Top stories in health and medicine, March 13, 2015
From MedPage Today: Opioid Abuse Drops, Then Levels Off. Making an abuse-deterrent formulation of OxyContin (oxycodone ) diminished abuse in the short term, but the reductions eventually hit a plateau. After Ebola, Measles Death Toll Could Be High. The death toll from post-Ebola measles outbreaks in three West African countries could rival that of Ebola itself. Time Is Right for E-Cig Regulation. Reducing the risks of e-cigarettes to smokers, encouraging the smoking-cessation potential, and restricting access by nonsmokers offer a regulatory trifecta that can be implemented immediately. Risky Business: Working Where Viol...
Source: Kevin, M.D. - Medical Weblog - March 13, 2015 Category: Journals (General) Authors: Tags: News Emergency Infectious disease Pain management Source Type: blogs

Delirium and Physostigmine: ECG helps in Management
This patient took an unknown overdose and was delirious.  The axillae were dry.  Due to delirium and dry skin, there was suspicion of anticholinergic toxicity.Here is his ECG:There is sinus tachycardia.  There is also some QRS widening and a large R-wave in aVR, and an rSR' (RV conduction delay) in lead V1.  The QRS duration is 107 ms.  There is QT prolongation as well, with a computerized (Bazett) QTc of 480 ms (prolonged).The prolonged QRS and RV conduction delay make this very suspicious for Na channel blockade, and, most worrisome, for tricyclic antidepressant overdose (TCA).Do we treat the del...
Source: Dr. Smith's ECG Blog - March 7, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Painkillers? Prozac? Brazilian Blowout? Hotline Counsels Pregnant Women On Risks
    By Carey Goldberg Reprinted from Common Health Joy Shapiro of Framingham, Mass., was the sort of hyper-cautious expectant mother who doesn’t just cut out alcohol and caffeine. She worried about the ingredients in everything she consumed or put on her body, from fitness drinks to sunscreen. But thanks to a referral from her obstetrician, she had a secret weapon against her anxiety: Patricia Cole, the program coordinator for MotherToBaby Massachusetts — also known as the Pregnancy Exposure Infoline — whom she “bombarded” with queries. “At one point, I emailed her like 20 ingredients that were in ...
Source: Cord Blood News - March 2, 2015 Category: Perinatology & Neonatology Authors: joyce at mazelabs.com Tags: babies blood disorder brain development Cord Blood medical research parents pregnancy affordable cord blood banking bone marrow breast feeding cerebral palsy cord blood banking cost comparison cord blood banking information cord Source Type: blogs

Chronic Pain — The Invisible Public Health Crises
Chronic Pain -- The Invisible Public Health CrisesA Call for Moral Leadership“I am an invisible man. No I am not a spook like those who haunted Edgar Allen Poe: Nor am I one of your Hollywood movie ectoplasms. I am a man of substance, of flesh and bone, fiber and liquids- and I might even be said to possess a mind. I am invisible, simply because people refuse to see me.”- Ralph EllisonRalph Ellison’s famous novel, The Invisible Man, starts with this passage, which also reminds me of the problem of chronic pain. The Institute of Medicine (IOM) report, Relieving Pain in America, documented the more than 100...
Source: blog.bioethics.net - February 7, 2015 Category: Medical Ethics Authors: Practical Bioethics Tags: Health Care bioethics chronic pain medical ethics pain resources syndicated Source Type: blogs

Healthcare Update Satellite — 01-19-2015
Penicillin allergy? It’s associated with increased bad outcomes, but not for the reasons you think. The allergies themselves are mostly not allergies. And no, “my mother said I had a rash when I was a baby” isn’t an allergy. However, when compared with patients who don’t have penicillin “allergies”, patients with penicillin allergies have longer hospital stays and are between 14% and 30% more likely to get resistant infections while in the hospitals – possibly because the penicillin “allergic” patients are being treated with much stronger antibiotics that kill of...
Source: WhiteCoat's Call Room - January 19, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Deterrence Strategy
According to Dr. Janet Woodcock, opioid abuse-deterrence technology is in its “infancy” and FDA is unlikely to remove opioids that lack abuse-deterrence features from the market soon. She said approved abuse-deterrent opioids are “version 1.0.” FDA has approved three abuse-deterrent formulations, including Embeda morphine sulfate extended-release capsules with sequestered naltrexone from Pfizer; and reformulations of OxyContin oxycodone and Targiniq ER oxycodone/naloxone from Purdue Pharma. Woodcock added that there will be a “long path” to travel before FDA would require the incorporation of abuse-deterrence f...
Source: drugwonks.com Blog - November 10, 2014 Category: Pharmaceuticals Source Type: blogs

MKSAP: 42-year-old man with severe burning and stabbing pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 42-year-old man is evaluated for a 6-day history of severe burning and stabbing pain in both feet that is worse in the toes. The pain is more severe at night, is aggravated when the bed sheets touch his skin, and is partially relieved when he walks or massages his feet. The patient has an 8-year history of poorly controlled type 1 diabetes mellitus and a 2-year history of hypertension. He was hospitalized briefly 2 weeks ago for treatment of pneumonia and diabetic ketoacidosis. His fasting blood glucose levels...
Source: Kevin, M.D. - Medical Weblog - October 25, 2014 Category: Journals (General) Authors: Tags: Conditions Diabetes Endocrinology Neurology Source Type: blogs

How I Would Treat Myself for Ebola at Home
Health officials in Sierra Leone are admitting defeat in the fight against Ebola and are trying to set up self-treat kits for patients to use at home because of the lack of hospital beds to care for the ill. This sad development started me thinking about what I would do if I was stuck in a place with Ebola and could not receive care from a physician or in a hospital. ***Please note that any one who thinks there might be even a tiny chance that they have Ebola should present immediately to a hospital for definitive care.*** This is purely an academic exercise but here is what I think I would do to try to self-treat Ebola an...
Source: Inside Surgery - October 12, 2014 Category: Surgery Authors: Editor Tags: Ebola home treatment rehydration fluid self-treat Source Type: blogs

Healthcare Update Satellite — 09-22-2014
More updated from around the web at my other blog at DrWhiteCoat.com Study in the journal Pediatrics shows that about 10,000 children are hospitalized each year for accidental medication ingestions. Three quarters of those hospitalizations involved 1 or 2 year olds. Twelve medications were responsible for 45% of all pediatric emergency hospitalizations for accidental drug ingestions. Opioids were not surprisingly the top classification prompting hospitalizations, but buprenorphine and clonidine were the top two medications – responsible for 15% of all hospitalizations. The rate of hospitalization for buprenorphine pr...
Source: WhiteCoat's Call Room - September 22, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Curbing prescription pain medication abuse by working together
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I recently heard a story on the news about a grandmother of eight who had gotten addicted to heroin after being prescribed an opioid painkiller, Oxycontin, for hip pain. It sounds extreme, but unfortunately to those of us in the pain medicine field, it’s all too familiar. Every year in September we acknowledge people struggling with pain during National Pain Awareness Month. It’s an important month dedicated to the roughly 100 million people suffering from chronic pain in the U.S. It’s also important to acknowledge that the abus...
Source: Kevin, M.D. - Medical Weblog - September 18, 2014 Category: Journals (General) Authors: Tags: Physician Pain management Source Type: blogs

Higher Authorities? - Pharmaceutical Companies, Addiction Experts, and Marijuana Policy
We have often discussed the web of conflicts of interest that is draped over medicine and health care, and seems responsible for much of our current health care dysfunction.  We have discussed examples of conflicts of interest affecting clinical research, clinical teaching, clinical care, and health care policy.  Each time I think we must have cataloged all the useful examples, a striking new one appears.So, let us get down into the weeds, so to speak, in the trendy new area of marijuana policy.I am not about to express an opinion on whether marijuana will prove to be useful in health care, but certainly some peo...
Source: Health Care Renewal - September 11, 2014 Category: Health Management Tags: conflicts of interest narcotics patient advocacy groups stealth health policy advocacy Source Type: blogs

Don’t become your kids’ drug dealers
Doing drugs no longer requires a dealer on the street corner. Between the late 1990′s and 2010 sales of narcotic pain medicines quadrupled in the United States. Hydrocodone use increased by 280%, methadone by 1300%, and oxycodone by 900%. As the consumption of these medicines increased, so did ER visits and deaths from overdose — up by about 500%. Continue reading ... 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 - September 11, 2014 Category: Journals (General) Authors: Tags: Meds Medications Pediatrics Source Type: blogs

Once an Addict, Always an Addict?
This is a saying I’ve always grappled with. One part of me is against any type of labeling, let alone a heavy label to be carried for the rest of your life. We are all so interchangeably dynamic, that to categorize someone into a box forever doesn’t sit well.  Another part of me completely agrees with this statement and perceives it to be utterly valid. Instead of denying who you are, true acceptance perhaps is the only way to not only recover, but to continue to maintain your recovery. However much I am against “branding” someone for life, it is human nature to create categorizes in order to piece things togethe...
Source: World of Psychology - August 30, 2014 Category: Psychiatrists and Psychologists Authors: Kristin Bach Tags: Addiction Celebrities Habits Health-related Mindfulness Personal Recovery Born Again Designer Drugs Party Drugs Peer Pressure Self Acceptance smoking Substance Abuse Source Type: blogs

The Medical Marijuana Mess
The thin veneer of “medical” marijuana has been stripped away in Colorado, where stores originally providing remedies for patients have been quick to plaster themselves with new signs touting recreational use for all adults. (The signs above are among those I spotted this month in just one small town.) And while federal regulations and public pressure have largely kept alcohol and nicotine out of candy and other child-friendly, sugary products, the marijuana industry is moving in the opposite direction by offering an ever-widening array of pot-infused “edibles,” complete with approving coverage fro...
Source: Health Business Blog - August 27, 2014 Category: Health Managers Authors: David Williams Tags: Policy and politics colorado legalization of marijuana Massachusetts Source Type: blogs

Cases: Second-Line Anti-emetic Therapies for Refractory Chemotherapy-Induced Nausea and Vomiting (CINV)
Discussion:Nausea and vomiting (NV) are commonly reported side effects with chemotherapy.1 The primary pathway for NV involves the chemotherapy drugs directly stimulating the chemoreceptor trigger zone (CTZ), in the area postrema at the base of the fourth ventricle. Activated receptors in the CTZ transmit signals to the vomiting center in the brainstem to produce NV. Receptors in the CTZ include serotonergic receptor 5-hydroxytryptamine type 3 (5-HT3), dopaminergic (D2) and neurokinin type 1 (NK-1) receptors. In addition, chemotherapy can damage GI mucosa causing local release of 5-HT3 neurotransmitters by gut enteroch...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 25, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs