What's in a name?
You have waited a long time for this post, I notice! I am sure you have had plenty to do while waiting.In their articleChronic renal confusion, Chi-yuan Hsu and Glenn Chertow looked at the wide variety of terms used to describe the same level of kidney function, and the wide range of renal function described by the use of a term like " chronic renal failure " . They examined a sample of literature to reach their conclusions (1).They argue that some terms should be dropped - a term like " chronic renal failure " has negative connotations for patients, and a term like " pre-dialysis " might discourage pract...
Source: Browsing - September 1, 2016 Category: Databases & Libraries Tags: literature searching nephrology systematic reviews Source Type: blogs
What PPIs and the Kardashians have in common
The science we conduct often reflects the society we live in. One phenomenon of current society is the rise of the reality television show. Participants are promised instant media fame without having to struggle through acting school. I worry that this has rubbed off on some of the studies we now conduct. Sir Richard Doll and Austin Hill, the architects of modern epidemiology, realized that it was hard for epidemiology to prove or disprove anything. Their studies were driven by clear hypotheses as some took five to 10 years to complete. Furthermore, their landmark paper on smoking and lung cancer devoted over a page of dis...
Source: Kevin, M.D. - Medical Weblog - August 24, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/dr-paul-moayyedi" rel="tag" > Dr. Paul Moayyedi < /a > Tags: Conditions GI Source Type: blogs
When too many cooks … the problem of too many consultants
Recently I communicated with a patient’s mother in another state. She had great angst when a series of subspecialists gave her different opinions on the ongoing plan for her grown son.
This problem happens too often in 2016. Each subspecialist seems to see the patient solely through the prism of their expertise. We have seen one consultant call 3 or 4 other consultants.
Many hospitalists will tell you this story. At many community hospitals the consultants do not just provide an opinion, but rather they write orders. This practice leads to confusion and sometimes conflict amongst the subspecialties.
Several...
Source: DB's Medical Rants - August 24, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Absolution
By ANISH KOKA, MD
Like many cities, Philadelphia is a city defined by its neighborhoods. I practice in two neighborhoods separated by a few miles but leagues apart in every other way. One of the hospitals is a tertiary care facility in the heart of Center City – a well to do upcoming part of town – and the other is a small community hospital a few miles South. The patients at the two locations are quite different, and the mechanism of health care delivery is also starkly different. Medical care at the Center City campus is provided mostly by employed physicians, and care at the community hospital is provide...
Source: The Health Care Blog - August 2, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
A doctor turns to social media for organ donation
A guest column by the American College of Physicians, exclusive to KevinMD.com.
A couple of months ago I received a Facebook invitation to “like” a page. That was not unusual, and usually the pages are on silly or obscure topics, but this page was different. The name of the page was New Kidney for Stu.
Stuart Himmelstein, MD, FACP, is one of my Facebook friends. Stu is a solo internist in private practice in Delray Beach, Florida. He is also a past Governor of the Florida Chapter of the American College of Physicians (ACP), which is how I met and got to know him. His ACP service is just one of his many contributions to...
Source: Kevin, M.D. - Medical Weblog - July 29, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/yul-ejnes" rel="tag" > Yul Ejnes, MD < /a > Tags: Physician Nephrology Source Type: blogs
The story of the man who could see the invisible
Once upon a time long, long ago there lived a man who could see things that other people simply could not see. He was not born with this skill but cultivated it slowly and continuously with years of focused attention.
He worked as a physician in a large hospital and would sometimes have students go with him to see patients. As far as the students were concerned, he could really see the invisible.
When he was asked what afflicted a patient, he would share his impressions and then carefully and systematically explicate the chain of observational evidence that lead to his indisputable conclusion. For example, after shaking an...
Source: Kevin, M.D. - Medical Weblog - July 25, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mark-e-williams" rel="tag" > Mark E. Williams, MD < /a > Tags: Physician Health IT Hospital Source Type: blogs
Fight Aging! Newsletter, June 27th 2016
In conclusion, we showed for the first time that 7-KC induces oxidative stress via lysosomal dysfunction, resulting in exacerbation of calcification.
CHIMERIC ANTIGEN RECEPTOR CANCER THERAPIES CAN NOW TARGET SOLID TUMORS
https://www.fightaging.org/archives/2016/06/chimeric-antigen-receptor-cancer-therapies-can-now-target-solid-tumors/
If the research community is to win in the fight to cure cancer, and win soon enough to matter for all of us, then the focus must be on technology platforms that can be easily and cheaply adapted to many different types of cancer. The biggest strategic problem in the field is t...
Source: Fight Aging! - June 26, 2016 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
7-ketocholesterol Accumulation Speeds Calcification of Blood Vessels
In conclusion, we showed for the first time that 7-KC induces oxidative stress via lysosomal dysfunction, resulting in exacerbation of calcification.
Link: http://onlinelibrary.wiley.com/enhanced/doi/10.1111/gtc.12301 (Source: Fight Aging!)
Source: Fight Aging! - June 22, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Fight Aging! Newsletter, June 6th 2016
This study teaches us that poor wound healing and wrinkling and sagging that occur in aging skin share similar mechanisms."
Reduced cell cohesiveness of outgrowths from eccrine sweat glands delays wound closure in elderly skin
Human skin heals more slowly in aged vs. young adults, but the mechanism for this delay is unclear. In humans, eccrine sweat glands (ESGs) and hair follicles underlying wounds generate cohesive keratinocyte outgrowths that expand to form the new epidermis. Our results confirm that the outgrowth of cells from ESGs is a major feature of repair in young skin. Strikingly, in aged skin, ...
Source: Fight Aging! - June 5, 2016 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Reviewing What is Known of FGF23 and Klotho Signaling in Aging
In past years researchers have demonstrated in animal studies that reduced levels of klotho can shorten life span while increased levels modestly extend life span. The underlying mechanisms are complex and not fully understood. As is also the case for other longevity-related proteins, altering levels in circulation through gene therapy or other methods changes many aspects of cellular metabolism. Unraveling this complexity is a slow and expensive process. One small part of the bigger picture in this case is the relationship between klotho and fibroblast growth factor 23 (FGF23). The review paper below examines what is know...
Source: Fight Aging! - May 30, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
In Rural States Policy Changes To Improve Access To Home Dialysis Are Vital
By its very nature, chronic kidney disease can rob individuals of their independence. It gradually causes a person to lose the ability to filter wastes from the body, and should kidneys fail entirely, a patient must rely on renal replacement therapy (dialysis) to live. An estimated 26 million Americans have chronic kidney disease of varying degrees; more than 600,000 have end-stage kidney failure. In my home state of West Virginia, some 3,500 patients were on dialysis in 2013, and for most of the past two decades, our state has led the nation in per capita numbers of patients starting dialysis.
Dialysis can be provided thr...
Source: Health Affairs Blog - April 12, 2016 Category: Health Management Authors: Rebecca Schmidt Tags: Costs and Spending Health IT Health Professionals Public Health Quality chronic disease dialysis kidney disease nephrology rural health Telehealth Source Type: blogs
STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes
Conclusions: In the select group of hypokalemic patients studied, potassium infusions of 20 to 40 mmol delivered over 1 hr were safe to administer and effectively increased serum potassium levels in a dosedependent and predictable fashion. Furthermore, these results were independent of the patient's underlying renal function or associated diuretic administration. (Crit Care Med 1991; 19:694)Concentrated Potassium Chloride Infusions in Critically Ill Patients with HypokalemiaThe Journal of Clinical Pharmacology. Volume 34, Issue 11, pages 1077–1082, November 1994Although concentrated infusions of pota...
Source: Dr. Smith's ECG Blog - April 7, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest pain in an Elderly Woman
This case was sent by one of our great FOAM colleagues, Salim Rezaie of REBEL EM!!"A 67 y/o female with PMH of Type 2 DM, HTN, Hyperlipidemia, and Hx of MI x 2, with chronic kidney disease awoke at 2am with left sided chest pain. She arrived at 2:45 AM and had this initial ECG below:"What do you think? Smith response: There is sinus rhythm. There is No significant ST elevation in any lead. There are large, symmetric T-waves in I, aVL, V2-V5 diagnostic of proximal LAD occlusion. There are also down-up T-waves in III and aVF (these are very specific RECIPROCAL findings and clinch the diagnosis.)S...
Source: Dr. Smith's ECG Blog - March 3, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 17
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Source: Cardiophile MD - February 16, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Study Finds No Improvement In Quality Of Life With ESAs
Erythropoietin-stimulating agents (ESAs) continue to be widely prescribed despite the absence of evidence demonstrating benefit. TREAT– the first and only large trial to test clinical outcomes with the drugs–showed that ESAs did not reduce clinical events, though it did raise concerns that the drugs might increase the risk of stroke. Critics say that the drugs...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - February 15, 2016 Category: Cardiology Authors: Larry Husten Tags: Diabetes Policy & Ethics Prevention, Epidemiology & Outcomes anemia chronic kidney disease CKD dialysis Erythropoietin ESAs Source Type: blogs
