hoping to lower the environmental impact of livestock by reducing the rate at which soil microbes convert ammonia from animal urine into nitrates and nitrous oxide, thus slowing nitrate leaching from pasture. DCD recently hit the headlines when traces were found in milk. Although the authorities said of the Westland Milk Products example that it did not represent a health risk to consumers, there are echoes of the melamine debacle I first discussed on Sciencebase back in September 2008; manufacturers have withdrawn DCD products from the agricultural market. Direct exposure to DCD powder may cau...

In oncology, hoofbeats are nearly always from zebras

Kevin, M.D. - Medical Weblog — Wed, 30 Jan 2013 00:00:39 +0100

It happened again today. A youngish man, age 59 (youth being relative these days) comes in for a consultation. His history began eighteen months ago when he started to notice hoarseness. Thinking he had laryngitis, he saw his primary care doctor. He was indeed diagnosed with laryngitis despite the fact that he had not been shouting for his grandson at the local soccer playoffs, nor had he had upper respiratory symptoms such as a snotty nose or a cough or a fever. He was treated with antibiotics, and did not improve.Continue reading ... Read KevinMD's book: Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. (Source: Kevin, M.D. - Medical Weblog)

The LITFL Review 093

Life in the Fast Lane — Tue, 29 Jan 2013 02:55:28 +0100

Welcome to the awesome 93rd edition! The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around. The Most Fair Dinkum Ripper Beaut of the Week boringem Top spot is taken out by boringem with a great review on Palliative Care in the ED and how to use a 4 step approach to managing the terminally ill patient. Critical care resuscitation is something we all love to do every shift, however when that level of care isn’t...

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Problem is Not that Electronic Cigarette Companies are Making False Claims; Problem is that Anti-Smoking and Health Groups Are

The Rest of the Story: Tobacco News Analysis and Commentary — Mon, 28 Jan 2013 12:53:00 +0100

Many anti-smoking groups and advocates have expressed grave concern that electronic cigarette companies are widely misleading the public about the scientific truths regarding these products. Accordingly, they have called for strict regulation of these claims, with some groups calling for prohibition of these statements. For example, Stan Glantz on his blog last week expressed concern about "false advertising" claims being made by electronic cigarette companies. According to Glantz and others, electronic cigarette companies are falsely claiming that their products may be helpful in smoking cessation, and immediate measures are necessary to protect the public from this false advertising.Since there is in fact strong evidence that electronic cigarettes may be useful in smoking cessation, thes...

Healthcare Update — 01-28-2013

WhiteCoat's Call Room — Mon, 28 Jan 2013 10:00:20 +0100

You can keep your doctor and your insurance … if you can afford it. Some insurance brokers expect health insurance premiums to triple in the fall prior to full implementation of Obamacare. Oh, and if you can’t afford that insurance, plan to pay a punitive tax. But don’t worry, Mississippi Gov. Phil Bryant thinks that everything is fine now. Everyone in America has health care. All they have to do is go to the emergency room. Once no one can afford private insurance due to premium hikes, then government funding cuts can affect essential hospital services – like what is happening in Australia. Should smokers and obese patients be left to their own vices? Is increasing their insurance premiums an additional 50% above regular policy premiums under Obamacare enough? How do you get c...

Balancing Honesty and Optimism with Critical Care Patients

Lab Soft News — Fri, 25 Jan 2013 20:17:22 +0100

I have a high degree of respect for critical care physicians who are constantly on the spot to make key life-and-death decisions for their patients. A recent article discussed how physicians in general, and intensivists in particular, need to balance honesty and optimism in their interactions with sick patients and their families (see: Balancing honesty and optimism in critical care). Below is an excerpt from the note: A recent little essay entitled “Do patients bond best with doctors who misinform them with optimism” got me thinking about balancing honesty and optimism in practicing any medical specialty in which patients not infrequently die. Tragic things can happen in the pediatric intensive care unit. Anyone who works there — doctors, nurses, respiratory therapists, and ma...

EMS Assessment of Newborns

The EMT Spot — Thu, 24 Jan 2013 17:36:29 +0100

Babies make us nervous. It’s a simple fact. And it’s nothing to be embarrassed about. Assessment and evaluation of the newborn infant is the patient assessment equivalent of a high-wire act. The stakes are high and it’s easy to make a mistake. Obstetricians and pediatricians spend years learning how to properly assess the neonatal patient. Even with their training and experience, proper evaluation of a newborn remains remarkably difficult. They are not simple little adults.They are a unique and challenging patient population. Here are some tips and thoughts to consider the next time you are called to assess a newborn infant in the prehospital environment. Hopefully these clinical pearls will help make the next newborn evaluation a little less intimidating. 1) Take a goo...

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Slow motion sneezing

virology blog — Wed, 23 Jan 2013 15:59:47 +0100

A bit unsettling, but this is what happens when a sneeze is not contained: If you have a respiratory viral infection, each drop expelled can contain tens of thousands of infectious virions. Made by South Australian Health. (Source: virology blog)

Should I take Tamiflu to treat the flu?

Consumer Reports Health Blog — Wed, 23 Jan 2013 15:15:09 +0100

Not unless you're very sick with the flu or you're sick from it and vulnerable to complications because you're hospitalized, pregnant, 65 or older, have asthma, or are otherwise at high risk. "Tamiflu is a tricky topic. People have an unrealistic idea about what this drug can do," says Beverly Schaefer, RPh, pharmacist and co-owner of Katterman's Sand Point Pharmacy in Seattle. Tamiflu (oseltamivir) and another prescription drug called Relenza (zanamivir) are approved by the Food and Drug Administration to treat the flu. Unlike flu drugs you can buy without a prescription, Tamiflu and Relenza don't just treat flu symptoms but can shorten how long you have the illness, by inhibiting the growth of the virus. And they can reduce the risk of complications such as pneumonia and respiratory fai...

More Joys of Electronic Medical Records

WhiteCoat's Call Room — Tue, 22 Jan 2013 21:00:39 +0100

Go up to your favorite emergency department staff member and ask them what they think of “twofers.” Depending on that person’s mood, chances are that you’ll get anything from a scowl to a punch in the gut in response. Two patients from the same family both needing emergent medical care at the exact same time? It still happens … car accidents, fires, maybe a stomach bug. But it can be frustrating. There’s a saying in emergency medicine that the likelihood of a true emergency is inversely proportional to the number of patients in the family registering to be seen. That being said, a “fivefer” will raise the hairs on the back of the neck of pretty much any emergency department personnel. When the complaint is that everyone in the family has a co...

European CME Standards Evolving but Fragmented

Policy and Medicine — Mon, 21 Jan 2013 05:00:00 +0100

Discussion is needed as to which system would be best for Europe. Furthermore, is a uniform system in Europe possible? Just among the EU we have 27 countries with different codes of practice as well as health systems, so a completely different situation to the US.” In concluding the interview, Thalmann noted that in Europe, there is a great need for “more cooperation and guidance on educational programs and topics from the Medical Societies,” particularly in reference to commercial support. She added that Medical Societies should review more educational programs and could ask the industry to cover topics that are important. There needs to be “new approaches between Medical Societies, accreditation bodies and the industry to ensure that all medical programs are meeting the high...

