The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.
Putting the “A” Back in SOAP Notes: Time to Tackle An Epic Problem
From the inventor of the word “hospitalist”, @Bob_Wachter: “At UCSF Medical Center, we went live with our version of the Epic electronic medical record three months ago. It beats pen and paper, and it beats the EMR system that we traded out (at a cost of a hundred million dollars or so) by a long shot. But the effect I witnessed on patient care and education was less positive.” Read why here: http://goo.gl/HuvUd
Whatever happened to personal contact?
From the surgeon who writes Skeptical Scalpel blog @Skepticscalpel: "No one has time for lunch nowadays and the hospitalist movement has succeeded in eliminating the primary care doctors from the hospital environment. I have been practicing at the same hospital for over three years and have never even met 95% of the local primary care docs. Something is lacking when you aren’t able to attach a face to a name." http://goo.gl/MTS3Z
ACP: Stop making laws telling physicians how to practice medicine
From db's Medical Rants, ACP President, David Bronson, had this to say: "Government doesn't belong in the physician-patient relationship. It's a one-on-one, very personal, very private relationship. The patient has to have confidence the physician is giving them their very best professional advice and judgment." http://goo.gl/3NpOl
On Outcomes
Dr. Wes @doctorwes: It is difficult to follow pre-defined guidelines when there are many, many independent variables that weigh on patient management decisions. Payers want perfect outcomes or they will not pay for care, as if people are widgets on a production line with interchangeable parts. But for the majority of individuals who fall outside the center of normative data sets upon which standards, guidelines, protocols and checklists are based, the doctor and patient must face the reality that there are often no perfect answers for treatment. http://goo.gl/xQFQn
How To Integrate Twitter into Your Workflow
Krafty Librarian: If you have tried to do Twitter for professional communication but you use it through Twitter’s site and it hasn’t gone well, try TweetDeck or Hootsuite. http://goo.gl/3Dw0a
Sherpaa founder: How $1.85M in the bank are not enough to buy 2 Apple workstations http://goo.gl/J6yht
A good tweet is a terrible thing to waste. The blog Academic Life in Emergency Medicine (@m_lin) started collecting and posting important Twitter pearls in Emergency Medicine and Critical Care from the past week. Here is an example: http://bit.ly/RBhcbo
I think "Tweet Pearls" summary is a good idea although the perceived usefulness of the tweets will obviously vary according to your interest in the topic. The slideshow uses Storify and considering Twitter, Inc.'s increasingly restrictive approach, the ability of some 3rd party services (Storify, Flipboard, etc.) to display tweets may be limited in the future. The easiest approach is to copy/paste the text of the interesting tweets in a blog post but that may be against the Twitter guidelines for the use of their content (tweets) which is actually ours.
Insomnia is a common condition that can present independently or comorbidly with another medical or psychiatric disorder.
Treatment of chronic insomnia
Benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence.
Benzodiazepine-receptor agonists (BzRAs) are effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce. Also, most hypnotic drugs are associated with potential adverse effects.
Cognitive-behavioural therapy (CBT) is an effective alternative for chronic insomnia.
CBT is more time consuming than drug management but it produces sleep improvements that are sustained over time.
However, CBT is not readily available in most clinical settings. Access and delivery can be made easier through:
- telephone consultations - group therapy - self-help approaches
How to succeed? Get more sleep
In this 4-minute talk, Arianna Huffington (founder of The Huffington Post) shares a small idea that can awaken much bigger ones: the power of a good night's sleep. Instead of bragging about our sleep deficits, she urges us to sleep our way to increased productivity and happiness -- and smarter decision-making.
References:
Chronic insomnia. The Lancet, Volume 379, Issue 9821, Pages 1129 - 1141, 24 March 2012. Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.
More Self-Control as a Child, Lower BMI as Adult (study) http://goo.gl/FElcw
FDA approved the first generic version of Actos (Pioglitazone) to treat adults with type 2 diabetes http://goo.gl/kUq9k
Mississippi has the highest proportion of obese adults at 35%, and Colorado has the lowest at 21% (survey) http://goo.gl/JDD6C
"GSK drug halves attacks in hard-to-treat asthma" - anti-IL5 antibody mepolizumab for eosinophilic asthma http://goo.gl/Be6IU
New Epinephrine Auto-Injector Talks Patients Through Injection Process, has a 5-sec countdown, signaling lights http://goo.gl/rYJZI
Autoinflammatory syndromes: Fever is not always a sign of infection - CCJM http://goo.gl/uTc2X
Genetic counselors: Your partners in clinical practice - CCJM http://goo.gl/ZkJb4
Atrial fibrillation: New drugs, devices, and procedures - CCJM http://goo.gl/O0AQN
The demise of the stethoscope as a metaphor of the “hyposkillia” of our times - CCJM http://goo.gl/xu5qS -- An argument for reviving the disappearing skill of cardiac auscultation - CCJM http://goo.gl/59ikK
Dark chocolate can help decrease blood pressure by 2-3 mmHg http://goo.gl/xTnn1
Eating egg yolks as 'bad as smoking' - NHS Choices blog reviews the evidence http://goo.gl/IosBG
30% of new prescriptions never get filled. Will smart pills boost drug compliance? http://goo.gl/omhjJ
Small practices may be least able to take new Medicaid patients - NJ Medicaid physicians get paid 37% of Medicare rates http://goo.gl/g3RLN
4 ways for practices to benefit from a social media presence: Offer information beyond the appointment, Raise physician profiles, Influence online search, Marketing toolkit http://goo.gl/5mAz4
The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.
Thyrotoxicosis is a common disorder, especially in women. Thyroid disease affects 7 times more women than men.
Etiology
There are 3 main causes of thyrotoxicosis: Graves' disease, toxic nodular hyperthyroidism, and thyroiditis.
Here are some more details about them:
- Graves' disease (autoimmune hyperthyroidism) is the most frequent cause of thyrotoxicosis - toxic nodular hyperthyroidism, due to the presence of one or more autonomously functioning thyroid nodules - thyroiditis caused by inflammation, which results in release of stored hormones
Treatment
The available treatments for thyrotoxicosis have been unchanged for 60 years.
Antithyroid drugs are the usual initial treatment. Thionamides such as carbimazole or its active metabolite methimazole are the drugs of choice.
A prolonged course leads to remission of Graves' hyperthyroidism in only 30% of cases.
Because of this low remission rate in Graves' disease (only 30%) and the inability to cure toxic nodular hyperthyroidism with antithyroid drugs alone, radioiodine is increasingly used as first line therapy. It is the preferred choice for relapsed Graves' hyperthyroidism.
Surgery with total thyroidectomy is an option in selected cases. .
References:
Thyrotoxicosis. The Lancet, Volume 379, Issue 9821, Pages 1155 - 1166, 24 March 2012.
The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.
