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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 wisd...
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 A...
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. L...
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 pla...
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 Depar...
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 ...
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 ...
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].&nbs...
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 edi...
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 (an...
Source: The Health Care Blog - February 3, 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&am...
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 Mill...
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

LITFL Review 217
Welcome to the 217th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week How do we reach deep within to find empathy when we feel at our worst? By remembering the other side of the story, writes Phil Berry in his blog.“The trick at such times is to access the human in ourselves” [SO]   The Best of #F...
Source: Life in the Fast Lane - January 31, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Championing your specialty through awareness weeks
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Fire Prevention Week.  National Volunteer Week.  Save Your Vision Week.  tTe list goes on! These observances or “awareness weeks” aim to advocate important messages both locally and nationally to the media and public. You may wonder about the effectiveness of an overload of awareness weeks, but if the reasons behind the rally are clear and well-organized, a day, week or month-long observance can serve a distinct purpose and result in tangible benefits; this is especially true for health care. Physicians play a ...
Source: Kevin, M.D. - Medical Weblog - January 31, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Research and Reviews in the Fastlane 119
This study examines the dose-relationship of oxygen therapy and infarct size assess by biomarkers. Excluding hypoxic patients and those with cardiogenic shocks 441 patients with STEMI were randomized to oxygen or room air. Every 100 L increase in oxygen exposure in the first 12 h was associated with significantly increased cTnI and CK of 1,4% and 1,2% respectively. As the median supplemental oxygen exposure was 1746 L this would result in a 21% increase in infarct size. Recommended by: Soren Rudolph Quirky, weird and wonderful Wood CD et al. Evaluation of sixteen anti-motion sickness drugs under controlled laborato...
Source: Life in the Fast Lane - January 27, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Gastroenterology Intensive Care Neurology Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Toxicology Toxicology and Toxinology critical care r Source Type: blogs

TechTool Thursday 065 Nerve Blocks
TechTool review – Nerve Blocks by C&S Publishing on iOS (iPhone and iPad) Nerve Blocks is an app providing guidance on delivering effective regional anaesthesia. It was created by two Australian anaesthetists and was originally the Regional Anaesthesia Pocket Guide, a well-thumbed copy of which sits on the shelf of every Emergency Department in Australia. The app is a modified version of the book, aimed internationally and adapted to include ultrasound guided techniques. Website: – iTunes – Website Design The design is not going to drive you wild with excitement, and particularly given its high p...
Source: Life in the Fast Lane - January 21, 2016 Category: Emergency Medicine Authors: Tessa Davis Tags: Education Review Tech Tool App iOs Nerve Blocks Source Type: blogs

Research and Reviews in the Fastlane 118
This study provides validation of that approach. Although the study was retrospective and only included 45 patients with acute coronary occlusion, it provides valuable information on the utility of ST elevation/S wave ratio for diagnosis of acute MI in this subset of patients. Recommended by: Anand Swaminathan Pediatrics Study of Maternal and Child Kissing (SMACK) Working Group. Maternal kisses are not effective in alleviating minor childhood injuries (boo-boos): a randomized, controlled and blinded study. J Eval Clin Pract 2015. PMID: 26711672 This is kind of interesting in many ways, it appears that the paper was...
Source: Life in the Fast Lane - January 21, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Anaesthetics Cardiology Clinical Research Education Emergency Medicine Haematology Intensive Care Pediatrics R&R in the FASTLANE Respiratory critical care EBM recommendations research and reviews Resuscitation Source Type: blogs

Ann Marie O’Callaghan and Perjeta
By DAVID BELK, MD A respected group of cancer specialists developed a chemotherapy program for a breast cancer patient. But then her insurance company denied the claim, so the cancer center stuck her with a bill three times as large as what they would have required from the insurance company. In June of 2012 Ann Marie O’Callaghan got some of the most terrifying news a woman can get: she had breast cancer. Worse, Ann Marie was only 39 at the time and the oldest of her two children was about to go into kindergarten. Cancers that strike young women can often be very aggressive, but fortunately there were proven treatmen...
Source: The Health Care Blog - January 21, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