Does the Flu Vaccine Work? What 62% "Effective" Really Means

Pharma Marketing Blog — Fri, 18 Jan 2013 18:22:00 +0100

JAMA has posted today a Viewpoint titled “Influenza Prevention Update: Examining Common Arguments Against Influenza Vaccination.”In this Viewpoint, the authors (from the Vanderbilt University School of Medicine) provide perspective to some of the reasons why people refuse the flu vaccination, including:The vaccine does not workThe vaccine causes the fluI have an allergy to eggsI cannot get the vaccine because I am pregnant or have an underlying medical condition or because I live with an immunocompromised person.I never get the flu/I am healthy I was disappointed when Dr. LaPook on a recent CBS Evening News program said that this year's Flu vaccine was 62% effective in preventing the flu. First of all, I would have liked it to be 100% effective in preventing the flu. And I'm prett...

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Effectiveness of this season’s influenza vaccine

virology blog — Fri, 18 Jan 2013 15:23:57 +0100

The Centers for Disease Control and Prevention has released early estimates of the effectiveness of this season’s influenza vaccine in preventing influenza infection. Influenza vaccine effectiveness is assessed each year by the U.S. Influenza Vaccine Effectiveness Network. Patients with acute respiratory infection (ARI) are enrolled in the study; respiratory samples are taken and the presence of influenza virus is determined by polymerase chain reaction. Data from 1,155 children and adults with ARI during December 3, 2012–January 2, 2013 were collected at five study sites and used to determine that the estimated vaccine effectiveness is 62% (95% confidence intervals = 51%–71%). This number represents the overall effectiveness of seasonal influenza vaccine for preventing laborato...

2003 Canberra Firestorm remembered.

impactEDnurse — Thu, 17 Jan 2013 22:22:03 +0100

Today is the 10th anniversary of the Canberra Firestorm. On Saturday 18th January 2003 a freak and devastating firestorm tore through our city. 4 people died and over 500 homes were destroyed. It resulted in the 2nd largest single hospital disaster response in Australian history. I was working that day. 2 days later I wrote this story. ———————————————————————– the firestorm. It was bloody horribly awesome. Peeking out of the small window in the resuscitation room, it seemed the world had been dipped in a bucket of hell. Gale force winds whipped at trees beneath a swirling black sky. Pressing my face against the glass I could see over towards Weston...

Should I get the flu shot if I already got sick with the bug this year?

Consumer Reports Health Blog — Thu, 17 Jan 2013 14:30:00 +0100

Yes, for several reasons. First, unless you were tested for the flu virus it's possible that your symptoms actually stemmed from the common cold, sinusitis, or some other respiratory illness. And even if you're certain you had the flu, this season's vaccine protects against three strains of the virus. So getting vaccinated lowers your risk of getting sick from the other two strains. You can even get the flu shot while you have symptoms of a respiratory illness, as long as you don't have a fever. If you do have a temperature, talk to your doctor or nurse about scheduling the vaccine for a later date. And see our advice on how to treat flu symptoms, as well as our reviews of thermometers. It's also important to get vaccinated if you got the shot in a prior year, since the virus often dif...

CDC Reports Flu Widespread, Google Search Trends Alarming

Highlight HEALTH — Tue, 15 Jan 2013 05:57:52 +0100

According to new surveillance statistics released on Friday from the Centers for Disease Control and Prevention (CDC), forty-seven states in the U.S. are now reporting widespread influenza activity [1]. The virus, which first appeared in the Southeast, has reached epidemic levels. Forty-seven states have reported widespread geographic influenza activity (i.e. incidence of flu) for the week between December 30, 2012 and January 5, 2013, and twenty-four states and New York City have reported high influenza-like illness (ILI) activity (i.e. the proportion of outpatient visits to healthcare providers for influenza-like illness; see map above) [2]. Earlier this month, Dr. Joe Bresee, Chief of the Epidemiology and Prevention Branch in CDC’s Influenza Division, said that “reports ...

Did you get the flu or get the vaccine this year?

Happy Nutritionist's Nuggets — Sun, 13 Jan 2013 04:39:00 +0100

They say the flu is now at epidemic proportions, as it is widespread in almost every state in the United States. So far it has not touched our family, but it could be very serious if it did, as my husband has heart issues.It was the flu he had a few years back (even though he had a flu shot) that put his heart out of rhythm again, and it's been that way since. He is also a Diabetic. Each year he has the flu shot because he has heart issues and Diabetes, while I tend to put it off. Though there is not a 100% guarantee that you won't get the flu if you have the shot, it does reduce the likelihood depending upon the strain of flu that is going around.I work from home, and am not one to spend a lot of time in large crowds, so don't feel the urgency...but am considering having it done when I g...

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Friday flu shot

virology blog — Fri, 11 Jan 2013 22:28:00 +0100

Yesterday many US newspapers carried front-page stories on the severity of influenza so far this season. The New York Times story began with “It is not your imagination — more people you know are sick this winter, even people who have had flu shots.” Is this really a bad flu season? Before we answer that question, I would like to complain about what the Times wrote: ‘more people you know are sick this winter, even people who have had flu shots”. A similar sentiment appeared in a recent Forbes column “Influenza-like-illness is sweeping the country with the Centers for Disease Control & Prevention reporting that most areas of the country experiencing high rates. I should know, my family is in the midst of it despite having been vaccinated.” Remem...

Surprising Factors Affecting Eating and Weight Gain

Normal Eating — Fri, 11 Jan 2013 05:00:00 +0100

For those of you who are down on yourselves because you can’t lose weight, please realize the complexity of the issue. Forget will power and self-discipline, calories in and energy out. The truth is, many factors affect our eating and size. Out of body experiences by Julie Deardorff (Sarasota Herald Tribune, Health and Fitness, 10/30/12) provides the lowdown on how our weight is affected by environment. I guarantee that on your own you’d never have imagined that some of these factors would impact your weight, so three cheers for scientific studies. Pregnant women who breathe high levels of diesel fuels/hydrocarbons are more likely to have obese children than those who don’t. These chemicals can be found outdoors, but are also in “cigarette smoke, candles...

Does Second Hand Smoke Cause Dementia?

Alzheimer's Reading Room, The — Thu, 10 Jan 2013 05:00:00 +0100

According to study authors, a signiﬁcant association between environmental tobacco smoke exposure (second hand smoke) and severe dementia syndromes was found. Alzheimer's Reading Room Second Hand Smoke Environmental tobacco smoke (ETS) is known to be harmful. Could second hand smoke be a cause of dementia? In the study described below the authors found that the risk of dementia increases with exposure to environmental tobacco smoke. The issues: Should cigarette and cigar smoking be banned in public areas? Would the reduction of environmental tobacco smoke reduce the incidence of dementia? Subscribe to the Alzheimer's Reading Room Email: Passive smoking link to dementia Passive smoking increases risk of severe dementia, according to study An international study by...

Fisher-Price recalls Rock 'N Play infant sleepers due to mold risk

Consumer Reports Health Blog — Tue, 08 Jan 2013 20:00:00 +0100

Fisher-Price Inc., of East Aurora, N.Y., has "recalled to inspect" 800,000 Newborn Rock 'n Play Sleepers for mold that can develop between the seat cushion and frame when it remains moist or is infrequently cleaned. The recall was announced today by the Consumer Product Safety Commission. Fisher-Price received 600 reports of mold on the product, and 16 consumers have reported that their infants were treated for respiratory issues, coughs, and hives after sleeping in the product. The recall is being done to ask owners to inspect the Rock N' Play infant recliners for mold. If you own one of the recalled sleepers, check for mold under the seat cushion. Dark brown, gray, or black spots can indicate the presence of mold. If you find mold, call Fisher-Price for cleaning instructions and furt...

West Springfield Board of Health Considering Banning the Sale of Electronic Cigarettes, But Keeping the Real Ones

The Rest of the Story: Tobacco News Analysis and Commentary — Tue, 08 Jan 2013 12:57:00 +0100

According to an article in the Springfield Republican, the West Springfield Board of Health is considering a regulation that would ban the sale of electronic cigarettes in the town. Unlike laws in other cities which ban the sale of electronic cigarettes to minors, this proposed regulation would ban all sales of electronic cigarettes in the town. Such sales would be allowed only if and when the FDA officially "approves" these products. If the Board of Health enacts this regulation, West Springfield would become the first locality in the U.S. to ban the sale of electronic cigarettes.Although the draft regulation mentions only a ban on the sale of electronic cigarettes to minors, a letter from the Director of Public Health to tobacco sellers refers to an outright "ban on the sale of e-cigaret...

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Serious Allegations against HPV Vaccine Trials Affecting Thousands of Girls Accepted by Supreme Court of India

vactruth.com — Tue, 08 Jan 2013 05:22:01 +0100

CONCLUSION There has been no evidence to suggest that any of the above crucial issues were ever considered by any of the organizations involved in these vaccination trials. Time and again, according to the petition, PATH has denied that it carried out a trial in India. It insists that what it was doing was merely a post-licensure study. This explanation was unacceptable to the Indian government’s inquiry. It concluded that by whatever name PATH chooses to call its exercise, under the Indian Drugs and Cosmetics Act, it was indeed a clinical trial and all safeguards should have been observed. Yet PATH and WHO have hailed the trial a resounding success in order to carry on vaccinating other vulnerable communities in the third world with dangerous, potentially life-threatening vaccines. Unde...

China Chops

PharmaGossip — Tue, 08 Jan 2013 05:00:00 +0100

China to Cut Prices of More Than 400 Drugs by Average 15% China will cut the maximum retail prices of more than 400 varieties of drugs by an average 15 percent, including products from Pfizer Inc. (PFE), Novartis AG (NOVN) and Merck & Co. (MRK), to reduce health-care costs in the nation. The changes, effective Feb. 1, will cover drugs used for respiratory diseases and pain relief, as well as other specialized medicines, the National Development and Reform Commission said in a statement on its website. This is the fourth set of state-mandated price adjustments since 2011, with earlier cuts for drugs including antibiotics, vaccines and cancer medicines, the NDRC said. The government wants to reduce medical costs for China’s aging population, through means such as requiring hospitals der...

Gifts Given And Taken Away

In My Humble Opinion — Tue, 08 Jan 2013 05:00:00 +0100

It was a striking piece of porcelain. I admired the craftsmanship, and turned it in my hands as if the rotation could recreate the expertise of the potter's wheel. I gently placed it back on the desk, and looked up at the women sitting on the exam table. She wanted to thank me for saving her husband's life. I averted my eyes towards the floor and blushingly scolded her. But we both knew it was a half hearted attempt. We both knew that I indeed had saved his life after a series of miscalculations by other physicians. And I couldn't help but think of other offerings proffered by those who entrusted their care to me. The various trinkets and bobbles during holidays, at the end of a long journey, or just ...

Answer to Case 240

Creepy Dreadful Wonderful Parasites — Mon, 07 Jan 2013 03:28:00 +0100

Identification: Detached ciliary tufts from bronchial epithelial cells, also know by the fun-to-pronounce name "ciliophthoria". Everyone who wrote in correctly realized that these are NOT ciliated parasite in the respiratory tract - although they are a common parasite mimic. On wet-preps of unfixed specimens, the cilia may still be beating and therefore they are definitely eye-catching! (Source: Creepy Dreadful Wonderful Parasites)

Pneumonia

Life in Manch Vegas — Sun, 06 Jan 2013 17:39:00 +0100

Not me!! Peyton, my beloved little grand-daughter, spent four days as an inpatient at the Elliot Hospital in Manchester being treated for what turned out to be a rather vicious episode. She actually staeted getting sick about 10 days ago with a cough and sniffles. It blossomed from there into fever then chest congestion that would not clear. The fever also refused to go, and that was the laat straw. Chest x-rays confirmed the presence of infiltration on both lungs. Combine that with the fever and dehydration (regardless of how much we forced fluids she was in defecit) it bought her a 5 day hospital stay. Fast forward to today. She is being discharged as I write this. She is definitely doing better, albeit a little bit cranky. She ...

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Doctors Prescribe, Pharmacists Dispense, Patients Suffer

Malaysian Medical Resources — Fri, 04 Jan 2013 09:43:41 +0100

Spotted in LKS’ blog by Product Of The System Real Life Scenario Madam Ong is a 52-year-old lady with a twelve-year-history of hypertension and diabetes. She complained of generalised lethargy, lower limb weakness, swelling and pain. She brought along her cocktail of medications for my scrutiny. Her regular medications included the oral antidiabetics metformin and glicazide and the antihypertensives amlodipine and irbesatan. Madam Ong also had a few episodes of joint pains three months ago for which she had seen two other different doctors. The first doctor suspected rheumatoid arthritis and started her on a short course of the potent steroid prednisolone. Thereafter, she developed increasing lower limb swelling for which a third doctor prescribed the powerful diuretic frusemide. Mad...

Biogen And ALS Patients Lose As A Key Trial Fails

Pharmalot — Thu, 03 Jan 2013 14:26:26 +0100

In a blow to both a high-flying biotech and the relatively few patients with Lou Gehrig’s disease, a Phase III clinical trial being run by Biogen Idec showed that its dexpramipexole for treating amyotrophic lateral sclerosis failed to demonstrate any efficacy in improving either function or survival. As a result, further study is being discontinued, a move that also disappointed investors, who sent Biogen (BIIB) shares down 6 percent in early trading. The failure comes almost exactly a year after Biogen ceo George Scangos told an investor conference the drug “is far from a long shot.” His declaration (back story) helped propel Biogen stock more than 30 percent since then (here is the Biogen statement about the failed trial). ALS, which is also named for the famous New Yor...

Cardiac fucntional capacity :Do not under estimate the value of 6 minute walk test

Dr.S.Venkatesan MD — Mon, 31 Dec 2012 18:28:49 +0100

6 minute walk test is the simplest of all functional testing in cardiac evaluation . Though walking is a routine day to day motion it is essentially a hemodynamic stress for the heart especially so for an ailing heart .Even though it appears simplest of all investigation there are strict guideline available for performing this . It is surprising American thoracic society has come out specific with a guideline for this .Many of us are not aware of existence of such guidelines , hence this post with courtesy of ATS aim giving a link Guyatt G. H.,Sullivan M. J.,Thompson P. J.,(1985) The six-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can. Med. Assoc. J. 132:919–923. Butland R. J. A.,Pang J....

Cardiac functional capacity :Do not under-estimate the value of 6 minute walk test !

Dr.S.Venkatesan MD — Mon, 31 Dec 2012 18:28:49 +0100

6 minute walk test is the simplest of all functional testing in cardiac evaluation . Though walking is a routine day to day motion , it is essentially a hemo-dynamic stress for the heart , especially so for an ailing heart . Even though it appears simplest of all investigation there are strict guidelines available for performing this . It is surprising American thoracic society has come out with a specific guideline for this .Many of us are not aware of existence of such guideline , hence this post , with courtesy of ATS I am giving a link. Guyatt G. H.,Sullivan M. J.,Thompson P. J.,(1985) The six-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can. Med. Assoc. J. 132:919–923. Butland R....

Healthcare.gov, EMR Switch, and Flu and RSV Detector: Around Healthcare Scene

EMR and HIPAA — Mon, 31 Dec 2012 06:22:36 +0100

It was a quiet week around Healthcare Scene, but here are a few of the posts that did get posted. Hope everyone had a wonderful holiday, and this new year will be the best yet! EMR and EHR 11 Reasons Why Healthcare is So Screwed Up This list was initially created by GetReferralMD and reposted on EMR and EHR. This post doesn’t go into details about each of the reason, but it provides some interesting food for thought. Some of the reasons on the list include insurance companies, ignorance, and McDonalds. With the upcoming new year, it’s the perfect time for resolutions to be made, and some of these issues to be addressed. Healthcare.gov This government-run website has recently been revamped, and now offers a lot more features. It has an obvious mission — to convince every...

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Study Shows This Amazingly Simple Act Reduces 2 Leading Childhood Diseases by 50% or More!

vactruth.com — Sat, 29 Dec 2012 06:11:39 +0100

Conclusion What’s the moral of the story? The data revealed by Stephen P. Luby in the Karachi Health Soap Study is nothing short of spectacular. Children who washed their hands and skin with plain soap had 52% less diarrhea and 50% less pneumonia. Good hygiene has a significant impact on decreasing disease, and I think it is something we take for granted in the United States. Please remember this point: If better nutrition and sanitation were added as components of this or a future study, I suspect that Karachi, Pakistan, would see a more dramatic drop in diseases, much like in the United States—and I would highly encourage such efforts. Just imagine the implications of a comparative study being performed between hygiene practices and vaccines for decreasing disease. What do you think ...

Why are physicians burning out? Too many emotional extremes

Kevin, M.D. - Medical Weblog — Fri, 28 Dec 2012 12:00:12 +0100

1,742 Reports of Adverse Events After Children Received This Vaccine

vactruth.com — Thu, 27 Dec 2012 05:32:16 +0100

CONCLUSION These adverse events were being reported as far back as 2009. So, why are these two vaccines still being recommended for babies as young as 6 weeks old? Surely, the most sensible and responsible action would be for the manufacturers GlaxoSmithKline and Pfizer to suspend the use of these vaccines until their use can be shown to be reliable, effective, and safe. Instead, this information is being hidden from the public. Furthermore, the mainstream media is so quiet you could hear a pin drop. Dr. Rebecca Carley, an expert specializing vaccine-induced diseases syndromes, has often stated on her radio shows that vaccinations are the ‘True Weapons of Mass Destruction,” and the evidence contained in these leaked, confidential documents shows she could be right. Acknowledgemen...

ICU Admission Ominous Sign for George H. W. Bush?

Inside Surgery — Thu, 27 Dec 2012 02:53:22 +0100

Although none of the editors of InsideSurgery are treating former President George H. W. Bush, we are following with interest news reports of his recent medical stays in a Houston hospital and today’s announcement that President Bush has been transferred to an ICU for “complications.” What is wrong with President Bush? World class medical care is available in Houston and one presumes that President Bush is being treated by the top docs that are available. One also presumes that these physicians know full-well that critical care outcomes are not improved for patients if they are admitted for a diagnosis that falls outside of a well-described list of parameters such as sepsis, bleeding, hypotension, respiratory decline, or and impending condition involving theses. etc. A &...

It’s only Bird Spit!

Malaysian Medical Resources — Thu, 27 Dec 2012 01:00:25 +0100

The Malay Mail featured an item called Health values in delicacy The main ingredient in bird’s nest of the popular Chinese dish is the saliva of the male sea swiftlet. It is widely believed that the bird’s nest helps in beauty care and improve skin complexion. The delicacy is said to enhance the body’s immune system through cell division caused by the water-soluble glyco-protein and helps to heal illness among others, connected with the respiratory system such as chronic cough, asthma or throat infection. It can also reduce fatigue, strengthen body’s self-regulating actions, resistance to disease, and provide superior food supplement for pregnant women and after childbirth. Chemical analysis of edible bird’s nest reveals that the main constituents are about 6...

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The unsung heroes of modern medicine

Caroline's Breast Cancer Blog — Sat, 22 Dec 2012 14:06:00 +0100

This article made me remember them all. We shoudl take a moment to thank them all. (Source: Caroline's Breast Cancer Blog)

FOAM Procedure Video Database

Life in the Fast Lane — Fri, 21 Dec 2012 03:44:07 +0100

I know, I know – I’ve been told. “Nickson, why are you slacking off, there have been bugger all posts by you the last month or so.” Hey, I’ve been busy. First up, I’ve finally got around to putting a collection of FOAM videos of emergency medicine and critical care procedures from around the web online in one searchable database. The database lives on the LITFL Procedures page (down the bottom of the Education drop down menu on the LITFL website task bar). I’ve reproduced it here so you can have a play with it. SectionTitleKeyWordsAuthorLink airwayInserting an OPAOPA, oropharyngeal airway, ACLSemtfiretrainingVIDEO airwayInserting a NPANPA, nasopharyngeal airway, ACLSemtfiretrainingVIDEO airwaySuctioning the airwaySuctioni...

Acute Respiratory Distress Syndrome (ARDS)

Inside Surgery — Wed, 19 Dec 2012 00:37:40 +0100

Pathophysiology 1) final common pathway of acute-onset progressive lung tissue damage after injury or physiologic insult Predisposing factors – 2) sepsis 3) shock 4) infection 5) massive trauma 6) massive blood transfusion 7) near drowning 8) aspiration 9) fat embolism 10) heroin overdose 11) radiation exposure 12) DIC 13) bleomycin 14) paraquat Signs and Symptoms 1) hypoxemia 2) tachypnea 3) dyspnea 4) severe cases can result in lung fibrosis, respiratory insufficiency, and pulmonary hypertension Characteristic Test Findings Radiology – 1) bilateral diffuse infiltrates up to complete “white out” of lung fields on chest radiograph PFTs – 2) decreased lung compliance (“stiff lungs”) Ventilation status – 3) PaO2/FiO2 < 200 mm Hg (regardless of ...

