Should we be recommending vitamin D supplementation?

And for whom?


There's biologic plausibility and lots of indirect evidence, but the jury is still out.


Via the Clinical Correlations blog.

Tox Rounds: Ecstasy

From Emergency Medicine News.

Which patient with a murmur needs an echo?

Here's a brief summary of the ACC/AHA guideline focused update.

Bill Maher: We have Democrats for one reason

---to drag the ignorant hillbilly half of this country into the next century.



Brilliant!

More auscultation resources

Here and here.

Check out ECGpedia

This is an ECG wiki containing an on line text book, case studies and a tutorial, spanning from basic to advanced levels of difficulty.

Industry sponsored education and adherence to evidence based practice

I just happened on a study the pharmascolds won't want you to see.


The critics of industry sponsored education are fond of citing studies demonstrating that pharmaceutical industry promotion influences doctors away from best evidence. As I once said in a Medscape Roundtable article on this subject, that research was unbalanced because it selectively looked at areas of known overuse of pharmaceuticals. The effect on attitudes and practice of promotions in areas of known underuse of evidence based treatments was ignored in this research for years.


Only very recently has research even begun to pay attention to the effects of industry promotion on areas of known underutilization. Specifically, there have been two studies now. The first one, which I have mentioned several times before in these pages, was a study on the effects of the Surviving Sepsis Campaign, one of the most maligned industry campaigns in all of medicine, showing that the campaign resulted in improved adherence to evidence based practice (and better patient outcomes to boot). The second one, the most recent one the pharmascolds won't want you to see, is this one just presented at the ACCP annual meeting. The educational activity in question was funded by Novartis. Here are the study findings:

RESULTS: Physicians who participated in CME programs were 50% more likely to provide evidence-based COPD care than those who did not participate. Furthermore, compared with non-participants, participants were more likely to correctly recognize COPD in a patient presenting with dyspnea (74% vs 94%; p=0.007), recognize that women may have a greater susceptibility than men to the toxic effects of smoking (54% vs 90%; p less than 0.001), and identify the mechanisms of action of emerging therapies (33% vs 65%; p=0.003). Participants were also twice as likely as non-participants to report complete familiarity with the GOLD guidelines for managing COPD (28% vs 14%), and less likely to cite difficulty in obtaining spirometry results as a barrier to optimal COPD care (25% vs 40%).

CONCLUSION: According to validated measurements of efficacy of CME on physician competency and performance, PCPs who participated in a half-day regional CME program on COPD diagnosis, staging, and treatment were significantly more likely than nonparticipants to deliver evidence-based COPD care.

H/T to Policy and Medicine.

Great cardiology site

Blaufuss.org


Via Dr. Wes.

Myeloma and the kidney

A post at the Clinical Correlations blog summarizes the multiple mechanisms of myeloma kidney.

Renal rap

Via Uremic Frost.

Teflaro (ceftaroline fosamil) approved and ready for launch

This is a new cephalosporin (fifth generation). What's unique about it among cephalosporins is activity against MRSA. Like other new antibiotics these days, the FDA approval is limited to a couple of indications. In this case, CAP and skin and skin structure infections. The MRSA approval is for the skin infections only, not for pneumonia. (OK against MSSA in pneumonia, but not MRSA. Not sure why that is, whether it's a penetration issue or just not enough clinical data).


Here's a summary along with prescribing info.

DB on direct to consumer advertising

He writes:

DTC drug advertising contaminates the doctor patient interaction.  DTC drug advertising encourages patients to ask for more medications – and almost only expensive medications.

We should be able to ignore these demands, but we are not always able to resist.

That's especially true under today's patient satisfaction incentives.

DTC drug advertising perverts medication decision making, and this is a huge unethical problem.

Indeed. DTC advertising, more harmful in my opinion than direct to physician promotion, has exploded in recent years. It's an unintended consequence of the public beating drug companies have taken for promoting to doctors. The drug companies are going to spend a certain amount of money on marketing no matter what. The more it's taken away from doctors the more it will be diverted to consumers.

The changing profile of nephrogenic systyemic fibrosis

According to this summary post at the Clinical Correlations blog:

Since NSF’s identification as a disease entity, there has been a marked shift in radiological standards and practices, as well as rapid growth of literature regarding the disease.

Among other things the incidence appears to have fallen sharply since widespread adoption of safety protocols.

Acid base slide show

From Slideshare.

Pravin Pawal Abg

View more presentations from pravinpawal.

Idiot's guide to capnography

You might as well get used to wave form capnography because it's now in the main cardiac arrest algorithm. As illustrated in this video, it has uses beyond cardiac arrest.

Should I read White Coat, Black Hat?

I'm not in the habit of reviewing other people's book reviews but two articles on the book in question, one by Thomas Sullivan and the other by Sally Satel, are worth mentioning here because they nicely address the broader controversy about the relationship between the medical profession and industry. Now that I've read those two articles I think I'll pass on White Coat, Black Hat. The book, based on those two articles and another positive review I recently read seems to be anything but a balanced treatment of the issue. In fact, it comes across as a knee-jerk, intellectually lazy collection of anecdotes designed to appeal to popular animosity against the pharmaceutical industry.


Sullivan and Satel offer a nuanced view of physician-industry relationships. Sullivan makes this point, with which I partially disagree:

For now, there is no data suggesting any harm to patients from working with industry because no studies have used clinical outcomes.

It's true that there are no data suggesting harm to patients from working with industry. The pharmascolds have no data in support of their position. All they can do is appeal to a set of popular beliefs. What I disagree with is the statement that no studies have looked at clinical outcomes. One study did look at clinical outcomes following an industry sponsored campaign. I've blogged about it extensively before. One of the most maligned Pharma campaigns in all of medicine resulted in improved outcomes, even reduced mortality, in septic patients.

Even mild hypophosphatemia may cause muscle weakness

Via Renal Fellow Network.

Accountable care organizations

Funny.

P4P is unethical

---says Retired Doc. He's right.

The acceptance of P4P is so antithetical to the basic medical ethical tradition that I cannot believe professional organizations of physicians are supporting it...

Diagnosis of SIADH

---and differentiation from other forms of hyponatremia. This is often difficult because volume assessment can be tricky and there are nuances to the interpretation of urine chemistries. Here's a review article on the subject and a nice summary post at Renal Fellow Network.