LITFL Review 215
Discussions. [SR] In the UK, junior doctors (equivalent of interns/residents) have just staged a walkout due to unfair working conditions. Dr Helgi (@traumagasdoc) sums up some of the issues for anaesthetist/critical care trainees in this blog post. [SO] The Best of #FOAMed Emergency Medicine Fantastic podcast on UK Trauma Units from the St Emlyns Team and Tim Coates. [SL] Cliff Reid discusses prehospital dogma focusing on our resuscitation approach to crush injuries. [AS] The Best of #FOAMcc Critical Care Another great SMACC podcast as Manoj Saxena discusses temperature control in TBI. [SO] The Best of #FOAMtox Toxic...
Source: Life in the Fast Lane - January 17, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Research and Reviews in the Fastlane 117
This study looked at adding the high frequency linear transducer after failure to identify IUP with the standard transducer. Of 81 initial scans, 27 patients did not have an IUP visualized with the curvilinear probe. Of those, 9 (33%) were found to have an IUP by using the linear probe. (It seems like it is helpful if you can see a probable gestational sac, but can’t identify a fetal pole or yolk sac). Recommended by: Justin Morgenstern Pediatrics Padua AP et al. Isotonic versus hypotonic saline solution for maintenance intravenous fluid therapy in children: a systematic review. Pediatr Nephrol. 2015; 30(7): 1163-7...
Source: Life in the Fast Lane - January 13, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Disaster Education Emergency Medicine Emergency Medicine Update Pediatrics Pre-hospital / Retrieval Radiology Trauma critical care examination Intensive Care R&R in the FASTLANE recommendations research and reviews Resuscitatio Source Type: blogs

ENT Surgical Team Annual Volunteer Trip
Annual Volunteer Trip Takes UM Surgical Team to Fiji to Treat Patients with Head and Neck Conditions Update (2/21/16): This past weekend, Fiji was devastated by Cyclone Winston.  All 12 members of the UM surgical team are OK and awaiting the international flight home. Our thoughts and prayers go out to the people of Fiji as they struggle to rebuild, and we pray for the families who lost loved ones and whose homes were destroyed. We are exceptionally proud of the courage and dedication of our mission team. They saw over 100 patients over the course of their stay and completed a large number of surgeries. The ...
Source: Life in a Medical Center - January 12, 2016 Category: Universities & Medical Training Authors: Chris Lindsley Tags: Doctors surgery ENT Fiji Jeffrey Wolf medical mission Natuvu Creek Rodney Taylor Vanua Levu Source Type: blogs

Helmut Schwilden
With regret, we received notice of the death of Helmut Schwilden, Section Head for Technology & Monitoring in Anesthesiology. Schwilden was Professor Extraordinarius at Friedrich-Alexander-Universität in Erlangen-Nürnberg, and joined F1000 in 2008. In his obituary in the Frankfurter Allgemeine, his … Continue reading → (Source: Naturally Selected)
Source: Naturally Selected - January 12, 2016 Category: Biomedical Science Authors: Eva Amsen Tags: Anesthesiology & Pain Management Obituary Source Type: blogs

The struggle of mommy-guilt in physician-mothers is real
What does a 3 year old know? If you don’t like our toddler’s opinion, just wait; she’ll change her mind in a few seconds.  The ever-changing mind of a 3-year-old is what makes the fact that I decided to be a  doctor at that age all the more amazing.  But, that’s how old I was when my parents took me on a mission trip to Haiti, and I decided I wanted to be a doctor.  I witnessed a delivery of twins, and I knew that I was going to grow up and be a doctor. Becoming an MD + Mom: My personal goals seemed so simple until babies arrived I ended up as a pediatric anesthesiologi...
Source: Kevin, M.D. - Medical Weblog - January 12, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

LITFL R&R – Best of 2015
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many  institutions in the U.S. Stop the madness! Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal...
Source: Life in the Fast Lane - January 9, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Trauma critical care examination research and reviews Source Type: blogs

