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4562. A conversation with a Rigvir flack

don’t care about existing registration, but unfortunately your analysis is used to doubt the registration. Which is off course strange, because nowhere in the world rules and regulations (in our case standards for clinical trials) are used with backward date. Yes for new registrations - we know the rules – we will provide proper RCT data, but as for now, please respect that the medicine is prescription medicine that is prescribed only in national clinics and by certified doctors for last 13 years (...) than 13 years and before the era of modern trials and most of the evidences is not published. Doctors and clinics in Latvia use this medicine for majority of melanoma patients in Latvia for many years. In Latvia medicine is prescribed only in national clinics and by certified doctors and they have also other alternatives, so probably they know what they do. 2 years ago we started EMA (centralised EU) commercialisation process and even obtained EU commission support from Horizon2020 grant, we also

2017 Respectful Insolence

4564. Difficult Patient vs Difficult Doctor

a study that found that patients that were labeled noncompliant had underlying issues and NOT mental illness or just being difficult. Of patients that were not taking medication, the issue was that the patients could not afford the cost of the medications prescribed. The paper encouraged physicians to see if this was the issue and seek cheaper alternatives for the plan of care. (Source: ) This has been around for a long time and I have seen nurses commonly share this on social media. I have also heard

2018 Bioethics Discussion Blog

4567. Petition to retire the surviving sepsis campaign guidelines

. Guidelines should summarize evidence and provide recommendations to clinicians. Unfortunately, the SSC doesn’t seem to trust clinicians to exercise judgement. The guidelines infantilize clinicians by prescribing a rigid set of bundles which mandate specific interventions within fixed time frames (example above)(10). These recommendations are mostly arbitrary and unsupported by evidence (11,12). Nonetheless, they have been adopted by the Centers for Medicare & Medicaid Services as a core measure (SEP-1 (...) for Medicare and Medicaid Services quality measure SEP-1: The early management bundle for severe sepsis/septic shock. Emergency Medicine Clinics of North America 2017; 35: 219-231. Marik PE. Surviving sepsis: going beyond the guidelines. Annals of Intensive Care 2011; 1: 17. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Medicine. Electronic publication ahead of print, PMID 29675566. Kanwar M, Brar N, Khatib R, Fakih MG. Misdiagnosis of community-acquired

2018 First10EM

4568. How doctors can distinguish themselves in a data-driven world

. Other doctors and I now have electronic medical records in the majority of hospitals and medical offices; there are claims data warehouses, and there is a host of other forms of data. Along with this big data, we have ever-evolving ways to analyze and visualize data which enable more precise measurement, the ability to compare, and the opportunity to predict future events and outcomes. According to a McKinsey report, health care analytics has the potential to create $300 billion in value. New health (...) data like laboratory results and prescriptions. Data may also include a plethora of unstructured information that come from consumer intake tools or medical records. Doctors who have a thorough knowledge of clinical and operational medicine understand how diseases and health care services are classified and those who can take their clinical knowledge and explain it with data elements are poised to be critical translators for analytics teams. For example, in my role, I often work with analytics

2018 KevinMD blog

4569. Choosing Wisely around the world: Professionalism as a force to reduce unnecessary care

healthcare systems, insurers, government, and payers can chip away at professionalism, and pull physicians’ primary focus away from patients. , physicians spent just a quarter of their time in direct face to face contact with patients, while about half of their time was spent on electronic health record (EHR) and desk work. It should not come as a surprise then that in this environment of limited time and limited physician-patient interactions, overtesting and overinvestigation persists. Indeed, when (...) with patients. In fact, more mature campaigns are seeing progress on identified shortcomings. In Canada, for example, there is of evidence of of Choosing Wisely recommendations, which has been led by clinicians. Canada’s next steps include strategies to scale up local implementation and to measure outcomes. Collaboration with the Organization for Economic Cooperation and Development (OECD) has led to the introduction of three indicators of overuse (the overall number of antibiotic prescriptions

2017 The BMJ Blog

4570. Preparing Your Medicine Cabinet for an Emergency: A Checklist

of an emergency. Plan ahead . Make sure you know the shelf life and optimal storage temperature for your prescriptions, because some medications and supplies cannot be safely stored for long periods of time at room temperature. If you take a medication that needs to be refrigerated or requires electronic equipment plan ahead for temporary storage and administration in an emergency situation. Check before using . Before using the medication in your emergency kit, check to make sure the look or smell hasn’t (...) keep in your emergency kit – water, food, a flashlight, and a battery-powered radio. What you may not think about is personalizing your kit for your unique medical needs or the needs of your family. Particularly, including prescription medications and other medical supplies in your emergency kit and plans. As a pharmacist whose job is focused on emergency preparedness and response, I want to give you 10 pointers about how to prepare your medications for an emergency so you can decrease the risk

2017 CDC Public Health Matters

4571. Jane Morris: Do school children need happiness lessons?

drinks and takeaways rather than sitting down to eat together at school or home. We abandon them to the mean streets of social media without proper security systems because we’re not virtually streetwise ourselves. Secondary schools are getting bigger and becoming increasingly focused on academic results. For many adolescents, “play” and leisure time means all-nighters round electronic game consoles. Only felt that they got enough sleep, exercise, rest, and time for reflection. Psychological self (...) attempt to soothe the students’ extreme exam stress, which might interfere with their place in the league tables. Not all patients are the same. This raises the question of whether it’s better to offer these lessons and techniques to targeted groups or to all young people. We don’t yet know what sort of intervention we are dealing with here. Is mindfulness psychological fluoride—something to be added to the tap water? Or is it the mental health equivalent of prescribing antibiotics to all children

2017 The BMJ Blog

4572. Richard Lehman’s journal review—13 March 2017

This is . It is a sort of Proust biscuit, bringing back memories of warm, wood floored libraries with the whirr of a photocopier in a distant corner. No electronic screens then, except perhaps a flickering greenish thing in the keep of the librarian. Here is pure exam knowledge for the world outside the northeastern and upper midwestern regions of the United States, where the incidence of babesiosis has increased dramatically in the past 10 years. This is “a tickborne zoonotic disease caused by intraerythrocytic (...) data and clinical experience will be useful to determine how polypills can best be implemented to achieve this goal.” The Lancet has chosen the positive speculation in this passage for its front cover and left out the rest. The , which is not really a science but a bunch of strategies that you bring to bear once you have proved something works. Unless you intend to put the polypill into the water supply, this consists of persuading individuals to take a pill every day for life. For the prescriber

2017 The BMJ Blog

4573. I love it when an antivax “study” meant to show how “dirty” vaccines are backfires so spectacularly

to autoimmune disease and leukemia. Wow. Sounds really, really scary, doesn't it? The authors, after all, used electron microscopy, specifically a Field Emission Gun Environmental Electron Scanning Microscope equipped with the X-ray microprobe of an Energy Dispersive Spectroscope to detect the possible presence of inorganic, particulate contaminants and identify their chemical composition, to examine the vaccines and found all sorts of scary-looking stuff! My first response was: Unsafe levels. You keep (...) for electron microscopy: A drop of about 20 microliter of vaccine is released from the syringe on a 25-mm-diameter cellulose filter (Millipore, USA), inside a flow cabinet. The filter is then deposited on an Aluminum stub covered with an adhesive carbon disc. The sample is immediately put inside a clean box in order to avoid any contamination and the box is re-opened only for the sample to be inserted inside the FEG-ESEM chamber. We selected that particular type of microscope as it allows to analyse watery

2017 Respectful Insolence

4574. Primary Care Corner with Geoffrey Modest MD: Early Activity After Concussion?

, view about dealing with injury, in this case concussion. Similarly, for a long time, we were all advised to limit any activity at all for patients with low back pain, for a minimum of two weeks. That also seemed prudent at the time, but turned out to be the antithesis of what we should have been doing. And in these cases, I think this conception that rest is the right prescription really undercuts the power of exercise in preserving and restoring health. So, based on the study as well as some (...) different exercise programs. And, also to look at the effect of cognitive rest (which, i think, may be nearly impossible in our technological era, given the intense cognitive stimulation of smartphones, electronic devices, etc.) For prior blogs: for another study suggesting more rapid introduction of physical activity; or ​ for a study looking at the time-course of postconcussive symptoms in kids seen in the Boston children’s hospital ED (Visited 17 times, 1 visits today) Post navigation 27 March 2019

2017 Evidence-Based Medicine blog

4575. Richard Smith: Surely time to let the private sector take over dental care completely

unlike a visit to a general practitioner—albeit less than the true cost. The dentist tapped my lower left wisdom tooth, took an X-ray, and pronounced it “crumbing away.” It needed to come out, which has to be done by a specialist. He said he would refer me, warning that it would probably take a month to receive an appointment and another month for it to happen. He also gave me a prescription for antibiotics in case I began to develop an abscess. I haven’t used the prescription, but a few days after (...) -ray, explained everything well, including possible adverse effects, and advised an extraction under local anaesthetic, exactly what I was expecting. He said that as the operation would be done under local anaesthetic it could probably be one soon, in not much more than two weeks. In passing he explained that dentistry unlike the rest of the hospital hadn’t switched to electronic records because their their heavy workload. So I went upstairs to make an appointment, which I had to do at a desk

2017 The BMJ Blog

4576. Jeffrey Aronson: When I use a word . . . Language that counts

write) and an uncountable process (e.g. medication or prescription, acts of medicating or prescribing). However, plurals of non-count nouns are often used, as in the examples given in the Table, and eventually they may become count nouns with new meanings. Here are some bête noires: methodologies (generally use “methods”); safeties (use “harms”); surgeries (use “operations”, when it doesn’t mean doctors’ places of work); symptomatologies or symptomologies (use “symptoms”); toxicities (use , since (...) ’.” ( The Philosophy of Grammar , George Allen & Unwin Ltd, 1924) Some nouns have it both ways, depending on meaning. Chocolates in a box are countable—two chocolates, a few chocolates, many chocolates (but who’s counting?). Chocolate in a bar is not countable—much chocolate, little chocolate, less chocolate. Morbidity (sickness) is not countable, but comorbidities means diseases. This duality arises, for example, when a noun can mean both a countable object (a medication that you give or a prescription that you

2017 The BMJ Blog

4577. Amitava Banerjee: Is conflict of interest a concern in healthcare IT?

Amitava Banerjee: Is conflict of interest a concern in healthcare IT? Amitava Banerjee: Is conflict of interest a concern in healthcare IT? - The BMJ ---> In the UK, electronic health records (EHR) have been almost universal in general practice since the 1990s, and were deployed across hospitals in the early 2000s. The (PRSB) was set up in 2013 “to develop high quality, consistent care records and promote their use.” As I sat in the third annual general meeting of the PRSB recently, I wondered (...) ). Patient safety cannot play second fiddle to COI. has been problematic, particularly in the UK. However, renewed enthusiasm has come from high-level recommendations and national initiatives, such as the , , and the Faculty of Clinical Informatics. Moreover, the Wannacry cyber-attack in May 2017 showed that robust HIT infrastructure is a pre-requisite of data security. , including EHRs, telehealth, electronic ordering systems and clinical decision support systems, . Given the scale of investment

2017 The BMJ Blog

4578. A conversation with a Rigvir flack

existing registration, but unfortunately your analysis is used to doubt the registration. Which is off course strange, because nowhere in the world rules and regulations (in our case standards for clinical trials) are used with backward date. Yes for new registrations - we know the rules – we will provide proper RCT data, but as for now, please respect that the medicine is prescription medicine that is prescribed only in national clinics and by certified doctors for last 13 years. They have (...) trials and most of the evidences is not published. Doctors and clinics in Latvia use this medicine for majority of melanoma patients in Latvia for many years. In Latvia medicine is prescribed only in national clinics and by certified doctors and they have also other alternatives, so probably they know what they do. 2 years ago we started EMA (centralised EU) commercialisation process and even obtained EU commission support from Horizon2020 grant, we also obtained EMA regulatory advice

2017 Respectful Insolence

4579. Tell the FDA not to embrace quackery: Write to oppose its proposal on acupuncture and chiropractic for chronic pain

will all have a chance to weigh in. The FDA will take . The blueprint released this week is part of a strategy the FDA rolled out in 2011 to address a crisis of prescription drug abuse. The FDA required opioid manufacturers to provide education for health providers who prescribe their pain medications — but didn’t mention chiropractic care or acupuncture in for what that education ought to look like. Interesting. I wonder how that one line recommending acupuncture and chiropractic found its way (...) . The guidelines now recommend that doctors get information about chiropractic care and acupuncture as therapies that might help patients avoid prescription opioids. “[Health care providers] should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management,” the agency wrote in the proposal. The suggested changes come as chiropractors and other alternative medicine providers have stepped up lobbying

2017 Respectful Insolence

4580. Primary Care Corner with Geoffrey Modest MD: Benzos may not increase mortality risk

to propensity scoring, the benzodiazepine group had more smokers, hypertensives, atherosclerotic disease, hyperlipidemia, COPD/asthma, neuropathic pain, cancer, a lot more anxiety and depression, and were much more likely to be on beta blockers, steroids, opioids (35% vs 24%!!), anticonvulsants, SSRIs (22 vs 12%), and other hypnotics. All of these characteristics were well-balanced after propensity score matching — Short acting benzodiazepines were more frequently prescribed, 75% of the filled prescriptions (...) on a benzodiazepine during a medical visit within the prior 14 days vs 1,252,988 non-initiators, from 2004-2013 — all patients were required to fill at least one prescription for any medication both in the 90 days and 91- 180 days before the index date (ie, they were plugged into medical care and filling prescriptions), and high dimensional propensity scoring was done (see below). — Mean age 46, 85% men, mean Charlson comorbidities score 0.5 (ie, low), 5% smokers, 4% obesity/overweight, 28% hypertension, 1% heart

2017 Evidence-Based Medicine blog

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