Professionalism And Choosing Wisely
The US health care system is plagued by the use of services that provide little clinical benefit. Estimates of expenditures on overuse of medical services range from 10–30 percent of total health care spending. These estimates are typically based on analyses of the geographic variation in patterns of care. For example, researchers at the Dartmouth Institute focused on differences in care use between high-spending and low-spending regions with no corresponding reductions in quality or outcomes. An analysis by the Network for Excellence in Health Innovation (formerly known as the New England Healthcare Institute) ident...
Source: Health Affairs Blog - October 24, 2017 Category: Health Management Authors: Michael Chernew and Daniel Wolfson Tags: Costs and Spending Quality Choosing Wisely inefficiency overuse of medical services Source Type: blogs
FDA Grants First Clearance for Patients to Perform Hemodialysis on Themselves at Home
NxStage Medical, a company based in Lawrence, MA that focuses on hemodialysis equipment, won FDA clearance for its System One to be used by the patients at home and by themselves. This is the first such clearance that gives people with end stage renal disease a new level of independence from clinics and at-home carers. While the system can also be used to dialyze blood while the patient is sleeping, doing so without assistance requires the patient to undergo dialysis while awake.
This new regulatory green light will allow considerably more patients to be eligible for at-home dialysis, something that they’ve been rest...
Source: Medgadget - August 30, 2017 Category: Medical Devices Authors: Editors Tags: Medicine Source Type: blogs
Laminate Medical ’s VasQ Fistula Supporting Device Gets FDA Investigational Device Exemption
Laminate Medical Technologies, an Israeli firm, won an Investigational Device Exemption (IDE) from the FDA to begin a clinical trial of its VasQ device designed to support arteriovenous fistulas. The technology will hopefully benefit patients that receive hemodialysis via AVF in the upper extremity.
In many dialysis patients the fistulas that are created too often have trouble staying in shape and may require revision procedures. Additionally, the connection may narrow, leading to complications, and blood turbulence near the connection can lead to clots or cell lysis.
The VasQ device, made of Nitinol memory alloy, support...
Source: Medgadget - August 3, 2017 Category: Medical Devices Authors: Editors Tags: Vascular Surgery Source Type: blogs
End-of-Life Healthcare Sessions at ASBH 2017
Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.
THU 1:30 pm: “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)
Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if dea...
Source: blog.bioethics.net - July 26, 2017 Category: Medical Ethics Authors: Thaddeus Mason Pope, JD, PhD Tags: Health Care syndicated Source Type: blogs
Hemopurifier Filters Ebola, Hep C, Metastatic Melanoma: Interview with James A. Joyce, CEO of Aethlon Medical
Filtering infectious pathogens and cancer cells directly from whole blood has been an almost fantastic proposition, but the Hemopurifier from Aethlon Medical does just that. We’ve been covering it for over 10 years on Medgadget as it proves itself in clinical trials and new applications for it are discovered. It has already been studied as a treatment option for hepatitis C, metastatic melanoma, and the Ebola virus. Recently at the 2017 BIO International Convention in San Diego, virus capture data was presented from a study of the Hemopurifier involving health-compromised patients infected with a virus.
We wer...
Source: Medgadget - July 18, 2017 Category: Medical Devices Authors: Editors Tags: Exclusive Medicine Oncology Source Type: blogs
An interesting finding, and absence of another, in an intoxicated patient found down
CONCLUSION: Administration of subcutaneous terbutaline obviates the need for intravenous access and should be considered as an alternative to nebulized or inhaled beta-agonists to treat acute hyperkalemia in patients with CKD. As with the use of any beta-adrenergic agonist, close cardiovascular monitoring is necessary to avoid or minimize toxicity during therapy.Hypokalemic effects of intravenous infusion or nebulization of salbutamol in patients with chronic renal failure: comparative study.AULiou HH, Chiang SS, Wu SC, Huang TP, Campese VM, Smogorzewski M, Yang WC SOAm J Kidney Dis. 1994;23(2):266. To exami...
Source: Dr. Smith's ECG Blog - July 1, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Jittery Patient
A 22-year-old woman with no past medical history presented to the emergency department with palpitations. She reported that she had ingested a handful of caffeine tablets with a large glass of wine two hours earlier. She reported feeling "stressed out" and wanting to hurt herself. The patient was alert but appeared anxious on arrival at the ED.Her blood pressure was 90/49 mm Hg, heart rate was 115 beats/min, respiratory rate was 20 breaths/min, and SPO2 was 100% on room air. An ECG showed sinus tachycardia at 120 beats/min with normal intervals. Shortly after arrival, her blood pressure dropped to 83/42 mm Hg,...
Source: The Tox Cave - March 31, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
‘ Going to Extremes ’ Redux
LITFL: Life in the Fast Lane Medical Blog
LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Five years ago, based on a suggestion by Greg Kelly, we sought out the most extreme parameters clinicians have encountered in looking after their patients.
This is the league table we have assembled so far:
ParameterLevelDiagnosisSubmitted by
Fluid gain between hemodialysis sessions21 LRenal failureKT
CRP950 mg/LNicky
Highest glucose121 mmol/LHHS/ HONKGuru
Troponin I180.0 ng/mlMIWanderer
CD4 count (lowest)2 cells/uLAIDSAnne
pH (lowest in DKA, and survived...
Source: Life in the Fast Lane - March 22, 2017 Category: Emergency Medicine Authors: Chris Nickson Tags: Emergency Medicine Intensive Care clinical extremes laboratory parameters pathophysiology Source Type: blogs
Indications for hemodialysis in salicylate poisoning
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - March 7, 2017 Category: Internal Medicine Tags: critical care toxicology Source Type: blogs
Beyond the Destination LVAD
There are many forms of life sustaining treatment available
to patients thanks to advances in medical technology. When a person’s
physiology weakens or fails, devices may be attached or implanted to take over
for organs that can no longer bear the workload of processing, moving, or
taking in the elements needed to keep a body alive. Conceptually, this is
appealing to a society that is as averse to death as are those of us here in
the US. But we still struggle to accommodate the range of needs that crop up
when function is compromised. As an ethicist, the general trend in my work
suggests that the more advanced the te...
Source: blog.bioethics.net - February 15, 2017 Category: Medical Ethics Authors: Bioethics Today Tags: Health Care Informed Consent Justice decision making LVAD syndicated Source Type: blogs
Rejuvenation Biotechnology Update for January 2017
This study provides evidence that adding senescent cells to a healthy joint can create a constellation of symptoms that resemble osteoarthritis. It is an important step in linking cellular senescence and osteoarthritic joint damage. However, the "smoking gun" that would really implicate senescent cells as a clinically-relevant target for osteoarthritis treatment would be to demonstrate that using senolytic drugs or genetic approaches to remove senescent cells from the joint of an animal with osteoarthritis leads to an improvement in osteoarthritis symptoms and the restoration of joint structure and function. Furthermore, t...
Source: Fight Aging! - February 2, 2017 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Lactate Intolerant
A 76-year-old woman presented to the ED with altered mental status. Her family said she had increasing fatigue for two days. That morning, the patient had nausea, vomiting, and shoulder pain. EMS found she had a blood glucose of 34. She was given an ampule of D50 and brought to the ED.The patient reported dizziness and fatigue in the ED, and stated that she had not eaten for a few days. Her initial vital signs included temperature 94.1℉, pulse 76 bpm, blood pressure 120/67 mm Hg, respiratory rate 18 bpm, and pulse oximetry 99% on room air. Her physical examination is unremarkable.Initial laboratory values are remarkable ...
Source: The Tox Cave - September 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Leucovorin to the Rescue
A 78-year-old man was advised to go to the emergency department by his rheumatologist after reporting symptoms of nausea, severe fatigue, and feeling "off" for two days. The patient had recently been prescribed methotrexate for his polymyalgia rheumatica, and was instructed to take 5 mg once a week, but he misunderstood and took 5 mg daily for six days.The patient's heart rate was 80 beats per minute, his blood pressure was 155/75 mm Hg, his pulse ox was 98% on room air, and his temperature was 98°F. His initial labs included a CBC with no abnormalities, but his creatinine was 2.5 mg/dL with a GFR of 25. Baselin...
Source: The Tox Cave - August 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
