In August, I posted this: "A paper of mine was published. Did anyone read it?" A recent comment on it raised an interesting point. Dr. Christian Sinclair at Pallimed said the site had received almost 2 million views since 2005. He then made the following calculation: Two million views with an average of 1:30 minutes on a page = 3 million minutes = 50,000 hours = 2,083 days = 5.7 years ...

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Recently, my 16-month-old grandson was at a backyard barbecue with his parents. He had been eating some potato chips when he suddenly stopped breathing and turned blue. Having had CPR training, my son started rescue breathing and suspecting aspiration, performed toddler airway clearance maneuvers. No obstruction was found. The child slowly awakened but was very drowsy. Because of the concern for aspiration, an ambulance was called and the child was taken to ...

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The outrageous $117,000 bill from an assistant surgeon Recently, I wondered why Medicare could not control its costs using the investigative power of the federal government instead of releasing physician payment data and relying on journalists to do the work. Two stories that appeared within days of each other raise a similar question about the private insurance industry's methods. An article in Modern Healthcare described the impending closure of ...

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The astronauts are halfway to Mars when suddenly one of them develops abdominal pain and requires surgery. What will they do? According to NASA, a miniature robot capable of assisting in surgery has been developed, tested in pigs, and is soon to be trialed in a weightless environment. The robot, which weighs less than 1 pound, can be inserted into the abdomen via the umbilicus and controlled remotely. The press release from ...

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Risk-adjusted 30- to 90-day outcome data for selected types of operations done by specific surgeons and hospitals are now being publicly posted online by England's National Health Service. According to the site, "Any hospital or consultant [attending surgeon in the UK] identified as an outlier will be investigated and action taken to improve data quality and/or patient care." After cardiac surgery outcomes data were made public in New York, some interesting unexpected ...

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Contrary to what you may have heard, pain is not the fifth vital sign. It's not a sign at all. Vital signs are the following: heart rate, blood pressure, respiratory rate, temperature. What do those four signs have in common? They can be measured. A sign is defined as something that can be measured. On the other hand, pain is subjective. It can be felt by a patient. Despite efforts to quantify it with numbers ...

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An orthopedist asked me if I could explain why a couple of papers of his did not generate any feedback. He wasn't even sure that anyone had read them. He enclosed PDFs for me. Not being an orthopedist, I cannot comment on their validity. But I think I can explain why the papers have not created much interest. Are you familiar with the term, "impact factor"?

A journal's impact factor is an ...

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Several months ago, a post called, "Everything's my fault: How a surgeon says I'm sorry," appeared here on KevinMD.com. It was written by a plastic surgeon who feels that no matter goes wrong with a patient, surgeons should never blame anyone else. She gave some examples such as the lab losing a specimen, a chest x-ray that was ordered and not done, a patient eating something when he was not to ...

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In case you haven't noticed, a hot new topic in education is "grit." In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more grit or conscientiousness. A recent paper in Surgery reported residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the surgical programs ...

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You may find this story hard to believe, but it's true. A 75-year-old non-smoking man with no serious medical problems and a relatively low-risk family history (father, a life-long smoker, died of a stroke at age 76) has been undergoing routine physical examinations by his primary care physician in Florida every 6 months for several years. The visits include a full battery of laboratory studies, nearly all of which have been completely ...

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