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Managing Sacroiliac Pain in the Emergency Department
I have been treating specifically localized sacroiliac pain with injections of bupivacaine and methylprednisolone for several years. It seems that every few months I have a patient who presents with localized pain and can benefit from this procedure. The only patients on whom I perform these injections are those who localize their pain to the back dimples, also known as the dimples of Venus or fossae lumbales laterales.   Anatomically, it is known that beneath these dimples are the superior aspects of the sacroiliac joints. These sacral sulci are anatomically just above the posterior superior iliac spine and also the ...
Source: M2E Too! Mellick's Multimedia EduBlog - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Motivate smokers to quit before surgery. It could save lives.
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Physicians who care for surgical patients witness the devastating consequences of cigarette smoking almost every day.  For example, smoking increases the risk of acute complications such as pneumonia and wound infections, and adds to the burden of smoking-related diseases such as heart disease. As we approach November, which is COPD Awareness Month, Lung Cancer Awareness Month and with the Great American Smokeout taking place November 19, we as physicians need to be aware of the important role we can play  in helping ...
Source: Kevin, M.D. - Medical Weblog - November 2, 2015 Category: Journals (General) Authors: Tags: Conditions Surgery Source Type: blogs

Freud and his Drug Demons
Cocaine addiction and psychoanalysis.That Sigmund Freud was a cocaine abuser for some portion of his professional life is by now well known. Reading An Anatomy of Addiction by Howard Markel, M.D., which chronicles the careers of Freud and another famed cocaine abuser, Johns Hopkins surgeon William Halsted, I was struck by the many ways in which even the father of modern psychotherapy could not see the delusions, evasions and outright lies that were the byproducts of his very own disease of the body and mind: drug addiction. Markel makes the case that in several important ways Freud’s cocaine addiction was hopelessly ...
Source: Addiction Inbox - October 30, 2015 Category: Addiction Authors: Dirk Hanson Source Type: blogs

Will your anesthesiologist leave the OR? Patients deserve to know.
“For some must watch, while some must sleep.” – William Shakespeare, Hamlet I admit, I was taken aback at the headline that ran in the Houston Press today: “Going under:  What can happen if your anesthesiologist leaves the room during an operation.” It’s bound to make the curious reader wonder why the anesthesiologist would leave the operating room in the first place. Of course, reporter Dianna Wray explains that in many hospitals, one physician anesthesiologist often supervises multiple cases staffed by nurse anesthetists. This model of care is called the “anesthesia car...
Source: Kevin, M.D. - Medical Weblog - October 27, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Research & Reviews in the Fastlane 105
Welcome to the 105th 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&am...
Source: Life in the Fast Lane - October 21, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Emergency Medicine Update Intensive Care Pre-hospital / Retrieval Psychiatry and Mental Health Resuscitation Trauma critical care R&R in the FASTLANE recommendations research and r Source Type: blogs

FDA Removes Pacira Warning Letter in Midst of Free Speech Suit
We have previously written about Pacira Pharmaceuticals, Inc. and their constitutional challenge against the Food and Drug Administration, which alleges that the FDA has placed unconstitutional restrictions on Pacira’s commercial speech. Pacira filed suit to establish its right to provide truthful and non-misleading information to doctors about its anesthetic product, Exparel. The case goes back to September 2014, when the FDA sent a warning letter accusing Pacira of promoting the anesthetic Exparel for unapproved uses and overstating the drugs effectiveness. The FDA concluded their letter by warning Pacira of potent...
Source: Policy and Medicine - October 21, 2015 Category: American Health Authors: Policy and Medicine Writing Staff Source Type: blogs

How Proposed New Rules Could Change the Anesthesia Care Team
By KAREN SIBERT, MD I admit, I was taken aback at the headline in the Houston Press: “Going Under: What Can Happen if your anesthesiologist leaves the room during an operation.” The curious reader is bound to wonder why the anesthesiologist would leave the operating room in the first place. Of course, reporter Dianna Wray explains that in many hospitals, one physician anesthesiologist often supervises multiple cases staffed by nurse anesthetists. This model of care is called the “anesthesia care team“, and has a very long record of safe practice in nearly all major hospitals in the United Stat...
Source: The Health Care Blog - October 16, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Karen Sullivan Sibert Source Type: blogs

