Conflicts of interest in medical research are extremely common – one recent study found that 52% of the experts involved in developing clinical practice guidelines for the management of diabetes in the United States and Canada had a financial conflict of interest.  Although doctors and researchers often declare financial conflicts of interests when they make presentations and publish papers, there are many who argue that declaring financial conflicts is no longer enough, and that other conflicts, such an intellectual conflicts, may be more important to manage.

Read the rest of Conflicts of interest don’t always involve money on KevinMD.com.

Category: Education | Tags: | No comment

In October 2011, the Centers for Disease Control and Prevention reported a 60% increase in “emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents” over the past decade. That’s good news: as the CDC’s press release said, they believe the increase was due in part to “growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected TBI to be seen by a health care professional.” Great improvements have been made in terms of sports head injuries among kids, like through the CDC’s Heads Up initiative.

Read the rest of Avoid malpractice while treating minor head trauma in children on KevinMD.com.

Category: Conditions | Tags: Emergency, Malpractice, Pediatrics, Radiology | 5 comments

There is a healthy debate over whether a lab that created an extremely infectious version of influenza ought to publish the genetic sequence. The debate speaks to a larger problem: sometimes, medical advances do the world a disservice. The medical field could use some soul-searching, just as physicists did in the wake of the Manhattan Project.

A few years ago, I read a neat research finding.  In a pregnant woman, some of the fetus’s DNA crosses the placenta and circulates in the mother’s bloodstream. Drawing on this finding, some researchers developed a clever blood test that is allowing pregnant women to non-invasively screen their fetuses for Down Syndrome (whereas in the past, amniocentesis or chorionic villus sampling were the definitive screens).

Read the rest of When medical advances do the world a disservice on KevinMD.com.

Category: Conditions | Tags: OB/GYN | 1 comment

This series is brought to you by MedPage Today.

1. Last Patients on ICU Rounds Get Least Time. Clinical staff spent significantly less time with intensive care unit patients at the end of rounds as compared with the beginning.

2. Women Suffer More ICD Complications. Women are at greater risk of complications and are less likely to receive appropriate shocks from their implantable cardioverter-defibrillators (ICDs) than men.

3. Drugs Not Equal Against Bladder Infection. For uncomplicated bladder infections, cefpodoxime (Vantin) may not be a viable antibiotic alternative to fluoroquinolone ciprofloxacin (Cipro, Proquin).

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As a follow-up to my post on why patients with implantable defibrillators should have access to their device’s data, I am going to talk about what your physician looks for when a device is interrogated.  Many times this happens in silence or with few words, and some pushes of a button, when done in the office, and when done with remote patient management, is accomplished either automatically or with the patient pressing a transmission button.  Lengthy discussions or explanations are the exception and not the rule for most practices. And the paucity of verbal exchanges in association with the defibrillator interrogation creates anxiety in addition to not being accompanied by in many instances a discussion about clinical aspects of care: symptoms, the emotional components of being an ICD patient who anticipates or who has experienced device therapy, or a partner wondering about sexual activity.

Read the rest of There is a patient attached to that implantable defibrillator on KevinMD.com.

Category: Tech | Tags: Heart, Specialist | 1 comment

It’s amazing how quickly you can lose track of time as you power through the books. Once everything is setup — coffee to the left, pens and highlighters to the right, Grooveshark playlist perfectly tuned — you can suddenly look up and realize that three weeks have flown by and there are 123 multiple choice questions to be answered in the morning.

Over the past year and a half I’ve learned a lot: pages upon pages on everything from the toes to the head and a few things in between. Along the way, I’ve also discovered the following six things that I wish I had known at the beginning of medical school:

Read the rest of 6 things I wish I had known at the beginning of medical school on KevinMD.com.

Category: Education | Tags: Medical school | 2 comments

I just finished reading George’s recent post on Evelyn Lauder, who recently passed away from ovarian cancer, and am still stirred by the passing of Patrick Swayze from pancreatic cancer and Elizabeth Edwards from metastatic breast cancer. There’s a reason I am a surgeon, and not a medical oncologist. Death has this bleak sadness about it, that eternal optimists like me have difficulties dealing with.

Read the rest of Cancer has a way of teaching us poignant life lessons on KevinMD.com.

Category: Physician | Tags: Cancer | 1 comment

The orders came indirectly from the government.

Reduce hospital re-admissions. Cut costs.

So, the hospital contacted the local hospice-palliative care center and asked for help. Of course, overwhelmed with work and understaffed, the project was handed off to me.

Read the rest of The challenge of creating a palliative care program on KevinMD.com.

Category: Physician | Tags: Palliative care | 2 comments

This series is brought to you by MedPage Today.

1. Fighters Need Padded Gear to Cut Head Injury. Rotational head injuries in fighting sports can be minimized if participants wear padded boxing gloves and headgear rather lighter protective gear or no protection at all.

2. Heart Failure, Fractures Linked. Heart failure appears to be associated with a greater risk of major osteoporotic fractures, independent of bone mineral density.

3. Soda Linked to Lung Disease. More bad news for soda lovers: in addition to obesity and heart disease, the sugary drinks may be tied to asthma and chronic obstructive pulmonary disease (COPD).

Category: News | Tags: | No comment

I’m reluctant to write a post about ADHD.  It just seems like treacherous ground.  Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another.  But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.

Read the rest of Why we should eliminate the diagnosis of ADHD on KevinMD.com.

Category: Conditions | Tags: Medications, Psychiatry | 20 comments