MKSAP: 54-year-old man with a tremor
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is seen for follow-up evaluation of a tremor in his upper extremities that has been present since age 20 years. The tremor was mild for many years and did not interfere with his work but has become more prominent in recent years. He has difficulty writing and using utensils during meals. He has no associated slowness, stiffness, or change in gait. The patient started a trial of propranolol, which provided better control of the tremor, but after a few months, the tremor again worsened. He has su...
Source: Kevin, M.D. - Medical Weblog - December 19, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Neurology Source Type: blogs
Research and Reviews in the Fastlane 113
Welcome to the 113th 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&R project or check ou...
Source: Life in the Fast Lane - December 16, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Neurology Orthopedics Pediatrics Pre-hospital / Retrieval Resuscitation Cardiology Emergency Medicine Gastroenterology Infectious Disease Intensive Care critical care Education literature recommendations R&R in the FASTLANE R Source Type: blogs
Why I Disagree With The Government And Use Antipsychotics Anyway. It's Good Palliative Care!
The outcry over antipsychotics has ranged far and wide. Every one from governmental agencies to senior advocacy organizations have pointed to the abysmal data. Antipsychotics have a negative impact on morbidity and mortality. They say we are chemically restraining those who are too fragile to stick up for themselves. They say we are sedating instead of treating.And I disagree wholeheartedly. I manage a large group of moderately to severely demented nursing home patients. They are agitated and delirious on a regular basis. Often searches for infections, pain, constipation, depression, and...
Source: In My Humble Opinion - June 13, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Let’s Put An End to this Thoroughly Taxing Day…
Mental Illness has about whooped my ass for the day. I felt off all day like my body and mind was out of control. I thought nightfall and sleep would never arrive. Let’s hope for a better tomorrow. My Benadryl takes affect in 45 minutes, then I am going to grab a bite to eat and maybe a glass of V-8, and then hit the hay. Let me say this, though, about my mental health regimen. My bouts with mental illness are not near, not nearly as severe as they used to be, and not nearly as frequent either. This is mainly just feeling mentally uncomfortable in comparison to those past days – a jumping...
Source: The 4th Avenue Blues - March 18, 2014 Category: Mental Illness Authors: Andrew Quixote Source Type: blogs
Hospital Quality Measures: Value Based Purchasing 2.0 (The Funny Version).
For years, hospital quality measures have been tracked by private and government insurance programs to try and improve the healthcare services received by their beneficiaries. The most recent example is the Value-Based Purchasing Program (VBP) initiative by The Centers For Medicare & Medicaid Services (CMS). How does CMS describe VBP?"Under the Program, CMS will make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a basel...
Source: The Happy Hospitalist - March 14, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Suboxone Controversy: Brattleboro Reformer gets a C
In their story about buprenorphine, Suboxone, and opioid dependence, the Brattleboro Reformer gets it about 60% right. They describe the shortage of physicians certified to treat addicts with buprenorphine, correctly identifying most of the diversion of buprenorphine as desperate attempts at self-treatment. They lose points, though, for allowing an ill-informed legislator to suggest getting rid of buprenorphine altogether, without pointing to the example of Georgia, the former USSR republic, where the ban on buprenorphine resulted in the birth of krokodil, a nightmare drug now found in parts of the US.
Cost concerns
...
Source: Suboxone Talk Zone - March 8, 2014 Category: Addiction Authors: J T Junig Tags: Addiction Buprenorphine Public policy Suboxone treatment cost of suboxone film patient cap on suboxone safety of buprenorphine and suboxone suboxone regulation Source Type: blogs
When Waking Up Becomes the Nightmare: Hypnopompic Hallucinatory Pain
In conclusion, to our knowledge this is the first report of a NREM parasomnia associated with painful paroxysms, for which we postulate the following underlying pathophysiological mechanism: an internal or external stimulus triggers arousal, facilitating the activation of innate motor pattern generators in the brainstem and activating somatosensory cortical areas to produce hypnopompic hallucinatory pain.So instead of the more typical visual hallucinations, the patient experiences pain hallucinations that originate.... where?? It seems to me that the sleep EEG could be analyzed more thoroughly, beyond merely ruling out sei...
Source: The Neurocritic - December 21, 2013 Category: Psychiatrists and Psychologists Authors: The Neurocritic Source Type: blogs
When the hurting won't stop: How chronic physical pain drove a Calgary teen to take his life
CALGARY – Dominic Boivin's black and brown paisley school backpack sits empty in a corner of his bedroom, near the computer chair where the Calgary teen used to play his Xbox.It's the same backpack his parents watched a police officer carry up their driveway one night last June. Behind the police officer, Dominic's body lay in a medical examiner's van. A citywide search for him was over.On June 6, 2012, Dominic "the Dominator" Boivin — a once-gifted soccer player and honour student with a lopsided grin and a gentle soul — took his life after four years of struggling against constant, mysterious, body-wide pain.At its...
Source: Psychology of Pain - March 21, 2013 Category: Psychiatrists and Psychologists Source Type: blogs
Medications that Increase the Risks of Patient Falls
Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older.
Alzheimer's Reading Room
“Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older, and research suggests that those taking four or more medications are at an even greater risk than those who don’t – perhaps two to three times greater,” said Susan Blalock, Ph.D., an associate professor at the UNC Eshelman School of Pharmacy.
In 2007, more than 21,700 Americans died as a result of falls and more than 7.9 million were injured by a fall including over 1.8 million older adults who had a fall-rela...
Source: Alzheimer's Reading Room, The - February 14, 2013 Category: Dementia Authors: Bob DeMarco Source Type: blogs
Into the Midnight Hours…
In an hour it will be midnight. It is not often I am up this late, but I can’t sleep. I’ve tried all the tricks of the trade including a warm glass of milk from the microwave. Maggie keeps traipsing into my computer room with a swagger to check on me. I will then hear her go jump back on the bed in the bedroom after a good ole back scratch. She is like me and we thrive on our routines. She wants me to join her in the bed. She can’t sleep without me. I’ve been afraid to take too much of my Clonazepam as it messes with my memory. It certainly would put me to sleep, though. Benadryl doe...
Source: The 4th Avenue Blues - January 8, 2013 Category: Mental Illness Authors: Andrew Quixote Source Type: blogs
