Primecuts – This Week in the Journals

January 29, 2018
Primecuts – This Week in the Journals

By Mariya Rozenblit, MD

Peer Reviewed

The medical community suffered the loss of yet another physician by suicide when a young doctor jumped to her death in New York City last week. There is growing recognition that physicians are at increased risk of suicide compared to the general population. In a recent article in the Washington Post, family physician Dr. Pamela Wible describes her research into physician suicide including the staggering statistic that nearly one million Americans lose their doctors to suicide each year .…

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Tales of Survival: Preserving Empathy for the Caretaker Who Can’t Let Go

January 26, 2018
Tales of Survival:  Preserving Empathy for the Caretaker Who Can’t Let Go

By Scarlett Olivia Murphy, MD

Peer Reviewed

During my recent ICU rotation, I witnessed complicated acts of love between patients and their caretakers as they navigated end-of-life decisions.  I observed many individuals struggle to find the right balance between preserving and palliating their loved one, and I watched patients in turn sacrifice their own comfort to keep their families happy.   When one’s primary obligation is to treat the patient first, this can pose a conundrum, especially when the voice of the patient caretaker becomes louder …

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From the Archives – Fever: Friend or Foe?

January 25, 2018
From the Archives – Fever: Friend or Foe?

Please enjoy this post from the archives, dated November 20, 2013

By Fernando Franco Cuadrado, MD, Julia Hyland Bruno, MD and  Mark D. Schwartz, MD

Faculty Peer Reviewed

When flu season returns, we will all see patients with sniffles, aches and a mild to moderate fever. History, tradition and habit have made the treatment of fevers almost automatic; however, how many of us pause and consider evolutionary principles before recommending acetaminophen for a fever? Could fever have an adaptive function? Are we sure we are …

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Slow Respiration to Lower Blood Pressure

January 24, 2018
Slow Respiration to Lower Blood Pressure

By Omotayo Arowojolu

Peer Reviewed

Approximately 32% of American adults have high blood pressure (>140/90 mmHg),1 or hypertension, and only 54% of these individuals have well-controlled hypertension.2,3 Hypertension costs $48.6 billion each year in healthcare services, medications, and missed days of work. Additionally, one in three Americans have pre-hypertension (120-139/80-89 mmHg) and are considered at risk for developing hypertension.1 These individuals benefit from management of risk factors with changes in diet (reduced sodium), weight loss, increased physical activity, and smoking or alcohol cessation. On the …

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Primecuts – This Week in the Journals

January 22, 2018
Primecuts – This Week in the Journals

By Scott Butler, MD 

Peer Reviewed

Could requiring Medicaid recipients to engage in community activities or work as a condition for eligibility improve health outcomes?  The Trump administration is planning to allow states to impose such requirements, much as they do for other programs such as food stamps and welfare1.  These conditions could be met by engaging in voluntary activities, attending school or caring for the elderly.  Given the recognized correlation between earnings and improved health outcomes, administration officials contend that the requirements themselves will …

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Tales of Survival: Fury and Forgiveness in the ED

January 19, 2018
Tales of Survival: Fury and Forgiveness in the ED

By Kate Otto Chebly

Peer Reviewed

“She refused the ultrasound!” my resident announced with exasperation, updating our attending on 17-year old, pregnant Mariana, who arrived four hours ago with abdominal pain and an unpleasant attitude that rubbed nearly everyone wrong way.

We could hear the crescendo of Mariana’s expletives from the hallway, as patient transport wheeled her back into our Emergency Department. “That bitch tried to stick a wand inside me!” she yelled out, to no one in particular, to everyone around her. “You all …

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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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Core IM: 5 Pearls on Chronic Hepatitis B Part 1

January 17, 2018

By Amy Shen Tang MD, Marty Fried MD and Shreya P. Trivedi MD; Illustration by Mike Natter MD.  Quiz yourself on the following 5 Pearls on Chronic Hepatitis B (HBV)

Time Stamps

  1. What are the most common ways HBV is transmitted and how can we use this to prioritize screening? (3:37)
    1. Who is at risk for HBV reactivation?
  2. What tests do you order when screening for HBV?   (10:48)
    1. In which populations is HBV vaccination recommended?
  3. What are the four possible meanings of an isolated positive total anti-HBc? (13:55)
  4. In an asymptomatic adult, is it necessary to send an anti-HBc IgM to distinguish acute from chronic HBV infection? (15:01)
  5. What are the implications of seroconversion of HBeAg from positive to negative? (16:19)

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