When babies are born prematurely, they often lack surfactant: a soapy substance produced in the lungs that helps to keep the air sacs open. Without surfactant, these tiny babies fight to breathe, a condition known as infant respiratory distress syndrome. Within the past 50 years, the delivery of artificial surfactant therapy has revolutionized neonatal care, saving many lives that previously would have had no chance at survival. As a neonatal intensive ...

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Her heart was failing; her ejection fraction was unmeasurable.  Her hip was broken, and she developed a pulmonary embolism post-operatively.  She was painfully close to death.  Yet at some point, the hospital finished and spit her out at the nursing home. She was confused. I tried to take the best history that I could.  Her answers where usually no more than a single word.  Her physical exam revealed a desperately weak woman, ...

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As part of the increasing push for health care quality improvement, a lot of energy is being focused on improving our communication with patients and making sure that patient-centered care is more than just a buzz phrase. Gone are the days when the doctor-patient interaction was a wholly paternalistic one, where the doctor’s word was taken as final and absolute, and patients weren’t encouraged to ask questions or raise concerns. Although we’ve moved on ...

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medpagetodayFrom MedPage Today:

  1. U.S. Seniors Losing Grip on Muscle Strength. The first national survey on grip strength in older adults found that 5% of those over 60 had weak muscle strength, and 13% had intermediate strength.
  2. Low MI Risk in Patients With Non-MI Chest Pain. Patients treated in emergency departments (EDs) for ...

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Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that? Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren ...

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We all went into medicine to save lives. Deep within even the most cynical of us, is still that pre-med hopeful that believes we can and should restart each non-beating heart, make the non-breathing breathe and fill with blood those who’ve bled, filling them back with life. We expect that a patient’s condition will improve while under our care, or at least not worsen. Intellectually, we know we’ll not be ...

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Patients admitted to the hospital ward sometimes get sicker instead of getting better right away.  Often this can happen acutely. Depending on the circumstances, ranging from a "rapid response" for unstable vital signs to a cardiac arrest (a "code”), previously uninvolved hospital staff might be called on to help.  Despite the commotion, these events are a period of time for the health care team to shine.  At inpatient emergencies, ...

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You live like this, sheltered, in a delicate world, and you believe you are living ... And then some shock treatment takes place, a person, a book, a song and it awakens [you] and saves [you] from death. - Anais Nin On June 12, 2013, my driver and I were on our way to Sierpe, Costa Rica from Manuel Antonio when the road entered a palm tree plantation.  About 50 meters in ...

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This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift. Fresh out of residency, I had accepted a job in the ER of a community hospital which -- though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview -- had turned into exactly the opposite when I was slugging through the night shifts alone and disgruntled ...

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shutterstock_60295858 I will always remember my awkward medical school interviews. Filled with bioethical scenarios and questions to measure my ability to prevent an impaired physician from practicing, the interviewers seemed hardly interested in my prior career achievements or humble beginnings. Such discussions carried on through the first two years of medical school. They never taught us how health care reimbursement works or why ...

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medpagetodayFrom MedPage Today:

  1. Is This Tattoo Worth a 1,000 Needle Pricks? Researchers at the University of California San Diego believe they have a feasible, noninvasive method for monitoring serum glucose: a temporary tattoo.
  2. Systolic Pressure Signals Risk in Young. Isolated systolic hypertension in young and middle-age adults was associated with an increased ...

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This isn’t a debate about vaccines. The fight here has nothing to do with that. For the record, I strongly support the concept of vaccination. Public health is better in the 21st century because of it. Measles? Mumps? Oh, I can find you in the United States, but we aren’t living our lives every day petrified of an outbreak. Smallpox? Polio? Where did you go? Not here, that’s for sure. And, ...

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michael davidson This week the local and national attention has been riveted on accusations that Bill Belichick and the Patriots football team deliberately deflated the footballs used in the division championship game.  Football, remember, is a multi-billion dollar industry in which the commodity being sold is grown men throwing brown, oblong balls at each other and knocking each other down.  Boston.com, a ...

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american society of anesthesiologists A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. In an emergency, the first question people often ask is: “Is there a doctor in the house?” When you have a medical problem, the best advice is, “Ask your doctor.”  Most people automatically assume that “doctor” in this context refers to a physician with a ...

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In a recent article posted on this site, the author (a radiologist) waxed rhapsodic about a young medical student that was convinced to pursue primary care. When the author asked the student about the economic downsides to primary care, he responded by saying, "I’m not in it for the money ... What matters to me isn’t the money -- it’s making a difference in my patients’ lives.” Well, good for him. Time ...

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1. Before anything, advertise yourself as a protector of the public against incompetent physicians. 2. Design the examinations for each specialty with a “one size fits all” approach. You can achieve this by disregarding the fact that many physicians prune their practices over time to accommodate to the demographics of their communities and their availability of specialty care. This has particular significance for internal medicine and family medicine. Also, by including a large ...

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We’ve almost made it. Long gone are the purgatory stints of library study, slaving to solve esoteric problems relating to planks and pulleys. Innumerable several-day exams have been conquered and tucked far away in our memories, hopefully never to haunt us again. The last of our forced smiles and faux-eager nods have been displayed toward ambivalent instructors and medical teams during the throes of our student rotations. Post-graduate training is also nearing ...

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DeathByDespair-640x385 A friend just got back from a big medical conference at a fancy hotel. The cleaning ladies actually pulled her aside to ask, “What’s with all the grim faces and sad eyes?” Do doctors realize medical conferences look like funerals? That’s what the cleaning ladies think. I bet they’re not the only ones. Why do medical conferences feel like funerals? Maybe because doctors ...

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medpagetodayFrom MedPage Today:

  1. PCP Flying High on Corporate Wellness. In 2008, E. Brooks Wilkins, MD, was faced with a hard choice: shutting down a wellness and weight-loss center designed for people who had tens of thousands of dollars to spend on a 30-day intensive treatment program or toughing it out through a devastating recession.

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Times change, and, as with Darwinian natural selection, those who adjust survive and those who don’t perish. Henry Ford’s assembly line greatly ramped up the production of automobiles but put many people out of work. The elevator operators of my childhood are long gone. Those who have embraced new technology have usually thrived; those who have fought it or failed to understand it have suffered. Witness the success of Amazon versus ...

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