Research & Reviews in the Fastlane 104
Welcome to the 104th 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&am...
Source: Life in the Fast Lane - October 15, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Emergency Medicine Update Haematology Immunology Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care Review Source Type: blogs

How pediatric critical care and a physician anesthesiologist saved a teen’s life
It’s amazing when events that seem to be “miracles” happen, and even more magical to be a part of them, however peripherally. My husband, David Merzel, MD, a physician anesthesiologist and pediatric intensive care specialist, and his patient, 17-year-old Chiann Wheeler, share the remarkable story of Chiann’s brush with death from sepsis, and how David’s quick diagnosis saved her life. The story began one morning when then 15-year-old Chiann felt so sick that her father brought her to the emergency department at Bakersfield Memorial Hospital (BMH) in Bakersfield, a town of about 350,000 in cent...
Source: Kevin, M.D. - Medical Weblog - October 11, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Hospital 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 doe...
Source: Policy and Medicine - October 9, 2015 Category: American Health Authors: Policy and Medicine Writing Staff Source Type: blogs

Editorial Board Q&A: Peter M. Fleischut, MD
Peter M. Fleischut, MD, associate professor of anesthesiology, Weill Cornell Medical College, and attending anesthesiologist, New York–Presbyterian Hospital, New York, New York. 1.  Describe your current activities. I’m currently the founding director of the Center for Perioperative Outcomes (CPO) at Weill Cornell Medical College. The CPO encompasses methodological, statistical, and information technology resources within a single center to encompass operational efficiencies, quality, compliance, and outcomes research. 2. What gaps do you see in today’s scholarship? Within current academic medicine, ...
Source: Academic Medicine Blog - October 8, 2015 Category: Universities & Medical Training Authors: Guest Author Tags: Editorial Board Q & A Featured anesthesiology health outcomes innovation New York–Presbyterian Hospital Peter M. Fleischut Weill Cornell Medical College Source Type: blogs

Research & Reviews in the Fastlane 103
This study is quite limited as it doesn’t include potential recommendations for these over the counter medications but is a good reminder to prescribe stool softeners/laxatives with opioids. Recommended by Lauren Westafer Emergency medicineRodrigo GJ et al. Assessment of acute asthma severity in the ED: are heart and respiratory rates relevant? Am J Emerg Med 2015. PMID 26233619 The authors of this paper want to tell us that vitals signs aren’t helpful in asthma, but I think their conclusions are entirely backwards. This is a retrospective look at data that was collected prospectively as part of 7 other asth...
Source: Life in the Fast Lane - October 7, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Immunology Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care Review Source Type: blogs

Terminal dehydration: A gentle way to die?
On a September night not long after his 83rd birthday, my father suffered a massive stroke.  It left him conscious yet unable to talk and communicate, unable to swallow, and almost completely paralyzed. After numerous scans and other tests, his doctors determined that there was no chance for recovery.  My father would never walk, talk, or swallow food again.  With nothing more to do for him in the hospital, we — my mother, my sister, and I — needed to decide what to do next.  The social worker on the case encouraged us to put Dad in a nursing home.  A gastric feeding tube could be put i...
Source: Kevin, M.D. - Medical Weblog - October 7, 2015 Category: Journals (General) Authors: Tags: Physician Palliative care Source Type: blogs

Finding Common Ground in the Search for Better Patient Care and Outcomes
By JOE V. SELBY, MD A basic rule of scientific discovery is that the answers you get are only as good as the questions you ask. That is certainly the case in health care. Traditionally, it has been the sole responsibility of health researchers to develop questions for study that, when answered, can provide reliable and relevant information for patients and clinicians. For the most part, they’ve done an exceptional job, as evidenced by countless discoveries about the nature of disease and remarkable advances in diagnosing, preventing and treating them. But when researchers are the only ones determining scientific inqu...
Source: The Health Care Blog - October 7, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Source Type: blogs

Watch these anesthetists smoothly croon in the OR
If only being in the OR can be as smooth as the singing from Gary Corzine’s group, the Laryngospasms. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 6, 2015 Category: Journals (General) Authors: Tags: Video Surgery Source Type: blogs

