FEED Validator

Sorry

This feed does not validate.

• line 538, column 370: Undefined item element: georss:featurename [help]

  ... 72" width="72"/><thr:total>0</thr:total><georss:featurename>Marina del R ...
                                               ^

In addition, interoperability with the widest range of feed readers could be improved by implementing the following recommendations.

• line 1, column 38: Use of unknown namespace: http://schemas.google.com/blogger/2008 [help]

  <?xml version='1.0' encoding='UTF-8'?><rss xmlns:atom="http://www.w3.org/200 ...
                                        ^

• line 1, column 38: Unable to validate namespace: http://schemas.google.com/g/2005. See the Google Data specification at https://developers.google.com/gdata/docs/1.0/elements [help]

  <?xml version='1.0' encoding='UTF-8'?><rss xmlns:atom="http://www.w3.org/200 ...
                                        ^

• line 1, column 0: description should not contain imageanchor attribute (69 occurrences) [help]

  <?xml version='1.0' encoding='UTF-8'?><rss xmlns:atom="http://www.w3.org/200 ...
  

• line 27, column 0: description should not contain iframe tag (8 occurrences) [help]

  <iframe frameborder="0" height="327" scrolling=" ...
  

• line 382, column 0: style attribute contains potentially dangerous content: mso-bidi-font-family (17 occurrences) [help]

  <li><span style="font-family: Symbol; mso-bidi-font-family: Sy ...
  

• line 982, column 311: Missing atom:link with rel="self" [help]

  ... </author><thr:total>0</thr:total></item></channel></rss>
                                               ^

