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Mental Healthcare: Time to End the Stigma

Mental Healthcare: Time to End the Stigma

It was with great sadness that we all saw the tragic news of Robin Williams’ suicide. For years, mental health has been a taboo topic. While the passing of this great actor is horrifying, we are only aware of it because of his stardom. How many others have met a tragic fate like his, but we just do not hear about it because they are ordinary people? It affects all ages, all races, and socioeconomic statuses. It is not a phenomena located to the U.S. but all across the globe. True that many people have trouble gaining access to mental healthcare sources, often for insurance coverage reasons or lack of available providers. But more often, help isn’t pursued because of the stigma attached to mental health diagnoses. All too often patients are embarrassed to admit they have a mental health problem. Yet, diseases such as anxiety and depression are very prevalent in our society. These conditions are chronic medical problems, just like diabetes and hypertension. But patients are often made to feel that these diseases are just in their head and that they can just “get over it.” This does not just happen in our general society, but when they seek medical help as well. Patients do not understand that even physical pain can be an underlying sign of depression. And many feel that their healthcare providers brush it off as “just depression.” So, rather than face these stigmas and embarrassments, many choose to deny or hide their illnesses. They are left untreated, which allows tragedies like suicide to occur. How can mental healthcare stigmas be ended? 1. More...
Proactive Diagnosis of Narcolepsy

Proactive Diagnosis of Narcolepsy

Narcolepsy can be a debilitating sleep disorder caused by the dysregulation of neurophysiological pathways that control the stability of sleep and wake states in patients. Narcolepsy has a worldwide prevalence of about 26 to 50 per 100,000 individuals. However, the disease is associated with high healthcare resource use, substantial functional limitations, and reduced employment and work productivity. Studies also show that patients with narcolepsy have a higher medical and psychiatric comorbidity burden. The chronicity of narcolepsy mandates that patients receive life-long treatment, regardless of their age of onset. Narcolepsy Symptom Onset The onset of narcolepsy generally occurs during a person’s second decade of life, but it’s commonly reported that there are delays between symptom onset and a narcolepsy diagnosis, sometimes for as long as 5 to 10 years. Narcolepsy tends to be clinically defined by a symptom tetrad of: 1. Excessive daytime sleepiness. 2. Cataplexy. 3. Hypnagogic or hypnopompic hallucinations. 4. Sleep paralysis. Disturbed and fragmented nocturnal sleep often reported by patients suggests that narcolepsy actually comprises a symptom pentad. However, patients typically do not show all five symptoms. Research suggests that there is an autoimmune explanation for narcolepsy. It has been associated with seasonal streptococcus infections and H1N1 influenza and vaccination. Narcolepsy has also been linked to a specific genotype of the human leukocyte antigen, HLA-DQB1*06. This genotype may underlie the observed loss of the hypocretin-producing neurons that are associated with narcolepsy. Understanding & Perceptions of Narcolepsy My colleagues and I recently published a survey—the Awareness and Knowledge of Narcolepsy—to assess the understanding and perceptions of narcolepsy. Participants included 1,000 adults, 300 primary care physicians (PCPs), and 100...
Alcohol Abuse Among Physicians: Taking Control

Alcohol Abuse Among Physicians: Taking Control

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially-appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices (1). The National Institute of Health (NIH) suggests a man—younger than 65 years of age—not have more than 14 drinks a week, and a woman—who is not pregnant or attempting to become pregnant—not exceed more than seven drinks per week (2). If you or a colleague drink more than that, an unhealthy drinking habit may be emerging. Rigorously honest self-evaluation or peer-reporting is the next necessary step to avoid developing more serious issues of alcoholism. Reporting Harmful Behaviors Benefits the Medical Community The American Medical Association (AMA) Code of Ethics, considered the most widely accepted ethics guide for physicians, requires all doctors to promote personal health and wellness and to promptly inform relevant authorities of an impaired or incompetent colleague (3). Yet, one in three (36%) physicians surveyed in a recent national poll said they’ve had firsthand knowledge of a physician struggling with drug and/or alcohol misuse and yet did nothing. Some of the reasons these surveyed doctors gave for ignoring harmful behaviors included: “someone else would take care of the problem,” “nothing would happen as a result of the report,” “fear of retribution,” and feelings of being ill-prepared to deal with an unstable colleague (4). If we are to continue safeguarding patients’ care...

