I’m back at it again, talking about my continued love/hate relationship with EMRs. From my conversations with doctors at different hospitals in our region, it seems that most docs appear to be falling into the “hate” column. Meanwhile, I’m still chugging along with the EHR that’s been installed in my office. And while it works just fine for the needs of a 3 physician single-specialty outpatient practice, it’s hardly the ...

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I first met Carol* (name and identifying details have been changed) when she came to my clinic after a severe asthma attack had sent her to the intensive care unit.  After a few days, she had been extubated and had acquired a new diagnosis: asthma.  When she saw me in clinic, she felt better than she had when she had come to the hospital, but she continued to complain of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman is evaluated for increasing asthma symptoms. Her symptoms now require her to use her as-needed albuterol inhaler two to three times per week, and she has been waking up at night at least once a week with asthma symptoms that require her inhaler. She is still able to perform ...

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If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the ...

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Clinical medical research -- finding out which treatments help and which ones don’t (or even make the situation worse) -- is tough research to do. In the laboratory a scientist can control conditions so that only one thing is different between the control and the experimental groups. This isolates the effect of the particular thing and one can see if there is any difference in outcomes depending upon what is ...

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From MedPage Today:

  1. Is Belphen the Next Blockbuster Diet Drug? Even though there are scant data, obesity researchers and patients have already put a name to a potential new weight-loss craze: Belphen, a combination of lorcaserin (Belviq) and phentermine.
  2. Does COPD Dull the Mind? Mild cognitive impairment was more likely in patients with chronic obstructive pulmonary disease (COPD), particularly the longer it went on.

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From MedPage Today:

  1. Preop PET Cuts Lung Cancer Surgery. Routine preoperative PET imaging led to a significant reduction in unnecessary surgery for non-small cell lung cancer (NSCLC).
  2. A Cure for Chlamydia Arthritis? Increased understanding of the biology and survival tactics of Chlamydia trachomatis is suggesting that the post-infectious chronic arthritis experienced by many patients may actually be curable.
  3. Efavirenz Tops Lopinavir in ...

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A few years ago when I went skydiving for the first time, I learned about the backup parachute. This is a second chute, just in case the first one failed. While no one wants to think about the primary parachute failing, it was comforting to know we were prepared ... just in case. That’s kind of how I see end of life care planning, while we don’t want to think ...

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From MedPage Today:

  1. Scleroderma Survival Tied to Lung Problems. Survival among patients with scleroderma was strongly influenced by the development of major pulmonary involvement.
  2. HIV Tx Tied to Low Infection From Sex. Serodiscordant couples who engage in unprotected sexual intercourse have a very small risk of transmitting HIV if the infected partner is well treated with suppressive antiretroviral therapy.
  3. Xolair Makes Milk ...

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I just didn’t like the looks of him. It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in ...

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