#PWChat – Pseudoscience in Medicine: Steering Patients Toward Reliable References

#PWChat – Pseudoscience in Medicine: Steering Patients Toward Reliable References

Join us Tuesday, September 26 at 3:00pm ET for a live, interactive tweetchat with Linda Girgis, MD, on how to steer patients toward reliable resources when it comes to pseudoscience-related topics. Topics to be discussed are subject to change but will likely include: Examples of the presence of pseudoscience in medicine The pros and cons of naturopathy. The pros and cons of homeopathy. Toxins and the use of detoxing diets/methods/etc. Organic foods and whether they’re safer than “regular” foods. The touted benefits of yoga and meditation, and whether or not they are founded in true science. Non-GMO foods and whether or not there are valid concerns with GMOs from a health standpoint. How patients get sucked into following a type of pseudoscience. How clinicians can address pseudoscience with their patients, including potential harms. How to explain to patients the difference between causation and correlations, as well as other ways to really understand study results. How clinicians can help patients find reliable sources for medical information. What clinicians can do on a wider scale to spread the word about the dangers of pseudoscience and those who tout it. What can be done to counter physicians who sell supplements that “boost the immune system” or are “better than what can be bought elsewhere.” More… How to Join the Chat Log into your Twitter account. Don’t have an account? Where have you been?! Just kidding, we don’t judge, but you should get one! It’s easy to create, and free. You’ll be glad you did. A couple minutes before 3:00pm ET on September 26, Search Twitter (top right of every Twitter page) for...
Continuing Life Sustaining Therapy in the Face of Futility

Continuing Life Sustaining Therapy in the Face of Futility

One of the most difficult challenges physicians encounter is assisting terminally ill patients who are nearing the ends of their lives. These patients and their families are faced with the decision of whether it’s time to discontinue life sustaining therapy as the treatment when it may no longer be beneficial or the patient doesn’t want to continue with the therapy. Just as it’s the physician’s role to make recommendations when beginning treatment, it’s the physician’s role to initiate this discussion of stopping treatment as well. These conversations, however, are difficult for physicians. While it’s easier to talk with patients who can make their own decisions, some are unable to, and it’s up to the families to decide when to stop treatment. Most families struggle with this decision primarily because of the guilt and grief they are experiencing. They might think that they aren’t doing enough or are concerned that the decision to cease all medical treatment is not right. Also, they may wonder if they are giving enough opportunity for a miracle to happen where the patient suddenly improves. These are the feelings that paralyze families from making the decision to stop treatment. Another issue that affects the continued use of life sustaining therapy is taking into consideration the resources used. For example, when a patient is on a ventilator and needs dialysis, the costs can be staggering especially for terminally ill patients, where no meaningful change in their condition is expected. This is a significant drain on both the medical system as well as healthcare and Medicare resources. Prolonging life is not always the answer, especially when weighed...
#PWChat: Incorporating Physician Assistants & Nurse Practitioners into Practice

#PWChat: Incorporating Physician Assistants & Nurse Practitioners into Practice

Join us Wednesday, September 13 at 9:00pm ET / 6:00pm PT for a live, interactive tweetchat with Shereese Maynard, on incorporating nurse practitioners (NPs) and physician assistants (PAs) into practice. Topics to be discussed will include: The advantages to a medical practice in integrating an NP or PA. Why a solo or group medical practice would be reluctant to integrate an NP or PA. Other obstacles that can be expected when integrating an NP or PA. How a medical practice should plan for the integration of an NP or PA. What should be taken into account in regard to role definitions, care models, collaboration,  when integrating an NP or PA. How else the obstacles of integrating an NP or PA can be overcome. What qualities and competencies a medical practice should look for in an NP or PA. Where and how integrating an NP or PA can improve workflows clinically and administratively. More… How to Join the Chat Log into your Twitter account. Don’t have an account? Where have you been?! Just kidding, we don’t judge, but you should get one! It’s easy to create, and free. You’ll be glad you did. A couple minutes before 9:00pm ET on September 13, Search Twitter (top right of every Twitter page) for #PWChat. On the search results page, click Latest at the top left. This will show you all the latest tweets using the #PWChat hashtag. The page will automatically update every couple minutes, letting you know how many new tweets there are using the #PWChat hashtag. Answer questions, reply to other’s comments, or make a comment of your own as...
#PWChat – The Ins & Outs of Shared Decision Making

#PWChat – The Ins & Outs of Shared Decision Making

Join us Wednesday, September 6 at 9:00pm ET / 6:00pm PT for a live, interactive tweetchat with Marc Probst, MD, and Hemal Kanzaria, MD, on shared decision making in the ED. Topics to be discussed are based on their recent PW article and will include: Why there are still misconceptions surrounding how and when to use shared decision making. Examples of those misconceptions. Necessary and sufficient factors for determining if a clinical scenario is appropriate for shared decision making. What clinical equipoise refers to in emergency department context and how it should be factored into shared decision making What compassionate persuasion refers to and how it plays into shared decision making. What a patient would be unwilling and/or unable to participate in shared decision making. In what situations shared decision making should be forgone or delayed. How shared decision making in the ED differs from shared decision making in the primary care or other practice setting. “Fast food medicine” and why it is important to differentiate it from shared decision making. Whether or not shared decision making is meant to be medico-legally protective. The common barriers to shared decision making in the emergency department. Practical approaches to shared decision making. Patient decision aids and whether any have been developed for the emergency department. More… How to Join the Chat Log into your Twitter account. Don’t have an account? Where have you been?! Just kidding, we don’t judge, but you should get one! It’s easy to create, and free. You’ll be glad you did. A couple minutes before 9:00pm ET on September 6, Search Twitter (top right of every Twitter...
#PWChat – Convincing Antivaxxers: Winning the Vaccine Argument With Patients

#PWChat – Convincing Antivaxxers: Winning the Vaccine Argument With Patients

Join us Wednesday, August 30 at 9:00pm ET / 6:00pm PT for a live, interactive tweetchat with Linda Girgis, MD, on how to handle antivaxxers in your practice. Topics to be discussed are subject to change but will likely include: The current status of the antivaxxer movement in the United States. Why, despite evidence behind the safety & efficacy of vaccines, there are still antivaxxers. The most important things for clinicians to know about antivaxxers as a whole. The first steps to teak when met with a patient or parent of a patient who is an antivaxxer. The most common arguments seen/heard among those who don’t/won’t vaccinate themselves or their children. Whether or not antivaxxers with these arguments can be educated to the point of changing their minds, and if so, how. How to combat antivaxxers who say mainstream media claims vaccines are safe and effective with no unbiased proof. How to combat patients and parents who view physicians as consultants who advice can be freely rejected or accepted. How to educate patients–such as antivaxxers who site single cases as “studies”–on how to better understand study results. The effect of redirecting resources toward counseling antivaxxers or those questioning vaccines. Whether or not parents who refuse to immunize their children should be dismissed from a pediatrician’s practice. More… How to Join the Chat Log into your Twitter account. Don’t have an account? Where have you been?! Just kidding, we don’t judge, but you should get one! It’s easy to create, and free. You’ll be glad you did. A couple minutes before 9:00pm ET on August 30, Search Twitter (top right...
#PWChat – Hospitals, Not Hotels: A Look at Global Budgets

#PWChat – Hospitals, Not Hotels: A Look at Global Budgets

Join us Thursday, August 24 at 9:00pm ET / 6:00pm PT for a live, interactive tweetchat with Joshua Sharfstein, MD, on why hotels and hospitals shouldn’t necessarily be compared to one another and how global budgets can help avoid the comparison, inspired by his TEDx talk Hospitals, Not Hotels (below), as well as the newly published report, “An Emerging Approach to Payment Reform: All-Payer Global Budgets for Large Safety-Net Hospital Systems,” from the Commonwealth Fund. Topics to be discussed include: The problem in touting, and focusing on, the unique customer service of the U.S. healthcare system Why so many hospitals resemble hotels Whether paying hospitals based on filled beds is good for the country Why life expectancy in the U.S. is ranked 31st in the world but healthcare costs in the U.S. are ranked number 1 Whether hospitals should be encouraged to invest in the health of the communities and what the benefits of doing so may be What global budgets are for hospitals The benefits of global budgets for hospitals The disadvantages of global budgets for hospitals Whether global budgets for hospitals or paying hospitals more the more they treat/see patients is stranger Real-world experiences with global budgets for hospitals Whether the use of global budgets for hospitals have taken hold and what states/hospitals are jumping on board More… How to Join the Chat Log into your Twitter account. Don’t have an account? Where have you been?! Just kidding, we don’t judge, but you should get one! It’s easy to create, and free. You’ll be glad you did. A couple minutes before 9:00pm ET on August 24, Search...
Shared Decision Making in the ED

Shared Decision Making in the ED

For decades, the paradigm of paternalistic medicine ruled the land. Patients were expected to be polite, passive, and compliant with doctor’s orders. More recently, a new movement has emerged—one focused on partnership, mutual respect, and patient engagement. Patient engagement refers to the active patient involvement in their own healthcare decisions; doing so strengthens a patient’s influence on medical decisions and behaviors so that their values and preferences can be prioritized. A key component of patient engagement is the use of shared decision making. Although shared decision making has been around in general medicine informally for decades, its study and formal use in emergency medicine remains in its infancy. Despite the increasing popularity of the term, there are still some misconceptions surrounding how and when it should be used. In a “Concepts” piece published in the Annals of Emergency Medicine, the authors propose a new conceptual model to guide emergency clinicians in determining when shared decision making should be used in the ED. The following three factors are necessary and sufficient to determine whether a clinical scenario is appropriate for shared decision making:   Clinical Equipoise Clinical equipoise in the ED context refers to the existence of two (or more) medically reasonable options. For example, for the treatment of acute streptococcal pharyngitis, both oral and intramuscular antibiotics are medically reasonable depending on the preferences of the patient. If only one medically reasonable option exists, then informed consent should be sought with “compassionate persuasion,” used as needed.Compassionate persuasion refers to a benevolent attempt by the clinician to persuade a patient to receive care that they have initially refused, given that this...
Implementing In-Hospital 3D Printing

Implementing In-Hospital 3D Printing

Although 3D printing has become more popular in the last decade, few hospitals are printing by themselves. The Elisabeth-Tweesteden Hospital in Tilburg, the Netherlands, has purchased two 3D printers—the Makerbot Replicator Z18 and the Ultimaker 3—in the past year. The hospital, a Level-1 trauma center with a large neurosurgical department, aims to service 75% of all major trauma patients in the area. The trauma center’s 3D printing system focuses on bone structures and aims to help trauma surgeons better prepare for complex fractures.   Taking a Closer Look The 3D printing lab is directed by trauma surgeon Mike Bemelman, MD, and Lars Brouwers, MD, MSc, PhD-candidate. Their goal is to provide all surgeons and residents with 3D-printed anatomical models to help with surgical preparations, understand fracture patterns, and determine optimal surgical approaches. “The beginning of our 3D-printing process was difficult, because we had to find out which printers were suitable for medical 3D printing,” says Dr. Brouwers. “Furthermore, we had to determine how to convert CT files into 3D printing files called stereolithography (STL) files.” The team purchased two poly lactic acid (PLA, one of two major material types used in 3D printing) printers because of the affordable raw plastics and the simplicity of the printing process. “The added value is immense,” says Dr. Bemelman. “We can also pre-bend titanium plates on the 3D-printed models to reduce operation time.” To make this solution available to all patients, work-flow in the 3D printing lab had to be economically sound, without the need for a technician. Using in-hospital software from Philips, Drs. Brouwers and Bemelman convert CT data into STL files...
Personalizing Coronary Artery Disease Diagnosis

Personalizing Coronary Artery Disease Diagnosis

Coronary artery disease (CAD) causes one in seven deaths among Americans, and diagnosis can be challenging. To provide the most appropriate care pathways, helpful and convenient testing modalities need to be explored. A diagnosis is only as good as the tools used to help make it. A few considerations: Slightly more than one-third of cardiac catheterizations in patients with stable symptoms find obstructive CAD. Patient follow-up data suggest that only 10% of patients presenting with stable chest pain to outpatient clinics have a cardiac etiology. The recently published PROMISE trial determined the rate of obstructive disease in patients referred for cardiac imaging tests to be just 6%. These data indicate that CAD, as prevalent as it is, often presents with symptoms so general that an accurate means to rule it out is needed prior to exposing patients to expensive and potentially risky tests. Ideally, clinicians should be able to select patients who truly need cardiac catheterization, which has historically been somewhat difficult. However, medicine and diagnostics are continually evolving and providing new tools to help improve cardiac care. A relatively new study indicated that a personalized medicine test helped determine the appropriate cardiac care pathway for patients. An age, sex, and gene expression score (ASGES) is determined by a simple blood test, with an easy-to-understand score. On a scale of 1-40, scores of 15 or less provide confidence that the likelihood of obstructive CAD, and thus need for coronary artery revascularization in the near term, is low. For the study, obstructive CAD was defined as at least one atherosclerotic plaque causing 50% or greater luminal diameter stenosis in a...
Technology and Internet Addiction: How to Recognize it and Recover From it

Technology and Internet Addiction: How to Recognize it and Recover From it

The following is an excerpt from a complete guide published by Comparitech. “Internet Addiction” is a growing problem. As more individuals gain internet access every year, the number of people becoming obsessed and then addicted to the internet is increasing as well. Internet addiction shares a lot of similarities to other additions, and like other addictions, can also be treated. This guide will help you understand what internet addictions can look like, and how they can be treated. Defining Internet Addiction In 2012, popular satire news website The Onion posted a fake video news report: “Brain-Dead Teen, Only Capable Of Rolling Eyes And Texting, To Be Euthanized.” The video amusingly dramatizes the slow degradation of “Caitlin,” a once energetic and active young girl whose brain has succumbed to lifelessness amidst texting and social media usage (and, one would assume, the general malaise of being a teenage girl). Her doting yet troubled parents have decided to take the most loving step they can consider: euthanasia. As the fake doctor in the clip states: “Her eyes may flutter a bit, or she may murmur: ‘Are you for real killing me right now?’, but then the struggle will finally be over.” The Onion is well known for its biting humor, but also, in a similar fashion to television’s Saturday Night Live, for the observational intelligence of its satire. In this case, the site hits fairly close to home for many who have dealt with technology and internet addiction, or who have family members currently struggling with this growing problem. Although realinternet addiction rarely, if ever, results in such a dramatic effect as The Onion’s notably hyperbolic example, its consequences...
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