EvidenceCare, a Nashville-based decision support tool for healthcare providers, announces the integration of drug information from Tarascon Pharmacopoeia, the most popular and trusted source of portable drug information since 1987. The integration provides EvidenceCare the opportunity to deliver content that has been relied upon by Providers worldwide for nearly three decades. EvidenceCare presents the information in a format that is easy-to-access and is personalized to each unique patient.
The Tarascon Pharmacopoeia 2015 Editions continue the tradition as the leading pocket drug reference packed with vital drug information to help clinicians make better decisions at the point of care.
Topics: Cardiology, doctors, dosing, Global Health Blog, Hospital Medicine Blog, emergency medicine, General Medicine, hospital medicine, Infectious Disease, infectious disease, medicine, mobile medicine, oncology, Pharma, pharma, Pharmacopoeia, physicians, prescribe, prescribing, Prescribing, primary care, Pyschiatry & Mental Health, Tarascon
The Tarascon Pediatric Inpatient Pocketbook has just published, and is an essential pocket reference when treating pediatric patients in a hospital setting.
Rare diseases are notoriously difficult to diagnose. According to the FDA, one-third of people with a rare disease will wait one to five years before receiving a correct diagnosis. A new search engine created by researchers at the Technical University of Denmark, FindZebra, is aiming to change that.
"Zebra" is a medical slang term for a surprising diagnosis. The term derives from the aphorism "When you hear hoofbeats behind you, don't expect to see a zebra", which was coined by a professor at the University of Maryland School of Medicine to describe unexpected diagnoses. This term is widely used in medical communities, and refers to diseases occurring in less than 1 in 2000 of the population.
The FindZebra website states that it aims to "[address] the task of searching for relevant rare diseases given a query of patient data. The patient data is given as free text, which means that the queries do not have to use a controlled vocabulary or specific query language restrictions as in conventional diagnostic assistance systems. The patient data submitted as a query to the information retrieval (IR) system could consist of patient age, gender, demographic information, symptoms, evidence of diseases, test results, previous diagnoses, and other information that a clinician might find relevant in the differential diagnosis."
Topics: Diagnosis, Hospital Medicine Blog, findzebra, General Medicine, hospital medicine, patient education, patient education, physicians, rare disease, search engine for rare disease, Technical University of Denmark, zebras
Topics: aspirin, biliary cancer, brain cancer, Breast Cancer, colorectal cancer, Dr. Joseph Esherick, Hospital Medicine Blog, Dr. Peter Rothwell, esophageal adenocarcinoma, gastric cancer, hospital medicine, Authors, Lancet, lung adenocarcinoma, metastasis, oncology, pancreatic cancer
Dr. Joseph Esherick Monthly Blog – February 2012
Are you a hospitalist who would like to incorporate procedures into your practice but don’t feel competent or confident in your skills? Are you a hospitalist who does procedures so infrequently that you feel more comfortable referring your patients to a specialist for such procedures? Are you a hospitalist who believes that you can get better reimbursement seeing more inpatients rather than incorporating hospital procedures into your practice? Are you a hospitalist who believes that doing procedures will decrease your job satisfaction? These are a few of many scenarios and myths that prevent hospitalists from performing bedside procedures.
Hospitalists who perform procedures enjoy their jobs more than those who do not. In one Canadian study of over 19,000 physicians, the degree of job satisfaction was directly linked to the range of procedures performed by the physician.
Additionally, patients feel better when the bedside procedures are performed by their primary physician with whom they have developed a rapport. There are a few reasons for this. Frequently, procedures performed by a specialist, especially an interventional radiologist, require that the patient has long waits, is taken away from their room, their nurse, and their family. Furthermore, patients have often developed a relationship and trust with their primary inpatient physician and feel more comfort when they are performing the procedure rather than a complete stranger.
Topics: American Board of Internal Medicine, American College of Physicians, bedside procedures, Dr. Joseph Esherick, Hospital Medicine Blog, hospital medicine, hospitalist, patient, Physician, point-of-care, primary care, simulation-based training, Society of Hospital Medicine, surgical skills
Dr. Joseph Esherick Monthly Blog – November 2011
Numerous studies have shown that ultrasound guidance lowers the rate of complications and increases the success rate for virtually every hospital procedure compared with traditional landmark-based techniques. This has proved to be the case for ultrasound-guided central lines, ultrasound-guided paracentesis, and ultrasound-guided lumbar punctures in obese patients. This essay will focus on ultrasound-guided thoracentesis which has a decreased rate of pneumothorax and need for tube thoracostomy compared with the blind approach.
Pleural effusions affect nearly 1.5 million people each year in the United States. Many of these people require thoracentesis for pleural fluid analysis to either determine the etiology of their pleural effusions or as a therapeutic procedure to relieve dyspnea and hypoxia. Examination of the pleural space with sonography is best carried out using a convex array 3.5- to 5 MHz probe. Ideally, the patient is in the sitting position and sonography should identify the uppermost extent of the pleural effusion and the location of the diaphragm. The depth of insertion can also be approximated by using the depth markers on the ultrasound screen. At this point, a mark can be made on the posterior thorax just above the rib at the optimal site for thoracentesis. The thoracentesis can then be carried out in standard fashion with the patient in the same sitting position. Alternatively, the convex array probe can be placed in a sterile sheath and the thoracentesis can be performed using real-time ultrasound guidance. The complication rate is identical with either technique for ultrasound-guided thoracentesis...
Dr. Joseph Esherick Monthly Blog – October 2011
Drotrecogin-alfa (DrotAA) has been an integral part of the care bundle for adult patients hospitalized with severe sepsis or septic shock and a high risk of death since 2002. DrotAA is a synthetic activated Protein C (APC) which has good scientific evidence for why it may be beneficial in patients with severe sepsis and septic shock. Patients with severe sepsis have abnormal activation of their coagulation pathways and inflammatory system and impaired fibrinolysis, which lead to a procoagulant state. Normally, APC acts with Protein S to degrade clotting factors Va and VIIa to promote anticoagulation. However, intrinsic levels of APC are diminished in patients with severe sepsis because of impaired APC synthesis and increased degradation by neutrophil elastases. Therefore, the theory was that a synthetic APC could benefit patients by decreasing the abnormal clotting which occurs in the micro-circulation.
Dr. Joseph Esherick Monthly Blog – August 2011
There has been considerable interest in antibiotic stewardship programs over the past decade given the increase in drug-resistant bacteria. The best way to combat the problem of drug-resistant bacteria is to develop systems which discourage the inappropriate initiation of antibiotics or the unnecessary prolongation of antibiotics. The measurement of serum procalcitonin levels can aid sound clinical judgment for decisions regarding proper antibiotic use.
Procalcitonin, the precursor peptide of calcitonin, is released in response to a body’s exposure to bacterial antigens or toxins. Furthermore, the procalcitonin levels are suppressed by exposure to cytokines activated during viral infections, namely interferon gamma. We know that the level of procalcitonin elevation is directly correlated with the severity of the bacterial infection. In addition, procalcitonin levels rise within 6-12 hours after symptom onset of bacterial infections and decrease by about 50% per day once a bacterial infection is under control.
A number of randomized controlled trials have led to the development of procalcitonin guided clinical algorithms for various infections which have been used throughout Europe. These protocols have led to a marked reduction in the use of antibiotics in adult patients treated in a variety of clinical settings with no increase in mortality or morbidity...
The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891This technique utilizes the iliac crest and the posterior lumbar spinous processes to determine the optimal sites for spinal needle introduction in either the L3-4 or the L2-3 interspinous spaces. The landmark-guided technique of lumbar puncture is usually successful in experienced hands as long as the patient is not obese, pregnant, edematous, or have scoliosis, degenerative joint disease, or a history of lumbar spine surgery. Patients who have any of these characteristics or conditions can lead to more difficult landmark-guided lumbar punctures. It is in these cases when bedside ultrasound can increase the success rate of lumbar punctures.[2,3,4,5]
Ultrasound-guided regional neuraxial anesthesia has been described in the anesthesia literature since 1971. The literature reports a reduction in the number of attempts, need for repositioning, and interspaces accessed compared with landmark-guided spinal or epidural anesthesia.[7,8] The use of bedside ultrasound to help guide difficult lumbar punctures has spread to the emergency room, ICU, and the hospital wards over the last 7 years. Observational studies have demonstrated that lumbar landmarks can be correctly identified using ultrasound about 76% of the time when they are difficult to palpate.[2,3,9]
Topics: bedside ultrasound, Dr. Joseph Esherick, Hospital Medicine Blog, emergency medicine, emergency physician, Heinrich Quincke, hospital medicine, hospitalist, Authors, landmark-guided, lumbar puncture