City of St. Paul Takes Cowardly Political Move that is a Public Health Sham; Anti-Smoking Groups Supporting Law Should be Ashamed
Last night, the St. Paul City Council voted to enact an ordinance which bans the sale of flavored tobacco products and flavored electronic cigarettes, unless the retail store is purely a tobacco outlet and access is restricted to adults only.City Council members and health groups put themselves up on a pedestal, claiming that they were taking on Big Tobacco and protecting youth from being seduced by flavorings into using hazardous tobacco products and e-cigarettes.For example, ClearWay Minnesota stated: "With this measure, St. Paul is protecting the health of its young citizens. Not only does this action make the city...
Source: The Rest of the Story: Tobacco News Analysis and Commentary - January 7, 2016 Category: Addiction Source Type: blogs

Research and Reviews in the Fastlane 116
This article raises the question of how important MIC is and whether we should be developing and testing alternate ways to assess antibiotic efficacy. Recommended by: Anand Swaminathan Emergency Medicine Piazza G et al. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. JACC Cardiovasc Interv 2015; 24;8(10):1382-92. PMID: 26315743 This is simple prospective data on a highly selected group of patients with massive or sub massive PEs. There were almost as many authors as patients here&he...
Source: Life in the Fast Lane - January 6, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Infectious Disease Intensive Care Pediatrics Radiology Respiratory critical care examination R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

To See or Not to See
A   A 17-year-old boy presented to the emergency department after having a seizure. Initial vital signs included a temperature of 38°C, heart rate of 134 beats/min, respiratory rate of 22 breaths/min, blood pressure of 142/93 mm Hg, and pulse oximetry of 97% on room air. His physical exam is significant for tachycardia and pupils are 5 mm bilaterally and reactive to light with horizontal nystagmus. He is awake, confused, and combative.   Paramedics report that his mother found him in his bedroom was acting strangely before he fell to the floor and began convulsing. ED staff administered 2 mg intravenous ...
Source: The Tox Cave - January 4, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Should Fluoro be Your New Go-To?
Part Three in a Three-Part Series   This is the third and final part of our series on foreign bodies and fluoroscopy. Click here for part one and here for part two.   This month, we walk you through a step-by-step guide with bonus video footage to aid in your technique. This progressive procedure is absolutely significant to your practice, and we hope you all get a chance to try it.     The Approach n        Identification of foreign body on plain film or ultrasound n         Saphenous or posterior tibial nerve block...
Source: The Procedural Pause - January 4, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Stealth Public Relations and Health Advocacy, Special Pleadings and the Opposition to Guidelines Discouraging Overuse of Narcotics
As I have written before as a physician who saw too many dire results of intravenous drug abuse, I was amazed how narcotics were pushed as the treatment of choice for chronic pain in the 1990s, with the result that the US was once again engulfed in an epidemic of narcotic abuse and its effects.  In mid-December, 2015, as reported in the Washington Post,The nation continues to suffer through a widespread epidemic to prescription opioids and their illegal cousin, heroin. The CDC estimated that 20 percent of patients who complain about acute or chronic pain that is not from cancer are prescribed opioids. Health-care prov...
Source: Health Care Renewal - January 4, 2016 Category: Health Management Tags: CDC Cephalon conflicts of interest deception Endo Health Solutions Johnson and Johnson narcotics public relations Purdue Pharma stealth health policy advocacy Source Type: blogs

New Hampshire Legislation Targets Boards that Govern Opioid Prescribers
This year the presidential primaries in New Hampshire are bringing to national attention the crisis of Opioid addiction.  In a small state like New Hampshire their rate of 400+ overdose deaths a year, brings the issue to the forefront. At New Hampshire town hall meetings candidates are asked hard questions about issues related to Opioid abuse. The New Hampshire State House has proposed legislation that would require all state regulatory boards governing opioid prescribers to update their rules in light of the recent New Hampshire opioid epidemic. Such an update would have a wide-ranging effect, from anesthesiologists...
Source: Policy and Medicine - January 4, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

6 tips to be a great physician leader
I was recently invited to visit an academic anesthesiology department to speak to the residents about becoming a leader.  In addition to recognizing the honor and privilege of addressing this important topic with the next generation of physician anesthesiologists, I had two other initial thoughts:  1) I must be getting old; and, 2) This isn’t going to be easy. I came up with the following list of lessons that I’ve learned over the years.  While some examples I included are anesthesiology-specific, the lessons themselves are not.  Please feel free to edit, adapt, and add to this list; then di...
Source: Kevin, M.D. - Medical Weblog - December 28, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Primary care Source Type: blogs

