The challenge of “ evidence based ” sore throat guidelines
CONCLUSION Although the evidence for the management of acute sore throat is easily available, national guidelines are different with regard to the choice of evidence and the interpretation for clinical practice. Also a transparent and standardized guideline development method is lacking. These findings are important in the context of appropriate antibiotic use, the problem of growing antimicrobial resistance, and costs for the community.
We assume that the word “evidence” is all inclusive. How can 9 guidelines on one subject differ significantly? The first problem occurs in selecting the evidence. Like ...
Source: DB's Medical Rants - October 23, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Thoughts on diagnostic errors in 2017
The Society to Improve Diagnosis in Medicine has on its website this quote:
Reducing Harm from Diagnostic Error
1 in 10 diagnoses are incorrect.
Diagnostic error accounts for 40,000-80,000 US deaths annually—somewhere between breast cancer and diabetes.
Chances are, we will all experience diagnostic error in our lifetime.
(US Institute of Medicine 2015, BMJ Quality & Safety 25-Year Summary of US Malpractice Claims, 2013.)
The current focus on diagnostic error raises an interesting question: Is this a larger problem in 2017 than in the 1970s and 1980s?
In this post, I postulate that the problem has increased. Se...
Source: DB's Medical Rants - August 7, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Frankly my dear, I do give a damn
LITFL: Life in the Fast Lane Medical Blog
LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka: Paediatric Perplexity 016
An 18 month old girl is brought in by Gran after developing a very red rash over the last 2 days.
She was seen by her GP a few days before with fevers, sore throat and lethargy and was diagnosed as a viral infection.
However the rash then came up the following day and she seemed to deteriorate…
What is the diagnosis?
+ Reveal Answer
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Scarle...
Source: Life in the Fast Lane - May 2, 2017 Category: Emergency Medicine Authors: Johnny Iliff Tags: Clinical Cases Pediatrics paediatric rash scarlet Source Type: blogs
New BD Veritor Plus for In-Office Detection of Flu, RSV, Group A Strep
BD has unveiled a new portable device for rapid detection of influenza A and B, respiratory syncytial virus (RSV), and group A strep. The immunoassay device can allow physicians to diagnose patients and decide on a therapy regimen all within one office visit. This can help get the patient started taking pills earlier and so lead to better overall outcomes.
The device is an upgrade to the original BD Veritor, and promises improved quality control of the results, as well as data keeping that can help trace patients to their tests. It can be connected to the cloud via BD’s own platform so that results are automatically ...
Source: Medgadget - September 27, 2016 Category: Medical Equipment Authors: Editors Tags: Medicine Pathology Pediatrics Source Type: blogs
Why I oppose home strep testing
Yesterday I read this tweet:
home strep test likely to reduce inconvenience, cost, strep complications, unneeded antibiotic and antibiotic resistance #medx
I disagree, but the reasons are fairly complex.
In order to understand this problem, we have to define the possible test, its use, the likely misuse and both the intended and unintended consequences of such a test.
What makes a good home test? Users should have no difficulty collecting the test sample. The test performance must be straightforward and simple. The test should answer a question that has a dichotomous implication.
Clearly, even health care profession...
Source: DB's Medical Rants - September 20, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Funtabulously Frivolous Friday Five 133
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…introducing Funtabulously Frivolous Friday Five 133
Question 1
Why do onions make you cry?
+ Reveal the Funtabulous Answer
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Propanethiol S-oxide
When you cut an onion, separate enzymes start mixing and produce propanethiol S-oxide, which is a volatile sulphur compound. The gas that is emitted reacts with the water of your eyes and forms sulphuric acid. The sulphu...
Source: Life in the Fast Lane - January 29, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five erysipelas FFFF fish sperm Hamptons hump heparin onions propanethiol S-oxide protamine pulmonary embolism St Anthony's Fire Source Type: blogs
A young healthy male with epigastric pain and tachycardia
A young previously healthy man with no past medical history presented with a complaint of epigastric pain for a few days. He had no other complaints. He appeared well. Vitals were HR 107, BP 140/70, sats 98%, RR 20, Temp 36.7. He had a normal exam except for the mild tachycardia.The physician was planning on discharging the patient except for the tachycardia, which prompted him to obtain an ECG. He was startled by the result. He showed it to me:QRS 105 ms. Sinus tach. RV conduction delay (R'-wave in V1)Diffuse ST depression, diagnostic of ischemia.Not knowing anything else about t...
Source: Dr. Smith's ECG Blog - August 14, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Is hyaluronic acid a good anti-aging ingredient? Episode 75
Do you wonder which anti-aging ingredients really work? Today we’re reviewing the evidence for hyaluronic acid.
Which anti-aging ingredients really work?
When it comes to anti-aging products it’s easy to be tricked into spending a lot of money on products that aren’t worth it. That’s because there’s so much pseudoscientific misinformation out there about anti-aging cosmetic ingredients. Also, once you buy an anti-aging product, it takes you a long time to determine if it’s really working for you or not. That’s why we’re going to focus some of our podcast episodes on specific anti-aging ingredients, Today we...
Source: thebeautybrains.com - March 24, 2015 Category: Consumer Health News Authors: Perry RomanowskiDiscover the beauty and cosmetic products you should use and avoid Source Type: blogs
Enterococcus faecalis
is a gram positive, catalase negative bacteria that is an increasing worry for clinicians as a cause of hospital-acquired infections.
It is a normally occurring bacteria in the intestines, bile ducts, and genitourinary system. However, when there is local overgrowth due to other flora being suppressed (especially by cephalosporins) it causes clinically important urinary and biliary tract infections.
Interestingly, Enterococcus faecalis has an outer capsule that prevents it from being degraded by bile salts.
Of particular worry is the ability of Enterococcus faecalis to enter the bloodstrean and colonize heart valves in su...
Source: Inside Surgery - March 15, 2015 Category: Surgery Authors: Editor Tags: Infectious Disease cephalosporins enterococcus UTI vancomycin resistant Source Type: blogs
Interpreting the new sore throat article
First, this study required the work of a large team. The main work happened in two places – a research microbiology laboratory and our college health clinic. They took an idea and translated it into an opportunity to collect and analyze data.
Second, the accompanying editorial (written by a friend and excellent researcher Dr. Jeffrey Linder) raises some questions that I will work to answer. He writes that we do not have enough evidence to change practice yet. He postulates that Fusobacterium necrophorum might not actually cause pharyngitis and that linking positive PCR testing to the risk of suppurative complicat...
Source: DB's Medical Rants - February 23, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Still worrying about Lemierre syndrome #continuedfrustration
Periodically something happens that reminds me that I must continue working to increase our knowledge of Lemierre syndrome. Today I received a comment on a post from 2008 – Championing an orphan disease – Lemierre syndrome. The latest comment makes 15 comments over the years. If you doubt the personal impact this disease has on adolescents and their families, please read the comments.
Here is the problem. Lemierre syndrome is infrequent but very dangerous. It can kill and can disable. It occurs more frequently in the US than does rheumatic fever. The most common organism causing Lemierre syndrome is Fu...
Source: DB's Medical Rants - October 21, 2014 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
I basically have respect for the medical profession but this is ridiculous
Using data from the National Ambulatory Medical Care surveys (there are two because on covers outpatient practices and the other ambulatory care delivered in hospitals, mostly EDs), Drs. Barnett and Linder (no link because you need a subscription to JAMA Internal Medicine) give us some disturbing news.Only 10% of people with sore throats have an infection that is treatable by antibiotics. And almost all of them have group A streptococcus. Good news about good ol' group A strep -- it's not antibiotic resistant, in fact it's 100% susceptible to good ol' penicillin, which by now isn't good for much else, and is also very chea...
Source: Stayin' Alive - November 27, 2013 Category: Health Medicine and Bioethics Commentators Source Type: blogs
Not all sore throats are self-limited – the role of antibiotics
This article is written in French, but the translate button allowed me to read the article clearly.
These ENTs note increasing numbers of peritonsillar abscess. They argue that sore patients deserve more than a rapid test. They argue for a history and physical done by a physician who looks for complications and explains red flags to the patient.
Long time readers know that I lament the term “just a sore throat”. While most sore throats are self-limited, we still should respect the possibilities for either suppurative or non-suppurative complications. I argue regularly that our sore throat treatment nihilism...
Source: DB's Medical Rants - October 22, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs
Essure birth control: Woman dies, doctor files report with the FDA . By
Lauren Gilger and Maria Tomasch
Since 2004, almost 850 women and doctors have filed Adverse Event Reports with the Food and Drug Administration (FDA) about Essure birth control.They detail extreme symptoms – from women experiencing excess bleeding, rashes and bloating to women who were forced to have their reproductive organs removed.Now, the ABC15 Investigators found a new Adverse Event Report filed with the FDA just weeks ago regarding Essure. It details a woman’s death after she was admitted to the hospital for abdominal pain. She had the Essure coils implanted this year, but it has not been determined what caused her death.‘THE LATEST AND GREAT...
Source: PharmaGossip - October 8, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs
