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This page shows you the most recent publications within this specialty of the MedWorm directory. This is page number 3.

Utah : Just Say "NO!"
This is not a post on abortion.  Let's not even go there.  This is a post on who gets to practice medicine.So Utah passed a law -- signed by their governor after how many years of medical school? -- that mandates doctors to give general anesthesia to women having abortions after 20 weeks of gestation.  Legislators sometimes unwittingly attempt to practice medicine and pass laws that interfere with the doctor patient relationship, but this is the first time I've heard of legislation that demands a procedure that endangers a patient's life.  The theory is that the fetus might feel pain and that general an...
Source: Shrink Rap - April 5, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

ABIM Considers Open Book Testing
We have previously written about the 2020 Task Force organized by the American Board of Internal Medicine (ABIM) on Maintenance of Certification (MOC) assessments. ABIM is using the task force in an attempt to continue perfecting their MOC program and setting a new process for internists and subspecialists. Most recently, ABIM announced that they are looking at permitting access to online resources for a portion of the maintenance of certification assessments. In a blog post written by President and CEO of ABIM, Richard J. Baron, M.D., MACP, he announced that the idea to "make at least a portion of ABIM's assessment 'ope...
Source: Policy and Medicine - April 4, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Can I Get a Side of Fat with that Overdose?
​An 88-year-old woman with a history of dementia presented with dizziness. Her daughter reported that she may have taken at least 12 tablets of diltiazem, which she mistook for her other medications. She is alert and oriented with normal vital signs. Her heart rate is 40 beats per minute and blood pressure is 70/45 mm Hg. Boluses of calcium gluconate and high-dose insulin therapy are initiated. The patient remains hypotensive at 80/40 mm Hg. Toxicology is consulted about intravenous lipid emulsion therapy.How does lipid emulsion therapy work?Two main theories describe the mechanism of action of intravenous lipid emulsion...
Source: The Tox Cave - April 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Ultrasound: Foreign Body Removal
Part 2 in a SeriesAre you ready for summer? That means more bare feet, flip-flops, and the potential for foreign bodies of the foot and toe. We will continue to highlight tools and tricks to help you master soft tissue foreign body removal in the emergency department. A refresher on the basics of ultrasound is available in our blog post from last month: http://emn.online/1UGtduz.Foreign bodies of the toe or foot are common presentations in emergency departments, and one way to determine the size and shape of retained superficial foreign bodies is to use ultrasound and the linear probe. This simple technique may hel...
Source: The Procedural Pause - April 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Medical school has killed my soul. What can I do?
Hi Pamela, I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started, I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel anything anymore. How can I overcome this? I so badly want to tap into the vibrant me from 6 months ago! Before starting medical school, I was a curious and loving young man. My life hadn’t been plain sailing: I had been through my parents’ divorce as a young teenager; I had ...
Source: Kevin, M.D. - Medical Weblog - March 30, 2016 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

The Gender Pay Gap in Nursing
With women dominating nursing, it could be assumed that a gender pay gap doesn’t exist. However, according to a recent study published in the Journal of the American Medical Association (JAMA), nothing could be farther from the truth. Although women make up the vast majority of the nursing workforce, they are paid significantly less than their male counterparts—to the tune of $5,100 less per year on average. If you’re a nurse anesthetist, it’s even worse. Annually, male nurse anesthetists make an average of $17,290 more than women in the specialty. In a recent publication, Nursing@Simmons explored the factors which...
Source: Disruptive Women in Health Care - March 29, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Advocacy Nurses Source Type: blogs

Teaching students should be the primary focus of medical schools
An anonymous medical student has this post on KevinMD — A star medical student feels like he made a terrible decision: And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where they limit their involvement with patients: dermatology, radiology, ophthalmology, anesthesiology. It begs the question: why are these the happiest, the most high-salaried, and patient-limited specialties? They all must have a connection. He goes on to la...
Source: Kevin, M.D. - Medical Weblog - March 26, 2016 Category: Journals (General) Authors: Tags: Education Medical school Source Type: blogs

