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Research and Reviews in the Fastlane 134
This article is a large, population-based, retrospective cohort of adults> 65 years of age. It compares those who were prescribed a macrolide with those prescribed a non-macrolide antibiotic looking at the primary outcome of a presentation for a ventricular dysrhythmia at 30 days and a secondary outcome of all-cause mortality at 30 days. They found no difference. While it’s a suboptimal study methodology, this is further evidence that we need not fear these complications. But, this shouldn’t stop us from restricting treatment to only those who need it (i.e. don’t prescribe a Z-pack for a URI). Recommen...
Source: Life in the Fast Lane - May 11, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Clinical Research Education Emergency Medicine Intensive Care critical care R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

The Tangled Hospital-Physician Relationship
Together, hospital and physician services account for more than half of national health spending. In its 2014 National Health Expenditures estimates, the Centers for Medicare and Medicaid Services’ actuaries make the hospital (nearly $1 trillion) and physician practice (nearly $600 billion) sectors appear to be independent and non-overlapping. This is an optical illusion. Hospitals and physicians are, in day-to-day practice, hopelessly intertwined. And while power appears to be shifting from physicians to hospitals with the increasing salaried employment of physicians, appearances can be deceiving. This post discusse...
Source: Health Affairs Blog - May 9, 2016 Category: Health Management Authors: Jeff Goldsmith, Nathan Kaufman and Lawton Burns Tags: Costs and Spending Featured Health Professionals Hospitals Medicare Payment Policy Population Health Quality ACOs Bundled Payments EMTALA MACRA Medicare Part B Physicians Source Type: blogs

LITFL Review 230
Welcome to the 230th 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  The Australian and New Zealand College of Anaesthetists have uploaded some talks from their recent ASM. Listen to Anil Patel talk on THRIVE (think NODESAT on steroids!), Stuart Marshall talk on Human Factors in airway management, and Helen K...
Source: Life in the Fast Lane - May 8, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Don’t be ashamed to receive an epidural during childbirth. Here’s why.
Life as a resident doctor can bring some of the most memorable patients encounters of our career. After all, this is the time in our training when we are the most naïve, vulnerable and most importantly impressionable. There is a certain patient scenario, however, which has changed the way I view one the most important experiences a patient can have: labor. Let me explain. I get paged for an epidural.  Once I arrive, I am often surprised by the look of defeat and despair on the patients face. I often ask the reason for concern or hesitation. “I thought I could do it naturally, but I’m ready for the epi...
Source: Kevin, M.D. - Medical Weblog - May 8, 2016 Category: Journals (General) Authors: Tags: Conditions OB/GYN Source Type: blogs

My double life: Mental illness in the health care
I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have carried the diagnosis of major depressive disorder since I was 11 years old. My family noticed something was wrong well before I was actually diagnosed, and after a few years of going to therapy and not im...
Source: Kevin, M.D. - Medical Weblog - May 6, 2016 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

ABIM MOC Survey Results Announced
We have previously written about the way the American Board of Internal Medicine (ABIM) is seeking physician input on Maintenance of Certification (MOC) assessments. recently, ABIM announced the findings from that recent survey. All ABIM Board Certified physicians were invited to participate in the survey, and over 9,200 responded, a 4.7% response rate. ABIM presented the results from the survey ("Improving the MOC Assessment Experience") at a recent ABIM meeting, in front of more than seventy leaders of medical societies. Following the presentation, the ABIM Board of Directors and Council continued discussions...
Source: Policy and Medicine - May 5, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

A Deep Dive on the MACRA NPRM
By JOHN HALAMKA As promised last week, I’ve read and taken detailed notes on the entire 962 page MACRA NPRM so that you will not have to. Although this post is long, it is better than the 20 hours of reading I had to do!Here is everything you need to know from an IT perspective about the MACRA NPRM. 1.  What is the MACRA NPRM trying to achieve with regard to healthcare IT? The MACRA NPRM proposes to consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for...
Source: The Health Care Blog - May 5, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

A Deep Dive on the MACRA NPRM
As promised last week, I’ve read and taken detailed notes on the entire 962 page MACRA NPRM so that you will not have to.Although this post is long, it is better than the 20 hours of reading I had to do!Here is everything you need to know from an IT perspective about the MACRA NPRM.1.  What is the MACRA NPRM trying to achieve with regard to healthcare IT?The MACRA NPRM proposes to consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for eligible professio...
Source: Life as a Healthcare CIO - May 5, 2016 Category: Information Technology Source Type: blogs

