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Archive for the ‘Health Sciences & Medicine’ Category

The whole post is a good read, but the following caught my eye:

A reflection: Is our national medical obsession with chest pain a manifestation of our national anxiety and fear of uncertainty? Of our national terror of death, or our collective unease even in the face of relative security and prosperity? Is it because we’ve subsituted faith for pharmaceuticals?

via edwinleap.com | Sunday morning in the ER.

My answer: yes.   More specifically, we have substituted Science as the religion, humanity as supreme, and have found both sorely lacking.

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Some well reasoned advise regarding the recent federal advisory committee report on acetaminophen published in the New York Times health blog.  I think the key points include the very low level of incidence, and the comparitively high level of side effects (although still low compared to how much it is used) of NSAIDs and Aspirin.

Few drugs are more ubiquitous than acetaminophen, the pain reliever found in numerous over-the-counter cold remedies and the headache drug Tylenol.

But last week, a federal advisory committee raised concerns about liver damage that can occur with overuse of acetaminophen, and the panel even recommended that the Food and Drug Administration ban two popular prescription drugs, Vicodin and Percocet, because they contain it.

The news left many consumers confused and alarmed. Could regular use of acetaminophen for pain relief put them at risk for long-term liver damage?

via Well – Reasons Not to Panic Over a Painkiller – NYTimes.com.

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Article from Ars Technica, discussing the move to digital archiving.  Personally, I would love it if people would stop sending me dead trees and just give me an option for online subscriptions for my journals…

Last week, the head of the US branch of Oxford University Press noted an event that was striking, if unsurprising. When grading an assigned paper, a Columbia University professor found that the majority of his students had cited an obscure work of literary criticism that was roughly a century old. The reason? Because the work was in Google Book Search, while much other (more recent) work was not.

The relative invisibility of offline information has an impact on almost all areas of life, but it’s felt especially acutely in the academic world, where work builds on the existing body of knowledge. Getting all of that dead-tree information onto the Internet (or into archives like J-Stor) would be of tremendous utility to scholars and students, but convenience isn’t the only reason for digital distribution of academic work. A recent decision by a prominent academic publisher to switch to digital-only distribution was apparently motivated by simple economics: print no longer made financial sense.

via Science moves from the stacks to the Web; print too pricey – Ars Technica.

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Too often, EMS crews feel obliged to bring unresponsive patient to hospital, study finds

Quote and Link below

In the United States, paramedics treat almost 300,000 people with cardiac arrest each year. But despite what’s portrayed on TV, fewer than 8 percent survive, according to the American Heart Association.

The association’s guidelines include the recommendation that people who have not responded to cardiopulmonary resuscitation (CPR) and advanced cardiac life support in the field not be taken to a hospital. After paramedics have tried and failed to resuscitate a patient, they should stop, researchers say.

“Paramedics provide all the same lifesaving procedures that we can provide in the emergency department,” said the study’s lead researcher, Dr. Comilla Sasson, Robert Wood Johnson clinical scholar and clinical lecturer in emergency medicine at the University of Michigan Medical School.

“Once you have done 20 to 30 minutes of cardiac resuscitation, the best practice guidelines are to cease if a patient does not have a pulse,” she said. But the study, published online June 30 in Circulation: Cardiovascular Quality and Outcomes, found that several factors inhibit this from happening, including:

via HealthDay.

Most of the time when I get a patient like this, I find that the patient is ready to be declared dead within a couple minutes of arrival, but one is afraid the family will feel that no attempt was made if one stops that quickly.  The paperwork and burden of telling the family then falls on the ER doctor, who honestly knows very little about the case other than what the paramedics just told him.  I’m not sure what is the best option for this, but these cases can lead to significant crowding and disrupt the flow of the Emergency Department, and it would certainly be nice if they weren’t brought to the Department if it is not necessary.

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Many scientists view homeopathic remedies as modern snake oil – ineffective but mostly harmless because the drugs in them are present in such tiny amounts.

But an Associated Press analysis of the Food and Drug Administration’s side effect reports found that more than 800 homeopathic ingredients were potentially implicated in health problems last year. Complaints ranged from vomiting to attempted suicide.

via News from The Associated Press.

I never understood how people keep insisting that “it is natural, so it has no side effects.”  That just didn’t make any scientific sense.  Many synthetic drugs are derivatives of natural substances that are modified to reduce or minimize side effects that would normally occur if taken “naturally.”

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One of the best articles I’ve read in a while:

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

via Annals of Medicine: The Cost Conundrum: Reporting & Essays: The New Yorker.

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I’ve seen this guy a few times now, and he’s at least entertaining, and is perhaps becoming a voice of the science community.

LINK

update: WordPress.com is not letting me embed this, and I’m rather frustrated. Sorry about the messed up earlier posts.

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It’s a new year, and it’s time for new guidelines…

For those of you who want to check on your cardiologists, new recommendations for when it appropriate to revascularize coronary arteries has been published by a joint expert panel of just about every major group you can think of (and a few you couldn’t).  It is no surprise given the recent data that revascularizations are being recommended less and less.

Medpagetoday.com has a summary, and for those of you who feel brave and want to attack the novel itself, you can find it on the website of the JACC.

BTW – I’m recommending this for physicians only.

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Link to Story

Writing in the journal Academic Emergency Medicine, lead author Dr. Carlos A. Camargo of Massachusetts General Hospital estimates that it would take until 2019 to find enough fully-trained, board-certified emergency physicians to work in the 4,828 emergency departments that are open 24 hours a day. And that best-case projection assumes that no current doctors who meet those qualifications die or leave their jobs.

The Institute of Medicine said in 2006 that ERs should ideally be staffed by doctors who had spent their residency training in emergency medicine and had later passed tests to become certified in the specialty. But only about 55 percent of doctors working in ERs meet that standard, Camargo and his co-authors write.

Does any other field have such a low percentage of physicians that are not board certified in the field of practice?  I know some of this has to do with the recent certification process, but that is pushing nearly 20 years now, and grandfathering options were available for those who were practicing before that.  What makes this worse, these calculations were done under the rosiest of scenarios where the doctors do not burn out and leave the field… good luck with that.

I’m not sure there is an easy solution to this problem.  I don’t think anyone is (or shoud be) suggesting we lower the standard of being qualified as an emergency medicine specialist.  There are already over 1000 residents trained a year, and at some point you run out of quality facilities to train residents (getting the right amount of volume with broad, well-rounded training isn’t possible just anywhere).  Decreasing the meteoric rise in ER visits in the past decade will also help a whole lot.

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A really great article by Atul Gawande (writer of “Complications” and “Better”) was published in the New Yorker. The ariticle follows the work on intensivist Dr Peter Pronovost, who made simple workflow interventions which made dramatic reductions on the rate of complications in the intensive care unit. The following quote, however, made him an instant hero to me:

“The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.”

A link to the article is here.

Thanks Phil Andrus at the Mount Sinai Emergency Medicine Critical Care Blog for bringing this to my attention.

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