If surgery is a team sport, should surgeons bear sole responsibility for errors?
A Kentucky appeals court ruled that a surgeon was not responsible for a burn caused by an instrument that had been removed from an autoclave and placed on an anesthetized patient’s abdomen. According to an article in Outpatient Surgery, the surgeon was not in the room when the injury occurred and only discovered it when he was about to begin the procedure. An insufflator valve had been sterilized and was apparently still hot when an unknown hospital staff member put it down on the patient’s exposed skin. (An insufflator is a machine that is used to pump CO2 through tubing into the abdomen for laparoscopic surge...
Source: Kevin, M.D. - Medical Weblog - December 26, 2015 Category: Journals (General) Authors: Tags: Physician Malpractice Surgery Source Type: blogs

Funtabulously Frivolous Friday Five 131
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 131 (Christmas Special) Question 1 Approximately how many people are injured by Christmas trees every year in the UK? + Reveal the Funtabulous Answer expand(document.getElementById('ddet1631913265'));expand(document.getElementById('ddetlink1631913265')) 2,500 According to the Royal Society for the Prevention of Accidents, each year 1,000 people go to hospital after accidents involving Christmas trees A further 1,000 a...
Source: Life in the Fast Lane - December 25, 2015 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five christmas tree heart attack renal tubular acidosis humbug Turkey masturbators Horace Wells Tiny Tim Source Type: blogs

CMS Releases Draft 2017 Letter To Issuers In The Federally Facilitated Marketplaces
Implementing Health Reform. On December 23, 2017, the Centers for Medicare and Medicaid Services (CMS) released its draft 2017 Letter to Issuers in the Federally Facilitated Marketplaces (FFMs). CMS also released a draft bulletin on the timing of rate filing submissions and rate filings for January 1, 2017 non-grandfathered individual and small group plans and a table of key dates for qualified health plan (QHP) certification, rate review, risk adjustment, and reinsurance for 2017. The Draft Letter To Issuers CMS issues a draft letter to FFM insurers (the “draft letter”) late each year following the releas...
Source: Health Affairs Blog - December 24, 2015 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Medicaid and CHIP Medicare Payment Policy cost-sharing reductions essential community providers Essential Health Benefits Federally Facilitated Marketplace Provider Participation Rate QHPs SHOP exchanges Source Type: blogs

Research and Reviews in the Fastlane 114
This article reviews techniques, indications, contraindications and complications of VV and VA ECMO. A literature review of ECMO in poisoned patients is also included. Recommended by: Meghan Spyres Critical CareMadhuri S. Kurdi et al. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res 2014; 8(3): 283–290.  PMID: 25886322 A nice review article on the use of ketamine in the field of anesthesia, pain, palliative care, intensive care and procedural sedation. Based on at quite extensive literature search this paper highlights Ketamine’s current eviden...
Source: Life in the Fast Lane - December 23, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Neurosurgery Respiratory Resuscitation Trauma Emergency Medicine Intensive Care R&R in the FASTLANE critical care examination LITFL R/V research and reviews recommendations Source Type: blogs

Should you buy Organic Botox from Kim Kardashian? Episode 113
Should you soak in Vitamin C? Mindy says…I have read about vitamin C being good for your face. What about putting it in the bath water? I heard something about it neutralizing chlorine. What I want to know is if it will give you the same benefits that it does for your face, if I put L-Ascorbic Acid Powder in my bath water. I know the concentration will not be exact and will be lower. I think putting ascorbic acid in your bath water is a waste of money compared to using a good vitamin C lotion. I say that for several reasons: 1. For the most part the benefits provided by vitamin C are related to fighting the aging af...
Source: thebeautybrains.com - December 22, 2015 Category: Consumer Health News Authors: Perry RomanowskiDiscover the beauty and cosmetic products you should use and avoid Source Type: blogs