Antibiotics for Appendicitis? I’m Still Not Convinced

Two recent papers have added more fuel to the debate about whether appendicitis can be managed without surgery. The first paper was a prospective observational study from Italy involving 159 patients over the age of 14 who were thought to have uncomplicated appendicitis. Nonoperative management with oral antibiotics was planned for all of the patients. Nonoperative management failed within 7 days in 19 (11.9%) patients, all of whom underwent immediate surgery. Appendicitis was found in 17 patients, and two had tubo-ovarian abscesses The abstract says “After 2 years, the overall recurrence rate was 13.8% (22/159).” This is blatantly misleading. The overall recurrence rate was 19 recurrences within 7 days plus 22 more recurrences between 7 days and 2 years for a total of 41 (25.8%) recurrences with 27/159 (17%) of the patients requiring surgery. If you look at this paper more carefully, you will find the following figures from Table 3: ♦ US done 116 (73%) ♦ US positive88 (76%) ♦ CT scan done 27 (17%) ♦ CT scan positive 21 (78%) ♦ Clinical diagnosis only of acute appendicitis 16 (10%) The authors do not explain why patients with negative ultrasounds and CT scans were included in the cohort of nonoperatively treated patients with appendicitis. If they were going to disregard the results of the imaging studies, they shouldn’t have done them in the first place. If you add the 16 patients with clinical diagnoses only, the 28 with negative ultrasounds and the six with negative CT scans, a total of 50 (31%) of the patients may not have even had appendicitis. These patients would have gotten better no...
Sexual Function in Women After Bariatric Surgery

Sexual Function in Women After Bariatric Surgery

Published reports have consistently shown that obesity impairs quality of life (QOL) and can contribute to depression as well as body image dissatisfaction. “Weight loss typically improves most aspects of QOL, but one aspect that is often overlooked in clinical research is sexual health,” says David B. Sarwer, PhD. Some reports have found that more than half of obese women considering bariatric surgery have sexual dysfunction that is accompanied by significant psychosocial distress. Exploring the Issue Few studies have investigated changes in sexual function, sex hormone levels, and psychosocial variables in women who undergo bariatric surgery. Recently, Dr. Sarwer and colleagues had a study published in JAMA Surgery that sought to address this research need. The analysis involved 106 women who received bariatric surgery. Overall, women lost an average of 32.7% of their initial body weight in the first year after surgery and 33.5% when assessed at the end of the second postoperative year. Women reported significant improvements in overall sexual function and satisfaction at 2 years after surgery. They also experienced significant changes in all hormones assessed in the study. Women also reported improvements in most domains of QOL—in addition to body image and depressive symptoms—1 and 2 years after surgery. “Importantly,” says Dr. Sarwer, “women who reported having the poorest quality of sexual functioning before bariatric surgery had the greatest improvements in functioning after surgery. Their functioning was comparable to women who reported the highest quality of sexual functioning before surgery.” These improvements occurred within the first postoperative year—when patients lost the largest percentage of their weight—but persisted even when the rate of weight loss had slowed....
How Primary Care Can Help Reduce Avoidable ED Visits

How Primary Care Can Help Reduce Avoidable ED Visits

Throughout the United States, patients are using the ED for the treatment of acute but minor episodic conditions. According to Truven Health Analytics, 42% of ED visits are for urgencies that could be treated in the primary care office setting. Even as more urgent care centers are being opened, this problem persists. In some cases, ED care is sought because a patient’s primary care physician (PCP) office operates mostly within normal daytime business hours. Other times, it may be because of difficulty in obtaining same day appointments. There are simple changes PCPs can make to help patients avoid ending up in the ED for these types of conditions. The Greater Detroit Area Health Council (GDAHC) ED Utilization Team leads the effort in Detroit. In my work as chair of the GDAHC team—which includes representation from EDs, PCPs, purchasers, health plans and consumers—we piloted an initiative with 11 PCPs at five practice sites to give patients better options when faced with acute, unscheduled medical needs. Sites were chosen because they had a worsening trend of their HMO members using the ED for conditions likely treatable in the PCP office. Collectively, these PCPs reduced these types of ED visits from 49.2 to 7.3 visits per 1,000 members. Here are some of the key lessons from our program: Collaborate The goal is to get everyone in the PCP office working together in the same direction. The first step is to establish an access-to-care policy. Everyone from receptionists to nurses to physicians needs to understand what access to care means and define it together. This includes how to handle clinical advice for patients...
Managing Skin Abscesses in the MRSA Era