Become somebody: The importance of physician advocacy
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. “I said, ‘Somebody should do something about that.’  Then I realized I am somebody.” – Lily Tomlin Each day, family, work and extracurricular activities all compete for our attention. They are positive aspects of our lives but can be overwhelming at times.  When legislative or regulatory issues arise that might impact our profession or patient safety, it is easy to simply say “shouldn’t somebody do something about that?!”  Sometimes we get angry when “someone&...
Source: Kevin, M.D. - Medical Weblog - May 5, 2016 Category: Journals (General) Authors: Tags: Policy Primary care Source Type: blogs

Dual antiplatelet therapy beyond 1 year after coronary stenting
It is now standard practice to give dual antiplatelet therapy (DAPT) for one year after implantation of a drug eluting stent in a coronary artery. The question of continuing has been addressed in the DAPT Study. Now the results of the DAPT Study for the diabetic subset has been published in Circulation [1]. Around twelve thousand patients who received dual antiplatelet therapy for one year after coronary stenting and free of ischemic or bleeding complications were randomized to further 18 months of dual antiplatelet or single antiplatelet therapy. It was found that there is a further reduction in stent thrombosis...
Source: Cardiophile MD - May 5, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Coronary Interventions Source Type: blogs

FDA ER-LA REMS Day 2 of the Drug Safety and Risk Management Advisory Committee
Day Two of the Joint Meeting of the Drug Safety and Risk Management Advisory Committee (DSaRM) and the Anesthetic and Analgesic Drug Products Advisory Committee (AADPAC) was lively and full of debate and conversation. The day started out with comments from the FDA, followed by presentations by Joanna G. Katzman, MD, MSPH, of the University of New Mexico Health Sciences Center and Graham McMahon, MD, the President and CEO of the Accreditation Council for Continuing Medical Education (ACCME). The bulk of the morning was spent on the "Open Public Hearing" portion, where twenty-three participants, from various wa...
Source: Policy and Medicine - May 4, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

FDA ER-LA REMS Day One of Meeting of the Drug Safety and Risk Management Advisory Committee
Discussion ensued as to whether the rate of success is translating into improved outcomes. The discussion seemed as though it was positive for CE and REMS, and that some industry leaders recognize that working with CE providers to help educate providers is beneficial to patients and the healthcare system overall. The meeting continues Wednesday, May 4, 2016, with discussions that are expected to elicit recommendations from the panel members.       Related StoriesCME and the Opioid CrisisFDA Opinion on Proactive Response to Prescription Opioid AbuseThe FDA Shield - The Medtronic Infuse Ca...
Source: Policy and Medicine - May 3, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Hello world!
Welcome to WordPress. This is your first post. Edit or delete it, then start writing! (Source: Waking Up Costs)
Source: Waking Up Costs - May 1, 2016 Category: Anesthesiology Authors: claven1 Tags: Uncategorized Source Type: blogs

Hello world!
Welcome to WordPress. This is your first post. Edit or delete it, then start writing! The post Hello world! appeared first on Waking Up Costs. (Source: Waking Up Costs)
Source: Waking Up Costs - May 1, 2016 Category: Anesthesiology Authors: claven1 Tags: Uncategorized Source Type: blogs

Addiction Treatment Has it ALL WRONG
Today on SuboxForum members discussed how long they have been treated with buprenorphine medications.  Most agreed that buprenorphine turned their lives around, and most are afraid they will eventually be pushed off the medication.  Most buprenorphine patients described a reprieve from a horrible illness when they discovered buprenorphine.  But most have new fears that they never anticipated– that their physician will die or retire, that politicians will place arbitrary limits on buprenorphine treatment, or that insurers will limit coverage for the medication that saved there lives. I joined the discus...
Source: Suboxone Talk Zone - April 30, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine recovery Suboxone Suboxone Forum addiction counseling character defects heroin addiction Vivitrol Source Type: blogs

Breaking Down The MACRA Proposed Rule
The mother ship has landed. On Wednesday, April 27, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated proposed rule that would establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These policies were established by the latest, permanent ‘doc fix,’ the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). For additional background, please refer to recent Health Affairs Blog posts on MACRA, MIPS, and APMs, as well as a comprehensive brief on MACR...
Source: Health Affairs Blog - April 29, 2016 Category: Health Management Authors: Billy Wynne, Katie Pahner and Devin Zatorski Tags: Costs and Spending Featured Health Professionals Medicaid and CHIP Medicare Organization and Delivery Payment Policy Quality APMS CMS EHRs MACRA mips payment models Source Type: blogs

Funtabulously Frivolous Friday Five 143
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 FFFF…introducing Funtabulously Frivolous Friday Five 143 Question 1 What is Fagan famous for in evidence-based medicine (nothing to do with Oliver Twist)? + Reveal the Funtabulous Answer expand(document.getElementById('ddet275353453'));expand(document.getElementById('ddetlink275353453')) The Fagan nomogram converts pre-test porbabilities into post-test probabilities using the likelihood ratio for any given test.   Question 2 What do a sloth bear and local peo...
Source: Life in the Fast Lane - April 29, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five airway Fagan nomogram Guedel hyperthyroidism Jod-Basedow phenomenon King George the second Madhuca flowers pericardial tamponade twin lannister Wolf-Chaikoff effect Source Type: blogs

BioEthicsTV: A night of consent issues on ChicagoMed
by Craig Klugman, Ph.D. On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus. The first major storyline concerned a 16-year-old in abdominal pain who enters the ED with her father, a heroin addict. Although in pain and in need of a diagnostic endoscopy, the patient refuses any and all medications: She fears that even one dose will turn her into the addict that her father has been for her entire life. The doctors try the endoscopy without anesthetic or pain medications and they are unable to get through the procedure.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - April 27, 2016 Category: Medical Ethics Authors: Craig Klugman Tags: Clinical Ethics Featured Posts Informed Consent Reproductive Medicine BioethicsTV NBCCHicagoMed Source Type: blogs

Do not be this person.
This week I wanted to die, in a sustained and sincere manner, rather than return to work after my first shift back from vacation.Why?Because I had a patient. Who weighed six hundred pounds. That's a BMI of 79.9 if you're counting, and not something that you want to aspire to. However, the trouble was not the patient. The trouble was one of her family members, the one Person You Should Never, Ever. Be.This Person was, she claimed, a cousin-level relative of my patient and, she claimed, a neuro ICU nurse. The fact that she was a neuro ICU nurse at a hospital in the most far-flung district of the most distant, inbred county o...
Source: Head Nurse - April 22, 2016 Category: Nursing Authors: Jo Source Type: blogs

CME and the Opioid Crisis
Dramatic increases in death due to prescription opioid abuse has gained national attention. In the last month alone, the Centers for Disease Control and Prevention (CDC) has issued new guidelines on prescribing opioids, the Food and Drug Administration (FDA) has issued restrictive labeling guidelines on immediate release opioids, and Congress has held almost weekly hearings on the issue of opioid abuse. All major party candidates for President have stated that reducing opioid abuse is a top priority of theirs. Congress is in the midst of passing several large bills designed to restrict access to prescription opioids and he...
Source: Policy and Medicine - April 21, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

What We Think We Know and Don't Know About tDCS
image: Mihály Vöröslakos / University of Szeged “Don't Lose Your Head Over tDCS,” I warned last time. Now the infamous cadaver study has reared its ugly hot-wired head in Science News (Underwood, 2016).The mechanism of action of transcranial direct current stimulation (tDCS) had been called into question by Dr. György Buzsáki during his presentation at the Cognitive Neuroscience Society meeting....Or had it?To recap, my understanding was that an unpublished study of transcranial electrical stimulation (TES) in human cadaver heads showed a 90% loss of current when delivered thro...
Source: The Neurocritic - April 21, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs

What We Think We Know and Don't Know About tDCS
image: Mih ály Vöröslakos / University of Szeged “ Don't Lose Your Head Over tDCS , ” I warned last time. Now the infamous cadaver study has reared its ugly hot-wired head in Science News ( Underwood, 2016 ). The mechanism of action of transcranial direct current stimulation ( tDCS ) had been called into question by   Dr. Gy örgy Buzsáki during his presentation at the Cognitive Neuroscience Society meeting. ...Or had it? To recap, my understanding was that an unpublished study of transcranial electrical stimulation (TES) in human cadaver heads showed a 90% loss o...
Source: The Neurocritic - April 21, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs

It’s time for physicians to practice an evidence-based life
Evidence-based medicine is at the heart of what we physicians do. It is the basis for professional decision-making, and a focus of most journal articles we read. Using solid evidence to practice good medicine has been a foundation of clinical practice for decades. There are consequences for failing to follow evidence-based guidelines. If patient harm results from straying from a more loosely defined “standard of care,” which tends to be evidence-based, we may find ourselves facing a dreaded malpractice lawsuit. If certain evidence-based quality metrics are not met, our paychecks may suffer. That is the case wit...
Source: Kevin, M.D. - Medical Weblog - April 20, 2016 Category: Journals (General) Authors: Tags: Physician Primary care Surgery Source Type: blogs

Technology in health care: Is medicine really evolving?
Evolution is part of life, something we accept as a fact and evidenced by the changes we see and know compared to hundreds of years ago. No one can dispute the great technological advances that have been made; transport has been revolutionized from the animal power of horse and cart to the mechanized systems of train, plane and automobile we have today. Communication systems once reliant upon the written word and postal service are today instant through email, telephone, Skype, and FaceTime. Radio, television, computers, tablets, iPads and iPhones are all instant sources of information and entertainment. We can ask Google ...
Source: Kevin, M.D. - Medical Weblog - April 20, 2016 Category: Journals (General) Authors: Tags: Tech Health IT Source Type: blogs

Toussaint Found Guilty: Faces 70 Years in Prison and Millions in Fines
Richard Toussaint, best known as a Dallas, Texas anesthesiologist and the co-founder of the recently-bankrupt hospital chain Forest Park Medical Center, was recently found guilty of seven counts of healthcare fraud and faces up to seventy years in prison. Last May, Toussaint was indicted after investigators found that $10 million of false claims had been filed to many insurance companies, including, Blue Cross Blue Shield of Texas, UnitedHealthcare, and the Federal Employees Health Benefits Program. The scheme took place from 2009 to 2010, over an eighteen month period. The trial for Toussaint took just four days, and th...
Source: Policy and Medicine - April 14, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Don't Lose Your Head Over tDCS
Recent studies of transcranial electrical stimulation in human cadaver heads showed a 90% loss of current when delivered through the skin (Buzsáki, 2016 CNS meeting).Siren SongBy Margaret AtwoodThis is the one song everyone would like to learn: the songthat is irresistible:the song that forces mento leap overboard in squadronseven though they see the beached skullsthe song nobody knowsbecause anyone who has heard itis dead, and the others can't remember.Better living through electricity. The lure of superior performance, improved memory, and higher IQ without all the hard work. Or at least, in a much shorter amount ...
Source: The Neurocritic - April 13, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs

Don't Lose Your Head Over tDCS
Recent s tudies of transcranial electrical stimulation in human cadaver heads showed a 90% loss of current when delivered through the skin (Buzs áki, 2016 CNS meeting ). Siren Song By Margaret Atwood This is the one song everyone would like to learn: the song that is irresistible: the song that forces men to leap overboard in squadrons even though they see the beached skulls the song nobody knows because anyone who has heard it is dead, and the others can't remember. Better living through electricity. The lure of superior performance, improved memory, and higher IQ without all the hard work. Or at le...
Source: The Neurocritic - April 13, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs

The Role of Nurse Practitioners in Health Care Reform
Conclusion The United States is in the midst of a significant shortage4 in the provision of primary care, jeopardizing millions of Americans’ access to the most basic health care.22 Greater use of Nurse Practitioners could allay a significant portion of this shortage. While funding for grants and demonstration projects provided in the ACA makes a start toward greater use of NPs, risks to funding and disparate scope of practice regulations throughout the country provide significant barriers to their use. ___ The Institute of Medicine [report]. “Assessing progress on the Institute of Medicine report ‘The f...
Source: Disruptive Women in Health Care - April 11, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Access Advocacy Health Professions Nurses Source Type: blogs

AF ablation still has a role
In this study, Prash Sanders and Rajeev Pathek and others showed that lifestyle measures before and after the an ablation procedure increases the odds of success 5-fold. Given the modest success rates, costs, and risks of AF ablation, it’s imperative to improve the odds of the procedure. JMM Related posts: AF Ablation Update – 2016 A cautionary note on AF ablation in 2015 Dabbling in ablation is not so good… (Source: Dr John M)
Source: Dr John M - April 7, 2016 Category: Cardiology Authors: Dr John Source Type: blogs

A patient secretly records her surgeons during an operation. Will they be fired?
Advice to doctors: Beware of what you say during a procedure! Before, we had a patient secretly record an anesthesiologist during a colonoscopy. Now, a patient hid a microphone in her hair, and secretly recorded the medical staff during hernia surgery. It’s now national news. 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 - April 7, 2016 Category: Journals (General) Authors: Tags: Video Surgery Source Type: blogs

What’s New and In the Queue for Academic Medicine
What’s New: A Preview of the April Issue The April 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. Highlights from the issue include: The Strategic Value of Succession Planning for Department Chairs Rayburn and colleagues highlight the importance of succession planning—which provides institutional leaders the opportunity to optimize, renew, and revitalize their organization by ensuring successful leadership transitions—and emphasize the general need for transparency.  T...
Source: Academic Medicine Blog - April 5, 2016 Category: Universities & Medical Training Authors: Journal Staff Tags: Featured Issue Preview case reports clinical outcomes closed-book examinations educational outcomes health professions education open-book examinations speaking up succession planning Source Type: blogs

Patient-centered perioperative checklists to improve surgical care quality
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. With the recent expansion of ambulatory surgical centers, the number of outpatient surgical procedures has increased at an exponential rate. Coupled with the rise in volume has been the increasing complexity of procedures and underlying diseases of patients. The convergence of these factors represents a challenging environment for physicians to deliver safe, high-quality and efficient care. One potential tool to improve patient safety is the surgical safety checklist. The World Health Organization (WHO) has guidelines in place ...
Source: Kevin, M.D. - Medical Weblog - April 4, 2016 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Utah : Just Say "NO!"
This is not a post on abortion.  Let's not even go there.  This is a post on who gets to practice medicine.So Utah passed a law -- signed by their governor after how many years of medical school? -- that mandates doctors to give general anesthesia to women having abortions after 20 weeks of gestation.  Legislators sometimes unwittingly attempt to practice medicine and pass laws that interfere with the doctor patient relationship, but this is the first time I've heard of legislation that demands a procedure that endangers a patient's life.  The theory is that the fetus might feel pain and that general an...
Source: Shrink Rap - April 4, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

ABIM Considers Open Book Testing
We have previously written about the 2020 Task Force organized by the American Board of Internal Medicine (ABIM) on Maintenance of Certification (MOC) assessments. ABIM is using the task force in an attempt to continue perfecting their MOC program and setting a new process for internists and subspecialists. Most recently, ABIM announced that they are looking at permitting access to online resources for a portion of the maintenance of certification assessments. In a blog post written by President and CEO of ABIM, Richard J. Baron, M.D., MACP, he announced that the idea to "make at least a portion of ABIM's assessment...
Source: Policy and Medicine - April 3, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

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

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

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

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

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

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

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

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

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

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

A Detached Sense of Self Associated with Altered Neural Responses to Mirror Touch
Our bodily sense of self contributes to our personal feelings of awareness as a conscious being. How we see our bodies and move through space and feel touched by loved ones are integral parts of our identity. What happens when this sense of self breaks down? One form of dissolution is Depersonalization Disorder (DPD).1 Individuals with DPD feel estranged or disconnected from themselves, as if their bodies belong to someone else, and “they” are merely a detached observer. Or the self feels absent entirely. Other symptoms of depersonalization include emotional blunting, out-of-body experiences, and autoscopy.Auto...
Source: The Neurocritic - March 19, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs

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

New doctors should listen to this advice if they want to last
A few years ago, the hospital where I work started new residency programs in internal medicine and family practice. Many of the residents do rotations in anesthesiology and surgery where I have an opportunity to meet and talk with them. They are eager to learn medicine of course, but they are also interested in the perspective that many of us who have been practicing medicine for many years have to offer them. Given the opportunity to speak to a large group of early career physicians or medical students, I think I would offer the following advice. First and foremost, do not be afraid to take care of yourself. With all ther...
Source: Kevin, M.D. - Medical Weblog - March 15, 2016 Category: Journals (General) Authors: Tags: Physician Medical school Residency Source Type: blogs

A female physician is murdered. A call to action to end intimate partner abuse.
This week, the community of women physicians was rocked by the death of one in our midst, an anesthesiologist, intensivist, medical school faculty member, and mother, in an apparent domestic violence homicide. Dr. Casey Drawert (yes, we will say her name) was a highly accomplished physician married to a “prominent businessman” adding to the media-stickiness of the story.  Her success clashes with our deeply entrenched biases about the demographics of domestic violence victims. Yet again, we were reminded that although certain groups may be more susceptible, domestic violence (I pre...
Source: Kevin, M.D. - Medical Weblog - March 13, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

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

What medical students and residents deserve
An anonymous medical student has this post on KevinMD – A star medical student feels like he made a terrible decision. And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where they limit their involvement with patients: dermatology, radiology, ophthalmology, anesthesiology. It begs the question: why are these the happiest, the most high-salaried, and patient-limited specialties? They all must have a connection. He goes on t...
Source: DB's Medical Rants - March 9, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs