"Internal medicine residents who report higher levels of fatigue, sleepiness, and distress are at greater risk for reporting major medical errors," according to a study in the Journal of the American Medical Association. Researchers issued questionnaires to residents who had enrolled in a "Mayo Internal Medicine Well-being Study between July 2003 and February 2009."
Among the "356 participants, 139 (39 percent) reported making at least one major medical error." Of those who reported an error, "68.7 percent screened positive for depression at some point during the study." The researchers also found that "one-point increases on the fatigue and sleepiness scales were associated with 14-percent and 10-percent increased likelihoods of an error being reported during the subsequent three months."
Other factors associated with subsequent error were "burnout, depersonalization, emotional exhaustion, lower personal accomplishment, a positive depression screen," and overall quality of life. The study authors concluded that "in addition to the national efforts to reduce fatigue and sleepiness, well-designed interventions to prevent, identify, and treat distress among physicians are needed." Still, they stressed that "additional research is necessary to determine the most effective strategies for accomplishing these goals."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Wednesday, November 3, 2010
Thursday, October 28, 2010
CT scans may diagnose heart attacks faster than standard tests.
A rapid CT scan of the heart may provide doctors with a more efficient way to diagnose blocked arteries in people complaining of chest pain," according to research reported at the American Heart Association meeting. In "a study of 701 patients," researchers found that CT angiography "cuts in half the time it usually takes for a doctor to detect a blockage in an artery supplying the heart."
The procedure also provides a "cheaper way to diagnose a heart attack when someone goes to the" emergency department (ED) with chest pains. The study showed that CT scan patients' testing cost "$2,137 on average versus $3,458 for standard screening."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
The procedure also provides a "cheaper way to diagnose a heart attack when someone goes to the" emergency department (ED) with chest pains. The study showed that CT scan patients' testing cost "$2,137 on average versus $3,458 for standard screening."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Friday, October 15, 2010
Survey suggests more adults searching Internet for health information.
The number of adults who turn to the Internet for health information has nearly doubled in the past two years, from 31 percent to 60 percent," according to a study conducted by the Pew Internet & American Life Project. Researchers surveyed "2,253 people by landline phone and 502 by cellphone." Ranking highest "as the source adults most often turn to for health information" was healthcare professionals at 86 percent, followed by "family and friends" at 68 percent. Notably, "about half of all online health searches are on behalf of someone else, and...59 percent of users who go to the Internet for health information have read blogs or online comments made by others." Yahoo's Web life editor, speculates that "many adults may turn to the Internet for health advice," because "unlike the doctor's office, the Web is open 24/7, and it's increasingly accessible."
"Unlike the doctor's office, the Web is open 24/7, and it's increasingly accessible in all of the spaces where we live and work," she says.
"People are becoming advocates for themselves as patients by researching illnesses and health care information through the vast resources of the Web."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
"Unlike the doctor's office, the Web is open 24/7, and it's increasingly accessible in all of the spaces where we live and work," she says.
"People are becoming advocates for themselves as patients by researching illnesses and health care information through the vast resources of the Web."
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Tuesday, October 5, 2010
THE TWO OTHER INFLAMMATORY BOWEL DISEASES (IBD)
Most people know about the two most common idiopathic [cause not known] inflammatory bowel disorders—Crohn’s disease and ulcerative colitis. There are also two other inflammatory bowel diseases that most people don’t know about.
That is collagenous colitis and lymphocytic colitis. The diagnosis is made by biopsy through a colonoscope. The treatment is a type of steroid called Budesonide.
Results of studies show that Histologic remission was observed in 73% of patients given budesonide compared with 31% given placebo (P = .030). During a mean follow-up period of 14 months, 15 patients (44.1%) experienced a clinical relapse (after a mean of 2 months); 8 of the relapsing patients were retreated with and responded again to budesonide. Budesonide effectively induces clinical remission in patients with lymphocytic colitis and significantly improves histology results after 6 weeks.
Clinical relapses occur but can be treated again successfully with budesonide.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
That is collagenous colitis and lymphocytic colitis. The diagnosis is made by biopsy through a colonoscope. The treatment is a type of steroid called Budesonide.
Results of studies show that Histologic remission was observed in 73% of patients given budesonide compared with 31% given placebo (P = .030). During a mean follow-up period of 14 months, 15 patients (44.1%) experienced a clinical relapse (after a mean of 2 months); 8 of the relapsing patients were retreated with and responded again to budesonide. Budesonide effectively induces clinical remission in patients with lymphocytic colitis and significantly improves histology results after 6 weeks.
Clinical relapses occur but can be treated again successfully with budesonide.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Monday, September 27, 2010
VITAMIN B12 DEFICIENCY DUE TO METFORMIN
Vitamin B12 deficiency due to metformin is a less common, but potentially severe complication that is often overlooked. Patients at risk for vitamin B12 deficiency include those taking more than 1,000 mg daily of metformin for three years or longer. Patients receiving metformin therapy should be monitored for signs and symptoms of vitamin B12 deficiency such as megaloblastic anemia or peripheral neuropathies.
Also, advise patients on metformin to take a multivitamin with B12 and encourage them to get their recommended daily amount of calcium, although there's no proof this will prevent B12 deficiency.
While neuropathy can be related to hyperglycemia, vitamin B12 deficiency should be ruled out as a cause, especially in those patients with diabetes who are taking metformin.
In patients with vitamin B12 deficiency, supplemental oral vitamin B12 should be administered. Calcium supplementation to assure that the recommended daily allowance is being met can also be considered
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Also, advise patients on metformin to take a multivitamin with B12 and encourage them to get their recommended daily amount of calcium, although there's no proof this will prevent B12 deficiency.
While neuropathy can be related to hyperglycemia, vitamin B12 deficiency should be ruled out as a cause, especially in those patients with diabetes who are taking metformin.
In patients with vitamin B12 deficiency, supplemental oral vitamin B12 should be administered. Calcium supplementation to assure that the recommended daily allowance is being met can also be considered
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Tuesday, September 14, 2010
Clinically Significant Statin Drug Interactions
Perhaps the most serious consequence of statin interactions is rhabdomyolysis. The risk of myopathy is increased when statins are coadministered with medications that inhibit their metabolism. Atorvastatin (Lipitor), lovastatin (Mevacor), and simvastatin (Zocor) are CYP3A4 substrates and when coadministered with potent CYP3A4 inhibitors the incidence of myopathy is increased by about five fold.
The extent of interaction between atorvastatin and CYP3A4 inhibitors is less than that with lovastatin and simvastatin. Lovastatin and simvastatin are termed "sensitive substrates" because their levels may be increased five-fold or higher by CYP3A4 inhibitors.
Fluvastatin (Lescol) is primarily metabolized by CYP2C9 and to a lesser extent by CYP3A4 and CYP2D6. Pravastatin (Pravachol) is not significantly metabolized by the cytochrome P450 system and does not interact with other CYP substrates. Rosuvastatin (Crestor) is also not extensively metabolized by the cytochrome P450 system. Statins are substrates for P-glycoprotein; therefore, drugs that inhibit p-glycoprotein (e.g., cyclosporine, diltiazem, etc) may increase statin levels.
The increased risk of myopathy is well recognized when statins and fibric acid derivatives are coadministered since both classes of drugs have the potential for inducing myopathy. However, the risk is less with fenofibrate than gemfibrozil. This may be because gemfibrozil inhibits hepatic glucuronidation of statins, thereby interfering with statin elimination.
In managing statin interactions, choosing a non-interacting medication or switching to a non-interacting statin (i.e., for chronic therapy) may be the safest or easiest option. For certain statin interactions, reducing the statin dose may be an acceptable management technique.
Interactions between lovastatin or simvastatin and strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole) are managed by stopping the statin as soon as the interacting drug is started. Recommendations vary, but some experts suggest restarting the statin three days or so after the interacting drug has been discontinued. The cardiovascular risk of stopping a statin must be considered when managing drug interactions. Stopping a statin for up to six weeks in a stable patient appears safe. The cardiovascular risk of stopping a statin is higher in unstable patients. Morbidity and mortality is increased in acute myocardial infarction (MI) patients whose statins are discontinued.The results of statin discontinuation in high risk patients may be seen quickly. In one study there was increased risk of in-hospital death in patients with non-ST segment elevation MI whose statin was discontinued. In addition, stopping statin therapy in acute ischemic stroke patients resulted in early neurologic deterioration and poorer outcomes in an unpublished study. Therefore, statins should only be discontinued in acute MI or stroke when indicated (e.g., rhabdomyolysis).
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
The extent of interaction between atorvastatin and CYP3A4 inhibitors is less than that with lovastatin and simvastatin. Lovastatin and simvastatin are termed "sensitive substrates" because their levels may be increased five-fold or higher by CYP3A4 inhibitors.
Fluvastatin (Lescol) is primarily metabolized by CYP2C9 and to a lesser extent by CYP3A4 and CYP2D6. Pravastatin (Pravachol) is not significantly metabolized by the cytochrome P450 system and does not interact with other CYP substrates. Rosuvastatin (Crestor) is also not extensively metabolized by the cytochrome P450 system. Statins are substrates for P-glycoprotein; therefore, drugs that inhibit p-glycoprotein (e.g., cyclosporine, diltiazem, etc) may increase statin levels.
The increased risk of myopathy is well recognized when statins and fibric acid derivatives are coadministered since both classes of drugs have the potential for inducing myopathy. However, the risk is less with fenofibrate than gemfibrozil. This may be because gemfibrozil inhibits hepatic glucuronidation of statins, thereby interfering with statin elimination.
In managing statin interactions, choosing a non-interacting medication or switching to a non-interacting statin (i.e., for chronic therapy) may be the safest or easiest option. For certain statin interactions, reducing the statin dose may be an acceptable management technique.
Interactions between lovastatin or simvastatin and strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole) are managed by stopping the statin as soon as the interacting drug is started. Recommendations vary, but some experts suggest restarting the statin three days or so after the interacting drug has been discontinued. The cardiovascular risk of stopping a statin must be considered when managing drug interactions. Stopping a statin for up to six weeks in a stable patient appears safe. The cardiovascular risk of stopping a statin is higher in unstable patients. Morbidity and mortality is increased in acute myocardial infarction (MI) patients whose statins are discontinued.The results of statin discontinuation in high risk patients may be seen quickly. In one study there was increased risk of in-hospital death in patients with non-ST segment elevation MI whose statin was discontinued. In addition, stopping statin therapy in acute ischemic stroke patients resulted in early neurologic deterioration and poorer outcomes in an unpublished study. Therefore, statins should only be discontinued in acute MI or stroke when indicated (e.g., rhabdomyolysis).
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Wednesday, September 8, 2010
10 Tips on Hemorrhoids
1.Hemorrhoids are masses of swollen veins in the lower rectum (internal hemorrhoids) or at the anus (external hemorrhoids).
2.Symptoms of internal hemorrhoids include:
Bright red rectal bleeding
Staining of undergarments with mucus
3.Symptoms of external hemorrhoids include:
Pain and itching when irritated by constipation or diarrhea
Difficulty with hygiene
4.Hemorrhoids are caused by:
Straining
Work strain (lifting, etc.)
Straining while defecating
Chronic constipation
Passing hard, dry, small stools
Laxative abuse
5.Do not assume rectal bleeding is from hemorrhoids. See your doctor to rule out cancer or other disease.
6.To prevent or manage hemorrhoids, increase your fiber and fluid intake. Consider adding a fiber supplement.
7.Avoid straining at stool or sitting on the toilet for a long time.
8.Clean the external rectal area gently with soap and water following stool evacuation.
9.Try a topical cream or sitz baths to reduce inflammation.
10.See your doctor if you don't improve.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
2.Symptoms of internal hemorrhoids include:
Bright red rectal bleeding
Staining of undergarments with mucus
3.Symptoms of external hemorrhoids include:
Pain and itching when irritated by constipation or diarrhea
Difficulty with hygiene
4.Hemorrhoids are caused by:
Straining
Work strain (lifting, etc.)
Straining while defecating
Chronic constipation
Passing hard, dry, small stools
Laxative abuse
5.Do not assume rectal bleeding is from hemorrhoids. See your doctor to rule out cancer or other disease.
6.To prevent or manage hemorrhoids, increase your fiber and fluid intake. Consider adding a fiber supplement.
7.Avoid straining at stool or sitting on the toilet for a long time.
8.Clean the external rectal area gently with soap and water following stool evacuation.
9.Try a topical cream or sitz baths to reduce inflammation.
10.See your doctor if you don't improve.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
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