LITFL Review #211
Welcome to the 211th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week A long time ago, in a galaxy far, far away… Astrophysicist and anaesthetist, Kevin Fong, gives an amazing talk about the medical lessons from space exploration. [JS] Pat Croskerry’s gives an incredible talk on Cognitive Debiasing from...
Source: Life in the Fast Lane - December 20, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Reducing Healthcare Spending Waste Attributed to Aggressive Care at End of Life
Michael Mazzeffi, assistant professor of anesthesiology at the University of Maryland School of Medicine offers three strategies for reducing healthcare spending waste attributed to aggressive care at end of life 1.  "First, the American Council ... (Source: blog.bioethics.net)
Source: blog.bioethics.net - December 16, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

The Critically Ill Airway Course
Disclosure: I am the Convenor of The Critically Ill Airway Course and designed the programme, skill stations and simulation sessions. We’ve just finished another ‘Critically Ill Airway’ course at The Alfred ICU, so now seems a good time to say what it all about. The course targets doctors from all critical care specialties (ICU, EM, anaesthesia, retrieval and remote practitioners) who need to be able to provide airway management for critically ill patients. It is limited to 24 participants, who go through 12 (!) immersive simulations over 2 days as well as numerous skill stations covering all the es...
Source: Life in the Fast Lane - December 11, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Anaesthetics Emergency Medicine Intensive Care Critical Care Compendium Airway CIA critically ill airway course #alfredCIA Source Type: blogs

Is Hoof Maker cream for horses really good for your nails? Episode 111
This study is often quoted as saying it worked better than or as well as 4% hydroquinone but 4 weeks is not long enough to judge that and again, and this was not about hexylresorcinol itself .” Finally, the website Truth in Aging says… ”HR’s ability to target pathways in the skin that lead to hyperpigmentation has propelled it into the skin lightening ingredient category. There is also thought that Hexylresorcinol has more benefits as well, including an ability to reduce the appearance of fine lines and wrinkles, increase protection against UVB and UVA rays, and improve the skin’s barrier aga...
Source: thebeautybrains.com - December 8, 2015 Category: Consumer Health News Authors: Perry RomanowskiDiscover the beauty and cosmetic products you should use and avoid Source Type: blogs

A Less Risky Anesthesia for Babies
Spinal anesthesia, as opposed to general anesthesia, is being studied at a growing number of hospitals for surgeries that last an hour and a half or less. (Source: WSJ.com: The Informed Patient)
Source: WSJ.com: The Informed Patient - December 7, 2015 Category: Consumer Health News Tags: FREE Source Type: blogs

A Potentially Important Advance in the Control of Pain
Some rare few individuals do not feel pain, and are consequently a danger to themselves, often dying young. Unfortunately little headway has been made in manipulating the mechanisms thought to cause this condition, not just as a matter of treatment, but also as a way to create much safer and more sophisticated methods to temporarily switch off pain in the rest of us. Now, researchers have succeeded in reversing painlessness in an afflicted individual, better characterized the central mechanism of this condition, and this should directly result in a new methodology for efficient pain suppression. While this research is not ...
Source: Fight Aging! - December 7, 2015 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

What I Believe The Public Should Know About Clinicians
The daughter of the patient walked out of the room livid.  She was convinced that the nurse had no business taking care of patients.  She seethed as she recounted all the supposed injuries and mistakes that had occurred.  I took a deep breath and paused for a moment, trying to collect my thoughts.The daughter didn't know that I had watched this same nurse successfully perform CPR on a man the day before, and her quick thinking was one of the factors that save his life.  She had once recognized a rare side effect of a medication, and solved a clinical mystery that had hounded doctors, hospitals, and phar...
Source: In My Humble Opinion - December 7, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs

Trans Esophageal Echocardiography (TEE)
Transesophageal echocardiography is a specialised form of echocardiographic study using an echo probe held at the tip of an endoscope like device.  As the esophagus is very close to the heart, higher quality images are obtained. Interference by air in the lungs, which is usual for transthoracic echocardiography (TTE) is also avoided. As the imaging is in the near field, higher frequency transducers can be used, providing better image resolution. TEE imaging frequency is of the order of 5 – 10 MHz. TEE is very useful for imaging the posterior structures of the heart like the left atrium. Clots in the left at...
Source: Cardiophile MD - December 6, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiography Intra operative TEE Intra operative trans esophageal echocardiography risk of TEE risk of trans esophageal echocardiography TEE for liver transplantation surgery TEE in those with esophageal varices Transesophageal echocardi Source Type: blogs