Source: http://imedres.blogspot.com/feeds/posts/default?alt=rss

1. <?xml version='1.0' encoding='UTF-8'?><rss xmlns:atom="http://www.w3.org/2005/Atom" xmlns:openSearch="http://a9.com/-/spec/opensearchrss/1.0/" xmlns:blogger="http://schemas.google.com/blogger/2008" xmlns:georss="http://www.georss.org/georss" xmlns:gd="http://schemas.google.com/g/2005" xmlns:thr="http://purl.org/syndication/thread/1.0" version="2.0"><channel><atom:id>tag:blogger.com,1999:blog-1186205362940782275</atom:id><lastBuildDate>Thu, 14 Mar 2024 04:30:25 +0000</lastBuildDate><category>OMR</category><category>hcm</category><category>resident report</category><category>weekly roundup</category><category>acp</category><category>away conference</category><category>cardiology</category><category>endocrine</category><category>ethics</category><category>gim</category><category>health systems</category><category>id</category><category>intern intake</category><category>medical decisions</category><category>women&#39;s health</category><category>RAPID</category><category>academic society</category><category>advance directive</category><category>contraception</category><category>documentation</category><category>ebv</category><category>fall retreat</category><category>gi</category><category>hospice</category><category>hospitalist</category><category>infective endocarditis</category><category>insomnia</category><category>intro</category><category>journal club</category><category>lgbt</category><category>membership</category><category>menopause</category><category>mobile app</category><category>oncology</category><category>op-ed</category><category>osteoporosis</category><category>psychiatry</category><category>pulm</category><category>qi</category><category>research</category><category>resources</category><category>rheum</category><category>sgim</category><category>signout</category><category>thyroid</category><category>underserved</category><category>volunteer</category><title>Medicine In Residence</title><description></description><link>http://imedres.blogspot.com/</link><managingEditor>noreply@blogger.com (ZZTOP)</managingEditor><generator>Blogger</generator><openSearch:totalResults>42</openSearch:totalResults><openSearch:startIndex>1</openSearch:startIndex><openSearch:itemsPerPage>25</openSearch:itemsPerPage><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-8097736053334732220</guid><pubDate>Wed, 07 May 2014 19:17:00 +0000</pubDate><atom:updated>2014-05-07T14:45:16.910-07:00</atom:updated><title>RAPID Live Survey - May 2014 - Results</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://1.bp.blogspot.com/-KflQzIg7cjI/U2qpY84WMsI/AAAAAAAAAVk/VSLZqFLlM5Q/s1600/Q1.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://1.bp.blogspot.com/-KflQzIg7cjI/U2qpY84WMsI/AAAAAAAAAVk/VSLZqFLlM5Q/s640/Q1.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://2.bp.blogspot.com/-MsBFwIEy6aY/U2qpY_hPV6I/AAAAAAAAAVo/oHmBG9Rj_Z8/s1600/Q2.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://2.bp.blogspot.com/-MsBFwIEy6aY/U2qpY_hPV6I/AAAAAAAAAVo/oHmBG9Rj_Z8/s640/Q2.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://3.bp.blogspot.com/-iIYo2JN8bDI/U2qpY1U0Y3I/AAAAAAAAAVs/T2Xl3_11Wi4/s1600/Q3.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://3.bp.blogspot.com/-iIYo2JN8bDI/U2qpY1U0Y3I/AAAAAAAAAVs/T2Xl3_11Wi4/s640/Q3.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://3.bp.blogspot.com/-RO3-U_aXZRc/U2qpZELaTKI/AAAAAAAAAVw/tfqJgp8M6Zo/s1600/Q4.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://3.bp.blogspot.com/-RO3-U_aXZRc/U2qpZELaTKI/AAAAAAAAAVw/tfqJgp8M6Zo/s640/Q4.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;</description><link>http://imedres.blogspot.com/2014/05/rapid-live-survey-may-2014.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://1.bp.blogspot.com/-KflQzIg7cjI/U2qpY84WMsI/AAAAAAAAAVk/VSLZqFLlM5Q/s72-c/Q1.png" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-1400566938150029471</guid><pubDate>Wed, 12 Mar 2014 07:52:00 +0000</pubDate><atom:updated>2014-03-12T17:11:40.660-07:00</atom:updated><title>RAPID conference - March 2014</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://1.bp.blogspot.com/-dK7LFAPPCQo/UyD3kgCXDzI/AAAAAAAAHHk/HUZHSb_Nz1I/s1600/Q1.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://1.bp.blogspot.com/-dK7LFAPPCQo/UyD3kgCXDzI/AAAAAAAAHHk/HUZHSb_Nz1I/s400/Q1.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://4.bp.blogspot.com/-XHitgEHAN3I/UyD3kg9TuBI/AAAAAAAAHH8/Yppy9YCQJq8/s1600/Q2.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://4.bp.blogspot.com/-XHitgEHAN3I/UyD3kg9TuBI/AAAAAAAAHH8/Yppy9YCQJq8/s400/Q2.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://2.bp.blogspot.com/-PQvOrI0bKmM/UyD3kjB3OYI/AAAAAAAAHHo/vYaI3byzIBg/s1600/Q3.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://2.bp.blogspot.com/-PQvOrI0bKmM/UyD3kjB3OYI/AAAAAAAAHHo/vYaI3byzIBg/s400/Q3.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://3.bp.blogspot.com/-KI9wiq1tqO0/UyD3k4Ec5gI/AAAAAAAAHHs/BzI05RMdQU0/s1600/Q4.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://3.bp.blogspot.com/-KI9wiq1tqO0/UyD3k4Ec5gI/AAAAAAAAHHs/BzI05RMdQU0/s400/Q4.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://2.bp.blogspot.com/-neIB7tDf6N8/UyD3piUc7ZI/AAAAAAAAHIE/kw4bnEAW9f8/s1600/comments.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://2.bp.blogspot.com/-neIB7tDf6N8/UyD3piUc7ZI/AAAAAAAAHIE/kw4bnEAW9f8/s400/comments.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;</description><link>http://imedres.blogspot.com/2014/03/rapid-conference-march-2014.html</link><author>noreply@blogger.com (pdicapua)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://1.bp.blogspot.com/-dK7LFAPPCQo/UyD3kgCXDzI/AAAAAAAAHHk/HUZHSb_Nz1I/s72-c/Q1.png" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-5406359360659815263</guid><pubDate>Thu, 16 Jan 2014 06:57:00 +0000</pubDate><atom:updated>2014-01-16T13:16:59.380-08:00</atom:updated><title>Jan 16 - RAPID Conference survey and evaluation</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;
2. <br /></div>
3. <div class="separator" style="clear: both; text-align: center;">
4. <a href="http://2.bp.blogspot.com/-261kphmMKnA/UthLpfUR8QI/AAAAAAAAHCg/tbI1dstbN3c/s1600/Q1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-261kphmMKnA/UthLpfUR8QI/AAAAAAAAHCg/tbI1dstbN3c/s400/Q1.png" height="640" width="550" /></a></div>
5. <div class="separator" style="clear: both; text-align: center;">
6. <a href="http://2.bp.blogspot.com/-SL-DsJouQ7w/UthLpBaYbCI/AAAAAAAAHCc/k2s4Hzou6tk/s1600/Q2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-SL-DsJouQ7w/UthLpBaYbCI/AAAAAAAAHCc/k2s4Hzou6tk/s400/Q2.png" height="640" width="571" /></a></div>
7. <div class="separator" style="clear: both; text-align: center;">
8. <a href="http://2.bp.blogspot.com/-LY7ZQN_i-eU/UthLpeNX5QI/AAAAAAAAHCk/Ee9GPzn8R1Y/s1600/Q3.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-LY7ZQN_i-eU/UthLpeNX5QI/AAAAAAAAHCk/Ee9GPzn8R1Y/s400/Q3.png" height="640" width="478" /></a></div>
9. <div class="separator" style="clear: both; text-align: center;">
10. <a href="http://2.bp.blogspot.com/-pmGTJA1IxUc/UthLpn-08MI/AAAAAAAAHCo/xWUqKqly_4g/s1600/RAPID.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-pmGTJA1IxUc/UthLpn-08MI/AAAAAAAAHCo/xWUqKqly_4g/s400/RAPID.png" height="640" width="470" /></a></div>
11. </description><link>http://imedres.blogspot.com/2014/01/jan-16-rapid-conference-survey-and.html</link><author>noreply@blogger.com (pdicapua)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://2.bp.blogspot.com/-261kphmMKnA/UthLpfUR8QI/AAAAAAAAHCg/tbI1dstbN3c/s72-c/Q1.png" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-2612590370796335553</guid><pubDate>Wed, 08 Jan 2014 18:57:00 +0000</pubDate><atom:updated>2014-01-08T10:57:07.240-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">gim</category><category domain="http://www.blogger.com/atom/ns#">oncology</category><title>OMR Roundup 1/8/14</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;
12. <a href="http://1.bp.blogspot.com/-9BlyQayoYAU/Us2eCDzk7aI/AAAAAAAAAT4/gEO_rHq2IYg/s1600/CCS.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-9BlyQayoYAU/Us2eCDzk7aI/AAAAAAAAAT4/gEO_rHq2IYg/s1600/CCS.jpg" height="145" width="200" /></a></div>
13. <br />
14. <div style="text-align: center;">
15. The Annals of Internal Medicine called us out this week!  Check out the summary below...</div>
16. <div style="text-align: center;">
17. <br /></div>
18. <a name='more'></a><br />
19. <div class="separator" style="clear: both; text-align: center;">
20. <a href="http://2.bp.blogspot.com/-KwLqcu3YR0A/Us2eCDodqVI/AAAAAAAAAT0/O_1rYS8PV9Y/s1600/summary.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-KwLqcu3YR0A/Us2eCDodqVI/AAAAAAAAAT0/O_1rYS8PV9Y/s1600/summary.jpg" height="320" width="310" /></a></div>
21. <span style="font-size: xx-small;">(<span style="font-family: Calibri;">Suh</span><span style="font-family: Calibri;"> E,
22. Daugherty CK, </span><span style="font-family: Calibri;">Wroblewski</span><span style="font-family: Calibri;"> K,
23. et al. General Internists’ Preferences and Knowledge About the Care of Adult
24. Survivors of Childhood Cancer. Ann Intern Med. 2014;160(1):11–17–17.)</span></span><br />
25. <span style="font-size: xx-small;"><span style="font-family: Calibri;"><br /></span></span>
26. <span style="font-family: Calibri;">Philippe took the topic and ran with it for us, covering Primary Care of Survivors of Childhood Cancer.  It was awesome.  Slideshow below:</span><br />
27. <iframe frameborder="0" height="327" scrolling="no" src="https://skydrive.live.com/embed?cid=5585EDB2B546C67F&resid=5585EDB2B546C67F%21132&authkey=AOWhtTnRJWWUD80&em=2" width="402"></iframe>
28.  
29. &lt;!--EndFragment--&gt;</description><link>http://imedres.blogspot.com/2014/01/omr-roundup-1814.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://1.bp.blogspot.com/-9BlyQayoYAU/Us2eCDzk7aI/AAAAAAAAAT4/gEO_rHq2IYg/s72-c/CCS.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-3536374316393414224</guid><pubDate>Thu, 19 Dec 2013 01:09:00 +0000</pubDate><atom:updated>2013-12-18T17:09:41.186-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">endocrine</category><category domain="http://www.blogger.com/atom/ns#">gim</category><category domain="http://www.blogger.com/atom/ns#">hcm</category><title>OMR Roundup 12/18/13</title><description>&lt;br /&gt;
30. <div class="separator" style="clear: both; text-align: center;">
31. <a href="http://4.bp.blogspot.com/-1JwxzHlCNqk/UrJFIV2UnDI/AAAAAAAAATk/XToh_aVyYEg/s1600/PreDM.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-1JwxzHlCNqk/UrJFIV2UnDI/AAAAAAAAATk/XToh_aVyYEg/s1600/PreDM.jpg" height="200" width="138" /></a></div>
32. Happy <a href="http://jama.jamanetwork.com/article.aspx?articleid=1791497">JNC8</a> Day!  Sharon presented a case from the Simms/Mann clinic that highlighted 3 areas of high importance in the outpatient world: (1) Pre-diabetes, (2) Medication non-adherance, and (3) Physical activity. <br />
33. <br />
34. Special shout-outs:<br />
35. <br />
36. <ul>
37. <li><a href="http://www.ncbi.nlm.nih.gov/pubmed/18029834">Pedometers</a> (set goals and monitor!)</li>
38. <li><a href="http://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/pillcard/pillcard.html">Pill Cards</a></li>
39. <li><a href="http://www.nejm.org/doi/full/10.1056/NEJMoa012512">Diabetes Prevention</a> for your pre-diabetics (HbA1c 5.7 isn't normal!)</li>
40. </ul>
41. <br />
42. Check out her slides:<br />
43. <br />
44. &lt;iframe frameborder=&quot;0&quot; height=&quot;327&quot; scrolling=&quot;no&quot; src=&quot;https://skydrive.live.com/embed?cid=5585EDB2B546C67F&amp;amp;resid=5585EDB2B546C67F%21126&amp;amp;authkey=AAnnGhYuBzBGs-A&amp;amp;em=2&quot; width=&quot;402&quot;&gt;&lt;/iframe&gt;</description><link>http://imedres.blogspot.com/2013/12/omr-roundup-121813.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://4.bp.blogspot.com/-1JwxzHlCNqk/UrJFIV2UnDI/AAAAAAAAATk/XToh_aVyYEg/s72-c/PreDM.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-8550486959633960948</guid><pubDate>Thu, 12 Dec 2013 02:36:00 +0000</pubDate><atom:updated>2013-12-11T18:36:19.171-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">health systems</category><category domain="http://www.blogger.com/atom/ns#">OMR</category><title>OMR Roundup 12/11/13</title><description>We reviewed contraception cases (similar to November 6 OMR), but I wanted to put Colin Robinson&#39;s slides up to highlight the important changes afoot with Health Insurance Marketplaces:&lt;br /&gt;
45. <br />
46. &lt;iframe frameborder=&quot;0&quot; height=&quot;327&quot; scrolling=&quot;no&quot; src=&quot;https://skydrive.live.com/embed?cid=5585EDB2B546C67F&amp;amp;resid=5585EDB2B546C67F%21123&amp;amp;authkey=ABqEZpBGS14EiH4&amp;amp;em=2&quot; width=&quot;402&quot;&gt;&lt;/iframe&gt;</description><link>http://imedres.blogspot.com/2013/12/omr-roundup-121113.html</link><author>noreply@blogger.com (ZZTOP)</author><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-1655696832413223577</guid><pubDate>Wed, 27 Nov 2013 21:43:00 +0000</pubDate><atom:updated>2013-11-27T13:43:40.254-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">gi</category><category domain="http://www.blogger.com/atom/ns#">resident report</category><category domain="http://www.blogger.com/atom/ns#">rheum</category><title>Resident Report: Phil Ge 11/26/13</title><description>&lt;!--[if gte mso 9]&gt;&lt;xml&gt;
47. <w:WordDocument>
48.  <w:View>Normal</w:View>
49.  <w:Zoom>0</w:Zoom>
50.  <w:TrackMoves/>
51.  <w:TrackFormatting/>
52.  <w:PunctuationKerning/>
53.  <w:ValidateAgainstSchemas/>
54.  <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
55.  <w:IgnoreMixedContent>false</w:IgnoreMixedContent>
56.  <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
57.  <w:DoNotPromoteQF/>
58.  <w:LidThemeOther>EN-US</w:LidThemeOther>
59.  <w:LidThemeAsian>X-NONE</w:LidThemeAsian>
60.  <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
61.  <w:Compatibility>
62.   <w:BreakWrappedTables/>
63.   <w:SnapToGridInCell/>
64.   <w:WrapTextWithPunct/>
65.   <w:UseAsianBreakRules/>
66.   <w:DontGrowAutofit/>
67.   <w:SplitPgBreakAndParaMark/>
68.   <w:DontVertAlignCellWithSp/>
69.   <w:DontBreakConstrainedForcedTables/>
70.   <w:DontVertAlignInTxbx/>
71.   <w:Word11KerningPairs/>
72.   <w:CachedColBalance/>
73.  </w:Compatibility>
74.  <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel>
75.  <m:mathPr>
76.   <m:mathFont m:val="Cambria Math"/>
77.   <m:brkBin m:val="before"/>
78.   <m:brkBinSub m:val="--"/>
79.   <m:smallFrac m:val="off"/>
80.   <m:dispDef/>
81.   <m:lMargin m:val="0"/>
82.   <m:rMargin m:val="0"/>
83.   <m:defJc m:val="centerGroup"/>
84.   <m:wrapIndent m:val="1440"/>
85.   <m:intLim m:val="subSup"/>
86.   <m:naryLim m:val="undOvr"/>
87.  </m:mathPr></w:WordDocument>
88. </xml><![endif]--><br />
89. <!--[if gte mso 9]><xml>
90. <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
91.  DefSemiHidden="true" DefQFormat="false" DefPriority="99"
92.  LatentStyleCount="267">
93.  <w:LsdException Locked="false" Priority="0" SemiHidden="false"
94.   UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
95.  <w:LsdException Locked="false" Priority="9" SemiHidden="false"
96.   UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
97.  <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
98.  <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
99.  <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
100.  <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
101.  <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
102.  <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
103.  <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
104.  <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
105.  <w:LsdException Locked="false" Priority="39" Name="toc 1"/>
106.  <w:LsdException Locked="false" Priority="39" Name="toc 2"/>
107.  <w:LsdException Locked="false" Priority="39" Name="toc 3"/>
108.  <w:LsdException Locked="false" Priority="39" Name="toc 4"/>
109.  <w:LsdException Locked="false" Priority="39" Name="toc 5"/>
110.  <w:LsdException Locked="false" Priority="39" Name="toc 6"/>
111.  <w:LsdException Locked="false" Priority="39" Name="toc 7"/>
112.  <w:LsdException Locked="false" Priority="39" Name="toc 8"/>
113.  <w:LsdException Locked="false" Priority="39" Name="toc 9"/>
114.  <w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
115.  <w:LsdException Locked="false" Priority="10" SemiHidden="false"
116.   UnhideWhenUsed="false" QFormat="true" Name="Title"/>
117.  <w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
118.  <w:LsdException Locked="false" Priority="11" SemiHidden="false"
119.   UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
120.  <w:LsdException Locked="false" Priority="22" SemiHidden="false"
121.   UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
122.  <w:LsdException Locked="false" Priority="20" SemiHidden="false"
123.   UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
124.  <w:LsdException Locked="false" Priority="59" SemiHidden="false"
125.   UnhideWhenUsed="false" Name="Table Grid"/>
126.  <w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
127.  <w:LsdException Locked="false" Priority="1" SemiHidden="false"
128.   UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
129.  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
130.   UnhideWhenUsed="false" Name="Light Shading"/>
131.  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
132.   UnhideWhenUsed="false" Name="Light List"/>
133.  <w:LsdException Locked="false" Priority="62" SemiHidden="false"
134.   UnhideWhenUsed="false" Name="Light Grid"/>
135.  <w:LsdException Locked="false" Priority="63" SemiHidden="false"
136.   UnhideWhenUsed="false" Name="Medium Shading 1"/>
137.  <w:LsdException Locked="false" Priority="64" SemiHidden="false"
138.   UnhideWhenUsed="false" Name="Medium Shading 2"/>
139.  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
140.   UnhideWhenUsed="false" Name="Medium List 1"/>
141.  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
142.   UnhideWhenUsed="false" Name="Medium List 2"/>
143.  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
144.   UnhideWhenUsed="false" Name="Medium Grid 1"/>
145.  <w:LsdException Locked="false" Priority="68" SemiHidden="false"
146.   UnhideWhenUsed="false" Name="Medium Grid 2"/>
147.  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
148.   UnhideWhenUsed="false" Name="Medium Grid 3"/>
149.  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
150.   UnhideWhenUsed="false" Name="Dark List"/>
151.  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
152.   UnhideWhenUsed="false" Name="Colorful Shading"/>
153.  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
154.   UnhideWhenUsed="false" Name="Colorful List"/>
155.  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
156.   UnhideWhenUsed="false" Name="Colorful Grid"/>
157.  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
158.   UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
159.  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
160.   UnhideWhenUsed="false" Name="Light List Accent 1"/>
161.  <w:LsdException Locked="false" Priority="62" SemiHidden="false"
162.   UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
163.  <w:LsdException Locked="false" Priority="63" SemiHidden="false"
164.   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
165.  <w:LsdException Locked="false" Priority="64" SemiHidden="false"
166.   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
167.  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
168.   UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
169.  <w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
170.  <w:LsdException Locked="false" Priority="34" SemiHidden="false"
171.   UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
172.  <w:LsdException Locked="false" Priority="29" SemiHidden="false"
173.   UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
174.  <w:LsdException Locked="false" Priority="30" SemiHidden="false"
175.   UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
176.  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
177.   UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
178.  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
179.   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
180.  <w:LsdException Locked="false" Priority="68" SemiHidden="false"
181.   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
182.  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
183.   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
184.  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
185.   UnhideWhenUsed="false" Name="Dark List Accent 1"/>
186.  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
187.   UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
188.  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
189.   UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
190.  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
191.   UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
192.  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
193.   UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
194.  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
195.   UnhideWhenUsed="false" Name="Light List Accent 2"/>
196.  <w:LsdException Locked="false" Priority="62" SemiHidden="false"
197.   UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
198.  <w:LsdException Locked="false" Priority="63" SemiHidden="false"
199.   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
200.  <w:LsdException Locked="false" Priority="64" SemiHidden="false"
201.   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
202.  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
203.   UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
204.  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
205.   UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
206.  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
207.   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
208.  <w:LsdException Locked="false" Priority="68" SemiHidden="false"
209.   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
210.  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
211.   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
212.  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
213.   UnhideWhenUsed="false" Name="Dark List Accent 2"/>
214.  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
215.   UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
216.  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
217.   UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
218.  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
219.   UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
220.  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
221.   UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
222.  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
223.   UnhideWhenUsed="false" Name="Light List Accent 3"/>
224.  <w:LsdException Locked="false" Priority="62" SemiHidden="false"
225.   UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
226.  <w:LsdException Locked="false" Priority="63" SemiHidden="false"
227.   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
228.  <w:LsdException Locked="false" Priority="64" SemiHidden="false"
229.   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
230.  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
231.   UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
232.  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
233.   UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
234.  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
235.   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
236.  <w:LsdException Locked="false" Priority="68" SemiHidden="false"
237.   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
238.  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
239.   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
240.  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
241.   UnhideWhenUsed="false" Name="Dark List Accent 3"/>
242.  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
243.   UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
244.  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
245.   UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
246.  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
247.   UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
248.  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
249.   UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
250.  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
251.   UnhideWhenUsed="false" Name="Light List Accent 4"/>
252.  <w:LsdException Locked="false" Priority="62" SemiHidden="false"
253.   UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
254.  <w:LsdException Locked="false" Priority="63" SemiHidden="false"
255.   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
256.  <w:LsdException Locked="false" Priority="64" SemiHidden="false"
257.   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
258.  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
259.   UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
260.  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
261.   UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
262.  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
263.   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
264.  <w:LsdException Locked="false" Priority="68" SemiHidden="false"
265.   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
266.  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
267.   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
268.  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
269.   UnhideWhenUsed="false" Name="Dark List Accent 4"/>
270.  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
271.   UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
272.  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
273.   UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
274.  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
275.   UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
276.  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
277.   UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
278.  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
279.   UnhideWhenUsed="false" Name="Light List Accent 5"/>
280.  <w:LsdException Locked="false" Priority="62" SemiHidden="false"
281.   UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
282.  <w:LsdException Locked="false" Priority="63" SemiHidden="false"
283.   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
284.  <w:LsdException Locked="false" Priority="64" SemiHidden="false"
285.   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
286.  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
287.   UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
288.  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
289.   UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
290.  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
291.   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
292.  <w:LsdException Locked="false" Priority="68" SemiHidden="false"
293.   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
294.  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
295.   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
296.  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
297.   UnhideWhenUsed="false" Name="Dark List Accent 5"/>
298.  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
299.   UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
300.  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
301.   UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
302.  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
303.   UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
304.  <w:LsdException Locked="false" Priority="60" SemiHidden="false"
305.   UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
306.  <w:LsdException Locked="false" Priority="61" SemiHidden="false"
307.   UnhideWhenUsed="false" Name="Light List Accent 6"/>
308.  <w:LsdException Locked="false" Priority="62" SemiHidden="false"
309.   UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
310.  <w:LsdException Locked="false" Priority="63" SemiHidden="false"
311.   UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
312.  <w:LsdException Locked="false" Priority="64" SemiHidden="false"
313.   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
314.  <w:LsdException Locked="false" Priority="65" SemiHidden="false"
315.   UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
316.  <w:LsdException Locked="false" Priority="66" SemiHidden="false"
317.   UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
318.  <w:LsdException Locked="false" Priority="67" SemiHidden="false"
319.   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
320.  <w:LsdException Locked="false" Priority="68" SemiHidden="false"
321.   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
322.  <w:LsdException Locked="false" Priority="69" SemiHidden="false"
323.   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
324.  <w:LsdException Locked="false" Priority="70" SemiHidden="false"
325.   UnhideWhenUsed="false" Name="Dark List Accent 6"/>
326.  <w:LsdException Locked="false" Priority="71" SemiHidden="false"
327.   UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
328.  <w:LsdException Locked="false" Priority="72" SemiHidden="false"
329.   UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
330.  <w:LsdException Locked="false" Priority="73" SemiHidden="false"
331.   UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
332.  <w:LsdException Locked="false" Priority="19" SemiHidden="false"
333.   UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
334.  <w:LsdException Locked="false" Priority="21" SemiHidden="false"
335.   UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
336.  <w:LsdException Locked="false" Priority="31" SemiHidden="false"
337.   UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
338.  <w:LsdException Locked="false" Priority="32" SemiHidden="false"
339.   UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
340.  <w:LsdException Locked="false" Priority="33" SemiHidden="false"
341.   UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
342.  <w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
343.  <w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
344. </w:LatentStyles>
345. </xml><![endif]--><!--[if gte mso 10]>
346. <style>
347. /* Style Definitions */
348. table.MsoNormalTable
349. {mso-style-name:"Table Normal";
350. mso-tstyle-rowband-size:0;
351. mso-tstyle-colband-size:0;
352. mso-style-noshow:yes;
353. mso-style-priority:99;
354. mso-style-qformat:yes;
355. mso-style-parent:"";
356. mso-padding-alt:0in 5.4pt 0in 5.4pt;
357. mso-para-margin:0in;
358. mso-para-margin-bottom:.0001pt;
359. mso-pagination:widow-orphan;
360. font-size:10.0pt;
361. font-family:"Times New Roman","serif";}
362. </style>
363. <![endif]-->
364.  
365. <br />
366. <div class="MsoNormal">
367. Phillip Ge presented an excellent case of Sjogren’s disease
368. yesterday, complicated by cirrhosis and variceal bleed. Please see his
369. excellent presentation, especially some of his slides on management of variceal
370. bleed that we didn’t have time to discuss! <br />
371. <a name='more'></a></div>
372. <div class="MsoNormal">
373. <br /></div>
374. <div class="MsoNormal">
375. <br /></div>
376. <iframe frameborder="0" height="327" scrolling="no" src="https://skydrive.live.com/embed?cid=5585EDB2B546C67F&resid=5585EDB2B546C67F%21121&authkey=AIrpvKpGk7t2IoE&em=2" width="402"></iframe>
377.  
378. <div class="MsoNormal">
379. <br />
380. Key take away points:</div>
381. <ul>
382. <li><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Sjogren’s has a wide spectrum of neurological
383. symptoms, including mononeuritis  multiplex</li>
384. <li><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Treatment for Sjogren’s is symptomatic, unless
385. there are extraglandular manifestations</li>
386. <ul>
387. <li><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Steroids</li>
388. <li><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Cyclophosphamide</li>
389. <li><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Rituxan
390. (rituximab)</li>
391. <li><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Epratuzumab
392. (anti-CD22 mAb)  </li>
393. </ul>
394. </ul>
395. </description><link>http://imedres.blogspot.com/2013/11/resident-report-phil-ge-112613.html</link><author>noreply@blogger.com (ZZTOP)</author><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-5051531751424315978</guid><pubDate>Thu, 14 Nov 2013 21:49:00 +0000</pubDate><atom:updated>2013-11-14T13:56:45.852-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">endocrine</category><category domain="http://www.blogger.com/atom/ns#">OMR</category><category domain="http://www.blogger.com/atom/ns#">thyroid</category><title>OMR Roundup 11/13/13</title><description>&lt;h2&gt;
396. Thyroid Day</h2>
397. <div class="separator" style="clear: both; text-align: center;">
398. <a href="http://1.bp.blogspot.com/-MeCiz-DaNiU/UoVBpEQPYjI/AAAAAAAAATE/7TyFXQuOUaY/s1600/goiter.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-MeCiz-DaNiU/UoVBpEQPYjI/AAAAAAAAATE/7TyFXQuOUaY/s1600/goiter.jpg" height="135" width="200" /></a></div>
399. <div>
400. We started the day with a brief discussion of "to-do list fatigue," an idea prompted by a <a href="http://blogs.jwatch.org/general-medicine">recent Journal Watch blog post</a>.  We also reviewed the <a href="http://jama.jamanetwork.com/article.aspx?articleid=1769902">article by UCLA's institutional leadership</a> in the epic <a href="http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=928805&direction=P">viewpoint-laden JAMA</a> from this week.  We then moved on to dual presentations on the thyroid...</div>
401. <div>
402. <a name='more'></a><br />
403. <b>I recommend Annals' In The Clinic <a href="http://www.ncbi.nlm.nih.gov/pubmed/19949140">Hypothyroidism</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19949140">Hyperthyroidism</a></b> to brush up on the topics from today.<br />
404. <br />
405. <h4>
406. Hypothyroidism</h4>
407. </div>
408. <div>
409. Jeremy Lorber led a discussion of <b>subclinical hypothyroidism</b>.  See his slideshow below for the details of his literature review.  We discussed the meaning of the <a href="http://www.uspreventiveservicestaskforce.org/3rduspstf/thyroid/thyrrs.htm">USPTF "I" rating</a> for population screening and our Health Services guest (Dr. Wong) highlighted the perils of routinely performing "I" items, especially in light of the clinic/health maintenance "to-do list fatigue" mentioned above.</div>
410. <div>
411. <br /></div>
412. <div>
413. Ramin and Colin emailed their favorite subclinical hypothyroidism <a href="http://www.nejm.org/doi/full/10.1056/NEJM200107263450406">review for your consumption</a>.</div>
414. <div>
415. <br />
416. <br />
417. <br /></div>
418. <iframe frameborder="0" height="285px" src="https://skydrive.live.com/embed?cid=5585EDB2B546C67F&resid=5585EDB2B546C67F%21108&authkey=AIPNR2DTm9emJt8&em=2&wdAr=1.3333333333333333" width="350px">This is an embedded <a target='_blank' href='http://office.com'>Microsoft Office</a> presentation, powered by <a target='_blank' href='http://office.com/webapps'>Office Web Apps</a>.</iframe><br />
419. <br />
420. <h4>
421. Hyperthyroidism</h4>
422. <div>
423. Radhika Zopey presented an interesting case of lithium-induced hyperthyroidism.  Check out her slides below:</div>
424. <div>
425. <br /></div>
426. &lt;iframe frameborder=&quot;0&quot; height=&quot;285px&quot; src=&quot;https://skydrive.live.com/embed?cid=5585EDB2B546C67F&amp;amp;resid=5585EDB2B546C67F%21107&amp;amp;authkey=AP8c_MKOyqi1VGc&amp;amp;em=2&amp;amp;wdAr=1.3333333333333333&quot; width=&quot;350px&quot;&gt;This is an embedded &lt;a target=&#39;_blank&#39; href=&#39;http://office.com&#39;&gt;Microsoft Office&lt;/a&gt; presentation, powered by &lt;a target=&#39;_blank&#39; href=&#39;http://office.com/webapps&#39;&gt;Office Web Apps&lt;/a&gt;.&lt;/iframe&gt;</description><link>http://imedres.blogspot.com/2013/11/omr-roundup-111313.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://1.bp.blogspot.com/-MeCiz-DaNiU/UoVBpEQPYjI/AAAAAAAAATE/7TyFXQuOUaY/s72-c/goiter.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-7991967956365237545</guid><pubDate>Sat, 09 Nov 2013 00:29:00 +0000</pubDate><atom:updated>2013-11-13T09:43:13.612-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">resident report</category><title>Resident Report: David Epstein 11-8-2013</title><description>&lt;div class=&quot;&quot; style=&quot;clear: both; text-align: left;&quot;&gt;
427. Today we had an action-packed differential on the ill patient with unknown or known ingestion. David took a little bit of artistic license to inject even more suspense into the case of a young woman who presented with sudden onset of confusion, chest pain, abdominal pain, tachycardia, and hypotension, who also had a history of suicide attempt via ingestion. The cause of the syndrome turned out to be intentional ingestion of potassium cyanide:</div>
428. <div class="separator" style="clear: both; text-align: center;">
429. <a href="https://www.blogger.com/blogger.g?blogID=1186205362940782275" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=1186205362940782275" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://4.bp.blogspot.com/-puFkiQxlu_0/Un17c3inoUI/AAAAAAAAAS4/MOiEshubU3s/s1600/PotassiumCyanide.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-puFkiQxlu_0/Un17c3inoUI/AAAAAAAAAS4/MOiEshubU3s/s1600/PotassiumCyanide.jpg" height="320" width="206" /></a></div>
430. <br />
431. Key take-away points:<br />
432. <ul>
433. <li>Toxic ingestions/exposures are common and can be rapidly fatal.</li>
434. <li>Diagnosis is often clinical and history often unreliable.  Use common toxidromes, vital signs, physical exam, and indirect evidence via labs, blood gas, EKG, to guide therapy.</li>
435. <li>Contact poison control <b>early</b> to help with therapy. </li>
436. <li>Potassium cyanide is a mitochondrial poison and blocks cellular utilization of O2, therefore venous O2 will often be high in these patients, and they are often not hypoxic unless a secondary process is present.</li>
437. </ul>
438. <a href="https://www.blogger.com/blogger.g?blogID=1186205362940782275" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a>Check out David's slides for more details on each toxidrome, available UCLA testing for drug ingestions, and details of cyanide poisoning.<br />
439. <iframe frameborder="0" height="327" scrolling="no" src="https://skydrive.live.com/embed?cid=8B8F89DACD2F264E&resid=8B8F89DACD2F264E%21185&authkey=AF6uhT8ktDLW0FE&em=2" width="402"></iframe>
440.  
441. <br />
442. <b>Interesting fact:</b> the word cyanide derives from the green <i>kyanos-<b> </b></i>meaning blue, as cyanide was first discovered after heating the dye Prussian Blue, with the chemical formula Fe7(CN)18.<br />
443. <br />
444. Cyanide is found in the seeds of members of the Rosaceae family, which includes peaches, apricots, and almonds, which lends it a scent of bitter almonds. One famous quote from the opening line of Gabriel Garcia Marquez's <i>Love in the Time of Cholera</i> makes use of this:<br />
445. <br />
446. &quot;It was inevitable: the scent of bitter almonds always reminded him of the fate of unrequited love.&quot;</description><link>http://imedres.blogspot.com/2013/11/resident-report-david-epstein-11-8-2013.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://4.bp.blogspot.com/-puFkiQxlu_0/Un17c3inoUI/AAAAAAAAAS4/MOiEshubU3s/s72-c/PotassiumCyanide.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-1772966464395901013</guid><pubDate>Thu, 07 Nov 2013 18:48:00 +0000</pubDate><atom:updated>2013-11-07T11:05:40.103-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">resident report</category><title>Resident Report: Radhika Zopey 11-5-13</title><description>&lt;a href=&quot;https://www.blogger.com/blogger.g?blogID=1186205362940782275&quot; imageanchor=&quot;1&quot; style=&quot;clear: left; float: left; margin-bottom: 1em; margin-right: 1em;&quot;&gt;&lt;/a&gt;Radhika presented a head scratcher of a case of a young woman with pmh of small bowel resection secondary to trauma, no other medical history, who presented with several months of intermittent confusion, ataxia, and dyarthria that occurred intermittently and resolved spontaneously, found on workup to have an anion gap metabolic acidosis with a negative lactate. She turned out to have D-lactic acidosis due to short gut syndrome/small bowel bacterial overgrowth. Dr. Reza Khorsan and Dr. Sharad Patel helped shed some light on this rare condition.&lt;br /&gt;
447. <div style="text-align: left;">
448. <a href="https://www.blogger.com/blogger.g?blogID=1186205362940782275" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><ul>
449. <li>This patient presented with the classical findings of D-lactic acidosis in short gut/small bowel bacterial overgrowth: intermittent confusion and ataxia, especially after high carbohydrate meals.</li>
450. <li>D-lactic acidosis is produced by gut bacteria (eukaryotic cells produce L-lactic acid).</li>
451. <li>Normal lab assays for lactate do NOT pick up D-lactic acid. Special send out lab for D-lactic acid takes several days to result (normal value is 0).</li>
452. <li>Other causes of D-lactic acidosis are rare and include certain peritoneal dialysis fluids, high dose lorazepam infusion (from high dose propylene glycol), and diabetic ketoacidosis due to metabolism of acetone to D-lactic acidosis.</li>
453. <li>Treatment of D-lactic acidosis due to short gut syndrome is empiric in most cases and involves low-carbohydrate diet and antibiotics.</li>
454. </ul>
455. Read more about it in this <a href="https://drive.google.com/file/d/0B_Q3YX0wAjTELU5lU3RpSVVvVmM/edit?usp=sharing">1998 review of D-lactic acidosis.</a><br />
456. <h3>
457. Radhika's PowerPoint presentation:
458. </h3>
459. </div>
460. &lt;iframe frameborder=&quot;0&quot; height=&quot;327&quot; scrolling=&quot;no&quot; src=&quot;https://skydrive.live.com/embed?cid=8B8F89DACD2F264E&amp;amp;resid=8B8F89DACD2F264E%21160&amp;amp;authkey=AGlrs8naQRLQ1eQ&amp;amp;em=2&quot; width=&quot;402&quot;&gt;&lt;/iframe&gt;</description><link>http://imedres.blogspot.com/2013/11/resident-report-radhika-zopey-11-5-13.html</link><author>noreply@blogger.com (ZZTOP)</author><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-4427389786474083173</guid><pubDate>Wed, 06 Nov 2013 19:46:00 +0000</pubDate><atom:updated>2013-11-06T11:52:58.964-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">contraception</category><category domain="http://www.blogger.com/atom/ns#">OMR</category><category domain="http://www.blogger.com/atom/ns#">women&#39;s health</category><title>OMR Roundup 11-6-13</title><description>&lt;h2&gt;
461. Contraception Day!</h2>
462. <div class="separator" style="clear: both; text-align: center;">
463. <a href="http://1.bp.blogspot.com/-btKwlUULJJw/UnqZh5LsU1I/AAAAAAAAASg/HU4L5OmruIA/s1600/contraception.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-btKwlUULJJw/UnqZh5LsU1I/AAAAAAAAASg/HU4L5OmruIA/s1600/contraception.jpg" height="151" width="320" /></a></div>
464. <br />
465. <br />
466. We discussed several cases from the resident clinic that highlight the trials and tribulations of <b>contraception counseling</b> in General Internal Medicine Clinic. Thanks to our guest <a href="http://www.uclahealth.org/body.cfm?id=479&action=detail&ref=122943">Aparna Sridhar</a> from Obstetrics & Gynecology!<br />
467. <br />
468. <a name='more'></a><br />
469. We started by discussing the utility of the CDC’s United States Medical Eligibility Criteria.  <a href="https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewSoftware?id=595752188&mt=8">Get the free app!</a><br />
470. <br />
471. <div class="separator" style="clear: both; text-align: center;">
472. <a href="http://4.bp.blogspot.com/-c7PRtbqzBKQ/UnqZecWqmgI/AAAAAAAAAR8/clXSycnZiFY/s1600/app.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-c7PRtbqzBKQ/UnqZecWqmgI/AAAAAAAAAR8/clXSycnZiFY/s1600/app.jpg" height="273" width="320" /></a></div>
473. <br />
474. <br />
475. <h4>
476. Highlights of the day:</h4>
477. <div>
478. <br /></div>
479. Radhika Zopey presented a case that involved combined oral contraceptive <b>quick start</b>.  This means assessing the possibility that the patient is pregnant at the time of the visit.  See the algorithm below:<br />
480. <div class="separator" style="clear: both; text-align: center;">
481. <a href="http://4.bp.blogspot.com/-y36ppYi-HzY/UnqZfu0ClVI/AAAAAAAAASQ/KqkfECaxKBM/s1600/quickstart.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-y36ppYi-HzY/UnqZfu0ClVI/AAAAAAAAASQ/KqkfECaxKBM/s1600/quickstart.jpg" height="320" width="284" /></a></div>
482. <br />
483. <div style="text-align: center;">
484. <span style="font-size: x-small;">Lesnewski R, Prine L. Initiating hormonal contraception. Am Fam Physician. 2006;74(1):105–112. <a href="http://www.aafp.org/afp/2006/0701/p105.html">Link</a>.</span></div>
485. <div style="text-align: center;">
486. <br /></div>
487. Unfortunately, this patient returned with vaginal bleeding and a <b>positive urine pregnancy test</b>.  We discussed methods for improving adherence to COCs, including phone apps and text messaging (and counseling at the time of contraceptive start). There is not much data in this area, but a recent <a href="http://summaries.cochrane.org/CD004317/ways-to-improve-use-of-hormonal-birth-control">Cochrane review</a> is available:<br />
488. <br />
489. <blockquote class="tr_bq">
490. “More women who got the structured counseling kept using the birth control than women who had the usual counseling. Also, fewer women who had the structured counseling stopped using the birth control due to bleeding changes. Another study gave special counseling with or without follow-up calls. In the short-term, more women with counseling and phone calls said they took the birth control pills regularly than those without phone calls or those with usual care. The third study sent text-message reminders to cell phones about birth control pills plus health information. More women in the text-message group were still taking their pills at six months than women with standard care.” </blockquote>
491. <br />
492. Aparna recommended checking out the website: <a href="http://bedsider.org/">bedsider.org</a>.  They can send text reminders to your patient!<br />
493. <div class="separator" style="clear: both; text-align: center;">
494. <a href="http://1.bp.blogspot.com/-2ud4hIr3Aac/UnqZgDLIatI/AAAAAAAAASc/8DxrBKyEys8/s1600/reminder.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-2ud4hIr3Aac/UnqZgDLIatI/AAAAAAAAASc/8DxrBKyEys8/s1600/reminder.jpg" height="132" width="320" /></a></div>
495. <br />
496. <br />
497. In another case, we discussed a 26yo who requested Yaz by name. Jennifer Chew counseled the patient on the VTE publicity/risk from a <a href="http://www.bmj.com/content/343/bmj.d6423">recent BMJ article</a>, and we discussed that the risk is overall very low.  The BMJ study states: “To prevent one event of VTE in one year about 2000 women should shift from ... drospirenone to ... levonorgestrel.”  The patient developed headaches and stopped her contraception, coming back in for a prescription for plan B after a condom broke. <br />
498. <br />
499. We discussed headaches in patients on oral contraceptives:<br />
500. <br />
501. <div class="separator" style="clear: both; text-align: center;">
502. <a href="http://1.bp.blogspot.com/-ziZPGfGj3GQ/UnqZeXC5UzI/AAAAAAAAARw/i8gnWcaA5b0/s1600/HA1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-ziZPGfGj3GQ/UnqZeXC5UzI/AAAAAAAAARw/i8gnWcaA5b0/s1600/HA1.jpg" height="228" width="320" /></a></div>
503. <br />
504. <div class="separator" style="clear: both; text-align: center;">
505. <a href="http://3.bp.blogspot.com/-xP-qdMrvWoQ/UnqZeaSsRZI/AAAAAAAAAR4/zITuIaS-7BA/s1600/HA2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-xP-qdMrvWoQ/UnqZeaSsRZI/AAAAAAAAAR4/zITuIaS-7BA/s1600/HA2.jpg" height="227" width="320" /></a></div>
506. <div class="separator" style="clear: both; text-align: center;">
507. <br /></div>
508. <div style="text-align: center;">
509. <span style="font-size: x-small;">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938905/</span></div>
510. <br />
511. We also touched upon emergency contraception (<a href="http://www.ncbi.nlm.nih.gov/pubmed/20410799">ACOG guidelines</a>), with may be obtained OTC or with your prescription.  A single dose of 1.5 mg Levonorgestrel is the current recommendation.<br />
512. <div class="separator" style="clear: both; text-align: center;">
513. <a href="http://2.bp.blogspot.com/-xD3Ru4-MRZs/UnqZfGdAnuI/AAAAAAAAASE/qIOSTZfhX9s/s1600/emergency.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-xD3Ru4-MRZs/UnqZfGdAnuI/AAAAAAAAASE/qIOSTZfhX9s/s1600/emergency.jpg" height="192" width="320" /></a></div>
514. <br />
515. Search for EC near you: <a href="http://ec.princeton.edu/">http://ec.princeton.edu/</a><br />
516. <div class="separator" style="clear: both; text-align: center;">
517. <a href="http://3.bp.blogspot.com/-AOgUg78hVTs/UnqZfTFoj-I/AAAAAAAAASU/sS8UlgOeWAM/s1600/emergency2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-AOgUg78hVTs/UnqZfTFoj-I/AAAAAAAAASU/sS8UlgOeWAM/s1600/emergency2.jpg" height="240" width="320" /></a></div>
518. <br />
519. <div>
520. <br /></div>
521. <div>
522. <br /></div>
523. </description><link>http://imedres.blogspot.com/2013/11/omr-roundup-11-6-13.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://1.bp.blogspot.com/-btKwlUULJJw/UnqZh5LsU1I/AAAAAAAAASg/HU4L5OmruIA/s72-c/contraception.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-8309503625051938212</guid><pubDate>Sun, 03 Nov 2013 01:46:00 +0000</pubDate><atom:updated>2013-11-07T15:05:17.921-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">acp</category><title>ACP regionals!</title><description>&lt;div&gt;
524. Congratulations to Asha Mansukhani for 3rd place clinical vignette!</div>
525. <div>
526. <br /></div>
527. <div>
528. And congratulations to our three-peat jeopardy champions, you're going to Orlando for nationals, Kali, Nimesh, and Brian!! (Bring your mosquito repellant)</div>
529. <br />
530. <div class="separator" style="clear: both;">
531. <a href="https://lh6.googleusercontent.com/-a16a_G0K8_Q/UnWuuFiMK7I/AAAAAAAAAQ4/nLhbCp2JsPU/s640/blogger-image-1368244909.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://lh6.googleusercontent.com/-a16a_G0K8_Q/UnWuuFiMK7I/AAAAAAAAAQ4/nLhbCp2JsPU/s320/blogger-image-1368244909.jpg" width="320" /></a><a href="https://www.blogger.com/blogger.g?blogID=1186205362940782275" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></div>
532. <div class="" style="clear: both;">
533. And your gloating chiefs:</div>
534. <div class="separator" style="clear: both;">
535. </div>
536. <div class="separator" style="clear: both;">
537. <a href="https://lh5.googleusercontent.com/-bs55Y7ItPKc/UnWwaxocdZI/AAAAAAAAARE/ooMNcfskGug/s640/blogger-image--1507403025.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://lh5.googleusercontent.com/-bs55Y7ItPKc/UnWwaxocdZI/AAAAAAAAARE/ooMNcfskGug/s320/blogger-image--1507403025.jpg" width="320" /></a></div>
538. &lt;br /&gt;</description><link>http://imedres.blogspot.com/2013/11/acp-regionals.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="https://lh6.googleusercontent.com/-a16a_G0K8_Q/UnWuuFiMK7I/AAAAAAAAAQ4/nLhbCp2JsPU/s72-c/blogger-image-1368244909.jpg" height="72" width="72"/><thr:total>0</thr:total><georss:featurename>Marina del Rey Marriott 4100 Admiralty Way, Marina del Rey</georss:featurename><georss:point>33.982552 -118.459065</georss:point></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-7683144310091398417</guid><pubDate>Fri, 01 Nov 2013 17:40:00 +0000</pubDate><atom:updated>2013-11-06T10:44:05.433-08:00</atom:updated><title>Care Harbor L.A.</title><description>Glad to see a great group of residents at &lt;a href=&quot;http://www.latimes.com/local/lanow/la-me-ln-thousands-pour-into-la-sports-arena-for-free-medical-dental-care-20131031,0,6348459.story#axzz2jPoNhuRd&quot;&gt;Care Harbor L.A.&lt;/a&gt; yesterday! &amp;nbsp;Send more photos from the groups today and over the weekend!&lt;br /&gt;
539. <br />
540. <div class="separator" style="clear: both; text-align: center;">
541. <a href="http://3.bp.blogspot.com/-jTU5_Mj386U/UnPmkWibsPI/AAAAAAAAAQo/djwg8nzuHFE/s1600/careharbor.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-jTU5_Mj386U/UnPmkWibsPI/AAAAAAAAAQo/djwg8nzuHFE/s1600/careharbor.jpg" height="240" width="320" /></a></div>
542. <div class="separator" style="clear: both; text-align: center;">
543. <br /></div>
544. <div class="separator" style="clear: both; text-align: center;">
545. <a href="http://web3.streamhoster.com/rpvideo/careharborweb4.mov">http://web3.streamhoster.com/rpvideo/careharborweb4.mov</a></div>
546. <div class="separator" style="clear: both; text-align: center;">
547. <br /></div>
548. </description><link>http://imedres.blogspot.com/2013/11/care-harbor-la.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://3.bp.blogspot.com/-jTU5_Mj386U/UnPmkWibsPI/AAAAAAAAAQo/djwg8nzuHFE/s72-c/careharbor.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-4594505661887727854</guid><pubDate>Thu, 31 Oct 2013 00:33:00 +0000</pubDate><atom:updated>2013-10-30T17:53:16.875-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">medical decisions</category><category domain="http://www.blogger.com/atom/ns#">menopause</category><category domain="http://www.blogger.com/atom/ns#">OMR</category><category domain="http://www.blogger.com/atom/ns#">osteoporosis</category><category domain="http://www.blogger.com/atom/ns#">women&#39;s health</category><title>OMR Roundup 10/30/13</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;
549. <a href="http://4.bp.blogspot.com/-3ozA14U0F70/UnGgAaD_ZQI/AAAAAAAAAPw/vTZ55WQyKxo/s1600/book.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-3ozA14U0F70/UnGgAaD_ZQI/AAAAAAAAAPw/vTZ55WQyKxo/s1600/book.jpg" height="320" width="251" /></a></div>
550. <br />
551. We had a special session today on women’s health; thank you Dr. Pregler for leading a discussion of challenging clinic cases!<br />
552. <br />
553. At the beginning of the session, we touched on recent publications about <b>patient-centered guidelines</b>, the <b>Camden Coalition</b>, and then went on to the discussion of <b>hormone therapy in menopause</b> and <b>osteoporosis</b> uncertainties.<br />
554. <a name='more'></a><br />
555. <h4>
556. Recent topics</h4>
557. <b><br /></b>
558. <b>1. “Incorporating Patient Preferences in Practice Guidelines”</b> - check out <a href="http://jama.jamanetwork.com/article.aspx?articleid=1763247">this JAMA article</a>. <br />
559. My favorite line: “Clinicians should remember that taking care of patients is supposed to be difficult. Although guidelines may simplify this task, when patient preferences and context matter, guidelines must not replace clinicians’ compassionate and mindful engagement of the patient in making decisions together.”<br />
560. <br />
561. <br />
562. <b>2. Macarthur Fellows “genius” awards</b> - this summer, we discussed innovation in managing complex “frequent flyers” with reference to <a href="http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande">Atul Gawande’s article</a>.  By way of follow-up, the founder of the Camden Coalition that is described in the article was <a href="http://www.macfound.org/fellows/886/">just awarded a Macarthur fellowship</a>.  <a href="http://podcasts.jwatch.org/index.php/podcast-168-the-camden-coalitions-work-on-alleviating-the-discontinuity-of-medical-care/2013/09/25/">Listen to an interview</a> on JournalWatch.<br />
563. <div>
564. <br /></div>
565. <div class="separator" style="clear: both; text-align: center;">
566. <a href="http://1.bp.blogspot.com/-nf7q5_uu92o/UnGgAhyrKOI/AAAAAAAAAQI/hp4sV2zhfaY/s1600/Camden.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-nf7q5_uu92o/UnGgAhyrKOI/AAAAAAAAAQI/hp4sV2zhfaY/s1600/Camden.jpg" height="256" width="320" /></a></div>
567. <div class="separator" style="clear: both; text-align: left;">
568. <br /></div>
569. <h4>
570. Hormone therapy</h4>
571. Patrick Ahearn discussed a 56-year-old complex patient who he is treating for peri-menopausal hot flashes.  She had failed a trial of venlafaxine previously and was started on low-dose Prempro with good effect.  We discussed shared decision-making for hormone therapy in peri/postmenopausal patients. Here’s an example <a href="https://www.healthwise.net/cochranedecisionaid/Content/StdDocument.aspx?DOCHWID=aa114076">shared-decision tool</a>. <br />
572. <b><br /></b>
573. <b>Highlights of the discussion:</b><br />
574. <br />
575. <ul>
576. <li>Contraindications to Hormone therapy</li>
577. <ul>
578. <li>Did you know that pancreatitis and nephrolithiasis are on the list?  </li>
579. <li>More commonly known: VTE, CVA, CAD, breast ca, liver disease, undiagnosed abnormal vaginal bleeding</li>
580. <li>Migraines are not a contraindication</li>
581. </ul>
582. <li>Stopping Hormone Therapy</li>
583. <ul>
584. <li>Most women stop on their own in 1-2 years</li>
585. <li>Abrupt withdrawal may precipitate hot flashes</li>
586. <li>Taper may be better tolerated</li>
