A Stressing Situation
A 64-year-old woman presented to the emergency department with two days of severe nausea, numerous episodes of vomiting, and progressively worsening right upper quadrant/epigastric abdominal pain. She was continuously spitting clear secretions into an emesis bag on arrival in triage. Her 8/10 dull ”ripping” pain originated in the right upper quadrant and radiated in a band-like pattern to her epigastrium. She was not experiencing any chest pain or shortness of breath. Her medical history included hypertension, type 2 diabetes mellitus, recurrent acute pancreatitis secondary to hyperglycemia, peripheral artery disease, ...
Source: Spontaneous Circulation - March 10, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Some inconvenient observations regarding our "National Program for IT in the HHS"
(To astute readers, "National Program for IT in the HHS" is a not-very-thinly-veiled reference to the NPfIT, the National Programme for IT in the NHS, a £12.7bn project that went "pffft.")I have been very concerned over the years about EHR and other clinical IT risk, and with patient's rights (e.g., to a safe care environment, a legal obligation of healthcare facilities to maintain in the U.S).Looking at the medical malpractice data at my Feb. 28, 2014 post "Malpractice Claims Analysis Confirms Risks in EHRs" (http://hcrenewal.blogspot.com/2014/02/patient-safety-quality-healthcare.html) I make the following observat...
Source: Health Care Renewal - March 3, 2014 Category: Health Medicine and Bioethics Commentators Tags: CRICO Healthcare IT failure healthcare IT risk HIT regulation medical malpractice Source Type: blogs
A Call To Rein In Phase III Trials
Here's a very nice perspective on what gets funded in drug research and why. Robert Kocher and Bryan Roberts bring their venture-capital viewpoint (Venrock) to the readers of the NEJM:
It is not mysterious why projects get funded. As venture-capital investors, we evaluate projects along four primary dimensions: development costs, selling costs, differentiation of the drug relative to current treatments, and incidence and prevalence of the targeted disease (see table). For a project to be attractive, it needs to be favorably reviewed on at least two of these dimensions. Many drugs designed for orphan diseases and cancers ...
Source: In the Pipeline - February 28, 2014 Category: Chemists Tags: Clinical Trials Source Type: blogs
The LITFL Review 127
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
Welcome to the 127th edition, brought to you by:
Kane Guthrie [KG] from LITFL
Tessa Davis [TRD] from LITFL and Don’t Forget The Bubbles
Brent Thoma [BT] from BoringEM, and ALiEM
Chris Ni...
Source: Life in the Fast Lane - February 25, 2014 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Education eLearning Emergency Medicine Featured Health Intensive Care Source Type: blogs
Pro vaccination campaign – Mumps
There is a lot of #BS talked about the harm vaccines might cause, most of it unproven scaremongering by patient advocates, lawyers, quacks and tabloid journalists. There is almost a religion growing out of the antivax campaign that seems to walk hand-in-hand with conspiracy theory nonsense and the gibberish peddled by those who think governments shouldn’t advise us on what to do when it comes to health, even if it could save lives. Here are a few answers to the antivax brigade.
Boy with mumps – http://en.wikipedia.org/wiki/Mumps – Mumps is rarely lethal but can cause orchitis in adolescent and adult male...
Source: Sciencebase Science Blog - February 10, 2014 Category: Medical Scientists Authors: David Bradley Tags: Science Source Type: blogs
Son of the absent-minded professor
I’m standing in the kitchen, but I haven’t a clue why I’m there. Again. I mean, I got up out of bed and came in here for some reason, obviously. I scratch my head distractedly and dislodge a few scabs. Crap! I’m supposed to leave those alone. I try a mental checklist. Am I hungry? No. Am I thirsty? No. Did I need a cup of coffee? A glass of wine? No and no. Defeated, I wander back to bed, clueless about the mission I set out on less than a minute before. This is my new reality. As my body heals, my mind dissolves. Probably, I’ve been out of my mind for a bit, but was just too sick to notice it. Now I’m well eno...
Source: LifeAfterDx--The Guardian Chronicles - January 20, 2014 Category: Diabetes Authors: Wil Source Type: blogs
Whatever Happened To The ADA Request For Data From Pharma?
Last spring, the American Diabetes Association attempted to resolve a burning debate about the safety of various diabetes drugs called GLP-1 inhibitors by asking several drugmakers to release patient-level data that could be used for an independent review. At issue was whether a definitive link exists to developing acute pancreatitis and pancreatic cancer.