Research and Reviews in the Fastlane 127
This study didn’t look at simple abscesses but rather at ones that most clinicians would have given antibiotics to and in spite of that, they found only a relatively modest benefit. Despite the headline, this is NOT practice changing. Recommended by: Anand Swaminathan Further reading: Are Antibiotics Back in Favor for Abscesses? (EM Literature of Note), Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses? (R.E.B.E.L. EM) The Best of the Rest Emergency Medicine Martin SP, et al. Double-dorsal single-volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A r...
Source: Life in the Fast Lane - March 23, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Anaesthetics Emergency Medicine Infectious Disease Neurology R&R in the FASTLANE Resuscitation EBM Education literature recommendations research and reviews Source Type: blogs

President Obama’s Budget Takes State-Level Debates Over Surprise Out-of-Network Bills To National Policymakers
President Obama’s final budget proposal was met with little fanfare, but a lot of political opposition. The President, however, put forth one legislative proposal that deserves attention. It is aimed at helping consumers who get stuck with surprise bills from out-of-network health care providers. Specifically, the proposal would protect patients from having to pay unexpected fees to out-of-network providers for services delivered while they are in an in-network hospital. Although details are sparse, the administration proposes to require hospitals to take “reasonable steps” to match patients with physicians who are i...
Source: Health Affairs Blog - March 22, 2016 Category: Health Management Authors: Sandy Ahn, Jack Hoadley and Sabrina Corlette Tags: Costs and Spending Featured Health Professionals Insurance and Coverage Payment Policy 2017 budget in-network hopsitals insurers out-of-network billing Physicians States Source Type: blogs

The World of FOAM and EMCC
Since 2009 we have reviewed, revised and revitalised the Emergency Medicine and Critical Care blogs (EMCC) database. It has been a great way to add new resources; marvel at the global collaboration and wealth of educational resources in the #FOAMed blogosphere and analyse the trends in the use of social media, and blogging platforms. In this 2016 analysis we review the #FOAMed conversation, blogging platforms and global spread of Free Open Access Medical Education and compare growth to 2011, 2012 and 2013 reviews. Readers can subscribe to 203 of the EMCC blogs/podcasts through FOAMEM either by RSS Feed or via a d...
Source: Life in the Fast Lane - March 22, 2016 Category: Emergency Medicine Authors: Mike Cadogan Tags: Education FOAM Review Social Media Web Culture blog EMCC FOAMed medical education research symplur Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 22
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 22. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - March 21, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

There They Go Again - the New England Medical Journal Publishes another Rant, this Time about Power Morcellation
In 2015, we noted (here and here) that the New England Journal of Medicine seemed to have been reduced to publishing rants about "pharmascolds" who are paranoid about conflicts of interest. Now there they go again.... BackgroundThe sad story about the risks of power morcellation for the treatment of fibroids has received considerable media attention.  The state of play through July, 2014 was described in a series of articles in the Cancer Letter of July 4, 2014. (Look here.) Uterine fibroids are a common affliction of women.  Their preferred surgical management had changed from open surgery to minimally invasive ...
Source: Health Care Renewal - March 20, 2016 Category: Health Management Tags: cancer FDA logical fallacies New England Journal of Medicine Partners Healthcare Source Type: blogs

A Detached Sense of Self Associated with Altered Neural Responses to Mirror Touch
Our bodily sense of self contributes to our personal feelings of awareness as a conscious being. How we see our bodies and move through space and feel touched by loved ones are integral parts of our identity. What happens when this sense of self breaks down? One form of dissolution is Depersonalization Disorder (DPD).1 Individuals with DPD feel estranged or disconnected from themselves, as if their bodies belong to someone else, and “they” are merely a detached observer. Or the self feels absent entirely. Other symptoms of depersonalization include emotional blunting, out-of-body experiences, and autoscopy.Autoscopy fo...
Source: The Neurocritic - March 20, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs

I’m a woman and a plastic surgeon. This is what beauty means to me.
When I introduce myself as a plastic surgeon, I am often greeted with surprise. Between the slightly quizzical looks, the concerned head tilts, and the explicit queries, the question is clear: How could a woman of substance find herself in that line of work? The truth is that real plastic surgery (in my world, at least) is nothing like its media representations. The nipped and tucked patients with outlandish requests, the salacious and provocative doctors, the ostentatious displays of wealth and consumption — these have nothing to do with my life or career. Plastic surgery, at its core, is an academic discipline that...
Source: Kevin, M.D. - Medical Weblog - March 17, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

New doctors should listen to this advice if they want to last
A few years ago, the hospital where I work started new residency programs in internal medicine and family practice. Many of the residents do rotations in anesthesiology and surgery where I have an opportunity to meet and talk with them. They are eager to learn medicine of course, but they are also interested in the perspective that many of us who have been practicing medicine for many years have to offer them. Given the opportunity to speak to a large group of early career physicians or medical students, I think I would offer the following advice. First and foremost, do not be afraid to take care of yourself. With all ther...
Source: Kevin, M.D. - Medical Weblog - March 16, 2016 Category: Journals (General) Authors: Tags: Physician Medical school Residency Source Type: blogs

A female physician is murdered. A call to action to end intimate partner abuse.
This week, the community of women physicians was rocked by the death of one in our midst, an anesthesiologist, intensivist, medical school faculty member, and mother, in an apparent domestic violence homicide. Dr. Casey Drawert (yes, we will say her name) was a highly accomplished physician married to a “prominent businessman” adding to the media-stickiness of the story.  Her success clashes with our deeply entrenched biases about the demographics of domestic violence victims. Yet again, we were reminded that although certain groups may be more susceptible, domestic violence (I prefer the more specific te...
Source: Kevin, M.D. - Medical Weblog - March 14, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Women may experience more pain than men, but receive less treatment for it
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. That men and women are different has been discussed since Adam and Eve. That they experience and cope with pain differently has been consistently described in research studies. It is concerning, however, to learn that women may experience more pain than men, but receive less treatment for it. In a study of 1,000 emergency room patients, it was found that women were up to 25 percent less likely to receive opioid pain medications to treat their pain despite reporting the same pain scores as men. In addition, they were made to wait more tha...
Source: Kevin, M.D. - Medical Weblog - March 12, 2016 Category: Journals (General) Authors: Tags: Physician Pain management Source Type: blogs

What medical students and residents deserve
An anonymous medical student has this post on KevinMD – A star medical student feels like he made a terrible decision. And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where they limit their involvement with patients: dermatology, radiology, ophthalmology, anesthesiology. It begs the question: why are these the happiest, the most high-salaried, and patient-limited specialties? They all must have a connection. He goes on to la...
Source: DB's Medical Rants - March 9, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Why we need to build bridges between primary care and anesthesiology
The numbers haven’t changed significantly in several years — only five percent of the U.S. population consumes a full 50 percent of annual health care spending, and just one percent is responsible for nearly 23 percent of spending. Within the top 10 percent of high spenders, most (nearly 80 percent) are age 45 or older. About 42 percent are persistent high consumers year after year, while the majority requires high spending only on an occasional basis. These episodes of high health care consumption often involve surgery or other invasive procedures in the older patient population. The experience of undergoing surge...
Source: Kevin, M.D. - Medical Weblog - March 7, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Data Simplification: Hitting the Complexity Barrier
Conclusions have no value until they are independently validated. Anyone who attempts to stay current in the sciences soon learns that much of the published literature is irreproducible (8); and that almost anything published today might be retracted tomorrow. This appalling truth applies to some of the most respected and trusted laboratories in the world (9), (10), (11), (12), (13), (14), (15), (16). Those of us who have been involved in assessing the rate of progress in disease research are painfully aware of the numerous reports indicating a general slowdown in medical progress (17), (18), (19), (20), (21), (22), (23),...
Source: Specified Life - March 5, 2016 Category: Information Technology Tags: complexity computer science data analysis data repurposing data simplification data wrangling information science simplifying data taming data Source Type: blogs

