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Inexact Sciences
Thoughts on the place of science in an era of false convictionSome recent articles, noted by a few of us in journals regularly monitored byHCR bloggers, provide real food for thought in our New World Order of alternate facts, fake news and truthiness.In a recent number of the still intrepidly pay-wall-free Guardian,  development economist John Rapleysummarizeshis new bookTwilight of the Money Gods. This summary is the best we in the colonies can do until this month ' s UK publication of the full volume makes it to our shores. (Rapley, a true globalist, both an academic and a public intellectual experienced a...
Source: Health Care Renewal - July 17, 2017 Category: Health Management Source Type: blogs

Palliative Care & CHF: PAL-HF trial
The main results of PAL-HF - a randomized, controlled trial of specialty palliative care team involvement in advanced heart failure patients -  have just been published in the Journal of the American College of Cardiology (DOI: 10.1016/j.jacc.2017.05.030. Clinicaltrials.gov registration here). This is an important, well-done study, with encouraging results - specialty PC improved the quality of life of patients with HF. I ' ll discuss the results in more details in this post.The study was done by a multi-disciplinary team of palliative& cardiology investigators at Duke. This week ' s ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 14, 2017 Category: Palliative Care Tags: chf heart failure research research issues rosielle Source Type: blogs

How Prepared Are You to Lead?
By: Peter Pronovost, MD, PhD, and Christopher Myers, PhD, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine Physicians increasingly are being asked to lead health systems and improvement efforts, so it is important that they have the necessary skills to do so. To see why and how these leadership skills matter, we propose a quick test. Below, we present three scenarios that a health leader might need to navigate. As you read these scenarios, we encourage you to reflect on whether you have a framework you could use to address the issues described, whether you have all of the necessary skills to addre...
Source: Academic Medicine Blog - June 13, 2017 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective coaching health care management health system leadership skills leadership training quality improvement Source Type: blogs

Should Emergency Physicians be interrupted by ECGs that are read as " Normal " by the computer?
This study was far too small (n = 222 " normal " ECGs) to conclude that ECGs do not need to be read by a human.This is probably why the authors only " suggest " and do not " conclude " this.According to 2 recent articles (2, 3), the computer misses one third of STEMI, but misses many more subtle MI that do not meet STEMI criteria. Most of these will not be " normal " but will have nonspecific ST-T abnormalities, or other features which the computer recognizes as " abnormal " but does not diagnose.However, subtle coronary occlusion may be completely missed by the computer and called " normal. "  This one was ...
Source: Dr. Smith's ECG Blog - June 12, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

Hours out of the OR for valve replacement surgery: patient with paced rhythm becomes hemodynamically unstable
Conclusions: ACO in VPR is an uncommon condition. The MSC showed good Sens for diagnosis of ACO in the presence of VPR, especially among patients with high peak cTn, and Spec was excellent. These methods and results are consistent with studies that have used the MSC to diagnose ACO in LBBB.
Source: Dr. Smith's ECG Blog - May 19, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

Trust and Medical Science
Concerned citizens will march this weekend to defend science. Standing up for science is a worthy cause. Look at what medical science has accomplished in recent times: serious diseases, HIV, heart attack, many forms of cancer, have been tamed by the advance of science. We need more not less science. It’s nuts to cut funding to the NIH. But science, especially medical science, has a trust problem. My editor at theheart.org | Medscape Cardiology asked me to write a piece exploring the broken trust. The title of the essay is: Want More Trust in Medical Science? Embrace Uncertainty and Cut the Hype The essay has three se...
Source: Dr John M - April 21, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

An open letter to Psychological Medicine, again!
In conclusion, noted Wilshire et al., “the claim that patients can recover as a result of CBT and GET is not justified by the data, and is highly misleading to clinicians and patients considering these treatments.” In short, the PACE trial had null results for recovery, according to the protocol definition selected by the authors themselves. Besides the inflated recovery results reported in Psychological Medicine, the study suffered from a host of other problems, including the following: *In a paradox, the revised recovery thresholds for physical function and fatigue–two of the four recovery measures–were so lax ...
Source: virology blog - March 23, 2017 Category: Virology Authors: Vincent Racaniello Tags: Commentary Information adaptive pacing therapy CFS chronic fatigue syndrome clinical trial cognitive behavior therapy Dave Tuller exercise graded exercise therapy mecfs myalgic encephalomyelitis outcome PACE trial recovery Source Type: blogs

Health Care Professionals and Trainees Finally Provoked to Resist - Cleveland Clinic Protest of CEO ' s Acquiescence to Trump ' s Muslim Travel Ban
We frequently discuss theanechoic effect, the failure of cases illustrating problems withconcentration and abuse of power, unethical andcorrupt behavior, and faulty leadership and governance in health care to generate much public discussion, much less outrage.  In particular, physicians and other health care professionals seem very reluctant to discuss such cases, perhaps fearing disapproval or retaliation by colleagues or bosses.  But they times they are a changin ' .Dr Delos (Toby) Cosgrove had been accused of multiple conflicts of interest the first decade of the century.  These charges seemingly generate...
Source: Health Care Renewal - February 5, 2017 Category: Health Management Tags: Cleveland Clinic conflicts of interest Donald Trump mission-hostile management Source Type: blogs

Making Research Suppressed Again - US Secretary of Health Candidate Accused of Suppressing Clinical Research at Behest of Campaign Donor
This report is greater than 5 years old. Findings may be used for research purposes but should not be considered current. 'In particular,Gary Beck, a policy assistant to the congressman, first reached out to the federal research agency about the study in July, emails show. ' I have been in contact with representatives from Arbor Pharmaceuticals based in Georgia in regard to some issues they have with the study that is linked below, ' he wrote, adding that the company told him ' the study might be outdated ' and they wanted it removed from the website.' I wanted to get in touch with you to get a better grasp on the situatio...
Source: Health Care Renewal - January 20, 2017 Category: Health Management Tags: BilDil CHF conflicts of interest evidence-based medicine health care corruption Nitromed suppression of medical research Source Type: blogs

Research and Reviews in the Fastlane 167
This article summarizes several retrospective reviews, concluding that patients with heroin overdose typically do well after EMS treat-and-release naloxone administration, and that they can be safely discharged from the ED after a period of one-hour observation. Considerable limitations in the retrospective nature of such reviews and significant impact of new adulterants such as fentanyl and U-47700 on current “heroin” overdoses seriously limit interpretation and applicability of these studies to today’s clinical practice. Strong caution should be taken in making practice changes based on retrospective and potentiall...
Source: Life in the Fast Lane - January 5, 2017 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Toxicology and Toxinology recommendations research and reviews Resuscitation Source Type: blogs

Atheist doctors must come out of the closet
Reading about the opening of the Noah’s Ark Theme Park in Kentucky brings to mind the days when I worked as a physician in that state. I had moved from an academic position in Colorado and joined a large group of private practice cardiologists in Louisville. I found that people in Kentucky were different from those in Colorado. They were much more overtly religious. As an interventional electrophysiologist, I would meet with each patient’s family before and after every procedure. Not infrequently, one person from each group in the waiting room was introduced as “this is our pastor.” Usually, at some point, the past...
Source: Kevin, M.D. - Medical Weblog - December 2, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/david-mann" rel="tag" > David Mann, MD < /a > Tags: Physician Primary care Source Type: blogs

Applying Human Centered Design to IV Infusions: Interview with Dr. Beth Kolko, CEO of Shift Labs
With the aspiration to address healthcare gaps around globe by applying human centered design to medical technologies, Shift Labs, a 2015 Y Combinator company, is first tackling the infusion market with DripAssist. Formerly known as Drip Clip, as rep...
Source: Medgadget - November 2, 2016 Category: Medical Equipment Authors: Michael Batista Tags: Anesthesiology Cardiology Critical Care Emergency Medicine Exclusive Pediatrics Source Type: blogs

Medicare Advantage – the Cup that Spilleth Over
By ANISH KOKA, MD I was asked to see an unfortunate elderly man – Harry – one afternoon.  He had multiple coronary stents placed for coronary disease over the course of the last ten years, and after presenting with difficulty speaking, was found to have a brain tumor.  The neurosurgeon was hoping I could provide some reassurance about how healthy his heart was to undergo an operation.  An assessment revealed him to be high risk for a coronary event, and I had a lengthy discussion with the surgical team, and the patient, who elected to proceed with the surgery.  Three hours after the surgery, the nurse practitioner...
Source: The Health Care Blog - November 1, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Once Again, Lancet Stumbles on PACE
This report outlines such egregious failings as outcome thresholds that overlapped with entry criteria, mid-trial promotion of the therapies under investigation, failure to provide the original results as outlined in the protocol, failure to adhere to a specific promise in the protocol to inform participants about the investigators’ conflicts of interest, and other serious lapses. Virology Blog first posted the open letter in November, with six signatories (link to letter). At that time, Dr. Horton’s office responded that he would reply after returning from “traveling.” Three months later, we still...
Source: virology blog - August 29, 2016 Category: Virology Authors: Vincent Racaniello Tags: Commentary adaptive pacing therapy chronic fatigue syndrome cognitive behavior therapy graded exercise therapy mecfs myalgic encephalomyelitis PACE trial specialist medical care The Lancet Source Type: blogs

Leaderboard: DM / DNB Cardiology Entrance New Test Series 5
This leaderboard is live and will change as and when new users attempt the quiz. Top scorers can add their photographs and brief CV of academic achievements at our Facebook Page, which will be transferred to Cardiophile MD home page. Leaderboard: DM / DNB Cardiology Entrance New Test Series 5 maximum of 30 points Pos. Name Entered on Points Result Table is loading No data available
Source: Cardiophile MD - August 13, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs