Sensible Medicine

APRIL 14, 2024

Including: The academic speakers— who often consult for the drug companies and receive sizable personal payments. Medicine has become a financial commodity with the rare adverse event of better health outcomes. A few companies will get rich doing this, and many well-intentioned people will be cheering us over the cliff.

Patient Safety 135

Patient Safety Academics Outcomes Wellness 135

Dr. Smith's ECG Blog

MARCH 14, 2024

Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. It is well known that NOMI usually has a normal ECG or nonspecific ECG.

EKG/ECG 103

EKG/ECG Documentation/Coding Patient Safety Outcomes 103

ALiEM

OCTOBER 30, 2023

Those who take the academic route face unclear promotion expectations, uncertainty about their niche, and a double-whammy of high clinical burden and a tacit expectation that you “prove” your worth as a teacher by taking on more tasks before being rewarded with salary support. But what can Dr. Garcia – or you – do?

Academics 64

Academics Leadership Wellness Research 64

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

Sensible Medicine

JUNE 28, 2024

If I had it all to do again, there is no doubt that I would choose medicine in general and academic general internal medicine in particular, but occasionally we all have a bad week. There were no personal crises or untoward patient outcomes. “Well, this isn’t really the aspect of my specialty that I specialize in.”

Stroke 80

Stroke Academics Hospitals EKG/ECG 80

ACEP Now

JULY 7, 2024

My current practice is a hybrid of academic and community sites, and I have worked in myriad community hospitals from busy ones to single coverage critical access hospitals. You are well prepared for this. Lead your room well. If the resuscitation does not go as well as you wanted, learn from it and move on.

Resuscitation 98

Resuscitation Risk Management Hospitals Critical Access 98

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C., Included traumatic and nontraumatic brain injuries.

CDC 114

CDC Radiology Radiology Outcomes 114

Sensible Medicine

NOVEMBER 28, 2023

For many doctors in academic medicine, publishing in peer reviewed journal is an important part of their careers. People can rise through the academic ranks as gifted clinicians, creative and effective educators, and talented administrators. [i] Being perfectly honest, not all the articles have aged well.

Stroke 71

Stroke Academics Outcomes Administration 71

Stop and Think

JUNE 13, 2023

One of my colleagues, a former academic, who is now in industry, tells me I shouldn’t have this chapter. In PARAGON-HF, the new drug reduced a composite primary outcome of heart failure events and death from cardiovascular causes but the reduction failed to meet statistical significance. PARAGON-HF randomized 10x more.)

Outcomes 98

Outcomes Academics Shock Hospitals 98

Taming the SRU

FEBRUARY 24, 2024

Early recognition and prompt treatment is key. non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.

Leadership 92

Leadership EMS Pediatrics Stroke 92

Sensible Medicine

AUGUST 21, 2023

On yesterday’s podcast , I talked with Bobby Yeh, an academic cardiologist who made a compelling case for enhancing credibility of observational research. Another problem, which is possibly surmountable, is the conflation of what one can call “patient outcomes” versus “doctor outcomes.”

Administration 76

Administration Outcomes Research COPD 76

Sensible Medicine

SEPTEMBER 12, 2024

We find the letter to be well-argued. 3 Another meta-analysis in HF patients indicated that higher doses of ACEIs and ARBs, compared to lower doses, significantly improved outcomes. 4 The study's open-label design increases the risk of differential misclassification of outcomes and performance biases. References 1. Am Heart J.

Academics 63

Academics Outcomes Hospitals Wellness 63

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose. PMID: 36108346 Clinical Question: What is the efficacy and safety of peripherally administered push dose pressors for the treatment of acute hypotension?

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Taming the SRU

APRIL 17, 2024

3) Methods This study was a retrospective observational study at a single academic tertiary care facility in their medical intensive care unit (MICU). The primary outcome was defined as agreement of less than 10 % of the mean arterial pressure (MAP) between simultaneously recorded IABP and NIBP measurements.