On Liberty

Stayin' Alive — Mon, 17 Dec 2012 18:29:00 +0100

It's not exactly a revelation that you get a huge political advantage from attaching a label with positive associations to your cause. Rights, liberty, life, freedom,choice -- who could be against any of those? Respecting the right to bear arms gives us more liberty, more freedom, more choice, and we can defend our lives and our property. If you want to restrict that right, you want to take away my freedom. Obviously.What's wrong with this picture? I shouldn't even have to point it out, yet somehow our public discourse can't arrive at the obvious.People walking around with guns on their hips may feel that they have liberty and freedom, but they diminish the freedom of others. Who would dare to offend a belligerent character with a gun in his hand? Are the people of Newtown, and every other...

The "King of Pain" Recants - Pharmaceutical Paid Key Opinion Leader Admits It Was All "Misinformation"

Health Care Renewal — Mon, 17 Dec 2012 17:11:00 +0100

This article does not seem to be available online.)In 1986, at the age of 31, he co-wrote a seminal paper arguing that opioids could also be used in the much larger group of people without cancer who suffered chronic pain. The paper was based on just 38 cases and included several caveats. Nevertheless, it opened the door to much broader prescribing of the drugs for more common complaints such as nerve or back pain. Dr Portenoy also cited the statistic that less than 1% of opioid users became addicted.Today, even proponents of opioid use say that figure was wrong. 'It's obviously crazy to think that only 1% of the population is at risk for opioid addiction,' said Lynn Webster, president-elect of the American Academy of Pain Medicine, one of the publishers of the 1996 statement. '...

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The Boxer

WhiteCoat's Call Room — Fri, 14 Dec 2012 15:22:26 +0100

He used to be a boxer. Those days were long-gone, though. Now he was a shell of his former self. The hands that formerly knocked opponents to the mat were now contracted and full of arthritis. Dementia had taken away his ability to tell the stories about his career. Metastatic lung cancer ravaged his body. Multiple bed sores ate away at his sacrum and his heels. Repeated courses of treatment for his MRSA and other drug-resistant infections had caused him to get clostridium difficile colitis. The diarrhea made the bed sore on his sacrum even worse. Now he was in respiratory distress. Paramedics tried to intubate him, but his contractures prevented them from being able to properly position him. He wasn’t moving enough air to sustain life. The old man’s friend wasn’t quick enough to sav...

New Dutch Emergency Medicine Blog

Life in the Fast Lane — Fri, 14 Dec 2012 09:40:28 +0100

I’ve been lucky enough to be part of the inaugural pilot ‘Masterclass’ for Emergency Physicians in Holland this week. A group of 20-ish Emergency Physicians have been working through Cardiovascular and Respiratory Emergencies over the last 3 months and this culminated in an intensive 3 day residential course where we’ve been having case based discussions on esoteric ECG findings (De Winter t waves = another Dutch cardiology invention coming our way), forcing the candidates to adopt Pro/Con positions in hot topic debates and torturing them needlessly with ACEM exam SCE’s I’ve been really struck by everyone’s enthusiasm and by the level of the discussions we’ve been having. Emergency medicine is either non-existant or in its infancy in most of ...

You might want to play with this

Stayin' Alive — Thu, 13 Dec 2012 19:17:00 +0100

An on-line app from the Guardian that let's you look at death rates globally or regionally, by age, from various causes, in 1990 and 2010.Worldwide, heart disease and circulatory disease are by far the leading cause of death. No surprise there, but you might be surprised by the importance of chronic respiratory diseases in carrying off the old folks. Unintentional injuries -- falls -- aren't way up there in the rankings but they're pretty important. A broken hip is very often the beginning of the end.There have also been some big changes since 1990. HIV of course has jumped way up, while other communicable diseases have tended to go down in rank.Anyway, you get to visualize it all sorts of different ways -- try it, it's very informative. (Source: Stayin' Alive)

Improving outcomes: a strategy for cancer - second annual report 2012

Health Management Specialist Library — Wed, 12 Dec 2012 05:00:00 +0100

This report demonstrates that cancer survival rates are improving. Speaking at the Britain against Cancer Conference, Health Secretary Jeremy Hunt emphasised the need to reduce variation across England, so all areas reach the excellent standards of the best. He also pledged to make England among the best in Europe at tackling cancer, stroke, and heart, respiratory and liver disease. The report is published alongside a report of the first pilot survey of cancer survivors, in which people with specific cancers were asked about their quality of life after diagnosis. This report is aimed at commissioners, commissioning support units and providers to help them understand how to continuously improve after-care for cancer survivors. Improving outcomes report Survey report Infographic o...

Guest post on "The phone microbiome" from Georgia Barguil in Jack Gilbert's lab

The Tree of Life — Tue, 11 Dec 2012 05:00:00 +0100

In conclusion, there were more biological differences between shoes and phones than between the three geographical locations. Phones and shoes harbored microbiomes representing the environments they most often came into contact with. Phones were closely related to the skin and upper respiratory tract, and shoes reflected the bacteria found in soil and the environment. Although many of the groups found both in shoes and phones have pathogenic representatives, you should not be scared, as it does not mean that you are going to get sick. Most of the isolated, characterized and sequenced bacterial groups available in the sequence databases are the pathogenic ones, exactly because of their importance to human health by aiding in the diagnosing and treatment of diseases. Some of the “relative...

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New Study Confirms that Electronic Cigarettes are Much Safer than Real Ones, Suggests Minimal Risks of Secondhand Vapor

The Rest of the Story: Tobacco News Analysis and Commentary — Mon, 10 Dec 2012 12:50:00 +0100

This study confirms that electronic cigarette use is much safer than smoking and suggests that any health risks associated with passive exposure to electronic cigarette vapor are likely to be quite low.Further studies are necessary to better understand the exact effects that long-term inhalation of propylene glycol may have on the lung and to better characterize the exposure to formaldehyde that may occur from "active" or "passive" vaping. But there is no question that any risks associated with electronic cigarettes are dwarfed by those caused by smoking and secondhand smoke exposure. Thus, electronic cigarettes are a viable alternative to cigarettes that drastically reduce health risks.In my opinion, electronic cigarette companies which are claiming that use of their products reduces the ...

Influenza is on the rise

virology blog — Thu, 06 Dec 2012 14:12:23 +0100

December 2-8 is National Influenza Vaccination Week. It was established in 2005 by the Centers for Disease Control and Prevention to highlight the importance of continuing immunization throughout the holiday season. This year the push to immunize against flu comes as the disease has begun to increase substantially throughout the United States, as shown in the figure (click the figure for a larger version). During week 47, 812 of 5,342 (15.2%) of respiratory samples tested positive for influenza virus. Of those isolates that were subtyped, most were either H3N2 or an influenza B virus strain. The 2009 swine-origin H1N1 strain has only been found in one sample so far. Fortunately the H3N2 component of the influenza vaccine for 2012-13 is a good match for the circulating H3N2 strain. A subst...

Great ape protection act

virology blog — Tue, 04 Dec 2012 22:07:36 +0100

I received the following email today from Judith S. Bond, President of the Federation of American Societies for Experimental Biology (FASEB): Dear Colleague, We need your help to counter a serious threat to the humane use of animals in research. The Great Ape Protection and Cost Savings Act (S 810), which would prohibit the use of chimpanzees in medical research, may be voted on in the Senate this week (it was approved by a Senate committee in July)! Passage of this bill could have devastating consequences for ongoing research into human diseases such as hepatitis C, as well as studies benefiting the great apes themselves. Even if you do not work with great apes, you should be concerned about this bill because it would end research deemed by the Institute of Medicine (IOM) to be ethically ...

D.C. District Court Approves Corrective Statements for Cigarette Companies; Rest of the Story Approves Corrective Statements for Federal Government

The Rest of the Story: Tobacco News Analysis and Commentary — Mon, 03 Dec 2012 12:06:00 +0100

Last week, the D.C. federal district court approved corrective statements that the cigarette companies must make - on cigarette package inserts and public advertisements - as one of the remedies in the Department of Justice's RICO case against the tobacco industry. These statements are intended to correct past statements of the industry that disseminated false or misleading information to the public. Today, the Rest of the Story is announcing that it has approved a series of corrective statements for the federal government. These statements are intended to correct false or misleading statements that the government is currently disseminating to the public. First, here are the corrective statements that Judge Kessler approved:A. Adverse Health Effects of SmokingA Federal Court has ruled that...

Autism and Conor's Grand Mal Seizure: What Lies Ahead?

Facing Autism in New Brunswick — Sat, 01 Dec 2012 05:00:00 +0100

I know very little about seizures except that they are associated generally with epilepsy, that they are common in people with autism disorders and that they can be absolutely terrifying to a parent, even one whose personal conceits mislead him into thinking he is immune to fear. When I heard strange noises from my younger, severely autistic, and intellectually challenged son Conor and found him convulsing violently on our living room floor I thought for an instant that we might lose him. At this time I know very little about seizures. I know very little except how dangerous seizures can be. I can say that I had suspected seizure activity in Conor on previous occasions and reported them to his pediatrician over a year ago. The previous incidents involved his eyes rolli...

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Grapefruit-Drug Interaction Seen With More Drugs (CME/CE)

Dr Portnay — Thu, 29 Nov 2012 05:00:00 +0100

MedPage Today Cardiovascular Grapefruit-Drug Interaction Seen With More Drugs (CME/CE) By Cole Petrochko, Staff Writer, MedPage TodayPublished: November 28, 2012Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, BostonThe number of drugs that react adversely with grapefruit is higher than previously recognized, and the interactions occur at lower levels of grapefruit intake, according to a Canadian review.More than 85 drugs currently approved in Canada have adverse reactions with grapefruit, and 43 have potentially serious adverse reactions, according to David Bailey, PhD, of the London Health Sciences Center in Ontario, and colleagues.Common adverse events related to drug-grapefruit interacti...

Roller-coasters, resuscitations and burnout

edwinleap.com — Tue, 27 Nov 2012 16:01:49 +0100

My patient was brought by EMS after a respiratory, and subsequent cardiac, arrest. She could not be intubated in the field, and I did so on her arrival. We actually restored some circulation, albeit not much. Over the course of an hour, despite our best efforts, she became blue again, with lividity pooling in her flanks. I had spoken with her husband over and over, and he knew that the situation was grim. It was just after Thanksgiving, and he was wearing Christmas sweatshirt. His family was gathered all around, as families do, especially here in the South. We decided that it was time to stop. That she had, in essence, already died. That we were only supporting a shell. The family cried as we escorted them to the bedside before we stopped everything. It was a busy night...

Roche Offers Compromise On Tamiflu Data Fight

Pharmalot — Mon, 26 Nov 2012 13:05:48 +0100

In a bid to fend off its critics, Roche is offering to establish a multi-party advisory board to review all data for its Tamiflu influenza medication. The board would consist of experts from academia and private institutions, who would then agree on which analyses were useful in assessing the appropriate role that Tamiflu should have in aiding public health. “We think that would be an appropriate, fair and transparent way of handling this debate,” Daniel O’Day, who heads the Roche pharma business told Reuters late last week. “To what level data will be shared proactively and constantly is something we need to discuss.” His remarks were made on the eve of a workshop that was held by the European Medicines Agency to promote transparency and greater disclosure of...

How to Determine and Document an Evaluation/Management Code

Shrink Rap — Sun, 25 Nov 2012 05:00:00 +0100

With permission, I am stealing this entire post from Psych Practice, a NYC psychiatrist who was kind enough to go through a step-by-step How To Guide for determining and documenting the Evaluation and Management coding for the new CPT codes we'll be using in January. And thank you to Becca who found this for me. Now if someone could translate it into exactly what one needs to do when using these E/M codes in combination with the psychotherapy codes, that would be wonderful. E;M Coding, in All Its Glory There are three key components to E&M level of care: history, exam, and medical decision making. Each of these components has requirements for meeting the various levels of care. You need 2 out of 3 of these components to reach a specified level...

Nitric Oxide

Inside Surgery — Fri, 23 Nov 2012 02:44:45 +0100

Introduction Nitrous oxide (NO) was first used as an endogenous endothelial-derived vasodilator in 1987. NO is a colorless, odorless gas that is used in a variety of respiratory therapies, particularly in the treatment of pulmonary hypertension. Mechanism of Action After inhalation, NO is rapidly absorbed from the alveolar space into the adjacent capillary where it activates guanylate cyclase in the pulmonary vascular smooth muscles. Activated guanylate cyclase then promotes the conversion of guanosine triphosphate (GTP) to cyclic guanosine monophosphate (c-GMP), which causes relaxation of vascular smooth muscle. A key feature of inhaled NO therapy is pulmonary bed vascular selectivity secondary to the rapid binding of NO by hemoglobin. Once in the blood, NO reacts with oxyhemoglobin to fo...

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Some medicines that don’t work. Why doesn’t the MHRA tell us honestly?

DC's goodscience — Tue, 20 Nov 2012 11:50:47 +0100

Conclusion Although old products which were on the market before 1971 were supposed to be reviewed for efficacy and safety. This hasn’t been done efficiently. The make-believe has simply been perpetuated. I have no objection to people buying benylin etc, but they should not have full marketing authorisation and they should be labelled accurately so that it is clear that there is very little evidence that they’ll do you much good. The MHRA has let down the public, just as it did when it allowed misleading labels on homeopathic and herbal potions. Postscript After writing this, I discovered a very recent paper about guaifenesin (Seagrave et al, 2012), This paper shows some effects on mucus secretion in cultured human cells (not in humans) with prolonged exposure to concentrations...

Cell Death Pathways Controlled by Cytomegaloviruses

Microbiology Blog: The weblog for microbiologists. — Mon, 19 Nov 2012 05:00:02 +0100

from A. Louise McCormick and Edward S. Mocarski writing in Cytomegaloviruses: From Molecular Pathogenesis to Intervention:Cytomegalovirus (CMV) deploys multiple strategies to overcome host intrinsic, innate, and adaptive responses that limit infection by triggering cell death. Multiple cell death suppressors are encoded by cytomegaloviruses infecting humans, monkeys and rodents. The viral inhibitor of caspase activation (vICA) and even the viral mitochondrial-localized inhibitor of apoptosis (vMIA) represent evolutionarily conserved strategies, whereas viral inhibitor of receptor-interacting protein kinase (RIP) activation (vIRA), the mitochondrial complex I-associated b2.7 RNA and other viral gene products whose mechanisms are not fully understood, appear to have evolved independently in ...

RN v RT? Which Should I Choose? A someecard Explanation

The Happy Hospitalist — Mon, 19 Nov 2012 05:00:00 +0100

If you're trying to find a career as a medical professional and you've whittled your choices down to RN vs RT and you just can't decide whether nursing or respiratory therapy is the right field for you, it's time to look at your choices with an objective eye. Which field will you wake up day after day and feel like you've made a difference without being overwhelmed with all the nastiness that comes along with both fields? The patients are the same. The diseases are complicated. But, at the end of the day, I have just one answer for you to ponder if you're trying to decide on your education to become an RN or RT? Think poop vs PEEP. Any questions? Go here to see this best respiratory slogan ever in bumper sticker form. (Source: The Happy Hospitalist...

Fight Aging! Newsletter, November 19th 2012

Fight Aging! — Sun, 18 Nov 2012 05:00:00 +0100

Discussion - Latest Headlines from Fight Aging! - The State of Bioprinting - Molecular Tweezers Versus Alzheimer's Disease - Eliminating Metastasis in Melanoma - Investigating a Longevity-Related Mitochondrial Polymorphism - Injectable, Compressible, Shaped Tissue Scaffold - Humanity+ 2012 Conference, December 1st in San Francisco - Digging Deeper into Zebrafish Brain Regeneration - SENS Foundation Hiring a Telomere Biology Research Lead - "Successful Aging" Seems a Little Ridiculous as a Concept - The Goal of Lifelong Perfect Health MORE THOUGHTS ON RE...

Ben Roethlisberger’s First Rib Injury

Inside Surgery — Thu, 15 Nov 2012 19:01:10 +0100

This study is also used to screen for concominant rib fractures (which occur in over 20% of cases with first rib fractures), pulmonary contusion, pneumothorax, bronchial disruption, tracheal disruption, and esophageal disruption. Even in the very rare instance of an isolated first rib fracture with sternoclavicular joint dislocation without any other acute injuries, significant morbidity and mortality exist. If there has not been vascular injury acutely and there is avoidance of further blunt trauma during the healing phase, the risk of vascular injury in the post-injury period remains small. The main problems in the post injury period are management of the significant pain associated with the injury and the almost universally occurring respiratory compromise. Patients usually report close...

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Investigating a Longevity-Related Mitochondrial Polymorphism

Fight Aging! — Thu, 15 Nov 2012 05:00:00 +0100

Mitochondrial function is important in determining life span, and mitochondrial damage is one of the root causes of aging. Thus life span differences between similar species may to a large degree reflect differences in the damage resistance of mitochondria, and a number of studies in recent years have shown that some human mitochondrial haplogroups - which represent characteristic variations in mitochondrial DNA - can be correlated with increased longevity. The way in which mitochondria become damaged involves the production of reactive oxygen species (ROS) in the course of generating fuel to power the cell that contains them. Here researchers show that a longevity-associated difference in mitochondrial DNA reduces the pace of ROS production - which fits nicely with the present understand...

Mandatory flu vaccination for medical staff: a physician’s objection

edwinleap.com — Wed, 14 Nov 2012 17:07:35 +0100

Dear readers, Below is a letter from one of my dearest friends to his hospital administration. This year, the administration has mandated Influenza vaccination. Short of a few accepted exemptions, it is a requirement for continued medical staff participation by physicians or employment by other staff. Those who do not receive it must wear a mask while working for the entire duration of the flu season, as well as a badge stating that they did not receive the vaccination. It has become an issue of great contention among staff, but has been largely dismissed as of insufficient concern to the administrative staff. Another facility near his has excused its staff from this requirement on moral grounds. Most others are requiring the vaccine. Whatever you believe, or do not believe, about ...

CME Programs Assist Clinicians in Meeting Hospital Guidelines for Antibiotics Use

Policy and Medicine — Wed, 14 Nov 2012 05:00:00 +0100

Adding to our long list of continuing medical education (CME) programs that have positive outcomes on improving evidence based care, a recent program of education and feedback for pediatricians cut inappropriate antibiotic use by about half, reported MedPage Today. We have previously reported that CME has led to improvements in clinical care in area such as hypertension, COPD, ICU patients, improved taking of family history by physician assistants, Sepsis, healthcare-associated infections, reduction in CT scans, MS, and several other areas. In a cluster-randomized trial, the off-guideline use of broad-spectrum antibiotics for acute respiratory infections fell 48% in nine practices that got the intervention, according to Jeffrey Gerber, MD, of the Children's Hospital of Philadelph...

Is dyspnea due to “diastolic dysfunction” different from systolic dysfunction?

Dr.S.Venkatesan MD — Tue, 13 Nov 2012 10:42:28 +0100

No body wouldn’t ever have differentiated dyspnea with reference to systolic and diastolic dysfunction .I have made some observations in certain group of patients during EST . I do not know how far one would agree with this . For the same amount of stress or work load persons with systolic dysfunction behave differently . However ,both will complete the activity but the onset and perception of dyspnea is slightly different in patients with predominant diastolic dysfunction. Diastolic dyspnea (Dyspnea due to predominant diastolic dysfunction / HFPEF) Delayed dyspnea . It manifest well after the exertion is completed. It is more off a struggle to handle the venous return .The forward flow (Arterial circuit ) is relatively well toned and tuned ...

MKSAP: 70-year-old malnourished man with dementia

Kevin, M.D. - Medical Weblog — Sat, 10 Nov 2012 12:00:29 +0100

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 70-year-old malnourished man with a 4-year history of Alzheimer dementia is admitted to the intensive care unit from the emergency department for treatment of community-acquired pneumonia and impending respiratory failure. He is inattentive and confused and has a weak productive cough. His only medications are donepezil and memantine.Temperature was 38.3 °C (101.0 °F), blood pressure was 100/62 mm Hg, pulse rate was 110/min, and respiration rate was 26/min; BMI was 18 kg/m2. Arterial oxygen saturation on ambient air was 92%. Pulmonary examination revealed crackles in the right lower lobe. A chest radiograph confirmed an extensive right lower lobe pneumonia.The patient was trea...