Find your social media voice. Patients are listening.
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. “Social media engagement” is a buzzword in today’s business world. There is no clear definition of this term, but most agree that it involves some measure that those looking at your online content are actually interested in what you have to say. In other words, is anybody listening? One of the definitions of “engage” is to “hold the attention of, give attention to, or take part in something.” Chances are many of you reading this have a social media account (or two, or three) and your gr...
Source: Kevin, M.D. - Medical Weblog - October 5, 2015 Category: Journals (General) Authors: Tags: Social media Facebook Twitter Source Type: blogs

Funtabulously Frivolous Friday Five 119
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 119 Question 1 Which surgeon had a mortality rate of 300% during a single operation? How did this happen? + Reveal the Funtabulous Answer expand(document.getElementById('ddet109074172'));expand(document.getElementById('ddetlink109074172')) Robert Liston (1794-1847) Liston operated in a time before anaesthesia. It was recognised that a speedy operation could significantly improve the outcomes for a patient, and Mr Liston ...
Source: Life in the Fast Lane - October 2, 2015 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five capecitabine ciguatera FFFF louis pasteur Oncology rabies robert liston virchow Source Type: blogs

Tap that Knee! Basics of Arthrocentesis
Part 2 of a Series   Our series on joint care has given you a basic overview on knee arthrocentesis. Typically, it is not necessary to have an orthopedic consultant come to the bedside in the emergency department to do this procedure. Arthrocentesis is a procedure you can do well and feel confident about your technique.   Take a moment to review our last blog post on knee pain before reading this post and watching the accompanying video. (http://bit.ly/1Q7dG4h.) As always, review the anatomy; it plays a key part in successful bedside technique. Ultrasound-guided arthrocentesis is always a favored approach.  ...
Source: The Procedural Pause - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research & Reviews in the Fastlane 102
This study reviewed data from over 30,000 OHCA and found that the initiation of early CPR (prior to EMS arrival) was associated with increased 30-day survival (10.5% vs. 4.0%). Unfortunately, the database has only limited information on neurologic function and thus, improved functional status cannot be assessed from this data set. However, this study further supports the need for increased lay person training as well as methods of bringing those lay providers to the patient (i.e. GoodSam application, mobile phone programs etc). Recommended by Anand Swaminathan Trauma Reith G et al. Injury pattern, outcome and characteri...
Source: Life in the Fast Lane - October 1, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Education Emergency Medicine Emergency Medicine Update Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Review Toxicology Trauma critical care literature research and reviews Source Type: blogs

America’s Nursing Crisis
By SUSAN DENTZER Many of the nation’s nurses understandably erupted in anger when the co-hosts of ABC’s The View mocked Miss America contestant Kelley Johnson for her pageant-night monologue about being a nurse — and for wearing scrubs and a “doctor’s stethoscope” (their words) in the talent competition. The co-hosts, Joy Behar and Michelle Collins, have since apologized, especially for implying that only doctors use stethoscopes. “I didn’t know what the hell I was talking about,” Behar later said. It would be easy to attribute this episode solely to the ignorance...
Source: The Health Care Blog - September 26, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB National Academy of Medicine Nursing Practice Programs Professional Rivalries Robert Wood Johnson Foundation Susan Dentzer Source Type: blogs

The 21st Century Cures Act: More Homework To Do
In July, the US House of Representatives approved the 21st Century Cures Act, which heads to the Senate for a vote this fall. While no one can complain about the Act’s purported goal of “bring[ing] our health care innovation infrastructure into the 21st Century,” or increasing funding for the National Institutes of Health, the optimism surrounding the legislation obscures measures buried within that many agree will make newly approved drugs and medical devices less safe and effective, increase the cost of medical products, and discourage innovation in biomedical research. Long-term value to the public&rsq...
Source: Health Affairs Blog - September 24, 2015 Category: Health Management Authors: Susan Molchan, James Rickert and John Powers Tags: Costs and Spending Drugs and Medical Technology Featured Health Professionals Hospitals Public Health Quality 21st Century Cures Act Big Pharma Drug approval Fred Upton Research funding Thurgood Marshall Source Type: blogs

Maintenance of Certification: American Board of Anesthesiology Ends 10-Year Exam; ABIM Considers New Continuous Testing Model As Well
Recently, the American Board of Anesthesiology (ABA) announced it will become the first medical board to restructure its Maintenance of Certification (MOC) program. The Maintenance of Certification in Anesthesiology Program, or MOCA, has required physicians to take a recertification test every 10 years. It will be replaced by a program known as “MOCA 2.0,” which will allow anesthesiologists to continuously assess themselves and identify knowledge gaps through an online portal, including a "MOCA Minute" that allows physicians to answer multiple-choice questions at their own convenience. This shift is n...
Source: Policy and Medicine - September 21, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

