Class Act

Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

April 12, 2017
Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

By Christopher V. Cosgriff

Peer Reviewed

The American College of Physicians (ACP) recommends supplemental long-term oxygen therapy (LTOT) in all patients who have severe resting hypoxemia, defined as a PaO2 ≤55 mmHg or an SpO2 ≤88%. In patients with cor pulmonale or polycythemia they recommend initiation of oxygen therapy at a PaO2 ≤59 mmHg.1 Absent from the ACP recommendation is a target range to which saturation should be restored. The accepted standard of practice is restoration to a range of 88%-92%, and there are British …

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How Reliable Is Hemoglobin A1c?

April 6, 2017
How Reliable Is Hemoglobin A1c?

By Alexa Yuen

Peer Reviewed 

According to the CDC, there are 22 million people with an established diagnosis of diabetes mellitus in the United States, but more frightening is that the rate of diabetes continues to rise both nationally and globally, with predictions that 7.7% of the world’s adult population will be afflicted with the disease in 2030., Preventing, monitoring, and managing this disease is of utmost importance in responding to the growing epidemic. The hemoglobin A1c (HbA1c) blood test has become a powerful tool …

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Book Review: in-Training: Stories from Tomorrow’s Physicians

March 31, 2017
Book Review: in-Training: Stories from Tomorrow’s Physicians

By Amar Parikh, MD

Peer Reviewed

“Wounded healers. It’s a concept…inspired by the story of Chiron, a centaur in Greek mythology who was renowned for his skills as a healer. Chiron was wounded by a poisoned arrow but his immortal status sustained him…He was thus condemned to spend eternity roaming the earth in agonizing pain, healing everybody but himself….the phenomena of depression and suicide among medical students and doctors suggest that we…fit into this archetype. “

The above selection is an excerpt from a moving …

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A Trip Through the Granola Vortex

February 10, 2017
A Trip Through the Granola Vortex

By Michael J Hession

Peer Reviewed

Twenty blocks south of NYU Langone and steps east of First Avenue on 9th Street sits New York’s go-to supplier of fresh herbs, tinctures, and oils. Owned and operated since 1993 by Lata Chettri-Kennedy—The Green Witch of the East Village—Flower Power Herbs and Roots Inc. is lined floor-to-ceiling with shelves of cut and dried product in mason jars. A purple bumper sticker behind the counter proclaims “Health Care for People, Not for Profit,” and another infographic ranking peppers from …

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Gratitude: Benefits for the Soul, and the Body

February 3, 2017
Gratitude: Benefits for the Soul, and the Body

By Nicole Van Groningen, MD

Peer Reviewed

Although the “stress of the holidays” is a phrase used to refer to the multitude of to-do lists and travel obligations associated with the 6-week stretch between Thanksgiving and New Year’s Day, the pleasant emotional state associated with the season remains one of the most important positive influences on the American psyche. Chief among these warm emotions is an emphasis on gratitude for the people, relationships, opportunities, and circumstances we cherish. As the holiday season comes to a …

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What is the Evidence for Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema?

February 1, 2017
What is the Evidence for Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema?

By Jenna Conway, MD

Peer Reviewed

Introduction 

A 58-year-old man presents with worsening dyspnea and nonproductive cough for five days. Significant history includes a recent hospitalization for congestive heart failure. He is afebrile with a blood pressure of 95/55 mmHg, heart rate of 115 beats per minute, and oxygen saturation of 85% on room air. Physical exam is notable for rales bilaterally. Chest X-ray shows bilateral pulmonary infiltrates and an enlarged cardiac silhouette suggestive of cardiogenic pulmonary edema. Standard therapy is initiated with oxygen by …

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The Forbidden Fruit

January 27, 2017
The Forbidden Fruit

By Varun Narendra

Peer Reviewed

Griffith Hughes was the first to describe the grapefruit in 1750, naming it the “forbidden fruit” of Barbados for unknown reasons. Centuries later, it seems as if he may have been on to something, as grapefruit juice (GFJ) has been shown potentially to interact dangerously with a list of commonly prescribed medications. This list has steadily grown to include over 85 drugs.1 Meanwhile, the Internet is rife with anecdotes of near-death experiences attributed to drug interactions with the much-maligned fruit. …

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Optimism

January 25, 2017
Optimism

By Adam Blaisdell, MD

Peer Reviewed

Present Day – The patient is a 61 year-old male who presents with a one-week history of jaundice and intense pruritus. He has a medical history significant for hepatitis C virus (HCV) infection (genotype 1a) diagnosed 15 years ago, which was never treated. Three years prior, the patient was also diagnosed with hepatocellular carcinoma (HCC) and underwent transcatheter arterial chemoembolization (TACE) but was subsequently lost to follow-up. He has no documented evidence of cirrhosis. On this admission his total …

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Balancing patient information with our professional and relational duties to patients and families without appealing to paternalism.

December 2, 2016
Balancing patient information with our professional and relational duties to patients and families without appealing to paternalism.

A commentary by Antonella Surbone, MD PhD FACP, Ethics Editor on  yesterday’s article “Is There Such a Thing as Too Much Information?”

The insighftul and challenging piece Is there such a thing as too much information? by Mariya Rozenblit addresses a key issue in today’s medicine: how much information do we need to provide to our patients to enable them to make autonomous informed choices about their health, illnesses and treatments. She provides many data and examples from the literature to illustrate the potential damages …

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Mental Pathologies at the Root of Modern Medical Training: Lessons from the Life of Professor William Stewart Halsted

November 3, 2016
Mental Pathologies at the Root of Modern Medical Training: Lessons from the Life of Professor William Stewart Halsted

By Jafar Hamid Al-Mondhiry, MD, MA

Peer Reviewed

A critical care attending once told me that “learning scars” are some of our greatest teachers. And he was right. Many times, a sense of anxiety and rigorous self-criticism has pushed me to improve and develop more than I would have otherwise. This is the natural state of medical trainees: scared to fall behind their well-matched, naturally gifted, and occasionally outright competitive peers; scared to fall short in the eyes of evaluators; scared to stumble in front …

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The Rising Tide of Food Allergy

October 20, 2016
The Rising Tide of Food Allergy

By Kristina Cieslak, MD

Peer Reviewed

Food allergies affect approximately 8% of children and 5% of adults, with a steadily increasing prevalence .  Risk factors for the development of food allergy are numerous and include genetics, sex, and ethnicity . Indeed, children with a parent or sibling with peanut allergy are seven times more likely to develop a peanut allergy of their own, and peanut allergy demonstrates a 64% concordance rate among monozygotic twins as compared to 7% among dizygotic twins . The …

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Wedge

October 7, 2016
Wedge

By Kyra Edson

Peer Reviewed

Wedges are triangular tools that have traditionally been used to split wood along the grain. The mechanical advantage of a wedge is its ability to accomplish this split with less force and less waste of material. Its tapered end is snugly secured inside a small defect, and then a force is applied in order to separate a piece of wood neatly and precisely.

As a medical student at the Manhattan Veterans Affairs hospital, I witnessed this powerful tool wreak havoc …

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