dreamrct The most valuable assignment I received in fellowship was to write a few textbook chapters. I wrote on sodium, calcium, potassium, phosphorus, and magnesium for three different chapters. I had already developed deep knowledge of electrolytes writing "The Fluid and Electrolyte Companion," but writing these chapters forced me to look beyond how things work and dive into how we know how things ...

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Yesterday my friend Sophie asked me to accompany her to a Miami hospital intensive care unit to see her older brother, Guillermo. He'd been admitted the previous night with seizures and cardiac arrhythmia. Joined by my husband, we made our way to the ICU. When she saw Guillermo lying immobile, swollen and unresponsive, with a breathing tube in his mouth and other tubes snaking into his chest from IV poles, Sophie ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old woman is evaluated for a 3-month history of swelling of the face, hands, and feet. She has untreated hepatitis C virus infection. She takes lithium for bipolar disorder. She has no additional symptoms. On physical examination, temperature is normal, blood pressure is 134/93 mm Hg, pulse rate is 71/min, and respiration ...

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medpagetodayFrom MedPage Today:

  1. Time to Retire Lithotripsy for Kidney Stones? More than 30 years ago, extracorporeal shock wave lithotripsy (ESWL) had a highly anticipated, much-ballyhooed introduction as a nonsurgical therapy for kidney stones. Obviating the need to cut the skin or insert a device into the body, ESWL would use acoustic shock waves to ...

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medpagetodayFrom MedPage Today:

  1. Nephrologists Iffy About Dialysis in Expectant Moms. A third of nephrologists reported being somewhat to very uncomfortable caring for a pregnant patient on hemodialysis despite a growing number having to do so.
  2. What Makes an Opioid Stronger or Weaker Than Morphine? A February 2015 report from the Centers for ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man is evaluated as a new patient. He was diagnosed with type 2 diabetes mellitus during a health insurance evaluation 6 months ago. At that time, metformin was initiated. Medical history is otherwise unremarkable. On physical examination, blood pressure is 145/94 mm Hg; other vital signs are normal. BMI is 29. ...

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medpagetodayFrom MedPage Today:

  1. Flu Vaccine: A Matter of Time. The flu vaccine was about 23% effective this season.
  2. Supreme Court Spars With Both Sides in Subsidies Case. The Supreme Court pummeled both sides with questions during Wednesday's oral arguments over the fate of the subsidies granted to people enrolling in health insurance ...

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medpagetodayFrom MedPage Today:

  1. Statins and RA: No Joint Benefit. The use of statins does not reduce onset of new joint pain or stiffness in middle-age or older women but their use is associated with poor physical functioning and poor self-rated health.
  2. Expert Groups Clarify HPV Testing Recommendations. Primary cervical cancer screening with ...

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medpagetodayFrom MedPage Today:

  1. Should FDA Change Metformin's Black Box Warning? Diabetes experts are building a case to lift restrictions on using metformin in patients with moderate chronic kidney disease.
  2. Tacrolimus for Induction in Lupus Nephritis? Tacrolimus was found to be noninferior to mycophenolate mofetil (Cellcept) for lupus nephritis induction therapy when given ...

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One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients. I began to understand this paradox clearly when I listened to my friend’s anguish. She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town ...

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