The questions were raised after a pair of studies caused a stir. One study indicated that two widely used drugs – Merck’s (MRK) Januvia and Bristol-Myers Squibb’s Byetta – can double the risk of developing pancreatitis, which is an inflammation of the pancreas th...
Source: Pharmalot - December 18, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs
JellyBean 013
Dr Penny Stewart. Director of Alice Springs ICU.
The “white haired doctor” in the “land of the long white cloud”.
Red Hot Medicine in the Hot Red Centre of Australia.
Alice Springs Hospital, in the Northern Territory of Australia, is one of the worlds most remote Intensive Care Units.
It cares for some of the worlds most spectacular people in one of the worlds most spectacular environments.
Sick people but reversible causes.
Penny has published previously on the differences in the presentation of, and recovery from, severe sepsis in the indigenous western desert population that visit her unit...
Source: Life in the Fast Lane - October 27, 2013 Category: Emergency Medicine Doctors Authors: Doug Lynch Tags: Emergency Medicine Featured JellyBean Dr Penny Stewart Source Type: blogs
High triglycerides: Wheat elimination or gemfibrozil?
April posted this question about high triglycerides. High triglycerides are very confusing to many people, often even ignored by many of my colleagues. Because she got such lousy advice from her doctor and because the solutions are really SO simple, I thought I’d relate her story with the advice that really works.
I had blood work done last week after experiencing some edema in my feet and legs. My non-fasting triglycerides were 600 mg/dl and the doctor wants to put me on gemfibrozil and do a HbA1c to rule out diabetes. I want to try Wheat Belly first before taking the meds. Is that reasonable?
He told me I need to ...
Source: Wheat Belly Blog - October 14, 2013 Category: Cardiology Authors: Dr. Davis Tags: Lipids Triglycerides Source Type: blogs
Management of acute pancreatitis: can we be evidence based?
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - October 8, 2013 Category: Internists and Doctors of Medicine Tags: gastroenterology Source Type: blogs
Gliadin: The Universal Human Poison
Autoimmunity is the process describing an immune response waged against our own organs. The complex collection of mechanisms consisting of T and B lymphocytes, antibodies, and others, meant to provide protection against viruses, bacteria, and other body invaders, is misdirected against proteins of the body’s organs, such as liver, pancreas, thyroid, or brain. Autoimmune conditions now affect 8% of the American population–it is increasingly looking like diseases of autoimmunity are out of control.
Dr Alessio Fasano was recently awarded the Linus Pauling Award, the highest award from the Institute for Functional...
Source: Wheat Belly Blog - October 7, 2013 Category: Cardiology Authors: Dr. Davis Tags: Autoimmunity Gliadin Source Type: blogs
Medical Mispronunciations and Misspelled Words: The Definitive List.
Hearing medical mispronunciations and seeing misspelled words are an under appreciated joy of working in healthcare. Physicians often forget just how alien the language of medicine is to people who don't live it everyday. The best part about being a physician is not helping people recover from critical illness. The best part is not about listening and understanding with compassion and empathy. Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process. Doctors c...
Source: The Happy Hospitalist - October 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Onlgyza Appears to Raise Risk of Heart Failure
A two year long study of two DPP-4 inhibitors (one not available in the U.S.) found that these drugs did not, as hoped, lower the risk of heart attack in people with diabetes who took them, and they found a surprising increase in cases of heart failure among people taking Onglyza.UPDATE 2-Doctors get good and bad safety news on diabetes drugshttp://www.reuters.com/article/2013/09/02/heart-diabetes-idUSL6N0GY0S720130902The study also claimed to find no sign of pancreatic disease with Onglyza, but there are several reasons to discount this finding:1. The study only lasted 2 years, which is far too short a time for the ...
Source: Diabetes Update - September 2, 2013 Category: Diabetes Authors: Jenny Source Type: blogs
Case of the Week 270
The following were found in a stool specimen from a 52 year old immigrant from Vietnam with pancreatitis and right upper quadrant pain. They measure between 30 to 35 micrometers in length. Identification?What is a feared complication of infection? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - August 19, 2013 Category: Pathologists Source Type: blogs
Patients: Insist on being an equal and active partner in your care
It was the beginning of my third year of medical school. I had just started my first clinical rotation. My very first patient was Ray, a middle-aged man with pancreatitis.
I presented his case to the team. “What are Ranson’s criteria?” the attending physician asked.
My mind went blank. “Uh, I’m not sure,” I said.
“Next time, you’d better be sure,” the attending said. He turned to my colleague, who promptly gave the correct answer.
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 - August 16, 2013 Category: Family Physicians Tags: Physician Emergency Patients Source Type: blogs