587. <ul>
588. <li>UTD: Reduce by 1 pill/wk vs more prolonged</li>
589. <li>Consider non-hormone alternatives – SSRI, SNRI, gabapentin</li>
590. </ul>
591. <li>Many women on prolonged tx (>3yr) resume despite attempts to taper; must counsel risks</li>
592. </ul>
593. </ul>
594. <h4>
595. </h4>
596. <h4>
597. Bone Health</h4>
598. <br />
599. <div>
600. <div>
601. <br /></div>
602. <div>
603. Ramin Salehi-Rad and Bryan Garber discussed challenging bone health cases.  We know to screen women >65yo or with risk equivalent to 65 with a DEXA, but we don’t know <b>how often to screen</b>, <b>how long to treat</b>, and <b>how to monitor response to treatment</b>.  Dr. Pregler helped us to untangle some of these issues in a practical way, acknowledging the knowledge gaps in the field.  Please see the <a href="https://docs.google.com/presentation/d/1YqQA1UrHd8hGAnjfhpNpF3BqlvUJ11GHMlWh0OKlrUs/edit?usp=sharing">slides from Drs. Pregler/Cradall</a> for great learning points.</div>
604. <div>
605. <br /></div>
606. <b>Items of interest:</b><br />
607. <div style="text-align: center;">
608. Guidelines from various professional societies</div>
609. <div class="separator" style="clear: both; text-align: center;">
610. <a href="http://1.bp.blogspot.com/-IPr6OxKVTT4/UnGgBHmOLwI/AAAAAAAAAQQ/sMWDk3q77tQ/s1600/guidelines.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-IPr6OxKVTT4/UnGgBHmOLwI/AAAAAAAAAQQ/sMWDk3q77tQ/s1600/guidelines.jpg" height="86" width="320" /></a></div>
611. <div style="text-align: center;">
612. <br /></div>
613. <div style="text-align: center;">
614. Highlights of risk factors in men (<a href="http://annals.org/content/148/9/680.full">article</a>)</div>
615. <div>
616. <br /></div>
617. <div class="separator" style="clear: both; text-align: center;">
618. <a href="http://3.bp.blogspot.com/-R9dGMHAnkWs/UnGgBUH2G0I/AAAAAAAAAQY/04rIIZKlagU/s1600/men.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-R9dGMHAnkWs/UnGgBUH2G0I/AAAAAAAAAQY/04rIIZKlagU/s1600/men.jpg" height="292" width="320" /></a></div>
619. <div style="text-align: center;">
620. Ramin has one male patient who runs marathons but developed an <b>insufficiency fracture due to leuprolide</b> (Lupron) treatment!<br />
621. <br />
622. <div style="text-align: left;">
623. David Epstein spoke up and told the group to think of <b>screening their HIV patients</b> as well, especially those on Tenofovir. There is a <a href="http://cid.oxfordjournals.org/content/51/8/937.long">guideline</a> recommending screening in HIV patients >50 years old.</div>
624. </div>
625. <div style="text-align: center;">
626. <br /></div>
627. <div style="text-align: left;">
628. The <b>FDA admits to uncertainty</b> in their <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1202619">NEJM Perspective article.</a>  “The available data on long-term efficacy do not clearly identify subgroups of patients who are more likely to benefit from drug therapy beyond 3 to 5 years. Nevertheless, the emergence of safety concerns warrants consideration of new treatment algorithms for patients with osteoporosis. The available data do suggest that bisphosphonates may be safely discontinued in some patients without compromising therapeutic gains, but no adequate clinical trials have yet delineated how long the drugs' benefits are maintained after cessation.” <b>My favorite line:</b> “To optimize the efficacy of bisphosphonates in reducing fracture risk, decisions to continue treatment must be based on individual assessment of risks and benefits and on patient preference.” </div>
629. <div>
630. <br /></div>
631. <div>
632. If you haven’t played with the Mayo Clinic decision aids, <a href="http://osteoporosisdecisionaid.mayoclinic.org/index.php/osteo/index">this one</a> is worth checking out!</div>
633. </div>
634. <div class="separator" style="clear: both; text-align: center;">
635. <a href="http://2.bp.blogspot.com/-tkPPSumP1bk/UnGgBJO8iHI/AAAAAAAAAQc/jqY6ctBiE-U/s1600/mayo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-tkPPSumP1bk/UnGgBJO8iHI/AAAAAAAAAQc/jqY6ctBiE-U/s1600/mayo.jpg" height="225" width="320" /></a></div>
636. <div>
637. <br /></div>
638. <div>
639. For your phone - it's $6.  Buy it.</div>
640. <div class="separator" style="clear: both; text-align: center;">
641. <a href="http://2.bp.blogspot.com/-Qe0SUmmSDx4/UnGgAnDj64I/AAAAAAAAAQE/88FSTIRBt10/s1600/frax.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Qe0SUmmSDx4/UnGgAnDj64I/AAAAAAAAAQE/88FSTIRBt10/s1600/frax.jpg" height="200" width="134" /></a></div>
642. <div>
643. <br /></div>
644. <div>
645. <br /></div>
646. <div>
647. <br /></div>
648. </description><link>http://imedres.blogspot.com/2013/10/omr-roundup-103013.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://4.bp.blogspot.com/-3ozA14U0F70/UnGgAaD_ZQI/AAAAAAAAAPw/vTZ55WQyKxo/s72-c/book.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-7383317189002593414</guid><pubDate>Tue, 29 Oct 2013 19:02:00 +0000</pubDate><atom:updated>2013-10-29T12:02:49.458-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">advance directive</category><category domain="http://www.blogger.com/atom/ns#">OMR</category><title>OMR Roundup/Catchup 10/9/13</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;
649. <a href="http://4.bp.blogspot.com/-jBICliWbBxg/UnAFH2-uUMI/AAAAAAAAAPQ/PQ9ce8cMJhM/s1600/AmiOMR.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-jBICliWbBxg/UnAFH2-uUMI/AAAAAAAAAPQ/PQ9ce8cMJhM/s1600/AmiOMR.jpg" height="195" width="200" /></a></div>
650. <div style="font-family: Helvetica; font-size: 12px;">
651. <br /></div>
652. <div style="font-family: Helvetica; font-size: 12px;">
653. It was such a good Outpatient Morning that I had to post, even though it’s weeks late!  </div>
654. <div style="font-family: Helvetica; font-size: 12px;">
655. <br /></div>
656. <div style="font-family: Helvetica; font-size: 12px;">
657. Ami Thakor presented several cases highlighting the importance of <b>Advance Directives in the outpatient setting</b>.  Check out <a href="https://drive.google.com/file/d/0B0-L-nnozOOUY0s2Tk93LTYxVGM/edit?usp=sharing">her presentation</a>.<br />
658. <a name='more'></a></div>
659. <div style="font-family: Helvetica; font-size: 12px; min-height: 14px;">
660. <br /></div>
661. <div style="font-family: Helvetica; font-size: 12px;">
662. For further exploration, check out this <a href="http://www.aafp.org/afp/2012/0301/p461.html">AFP article</a> (<a href="http://www.aafp.org/afp/2012/0301/p461.pdf">pdf link</a>).  Are you discussing advance directives with your 50-year-old patients?</div>
663. <br />
664. <div class="separator" style="clear: both; text-align: center;">
665. <a href="http://4.bp.blogspot.com/-Ohux70245YU/UnAFKKpdFoI/AAAAAAAAAPY/iAps-HRBMhw/s1600/table.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-Ohux70245YU/UnAFKKpdFoI/AAAAAAAAAPY/iAps-HRBMhw/s1600/table.jpg" height="177" width="320" /></a></div>
666. <br />
667. <div style="font-family: Helvetica; font-size: 12px;">
668. We now have the ability to <b>track POLST status in CareConnect</b>, see it listed in the banner at the top of a patient’s chart as “POLST on file.”  The front desk needs to help mark the POLST as received to update this flag in CareConnect.  </div>
669. <div style="font-family: Helvetica; font-size: 12px;">
670. <br /></div>
671. <div style="font-family: Helvetica; font-size: 12px;">
672. <b>Try to complete a POLST when discharging patients from the hospital who have expressed specific wishes to limit care.  </b>Keep in mind that it is less useful for “full care” patients to have a POLST on file, and may discourage future providers from re-discussing goals of care when clinical status changes.  Looking forward to future QI on this front!</div>
673. <div style="font-family: Helvetica; font-size: 12px;">
674. <br /></div>
675. <div style="font-family: Helvetica; font-size: 12px;">
676. Ami ended with the obligatory pet photo... </div>
677. <div>
678. <br /></div>
679. <div class="separator" style="clear: both; text-align: center;">
680. <a href="http://3.bp.blogspot.com/-1SFkF4DAVvE/UnAFMZ7ORKI/AAAAAAAAAPg/bYF5VPWGoS4/s1600/amidog.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-1SFkF4DAVvE/UnAFMZ7ORKI/AAAAAAAAAPg/bYF5VPWGoS4/s1600/amidog.jpg" height="320" width="199" /></a></div>
681. &lt;br /&gt;</description><link>http://imedres.blogspot.com/2013/10/omr-roundupcatchup-10913.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://4.bp.blogspot.com/-jBICliWbBxg/UnAFH2-uUMI/AAAAAAAAAPQ/PQ9ce8cMJhM/s72-c/AmiOMR.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-717581380012899243</guid><pubDate>Mon, 28 Oct 2013 04:16:00 +0000</pubDate><atom:updated>2013-10-27T21:28:12.745-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">ebv</category><category domain="http://www.blogger.com/atom/ns#">hcm</category><category domain="http://www.blogger.com/atom/ns#">lgbt</category><category domain="http://www.blogger.com/atom/ns#">OMR</category><title>OMR Roundup 10/23/13</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;
682. <a href="http://4.bp.blogspot.com/--wU4tln0lmY/Um3ffcMTZTI/AAAAAAAAAOc/qmzn6lrozRU/s1600/Kiss.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/--wU4tln0lmY/Um3ffcMTZTI/AAAAAAAAAOc/qmzn6lrozRU/s1600/Kiss.jpg" height="320" width="320" /></a></div>
683. <br />
684. <div>
685. <div>
686. Last week (10/23), Katrina Lam presented an outpatient case of <b>EBV pharyngitis</b> - mono - acquired by kissing an exotic dancer in Las Vegas.  Her slides took us through presentations of EBV, common and uncommon.  With our remaining time, we discussed aspects of <b>primary care for transgender patients</b>.</div>
687. <div>
688. </div>
689. <div>
690. <a name='more'></a><h4>
691. Infectious Mononucleosis</h4>
692. </div>
693. <div>
694. <ul>
695. <li>We learned that adults (>40yo) are more likely to present with fevers and abnormal LFTs, (less likely to have pharyngitis and lymphadenopathy).  <b>Monospot is the test of choice</b>, but with 85% sensitivity, may need VCA (viral capsid antigen) IgM backup (97% sensitive). </li>
696. <li>Current practice is to advise a delay in return to sports for 3 weeks (non-contact) or 4 weeks (contact); splenic rupture is rare after 4 weeks.  Corticosteroids are not recommended unless there is airway compromise. </li>
697. <li>Beware the potential complications: AIN, hemolytic anemia, myocarditis, cardiac conduction abnormalities, cranial nerve palsies, encephalitis, meningitis, thrombocytopenia, upper airway obstruction, bacterial pharyngitis/abscess.</li>
698. </ul>
699. </div>
700. <div>
701. Check out the <a href="http://www.aafp.org/afp/2004/1001/p1279.pdf">AFP review</a> on the subject.  Here's their algorithm:</div>
702. </div>
703. <div class="separator" style="clear: both; text-align: center;">
704. <a href="http://3.bp.blogspot.com/-eFtcOR0sn2Q/Um3gk0kwf6I/AAAAAAAAAOk/yQC0uzp_YlI/s1600/algorithm.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-eFtcOR0sn2Q/Um3gk0kwf6I/AAAAAAAAAOk/yQC0uzp_YlI/s1600/algorithm.jpg" height="212" width="320" /></a></div>
705. <div>
706. <br /></div>
707. <h4>
708. Primary Care for Transgender Patients</h4>
709. <div>
710. <ul>
711. <li>We reviewed the <a href="http://dx.doi.org/10.1080/15532739.2011.700873">guidelines in existence</a>, acknowledging that there is no level 1 evidence to guide care in this vulnerable population.</li>
712. </ul>
713. </div>
714. <div>
715. <ul>
716. <li>We briefly touched on hormone therapy risks from the above guideline: </li>
717. </ul>
718. <div class="separator" style="clear: both; text-align: center;">
719. <a href="http://1.bp.blogspot.com/-_7DHj2DvvU0/Um3i5YGweJI/AAAAAAAAAO4/GDT2kOqkX5c/s1600/risks.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-_7DHj2DvvU0/Um3i5YGweJI/AAAAAAAAAO4/GDT2kOqkX5c/s1600/risks.jpg" height="217" width="320" /></a></div>
720. <div class="separator" style="clear: both; text-align: center;">
721. <br /></div>
722. <div class="separator" style="clear: both; text-align: left;">
723. </div>
724. <ul>
725. <li>For the remainder of the dissuasion, we used a <a href="http://transhealth.ucsf.edu/trans?page=protocol-00-00">helpful website</a> for primary care / transgender health from the UCSF center. </li>
726. </ul>
727. <br />
728. <div class="separator" style="clear: both; text-align: center;">
729. <a href="http://4.bp.blogspot.com/-LO1L2ASuDX0/Um3h4UOWLzI/AAAAAAAAAOw/qozirgNW33Q/s1600/banner.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-LO1L2ASuDX0/Um3h4UOWLzI/AAAAAAAAAOw/qozirgNW33Q/s1600/banner.jpg" height="64" width="320" /></a></div>
730. </div>
731. <div>
732. <ul>
733. <li><b><u>  Highlights:</u></b></li>
734. <ul>
735. <li><b>Cancer screening</b></li>
736. <ul>
737. <li>Same criteria as persons of their natal sex</li>
738. <li>Exceptions:</li>
739. <ul>
740. <li>cross-sex hormones </li>
741. <li>gender-affirming surgery</li>
742. </ul>
743. <li><u>Transwomen (MTF)</u></li>
744. <ul>
745. <li>Mammography if age >50 AND additional risk factors</li>
746. <ul>
747. <li>Estrogen and progestin use > 5 years</li>
748. <li>Positive family history</li>
749. <li>BMI > 35</li>
750. </ul>
751. <li>Pap smears in neovaginas are not indicated (speculum exam recommended for STI)</li>
752. <li>Standard screening for other cancers</li>
753. </ul>
754. <li><u>Transmen (FTM), with hormone use</u></li>
755. <ul>
756. <li>Breast</li>
757. <ul>
758. <li>Annual chest wall/axillary exam</li>
759. <li>Mammo not needed following chest reconstruction </li>
760. </ul>
761. <li>Cervical</li>
762. <ul>
763. <li>Depends if cervix/uterus intact, if prior hx dysplasia</li>
764. <li>Inform path (testosterone-atrophy mimic dysplasia)</li>
765. </ul>
766. <li>Uterine: evaluate vaginal bleeding as for post-menopausal natal females</li>
767. <ul>
768. <li>Exception – clear reason (missed or excessive testosterone doses, weight changes, thyroid disorders)</li>
769. </ul>
770. <li>Standard screening for other cancers</li>
771. </ul>
772. </ul>
773. <li><b>Physical exam</b></li>
774. <ul>
775. <li>Examine anatomy that is present, rather than the perceived gender.</li>
776. <li>Always refer to and treat the patient socially as their preferred gender. </li>
777. <li>Allow patients to specify the gender of chaperone.</li>
778. <li>"Unless there is an immediate medical need, sensitive elements of the exam particularly delay breast, genital and rectal exams until strong clinical-patient rapport has developed.”</li>
