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LITFL Review #165
Welcome to the 165th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.The Most Fair Dinkum Ripper Beauts of the WeekDo you re-spike IV fluid bags? The case of Ruby Chen from gravelessons.com should make us all re-think this. [SO] The Best of #FOAMed Emergency MedicineExcellent discussion of everything you need to know about AFib from EM Cases featuring Ian St...
Source: Life in the Fast Lane - January 19, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

LITFL Review 165
Welcome to the 165th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.The Most Fair Dinkum Ripper Beauts of the WeekDo you re-spike IV fluid bags? The case of Ruby Chen from gravelessons.com should make us all re-think this. [SO]The Best of #FOAMed Emergency MedicineExcellent discussion of everything you need to know about AFib from EM Cases featuring Ian Stiell. ...
Source: Life in the Fast Lane - January 19, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Physician Aid In Dying: Whither Legalization After Brittany Maynard?
Editor’s note: This post is part of a series stemming from the Third Annual Health Law Year in P/Review event held at Harvard Law School on Friday, January 30, 2015. The conference brought together leading experts to review major developments in health law over the previous year, and preview what is to come. A full agenda and links to video recordings of the panels are here. Brittany Maynard’s highly publicized decision to end her life under Oregon’s Death With Dignity law has given a new face to the American right to die movement. It is that of a young, attractive, athletic newlywed, who would not have considere...
Source: Health Affairs Blog - March 12, 2015 Category: Health Management Authors: Charles Baron Tags: Access All Categories Bioethics Chronic Care Consumers Coverage End-of-Life Care Health Care Costs Health Law Health Reform Physicians Policy Politics Public Opinion States Source Type: blogs

Owner Of Durable Medical Supply Company Sentenced to 6 ½ Years In Prison
Last week, the owner of a durable medical equipment (DME) supply company was sentenced to 6 ½ years in prison for her role in submitting more than $7 million in fraudulent claims to Medicare.  Adeline Ekwebelem’s Los Angeles-based DME company, Adelco Medical Distributors, Inc., billed Medicare for medically unnecessary power wheelchairs “for beneficiaries often recruited off the street,” notes the government press release. Ekwebelem’s scheme, according to the prosecutors, implicated a “handful of complicit doctors,” who would write fraudulent prescriptions for wheelchairs in exchange for kickbacks. One s...
Source: Policy and Medicine - May 4, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Diffuse ST Elevation and Chest Pain, What is it?
A male in his 40s presented by EMS with 24 hours of chest pain.  The pain was central, anterior, dull and squeezing, and 5/10, not worsened with activity but associated with mild shortness of breath.No prehospital 12-lead could be found.Here is the initial ECG at time zero:QTc is 386 ms.  There is scary ST elevation especially in V2 and aVL, with some reciprocal ST depression in III. However, the ST elevation in V2 has a saddleback appearance.  I have seen Anterior saddleback ST elevation as a finding in anterior MI only once ever, in all the ECGs and MIs I have reviewed.If you apply the early repol vs. LAD ...
Source: Dr. Smith's ECG Blog - July 6, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

This ECG is NOT Pathognomonic of Brugada
This was contributed by a friend and colleague from a Yale affiliated hospital, Brooks Walsh.Here is Brooks' caseI had a great opportunity to co-manage a patient with one of my partners, Dr. Charles Mize. He is not only an avid resuscitationist, but also a devoted reader of Dr Smith’s ECG Blog.A 30-something adult with type 1 DM, but no cardiac disease, presented to the ED with nausea, vomiting, and abdominal pain. They had a history of multiple visits to the ED for gastroparesis (with or without DKA), and their symptoms were stereotypic for prior visits. Analgesia, fluid, and antiemetics were provided, and a basic metab...
Source: Dr. Smith's ECG Blog - August 9, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

This ECG is NOT Pathognomonic of Brugada Syndrome
This was contributed by a friend and colleague from a Yale affiliated hospital, Brooks Walsh.Here is Brooks' caseI had a great opportunity to co-manage a patient with one of my partners, Dr. Charles Mize. He is not only an avid resuscitationist, but also a devoted reader of Dr Smith’s ECG Blog.A 30-something adult with type 1 DM, but no cardiac disease, presented to the ED with nausea, vomiting, and abdominal pain. They had a history of multiple visits to the ED for gastroparesis (with or without DKA), and their symptoms were stereotypic for prior visits. Analgesia, fluid, and antiemetics were provided, and a basic metab...
Source: Dr. Smith's ECG Blog - August 9, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Provider Payment Sunshine Act: Senators Grassley and Blumenthal Introduce Bill to Expand Open Payments Reporting Requirements to Nurse Practitioners and Physician Assistants
On October 7, Sen. Charles Grassley (R-Iowa) and Sen. Richard Blumenthal (D-Conn) introduced a bill that would expand the Open Payments reporting requirements to include nurse practitioners and physician assistants. Currently, to comply with the Sunshine Act, pharmaceutical and medical device manufacturers are required to report payments and other transfers of value to physicians and teachings hospitals. While the definition of physician is broad—and includes doctors of medicine, osteopathy, dentists, podiatrists, optometrists and chiropractors who legally authorized to practice by a state—the law currently does not co...
Source: Policy and Medicine - October 9, 2015 Category: American Health Authors: Policy and Medicine Writing Staff Source Type: blogs

Phooled Again - More Settlements Suggesting Bad Behavior by Big Pharma/ Biotech
Once again, here is a roundup of cases showing big multi-national pharmaceutical and biotechnology companies are up to their usual tricks.Presented in alphabetical order...Bristol-Myers Squibb Settles Charges of Bribery of Chinese Hospitals.The best version of this I could find was in USA Today, in early October, 2015,Pharmaceutical manufacturer Bristol-Myers Squibb has agreed to pay more than $14 million in fines to settle charges that its joint venture in China paid cash and other benefits to state-owned hospitals in exchange for prescription sales, the Securities and Exchange Commission announced Monday.After its invest...
Source: Health Care Renewal - October 15, 2015 Category: Health Management Tags: adulterated devices bribery Bristol-Myers-Squibb crime deception deferred prosecution agreement Genzyme intimidation legal settlements Pfizer Sanofi-Aventis Source Type: blogs

Learning about clinical reasoning from JGIM’s “Exercises in Clinical Reasoning”
The Journal of General Internal Medicine started a feature in 2010 titled “Exercises in Clinical Reasoning”.  This series presents clinical problem solving cases (similar to the NEMJ series) but adds an important twist.  The discussant responds to the case divided into nuggets, but then a second discussant reflects on the cognitive skills and processes that the clinical discussant has used.  The following represents 8 Exercises that gives an overview of some common methods for understanding clinical reasoning. Henderson, Mark C., Gurpreet Dhaliwal, Stephen R. Jones, Charles Culbertson, and Judith L. Bowen. ...
Source: DB's Medical Rants - November 17, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

On THCB
The Mess That is MACRA by Kip Sullivan Is Pornography Creating a Public Health Crisis? by Steve Findlay Why I Left My Pharma-Sponsored Academic Research Gig by Brad Flansbaum The Joint Commission Pain Standards: Five Misconceptions by David W Baker, MD The Pharma = Evil Narrative by David Shaywitz, MD Stephen Curry’s Health Care Plan by Charles Gross What Is Patient-Centered Care? What Isn’t Patient-Centered Care? by Rob Lamberts, MD All Providers Are Not Equal by Steven Findlay The C Word by Jeff Goldsmith Trump’s Healthcare Plan: Right Diagnosis, Wrong Prescription by Sally C. Pipes The Prescription for High Drug C...
Source: The Health Care Blog - April 23, 2016 Category: Consumer Health News Authors: John Irvine Tags: Featured THCB Source Type: blogs

Health Spending Growth: Still Facing A Triangle Of Painful Choices
The rate of growth in health spending increased in 2014 and 2015 but has recently trended downward, perhaps toward the record low levels experienced from 2009 through 2013. That’s the good news. The bad news is that even these record low levels are not sustainable in the long run without sacrifices that will cause extreme pain across the political-economic spectrum. The Current Path of National Health Spending In the four years immediately following the recession (2010 through 2013), health spending grew at a historically low average annual rate of 3.6 percent, about the same as gross domestic product (GDP). This era was...
Source: Health Affairs Blog - June 23, 2016 Category: Health Management Authors: Charles Roehrig Tags: Costs and Spending Featured Medicaid and CHIP Medicare culture of health GDP national health spending Triangle of Painful Choices Source Type: blogs

Bad Apple or Bad Orchard? - A Narrative of Alleged Individual Research Misconduct that Sidestepped the Pharmaceutical Corporate Context
Conclusion So it seems that in this case a study which may not have been conducted according to research standards was likely a pharmaceutical sponsored, designed, and controlled Phase II trial done as part of an effort to seek approval for a new drug.  Hence this case was not only about allegations of individual research misconduct, but about yet more problems with the implementation of commercially controlled human experiments designed to ultimately further marketing as well as science.  Yet none of the public discussion so far of this case was about whether Pfizer had any responsibilities to assure the quality...
Source: Health Care Renewal - July 7, 2016 Category: Health Management Tags: anechoic effect clinical research integrity clinical trials New York University Pfizer pharmaceuticals Source Type: blogs

Liposuction and Tubal Reversal: Unethical and Dishonest
Most people who know me understand I am a patient advocate. I would like to speak out against a practice I find professionally distasteful. Some reversal doctors charge patients more because of body weight. Some even require patients have unnecessary liposuction during tubal reversal surgery at additional cost. Liposuction has serious risks, can increase the chance of a surgical complication, and should be considered a cosmetic procedure only. Doctors who require patients to have mandatory liposuction during reversal surgery are either medical quacks or clever cons. Continue reading for better understanding… Requir...
Source: Tubal Reversal Blog - January 22, 2016 Category: Reproduction Medicine Authors: Dr. Monteith Tags: abdominal costs dishonest liposuction risk risks surgery tubal reversal unethical Source Type: blogs

Words are never enough – but does that stop us?
Pain may be said to follow pleasure as its shadow; but the misfortune is that in this particular case, the substance belongs to the shadow, the emptiness to its cause. CHARLES CALEB COLTON, Lacon I can bear any pain as long as it has meaning. HARUKI MURAKAMI, 1Q84 But pain … seems to me an insufficient reason not to embrace life. Being dead is quite painless. Pain, like time, is going to come on regardless. Question is, what glorious moments can you win from life in addition to the pain?  LOIS MCMASTER BUJOLD, Barrayer Language is not just words, but what those words symbolise. We use movements of lips, tongue and t...
Source: HealthSkills Weblog - July 17, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Education/CME Pain Professional topics Research biopsychosocial Health healthcare pain management Therapeutic approaches treatment Source Type: blogs