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All posts; Tags Include "Medical Ethics"

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  • November 9, 2011
  • 07:30 AM
  • 1,845 views

Is IV Bolus Nitro Dangerous – Part II

by Rogue Medic in Rogue Medic

Those high doses are enough to give a stroke to the doctors, nurses, and medics who think that CHF = Lasix (furosemide), but I am not writing this for people stuck in the 1980s. Most doctors, nurses, and medics appear to realize that nitrates are the most effective medication for CHF. The important question is "How aggressive is too aggressive?"... Read more »

  • October 20, 2011
  • 07:15 PM
  • 1,390 views

Sleep quality and fatigue among prehospital providers

by Rogue Medic in Rogue Medic

Even though many in EMS will tell you that EMS stands not for Emergency Medical Services, but for Earn Money Sleeping, sleep deprivation is a problem for many in EMS, many in medicine, and many in other fields. I am a night person, much more awake and alert at 2 AM, than at 8 AM. ... Read more »

Patterson PD, Suffoletto BP, Kupas DF, Weaver MD, & Hostler D. (2010) Sleep quality and fatigue among prehospital providers. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 14(2), 187-93. PMID: 20199233  

  • October 13, 2011
  • 07:30 AM
  • 1,292 views

Propofol and the Michael Jackson Effect

by Rogue Medic in Rogue Medic

Why do we allow one unusual, dramatically publicized case affect our expectations?

Because we don't stop and think for ourselves.... Read more »

Senula, G., Sacchetti, A., Moore, S., & Cortese, T. (2010) Impact of addition of propofol to ED formulary. The American Journal of Emergency Medicine, 28(8), 880-883. DOI: 10.1016/j.ajem.2009.04.035  

  • October 12, 2011
  • 05:03 PM
  • 1,418 views

Pedophilia and the Progranulin Gene

by William Yates, M.D. in Brain Posts

Solution Structure Model of Peptide Subdomain of GranulinThe development of pedophilic urges among pedophiles typically occurs during sexual maturation in adolescence.  However, in a minority of cases, pedophilic urges may emerge later in life.  An interesting case report has been published in the journal Biological Psychiatry describing a case of late-onset pedophilia.In the case description a 49 year old married man presented to a neurology clinic in with recent onset of pe........ Read more »

  • September 29, 2011
  • 07:53 PM
  • 1,045 views

The Genetical Book Review: The Psychopath Test

by Jon Wilkins in Lost in Transcription

So, welcome back to the Genetical Book Review! This episode? The Psychopath Test, by Jon Ronon. Ronson is the author of The Men Who Stare at Goats, which the movie was based on.

Also, his name is what my name would be if I were from Iceland.

The Psychopath Test traces Ronson's exploration of psychopathy: what a psychopath is, how you identify one, the effect they have on society, and society's efforts to contain them. The book is written engagingly, and makes for a quick read, even if you........ Read more »

Hare, R. D. (1980) A research scale for the assessment of psychopathy in criminal populations. Personality and Individual Differences, 1(2), 111-120. info:/10.1016/0191-8869(80)90028-8

  • September 29, 2011
  • 07:30 AM
  • 1,836 views

Reducing Unnecessary Hospitalizations of Nursing Home Residents

by Rogue Medic in Rogue Medic

Today in the New England Journal of Medicine there is a perspective piece on something near, and dear, to all of our hearts - unnecessary hospital admissions from nursing homes.

A lot of nursing home patients could be treated on site, without calling an ambulance to take them to the ED (Emergency Department) to produce large bill, but maybe not any better care.... Read more »

Joseph G. Ouslander, M.D., and Robert A. Berenson, M.D. (2011) Reducing Unnecessary Hospitalizations of Nursing Home Residents. N Engl J Med , 365(September 29, 2011), 1165-1167. info:/

  • September 12, 2011
  • 02:20 PM
  • 16,013 views

Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure – Part IV

by Rogue Medic in Rogue Medic

We seem to most insist on stripping information of its meaning when we create multiple choice tests. Correct answers become a simple matter of memorization separated from understanding. This is one way to create the protocol monkey - the automaton, whom we claim is rendered harmless by being prevented from thinking. This desire to prevent the use of judgment may be the ultimate irrational decision.... Read more »

Wears RL. (2011) Risk, radiation, and rationality. Annals of emergency medicine, 58(1), 9-11. PMID: 21459481  

  • September 11, 2011
  • 07:30 AM
  • 6,182 views

Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure – Part III

by Rogue Medic in Rogue Medic

Bringing up the imagery of Hiroshima radiation exposure in a study is one way to get us to by-pass the purpose of an objective study, while retaining the appearance of objectivity. Was this the intent of the authors? Probably not, since they got this question from an earlier study. However, they may have appreciated the emotional appeal.... Read more »

  • September 10, 2011
  • 07:30 AM
  • 1,688 views

Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure – Part II

by Rogue Medic in Rogue Medic

When presented as 50 out of 121 who did not answer the question, it seems to be a large percentage, but it is only 50 out of about a thousand patients who did answer the question. Not a large percentage.

The authors included a footnote to the study that produced the numbers they are relying on, but they never specifically cite the X-rays per CT number from that study.... Read more »

  • September 9, 2011
  • 07:30 AM
  • 1,599 views

Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure - Part I

by Rogue Medic in Rogue Medic

What do patients with abdominal pain want?

Maybe even more than pain medicine, patients seem to want a CT. If that doesn't provide answers, they want another one. As if radiation will work differently or the body will change or . . . .... Read more »

  • September 8, 2011
  • 03:10 PM
  • 1,458 views

Can We Simplify Triage by Using Just GCS

by Rogue Medic in Rogue Medic

Imagine a system where we intentionally ignore the usual horribly inaccurate trauma triage criteria, such as MOI (Mechanism Of Injury). And these are not even the usual criteria, because this is in a system with criteria already modifieded to avoid a lot of overtriage. :-)... Read more »

Norwood SH, McAuley CE, Berne JD, Vallina VL, Creath RG, & McLarty J. (2002) A prehospital glasgow coma scale score . The Journal of trauma, 53(3), 503-7. PMID: 12352488  

  • September 7, 2011
  • 08:07 AM
  • 1,633 views

Chronic Ketamine for Depression: An Unethical Case Study?

by The Neurocritic in The Neurocritic

A year ago, Ketamine for Depression: Yay or Neigh? covered acute administration of the club drug (and dissociative anesthetic) ketamine for rapid (albeit transient) relief of major depression. That post was part of a blog focus on hallucinogenic drugs in medicine and mental health, organized by Nature editor Noah Gray following publication of a review article on The neurobiology of psychedelic drugs: implications for the treatment of mood disorders. At the time, I wrote:Although the immediate on........ Read more »

Messer M, Haller IV (2010). Maintenance Ketamine Treatment Produces Long-term Recovery from Depression. (2010) Maintenance Ketamine Treatment Produces Long-term Recovery from Depression. Primary Psychiatry, 48-50. info:/

  • September 1, 2011
  • 07:30 AM
  • 1,608 views

Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury – Summary

by Rogue Medic in Rogue Medic

All EMS RSI patients had waveform capnography, which may explain why the results are so different from the results of the study by Davis on EMS RSI for TBI. This study raised a bunch of questions about those results, which showed worse outcomes for EMS RSI. One hypothesis was that the much higher incidence of hypocapnea contributed to the bad outcomes even though the EMS intubation success rates more than doubled for TBI patients. ... Read more »

  • August 28, 2011
  • 05:21 AM
  • 1,335 views

Drug Trials in 'At Risk' Youth

by The Neurocritic in The Neurocritic



Is it ethical to medicate healthy teenagers "at risk" of developing psychosis to prevent a symptom that may not occur? One such clinical trial in Australia was recently stopped before it could even begin:
Drug trial scrapped amid outcryJill Stark
August 21, 2011

FORMER Australian of the Year Patrick McGorry has aborted a controversial trial of antipsychotic drugs on children as young as 15 who are "at risk" of psychosis, amid complaints the study was unethical.The Sunday Age can reveal ........ Read more »

Mechelli, A., Riecher-Rossler, A., Meisenzahl, E., Tognin, S., Wood, S., Borgwardt, S., Koutsouleris, N., Yung, A., Stone, J., Phillips, L.... (2011) Neuroanatomical Abnormalities That Predate the Onset of Psychosis: A Multicenter Study. Archives of General Psychiatry, 68(5), 489-495. DOI: 10.1001/archgenpsychiatry.2011.42  

  • August 23, 2011
  • 08:13 PM
  • 1,057 views

LKD Eval Document's Notes on Hypertension, Proteinuria and GFR

by in Living Donors Are People Too

Thirty pages is a lot to filter through, especially if one is lacking context or familiarity with the process or vocabulary of transplant. But where this document becomes interesting and somewhat important is in its appendicies. The information about hypertension, proteinuria, kidney function (GFR) etc, is more than is shared with prospective living donors and if known, can help a living donor candidate to protect themselves and make the best decision possible for their future health. For exampl........ Read more »

Poggio, E., Rule, A., Tanchanco, R., Arrigain, S., Butler, R., Srinivas, T., Stephany, B., Meyer, K., Nurko, S., Fatica, R.... (2009) Demographic and clinical characteristics associated with glomerular filtration rates in living kidney donors. Kidney International, 75(10), 1079-1087. DOI: 10.1038/ki.2009.11  

  • August 7, 2011
  • 08:20 PM
  • 1,603 views

Internal medicine: writing and presenting

by Science Exploiter in Science Exploits

Many people get into medicine and don't know how to properly write a note or how to present a patient to an attending physician.  This includes medical students and those studying to become physician assistants and nurse practitioners.  Granted, most do learn through trial, error, and guidance from preceptors.  But I thought I would help my readers out with a quick "how to" on the topic.The first time you see a patient, you should perform a full history and physical.  If you ........ Read more »

Pryor DB, Shaw L, McCants CB, Lee KL, Mark DB, Harrell FE Jr, Muhlbaier LH, & Califf RM. (1993) Value of the history and physical in identifying patients at increased risk for coronary artery disease. Annals of internal medicine, 118(2), 81-90. PMID: 8416322  

  • August 2, 2011
  • 07:30 AM
  • 1,877 views

Management of prehospital seizure patients by paramedics

by Rogue Medic in Rogue Medic

Does that mean that we should make every medical EMS call ALS, just to check BGL?

This could be the Mechanism Of Injury that could help minor medical calls leapfrog past trauma in ALS over-triage.

"If it saves just one life (even though maybe a dozen who would otherwise have lived will now die), it's worth it! Go ALS!"... Read more »

Martin-Gill, C., Hostler, D., Callaway, C., Prunty, H., & Roth, R. (2009) Management of Prehospital Seizure Patients by Paramedics. Prehospital Emergency Care, 13(2), 179-184. DOI: 10.1080/10903120802706229  

  • July 24, 2011
  • 07:30 AM
  • 1,346 views

Is There a Placebo Effect – Part II

by Rogue Medic in Rogue Medic

If Daniel Moerman, PhD is correct and the subjective improvement is what is important, then we should pay attention to the following chart of subjective improvement. Subjective improvement is what the patient thinks is real, even if reality does not agree.

When we go to a magic show and see a woman being cut in half, we are experiencing subjective reality. The objective reality is that the woman was never really cut in half, even though our subjective experience is that she has been cut in ha........ Read more »

Wechsler, M., Kelley, J., Boyd, I., Dutile, S., Marigowda, G., Kirsch, I., Israel, E., & Kaptchuk, T. (2011) Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. New England Journal of Medicine, 365(2), 119-126. DOI: 10.1056/NEJMoa1103319  

  • July 24, 2011
  • 07:30 AM
  • 1,498 views

Is There a Placebo Effect – Part II

by Rogue Medic in Rogue Medic

If Daniel Moerman, PhD is correct and the subjective improvement is what is important, then we should pay attention to the following chart of subjective improvement. Subjective improvement is what the patient thinks is real, even if reality does not agree.

When we go to a magic show and see a woman being cut in half, we are experiencing subjective reality. The objective reality is that the woman was never really cut in half, even though our subjective experience is that she has been cut in ha........ Read more »

Wechsler, M., Kelley, J., Boyd, I., Dutile, S., Marigowda, G., Kirsch, I., Israel, E., & Kaptchuk, T. (2011) Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. New England Journal of Medicine, 365(2), 119-126. DOI: 10.1056/NEJMoa1103319  

  • July 23, 2011
  • 07:30 AM
  • 1,593 views

Is There a Placebo Effect – Part I

by Rogue Medic in Rogue Medic

There is the statement that a placebo is an inert agent, therefore a placebo cannot do anything. He concludes that there is no placebo effect.

This does not make sense.

The effect of giving an inert treatment is NOT an effect?... Read more »

Wechsler, M., Kelley, J., Boyd, I., Dutile, S., Marigowda, G., Kirsch, I., Israel, E., & Kaptchuk, T. (2011) Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. New England Journal of Medicine, 365(2), 119-126. DOI: 10.1056/NEJMoa1103319  

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