The human cost of breast cancer screening
This article originally appeared in Forbes. Image credit: Shutterstock.com Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 18, 2015 Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs

Research and Reviews in the Fastlane 100
This study, using skin tests, found that 0 out of 211 patients demonstrated cross-reactivity between penicillin and aztreonam. The authors recommend skin testing prior to administration and skin testing isn’t a perfect surrogate for a systemic reaction upon IV administration but the best evidence we have shows that cross-reactivity is highly unlikely. Recommended by: Anand Swaminathan Pediatrics Park G et al. Randomized single-blinded clinical trial on effects of nursery songs for infants and young children’s anxiety before and during head computed tomography. Am J Emerg Med. 2015. PMID: 26314215 This RCT ran...
Source: Life in the Fast Lane - September 16, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Education Emergency Medicine Emergency Medicine Update Haematology Immunology Infectious Disease Intensive Care Palliative care Pediatrics R&R in the FASTLANE critical care literature recommendations research and r Source Type: blogs

Promising news from ABIM
Discussion of Changes to ABIM Certification and MOC Here is the short story: Key recommendations from the report include: Change the MOC exam. The Task Force recommends replacing the 10-year MOC exam with more meaningful, less burdensome assessments. Focus assessments on cognitive and technical skills. Assessment of cognitive skills assures the public that physicians are staying current with the clinical knowledge relevant to patient care. Assessment of technical skills ensures that physicians can apply that knowledge to adequately perform the technical procedures appropriate to the discipline. Recognize specialization. Th...
Source: DB's Medical Rants - September 16, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

8th Annual Pediatric Bioethics Conference
Discussion: Ethical Issues Surrounding Childhood Immunizations  Bruce McIntosh, MD   Co-Interim Statewide Child Protection Team Medical Director  Ray Moseley, PhD Bioethics, Law and Medical Professionalism; Director, CTSI Academy of Research Excellence, University of Florida College of Medicine, Gainesville  Samir Midani, MD  Nemours Children’s Specialty Care, Infectious Disease CME Accreditation Statement (CMEs): (Source: blog.bioethics.net)
Source: blog.bioethics.net - September 16, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

What to say when medical certainty is elusive
Doctors do not know everything. We make mistakes and mistakes in judgment. Sometimes we make the mistake of speaking when we should keep silent. At times, patients ask us questions that we can’t or shouldn’t answer; and yet we do. It shouldn’t be our objective to force certainly into an issue that is amorphous and murky. Here’s a response that I recommend in situations where certainty is elusive. “I don’t know.” I saw a patient for the first time when he was sent to me for a colonoscopy. Prior to the procedure, we interviewed him to be acquainted with his medical history. We are al...
Source: Kevin, M.D. - Medical Weblog - September 15, 2015 Category: Journals (General) Authors: Tags: Physician Cancer GI Source Type: blogs

Wisdom versus knowledge for practicing internists
I have given my Learning How to Think like a Clinician several times recently. Each time physicians in the audience seem to particularly like one line that I use – Wisdom trumps Knowledge. In 2015, we all have rapid access to information. My team regularly uses smartphones, pads or computers to get precise information while on rounds. We cannot remember everything. More important than knowing is knowing what information we need. In our 2014 Annals of Internal Medicine editorial we called for a formative rather than summative process. A formative process describes a process in which the learner gets frequent feedback ...
Source: DB's Medical Rants - September 15, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

New books & e-books
Textbook of geriatric dentistry /Poul Holm-Pedersen (ed). 3rd ed, Chichester, West Sussex: Wiley Blackwell, 2015. This textbook provides a comprehensive review of the aging process and its relevance to oral health and dentistry. Now in full colour, the third edition has been fully revised and updated with new material encompassing recent research and clinical developments within geriatric dentistry. The dentist's quick guide to medical conditions /Mea A. Weinberg. Chichester, West Sussex: Wiley Blackwell, 2015. This book presents relevant information dentists need to deal with medical conditions: symptoms, diagnostic test...
Source: DentistryLibrary@Sydney - September 14, 2015 Category: Dentistry Tags: E-books New books Source Type: blogs