Managing Skin Abscesses in the MRSA Era

Abscesses are one of the most common skin conditions encountered by general practitioners and emergency physicians, and the incidence of these infections has increased in recent years. In addition, MRSA infections have become one of the most common causes of skin abscesses. “Community-associated MRSA (CA-MRSA) has also been shown to cause severe infections in non-immuno-compromised hosts,” explains David A. Talan, MD, FACEP, FIDSA. “We’re still unsure as to why CA-MRSA appears to be more virulent than other healthcare–associated strains and methicillin-susceptible Staphylo-coccus aureus. Unfortunately, the management of skin abscesses is highly variable throughout the country.” In a review article published in the New England Journal of Medicine, Dr. Talan and Adam J. Singer, MD, described helpful approaches to managing common skin abscesses that generally involve the extremities and trunk. “When possible, our recommendations were based on randomized trials,” Dr. Talan says. “However, many recommendations are based on small observational studies or expert opinion. While there may be some disagreement, the approaches we advise have been both workable and useful in our practice.” Diagnosis Skin abscesses typically appear as a swollen, red, tender, and fluctuant mass, often with surrounding cellulitis. The diagnosis of skin abscesses based on physical exams is often straightforward and proven correct by incision and drainage. Ultrasonography may be helpful for cases in which the abscess is deep, complex, or obscured by extensive cellulitis. It may also be helpful for patients treated for cellulitis in which initial antibiotic treatment fails and to ensure the adequacy of drainage. Needle aspiration is an alternative approach to diagnosing and treating abscesses. Treatments “Standard incision and drainage is the mainstay of...
The Increasing Burden of Atrial Fibrillation

The Increasing Burden of Atrial Fibrillation

Research suggests that atrial fibrillation (AF) is the most common heart rhythm disorder, but the global burden of AF has not been estimated until recently. The World Health Organization (WHO) assesses the global burden of many public health concerns every 20 years through its Global Burden of Disease Project, but AF was not included in 1990 when the project was last conducted. To establish the global and regional prevalence of AF—in addition to its associated incidence and mortality rates—Sumeet S. Chugh, MD, FACC, FHRS, FAHA, and colleagues systematically reviewed nearly 200 population-based studies of AF. Worldwide Findings “The most important metric that WHO established for understanding the burden that a disease imposes on society is disability-adjusted life-years (DALYs),” explains Dr. Chugh. He and his colleagues found that the burden associated with AF, measured in DALYs, increased by nearly 19% in both men and women between 1990 and 2010 (Figure 1). An estimated 33.5 million men and women had AF across the globe in 2010. The estimated age-adjusted, global prevalence rates per 100,000 population increased from 569.5 in 1990 to 596.2 in 2010 for men and from 359.9 in 1990 to 373.1 in 2010 for women. In addition, the overall incidence (Figure 2) and associated mortality rates (Figure 3) increased significantly for both genders during the study period. “AF is not a condition that directly leads to death,” notes Dr. Chugh. “However, it keeps company with many heart conditions that do.” On the Local Level It is well understood that patients are getting older, not only because of the baby boomer generation but also because survival rates among patients who...
Relieving Pain in Colorectal Surgery

Relieving Pain in Colorectal Surgery

Researchers have developed enhanced recovery pathways (ERP) to improve outcomes and reduce readmissions in colorectal surgery patients. “ERP protocols use a set of standardized pre- and postoperative orders,” explains Conor P. Delaney, MD, PhD, FACS, FASCRS. “Research clearly shows that these protocols can help speed recovery and improve outcomes.” ERP protocols emphasize early mobilization after surgery, optimal analgesia, and control of intravenous fluid volumes. Patients are also encouraged to eat the day after their procedure rather than wait several days. To further improve outcomes, it has been hypothesized that adding a transversus abdominis plane (TAP) block to ERP protocols may allow patients to bypass or reduce narcotics use after surgery. TAP blocks are usually administered with ultrasound guidance, but a laparoscopic technique has been developed in which regional analgesia is injected into the abdominal wall between the oblique muscles and the transversus abdominis. “The TAP block can be given after surgery to reduce pain in the operative area,” says Dr. Delaney. “While narcotics help alleviate pain, they can slow recovery. The TAP block is different in that it wears off in time for patients to avoid the worst pain that typically occurs immediately after surgery.” Encouraging Data In a study of 100 patients published in the Journal of the American College of Surgeons, Dr. Delaney and colleagues tested the use of a laparoscopically administered TAP block as part of ERP protocols. After the block, patients were also given intravenous painkillers. According to findings, the average hospital stay after surgery dropped to less than 2.5 days for those receiving the TAP block. This was significantly lower than what has been...
Proton Therapy for Prostate Cancer: Assessing Long-Term Results

Proton Therapy for Prostate Cancer: Assessing Long-Term Results

The American Cancer Society estimates that there will be 233,000 new cases and more than 29,000 deaths from prostate cancer in 2014. Although the disease can be serious, most men will not die from it. More than 2.5 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today. The disease can be managed with a variety of treatments, including watchful waiting, chemotherapy, surgery, brachytherapy, and external beam radiation therapy (EBRT) that is delivered with x-rays or protons. “Treatment selection for prostate cancer is dependent on the extent of the disease, the patient’s overall medical condition, and patient preferences,” says Nancy P. Mendenhall, MD. “Ideally, the goal is to find a treatment that will be highly effective and avoid toxicities.” The Role of Protons Radiation therapy is used in two-thirds of cancer patients and is most often delivered with EBRT, a radiation therapy that is produced from a source external to the body. The most common source of radiation in EBRT is x-rays (photons). Most x-ray-based EBRT procedures use sophisticated techniques, such as intensity modulated radiation therapy (IMRT), but there is growing interest in protons as a radiation source. “With proton therapy, a lower radiation dose is deposited in normal non-targeted tissues than with x-rays,” explains Dr. Mendenhall. “This has the potential to reduce toxicity, improve quality of life, and decrease risks for second malignancies. Reducing radiation doses to normal tissues may also permit shorter, less expensive treatment schedules, making proton therapy more convenient for patients.” Recent studies have shown that men with prostate cancer who are treated with proton...
Moving Emergency Care Systems Forward

Moving Emergency Care Systems Forward

Emergency care is an essential component of healthcare delivery in the United States but remains outdated and fragmented. A common sense approach to increasing the value of emergency care delivery is to develop regionalized integrated networks by taking advantage of market, financial, and technological changes to achieve a critical shift in emergency care. Instead of getting time-sensitive patients to the right place at the right time, regional networks can focus on delivering the right resources to patients at the right place, right time, and right cost. The delivery of care at specialty centers has grown in recent years but has resulted in some unintended consequences. Specialty evaluation resources and capabilities have become concentrated at urban specialty centers and hospitals with higher volumes than smaller, suburban, and rural hospitals. Over time, smaller hospitals have needed to unnecessarily transfer many local patients to bigger facilities for further evaluation. This can increase unnecessary costs, delay care, lead to a loss of capabilities, and undermine financial viability. With changing demands and payment models, the continuum of emergency care must be transformed to provide high-quality care at lower costs and across distances. A New, More Integrated Model To replace our fragmented system, a web of interconnected but separate hospitals and providers should be developed. These institutions should have shared quality and performance goals and incentives to improve outcomes across conditions, levels of acuity, and facilities. This type of integrated system can dramatically change day-to-day care delivery and improve local, regional, and national abilities to respond to public health emergencies. Real-time telemedicine interfaces and communications can be used to facilitate specialty care to places that...
Substance Use Disorders Among Emergency Physicians

Substance Use Disorders Among Emergency Physicians

The prevalence of substance use disorders among physicians ranges between 10% and 14%, a rate that is similar to that of the general population. “Research has shown that several specialties have a higher-than-expected rate of these disorders, most notably anesthesiology, emergency medicine, and psychiatry,” says John S. Rose, MD. Despite the reported higher rates of substance use disorders and participation in Physician Health Programs (PHPs) among these specialties, few studies have focused specifically on the prognosis and recovery of emergency physicians (EPs) in PHPs. Important New Data There are little data on whether EPs who receive treatment by PHPs have similar outcomes with these programs as other physicians. To address this research gap, Dr. Rose and colleagues conducted a study using data from 16 state PHPs that followed participants with substance use disorders for 5 or more years. Published in the Western Journal of Emergency Medicine, the study compared outcomes of EPs with other practitioners who were enrolled in state PHPs. “Research has been limited regarding whether EPs perform as well as other physicians after treatment from PHPs,” Dr. Rose says. “We wanted to determine if there were any characteristics for EPs that were significantly different from those of other physicians.” For the study, investigators reviewed data on 904 physicians with a diagnosis of substance use disorders between 1995 and 2001. They compared 56 EPs with 724 other physicians and assessed rates of relapse, successful completion of monitoring, and return to clinical practice within 5 years. Overall, EPs had a higher-than-expected rate of substance use disorders. “EPs were almost three times as likely to be enrolled in a PHP...
A Closer Look at MI Among Younger Women

A Closer Look at MI Among Younger Women

Over time, the frequency of myocardial infarction (MI) in the United States has been declining overall as improvements have been made with regard to medical therapy for coronary artery disease. Although there has been a decline in the rate of ST-elevation MI (STEMI) in those aged 55 and older, the rate has remained steady in patients younger than 55 and among younger women. “Studies have shown that it’s harder to recognize the signs of MI in women,” says Luke Kim, MD, FACC, FSCAI. “Previous analyses indicate that women tend to receive less aggressive treatment than men.” Analyzing Disparities In a study presented at the Society for Cardiovascular Angiography and Interventions 2014 Scientific Sessions, Dr. Kim and colleagues analyzed data on about 13,000 women and more than 42,000 men aged 55 and younger who were hospitalized with an acute MI from 2007 to 2011 using the Nationwide Inpatient Sample database. The authors looked at temporal trends in MI as well as adverse in-hospital outcomes to compare findings by gender. The researchers observed a slight decline in the number of MIs among younger women between 2007 and 2009 but little change after that. Women had more preexisting health problems than men, including diabetes, hypertension, kidney disease, peripheral vascular disease, congestive heart failure, and obesity. Women were also more likely than men to have non-STEMIs. The study by Dr. Kim and colleagues also revealed that there were disparities in the treatment of MI. “Women who suffered an MI were far less likely than men to be treated with PCI or CABG surgery,” explains Dr. Kim. “They were also more likely to face...
Updated Guidelines for Valvular Heart Disease

Updated Guidelines for Valvular Heart Disease

According to recent estimates, just less than 3% of Americans have moderate-to-severe valvular heart disease (VHD), a condition that increases in prevalence with age. The disease affects between 4% and 9% of those aged 65 to 75 and 12% to 13% of those aged 75 and older. Many of these patients require surgical or interventional procedures, but even with these treatments, the overall survival rates associated with VHD are lower than expected. The risk of adverse outcomes due to VHD is high because of limited options for restoring normal valve function and because of failures to intervene at the optimal time point in the disease course. A Welcome Update In 2008, the American College of Cardiology (ACC) and American Heart Association (AHA) released an updated guideline for diagnosing and managing adult patients with VHD. In 2014, the ACC/AHA updated these guidelines in an effort to facilitate access to concise, relevant information at the point of care when clinical knowledge is needed the most. “In the past 5 years, we have accumulated new evidence and a better understanding of earlier research surrounding VHD,” explains Paul Sorajja, MD, FACC, FAHA, FSCAI, who was a member of the ACC/AHA writing group that developed the most recent guideline update. “Our goal was to provide clinicians with concise, evidence-based recommendations and the supporting documentation to encourage their use.” Restructured Definitions The 2014 guidelines include restructured definitions of VHD severity into four classifications—at risk, progressive, asymptomatic severe, and symptomatic severe (Table 1). “These categories were created to help clinicians determine the optimal timing of interventions,” Dr. Sorajja says. The stages consider the degree of valve...
ICAAC 2014

