The rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in materna or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Changing the local culture and attitudes of obstetric care providers regarding the issues involved in cesarean delivery reduction will also be challenging This article reviews the indications for primary cesarean and how to mange abnormally progressing labor. (Obstet Gynecol Mar) Click here to view full-text.
News You Can Use
This “Clinical Decision Making” article explores understanding the cardiovascular diesease risk functions – Aim, development, and evaluation – through a case vignette on whether to begin ..or not begin statis therapy and when to monitor, or not monitor LDL cholesterol. The article takes the reader through 3 treatment options based on the new guidelines. (NEJM, April 24) Click here to read full text.
Safety and feasibility of a diagnostic algorithm combining clinical probability, d-Dimer testing, and ultrasonography for suspected upper extremity deep venous thrombosisby jmiller on April 24, 2014
Article concludes: The combination of a clinical decision score, D-dimer testing, and ultrasonography can safely and effectively esclude upper extremity deep vein thrombosis. (Ann Intern Med, April). Click here to read full-text.
UpToDate Mobile (Free) and NEW INTRANET Remote Access Now Available to AAMC Medical and Hospital Staffby jmiller on April 10, 2014
UpTodate is now available REMOTELY through the Intranet..and also through FREE mobile app to ALL medical and hospital staff. Easy access to UpToDate by logging in from any computer with an Internet connection. Free UpToDate Mobile app for most leading devices. Free continuing education credits when you research a clinical question using UTD onsite or remotely – including your mobile device. Questions: call or email Joyce Miller, email@example.com, ext 4877. To read more about how to access remotely and obtain the app, click here.
Article concludes: Unplanned readmissions in surgical patients are common in patients experiencing postoperative complications and can be predicted using the ACS NSQIP risk of major complications. Prospective identification of high-risk patients, using the NSQIP complication risk index, may allow hospitals to reduce unplanned rehospitalizations. (JAMA Surgery, March) Click here to view full-text.
MKSAP – Pulmonary Medicine and Critical Care - – CME credit – Speaker is Dr. Robert Peterson, Wednesday, Mary 26, 6:00 p.m. Second Floor Conference Room of the South Pavilion. Dr. Richard Colgan will be speaking on May 7th at 6:00, 2nd floor Conference Room South Pavilion on General Internal Medicine. The MKSAP program is sponsored by Drs. Robert Greenfeld and Anthony Caputo.
A 2-hour diagnostic protocol for possible cardiac chest pain in the Emergency Department and commentary: Rapid evaluation of chest pain in the Emergency Departmentby jmiller on January 24, 2014
From JAMA, (Jan), concludes: “Using the accelerated diagnostic protocol in the experimental pathway almost doubled the proportion of patients with chest pain discharged early. Clinicians could discharge approximately 1 of 5 patients with chest pain to outpatient follow-up monitoring in less than 6 hours. The diagnostic strategy could be easily replicated in other centers because no extra resources are required. Click here to read full-text.
The American College of Surgeons (Bull Am Coll Surg, Jan) has issued a revised statement from its original 1994 policy on Advance Directies in the operating room. Basically, there is now a requirement that a “reconsideration discussion” should occur as early as practical after a decision is made to have surgery to clarify patient’s wishes. “Policies that lead either to the automatic enforcement of all DNR orders or to disregarding or automatically cancelling such orders do not sufficiently support a patient’s right to self- determination.” Click here to read full text..