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

Stop the hostility among health care professionals
The amount of hostility among health care professionals seems to be at an all-time high.  Are “scope of practice” and “turf” battles really escalating, or is it just more palpable in the modern era of anonymous comments and viral online posts?  I don’t know for sure, but lately, the conversation seems louder and uglier to me. In medical school, I heard derogatory comments (“jokes”?) from physicians and nurses alike about pretty much everyone else in the hospital.  Emergency medicine physicians are “GTNs” — glorified triage nurses. (Wait — are ...
Source: Kevin, M.D. - Medical Weblog - December 5, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

CDC Feels the Pain
A panel set up to coordinate pain research across the federal government is blasting a CDC proposal to rein in opioid prescribing set for release next month.The level of evidence cited to support the guidelines, which are non-binding on physicians, "is low to very low and that's a problem," said Sharon Hertz, FDA's director of the Division of Anesthesia, Analgesia and Addiction Products. AHRQ health scientist Richard Ricciardi called the recommendations "ridiculous" and "an embarrassment to the government." (Source: drugwonks.com Blog)
Source: drugwonks.com Blog - December 4, 2015 Category: Pharmaceuticals Source Type: blogs

Funtabulously Frivolous Friday Five 128
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 128 Question 1 Melena suggests a proximal GI bleeding source in which there is time for enzymatic breakdown to transform blood to melena. How much blood in the stomach does it take to cause melena? + Reveal the Funtabulous Answer expand(document.getElementById('ddet427012215'));expand(document.getElementById('ddetlink427012215')) 50mL In clinical experiments, placing as little as 50 mL of blood in the stomach can caus...
Source: Life in the Fast Lane - December 4, 2015 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five button batteries EMLA Essex-Lopresti injury melena methaemoglobinaemia morel-lavallee lesion Source Type: blogs

LITFL Review #208
Welcome to the 208th 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 Tim Leeuwenburg’s talk from SMACC US, Coping with Isolation, speaks to those physicians who practice “all alone” in a rural environment. The take-home message: vulnerability is OK; be kind to each other; and we are never alone w...
Source: Life in the Fast Lane - November 29, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Cost, Value & Tools
By PETER PRONOVOST, MD Like a pro golfer swears by a certain brand of clubs or a marathon runner has a chosen make of shoes, surgeons can form strong loyalties to the tools of their craft. Preferences for these items — such as artificial hips and knees, surgical screws, stents, pacemakers and other implants — develop over time, perhaps out of habit or acquired during their training. Of course, surgeons should have what they need to be at the top of their trade. But the downside of too much variation is that it can drive up the costs of procedures for hospitals, insurers and even patients. Wh...
Source: The Health Care Blog - November 29, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Costs Johns Hopkins Peter Pronovost Quality Tools Value Source Type: blogs

‘Growth Clouds’ On The Horizon For Health Spending?
I was honored to work with the National Health Expenditures (NHE) Team in the CMS Office of the Actuary throughout 1995-2012, and I am honored again to have the opportunity to provide some thoughts on long-range spending trends in the U.S. Many health policy experts have referred to these accounts as the “gold standard” for comprehensive and authoritative information about the cost of health care in the United States, and the NHE Team’s articles on both the historical and projected NHE accounts routinely appear at the top of Health Affairs’ “most frequently read” list. The current focus ...
Source: Health Affairs Blog - November 23, 2015 Category: Health Management Authors: Richard Foster Tags: Costs and Spending Drugs and Medical Technology Featured Health Professionals Hospitals Medicaid and CHIP Medicare Payment Policy Aging Cadillac tax Nurses PCORI physician assistants Physicians States Source Type: blogs

The 2017 Benefit and Payment Parameters Proposed Rule: Drilling Down
On November 21, 2015, the Centers for Medicare and Medicaid issued a notice of proposed rulemaking (NPRM) for the 2017 Benefit and Payment Parameters (BPP), the annual rule through which it sets out Affordable Care Act policy for the coming years. This is the second of two posts analyzing this proposed rule. The first post summarized the provisions of the rule of most interest to a broader audience. This post will drill down into the details of the rule. One note to begin: throughout, the rule uses the legally precise term “exchange” rather than the more recent term “marketplace.” This post will use...
Source: Health Affairs Blog - November 23, 2015 Category: Health Management Authors: Timothy Jost Tags: Featured Following the ACA Insurance and Coverage Source Type: blogs

Proposed Benefits And Payment Rule Includes Standardized Plans, New Network Adequacy Standards
On November 20, 2015, the Center for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) for its 2017 Benefit and Payment Parameters (BPP) rule. Every fall CMS publishes a BPP proposed rule, which is finalized every spring for the next year. The BPP includes benefit parameters for qualified health plans and payment parameters for the Affordable Care Act’s premium stabilization programs—hence its name—but it is also an omnibus rule that CMS uses to amend and update all of its rules governing the ACA marketplaces and health insurance markets generally. Perhaps the most notable...
Source: Health Affairs Blog - November 21, 2015 Category: Health Management Authors: Timothy Jost Tags: Featured Following the ACA Insurance and Coverage Payment Policy Source Type: blogs

Watch these smooth singing anesthetists remind you to breathe
x Relax to the smooth harmonies of Gary Corzine’s singing anesthetists, 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 - November 20, 2015 Category: Journals (General) Authors: Tags: Video Surgery Source Type: blogs

Atrial septal defect (ASD)
Illustrated Review with ECG, CXR, Echo Video, Cath Images X-ray chest in atrial septal defect X-ray chest PA view in atrial septal defect with pulmonary hypertension (Click on the image for an enlarged view) The main pulmonary artery (MPA) is grossly dilated. The right pulmonary artery (RPA) is also quite enlarged. Right atrial enlargement is seen as a shift of the cardiac contour to the right of the spine. Pulmonary vascularity is increased and prominent end on vessels (End on) are also seen. Apex is upwards, suggesting a right ventricular configuration. All features suggest a large secundum atrial septal defect with a l...
Source: Cardiophile MD - November 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology X-ray ECG / Electrophysiology Echocardiography Structural Heart Disease Interventions ASD Crochetage Sign ASD ECG ASD echo ASD Echo Video ASD X-Ray Chest PA Colour Doppler Echo in ASD ECG in A Source Type: blogs

2016 Physician Fee Schedule: Includes Changes on Self-Referral Rules, Biosimilars and Reimbursement, Transparency Changes for Another Day
Earlier this year, we wrote about the proposed Medicare Physician Fee Schedule. In the proposed rule, CMS sought comment on whether to add Open Payments data to its "Physician Compare" website. Additionally, the proposal included a decision to fund previously controversial advance care planning codes, the first regulations implementing the post-SGR legislation, Stark Law exceptions, and more. For now, CMS decided against finalizing any decision to publish Open Payments data on the Physician Compare website, according to the rule. The final rule will be published in the Federal Register on November 16, 2015. Comm...
Source: Policy and Medicine - November 12, 2015 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Here are 10 patient suggestions for hospitals. Let’s make them happen.
Since undergoing a double-lung transplant at the Johns Hopkins Hospital in December 2011, Podge Reed Jr. has had four medical admissions, two surgical admissions, eight outpatient procedures requiring anesthesia, more than 100 outpatient appointments, and 700 labs and other tests. He’s amassed enough experiences with the health care system to write a book. So far, though, he’s mostly kept it to two letters, totaling 12 pages, to our patient relations office, detailing opportunities for improvement. So when our hospital hosted an employee town hall meeting about patient-centered care, Reed was a natural choice t...
Source: Kevin, M.D. - Medical Weblog - November 5, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

A Tale of Two Deliveries, or an Out-of-Network Problem
Two mothers gave birth within weeks of each other, at the same hospital, using the same employer-sponsored insurance. Both had an epidural. But one received a surprise physician bill for anesthesiology, while the other didn't have to pay a dime. Why? (Source: The RAND Blog)
Source: The RAND Blog - November 4, 2015 Category: Health Management Authors: RAND Corporation Source Type: blogs

Rosemary: The Hidden Kennedy Daughter, A Must Read for all Women (and Men)
Kate Clifford Larson’s masterful examination of the nearly-forgotten story of Rosemary Kennedy – sister of a President and two other famous brothers, but confined to the shadows for decades after a lobotomy – drew me in on multiple levels.  As a health professional, as a woman, as an activist – and as the niece of another soul lost to that misguided and devastating medical procedure of the early 20th century. Even with his vast financial resources, and his political and personal connections, Joseph Kennedy, Sr., perhaps saw no other way to deal with his mentally troubled daughter.  Maybe, ...
Source: Disruptive Women in Health Care - November 3, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Advocacy Source Type: blogs

A Tale Of Two Deliveries, Or An Out-Of-Network Problem
As co-workers and first-time moms-to-be, we shared much of the pregnancy journey together — including the same employer-sponsored health insurance plan. We even delivered within weeks of each other at the same hospital. For both of us, the key to managing the pain of labor and delivery was the epidural delivered by our anesthesiologists. When it came to paying the bill, our hospital experiences diverged in one key way. Layla received an unexpected bill for $1,600 for anesthesiology services and warned Erin to expect the same. Yet Erin’s bill never came. Layla happened to deliver on a day when an out-of-network ...
Source: Health Affairs Blog - November 3, 2015 Category: Health Management Authors: Erin Taylor and Layla Parast Tags: Costs and Spending Equity and Disparities Featured Insurance and Coverage Payment Policy Affordable Care Act anesthesiology Employer-Sponsored Insurance out-of-network billing pregnancy Source Type: blogs

Don't Be Blue
A 21-year-old woman presented with a sore throat, low-grade fever, body aches, swollen glands, and generalized malaise for three days. The patient said her symptoms had worsened over the past day. She denied any difficulty breathing but endorsed pain and difficulty swallowing.   Her initial vital signs were blood pressure 132/84 mm Hg, heart rate 113 bpm, respiratory rate 22 bpm, temperature 100.4°F, and pulse oximetry 100% on room air. She was diagnosed with a peritonsillar abscess, and the EP applied a topical anesthetic to the area prior to draining it. During the procedure, the patient’s pulse oximetry d...
Source: The Tox Cave - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Don't Be Blue
A 21-year-old woman presented with a sore throat, low-grade fever, body aches, swollen glands, and generalized malaise for three days. The patient said her symptoms had worsened over the past day. She denied any difficulty breathing but endorsed pain and difficulty swallowing.   Her initial vital signs were blood pressure 132/84 mm Hg, heart rate 113 bpm, respiratory rate 22 bpm, temperature 100.4°F, and pulse oximetry 100% on room air. She was diagnosed with a peritonsillar abscess, and the EP applied a topical anesthetic to the area prior to draining it. During the procedure, the patient’s pulse oximetry...
Source: The Tox Cave - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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

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 th...
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

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