Top stories in health and medicine, October 1, 2014
From MedPage Today:
Targeted Drugs Build on Efficacy Record in Melanoma. Targeted therapy solidified and clarified its role in the treatment of advanced melanoma, as studies showed superiority over chemotherapy, and that two targeted drugs outperform one.
Fish Oil Flops Again in Afib Study. High-dose fish oil failed to reduce atrial fibrillation (Afib) recurrence in patients with a history of Afib who were not receiving conventional antiarrhythmic therapy.
AAN Warns Against Opioids in Chronic Noncancer Pain. The risks of opioids far outweigh their benefits in chronic pain conditions such as headache, fibromyalgia, and l...
Source: Kevin, M.D. - Medical Weblog - October 1, 2014 Category: Journals (General) Authors: MedPage Today Tags: Uncategorized Cancer Heart Pain management Source Type: blogs
Research and Reviews in the Fastlane 050
This study compared bedside US by EPs vs radiology US vs CT as the INITIAL test in patients expected with nephrolithiasis. It found there was no difference in serious outcomes between the groups, but the rate of serious outcomes was overall very low.
Obviously patients that got only an US had lower radiation exposure and lengths of stay. But what is interesting is that 40% of patients with an initial ED US went on to get a CT also.
This study does not state that patients should ONLY undergo US, just that it should be the INITIAL test. If it cuts down on our CT ordering, it sounds like a good start. (Zack Repanshek)
Recomme...
Source: Life in the Fast Lane - September 29, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Emergency Medicine Infectious Disease R&R in the FASTLANE Radiology Resuscitation critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs
How does chronic pain management work? A hypothesis to ponder
There have been increasing calls for clinicians and researchers to move away from using grouped results from randomised controlled studies because these fail to distinguish between those people who do really well and those who do not. Eminent researchers like Amanda Williams, Chris Eccleston and Steven Morley have said it’s time to move away from “black box” RCTs in chronic pain, and begin to use more sophisticated methodologies to examine not only outcomes but processes during therapy (Williams, Eccleston & Morley, 2012). While early studies comparing CBT-approaches to chronic pain vs waiting list ...
Source: HealthSkills Weblog - August 24, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Cognitive behavioral therapy Coping strategies Research biopsychosocial Chronic pain Clinical reasoning Cognitive Behavioural Therapy pain management self management Therapeutic approaches Source Type: blogs
Research and Reviews in the Fastlane 043
This study claimed a sensitivity and specificity of 100% in this group of patients questioning the traditional “CT, LP” approach to managing patients with clinical suspicion for SAH. However, the study has flaws and we eagerly await external validation.
Recommended by: Salim R. Rezaie
Emergency Medicine
Williams CM, Maher CG, Latimer J et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014 Jul 23. pii: S0140-6736(14)60805-9. doi: 10.1016/S0140-6736(14)60805-9. PMID 25064594
Should we continue to give paracetamol for lower back pain? In this Austral...
Source: Life in the Fast Lane - August 12, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Anaesthetics Emergency Medicine Infectious Disease Intensive Care Neurology Pediatrics Pre-hospital / Retrieval R&R in the FASTLANE Radiology Toxicology and Toxinology critical care literature recommendations research and reviews Source Type: blogs
Back Pain Doctor Sarasota Fl
Failed back syndrome, or lumbar post-laminectomy syndrome, is the term given to patients who have had back surgery for back pain, but continue to have pain after surgery. Even worse, their back pain can be worse after the surgery. The main problem is the fact that low back pain is not an indication for back surgery – any more than neck pain is an indication for neck surgery (failed neck surgery: cervical post-laminectomy syndrome). Surgery done for the sole purpose of relieving neck or back pain is doomed to failure. Many spine surgeons make the false assumption that if a patient has back pain and there is a spine MR...
Source: Sarasota Neurology - August 7, 2014 Category: Neurologists Authors: Dan Kassicieh, D.O. Tags: Back Pain Platelet Rich Plasma Back Pain Doctors Back Pain Specialist joint pain Sarasota Neurology Surgery Source Type: blogs
Top stories in health and medicine, July 25, 2014
From MedPage Today:
Vitamin D Megadoses Safe in Frail Elderly. Giving a very high dose of vitamin D — 20,000 IU per week — to older patients in nursing homes keeps them sufficient in the vitamin and appears to be safe.
Medicare Tests Exceptions to 3-Day Rule. Medicare officials have allowed patients at dozens of hospitals participating in pilot projects across the country to be exempted from the controversial requirement that limits nursing home coverage to seniors admitted to a hospital for at least 3 days.
Acetaminophen Fails in Back Pain Trial. The use of acetaminophen for acute low-back pain was no more e...
Source: Kevin, M.D. - Medical Weblog - July 25, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Cancer Endocrinology orthopedics Source Type: blogs
Everything you need to know about back pain in 11 minutes
Family physician Mike Evans is famous for his terrific whiteboard videos, where he distills complex medical ideas to its most understandable essence. Here, he tackles low back pain, a condition that most adults will experience sometime during their lives. Watch and learn how more tests for back pain isn’t necessarily better.
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - July 22, 2014 Category: Journals (General) Authors: Admin Tags: Video orthopedics Source Type: blogs
Better ways to meet the needs of people with chronic pain
In this study, participants were randomised into two groups – one group received usual care, while the other received automated symptom monitoring via voice-recorded phone calls or the internet, along with one face-to-face meeting with a nurse care management, who discussed medications with a pain physician, followed by a phone call to discuss the care plan, and two other calls, one at one month and one at three months. Additional calls were provided on the basis of symptom records. Patients in the intervention group benefited, with reduced scores on pain severity and interference as recorded by the Brief Pain Inve...
Source: HealthSkills Weblog - July 20, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Groupwork Pain conditions Research function healthcare Occupational therapy pain management physiotherapy self management Source Type: blogs
No, JAMA does not now recommend chiropractic care first for low back pain
Of all the alternative medical systems out there, chiropractic is one of the oddest. Unlike many of the others, it has a modicum of plausibility, at least back problems due to musculoskeletal strains. After all, the science-based specialty of physical therapy uses spinal manipulation to treat back problems. Of course, the big difference between chiropractic… (Source: Respectful Insolence)
Source: Respectful Insolence - July 18, 2014 Category: Surgery Authors: Orac Tags: Complementary and alternative medicine Quackery Alex Vidan Chiropractic JAMA Journal of the American Medical Association Source Type: blogs
How to Talk About Pain - NYT
LONDON — IN 1926, Virginia Woolf published an essay on pain, "On Being Ill." Isn't it extraordinary, she observed, that pain does not rank with "love, battle and jealousy" among the most important themes in literature. She lamented the "poverty of the language of pain." Every schoolgirl who falls in love "has Shakespeare, Donne, Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry." Where are the novels or epic poems devoted to typhoid, pneumonia or toothaches, Woolf wondered? Instead, the person in pain is forced to "coin words himself, and, ta...
Source: Psychology of Pain - July 13, 2014 Category: Psychiatrists and Psychologists Source Type: blogs
Managing pain is an experiment
I’ve been thinking a lot about clinical reasoning recently. There’s been a lot written about clinical reasoning, but not as often applied to pain management, which is a shame. One definition of clinical reasoning is that it is a “complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions” (Simmons, 2009). It’s often used synonymously with with decision-making and clinical judgment. It’s not diagnosis alone, although it includes diagnostic reasoning, and it ...
Source: HealthSkills Weblog - June 29, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Clinical reasoning Professional topics Chronic pain healthcare pain management Source Type: blogs
Gaps, and answering gritty questions
Research journals are full of really interesting studies, but some of the studies I’ve been reading lately seem to lack something. While they’re interesting, they don’t seem to approach some of the gritty questions clinicians need answers to. There are enormous gaps in our understanding of processes of healthcare delivery.
I like to get practical when I want to ponder things. I’ll weed the garden, prune the roses, take some photographs, and recently I’ve even taken to getting out in the garage to carve and sand wood, rip pallets apart – and while I do, I let my mind wander over things th...
Source: HealthSkills Weblog - June 23, 2014 Category: Occupational Therapists Authors: adiemusfree Tags: Chronic pain Clinical reasoning Research biopsychosocial Source Type: blogs
Orthopedic EHR Software Selection Checklist for Small Clinics
Should an orthopedic clinic choose an orthopedic specific EHR or multi-specialty EHR which can support a number of other specialties? In the early development phase of EHR software, the general conscious was a one-size-fits-all system would work for any practice regardless of field. For years, however, specialty physicians have been pointing out the deficiency of systems created for primary care, according to EHR Intelligence.
Orthopedic practices have their own list of needs, just like an obstetrician or a pedestrian. Variation between specialties requires customization with designs that distinguish the subtle differences...
Source: EMR EHR Blog for Physicians - June 23, 2014 Category: Technology Consultants Authors: Alok Prasad Source Type: blogs
Healthcare Compass: Comparing primary care quality in Massachusetts
Massachusetts Health Quality Partners (MHQP) just launched Healthcare Compass, an informative and easy-to-navigate site for patients seeking comparative information on the quality of physician practices in the state. The site presents data on 19 elements of patient experience and clinical quality for adult practices and 14 for pediatric practices.
For example, patient experience includes feedback on how well doctors communicate with their patients and willingness to recommend the provider to family and friends. Clinical quality includes measures such as yearly follow-up to monitor patients on long-term medication and app...
Source: Health Business Blog - June 18, 2014 Category: Health Managers Authors: David Williams Tags: e-health Patients Physicians Healthcare Compass Massachusetts Health Quality Partners Source Type: blogs
Healthcare Update Satellite — 06-10-2014
This study found no benefit in doing so. However, note that the study population was limited to patients with a “bending or twisting injury.” Patients were excluded if they had suspected nonmusculoskeletal etiology, direct trauma, motor deficits, or local occupational medicine program visits.
I’m still giving steroids for exacerbations of chronic pain and for radiculopathy.
Potential patients gone wild … Colorado man shot in emergency department parking lot after “confronting” police with a knife.
Lesson #1: Don’t run around in a parking lot wielding a knife
Lesson #2: Don’t ...
Source: WhiteCoat's Call Room - June 10, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