Sepsis 92

Sepsis Research Stroke Academics 92

ALiEM

NOVEMBER 6, 2023

WPW Syndrome consists of characteristic EKG findings as well as symptomatic arrhythmias. Outcome and use of antiarrhythmic drugs during follow-up. WPW is a pre-excitation syndrome characterized by an accessory pathway caused by a congenital failure of cells to resorb near the AV valves. Crit Care Nurse. 1994 Jun;14(3):30-9; quiz 40-1.

EKG/ECG 78

EKG/ECG Academics Outcomes Wellness 78

SheMD

MAY 4, 2023

80% of department chair roles in academic medicine are held by men. Article Summary What they looked at: This article aimed to look at career trajectory differences between genders in faculty who have attained academic chair roles in emergency medicine. Why do we care about this article? How does this apply to us?

Leadership 52

Leadership Academics Operations Administration 52

The Skeptics' Guide to EM

MAY 30, 2020

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. AEM May 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is hypotensive and tachycardic.

Head Injuries 52

Head Injuries Academics Outcomes EMS 52

Sensible Medicine

SEPTEMBER 23, 2024

They also found that the largest difference between truncated and nontruncated trials occurred when the truncated trials had fewer than 500 outcome events. The rate of the composite primary outcome of CV death, MI, unstable angina, stroke or transient attack was 4.29% with asa vs 4.48% with placebo. The six-year trial was not stopped.

Stroke 81

Stroke Academics Outcomes Shock 81

ALiEM

DECEMBER 9, 2024

Physical Exam Vitals : BP 128/84; HR 88; Temp 98F; RR 18; SpO2 (on RA) 100% General : Well appearing HEENT : No conjunctival injection Cardiovascular : S1, S2; no murmurs, rubs, or gallops Skin : Erythematous patch with central clearing in left popliteal fossa Laboratory Data WBC : 5.1 Platelets : 223 Sodium : 139 Creatinine : 0.8

Emergency Department 60

Emergency Department CDC EMS Academics 60

SheMD

AUGUST 24, 2023

Medical specialty society membership can have an impact on the development of an academic physician’s career through networking, speaking opportunities, and awards. Underrepresentation of female faculty members may be an obstacle to career advancement in academic medicine. Why is this article important? Am J Clin Pathol. 2022.40001.

Leadership 52

Leadership Academics Outcomes Wellness 52

The Skeptics' Guide to EM

AUGUST 22, 2020

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. This review discusses the diagnostic accuracy of rt-PCR for COVID-19, as well as signs, symptoms, imaging, and other laboratory tests. Reference: Carpenter et al. Reference: Carpenter et al.

Emergency Department 52

Emergency Department Academics Research Administration 52

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. Long term outcome unknown but obviously bleak. Association of intravenous morphine use and outcomes in acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative. Am Heart J. Abstract 556.

EKG/ECG 82

EKG/ECG Outcomes Academics Documentation/Coding 82

EMDocs

MAY 25, 2023

Outcome: No statistically significant difference in primary outcome, which was absence of clinically apparent seizures without the need for additional anti-convulsant medications AND improving responsiveness at 60 minutes after the start of trial-drug infusion, as determined by the treating physician.

Seizures 64

Seizures Administration Anaphylaxis Outcomes 64

Taming the SRU

JUNE 12, 2023

However, there have been no studies statistically powered well enough regarding dog bite lacerations to confirm or dispute this claim. Academic Emergency Medicine. Academic Emergency Medicine. One meta-analysis reported a rate of infections after dog bites of 3-46% [8] versus 2-5% in simple laceration repairs in the ED [9,10].

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

Dr. Smith's ECG Blog

AUGUST 2, 2024

The LCx and OM branches are not as well seen. the investigators reviewed outcomes in 118 patients presenting with NSTEMI. This is the right anterior oblique cranial view Here is a representative still. This shot is typically best for viewing the LAD and its diagonal branches. There is non-obstructive disease here.