ICAAC 2014

New research is being presented at ICAAC 2014, the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy, from September 5 to 9 in Washington, DC.   Meeting Highlights Big Benefits With Antibiotic Stewardship Programs Finding Antibiotic-Resistant Bacteria Clinical Education Key to Procalcitonin Testing Trends in P. aeruginosa Septicemia Recurrent CDI: A Look at Outcomes   News From ICAAC 2014 Coinfection less likely among children with pneumonia serotypes Ebola Response: Slowed by a ‘Perfect Storm’ of Setbacks Researchers propose new strategies to combat antimicrobial resistance In-house PCR had greater sensitivity than commercial test kits for detecting intestinal protozoa Hospitalization rates increased for patients with HCV, diabetes Antimicrobial dosing adjusted for weight led to cost savings Lab-developed, commercial assays performed comparably in norovirus detection Clinical outcomes did not differ between children with, without C. difficile Swiss MSM had vague awareness of HCV treatments, modes of transmission Antifungal’s Lower Side Effects Hold Promise Depression Linked to Postop Infection Diabetic Foot Infections Fall — Not! Short TB Regimens Disappoint Moxifloxacin Struggles Against Current TB Drugs: REMox Trial Quadruple Dosing of Doripenem Safe in Patients With CF Early targeted antibiotics improved outcomes in S. aureus bloodstream infections Combination drugs in the pipeline offer increased convenience, fewer toxicities for patients with HIV SAPPHIRE-I, II trials demonstrate minimal serious AE in HCV Vancomycin May Protect Against C. Diff Recurrence One Dose of Flu Drug Shortens Fever Single-step NAAT algorithm improved C. difficile detection Efficacy of triple therapy varied among Israeli patients with HCV Peramivir safe, effective in treating influenza symptoms Ebola in Spotlight   More From ICAAC 2014 Registration Hotel Rates & Map Schedule-at-a-Glance General Information Online...
ESC 2014

ESC 2014

Research is being presented at ESC 2014, the European Society of Cardiology’s 2014 Congress, from August 30 to September 3 in Barcelona, Spain.   Meeting Highlights Fractional Flow Reserve for Managing NSTEMI Real-World Success With Retrievable & Repositionable Valve Renal Denervation, AF, & Hypertension   News From ESC 2014 Best of ESC Congress 2014 STICS – Short-term peri-operative statin treatment does not reduce complications after cardiac surgery X-VErT – Pre-treatment with rivaroxaban may expedite cardioversion AMIO CAT – Medication Improves Short-Term Recovery after Ablation for Atrial Fibrillation IBIS 4 – High-Dose Rosuvastatin Shrinks Coronary Plaque in Heart Attack Patients IMPI – Steroids Raise Cancer Risk in TB-associated HIV Simple awareness campaign in general practice identifies new cases of AF ROCKET AF trial suggests that digoxin increases risk of death in AF patients Coffee increases prediabetes risk in susceptible young adults Mechanical heart valves increase pregnancy risk Health structures explain nearly 20% of non-adherence to heart failure guidelines BIOSCIENCE – Experimental coronary stent combines ultrathin structure with biodegradable material ANTHEM-HF study shows significant improvement in cardiac function with left or right vagus nerve stimulation Biventricular pacing disappoints in BIOPACE trial SEPTAL CRT – Study finds alternative lead position is safe in cardiac resynchronisation therapy   STAR AF 2 – In Ablation for Persistent Atrial Fibrillation, “Less May be More”  EUROECO – ICD Home Monitoring: Cost Compares, but Reimbursement Lags CvL PRIT – Complete Revascularisation Improves Outcome in Heart Attack Patients  ATLANTIC – Ambulance administration of anti-clot drug may benefit heart attack patients NOMI – Nitric oxide inhalation in heart attack patients sends mixed messages, but may offer benefit MITOCARE – Hopes dashed...

Anesthesiologists Are Having a Bad Year

Let’s start with an American anesthesiologist now living in Australia has admitted that he was not improperly fired by the University of New South Wales. He has apologized and withdrawn the allegations. The 2009 dismissal and subsequent charges by the doctor resulted in a lengthy investigation by several entities. He had accused the University and its vice chancellor of a massive cover-up. The school has retaliated by calling the physician and “academic grifter” and accusing him of being a con man with a 15-year history of fraud and deceit. Other terms used to describe him in a story from The Australian and quoted in the Retraction Watch blog were “a fraud, a cheat and an incorrigible liar.” He is also accused of plagiarism and falsifying his credentials. His bibliography lists over 150 publications. I wonder if he will be featured on Retraction Watch in the future. The next example features a 61-year-old woman who became hypoxic during a routine AV node ablation procedure and died 10 hours later. A lawsuit naming the cardiologist and the anesthesiologist was filed. The anesthesiologist was accused of surfing the Internet during the case. In his deposition, the doctor who performed the ablation not only said the anesthesiologist was distracted, he also alleged that the oxygen saturation numbers on the anesthesia record were fabricated. An article in the Dallas Observer quotes the transcript of the anesthesiologist’s deposition in which he denied ever having used social media during cases or posting patient-related material online. Later in the deposition, the plaintiff’s lawyer showed the doctor his Facebook post complaining that his next patient had lice. A...
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