779. <li>"You will see a range of development in patients undergoing hormone therapy.” </li>
780. <li>"Physical findings in post-operative patients will depend on the types of surgeries which have been done, the quality of the surgical work, the impact of post-operative complications, and any revisions that have been performed after the initial surgery.”</li>
781. </ul>
782. <li><b>EHR/Insurance issues</b></li>
783. <ul>
784. <li>EMRs make it difficult to change specified sex</li>
785. <li>Office issues: Waiting room, restrooms, etc</li>
786. <li>Insurance: Coding systems provide certain procedures for individuals of specific sex</li>
787. <li>“Physicians or their support staff members may need to interact with insurance claims processors on behalf of their transgender or transsexual patients to insist that medically necessary treatments are covered. In such interactions it will be necessary to support the patient's preferred gender in relationship to the insurance company in the best interests of the patient's health.”</li>
788. </ul>
789. <li><b>Mental health</b></li>
790. <ul>
791. <li>Depression, PTSD, anxiety are common</li>
792. <li>Mental health providers may not be familiar with transgender issues</li>
793. <li>Referral to psychotherapy when starting hormones is standard (unless PMD expertise)</li>
794. <li>Recommends hormone rx if patient is determined and will use “street” hormones if no physician rx</li>
795. </ul>
796. </ul>
797. </ul>
798. </div>
799. </description><link>http://imedres.blogspot.com/2013/10/omr-roundup-102313.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://4.bp.blogspot.com/--wU4tln0lmY/Um3ffcMTZTI/AAAAAAAAAOc/qmzn6lrozRU/s72-c/Kiss.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-5049815944224603025</guid><pubDate>Fri, 25 Oct 2013 23:41:00 +0000</pubDate><atom:updated>2013-11-06T10:23:27.858-08:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">cardiology</category><category domain="http://www.blogger.com/atom/ns#">infective endocarditis</category><category domain="http://www.blogger.com/atom/ns#">resident report</category><title>Resident Report: Colin Robinson 10-25-13</title><description>&lt;table align=&quot;center&quot; cellpadding=&quot;0&quot; cellspacing=&quot;0&quot; class=&quot;tr-caption-container&quot; style=&quot;margin-left: auto; margin-right: auto; text-align: center;&quot;&gt;&lt;tbody&gt;
800. <tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-VckYzrPcLuQ/UmsBNH95LQI/AAAAAAAAAOM/bcMWWiPT_-w/s1600/stjudemedicalmechhv_hr.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://3.bp.blogspot.com/-VckYzrPcLuQ/UmsBNH95LQI/AAAAAAAAAOM/bcMWWiPT_-w/s1600/stjudemedicalmechhv_hr.jpg" /></a></td></tr>
801. <tr><td class="tr-caption" style="text-align: center;">St. Jude Prosthetic Heart Valve</td></tr>
802. </tbody></table>
803. Today we had an exciting of prosthetic valve endocarditis precepted by adult congenital cardiology expert Dr. Jamil Aboulhosn and ID guru Dr. Zachary Rubin. The case presented some difficult management decisions including whether or not to anticoagulate in the setting of acute embolic strokes and large prosthetic valve vegetation and the timing of valve surgery in high risk patients with prosthetic valve endocarditis.<br />
804. <br />
805. A couple of key teaching points:<br />
806. <ul>
807. <li>Embolic strokes due to infective endocarditis is NOT a contraindication to cardiac surgery and heparin anticoagulation associated with cardiopulmonary bypass. While there is concern for hemorrhagic transformation of septic emboli, if source control cannot be achieved in these patients they are unlikely to do well.</li>
808. <li>Surgery is indicated for complicated infective endocarditis and should be pursued early on in the course of diagnosis and management if clinically indicated.</li>
809. <li>TEE is the initial test of choice for patients with prosthetic valves in whom IE is suspected.</li>
810. </ul>
811. Check out &lt;a href=&quot;https://drive.google.com/file/d/0B_Q3YX0wAjTEZXp2UzctUlZPYU0/edit?usp=sharing&quot;&gt;Colin&#39;s slides&lt;/a&gt; for more on these debates!</description><link>http://imedres.blogspot.com/2013/10/resident-report-colin-robinson-10-25-13.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://3.bp.blogspot.com/-VckYzrPcLuQ/UmsBNH95LQI/AAAAAAAAAOM/bcMWWiPT_-w/s72-c/stjudemedicalmechhv_hr.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-1509641006838590307</guid><pubDate>Fri, 18 Oct 2013 23:02:00 +0000</pubDate><atom:updated>2013-10-18T16:02:25.022-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">ethics</category><category domain="http://www.blogger.com/atom/ns#">hospice</category><title>Ethics Conference 10-8-13</title><description>&lt;h2&gt;
812. Inpatient Hospice at UCLA</h2>
813. <h3>
814. Dr. Neil Wenger</h3>
815. Conventional hospice service:<br />
816. <ul>
817. <li>Hospice care is a service covered by medicare or private insurance.</li>
818. <li>General criteria: Patient with <6 months life expectancy, goal of care is comfort, not life prolongation.</li>
819. <li><b>You can (and perhaps should!) continue to manage your patients</b> after
820. they enroll in hospice via the hospice nursing and support staff.</li>
821. <li>Continuous hospice care is provided as patient approaches death.</li>
822. <li><b>Bereavement care</b> is provided and extended for 12 months after, including counseling, support groups, etc.</li>
823. </ul>
824. Previously, hospices are not licensed to take of patients in the acute hospital setting. Recent changes in laws and regulation have allowed hospices to treat patients in the hospital. Starting in the next few weeks, UCLA is rolling out a <b>new inpatient hospice service</b>:<br />
825. <ul>
826. <li>If the team in discussion with the attending and the family, feels inpatient hospice is appropriate, communicate this with palliative care consult team.</li>
827. <li>Palliative care team will facilitate transition to inpatient hospice.</li>
828. <li>Currently VITAS is the contracted hospice service available in the inpatient setting.</li>
829. <li>Details are still fluid, <b>please contact Dr. Neil Wenger or the inpatient Palliative Care Team if you would like additional information</b>.</li>
830. </ul>
831. We also discussed how to properly consent families and patients for ECMO. For a discussion on use of ECMO in ARDS, see this <a href="http://ECMO ARDS 2013 Crit Care Rev.pdf">2013 article from Current Opinions in Critical Care</a>. A quick preview:<br />
832. <blockquote class="tr_bq">
833. "Acceptance of ECMO requires knowledge and acceptance of risks as well as measurable benefits. ECMO has known adverse consequences/risks. Many authors are careful to note that the use of ECMO should be restricted to experienced centers, thereby (hopefully) mitigating these risks. Efficacy of ECMO depends on significant resource training and careful selection of patients directed to such a facility. More importantly, those patients who would benefit from ECMO, even if completely safe, remain unstandardized and unclear. The current healthcare climate also demands close scrutiny of resource consumption and attention to long-term outcomes. A future trial aimed at testing a defined protocol with clear patient selection criteria and no treatment crossover would clairfy the validity and generalizability of ECMO for adults with ARDS."</blockquote>
834. </description><link>http://imedres.blogspot.com/2013/10/ethics-conference-10-8-13.html</link><author>noreply@blogger.com (ZZTOP)</author><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-4370093804494200509</guid><pubDate>Thu, 10 Oct 2013 19:56:00 +0000</pubDate><atom:updated>2013-10-10T21:01:43.113-07:00</atom:updated><title>RAPID 10/10 - evaluation and feedback</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://4.bp.blogspot.com/-tZof7p2yaks/Uld4G_ZN_yI/AAAAAAAAANI/ZKOtiQHlq80/s1600/rapid+eval.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://4.bp.blogspot.com/-tZof7p2yaks/Uld4G_ZN_yI/AAAAAAAAANI/ZKOtiQHlq80/s640/rapid+eval.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;</description><link>http://imedres.blogspot.com/2013/10/rapid-1010-evaluation-and-feedback_10.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://4.bp.blogspot.com/-tZof7p2yaks/Uld4G_ZN_yI/AAAAAAAAANI/ZKOtiQHlq80/s72-c/rapid+eval.png" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-4032488792405346324</guid><pubDate>Wed, 09 Oct 2013 21:24:00 +0000</pubDate><atom:updated>2013-10-10T14:10:16.927-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">RAPID</category><title>RAPID 10/10 live survey results</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://3.bp.blogspot.com/-GRwY73BIfeA/UlcXqNFAUVI/AAAAAAAAAMs/n5Qfhg0NvMY/s1600/duty+hours+w+comments.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://3.bp.blogspot.com/-GRwY73BIfeA/UlcXqNFAUVI/AAAAAAAAAMs/n5Qfhg0NvMY/s640/duty+hours+w+comments.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://2.bp.blogspot.com/-4WhIodFDIdg/UlcXqFgqUpI/AAAAAAAAAMw/MQjI3NrHgoI/s1600/FCDs.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://2.bp.blogspot.com/-4WhIodFDIdg/UlcXqFgqUpI/AAAAAAAAAMw/MQjI3NrHgoI/s640/FCDs.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;&lt;a href=&quot;http://1.bp.blogspot.com/-6lULJDJi_TE/UlcXqHg5o6I/AAAAAAAAAMo/H2vou5TrGPo/s1600/futile+care.png&quot; imageanchor=&quot;1&quot; style=&quot;margin-left: 1em; margin-right: 1em;&quot;&gt;&lt;img border=&quot;0&quot; src=&quot;http://1.bp.blogspot.com/-6lULJDJi_TE/UlcXqHg5o6I/AAAAAAAAAMo/H2vou5TrGPo/s640/futile+care.png&quot; /&gt;&lt;/a&gt;&lt;/div&gt;</description><link>http://imedres.blogspot.com/2013/10/rapid-1010-live-survey-futile-care.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://3.bp.blogspot.com/-GRwY73BIfeA/UlcXqNFAUVI/AAAAAAAAAMs/n5Qfhg0NvMY/s72-c/duty+hours+w+comments.png" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-5059604843449636707</guid><pubDate>Mon, 30 Sep 2013 20:58:00 +0000</pubDate><atom:updated>2013-10-06T20:05:35.713-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">fall retreat</category><title>Fall Retreat!</title><description>&lt;table align=&quot;center&quot; cellpadding=&quot;0&quot; cellspacing=&quot;0&quot; class=&quot;tr-caption-container&quot; style=&quot;margin-left: auto; margin-right: auto; text-align: center;&quot;&gt;&lt;tbody&gt;
835. <tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-lhGAkxAQpkA/UknlibP5LHI/AAAAAAAAAKQ/_B3wFNg_zqA/s1600/Medpeds+pile.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://1.bp.blogspot.com/-lhGAkxAQpkA/UknlibP5LHI/AAAAAAAAAKQ/_B3wFNg_zqA/s400/Medpeds+pile.jpg" height="266" width="400" /></a></td></tr>
836. <tr><td class="tr-caption" style="text-align: center;">Congratulations to our Spirit Award Winners!</td></tr>
837. </tbody></table>
838. </description><link>http://imedres.blogspot.com/2013/09/fall-retreat.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://1.bp.blogspot.com/-lhGAkxAQpkA/UknlibP5LHI/AAAAAAAAAKQ/_B3wFNg_zqA/s72-c/Medpeds+pile.jpg" height="72" width="72"/><thr:total>3</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-6858649237125903335</guid><pubDate>Thu, 26 Sep 2013 02:13:00 +0000</pubDate><atom:updated>2013-09-26T06:12:18.493-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">hcm</category><category domain="http://www.blogger.com/atom/ns#">medical decisions</category><category domain="http://www.blogger.com/atom/ns#">OMR</category><title>OMR Roundup 9/25/2013</title><description>&lt;h2 style=&quot;text-align: center;&quot;&gt;
839. <span style="font-size: large;">
840. Medical Decision Making</span></h2>
841. <div class="separator" style="clear: both; text-align: center;">
842. <a href="http://www.askrogerdrummer.com/healingherbs/wp-content/uploads/2010/04/Confused-Doctor.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://www.askrogerdrummer.com/healingherbs/wp-content/uploads/2010/04/Confused-Doctor.JPG" height="200" width="156" /></a></div>
843. <div>
844. Robin Tang led the discussion this morning about the challenge of making a medical decision in the setting of multiple complex conditions, limited clinical trial data and patient-physician value differences.   We then explored the rapidly expanding field of shared decision making.  Read to the bottom for cool tools to play with!<br />
845. <br /></div>
846. <div>
847. <a name='more'></a><h3>
848. </h3>
849. <h4>
850. Case Presentation</h4>
851. </div>
852. <div>
853. Robin mapped out the overlapping issues involved in a treatment decision for a patient with ET, UC, and ovarian failure: <br />
854. <div class="separator" style="clear: both; text-align: center;">
855. <a href="http://1.bp.blogspot.com/-fl1gS0wlquU/UkOOdaXiGwI/AAAAAAAAAIk/HKvZiAezuFw/s1600/Screen+Shot+2013-09-25+at+6.30.23+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-fl1gS0wlquU/UkOOdaXiGwI/AAAAAAAAAIk/HKvZiAezuFw/s1600/Screen+Shot+2013-09-25+at+6.30.23+PM.png" height="145" width="200" /></a></div>
856. <div class="separator" style="clear: both; text-align: left;">
857. From there, he set about to mapping out a table of risk for each of the treatments in question (aspirin and OCPs):</div>
858. <div class="separator" style="clear: both; text-align: center;">
859. <a href="http://4.bp.blogspot.com/-djpzSBFuWfU/UkOPNYyZSVI/AAAAAAAAAI0/q-Kn04mt7MY/s1600/Screen+Shot+2013-09-25+at+6.34.20+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-djpzSBFuWfU/UkOPNYyZSVI/AAAAAAAAAI0/q-Kn04mt7MY/s1600/Screen+Shot+2013-09-25+at+6.34.20+PM.png" height="137" width="200" /></a><a href="http://4.bp.blogspot.com/-hjEGDY1xZ7M/UkOPZZWMQuI/AAAAAAAAAI8/QsfpXJJdNK0/s1600/Screen+Shot+2013-09-25+at+6.35.18+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-hjEGDY1xZ7M/UkOPZZWMQuI/AAAAAAAAAI8/QsfpXJJdNK0/s1600/Screen+Shot+2013-09-25+at+6.35.18+PM.png" height="131" width="200" /></a></div>
860. <div class="separator" style="clear: both; text-align: left;">
861. From this endeavor, we realized that the limitations of available data for specific patient scenarios is limited and that patients have different values for "their QALYs."</div>
862. <div class="separator" style="clear: both; text-align: left;">
863. <br /></div>
864. <b><u>
865. Suggested readings:</u></b><br />
866. <u>Robin Tang</u><br />
867. <div class="separator" style="clear: both; text-align: left;">
868. <i>How Doctors Think </i>(Jerome Groopman, UCLA Heme-Onc alum)</div>
869. <div class="separator" style="clear: both; text-align: left;">
