A study in the the February 2017 issue of Epidemiology discusses one of the untoward side effects of gluten free diet. The downside is increased blood levels of heavy metal toxicity primarily arsenic and mercury. An initial thought was increased intake of fish but the the hypothesized cause is thought to be increased rice which tends… Read More
This March 2014 CDC report shows a high incidence of tick borne pathogens causing including the usual Borrelia burgdorferi, the spirochete that causes Lyme disease and also a relatively new B. miyamotoi, which causes a similar syndrome and relapsing fever. B. miyamotoi has also been found in the Midwest and East Coast U.S. This CDC… Read More
Most Americans support requiring the measles, mumps and rubella vaccine for public school children in order to protect public health. They see high preventive health benefits of such vaccines, and low risk of side effects, and they consider the benefits of the vaccine to outweigh the risks.Yet, public concerns about childhood vaccines linger in the… Read More
This article from the January 30, 2017 issue of Canadian Medical Association Journal looks at which patients with chest pain can be safely discontinued from telemetry/cardiac monitoring after an initial evaluation. Although this article may not persuade me from discontinuing patients when we have enough monitors in the Emergency Department, but this study in conjunction… Read More
This ACEP Clinical Policy published in Annals of Emergency Medicine looked at the management of patients with suspected Carbon monoxide poisoning. The policy reviewed the literature to answer several questions. 1. In ED patients with suspected acute CO poisoning, can noninvasive COHb measurement be used to accurately diagnose CO toxicity? Level B recommendations: Do not… Read More
This 2017 ACEP Clinical Policy examines two questions in patients that present to emergency department with a positive pregnancy test. The policy reviews the literature and looks at HCG values and makes recommendations on the use of ultrasound and HCG levels. All these policies should be used in conjunction with clinical judgment. 1. Should the… Read More
A study, in February 8, 2017 Mayo Clinic Proceedings, looked at whether the core motivation of physicians to help people was related to burnout. The study tried to examine a physician’s passion to help others by examining their responses on six true-false questions: “I find my work rewarding” “My work is one of the most… Read More
This January 31, 2017 JAMA Viewpoint article examines whether Hemoglobin A1c should be used as an outcome (quality) measure Type 2 diabetes and its complications are one of the most expensive issues facing U.S. healthcare. An obvious goal is to reduce the number and scope of diabetic complications which should in return improve diabetic’s quality and likely longevity. The… Read More
A January 22, 2017 JAMA article examined the readmission rate and costs of patients discharged with a diagnosis of sepsis. The study examined the 30-day readmission rates. Currently, CMS tracks readmissions following index hospitalizations for acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia Although previously unstudied, the authors hypothesized that… Read More
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