Class Act

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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Breaking the Cycle: Shining a Light on Physician Depression and Suicide for the Next Generation

September 16, 2016
Breaking the Cycle: Shining a Light on Physician Depression and Suicide for the Next Generation

By Andrew Hallett

Peer Reviewed 

For decades, surveys and public data have shown staggeringly high rates of suicide, suicidal ideation, and depression among physicians when compared to the general population.1-4 Male doctors are 40% more likely to commit suicide than other men, and female doctors are 130% more likely to do so than other women, according to a 2004 analysis in the American Journal of Psychiatry.5 With expanded access to care and new regulatory requirements under the Affordable Care Act increasing pressure on doctors, a …

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