The NNT | Quick Summaries of Evidence-Based Medicine

The NNT | Quick Summaries of Evidence-Based Medicine.

I think I blogged this before, but didn’t describe it much.  Allow me to rectify that mistake.

theNNT.com is an ever expanding site which boils down high quality reviews of medications and interventions, and presents its recommendations in a very much more approachable grren/yellow/red/Warning triangle format rather than some ratio.

While I won’t use this as a single source to change my practice I’m going to have to do some more research on some ofht eh shibboleths of our age ( Octreotide for variceal bleeding, PPI infusions for Upper GI bleeding, etc) are just two of the studies that fly in the face of current practice.

An aside: while inhaled corticosteroids for asthma aren’t beneficial in the review, what it doesn’ tell you is that the Feds think it does, and will grade your asthma care on how many of your asthma patients get a prescription for them.  So, be aware.

Graham is behind this, and good for him.

retired doc’s thoughts: What are the plans of Don Berwick’s “leaders with plans”?

retired doc’s thoughts: What are the plans of Don Berwick’s “leaders with plans”?.

Wow.  I’m speechless.

Thanks to Retired Doc for getting this out in a cogent summary.

Happy Birthday, Marines!

I post this every year, and I still enjoy it…
original poster from: stores.ebay.com/WONDERFULART

Yeah, I was Navy, but spend 4/5 of your time with the USMC, and you identify. (Insert Stockholm syndrome joke here).

I kid, because I deeply respect. Happy Birthday, Marines.

Eye Dr DeLengocky: A second medical school in Fort Worth is a misplaced priority

…It is obvious that the priority of addressing physician shortages in the area is to develop new residency opportunities, not increasing the number of medical students. Therefore, the push for a second medical school on campus with a class size of 100 students is a travesty and misplaced effort.

via Eye Dr DeLengocky: A second medical school in Fort Worth is a misplaced priority.

A good article by a DO against a Fort Worth MD School, with a good point: what we need more are residency slots, not a new school.

This also ignores the elephant in the room, that hospitals don’t want Osteopathic residencies as there’s still a stigma (which is not justified but that is real).  I believe that’s the reason behind the allopathic push, with the not unreasonable belief that hospitals will be more amenable to opening MD residencies.

Still, a good blog post by a medblogger I was unaware of, and it makes very good points.

Scientists turn skin into blood in medical breakthrough; could help cancer treatment | The Australian

STEM cell researchers have found a way to turn a person’s skin into blood, a process that could be used to treat cancer and other ailments, according to a Canadian study published today.

The method uses cells from a patch of a person’s skin and transforms it into blood that is a genetic match, without using human embryonic stem cells, said the study in the journal Nature.

via Scientists turn skin into blood in medical breakthrough; could help cancer treatment | The Australian.

Wow.  Very cool.

I wonder if, hopefully, someday, this could be a replacement for random blood donation?

Lawmakers Discussing Dropping Health Care Program — Health Reform and Texas | The Texas Tribune

Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.

via Lawmakers Discussing Dropping Health Care Program — Health Reform and Texas | The Texas Tribune.

Hmmm.

Welcome to entitlement reality, Texas-style.  Currently 20Bn/year and going to go up with expanded eligibility, the article does say the Feds pay 60%, but doesn’t say: 1) it’s temporary, then the Federal contribution goes down or away, and 2) the Federal component doesn’t come from magical money fairies, it’s money takes from taxpayers then funneled back into a particular program.

Medicaid is not loved or respected in Medicine.  Decreasing reimbursements coupled to increasing requirements mean it’s at a minimum inefficient for both patients and providers.

I’m not against kicking Medicaid to the curb PROVIDING the state has some kind of replacement program.  Which I’m not sanguine about.

How to make Oral Rehydration Therapy fluid

Doc Gurley (who’s been going to Haiti since at least the first earthquake relief started) wrote a post today about cholera (currently hitting Haiti hard).

She found there were very few YouTube videos about how to make Oral Rehydration Therapy (ORT) fluid, which is the mainstay of cholera treatment.  Simply put, if you can replace orally what you’re losing from the far end, you get to live.  It’s cheap, it’s easy, but you have to know what to do for it to work.

ORT is super cheap and amazingly easy to make.  Thanks to Doc Gurley, there is now an illiterate (as in language independent) how to video: Recipe for Life!

While it seems graphic, I think it makes perfect sense.  Here’s hoping it helps!

Per Doc Gurley, swipe the video!  Repost it everywhere!  She says Haitians have cell phones, and the more universal this knowledge is the more likely it is to help.

Fort Hood Murders, one year ago today

Ace of Spades HQ has a nice salute to them.

They were murdered (minimally allegedly) by a Physician who should be on trial for Treason as well as murder.

Respect and condolences to the families of those murdered, thank you for their service.

Qantas grounds Airbus A380 fleet after engine cover falls off plane – CNN.com

CNN — Qantas, Australia’s national airline, grounded its Airbus A380 fleet indefinitely after part of a plane’s engine cover fell off in flight Thursday.

via Qantas grounds Airbus A380 fleet after engine cover falls off plane – CNN.com.

“The engine cover fell off”.  That’s like explaining death as turning very pale, neglecting to mention the heart stopped.

The engine cover fell off because the engine shucked some turbine blades.  One of the pictures in the CNN report is of holes in the top of the wing over then #2 engine which appear to be going up.

Good for Quantas for handling it professionally and safely.

Online doctor ratings aren’t very helpful – USATODAY.com

By Kevin Pho

When I ask new patients how they found me, frequently they say on the Internet through search engines such as Google.Out of curiosity, I recently Googled myself. Numerous ads appeared, promising readers a “detailed background report” or a “profile” of me. Among the search results was information about my practice, whether I was board certified, had any lawsuits against me, and reviews from online doctor rating sites. Thankfully, most were favorable, but some were not.

via Online doctor ratings aren’t very helpful – USATODAY.com.

Kevin, MD, who else?

Great work Kevin!  (I shook his hand once, might have been my brush with fame).

Dr. Wes: Accountable Care Organizations: It’s So Sad, It’s Funny

Dr. Wes: Accountable Care Organizations: It’s So Sad, It’s Funny.

Go and watch the video.

If you’re in medicine, you’ll get it.

If you’re not, you’ll still appreciate the clueless humor.

President Lyndon Johnson nearly shot dead by Secret Service agent… hours after JFK assassination | Mail Online

President Lyndon Johnson was milliseconds away from being shot dead by a Secret Service agent – only 14 hours after John F. Kennedy’s assassination, a new book has revealed.

via President Lyndon Johnson nearly shot dead by Secret Service agent… hours after JFK assassination | Mail Online.

Interesting.  Here’s the funny part.

Oh, dear.

You know that patient you saw yesterday…

…another in a series.

“You know that patient you saw yesterday?” was how the conversation started.

I did remember, it’s not often I Find the Pony, diagnostically.  A good case, which from my aspect means I had to think, act, and make things happen. Yesterday I was quite pleased with myself.

Now the ‘do you remember’ intro. Never good. Never.

A colleague tells me how the patient I saw yesterday (and made a couple of good, if odd-to-present-at-the-same-time diagnoses) died while getting an x-ray study, in the ED, when one set of their symptoms returned. (Sorry for the vagueness, thank a room full of lawyers who are afraid of their shadows and have rubber sheets).

Darn. The day before, the patient was doing well, thanks to a good diagnosis and getting the right people to buy in and act. And now my patient is dead, from one of the same diagnoses.

Lifetime death rate: 100%. I do what I can, we all do.

But 100% is an absolute. Sorry.

» Features » how NOT to pee in your scrubs…

» Features » how NOT to pee in your scrubs….

Genius.  Go, watch, and learn.  (Hint, it’s not just for scrubs…)

Joe Gibson Memorial Foundation – Home

Joe Gibson Memorial Foundation – Home.

I hadn’t heard about this, and while it’s probably a little late to start training for a 10K race being held tomorrow in Arizona, this looks to be a worthy foundation and a regular event.

What got my attention:

Joe Gibson, MD was a Phoenix Emergency Medicine Physician who had dedicated his life to saving and helping people in need. He was known to have a happy, infectious personality and a zest for life. A lifetime athlete, Joe spent time training and participating in triathlons and running races to balance his life and to stay healthy.

On December 29th, while on a training run in Phoenix, Joe was hit by a car. He sustained massive head injury and brain death. Even after this tragedy, Joe continued to give back as he became an organ donor and was able to save 4 lives with this last parting gift.

He was obviously loved, and he lives on through this foundation.  Inspiring.