Primary aldosteronism: an update
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - June 11, 2021 Category: Internal Medicine Tags: cardiovascular endocrinology nephrology Source Type: blogs
Procalcitonin guided antibiotic treatment is beneficial in a variety of infections
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - June 3, 2021 Category: Internal Medicine Tags: hospital medicine infectious disease Source Type: blogs
PROP ’s Disproportionate Influence on U.S. Opioid Policy: The Harms of Intended Consequences
ConclusionDespite being turned back from an effort to bluntly reduce opioid prescribing by the FDA in 2013 based on a lack of scientific evidence for its position (17,18), PROP has had a disproportionate effect on opioid policy in the Untied States for almost a decade. PROP found a willing federal regulatory partner in the CDC, and while PROP may not have “secretly written” the 2016 CDC Pain Guidelines (75), they certainly enjoyed disproportionate representation on CDC’s review panels and Core Expert Group (23-25) in a process that lacked transparency (22, 23, 26, 27). When the CDC admitted that its Pain Guideline ha...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 3, 2021 Category: Palliative Care Tags: CDC health policy kollas opioids pain prop Source Type: blogs
PROP s Disproportionate Influence on U.S. Opioid Policy: The Harms of Intended Consequences
ConclusionDespite being turned back from an effort to bluntly reduce opioid prescribing by the FDA in 2013 based on a lack of scientific evidence for its position (17,18), PROP has had a disproportionate effect on opioid policy in the Untied States for almost a decade. PROP found a willing federal regulatory partner in the CDC, and while PROP may not have secretly written the 2016 CDC Pain Guidelines (75), they certainly enjoyed disproportionate representation on CDCs review panels and Core Expert Group (23-25) in a process that lacked transparency (22, 23, 26, 27). When the CDC admitted that its Pain Guideline had been...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 3, 2021 Category: Palliative Care Tags: CDC health policy kollas opioids pain prop Source Type: blogs
Is evidence based medicine the same as science based medicine?
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - May 2, 2021 Category: Internal Medicine Tags: ethics pseudoscience Source Type: blogs
The price I paid to be in medicine
A few weeks back, Match Day welcomed smiles and celebratory tears across the nation. This particular match season was fueled by a pandemic and virtual interviewing. I reached out to my friend who got matched to his top internal medicine residency spot in the Lone Star State. “I’m ready to make some money,” he excitedly […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 20, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/ricardo-chujutalli-and-daniel-azzam" rel="tag" > Ricardo Chujutalli and Daniel Azzam < /a > < /span > Tags: Finance Medical school Practice Management Source Type: blogs
Widespread misunderstanding of hypoxemia, hypoxia and pulse oximetry
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - April 16, 2021 Category: Internal Medicine Tags: critical care hospital medicine pulmonary Source Type: blogs
Third heart sound in health and disease
Third heart sound (S3) occurs in early diastole due to rapid deceleration of transmitral blood flow as the ventricles fill [1]. It corresponds in timing to shortly after the peak of the early diastolic E wave of transmitral flow. S3 occurs just after the opening of the atrioventricular valve as blood filling the atria during ventricular systole flows quickly into the ventricles [2].
Third heart sound can occur under physiological conditions as well as in disease, though not heard in all individuals. A prospective study of 580 patients had isolated valvular mitral regurgitation in 299, aortic regurgitation in 121 and prim...
Source: Cardiophile MD - April 8, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Advance Care Planning? Meh. - Part 2
by Drew Rosielle (@drosielle)This is Part 2/2 of a couple posts about advance care planning (ACP).The last post outlined why there are really good reasons to believe that ACP (completion of health care directives and the healthcare conversations that occur around healthcare directive (HCD) completion, implemented on a broad scale) does not lead to any better, patient-centered outcomes, particularly when evaluated as a health intervention to be applied across a population (which is how ACP is typically conceptualized and researched).In the prior post, I perhaps obnoxiously promised that I thought one of the most important A...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 31, 2021 Category: Palliative Care Source Type: blogs
Some thoughts on diagnostic reasoning
Yesterday I tweeted about our success in making some worthwhile diagnoses in the category of unusual presentations of common diseases. As I consider these successes, the principles of diagnostic aggressiveness become central to my thoughts.
For arguments sake let’s imagine three types of diagnostic reasoning. The first occurs when there is no diagnosis but we know something is wrong. These patients generally require a broad differential and much clinical thought. We often go back and collect more history, repeat the physical exam and think broadly about labs and imaging. We often need several consultants and often...
Source: DB's Medical Rants - March 18, 2021 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
De Winter's T-waves are Not a Stable ECG condition. Upright T-waves in Posterior OMI are Distinct from de Winter's waves.
This was just published in JAMA Internal Medicine:The de Winter Electrocardiogram Pattern Evolving From Hyperacute T WavesIt reminded me that many believe, due to the assertions in the original de Winter ' s article, that de Winter ' s waves are stable. In fact, the title was "Persistent precordial ‘‘hyperacute’’ T-waves signify proximal left anterior descending artery occlusion. " The authors based this idea of persistence mostly on their perception, not on a rigorous evaluation involving frequent serial ECGs of all patients with de Winter ' s T-waves. But de Winter ' s waves are not stable.&...
Source: Dr. Smith's ECG Blog - March 8, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Courts Speak: Internists to Be Boarded to Death
It is with great sadness and a heavy heart that I must announce that on Thursday this past week, the United States 3rd Circuit Court of Appeals ruled in favor of the American Board of Internal Medicine (ABIM) and upheld the earlier District Court dismissal of the antitrust, racketeering and unjust enrichment lawsuit filed by four internists in December 2018. An attorney for the (Source: Dr. Wes)
Source: Dr. Wes - March 1, 2021 Category: Cardiology Authors: Westby G. Fisher, MD Source Type: blogs
ABIM and Its Washington Lobbyists
The American Board of Internal Medicine (ABIM) is a 501(c)(3) non-profit organization that certifies "internists and (medical) subspecialists who demonstrate the knowledge, skills and attitudes essential for excellent patient care." According to the IRS, "In general, no organization may qualify for section 501(c)(3) status if a substantial part of its activities is attempting to influence (Source: Dr. Wes)
Source: Dr. Wes - February 18, 2021 Category: Cardiology Authors: Westby G. Fisher, MD Source Type: blogs