New books & e-books
Textbook of geriatric dentistry /Poul Holm-Pedersen (ed). 3rd ed, Chichester, West Sussex: Wiley Blackwell, 2015. This textbook provides a comprehensive review of the aging process and its relevance to oral health and dentistry. Now in full colour, the third edition has been fully revised and updated with new material encompassing recent research and clinical developments within geriatric dentistry. The dentist's quick guide to medical conditions /Mea A. Weinberg. Chichester, West Sussex: Wiley Blackwell, 2015. This book presents relevant information dentists need to deal with medical conditions: symptoms, diag...
Source: DentistryLibrary@Sydney - September 14, 2015 Category: Dentistry Tags: E-books New books Source Type: blogs

Penalized for "On-Label" Marketing? In Wake of Amarin, Pacira Files First Amendment Complaint Against FDA
Last week, Pacira Pharmaceuticals, Inc. filed a lawsuit against the Food and Drug Administration (FDA) seeking to establish its right to provide truthful and non-misleading information to doctors about its anesthetic product, Exparel. This case follows last month’s decision in Amarin v. FDA, in which the Southern District of New York held that, under the First Amendment, FDA could not restrict Amarin Pharma’s ability to promote truthful non-misleading off-label information about Vascepa. Pacira's case brings a number of interesting facts to the table that have the potential to further shape how FDA regulates pr...
Source: Policy and Medicine - September 14, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Now is the time for acute pain medicine specialists
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Since September is Pain Awareness Month, it’s time to recognize that not all pain is equal. Chronic pain can be alleviated, but “acute” pain (sudden onset, brief in duration, often with an identifiable cause) must be eliminated. This requires a systems-based approach led by physicians dedicated to understanding the physiological processes associated with acute pain and investigating new ways to treat it. The solution is definitely not to give patients more and more opioids. As our understan...
Source: Kevin, M.D. - Medical Weblog - September 12, 2015 Category: Journals (General) Authors: Tags: Conditions Pain management Source Type: blogs

The AMA’s Forgotten Fight Against Physician Greed
By MICHAEL MILLENSON Perhaps the most well-known part of the 1965 Medicare creation tale is the opposition by the American Medical Association (AMA) to “socialized medicine.” Yet with financial incentives assuming a new prominence for provider and patient alike, we shouldn’t overlook the AMA’s equally unsuccessful battle against the excesses of capitalistic medicine. The forgotten story of the professionalism’s failure to contain physician greed provides an important policy perspective. The Myth Of Medicine’s ‘Golden Age’ Medical practice pre-1965 is often portrayed as a myth...
Source: The Health Care Blog - September 10, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Medicare, Fair Pay, And The AMA: The Forgotten History
Perhaps the most well-known part of the 1965 Medicare creation tale is the opposition by the American Medical Association (AMA) to “socialized medicine.” Yet with financial incentives assuming a new prominence for provider and patient alike, we shouldn’t overlook the AMA’s equally unsuccessful battle against the excesses of capitalistic medicine. The forgotten story of professionalism’s failure to contain physician greed provides an important policy perspective. The Myth Of Medicine’s ‘Golden Age’ Medical practice pre-1965 is often portrayed as a mythical “Golden Age.&r...
Source: Health Affairs Blog - September 10, 2015 Category: Health Management Authors: Michael Millenson Tags: Costs and Spending Health Professionals Hospitals Medicaid and CHIP Medicare Payment Policy Quality Affordable Care Act American Medical Association George H.W. Bush Kenneth Arrow Physicians Richard Nixon socialized medicine Source Type: blogs

Research and Reviews in the Fastlane 099
This study took a sample from healthy pregnant patients (n=760) at different stages of gestation. They found, unsurprisingly, that d-dimer increases with gestational age, congruent with limited prior literature. They propose a continuous increasing d-dimer in pregnancy. With PE experts such as Dr. Kline proposing gestation adjusted d-dimer, this is a research space to watch. Recommended by: Lauren Westafer Systems and administration Del Portal DA, et al. Impact of an Opioid Prescribing Guideline in the Acute Care Setting. J Emerg Med 2015. PMID: 26281819 As many EDs implement voluntary opioid prescribing guidelines, this...
Source: Life in the Fast Lane - September 9, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Wanted: Pharmacology, Physiology, and Biological Chemistry Division Director
Search Committee Members: Helen Sunshine, National Institute of General Medical Sciences, Chair René Etcheberrigaray, Center for Scientific Review Irene Glowinski, National Institute of Allergy and Infectious Diseases Sherry Mills, Office of Extramural Research, NIH Philip Cole, Johns Hopkins University School of Medicine Judith James, University of Oklahoma Health Sciences Center Scott Miller, Yale University With the recent retirement of Dr. Michael Rogers, the search is now open for an outstanding individual to serve as director of our Division of Pharmacology, Physiology, and Biological Chemistry (PPBC). This p...
Source: NIGMS Feedback Loop Blog - National Institute of General Medical Sciences - September 8, 2015 Category: Biomedical Science Authors: Monique Hall Tags: Job Announcements Source Type: blogs

Perfect Job, perfect specialty??
I remember how difficult it was for me to choose a specialty. Initially (as in before medical school), I wanted to be a dermatologist. I loved cosmetics and hair products, and as a college student I thought I'd go into some sort of 'beautifying' medical specialty.Once in medical school they forced upon us that primary care crap tried to encourage us to consider careers in primary care. And I did...seriously. I really, really liked the idea of family practice. The doctor that sees the entire family, and watch the kids grow up, and have continuity of care, and keep the family healthy, yadda yadda yadda.Then, I started having...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs

You can easily become the physician that you judge
A recent paper in the Annals of Internal Medicine has sparked a large media response. In it, two incidents are described: In one, a male OB/GYN is prepping a patient’s vaginal area for surgery, which involves running a brush soaked in Betadine or ChloraPrep solution over the labia, mons pubis, perineum, and inner thighs when the patient is already put to sleep by anesthesia.  He makes an appalling joke, “I bet she is enjoying this.” In the second, another male OB/GYN resident runs into a room with a patient bleeding to death from her vagina.  He controls the bleeding with manual pressu...
Source: Kevin, M.D. - Medical Weblog - September 7, 2015 Category: Journals (General) Authors: Tags: Physician OB/GYN Source Type: blogs

Infant Dies Following 5 Vaccine Doses
Life after losing a loved one to vaccines is very painful. With a heavy heart, we share Sebastian Ryan Morley’s story. He was a healthy boy whose life ended after routine vaccinations. Sebastian’s mother and grandmother have worked many years in both the veterinary and human healthcare fields. What they were taught in school led them to believe vaccines were safe, but now they will never vaccinate again. We thank his family for coming forward and sharing very important information the public isn’t usually made aware of. Sebastian’s grandmother, Valerie Murfin, shared: “On December 11, 2002, wh...
Source: vactruth.com - September 5, 2015 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Augustina Ursino Human Top Stories adverse reactions dtap Hepatitis B vaccine Sebastian Ryan Morley truth about vaccines Vaccine Death vaccine injury VAERS Valerie Murfin Source Type: blogs

“Our Family Secrets” Exposed — The Ethics of Whistleblowing
This week the Annals of Internal Medicine published an article so controversial they felt the need to publish an accompanying editorial, explaining their decision to publish the anonymous article. The article, “Our Family Secrets” describes two experiences where a health care provider has acted inappropriately while patients were under anesthesia. The editorial describes the acts with poignant alarm: “The first incident reeked of misogyny and... // Read More » (Source: blog.bioethics.net)
Source: blog.bioethics.net - August 29, 2015 Category: Medical Ethics Authors: Sarah Sawicki Tags: Health Care bioethics Culture / Ethnicity / Gender / Disability Ethical Method / Grounding Health Care Practice syndicated Source Type: blogs

What Should Public Health Officials Be Doing About E-Cigarettes?
Are electronic cigarettes a safer alternative to combustible cigarettes, or are they a new gateway to a lifetime of nicotine addiction? In the past month, the editors of The New York Times noted the opposite conclusions from the British agency Public Health England that reported e-cigarettes can reduce the health risks of smoking by 95 percent, compared to a study in the Journal of the American Medical Association, which showed that ninth graders who tried e-cigarettes were far more likely to then use regular combustible tobacco within a year. In a step that may help resolve this controversy, the Food and Drug Administrati...
Source: Health Affairs Blog - August 27, 2015 Category: Health Management Authors: John Maa Tags: Costs and Spending Drugs and Medical Technology Featured Global Health Population Health Public Health Children e-cigarettes FAA FDA Prevention Smoking tobacco vaping Source Type: blogs