EKG/ECG 105

EKG/ECG Fluid Resuscitation Academics Resuscitation 105

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

ALiEM

JANUARY 29, 2024

It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Case Question: What treatments can you perform in the ED for this diagnosis and do they improve outcomes? This has the potential to expedite consultations with specialty teams and treatment. 39,1 (2020): 197-202.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

SheMD

JULY 27, 2023

What were their outcomes: Physician mothers report having more domestic responsibilities than their partners. Unequal distribution of domestic responsibility has been documented as a factor in the underrepresentation in female physicians in leadership roles in academic medicine as well as contributing to career satisfaction.

Academics 52

Academics Leadership Documentation/Coding Research 52

The Skeptics' Guide to EM

JANUARY 20, 2018

She has contributed to the Academic Life in Emergency Medicine and EM PharmD blogs, […] The post SGEM#203: Let Me Clear My Sore Throat with a Corticosteroid first appeared on The Skeptics Guide to Emergency Medicine. She has contributed to the Academic Life in Emergency Medicine and EM PharmD blogs, and is a part of the ALiEM Capsules Team.

Academics 52

Academics Emergency Department EMS Administration 52

The Skeptics' Guide to EM

DECEMBER 12, 2020

She is systemically well and there is no sign of tracking, so you decide to perform incision and drainage in the ED. Secondary Outcomes: Ease of procedure, pain at the time of treatment, ease of care at 36 hours, pain at 36 hours. . Dr. Ladde is in an active academic emergency physician working at Orlando R.

Operations 52

Operations Outcomes Research Academics 52

The Skeptics' Guide to EM

NOVEMBER 26, 2022

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. Deaf and hard-of-hearing (DHH) experience disparities in social outcomes as well as health inequities (1), likely due to audism, which creates privilege for non-DHH people in our society (2).

Academics 40

Academics Emergency Department Research Outcomes 40

The Skeptics' Guide to EM

AUGUST 17, 2019

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. Attempting to decrease a patient’s pain to zero is certainly well-intentioned but you have to ask yourself how many patients are being harmed by such a goal? Volkow et al. JAMA 2011).

Emergency Department 52

Emergency Department Academics Fractures Outcomes 52

PulmCCM

DECEMBER 18, 2023

In a large, complicated pragmatic cluster-crossover study at a single academic center, there was no difference in any meaningful outcome (death, ventilator-free days, or severe complications) between patients randomized to an oxygen saturation target of 90%, 94%, or 98%. NICO trial ) Does oxygen target matter?

Outcomes 52

Outcomes Academics Wellness 52

The Skeptics' Guide to EM

APRIL 29, 2023

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. Clinical Question: What is the effect of TMH, versus in-person consult, on 30-day outcomes and processes of care during the visit? Yes * Was the outcome accurately measured to minimize bias?

Psychiatric 40

Psychiatric Emergency Department Urgent Care Academics 40

ALiEM

DECEMBER 8, 2023

Major risk factors for their development include prior abdominal surgeries that weaken the musculature as well as cardiovascular co-morbidities. Incidence, etiology, management, and outcomes of flank hernia: review of published data. PMID: 32310432. Zhou DJ, Carlson MA. 2018 Apr;22(2):353-361. doi: 10.1007/s10029-018-1740-1.

Academics 60

Academics Emergency Department Outcomes Wellness 60

Sensible Medicine

JUNE 6, 2023

Two nearly identical trials of the monoclonal drug aducanumab, ENGAGE and EMERGE, had disparate outcomes: ENGAGE showed no benefit and EMERGE showed that the drug slowed decline. This seemed important to consider, and so we looked at whether outcomes in trials of monoclonal antibodies for AD correlated with rates of ARIA.

Outcomes 72

Outcomes Infectious Diseases Research Academics 72