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Medical school – a lack of educational theory

DB's Medical Rants — Thu, 08 Nov 2012 19:55:19 +0100

Last weekend I attended the AAMC meeting in SF. There I heard a wonderful talk by Sal Khan. I highly recommend his TED talk – Let's use video to reinvent education On the way home I read his book – The One World Schoolhouse: Education Reimagined Then last night eating dinner with some thoughtful medical students we discussed the first two years of medical school and its many flaws. Thrun, Khan and many of their fellow educational disruptors want to upend that. Broadly termed “flipping the classroom,” the idea is that students watch lectures and work through problem sets on their own time, at their own pace. Once they prove mastery of a concept, adaptive software will suggest new ones, much like Amazon recommends new books. Teachers are kept abreast...

Rival Drugmakers Now Compete For FDA Warnings

Pharmalot — Thu, 08 Nov 2012 13:46:56 +0100

This may be a case of taking competition to a new low. Late last month, the FDA Office of Prescription Drug Program issued so-called untitled letters to a pair of drugmakers – ONY Pharmaceuticals and Cornerstone Therapeutics – for hyping their competing treatments for neonatal Respiratory Distress Syndrome. In both cases, the agency cites the pair for the usual violations – omitting risk information and making unsubstantiated superiority claims. ONY did so on its web site and in a video (here is the FDA letter), while Cornerstone ran afoul of regulations in a pitch letter that was purportedly distributed to journalists by the Fleishman-Hillard public relations firm (here is the FDA letter). The violations underscore the heated rivalry that occurs when dueling drugmakers ...

How Not to Die a Tragic Death from a Drug Overdose

Shrink Rap — Thu, 08 Nov 2012 05:00:00 +0100

Whitney Houston, Michael Jackson, Heath Ledger, Amy Winehouse, Anna Nicole Smith -- I imagine you know what these celebrities all have in common: they've died from accidental overdoses. In the first 20 years of my career, I can't recall hearing a single story of an accidental overdose resulting in the death of a young person that I knew, a friend knew, or a patient told me about. Maybe I've forgotten them, but if so, it's because they were spaced well apart and there weren't memorable trends. One close friend had a young relative, a substance abuser, overdose and end up in an ICU, but he lived. Somehow, in the past year, I've been hearing more and more stories of tragic deaths of young people, full of life and promise, who partied just a little too hard and stopped their lives...

A sneeze launches a thousand germs

Malaysian Medical Resources — Mon, 05 Nov 2012 21:30:55 +0100

CONCLUSION: Nasal S. aureus carriers disperse a significant amount of S. aureus into the air by sneezing. Experimental colds do not alter bacterial dispersal, but respiratory allergies multiply the effect of dispersing S. aureus. Sneezing is thus not a trivial act. It potentially is a source of transmission of serious pathogens. So please cover up your nose and mouth when that “Ah choo!” feeling comes about. The problem is not only do people not cover their nose or mouth, even if they do, the common habit of coughing or sneezing is into ones hands which is not right – you can spread germs via contact. If you don’t have a tissue handy, the best way is to sneeze into your elbow or sleeve, as mentioned in the previous post Don’t sneeze or cough into your hands! fro...

Bad Bugs: Facts About Food Safety (Part 1)

Diabetes Self-Management — Mon, 05 Nov 2012 20:38:29 +0100

By Amy Campbell The last thing you want to do is have to worry about becoming ill from something that you ate or drank. But with Hurricane Sandy paving a path of destruction along the East Coast and knocking out power to millions of homes, and with the holidays coming up, it's a good idea to brush up on keeping your food safe from nasty little organisms that can cause a stomachache, at the least, or lead to something much more serious. What's the Big Deal? Although it seems like food safety has been in the news an awful lot these past few years, the US really does have one of the safest food supplies in the world compared to other countries. But when a foodborne illness (aka, "food poisoning") strikes someone with a chronic disease like diabetes, it can be quite serious. As if you need a r...

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How to Make Health Insurance a Bad Bet

Zen Habits — Mon, 05 Nov 2012 19:43:16 +0100

Conclusion: Ways to Lower Risks So, for those who skipped to the end, let’s take the controllable risk factors, and eliminate them by doing these steps (please note that this isn’t medical advice, as I’m just a writer not a doctor, but it’s based on research from the CDC, Mayo Clinic, American Cancer Society and others): Don’t smoke (read my quit guide, written nearly 6 years ago) Don’t be overweight (healthy BMI, waist measurement of less than 35 inches in women and less than 40 inches in men) Eat healthy (plant-based diet, lots of fiber, not a lot of red meat, saturated fat or animal fat) Exercise (at least 30 mins daily) Don’t drink too much alcohol (limit to 1-2 glasses for women, 2-3 glasses for men) Keep your blood pressure at a good level (eat he...

Lester the Lion Kitty, Love of my Life :)

Occupational Therapy Students (B)e(LO)n(G) — Sun, 04 Nov 2012 06:55:00 +0100

lesterthelionkitty.blogspot.com :)This is Lester the Lion Kitty. Feel free to type in Lester the lion kitty on youtube and see his amazingness live. I just posted a video of him "shaking" for a treat under the name Meemaw teaches Lester how to shake or something like that. My Youtube name is OTStudentKaren if that helps.He's my star attraction of the South. I just briefly visisted Birmingham, AL for the weekend and we made a quick stop in Montgomery, AL so I could see my baby. (He was originally mine when I lived there, but I gave him to my good friend's mother when I left as it would be too challenging to get him cross country with all his braciocephalic aka flat face issues leading to respiratory distress). I think I'm going to see about getting him some occupational therapy...

A quick respiratory assessment and documentation guide.

impactEDnurse — Sat, 03 Nov 2012 05:03:05 +0100

The following guideline is by no means a complete or thorough respiratory assessment (For example, I have not covered palpation or percussion). It is, instead, one example of a structured approach to performing a quick respiratory assessment on a new patient, or a patient who requires rapid re-assessment (leave out the history taking part). Key descriptors are in bold to help you improve your documentation vocabulary. Presenting complaint: Ask questions: Cough. Sputum Haemoptysis Dyspnoea Wheeze Chest pain Fever Hoarseness Cough: is it dry or productive. If productive, what sort (and quantity) of sputum is being produced? Purulent (yellow or green) may indicate bronchiectasis or lobar pneumonia. Dark, offensive smelling may indicate lung abscess. Pink frothy secretions (not actually sput...

Large Meta-Analysis Purports to Find Huge Effect of Smokefree Laws on Heart Attacks, But Instead Fails to Demonstrate an Effect

The Rest of the Story: Tobacco News Analysis and Commentary — Thu, 01 Nov 2012 14:14:00 +0100

In the largest meta-analysis to date of studies examining the effect of smoking bans on heart attack admissions, a paper published this week in the journal Circulation concludes that smoking bans lead to an immediate 15% decline in heart attack admissions or deaths. The typical follow-up period in the reviewed studies was approximately one year. Thus, the paper is concluding that smoking bans produce a 15% decline in heart attacks in the first year following implementation of these bans. Furthermore, the paper argues that the observed decline is due to a reduction in secondhand smoke exposure. Most of the policies were bans on smoking in restaurants and/or bars.The basic method of the study was as follows: "We included studies examining the association between smokefree laws and hospitaliz...