medpagetodayFrom MedPage Today:

  1. NSAIDs Linked to Leaks After GI Surgery. Postoperative nonsteroidal anti-inflammatory drug (NSAID) use was associated with anastomotic leak after nonelective colorectal surgery.
  2. More Nurses May Mean Fewer Deaths in ICU. A high nurse to patient ratio in intensive care units was independently associated with a lower risk of in-hospital ...

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Last year, I underwent a colectomy, a surgery that removed my entire colon. Afterwards, I had to wear a temporary waste-collecting pouch attached to my abdomen known as an ostomy. Until my next surgery, I was now an “ostomate.” One of the early side-effects of the surgery was that I was prone to bouts of severe dehydration that left me hospitalized for a few days. During one of my dehydration-related ...

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Colonoscopy is the most effective test for the detection and prevention of colorectal cancer, the second leading cause of cancer death in the United States. An estimated 14 million colonoscopies are performed in the United States every year. About 20 to 40 percent of these colonoscopies have inadequate bowel preparation according to multiple studies. Inadequate bowel preparation is costly to the patient, the health care system, and society. In one study, poor ...

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Sovaldi (sofosbuvir), the new hepatitis drug manufactured and marketed by Gilead Sciences, has garnered considerable media attention over the last several months. The drug was approved by the FDA in December after phase III clinical trials showed it was highly effective in the treatment of chronic hepatitis C (HCV) infection. In fact, with an overall SVR (sustained virologic response) of 90 percent for the genotypes studied, Sovaldi may represent a cure for many of the 3.2 million Americans afflicted ...

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She arrived by ambulance in the middle of the night, awake, alert, and bleeding like crazy. We’d gotten a call earlier in the evening that she was on her way from a small hospital about forty miles to the north. We were the big city hospital, and an attending physician had agreed to have her transferred for a life-saving procedure, in this case a shunt that might stop her bleeding. People ...

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Most of us reject the rational argument that better medical quality costs more money.   Conversely, I have argued that spending less money could improve medical outcomes.  Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy.  Not a day passes that I don’t confront excessive and unnecessary medical care -- some of it mine -- being foisted on patients. At one point in my career, I would ...

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The holiday season is well underway. This is the time of year for celebrating with family and close friends and reflecting on what is truly important to us. It can also be a  time of significant stress, inevitable over-eating and deviation from our usual routines. Essentially, the holidays can be hazardous to your health and this is particularly true when it comes to your gastrointestinal (GI) system. So what can ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril. On physical examination, temperature is 37.5 °C (99.5 °F), ...

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A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system ...

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We always want to get it right the first time when treating patients, but the truth is this is difficult. When there is uncertainty of disease course and prognosis, multiple treatment options, and variable responses to therapy this becomes even more challenging.  Our typical strategy to making it “just right” isn’t too different from Goldilocks. We have mild treatments (too cold), and aggressive treatments (too hot), and even in the ...

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