870. <i>Thinking, Fast and Slow</i> (Daniel Kahneman)</div>
871. <div class="separator" style="clear: both; text-align: left;">
872. <br /></div>
873. <div class="separator" style="clear: both; text-align: left;">
874. <u>My addition</u></div>
875. <div class="separator" style="clear: both; text-align: left;">
876. Blood journal's <a href="http://bloodjournal.hematologylibrary.org/cgi/collection/how_i_treat">"How I Treat" series</a>.  For this case: <a href="http://www.ncbi.nlm.nih.gov/pubmed/21106990">"How I Treat Essential Thrombocythemia"</a> - based on <a href="http://www.ncbi.nlm.nih.gov/pubmed/14711910">this study</a> in PV, many recommend ASA for all patients with ET to prevent MI and CVA (in addition to CV RF modification).</div>
877. <div class="separator" style="clear: both; text-align: left;">
878. <br /></div>
879. <h3>
880. </h3>
881. <h4>
882. Surprise Case - Shared Decision Making</h4>
883. </div>
884. I pulled Saj Patel's case about (discussing aspirin for primary prevention), but he was post-night float!  Amion, you betray me!!!  We discussed shared decision making anyway.<br />
885. <h4>
886. </h4>
887. <b><u>
888. Key points:</u></b><br />
889. <br />
890. <div>
891. <ul>
892. <li>Shared decision making is an interactive process between physician and the patient/family around decisions for which the evidence supports more than one approach, there are significant trade-offs, and personal preferences should drive decisions.  Have you seen the USPTF Grade C?</li>
893. </ul>
894. <br />
895. <div class="separator" style="clear: both; text-align: center;">
896. <a href="http://2.bp.blogspot.com/-eLcswDZboaU/UkOTQiAeBLI/AAAAAAAAAJQ/9GBea8gWM4Q/s1600/Screen+Shot+2013-09-25+at+6.51.40+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-eLcswDZboaU/UkOTQiAeBLI/AAAAAAAAAJQ/9GBea8gWM4Q/s1600/Screen+Shot+2013-09-25+at+6.51.40+PM.png" height="126" width="320" /></a><a href="http://4.bp.blogspot.com/-XbJmQqjLQQ8/UkOTPZ1_rsI/AAAAAAAAAJI/-H1vm25pcEw/s1600/Screen+Shot+2013-09-25+at+6.51.22+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-XbJmQqjLQQ8/UkOTPZ1_rsI/AAAAAAAAAJI/-H1vm25pcEw/s1600/Screen+Shot+2013-09-25+at+6.51.22+PM.png" height="26" width="320" /></a></div>
897. <ul>
898. <li>We're not sure about the future of shared decision making, but we think it's maybe important.  See the face-off between NEJM and JAMA (published 2 days ago):<a href="http://3.bp.blogspot.com/-my9uik-UfKQ/UkOTvRfu0NI/AAAAAAAAAJY/VSREr9LaHNk/s1600/Screen+Shot+2013-09-25+at+6.52.51+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" src="http://3.bp.blogspot.com/-my9uik-UfKQ/UkOTvRfu0NI/AAAAAAAAAJY/VSREr9LaHNk/s1600/Screen+Shot+2013-09-25+at+6.52.51+PM.png" height="126" width="200" /></a><a href="http://4.bp.blogspot.com/-k6JQZ83JTAw/UkOTvtna16I/AAAAAAAAAJc/fJonVkXTZgU/s1600/Screen+Shot+2013-09-25+at+6.52.58+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" src="http://4.bp.blogspot.com/-k6JQZ83JTAw/UkOTvtna16I/AAAAAAAAAJc/fJonVkXTZgU/s1600/Screen+Shot+2013-09-25+at+6.52.58+PM.png" height="138" width="200" /></a></li>
899. <li>The new Milestones (ACGME requirements) highlight this for residency training: </li>
900. </ul>
901. <div class="separator" style="clear: both; text-align: center;">
902. <a href="http://4.bp.blogspot.com/-MYiH95cO7dc/UkOU3iY_mRI/AAAAAAAAAJs/D_eCPEkW46s/s1600/Screen+Shot+2013-09-25+at+6.58.03+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-MYiH95cO7dc/UkOU3iY_mRI/AAAAAAAAAJs/D_eCPEkW46s/s1600/Screen+Shot+2013-09-25+at+6.58.03+PM.png" height="112" width="200" /></a></div>
903. <div class="separator" style="clear: both; text-align: center;">
904. <a href="http://2.bp.blogspot.com/-XpH1u5XFpKY/UkOU3z8BIiI/AAAAAAAAAJw/9pH4XvGnQM0/s1600/Screen+Shot+2013-09-25+at+6.58.14+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-XpH1u5XFpKY/UkOU3z8BIiI/AAAAAAAAAJw/9pH4XvGnQM0/s1600/Screen+Shot+2013-09-25+at+6.58.14+PM.png" height="81" width="200" /></a></div>
905. <div class="separator" style="clear: both; text-align: center;">
906. <span style="text-align: -webkit-auto;">(courtesy of </span><a href="http://www.sgim.org/File%20Library/SGIM/Meetings/Annual%20Meeting/SSA1-Leigh-Simmons.pdf" style="text-align: -webkit-auto;">SGIM working group ppt</a>)</div>
907. <div class="separator" style="clear: both; text-align: left;">
908. </div>
909. <ul>
910. <li>Some really cool tools:</li>
911. <ul>
912. <li><a href="http://statindecisionaid.mayoclinic.org/">Mayo Clinic Statin/Aspirin Aid</a>  (Main Mayo <a href="http://shareddecisions.mayoclinic.org/">Shared Decision Site</a>)<div class="separator" style="clear: both; text-align: center;">
913. <a href="http://2.bp.blogspot.com/-HR8D9S6yXNo/UkOXCXJ6AzI/AAAAAAAAAKA/n-csSnzt2os/s1600/Screen+Shot+2013-09-25+at+7.07.47+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-HR8D9S6yXNo/UkOXCXJ6AzI/AAAAAAAAAKA/n-csSnzt2os/s1600/Screen+Shot+2013-09-25+at+7.07.47+PM.png" height="125" width="200" /></a></div>
914. </li>
915. <li><a href="http://decisionaid.ohri.ca/decguide.html">Ottawa Personal Decision Guide</a> (for working through generic decisions) </li>
916. <li><a href="http://patients.dartmouth-hitchcock.org/shared_decision_making/decision_aid_library.html">Dartmouth Decision Aid Library</a> (click through the links to Tests, Medicines, Treatments for great specific modules for your patients to work though).</li>
917. </ul>
918. </ul>
919. </div>
920. <div>
921. <br /></div>
922. <b><u>Suggested Reading</u></b><br />
923. <i>Your Medical Mind </i>(Jerome Groopman & Pamela Hartzband)<br />
924. &lt;br /&gt;</description><link>http://imedres.blogspot.com/2013/09/omr-roundup-9252013.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://1.bp.blogspot.com/-fl1gS0wlquU/UkOOdaXiGwI/AAAAAAAAAIk/HKvZiAezuFw/s72-c/Screen+Shot+2013-09-25+at+6.30.23+PM.png" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-7213749737157738737</guid><pubDate>Wed, 25 Sep 2013 16:39:00 +0000</pubDate><atom:updated>2013-09-25T09:39:31.061-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">away conference</category><category domain="http://www.blogger.com/atom/ns#">sgim</category><title>Society of General Internal Medicine Regional Meeting!</title><description>&lt;br /&gt;
925. <h2>
926. Society of General Internal Medicine California-Hawaii 2014 Regional Meeting</h2>
927. <b>Friday, January 31, 2014<br />Li Ka Shing Center at Stanford University<br />Palo Alto, CA</b><br /> <br />This year's theme is <b>"Innovation in General Medicine - Creating A Better Version of Health Care" </b>and our Keynote Speaker will be the distinguished <b>Dr. Abraham Verghese</b>, Professor of Theory and Practice of Medicine at Stanford and Senior Associate Chair of the Department of Internal Medicine.<br /><br /><u><i>Residents we need your help. </i></u><br />
928. <br />
929. <h3>
930. CALL FOR SUBMISSIONS </h3>
931. Workshops, Research Abstracts, Clinical Vignettes and Innovations<br /> <br />Open: <b>Friday, August 9, 2013</b><br />Deadline:<b> October 4, 2013</b><br />Acceptances sent:<b> October 31, 2013</b><br /> <br />
932. <h3>
933. ONLINE REGISTRATION</h3>
934. Open: &lt;b&gt;September 23, 2013&lt;/b&gt;&lt;br /&gt;Deadline: &lt;b&gt;January 22, 2014&lt;/b&gt;&lt;br /&gt;Registration will be closed from January 23rd – January 30th; Onsite Registration will be available on January 31st, 2014. &lt;br /&gt;&lt;br /&gt;Meeting Date: Friday, January 31, 2014&lt;br /&gt;&lt;a href=&quot;http://www.sgim.org/meetings/regional-meetings/california/call-for-submissions&quot;&gt; http://www.sgim.org/meetings/regional-meetings/california/call-for-submissions&lt;/a&gt;</description><link>http://imedres.blogspot.com/2013/09/society-of-general-internal-medicine.html</link><author>noreply@blogger.com (ZZTOP)</author><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-7065339707924668026</guid><pubDate>Tue, 24 Sep 2013 22:54:00 +0000</pubDate><atom:updated>2013-09-24T15:58:14.842-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">id</category><category domain="http://www.blogger.com/atom/ns#">weekly roundup</category><title>Weekly Roundup 9-20-13</title><description>&lt;div class=&quot;separator&quot; style=&quot;clear: both; text-align: center;&quot;&gt;
935. <a href="http://3.bp.blogspot.com/-b_5DxEAnfOU/UiI3jgioI5I/AAAAAAAAAEo/73Q6eAdhIZ8/s1600/rounds.600.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-b_5DxEAnfOU/UiI3jgioI5I/AAAAAAAAAEo/73Q6eAdhIZ8/s1600/rounds.600.jpg" height="149" width="320" /></a></div>
936. <br />
937. It was an antibiotics-filled week! First the <a href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf">CDC report on antibiotic resistance</a> highlighted the threat of overuse of antibiotics in animals in increasing bacterial antibiotic resistance. The report itself is a fascinating read…caveat lector: the thought of vancomycin–resistant Staph aureus may cause nightmares.  <br />
938. <a name='more'></a><br />
939. <b>We had two outstanding talks from ID gurus Jen Fulcher for intern intake and Dr. Martha Lewis Blum at Westwood noon conference:</b><br />
940. <br />
941. <a href="https://docs.google.com/file/d/0B0-L-nnozOOUY2Y1bXEyZGxwNE0/edit?usp=sharing">Intern Intake Handout - Antibiotics by Jen Fulcher</a><br />
942. Look for Dr. Blum's talk on <a href="http://domtv.med.ucla.edu/">DOM TV</a> coming soon!<br />
943. <br />
944. <b>From Patrick Ahearn (resident report): Patrick presented a case of a patient with known lupus who presented with acute worsening of chronic dyspnea found to have acute pulmonary embolism complicating likely chronic pulmonary hypertension of unclear etiology.</b><br />
945. <ul>
946. <li> Pulmonary Hypertension associated with SLE is rare (about 4% of lupus patients)</li>
947. <li> Massive PE defined as drop in SBP < 90mmHg OR drop of 40 points below patient's baseline for 15 minutes</li>
948. <li> Thrombolysis is recommended in Massive PE (grade 2C recommendation) </li>
949. <li> There is a grade1C recommendation <b>against systemic thrombolytics in most submassive PE</b></li>
950. <li> Grade 2C recommendation for systemic thrombolysis in select patients at high risk for developing shock</li>
951. <ul>
952. <li>         Risk factors for shock include, elevated troponin, elevated BNP, right heart strain, severe hypoxemia, PFO, free floating thrombus, large perfusion defect</li>
953. </ul>
954. <li>Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare complication of PE (1%)</li>
955. <li> PA endarterectomy is recommended for operative candidates with CTEPH and generally has good results (84% 4 year survival, >90% conversion from NYHA III or IV -> I or II)</li>
956. </ul>
957. <a href="https://docs.google.com/file/d/0B0-L-nnozOOUcHJmOXhKdTUxTnM/edit?usp=sharing">Slides from Patrick's presentation</a><br />
958. <br />
959. <b>From Janette Zara (resident report): Janette presented a case of a new diagnosis of infectious endocarditis presenting with a rash that was consistent with polyarteritis nodosa on biopsy (no prior known report in the literature! Look for the full report coming soon to a conference near you)</b><br />
960. <ul>
961. <li>Polyarteritis nodosa on pathology is classically seen as medium sized vasculitis without granulomas that spares the veins</li>
962. <li>The standard time for blood culture is sufficient for fastidious organisms (5 days at UCLA).</li>
963. <li>Indications for TEE (without prior TTE):</li>
964. </ul>
965. <div class="separator" style="clear: both; text-align: center;">
966. <a href="http://1.bp.blogspot.com/-S8n-8SWvjhc/UkIRivr0ewI/AAAAAAAAAIM/poFVbMWBib8/s1600/TEE-in-IE.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-S8n-8SWvjhc/UkIRivr0ewI/AAAAAAAAAIM/poFVbMWBib8/s1600/TEE-in-IE.png" height="222" width="320" /></a></div>
967. <ul>
968. <li><a href="https://docs.google.com/file/d/0B_Q3YX0wAjTEOThkTEgySDRLR0k/edit?usp=sharing">See her presentation for more IE pearls!</a></li>
969. </ul>
970. <b>And last but not least, a little gem from the past: from September 2011, <a href="http://news.menshealth.com/stop-superbugs-in-their-tracks/2011/09/17/">Dr. Dan Uslan quoted in men's health about the rise of Superbugs.</a></b><br />
971. <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
972. <tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-rB0aV07mNvY/UkISla0Po2I/AAAAAAAAAIU/rWA2BVZwtk4/s1600/Uslan.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://4.bp.blogspot.com/-rB0aV07mNvY/UkISla0Po2I/AAAAAAAAAIU/rWA2BVZwtk4/s1600/Uslan.jpg" /></a></td></tr>
973. <tr><td class="tr-caption" style="text-align: center;">Dr. Uslan, doing his best Nic Cage impression</td></tr>
974. </tbody></table>
975. <div class="separator" style="clear: both; text-align: center;">
976. <a href="http://2.bp.blogspot.com/-E1oL-CLafDM/UiaYNM2FQOI/AAAAAAAAAE4/ZfbKQZHZm58/s1600/porkypig.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-E1oL-CLafDM/UiaYNM2FQOI/AAAAAAAAAE4/ZfbKQZHZm58/s1600/porkypig.jpg" height="173" width="200" /></a></div>
977. <br />
978. &lt;br /&gt;</description><link>http://imedres.blogspot.com/2013/09/weekly-roundup-9-20-13.html</link><author>noreply@blogger.com (ZZTOP)</author><media:thumbnail xmlns:media="http://search.yahoo.com/mrss/" url="http://3.bp.blogspot.com/-b_5DxEAnfOU/UiI3jgioI5I/AAAAAAAAAEo/73Q6eAdhIZ8/s72-c/rounds.600.jpg" height="72" width="72"/><thr:total>0</thr:total></item><item><guid isPermaLink="false">tag:blogger.com,1999:blog-1186205362940782275.post-6164363640779057901</guid><pubDate>Sun, 22 Sep 2013 19:01:00 +0000</pubDate><atom:updated>2013-09-22T12:01:21.828-07:00</atom:updated><category domain="http://www.blogger.com/atom/ns#">journal club</category><category domain="http://www.blogger.com/atom/ns#">pulm</category><title>Journal Club - Nick Kolaitis</title><description>At Westwood noon conference on 9/12/13, Nick Kolaitis presented the recent New England Journal of Medicine article on prone positioning in ARDS:&lt;br /&gt;
979. <br />
980. <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1214103">http://www.nejm.org/doi/full/10.1056/NEJMoa1214103 (June 6, 2013)</a><br />
981. <br />
982. &lt;a href=&quot;https://docs.google.com/file/d/0B_Q3YX0wAjTEOXkyaC1xVll1S2s/edit?usp=sharing&quot;&gt;Slides from his presentation&lt;/a&gt; </description><link>http://imedres.blogspot.com/2013/09/journal-club-nick-kolaitis.html</link><author>noreply@blogger.com (ZZTOP)</author><thr:total>0</thr:total></item></channel></rss>

Home · About · News · Docs · Terms