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By Dr. Paul Kivela

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Month: April 2016

Medically Sound

With Dr. Paul Kivela

Morphine vs Hydromorphone: Does it Matter?

  April 30, 2016

An article by Padma Gulur et al. in Pain Research and Treatment Volume 2015 (2015), Article ID 482081 looked at morphine and hydromorphone use.  Hydromorphone (Dilaudid) is up to 7.5 times as potent as morphine and its use has dramatically increased in the past decade.  This study has some great background information and resources which… Read More


Limited English Proficiency a Risk Factor for 72...

  April 30, 2016

A study in the May 2016 issue of Annals of Emergency Medicine looks at the issue of the ability to speak and understand English and 72 hour returns.  The study concludes even with insurance status taken into account, whereas admission rates were unchanged, that people who don’t understand English are more likely to return to… Read More


UK physicians strike

  April 29, 2016

It is not uncommon to hear about nurses going on strike however, we never hear of physicians going on strike.  Physicians around the world are frustrated and many feel powerless.  Many proponents say the only way for the healthcare system to actually be reformed is to have the physicians lead the change.  Is a physician… Read More


EM physicians write less than 5% of opiate...

  April 29, 2016

Emergency physicians prescribe less than 5% of all opiate prescriptions in the United States.  Furthermore, emergency physicians had the highest decrease (-8.9%) of all medical specialties in opiate  prescriptions from 2010-2012.   Although there is an opioid epidemic, the data shows that emergency physicians are part of the solution. Overall, opiate prescriptions increased by 11.7%… Read More


Vitamin D Associated with Lower Cancer Risk

  April 29, 2016

The relationship between vitamin D deficiency and certain cancers was first reported in 1980. They determined that people residing at higher latitudes, were more likely to have Vitamin D deficiencies also had higher rates of colon cancer. Vitamin D has since been linked to other cancers including breast, lung, and bladder. A study published in… Read More


Causes of Stomach Cancer

  April 29, 2016

Stomach cancer – also known as gastric cancer – is the fifth most common cancer worldwide. Almost a million cases of stomach cancer are diagnosed annually and this accounts just under 10% all cancer. The average age at diagnosis in the United States  is 72 years. Stomach cancer is the third most common cause of… Read More


Hospitalist Compensation & Satisfaction 2016

  April 28, 2016

This is an interesting but somewhat confusing report on hospitalist compensation. Medscape’s Hospitalist Compensation Report describes the earnings, productivity statistics, and career satisfaction of these specialists. Source: Medscape Hospitalist Compensation Report 2016… Read More


Could marijuana help treat painkiller and heroin addiction?

  April 27, 2016

Associated Press, Michael Casey shares an interesting take on MMJ. CONCORD, N.H. (AP) — The growing number of patients who claim marijuana helped them drop their painkiller habit has intrigued lawmakers and emboldened advocates, who are pushing for cannabis as a treatment for the abuse of opioids and illegal narcotics like heroin, as well as… Read More


Telemedicine may reduce Emergency Department Utilization

  April 26, 2016

Background: High-intensity telemedicine has been shown to reduce the need for emergency department (ED) care for older adult senior living community (SLC) residents with acute illnesses. We evaluated the effect of SLC engagement in the telemedicine program on ED use rates. Materials and Methods: We performed a secondary analysis of data from a prospective cohort… Read More


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