Archive for the 'Medical' Category

The Happy Hospitalist: The Sleeping Husband Sign

I’ve seen this in action, but never put it together.  Another invaluable resource.

Popularity: 3% [?]

Medgadget Interviews Dr. J. James Rohack, President-elect of the AMA - Medgadget - www.medgadget.com
Medgadget rarely ventures into politics. However, after one of our editors contacted the American Medical Association (AMA) public relations department to check out how the AMA is doing, we were offered a chance to talk to senior leadership in the organization. We, of course, couldn’t have missed such an opportunity! The result is an interview with J. James Rohack, MD, a cardiologist from Bryan, Texas, in the Texas A&M Health Science Center College of Medicine, and recently announced president-elect of the American Medical Association. Dr. Rohack will assume the AMA presidency in about a year from now, in June 2009.

Looks to be a good interview.  I’ll read it when I get home tonight.  Way to go Dr. Ostrovsky!

Popularity: 8% [?]

DB’s Medical Rants » I love the Wal-mart program

Dead on.

Popularity: 11% [?]

FDA to Add Warning to Antibiotics - WSJ.com
By JARED A. FAVOLE
July 9, 2008; Page B7

WASHINGTON — The U.S. Food and Drug Administration will seek to add strong warnings about the risks of tendon rupture associated with a class of antibiotics used to treat bacterial infections.

The FDA wants to add black-box warnings, the strongest warning the agency issues, to a handful of drugs, including Bayer AG’s Cipro and Johnson & Johnson’s Levaquin. The move comes six months after the consumer group Public Citizen sued the FDA to require the agency to add black-box warnings to the drugs.
…
Serious reports of tendonitis and tendon rupture continue to increase with use of the drugs, prompting the FDA to ask companies to add the stronger warnings, the FDA said in a posting on its Web site Tuesday. Such ruptures most frequently involves the Achilles tendon, but also include ruptures of the shoulder, hand, biceps, and thumbs.
(emphasis mine)

Black box warnings used to be for very serious, life-threatening problems in drugs.  Now tendonitis and tendon rupture are life threats, or are so serious they warrant a Black Box?  The elevation of known, well-documented drug side effects to Black Box status dilutes its meaning, and will ultimately require the formation of a new class of warnings.

Tendon ruptures aren’t benign.  Neither are infections.  Name me an antibiotic that wouldn’t rate a black box under the criteria used on the flouroquinolones, then wonder at what’s happened to the FDA.

Popularity: 11% [?]

Some love for Epocrates.

I used Epocrates on Palms for a few years, then was an early adopter of Epocrates on the Backberry platform, and it had a glitch; they fixed it within a week, and it’s been smooth sailing/computing since (see here).

For those who aren’t using it yet, here’s a starting point: Epocrates: Go Mobile Their site will even help you pick which PDA/Mobile phone is best for you.

I use their free product, so this is essentialy a free endorsement, but here goes:

In this day and age of new drugs, continuously changing warnings, and patients on multiple drugs needing interaction checking, some resource is needed, and Epocrates is an excellent product.  It’s (relatively) easy to install, it will update automatically, and it works.  There are things I’d change if it were my product (like this: look up a drug name that’s been discontinued, you get ‘drug discontinued in the US’, but no link to the generic; I now have to back out, and re-search with the generic name: Dumb.) but for a handy, functional drug reference it’s hard to beat.

I use it, and if you don’t have a drug reference in a PDA, this is one you should look at.

Popularity: 10% [?]

Cases - Tim Russert’s Death Offers a Lifesaving Lesson - NYTimes.com

A Tim Russert Syndrome survivor.

via Kevin, MD

Popularity: 8% [?]

Recently, I and my colleagues have taken a lot of transfer calls that have, as their basis, professional incompetence.  Allow me to explain, and then to ask a question.

We’ll get a call from an ER doc with a patient who’s stuck in the middle of a situation: their ED patient has an emergency requiring specialty treatment, they have a specialist in said speciality, but said specialist ‘doesn’t feel comfortable / hasn’t done in years’ the procedure the patient needs, so we’re called to get the patient to a specialist that’ll take care of them.

As a description I’ll tell one bowdlerized tale to give the flavor: patient with an open femur fracture.  Sending hospital does have an orthopedist on call, but “s/he only does spines, and they doesn’t feel comfortable doing this”.  (This happens with virtually all specialties, I’m not singling out ortho, just using them as an illustration of a general problem).

So, yes, medically we can take care of this patient, and medically we accept the transfer; when I talk to admin, I make sure they know all the facts, and then I make sure we do the right thing for that patient, and that’s to bring them to us.

Here’s my question: besides an EMTALA complaint (which the hospital reportedly files a lot of, and reportedly come to nothing), is it time to start reporting this level of professed incompetence to certifying boards?  I would presume a Boarded Orthopedist would be able to take care of an open femur fracture as part of both routine training and certification (and I’d bet they’re credentialed for that procedure at their hospital); if they then profess incompetence in caring for that injury, wouldn’t their certifying board like to know?

What say you, physicians?  Report, yea or nay, and if not, why not?

Popularity: 33% [?]

The Blog that Ate Manhattan: Paul Levy - You Are Not the Boss of Me. Well, Okay, Maybe You Are.

TBTAM has a really well-written piece today about an interview with Paul Levy (and a nice part with some good introspection that most doctors would identify with about why they got into medicine), but she’s very troubled with his response to typical physician negotiating tactics. Read her post for the particulars, then come back here and read after the break.

Read the rest of this entry »

Popularity: 33% [?]

AMNews: May 12, 2008. Harvard offers discount on med school tuition … American Medical News
In March, Harvard announced that students whose families earn $120,000 or less a year will get up to $12,500 off the annual $65,000 cost of tuition and living expenses. The program will start with the 2008-09 academic year.

Wow.  How long does it take to pay off that debt?  Does anyone know Harvards’ percentage of grads going into primary care?  I think there’s be a correlation…

Popularity: 22% [?]

Celebrity-snooping ex-UCLA Medical Center staffer is indicted - Los Angeles Times
Celebrity-snooping ex-UCLA Medical Center staffer is indicted
Lawanda Jackson, who has since resigned after admitting to peeking at the hospital records of stars, was indicted by a federal grand jury on a charge of obtaining identifiable health data for profit.

Innocent until proven guilty; we’ll see.

Popularity: 13% [?]

When did this happen? amednews.com closed to nonmembers in 2005, and I stopped looking for medical news there because I’m not an AMA member.

Today I followed a link, and it’s now open to nonmembers (for the first 90 days after publication). This is a good thing, and I’m glad they did it.

Popularity: 14% [?]

Dr. Val is showing the power of blogs (well, the power of professionally done blogs) by getting a one on one interview with the Surgeon General.  Read her post for the interview, but here’s the part that I enjoyed the most:

(Dr. Carmona):….The American public wants the best of everything, they want it yesterday, and they don’t want to pay for it. That pretty much characterizes the problem that we have. We see health as a right, we want somebody to give us a card, and if we want to smoke, that’s our right too. There’s this attitude that if we want to drink excessively, that’s our right, and if we want to ride a motorcycle without a helmet, that’s our right (”you can’t tell us what to do”). However, when I crash my motorcycle and I have a head injury and I’m disabled for life, I also expect society to pay for that.

Heh.  I believe I’ve said something like that myself.

Popularity: 22% [?]

A little humor for your day, via Pallimed (via Dr. Wes. it’s a tangled WWW):

The description, per Pallimed:

A ICU Nurse and some colleagues rewrote the lyrics to the popular Nickelback song “Rockstar” to emphasize how some patients may feel in the ICU. The video itself is just the lyrics. Here is hoping she puts together more song parodies and maybe a video or two.

Gallows humor, but it’s well done and humorous.

Popularity: 20% [?]

I blogged about this when it happened in 2003 (and the suicide of a man who posthumously took the blame), and wondered idly if anything more came of it. Here’s the answer (complete with a what happened in a small ED that night description).

Farming community moving on after arsenic poisoning

By David Sharp, Associated Press Writer | April 26, 2008

NEW SWEDEN, Maine –It has been five years since this tiny farming community was turned upside down by a crime that still baffles: Someone used arsenic to spike the coffee at Gustaf Adolph Lutheran Church, killing one parishioner and making 15 others violently ill.

…

Soon those who drank the coffee were throwing up, suffering diarrhea, or both.

The first patient arrived in the Cary Medical Center emergency room in nearby Caribou at 3:30 p.m., and sick parishioners kept pouring in over the next six hours. Dr. Dan Harrigan, an emergency room physician, arrived at work at 6:30 p.m. to find one of the parishioners outside on his knees.

Not knowing what they were dealing with, doctors and nurses at the 65-bed hospital struggled to keep patients’ blood pressure from dropping too low.

It wasn’t a pretty sight. Nurses described countertops and the floors covered with vomit-filled basins, buckets and garbage cans. "Out of 26 years in emergency medicine, I doubt I’ll have another night like that," Harrigan said.

By dawn, one of the parishioners had died, several had been transferred to Eastern Maine Medical Center in Bangor, and doctors had figured out they were dealing with a heavy metal poisoning. Laboratory tests later confirmed it was arsenic.

Read the article: several were left with lifelong disabilities, but their community moves on.

Popularity: 14% [?]

In the email:

I know the ED you usually talk about is the emergency department and not the other kind but in February, I reached out to you to introduce Menshealthpd.com (www.menshealthpd.com), a website that offers men who are affected by Peyronie’s disease, both, information and support. Since the launch, it has been so exciting to watch the forum grow into a place for anonymous discussion; people speak openly about their experiences with the disease as well as pose questions that can be answered by physicians.

To keep that conversation going, the site is hosting a live chat on April 16th at 7 pm (EST) with Dr. Culley Carson – an urologist who specializes in the treatment of Peyronie’s. This is a great opportunity for people to have their questions about the disease and its treatment options addressed by an expert in the field, so I would love for you to share this event with your readers.

On the homepage, you will see “Participate in the chat on April 16”; you and your readers are more than welcome to learn more about Dr. Carson or submit comments here ahead of time if you can’t make it and have questions you would like answered during the chat.

If it interests you, tune in!

Popularity: 19% [?]