February blogs digest: Zika virus, getting published, sepsis, cancer, and more
Zika virus – investigating the outbreak Zika virus has recently been declared a global health emergency following an outbreak detected in Brazil last year. The virus has now moved into more than 20 countries in Latin America, becoming a huge threat, particularly with pregnant women whereby the virus has been linked to microcephaly. We asked Dr Claudia Nunes Duarte dos Santos, whose laboratory is responsible for confirming Zika virus in Brazil, more about the virus. In addition, we explored the genetic control methods that are ready to be used to control the Zika outbreak. How to get published: top tips from our editors W...
Source: BioMed Central Blog - March 4, 2016 Category: Journals (General) Authors: Sophie Marchant Tags: Biology Health Medicine blogs digest Source Type: blogs

Staff at work
One of the great pleasures of being ex-CEO of a hospital is to visit other places around the world and see the staff in action.  Whatever you might have heard about the stresses and problems faced by doctors and nurses and others, there remains an underlying sense of purpose and commitment that often shines through.Here's a example, from the theatre in which young patients at Royal Children's Hospital receive lumbar punctures and bone marrow tests to receive chemotherapy and/or to assess their progress with regard to leukemia treatments.  I offer the explanation totally in pictures, which pretty well tell the sto...
Source: Not running a hospital - March 4, 2016 Category: Hospital Management Source Type: blogs

New ABIM MOC Process: Asking for Physician Input
The American Board of Internal Medicine (ABIM) is setting a new process for internists and subspecialists on various aspects of Maintenance of Certification (MOC) assessments. These changes come in connection with the Assessment 2020 Task Force report, and will align with ABIM's continuous improvement efforts. As the MOC program continues to evolve, the goal is to ensure that the clinical content is relevant to a broad cross-section of physicians. As such, ABIM board certified physicians can provide input on what topics are most important and most often seen in practice, and some physicians will even be able to participa...
Source: Policy and Medicine - March 3, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

The 2017 Benefit And Payment Parameters Final Rule: Drilling Down (Part 2)
Implementing Health Reform. This is my third post on the 2017 Benefit and Payment Parameters final rule. The first post summarized the highlights of the rule and the final 2017 Letter to Issuers in the Federally Facilitated Marketplace. The second post offered a deep dive into the first half of the BPP rule; this post analyzes the second half of the rule. A final post on the details of the Letter to Issuers will follow in a day or two. This post will cover notices to employers; financial subsidy eligibility verification; reenrollment and binder payments; open and special enrollments; eligibility appeals; individual respon...
Source: Health Affairs Blog - March 2, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs

CMS Issues 2017 Benefit And Payment Parameters Rule And Letter To Issuers In The Federally Facilitated Marketplaces
Implementing Health Reform. On February 29, 2016, the Department of Health and Human Services released its final 2017 Benefit and Payment Parameters Rule (with fact sheet) and final 2017 Letter to Issuers in the Federally Facilitated Marketplaces (FFMs). It also released a bulletin on rate filings for individual and small group non-grandfathered plans during 2016, a frequently asked questions document on the 2017 moratorium on the health insurance provider fee recently adopted by Congress, and a bulletin announcing that CMS intends to allow transitional (grandmothered) policies to continue (if states permit it) through De...
Source: Health Affairs Blog - March 1, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs

'Dry eye' linked to chronic pain syndromes - Medical Xpress
Physician-researchers with Bascom Palmer Eye Institute, part of UHealth—the University of Miami Health System, have found a link between "dry eye" and chronic pain syndromes—a finding that suggests that a new paradigm is needed for diagnosis and treatment to improve patient outcomes. "Our study indicates that some patients with dry eye have corneal somatosensory pathway dysfunction and would be better described as having neuropathic ocular pain," said Anat Galor, M.D., M.S.P.H., a cornea and uveitis specialist and associate professor of clinical ophthalmology at Bascom Palmer Eye Institute at the U...
Source: Psychology of Pain - February 27, 2016 Category: Anesthesiology Source Type: blogs

Ear, Nose & Throat Team Returns from Medical Mission after Cyclone Winston Rocks Fiji
A 12-person team of nurses, surgeons, residents and anesthesiologists from the University of Maryland Medical Center have returned from their medical mission in Fiji.   Team members performed 15 surgeries and saw 150 patients before Tropical Cyclone Winston rocked the islands.   Watch the video above to hear about the mission from the team themselves. To donate & learn more about the team, click here. Previous coverage: ENT Surgical Team Annual Volunteer Trip   (Source: Life in a Medical Center)
Source: Life in a Medical Center - February 26, 2016 Category: Universities & Medical Training Authors: Chris Lindsley Tags: Community Outreach Employees & Staff Nurses Uncategorized ear medical mission nose and throats Source Type: blogs

Moops?: A Roadmap To MIPS
After a seemingly endless stream of stop-gap “doc fixes,” President Obama on April 14, 2015, signed into law a permanent repeal and replacement of Medicare’s Sustainable Growth Rate formula. The 2015 law, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10), permanently reformed Medicare physician payments and (finally) put to rest what had become a dreaded perennial legislative ritual of blocking reimbursement cuts. See my Health Affairs Blog post from last April for more on that. MACRA’s Two Physician Payment Pathways: MIPS And APMs MACRA replaced the Sustainable Growth Rate wit...
Source: Health Affairs Blog - February 26, 2016 Category: Health Management Authors: Billy Wynne Tags: Costs and Spending Featured Insurance and Coverage Medicaid and CHIP Medicare Payment Policy Congress MACRA Merit-Based Incentive Payment System Physicians Source Type: blogs

Research and Reviews in the Fastlane 123
Welcome to the 123th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is 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 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check ou...
Source: Life in the Fast Lane - February 24, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Education Emergency Medicine Intensive Care R&R in the FASTLANE Resuscitation Toxicology and Toxinology Trauma critical care recommendations research and reviews Source Type: blogs

Percutaneous balloon pericardiotomy :What is the anatomical track ? Where does the fluid drain ?
  Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='http://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(typeof jQuery !=='undefined')jQuery(d.body).trigger('pd-script-load');}(document,'script','pd-polldaddy-loader')); Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='http://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(ty...
Source: Dr.S.Venkatesan MD - February 24, 2016 Category: Cardiology Authors: dr s venkatesan Tags: cardiac tamponade Cardiology -Therapeutic dilemma Pericardium balloon pericardiotomy percutaneous baloon pericardiocentesis Source Type: blogs

Percutaneous balloon pericardiotomy :What is the anatomical track ? Where does the fluid drain ?
  Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='https://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(typeof jQuery !=='undefined')jQuery(d.body).trigger('pd-script-load');}(document,'script','pd-polldaddy-loader')); Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='https://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(...
Source: Dr.S.Venkatesan MD - February 24, 2016 Category: Cardiology Authors: dr s venkatesan Tags: cardiac tamponade Cardiology -Therapeutic dilemma Pericardium balloon pericardiotomy percutaneous baloon pericardiocentesis Source Type: blogs

A Better Pathway to Acute Care
By KAREN SIBERT, MD When patients need acute interventional care, coordinating the transitions away from and back to primary care is a challenge. The common pathway for these patients, no matter what their diagnosis, is an encounter with anesthesiology. But it often happens too late in the process. If we’re involved earlier, physician anesthesiologists can help reduce procedure risk, control costs, and improve the long-term health of this high-risk, high-spend population.                     The numbers haven’t changed significantly in several years—only five percent of the U.S. population consumes a full ...
Source: The Health Care Blog - February 21, 2016 Category: Consumer Health News Authors: Simon Nath Tags: Featured THCB Karen Sibert Source Type: blogs

Understanding Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM’s)
Discussion MACRA enshrines the concept of value vs. volume and a seismic shift from fee for service to value based payments. There will be tremendous need for education for today's clinicians to further understand MACRA and all its ramifications. Big questions need to be answered such as what the rule will look like, what does it mean to bear more than nominal financial risk, what will be included in value, will MIPS Meaningful Use, PQRS and Value Based Modifiers be similar to the current system . Fortunately, there will be opportunities to let your voice be heard on this very important program.    &#...
Source: Policy and Medicine - February 18, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Who are responsible for OR delays? And what can we do about them?
Every two or three years, someone, usually a hospital administrator, decides that delays in operating room turnover time need to be looked into. A committee of 20 or 30 stakeholders (love that term) is appointed and assigns someone the job of measuring the time between cases and identifying reasons for delays. In years when turnover time is not being studied, first case starting delays are on the agenda. In my nearly 24 years as a surgical department chair, one or the other of these issues was investigated at least ten times. We were never able to conclusively determine the exact causes of delays or solutions to the proble...
Source: Kevin, M.D. - Medical Weblog - February 17, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Who is responsible for OR delays? And what can we do about them?
Every two or three years, someone, usually a hospital administrator, decides that delays in operating room turnover time need to be looked into. A committee of 20 or 30 stakeholders (love that term) is appointed and assigns someone the job of measuring the time between cases and identifying reasons for delays. In years when turnover time is not being studied, first case starting delays are on the agenda. In my nearly 24 years as a surgical department chair, one or the other of these issues was investigated at least ten times. We were never able to conclusively determine the exact causes of delays or solutions to the proble...
Source: Kevin, M.D. - Medical Weblog - February 17, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

US Continues to Face Drug Shortages
Once again we are facing national shortage of key drugs, including anesthetics, painkillers, antibiotics, and cancer treatments. We have written several times about previous drug shortages, all resulting in little to no beneficial long-term action. The American Society of Health-System Pharmacists maintains a list of drug shortages, which is currently 150 drugs and therapeutics long. The 150 drugs are at inadequate supply levels for a multitude of reasons, ranging from manufacturing problems to federal safety crackdowns to drug makers abandoning low-profit drugs. While the shortages have long been public knowledge, what ...
Source: Policy and Medicine - February 15, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Is there any hope for physician-only anesthesia groups?
Today is a remarkable day for me. I’m officially leaving private practice after almost 18 years, to return to academic medicine with a faculty position in a highly regarded California department of anesthesiology. Why would I do that? There are many positive reasons. I believe in the teaching mission of academic medicine:  to train the anesthesiologists of the future, and the scientists who will advance medical care. I enjoy teaching. The years I’ve spent at the head of the operating room table, anesthetizing patients every day, have given me a great deal of hands-on experience (and at least some wisdom) that I’m h...
Source: Kevin, M.D. - Medical Weblog - February 12, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Funtabulously Frivolous Friday Five 135
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 135 Question 1 What was the cause for the most fatalities at Pearl Harbour? + Reveal the Funtabulous Answer expand(document.getElementById('ddet407585579'));expand(document.getElementById('ddetlink407585579')) NOT Thiopental (but the initial trauma or delayed hemorrhagic shock) It has been a popular myth that Thiopental caused more deaths than the initial trauma but of the 344 patients admitted to the Tripler Army Hospi...
Source: Life in the Fast Lane - February 12, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five Aluminium Anaesthetics Buddy Ebsen FFFF Heidelberg Electric Belt impotence Kehr's sign pearl harbour Princess Diana pulmonary vein splenic rupture thiopental thoracotomy Source Type: blogs

Is a punitive culture contributing to physician burnout?
Burnout, burnout, burnout.  It seems like that is all anyone wants to talk about these days.  And I admit, some days, I can get burnt out on burnout.  But, all the attention on the subject got me thinking.  Did burnout not exist 30 years ago? Why is this such a hot topic now? And that is what brings me to this post; I came to the realization that burnout very much existed 30 years ago, but that the current “write-up” culture, and what I affectionately refer to as the “Twitter effect,” that is now prevalent in healthcare and most U.S. hospitals has made it infinitely worse. Let’s face it.  Surgeons have a re...
Source: Kevin, M.D. - Medical Weblog - February 12, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

An open letter to The Lancet, again
On November 13th, five colleagues and I released an open letter to The Lancet and editor Richard Horton about the PACE trial, which the journal published in 2011. The study’s reported findings–that cognitive behavior therapy and graded exercise therapy are effective treatments for chronic fatigue syndrome–have had enormous influence on clinical guidelines for the illness. Last October, Virology Blog published David Tuller’s investigative report on the PACE study’s indefensible methodological lapses. Citing these problems, we noted in the letter that “such flaws have no place in publis...
Source: virology blog - February 11, 2016 Category: Virology Authors: Vincent Racaniello Tags: Information chronic fatigue syndrome Lancet mecfs myalgic encephalomyelitis PACE request for data Richard Horton vexations Source Type: blogs

Proposing a Microbial Cause of Alzheimer's Disease, Again
The biochemistry of the brain is enormously complex and still poorly understood at the detail level. This is also true of the mechanisms of Alzheimer's disease. Treating Alzheimer's is, more or less, the unified banner under which the research community raises funds to map and catalog the brain. It is why so much funding pours into the study of this one condition in comparison to others. In the research mainstream it is expected that only with much greater understanding of neurobiology will effective therapies emerge. Since the molecular biology involved is so very complicated, there are many gaps into which new theories o...
Source: Fight Aging! - February 11, 2016 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

Research and Reviews in the Fastlane 121
This article discusses a series of cases where fluids and medications were administered through a rectal catheter (Macy catheter) instead of via more traditional routes. The authors conclude that the successful management of the 3 included patients suggests that the device “may be an appealing alternative route.” I have a hard time believing that IV should be avoided in favor of rectal “access” or that IO sites are ever unavailable in patients with difficulty IV access. Recommended by Anand Swaminathan Emergency medicine Choo EK et al. Managing Intimate Partner Violence in the Emergency Departmen...
Source: Life in the Fast Lane - February 10, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Pediatrics Psychiatry and Mental Health R&R in the FASTLANE Resuscitation critical care recommendations research and reviews Source Type: blogs

Surgery for your child is scary. This pediatric anesthesiologist is here to help.
The parental drive to protect your child is passionate, and learning that your child needs surgery is jarring at best and terrifying at worst.  As her guardian and provider, your instinct is to prevent harm to her at all costs, and even if you know that surgery is ultimately in your child’s best interest, the thought of her going through an invasive procedure, combined with the presence of illness or injury, can shake you to the core. I understand all of this; I am a parent.  I recognize the overwhelmed and terrified look in your eyes as I meet you before your child’s operation.  But, I want you to know that as ...
Source: Kevin, M.D. - Medical Weblog - February 8, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Pessimism in Historical Perspective
Pessimism about potentially life-enhancing technologies is not new. The Twitter account Pessimist’s Archive (a favorite of the internet guru Marc Andreessen) chronicles the unending stream of pessimism with old newspaper excerpts.  Pessimistic reactions range from merely doubtful (such as this response to the idea of gas lighting in 1809, or this one to the concept of anesthesia in 1839) to outright alarmist (such as this 1999 warning that e-commerce “threatens to destroy more than it could ever create”).  In some cases, the pessimists insist that an older technology is superior to a new one. Some, for exa...
Source: Cato-at-liberty - February 5, 2016 Category: American Health Authors: Chelsea German Source Type: blogs

Funtabulously Frivolous Friday Five 134
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 134 Question 1 You do a ketamine sedation and the patient develops laryngeal spasm. What physical manoeuvre can you preform to try and resolve the laryngeal spasm while the nursing staff draw up a paralytic? + Reveal the Funtabulous Answer expand(document.getElementById('ddet309560156'));expand(document.getElementById('ddetlink309560156')) Larson’s point or the ‘laryngospasm notch’ [Reference]. Accordi...
Source: Life in the Fast Lane - February 5, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five coffee FFFF fox's sign Hammon's crunch larson's point pancreatitis Source Type: blogs

TechTool Thursday 067 MedShr
TechTool review – MedShr by MedShr Ltd on Android and iOS…and website MedShr is a private social network for doctors. It aims to allow the sharing of interesting patients including photos/videos. Members can discuss their cases and ask for suggestions from others. It aims to help improve clinical practice and facilitate learning and the sharing of patient data in a secure environment. The website gives no information about who runs MedShr (a bug bear of mine) but I know from speaking to them that it was created initially by a Cardiologist in the UK. I think they have brought in other UK clinicians to help edit...
Source: Life in the Fast Lane - February 4, 2016 Category: Emergency Medicine Authors: Tessa Davis Tags: Review Social Media Tech Tool Web Culture android App iphone MedShr social network social network for doctors techtool Source Type: blogs

Short-selling Private Practice
By KAREN SIBERT, MD Today is a remarkable day for me. I’m officially leaving private practice after almost 18 years, to return to academic medicine with a faculty position in a highly regarded California department of anesthesiology. Why would I do that? There are many positive reasons. I believe in the teaching mission of academic medicine:  to train the anesthesiologists of the future, and the scientists who will advance medical care. I enjoy teaching. The years I’ve spent at the head of the operating room table, anesthetizing patients every day, have given me a great deal of hands-on experience (and at least some ...
Source: The Health Care Blog - February 4, 2016 Category: Consumer Health News Authors: Simon Nath Tags: THCB Karen Sibert Source Type: blogs

Research and Reviews in the Fastlane 120
Welcome to the 120th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is 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 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check ou...
Source: Life in the Fast Lane - February 3, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Clinical Research Education General Surgery Ophthalmology Pediatrics Pharmacology Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care emergency Emergency Medicine recommendations resea Source Type: blogs

What’s New and In the Queue for Academic Medicine
What’s New: A Preview of the February Issue The February issue of Academic Medicine is now available! Read the entire issue online at academicmedicine.org or on your iPad using the Academic Medicine for iPad app. The issue includes a cluster of articles on entrustment; other highlights include: Health Care Transformation: A Strategy Rooted in Data and Analytics In this New Conversations piece, Koster and colleagues review three examples of the transformational force of data and analytics to improve health care and examine academic medicine’s vital role in guiding the needed changes. Amending Miller’s Pyramid to In...
Source: Academic Medicine Blog - February 1, 2016 Category: Universities & Medical Training Authors: Journal Staff Tags: Featured Issue Preview big data cognitive disabilities faculty development medical errors professional identity formation residency veteran-centered care Source Type: blogs

A Nefarious Character with an Agenda
Every new advanced nurse practitioner, physician assistant, or resident gets his fair share of complex emergency department procedures during training. Seasoned providers, however, are just as excited to place a central line in a septic patient, LP a "rule-out meningitis," or swiftly fix a nursemaid's elbow.This month we hope to remind you of a few sweet and satisfying procedures that take only moments to do. Your skill in completing these procedures is imperative. Not only will you amaze your patient, but you'll shorten your door to dispo-time.The StyeThe stye is a nefarious character with an agenda. It starts o...
Source: The Procedural Pause - February 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs