Medliorate

Improving medical students

The Association between Proton Pump Inhibitors and C. Difficile

Posted by medliorator on May 11, 2010

investigators conducted a secondary analysis of prospectively collected data from 101,796 patients who were discharged from a tertiary care medical center during a 5-year period. Acid suppression treatment was the primary exposure of interest, classified by intensity (no acid suppression, histamine2-receptor antagonist [H2RA] treatment, daily PPI use, and PPI use more often than daily).

The risk for nosocomial C difficile infection increased with increasing level of acid suppression. This risk was 0.3% (95% confidence interval [CI], 0.21% – 0.31%) in patients not receiving acid suppressive treatment, 0.6% (95% CI, 0.49% – 0.79%) in those receiving H2RA treatment, 0.9% (95% CI, 0.80% – 0.98%) in those using PPIs daily, and 1.4% (95% CI, 1.15% – 1.71%) in patients using PPIs more often than daily …The odds ratio was 1 for no acid suppression (reference), 1.53 for H2RA treatment (95% CI, 1.12 – 2.10), 1.74 for daily PPI use (95% CI, 1.39 – 2.18), and 2.36 for more frequent PPI use (95% CI, 1.79 – 3.11).

Proton Pump Inhibitor Use Linked to Clostridium Difficile Infection [Medscape]

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iPad for the Wards – A User’s Review

Posted by medliorator on May 9, 2010

The iPad should fit comfortably your white coat.

All iPhone apps will run, but unless they have been customized specifically, the screen resolution on the apps is pixilated and not aesthetically pleasing.

The keyboard was initially frustrating.  It feels awkward holding your fingers in traditional keyboard stance, and then not having feedback when you push down… With that said, after some use, I think the keyboard is relatively functional.

Apple claims you can squeeze approximately 10 hours out of it, but other reviewers have been able to get more.

iPad review for doctors: A hands on guide for medicine [Kevin MD]

Correlate: Top 5 Medical Apps for the Upcoming iPad [iMedicalApps]

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Sipuleucel-T (Provenge), The First FDA-Approved Cancer “Vaccine” – What Every Medical Student Should Know

Posted by medliorator on May 4, 2010

Here are the bare bones facts on Provenge. A basic understanding will help you to stand out when the discussion inevitably comes up.

Drug Name: Sipuleucel-T
Trade Name: Provenge
Trial Name: APC 8015
Manufacturer: Dendreon Corporation
Class: autologous, dendritic cell-based immunotherapy
Indication: hormone-refractory, metastatic prostate cancer
MOA: Induces patient’s own cells to attack prostate cancer.
MOA (detailed): Patient’s immune cells are collected by leukapheresis and sent to a Dendreon facility approximately 3 days prior to treatment. Immune cells are exposed to  recombinant protein (known as PA 2024) that has two, fused components: (1) a prostate cancer associated antigen called prostatic acid phosphatase (PAP) that is expressed in ~95% of prostate cancers and (2) granulocyte-macrophage colony-stimulating factor (GM-CSF), an immune cell activator.  After PA 2024 exposure and processing, the activated cells are infused back into the patient, divided into in three doses two weeks apart.
SFX: f/c, fatigue, back pain, nausea,joint ache, HA.
Cost: $93,000 per treatment
Efficacy: Extends men’s lives by an average of 4.1 months (based upon IMPACT trial D9902B, a 512-patient RTC).
Misconceptions: Provenge differs from traditional vaccines in that it does NOT prevent cancer. “Immunotherapy” is perhaps a better substitute for the term, “vaccine.”

Further reading…
FDA approves prostate cancer “vaccine” [BMJ]
Current status of immunological therapies for prostate cancer [Curr Opin Urol]

Posted in Oncology, Pharmacology, Urology | Comments Off on Sipuleucel-T (Provenge), The First FDA-Approved Cancer “Vaccine” – What Every Medical Student Should Know

Avoid Common Pitfalls When Undertaking New Medical Research Projects

Posted by medliorator on May 3, 2010

Rushing and overloading yourself in science is common, even normal… Never. Rush. The beginning. Ever.

Taking a step back to thoroughly assess the viability of your project… might actually be the one thing that can steer you clear from failure.

2. Read critically. It always pays off to spend some time delimiting the boundaries of your project, by putting it in the context of previous data and existing literature.  Read extensively and leisurely about all aspects of your future work, technical and conceptual… Being critical with what you read will help you identify the failed approaches between the lines, so you can avoid them as we

4. Mind your “n”. The statistical power of the tests that fit your design, and the depth and extend of the differences you expect to observe, are going to determine what sample number you will need to draw meaningful conclusions …use the available preliminary data or similar studies from the literature to calculate or infer what you appropriate n might be. Then revise the backbone design of your project accordingly

10 Things You Must Do Before Starting a New Project [Bitesize Bio]

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Kawasaki’s Disease for the Boards & Wards

Posted by medliorator on April 29, 2010

Pathophysiology:

  • necrotizing vasculitis of early childhood
  • possible infectious etiology (parvovirus B19)

Workup:

  • CBC –> normocytic anemia followed by thrombocytosis
  • ESR –> elevated
  • CRP –> elevated
  • LFTs –> low albumin

Diagnosis: clinical (“CRASH & Burn”)

