Data For Improving Healthcare vs Data For Exasperating Healthcare Workers
BY TOM BURTON
The phrase “healthcare data” either strikes fear and loathing, or provides understanding and resolve in the minds of administration, clinicians, and nurses everywhere. Which emotion it brings out depends on how the data will be used. Data employed as a weapon for purposes of accountability generates fear. Data used as a teaching instrument for learning inspires trust and confidence.
Not all data for accountability is bad. Data used for prescriptive analytics within a security framework, for example, is necessary to reduce or eliminate fraud and abuse. And data for improvement isn’t without its own fault...
Source: The Health Care Blog - January 29, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Data HealthCatalyst Tom Burton Source Type: blogs
The Guidelineification of American Medicine
His voice was gruff and his expression surly.I don't want any more medications.His face was indented by deep clefts, remnants of eight decades of life hard lived. His tone was commanding and certain. I knew that he was fond of me, but I could feel his patience slipping. He neither asked about nor accepted his diagnosis of heart failure. I could tell him till I was blue (or he was for that matter) in the face that his low ejection fraction portended a poor prognosis, and national guidelines suggested both a beta blocker and defibrillator placement.He wouldn't budge. And before the age of elect...
Source: In My Humble Opinion - January 8, 2017 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Additional thoughts on diuretics – a followup to the furosemide rant
Yesterday’s screed about loop diuretics initiated more twitter activity than any blog post this year. Who knew?
Several comments bear documenting.
Important information on comparative absorption and duration of diuretics – A wonderful long range colleague (you should follow @kidney_boy on twitter) posted this infographic concerning this question on his blog. This is a most important link.
@Ajauseon tweeted this: “aspired to teach ‘evidence-based’ diuresis on CCU this month only to find there isn’t any” This tweet reminds me that EBM does not work for all questions. This qu...
Source: DB's Medical Rants - December 27, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Things that Bug me 1 – improper use of diuretics
This month on our VA ward team we have had 3 admissions that involved complications of over diuresis for systolic dysfunction. We also see patients who do not have adequate diuresis.
Diuretics greatly help symptoms in patients with systolic dysfunction and volume overload. But diuretics are primarily symptom relief medications.
I often ask students and residents to write this sentence, memorize it, and use it:
The purpose of diuretic therapy in systolic heart failure is render the patient not wet, but not to make the patient dry.
The idea here is that we should only give enough diuretic therapy to relieve symptoms. ...
Source: DB's Medical Rants - December 22, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Can we say that women doctors are just better for everyone?
Recently, my friend had a patient. The guy, patient with a history of autoimmune disease came in with pain, anxiety, and tachycardia. She walked in and felt the psychosomatic overlay. What was her intervention? Meds? Psych? Nope.
She closed the door, held his hand, pulled out her mom self and let him tell her for 15 long minutes about his hard life. The nurse watched the monitor as his heart rate dropped in a linear fashion. Better than beta blocker or benzos. Took freaking forever. But no labs, no consults, discharged 45 minutes later completely happy with his care.
Not sure know many of our male colleagues could,...
Source: Kevin, M.D. - Medical Weblog - December 21, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/dara-kass" rel="tag" > Dara Kass, MD < /a > Tags: Physician Emergency Source Type: blogs
The need for pharmacy electives in the medical school curriculum
I spent one year working full-time as a pharmacy technician at a high-volume community pharmacy prior to entering medical school. Besides learning the intricacies of billing and the dispensing process, I was granted personal access into a world nearly all patients, but few providers are aware of. At the time my job was just that: a job. There were fun perks like counting pills in multiples of five and visualizing the different colors and sizes of capsules and tablets I had never come across before. But it wasn’t until medical school that I began to fully appreciate my pharmacy knowledge.
Our school has a free student-r...
Source: Kevin, M.D. - Medical Weblog - December 21, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/sarayna-schock" rel="tag" > Sarayna Schock < /a > Tags: Meds Medical school Medications Source Type: blogs
Cardiomyopathy Quiz
Short quiz on cardiomyopathy
Cardiomyopathy Quiz
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Question 1AV block in the presence of features of dilated cardiomyopathy (DC...
Source: Cardiophile MD - December 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Doppler jet in mitral stenosis with regurgitation
Mitral Doppler interrogation is usually done from the apical four chamber view. Good colour Doppler jet is initially obtained and the Doppler cursor is then aligned parallel to it. Continuous wave is used as the velocity is much above the aliasing limit of pulsed Doppler. Since the mitral antegrade flow is towards the apex, the diastolic jet of mitral stenosis is displayed above the base line. Regurgitant jet into left atrium, being away from the apex, is displayed below the baseline. Mitral valve area can be calculated from the pressure half time of the initial downward slope of the mitral A wave, which fuses with the E w...
Source: Cardiophile MD - December 5, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
A Young Man with Recurrent Chest Pain and Dyspnea with Exertion
CaseThis is a young man who has had chest pain and dyspnea with exertion for years. He presented to the ED with these symptoms again. On this occasion, the CP was associated with stress and accompanied by some SOB, 7/10 at it ' s worse and made worse with activity, with radiation up into the left side of his neck and face.No h/o hypertension.Here is the ECG:Probable Diagnosis?I was shown this ECG and gave my opinion, as below.Here is an ED bedside echo, parasternal long axis:Look at the small the end-systolic LV chamber sizeParasternal short axis:Again, look at the end-systolic chamber size!What is the Diagnosis?...
Source: Dr. Smith's ECG Blog - November 29, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
NxThera ’s Rezūm Provides a New Treatment Option for Patients with BPH: Interview with CEO of NxThera
Benign prostatic hyperplasia (BPH), or enlargement of the prostate gland, affects about half of men between the age of 51 and 60 and up to 90% of men over the age of 80. Symptoms include difficulty with initiating urination, weak urine flow, post-void dribbling, and the need to wake up frequently during the night to urinate. Not only are these symptoms bothersome and negatively affect an individual’s quality of life, they may also lead to more serious conditions like bladder stones, urinary tract infections, or bladder and kidney damage. Unfortunately, many people with BPH choose to live with their symptoms due to the li...
Source: Medgadget - November 10, 2016 Category: Medical Equipment Authors: Kenan Raddawi Tags: Exclusive Urology Source Type: blogs
An apparent SVT that does not persistently correct with adenosine
A middle-aged woman presented for abdominal pain. She was found to have a heart rate of 150. A 12-lead was recorded:There is a regular, narrow complex tachycardia.What is it?Regular narrow complex tachycardias can be sinus tach, atrial tach, atrial flutter, AV nodal reentrant tachycardia, orthodromic AV reciprocal tachycardia [using a bypass tract (accessory pathway), that is WPW], or junctional tachycardia.Here is a one hour lecture onSupraventricular Tachycardias; everything you ever need to know.MAT and atrial fibrillation, other causes of supraventricular tachycardia, are not possible because they are always ...
Source: Dr. Smith's ECG Blog - October 30, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Are these prescription drugs preventing your weight loss?
A number of drugs prescribed to treat common conditions, such as hypertension, allergies, depression, inflammation, and diabetes, block your ability to lose weight. Several of these drugs actually cause weight gain, and most doctors fail to inform their patients of such side effects. Among the drugs that block weight loss are:
Beta-blockers: metoprolol, atenolol, carvedilol, and propranolol
Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin, paroxetine (Paxil), trazodone, and others
Steroids: prednisone and hydrocortisone (but not inhaled or nasal steroids for allergies)
Antihistamines: diphenhydr...
Source: Wheat Belly Blog - September 13, 2016 Category: Cardiology Authors: Dr. Davis Tags: Depression Dr. Davis Drugs and wheat Nutritional supplements Weight loss Wheat Belly Wheat Belly Lifestyle Wheat Belly Total Health Wheat-Free Lifestyle anxiety Source Type: blogs
Physicians versus computers – the wrong question!!!
Over the past 2 days, listening to separate podcasts, I have heard the same story and now have a better understanding of artificial intelligence. A Freakonomics podcast – The Future (Probably) Isn’t as Scary as You Think
And in general, what’s happened in the past couple of years is the best chess player on this planet is not an AI. And it’s not a human. It’s the team that he calls centaurs; it’s the team of humans and AI. Because they’re complementary. Because AIs think differently than humans. And the same of the world’s best medical diagnostician is not Watson, it’s not a human doctor. It’s the...
Source: DB's Medical Rants - September 7, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Syncope, Hypotension, and a Large Right Ventricle -- What is the ECG Diagnosis?
CaseA 60-something woman had syncope and was unconscious for a few minutes. It was not a seizure. EMS found her lethargic and short of breath but without chest pain. Pulse was 103, BP 100/60, and O2 saturation on room air 98%.She was brought to the ED, where her SpO2 was 93%, BP 88/48, pulse 100.On arrival in the ED, she underwent an immediate bedside cardiac ultrasound:What do you see?There is a very large RV and very poor LV filling; the LV ejection fraction is nearly 100%. It is easy to jump to the conclusion that this patient has a pulmonary embolism (hypotension, tachycardia, low O2 saturations, sy...
Source: Dr. Smith's ECG Blog - August 31, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Nitrates – Cardiology MCQ
Wrong statement about nitrates:
a) Predominantly venodilators
b) Have coronary vasodilator effects
c) Contraindicated in vasospastic angina
d) Should be avoided in hypotensive patients
Correct answer: c) Contraindicated in vasospastic angina
Nitrates are useful in vasospastic angina. Non selective betablockers like propranolol are avoided in vasospastic angina as they can cause alpha overactivity. Nitrates are contraindicated in those on phosphodiesterase-5 inhibitor sildenafil. (Source: Cardiophile MD)
Source: Cardiophile MD - August 24, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
