Class Act

Insulin in a Pill: Barriers to Development of Oral Insulin

May 8, 2018
Insulin in a Pill: Barriers to Development of Oral Insulin

By Nicolas Gillingham

Peer Reviewed

Over 30 million Americans—9.4% of the population—live with diabetes, six million of whom are at least partially dependent on exogenous insulin. Insulin can be self-administered by subcutaneous injection, either classically via a syringe, an insulin pen, or using an insulin pump. However, patients with diabetes report that these daily injections can feel particularly burdensome, not to mention stigmatizing, when compared to oral medications like metformin, which is one reason why insulin carries a lower rate of adherence. What if our …

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Encephalopathy’s Muse

May 4, 2018
Encephalopathy’s Muse

By Gregory Rubinfeld, MD

The thick and sultry August outside,

The stale ammonia scented inside,

James The Poet, bedridden, writing in a fury,

Charlotte on a chair next to him, yawning.

 

So too have I become…

My whole frame taken, turned,

The very color of my flesh

Yellowed like the pages of an old book.

Moribund, we living antiques,

At the eternal doorway.

The snickering sardonic Footman ever beckoning.

 

The deep blue ink on the napkin ran some

But the words were still clear, burnished.…

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Why We Do What We Do: The Evidence Behind Rapid Response Teams

April 26, 2018
Why We Do What We Do: The Evidence Behind Rapid Response Teams

By Thatcher Heumann, MD

Peer Reviewed

“Rapid Response Team to 7W. Rapid Response Team to 7W.” After switching elevators and waiting for security to buzz you in through the double doors, you see your fellow residents rushing to one of the corner rooms. When you arrive, med consult is calmly delegating various tasks to nursing and residents: vitals, EKG, ABG, CXR, IV access. They quickly review the patient’s history and medications. Depending on the acute condition—respiratory failure, cardiac arrest, septic shock—interventions such as NIPPV, fluids, …

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Are Fasting Lipids Necessary?

April 20, 2018
Are Fasting Lipids Necessary?

By Anthony Marte
Peer Reviewed

It is a common sequence of dialogue in clinic: “I’d like to draw some blood for cholesterol,” says the doctor. “Have you eaten today?” With downcast eyes, the patient replies, “Yes, I had a snack. I just got so hungry.” The well-intentioned physician concedes, “That’s okay. Another time, then.”

Patients requiring lipid panels frequently report to their clinic appointments in the non-fasting state. These patients often leave clinic without having their blood drawn for lipids, with instructions to return early …

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Healthcare (Or Lack Thereof) in Communist Albania

March 9, 2018
Healthcare (Or Lack Thereof) in Communist Albania

By Mariela Mitre

Peer Reviewed

I was born in the late 1980s, a relatively fortunate time in Albanian history, considering that Enver Hoxha (1908-1985), the most xenophobic communist dictator of the Eastern European bloc, had recently died and the country was on the verge of transformative demonstrations. My parents, on the other hand, were born in the 1950s during the first decade of the establishment of the Communist regime. Over the four decades of the dictator’s rule, he became increasingly paranoid, managed to break ties …

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Do Appearances Really Matter? Examining the Role of the White Coat in Medicine Today

February 16, 2018
Do Appearances Really Matter? Examining the Role of the White Coat in Medicine Today

By Sonal Patel
Peer Reviewed

Prior to the 20th century, physicians’ attire was black, a color associated with formality, since patient-physician interactions were considered serious, formal matters. As the 19th century ended and medicine evolved from home remedies and “quackery” to the field of bioscience, values of cleanliness and antisepsis were emphasized. These were reflected in a change of physicians’ attire from black to white to highlight the “pureness” of medicine. Since this time, the white coat has been regarded as a symbol of medicine …

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Food for Thought

February 9, 2018
Food for Thought

By Hannah Kopinski
Peer Reviewed

Diabetes, hypertension, and hyperlipidemia. One would be hard pressed to find an adult primary care physician in the United States who would not list these three chronic medical conditions as the metaphorical bread and butter of his or her practice. Bread and butter in this case is, however, not just a metaphor. The single most important driver of these conditions and the complications that arise from them (myocardial infarction, stroke, renal failure, just to name a few) is poor diet. …

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A Critique of the ACGME Resident Work Hour Regulation Update

January 18, 2018
A Critique of the ACGME Resident Work Hour Regulation Update

By Simon Rodier

Peer Reviewed

On March 10, 2017, the Accreditation Council for Graduate Medical Education (ACGME) announced a controversial decision. They decided that, effective July 1, 2017, the maximum work shift for medical interns would increase from 16 to 24 hours. Work hour restriction is a decades-old debate in medicine that raises many valid arguments on both sides of the fence. Was increasing the work hour limit from 16 to 24 the right decision?

Investigations into the effects of long work hours of resident …

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