  • 4 of 5 signs:
    • Conjunctivitis – bilateral nonsuppurative
    • Rash – primarily truncal
    • Adenopathy – cervical, at least 1.5cm
    • Strawberry Tongue – URI mucous membrane changes
    • Hands & feet – erythema, edema, desquamation
  • Fever x 5 days

Treatment:

  • High dose IVIG
  • High dose ASA
  • After discharge, low dose of ASA x 8 weeks

Differential:

  • Mercury poisoning (acrodynia)
  • Scarlet fever
  • Toxic shock syndrome
  • juvenile idiopathic arthritis

See also,

Kawasaki’s Disease [Inside Surgery]

Posted in Pediatrics, Rheumatology | Comments Off on Kawasaki’s Disease for the Boards & Wards

Peer Evaluation – How to Compliment Fellow Medical Students and Residents

Posted by medliorator on April 26, 2010

Chris Birk

1. Be Specific
Detail is …the heart of a great compliment.  Hone in on a specific achievement or aspect and focus your words on that. A vague, generalized comment that can be recycled throughout the day …lacks real meaning because of its cookie-cutter nature.
Specific compliments have lasting power. So do those that favor character over objects or outward appearance. They indicate that you’ve truly taken stock of a person and their attributes and, in turn, compressed those thoughts into a value judgment.

2. Be Genuine

Sincerity is a byproduct of genuine belief or emotion.  To toss up a compliment because of social convention or circumstance is to speak without real meaning.  Writing about the art of compliments for Esquire magazine, Tom Chiarella summed it up perfectly: “If a worthwhile compliment needs anything, it is the weight of realization behind it.”

How to Give Compliments That Mean Something [Life Optimizer]

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Residency Switching – Prevalence and Methods

Posted by medliorator on April 21, 2010

by Elizabeth Losada, MD @SDN…

Anecdotally it is said that as many as ten percent of all residents switch specialties each year.

Studies looking at resident attrition rates have yielded some data on specialty switching among residents.  Attrition rates account for all residents who leave residency programs, not just those who change specialties.  This includes residents who leave medicine completely and those who switch to another program within the same specialty.  A study of Ob-Gyn resident attrition by McAlister et al. in 2008 (1) noted 2004-2005 ACGME reported annual resident attrition rates of 5.8% in Surgery, 5.1% in Ob-Gyn, 4.7% in Family Medicine, and 2.1% in Internal Medicine.  Of 1055 categorical Ob-Gyn residents who entered programs in 2001, 21% (228 residents) had left their original program after four years and were categorized in the attrition group.  Within the attrition group 33% (75 residents) switched specialties and 39% (29 residents) moved to primary care residencies.

Longo et al. (2) examined resident attrition from a general surgery residency program over a 20-year period and found a 30% attrition rate.  Of the 30 residents who did not complete their training at the program, 63% (19 residents) switched to other specialties, including plastic surgery and medicine most commonly.  The most common reasons cited for leaving the program included “lifestyle” and “passion for another specialty.”

How one goes about finding a new residency position varies, depending on the type of switch being made.  For some residents, especially those who decide to switch early on or who are switching to a field that is drastically different from their current specialty, the easiest way to switch may be to re-enter the match.  Going through the match again provides the most options for finding a new first-year position.  For residents who have completed training that may count towards the requirements for another field, looking for a position outside the match may make the most sense.  Simply calling area programs to ask about openings has been successful for some residents.  Additionally, several websites (see below) offer notification of off-cycle positions and application services.

Switching Specialties [SDN]

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Rheumatology Pearls

Posted by medliorator on April 18, 2010

  • A positive ANCA is meaningless if the patient’s illness doesn’t resemble Wegener’s, MPA or RPGN.
  • Septic arthritis—11% mortality.
  • Underappreciated complications of immunosuppressive therapy:
    • Corticosteroids — infectious complications
    • Anti-TNFs & Rituximab — Heb B flare, acute liver failure.
    • Azathiaprine — hypersensitivity syndrome.

Hospital Medicine 2010 April 9 sessions—rheumatology pearls [Notes from Dr. RW]

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How to Succeed in Medical School – Advice for all 4 years

Posted by medliorator on April 15, 2010

Dr. Lisabetta Divita @ SDN…

MS-1 and MS-2

How will you know what could be asked on an exam? Obtaining exams from previous years is perhaps the most important investment you could make. Get copies of previous exams. Old exams give you the best idea of the style and scope of questions that will be asked. There is simply too much information not to focus; the best way to focus is to get a feel for how previous classes were tested.

MS-3 and MS-4

  • DO NOT slow the interns/residents down
  • care for your patient whenever possible
  • assist/perform as many procedures as possible (IVs, central lines, arthrocenteses, paracenteses, etc.)
  • get all labs/study results as soon as they are ready
  • personally experience all interesting physical findings (your patient or not)
  • ask the senior resident/fellow general questions
  • ask the intern questions about your patient (that you cannot find out yourself)
  • DO NOT switch these last two items. In other words, DO NOT pimp the intern and DO NOT ask the resident/fellow about lab results

Tips for Surviving Medical School [SDN]

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The Medical Bottleneck – Residency Shortage & Health Care Reform

Posted by medliorator on April 14, 2010

a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC.

But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions… There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.

Doctors’ groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn’t make it into the final bill… The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

Medical Schools Can’t Keep Up [WSJ Health]

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