Maintenance is the process of maintaining or preserving someone or something, or the state of being maintained. Our certification documents that we have trained (in my case in internal medicine) and that we can pass a test on the breadth of internal medicine knowledge. We accept that the ABIM has developed a test the evaluates our entire exposure to the many diseases and treatments that reflect our patients. The idea of maintenance of ...

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As medical librarians, we’re certainly the first to say that PubMed is a superb database, elegantly crafted at the National Library of Medicine to do fast and efficient searches for almost all medical and health subjects. Much of the power of PubMed is that it makes it possible to search broad subjects easily. When the user searches “cancer,” for example, PubMed quickly finds thousands of citations on all types of ...

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I sometimes think doctors forget what it’s like to be patients. But I’ve been there, and I know how frustrating and scary it can be. I remember one night, I was lying in a hospital bed, resting peacefully. I heard a noise and opened my eyes to a room full of chaos. Nurses everywhere. A crash cart. Someone holding paddles. I tried to speak, but couldn’t. And then I got it out: “Please don’t.” Here’s my story: Before ...

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medpagetodayFrom MedPage Today:

  1. Studies Cement Value of HIV Prophylaxis. re-exposure prophylaxis (PrEP) with a single pill prevented HIV infection among more than 85% of two groups of men who have sex with men.
  2. NSAIDs: A Risky Addition to Post-MI Antithrombotics. Adding a non-steroidal anti-inflammatory drug (NSAID) to antithrombotic therapy after a heart ...

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Help, I need somebody! Help, not just anybody! Help, you know I need someone, help! - The Beatles We are all here on earth to help each other; what on earth the others are here for I don’t know.  - W. H. Auden “Help the doctor!” I’m sure most surgeons have heard this exasperated statement at some point in the operating room. It is said with that special mix of frustration, irritation, and sarcasm, usually when things aren’t going ...

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Physician burnout has been previously described as heartbreaking, and this may be an understatement.  The growing complexities of health care delivery, intricacies of documentation practices as required by Meaningful Use, and difficulties inherent to billing and reimbursement are only a few of the issues faced by residents and attending clinicians these days. Unfortunately, these topics are still not formally taught in American medical schools. As students, we really do not know ...

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For years, policy experts have been predicting the end of fee-for-service.  Yet it can be said of fee-for-service that, like Mark Twain’s alleged demise, reports of its death have been greatly exaggerated. (Actually, this is an often-used misrepresentation of what Twain actually said. After the New York Herald incorrectly reported that he was “grievously ill and possibly dying,” an “amused” Mark Twain wrote that “the report of my death has been ...

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shutterstock_243506278 Once the 2008 economic spiral began and, unemployment escalated with wallets and purses zipped closed, causes were not initially recognized. Since then, the causal details of this downturn were ferreted out pinpointing emanation from Wall Street banks. Public discontent demanding change has been ignored allowing potential for recurrence. Why? Business has influenced legislators swaying their vote as they filled campaign coffers. In the ...

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Two problems loom large over the American medical care system. First, we spend outrageous amounts of money on health care, with too many patients receiving too many services at too high a price. Second, our malpractice system is an international embarrassment, with too many health care providers sued by too many patients for too little reason. Many experts have pointed out that these problems are two sides of the same coin. ...

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Infrastructure is never quite as interesting or exciting as innovation. The grand opening of a new building incorporating all the latest integrated technology is far more exciting than bridge repairs. In our fascination for the innovation, we often turn a blind eye to our nation’s crumbling infrastructure.

In the United States today, one quarter of our bridges are structurally deficient or functionally obsolete and more than 100 ...

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The non-medical reader may wonder what I am complaining about.  Of course, many of you have to be credentialed in your fields as well, whether law or accounting, law enforcement or public service, education, nursing or a trade.  But those of you in medicine know how difficult it can be to become credentialed as a physician, either by a state for purposes of a license, or by a hospital in order ...

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medpagetodayFrom MedPage Today:

  1. More U.S. Women Rely on IUDs and Implants. The use of long-acting reversible contraceptives (LARC), such as intrauterine devices, among U.S. women has increased nearly five-fold in the last decade.
  2. Wise Buy? Drugs for Alzheimer's Dementia. On Sunday night when Julianne Moore collected an Oscar for her performance in ...

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“I had no idea how much cancer sucks.” My patient’s observation seems silly, basic.  Of course, cancer sucks.  It maims, humiliates and kills.  It takes.  What made the statement remarkable was its source.  This is not a medically naïve person, waiting to die. Rather it was spoken by a patient in complete remission, likely cured, who is an expert in cancer care.   To her amazement, it changed life forever. I think that ...

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The president's proposed Precision Medicine Initiative, as mentioned in his recent State of the Union address suggests it's probably time to get ready for some changes in our daily routines as health professionals. I'm not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better ...

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Early on in my career I called an Indian internist in the middle of the night to admit a patient to him. The patient was an 88-year-old female with advanced dementia, a terminal brain disease. She had aspiration pneumonia, which is often the final common pathway of this illness. She was in respiratory failure, in septic shock and was a “full code.” I can still recall our 4 a.m. conversation: “Hi, Dr. ...

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Cases of measles linked to an exposure at Disneyland continue to spread, not just in California, but in several other states and in Mexico. The numbers of cases are climbing -- and so are the number of exposed people who might get sick -- and expose more people before they realize they are sick. Measles is extremely contagious; if someone has it, they will infect 90 percent of the people ...

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A cartoon of an angry looking physician, a spotted boy, and some anxious parents in The New Yorker reads, “If you connect the measles, it spells out, ‘My parents are idiots’.”

A facetious article in GomerBlog announces, “Big Pharma Admits They’re Just Trying to Kill Everyone with Vaccines.”

Even television host Stephen Colbert gets in on the make-fun-of-anti-vaxxers act, recently declaring, ...

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Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe"? I hate that I can’t completely say they are ...

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medpagetodayFrom MedPage Today:

  1. Hand Dishwashing Tied to Fewer Allergies for Kids. Children whose families washed dishes by hand were associated with a lower risk of developing allergies compared to those who used a machine dishwasher.
  2. 10 Questions: Jordan Grumet, MD. What's the biggest barrier to practicing medicine today? "The government," said Jordan ...

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Significant snow in New England every winter is about as certain as sun in Florida every summer. When I moved to the USA from the south of (old) England to do my medical residency in Maryland, my first few years living in the United States were relatively snow-free. But when I started my first job as an attending physician in central Massachusetts, I was in for a big shock. I had ...

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