The Real Dark Side of Health Care: Health Care Corruption
The editors of the prestigious Annals of Internal Medicine just stated they they were shocked, shocked to find out that physicians occasionally express disrespect for patients when the patients cannot hear or see them.  The occasion was an editorial signed by three editors whose title included the phrase, "shining a light on the dark side of health care."(1)  The editorial referred to an anonymous narrative that recounted two incidents from the past.(2)Two Alleged Incidents of Physicians' Expression of Disrespect for Patients The first incident, discussed second hand, was of a obstetrician who made a se...
Source: Health Care Renewal - August 25, 2015 Category: Health Management Tags: anechoic effect Annals of Internal Medicine health care corruption medical journals professionalism Source Type: blogs

Maybe health costs should be a quality measure
How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for good care: How much is the bill? 15 years ago, I took care of Melissa for gallbladder cancer. She received surgery, radiation and has been in remission ever since. In fact, because she has no need of a grouchy oncologist, I have not seen her in years. Melissa works f...
Source: Kevin, M.D. - Medical Weblog - August 25, 2015 Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs

The "Dark Side" of Medical Education?
It is rare that a medical journal would publish an essay by a physician anonymously which describes the "dark side of medicine" and perhaps including the "dark side" of medical education.  The article is in the August 18 2015 issue of the Annals of Internal Medicine and in an editorial  in the same issue, the following:We hope that medical educators and others will use this essay as a jumping-off point for discussions that explore the reasons why physicians sometimes behave badly and brainstorm strategies for handling these ugly situations in real time. By shining a light on this dar...
Source: blog.bioethics.net - August 24, 2015 Category: Medical Ethics Authors: Maurice Bernstein, M.D. Tags: Health Care syndicated Source Type: blogs

The " Dark Side " of Medical Education?
Discussion Blog)
Source: Bioethics Discussion Blog - August 24, 2015 Category: Medical Ethics Source Type: blogs

How Stanford Med Got “Work-Life Balance” Wrong
By KAREN SIBERT, MD Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”? Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white? Every day, I go to work and see the example of the nurses and technicians who work right alongside me in tough thoracic surgery cases. Zanetta, for instance, is the single mother of five children. She leaves her 12-hour sh...
Source: The Health Care Blog - August 24, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Karen Sibert Stanford Medicine Workplace Wellness Source Type: blogs

Research and Reviews in the Fastlane 096
This study assessed the speed and accuracy of medication administration in simulated pediatric resuscitations. 10 teams consisting of physicians and nurses participated in a cross over study, so that they did one simulation with the new syringes and one without. Time to delivery of medications was quicker with the new syringes (47 versus 19 seconds, a difference of 27 seconds; 95%CI 21-33 seconds). Teams were also more accurate using the new color-coded syringes, with dosing errors occurring 17% of the time with the conventional approach and 0% of the time with the new syringes (absolute difference 17%; 95% CI 4-30%). Obvi...
Source: Life in the Fast Lane - August 19, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma EBM Intensive Care literature R&R in the FASTLANE recommendations research and reviews Respiratory urology Wilderness Medicine Tagg Source Type: blogs

The most feared medical specialty? It’s actually one of the safest.
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I often hear patients say, “I am not afraid of the surgery, just the anesthesia.” But should patients worry?   Physician anesthesiologists suffered a crisis in confidence in 1982 when the ABC television program 20/20 aired, “The Deep Sleep:  6,000 Will Die or Suffer Brain Damage,” about anesthesia complications, brain injury, and death.  At that time, physician anesthesiologists were having difficulty obtaining malpractice insurance because, although anesthesia claims were not the mos...
Source: Kevin, M.D. - Medical Weblog - August 18, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Patients can spot the fake: They need the authentic
“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” – Albert Einstein “Miracles happen every day; change your perception of what a miracle is, and you’ll see them all around you.” — Jon Bon Jovi “The miracle is this: The more we share, the more we have.” — Leonard Nimoy It is amazing when things in medicine work just the way they are supposed to —  it’s like a miracle. When I take an antihistamine, I can breathe, and all the itching and sneezing stops. When I...
Source: Kevin, M.D. - Medical Weblog - August 15, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs