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Ward attending notes to my younger self
Finishing my 38th year of internal medicine ward attending, I wish I knew then what I know now.  I estimate the equivalence of at least 10 full years of ward attending, I think this meets the magic 10,000 hour number.  Hopefully, these notes to myself will help some newly minted ward attendings.  The job is quite difficult and multifaceted. Understand the various responsibilities of the ward attending Help your learners grow Make certain the patients get top notch care Be a good role model for the learners Stay healthy, both mentally and physically Never lose your humanity What distinguishes ward attending is teach...
Source: DB's Medical Rants - December 16, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Funtabulously Frivolous Friday Five 218
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog 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 218, all about colours. Question 1 What colour are you if you are suffering from ‘argryia’? + Reveal the Funtabulous Answer expand(document.getElementById('ddet1414906888'));expand(document.getElementById('ddetlink1414906888')) Purple or Purple/Grey Argyria is t...
Source: Life in the Fast Lane - December 15, 2017 Category: Emergency Medicine Authors: Mark Corden Tags: Frivolous Friday Five amphotericin B argryia black lung blue bloater ciprofloxacin coal workers pneumoconiosis COPD emphysema infantile acrodynia mercury pink disease pink puffer Red man syndrome rifampicin silver skin teic Source Type: blogs

The Emperor of Performance has no clothes
Our greatest and worst attribute is seeing and saying that the Emperor has no clothes.  It requires intellectual honesty, a willingness to overcome confirmation bias and perhaps some hubris.  Often we make others uncomfortable with the raw honesty of such proclamations. For years many blogs have decried performance measures.  I have written about this problem for over 10 years.  Currently I serve on ACPs performance measure committee.  In this capacity I have reviewed well over 100 performance measures.  Most performance measures have the potential for harming patient care.  The committee has given a thumb down to m...
Source: DB's Medical Rants - December 9, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Artificial Intelligence in Healthcare: Lessons from Finance
By AJAY KOHLI, MD “We built it and we just let it run. We’re a few dudes in an office and our goal is to keep it running. It does everything we could do, except it’s significantly more powerful and it has completely automated how our work is being done,” casually said the hedge fund manager as he described the process by which nearly $1billion was being managed within his fund. The ‘it’ is an artificial intelligence (AI) based algorithm that uses complex statistics to analyze variables that went into successful decisions and uses advanced computer programs to keep replicating those decisions. All this, while it...
Source: The Health Care Blog - December 8, 2017 Category: Consumer Health News Authors: at RogueRad Tags: Uncategorized Source Type: blogs

Fight Aging! Newsletter, November 27th 2017
We examined associations between mortality and accelerometer-measured PA using age-relevant intensity cutpoints in older women of various ethnicities. The results support the hypothesis that higher levels of accelerometer-measured PA, even when below the moderate-intensity threshold recommended in current guidelines, are associated with lower all-cause and CVD mortality in women aged 63 to 99. Our findings expand on previous studies showing that higher self-reported PA reduces mortality in adults aged 60 and older, specifically in older women, and at less than recommended amounts. Moreover, our findings challenge th...
Source: Fight Aging! - November 26, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

What is lurking underneath this new right bundle branch block?
Written by Pendell Meyers, edits by Smith:CaseA 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain.Here is her triage ECG (the baseline is not available but reportedly " normal " ):What is your interpretation?There is sinus rhythm with PACs and PVCs.More important, there is right bundle branch block with hyperacute concordant T-waves in V3-V6, as well as hyperacute T-waves in leads III and aVF with reciprocal ST depression in aVL. This distribution is classic for a type III " wraparound " LAD occlusion.As a general rule, right bundle branch block should usually not have a...
Source: Dr. Smith's ECG Blog - November 25, 2017 Category: Cardiology Authors: Pendell Source Type: blogs

Failing Mitochondria and Cellular Senescence in the Aging Lung
Mitochondrial dysfunction and cellular senescence are two of the root causes of aging targeted by the SENS rejuvenation research programs. They overlap at least a little, in that one might cause the other, but it is unclear as to whether this is significant for the specific types of mitochondrial damage considered important in the SENS view of aging. The open access paper here walks through this territory in the case of the aging lung; in recent years, it has become clear that senescent cells are important in the development of fibrosis in lungs and other organs, as well as in other aspects of aging in lung tissue. The pre...
Source: Fight Aging! - November 21, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Advantages and disadvantages of echocardiographic assessment of myocardial viability
Echo based techniques for assessment of myocardial viability has certain advantages as well as limitations. Echocardiagraphic techniques are safe and do not have the risk of ionizing radiation like nuclear perfusion studies and positron emission tomography. Due to portability of echocardiographic equipment even bedside evaluation is possible and the equipments are widely available. Cost of procedure is much less compared to nuclear imaging studies. Unlike cardiac magnetic resonance (CMR) imaging, presence of pacemakers and defibrillators are not a problem. Other coexisting cardiac pathology can also be assessed by echocar...
Source: Cardiophile MD - November 18, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Multi-Purpose Soft Mist Inhaler Produces Different Size Medication Droplets
Pneuma Respiratory, a young company out of Boone, North Carolina, has announced that it developed a digital soft mist inhaler that can be set to deliver different size drug particles to the lungs, and that works with a variety of medications including large-molecule compounds. The company’s droplet ejector technology generates whichever size droplets are preferred and intelligently injects the soft mist into the air stream as the patient breathes in from the inhaler. Having different size droplets may significantly help improve a drug’s effectiveness, as the droplet’s size plays a role in determining whic...
Source: Medgadget - November 13, 2017 Category: Medical Devices Authors: Editors Tags: Medicine Pediatrics Thoracic Surgery Source Type: blogs

Sleep Sensors for Data-Driven Asthma Management: Interview with Tueo Health ’s Dr. Bronwyn Harris
About 10% of children between 5-17 years of age, or more than 7 million kids in the US alone, suffer from asthma. In half of these cases, the child’s asthma is not well controlled. This is typically due to a variety of reasons, such as inconsistent use of inhalers or the inability of parents or caregivers to successfully identify signs of poor asthma control. Given the difficulty that families face in keeping track of their child’s symptoms, solutions that enable better measurement of asthma control are urgently needed. That’s why Tueo Health (pronounced as “too-ee-oh”) , a startup out of Stanford Univers...
Source: Medgadget - November 13, 2017 Category: Medical Devices Authors: Mohammad Saleh Tags: Exclusive Medicine Pediatrics Source Type: blogs

Vaica Unveils Capsuled Drug Adherence System for Different Drug Types
Vaica Medical, a company out of Tel Aviv, Israel, is releasing a product designed to help introduce patients to new types of medications, such as injections and atomized drugs, or to complicated pill regimens. The cigar box-like device, called Capsuled, holds patient medications, like injectors and inhalators, and a touchscreen display provides a place to view detailed instructions on how to take the drugs. The Capsuled monitors every time it’s been accessed, and can send reminders and notifications if it’s not used according to a prescribed plan. The first use of the technology will be in two clinical trials i...
Source: Medgadget - November 9, 2017 Category: Medical Devices Authors: Editors Tags: Geriatrics Medicine Source Type: blogs

An Ingredient Technology Company Powering the World of Wearables: Interview with Valencell VP Ryan Kraudel
At Medgadget, we cover a lot of digital health devices and wearables. Some are developed by startups, while others come from brand name businesses that have branched out into this new and growing market. A common thread among most of the digital health technologies covered is the need to record data through various sensor technologies. However, most companies do not have the intellectual property or capability to develop sensors themselves and instead turn to “ingredient technology” companies to provide these components. Valencell is one of these ingredient technology companies, making some of the sensors powe...
Source: Medgadget - November 8, 2017 Category: Medical Devices Authors: Michael Batista Tags: Diagnostics Exclusive Source Type: blogs

NIH News in Health, November 2017
Check out the November issue of NIH News in Health, the monthly newsletter bringing you practical health news and tips based on the latest NIH research. In this issue: Healthy Body, Happy Heart: Improve Your Heart Health When Food Consumes You: Taking Eating to Extremes Health Capsule: Reducing Children’s Chances of Asthma Health Capsule: Out of Breath? Get Tested for COPD Featured Website: Healthy Bones, Joints, Muscles, and Skin NIH News in Health is available online in both HTML and PDF formats. Visit the NIH News in Health Facebook page to suggest topics you’d like to see covered, or share what you find helpful ...
Source: BHIC - November 6, 2017 Category: Databases & Libraries Authors: Kay Deeney Tags: Children and Teens Chronic Disease General Public Health Source Type: blogs

A Middle-Aged Man with crescendo angina
A middle-aged male with several comorbidities including DM presented with chest pain.  It had been on and off all day, then constant for 2.5 hours.  It was central without radiation, sharp but also tight, and was 9/10.   There was some cough, but no SOB; he reports COPD and has been using his inhalers without improvement. He also reports diaphoresis and tingling of his hands since the worsening of pain at 1700.His BP was 160/90.He was given aspirin and nitro via EMS with good improvement in his chest pain.First ED ECG at 2:40 after chest pain became severe.Sinus rhythm.Slight left axis deviation (mostly...
Source: Dr. Smith's ECG Blog - November 1, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

COPD: another example of the epidemic of misdiagnosis
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - October 31, 2017 Category: Internal Medicine Tags: pulmonary Source Type: blogs