Cure of those El'ils

A new study suggests not only that prehistoric creatures got cancer, but also that the disease looked similar to cancers in modern humans

Mechanical medi

A novel is a medicine bundle, holding things in a particular, powerful relation to one another and to us.

The hospitalist movement mirrors the health care trend toward ever-increasing specialization. However, hospitalists are fundamentally generalist physicians who provide and coordinate inpatient care, often aided by myriad subspecialists. How can a generalist be a specialist? Specialties in medicine are traditionally defined by organ (eg, cardiology), disease (oncology), population (pediatrics), or procedure/technology (surgery or radiology). The hospitalist, on the other hand, is a "site-defined generalist specialist" (similar to emergency medicine physicians or critical care specialists), caring for patients with a wide array of organ derangements, illnesses, and ages within a specific location.45 Accordingly, the hospitalist should not be seen as a retreat from generalism and its emphasis on coordination and integration9,77 but rather as an affirmation of these values and as a surrogate for the primary care physician in the hospital. The competing pressures resulting from the distance between office and hospital as well as the requirement of around-the-clock availability make the hospital-based generalist a logical evolution. Hospital medicine has already satisfied many of the requirements of a specialty. A large and enthusiastic group of practitioners identify themselves not according to their training background but as hospitalists. The NAIP is almost certainly the fastest growing physician society in the United States. The field hosts several successful meetings each year and has its own clinical textbook.78 To establish themselves as members of a recognized medical specialty, hospitalists must identify a core skill set or body of knowledge and obtain the approval of credentialing organizations. Advocates of specialty status for hospitalists should be encouraged by the history of 2 other site-defined inpatient specialties: emergency medicine and critical care medicine. Like these relatively young fields, it seems probable that hospitalists will ultimately define a unique set of skills and competencies that will distinguish their field. The identification of practice-training mismatches (Table 2) represents an important first step. Credentialing organizations deliver the final stamp of approval on new specialties by creating a board certification or added qualification. Most new fields quickly agitate for such status, their motivation both practical and visceral. However, for unique reasons, few hospitalists are pressing this point. Many physicians—hospitalists and nonhospitalists—worry that if a credentialing body (such as the American Boards of Internal Medicine or Pediatrics) created a hospital medicine credential, health maintenance organizations might require that physicians possess this credential to care for inpatients. This would be unacceptable to many primary care physicians, who would be excluded from the hospital despite their desire and competence to continue practicing there. For this reason, we expect neither NAIP nor the relevant boards to promote separate credentials in the near future. Nevertheless, as evolutionary forces lead to specialized training, some formal specialty designation may emerge.79

And earlier this year, CMS announced that by this time next year hospitalists would be assigned their own specialty designation code. SHM’s Public Policy Committee lobbied for the move for more than two years.

By 2003, the term “hospitalist” had become ubiquitous enough that NAIP was renamed the Society of Hospital Medicine

John Nelson, MD, MHM, and Winthrop Whitcomb, MD, MHM, founded the National Association of Inpatient Physicians (NAIP) a year after the NEJM paper, they promoted and held a special session at UCSF’s first “Management of the Hospitalized Patient” conference in April 1997

Hospitalists are often referred to as the quarterbacks of the hospital. But even the best QB needs a good team to succeed. For HMGs, that roster increasingly includes nurse practitioners (NPs) and physician assistants (PAs).

Aside from NPs and PAs, another extension of HM has been the gravitation in recent years of hospitalists into post-acute-care settings, including skilled-nursing facilities (SNFs), long-term care facilities, post-discharge clinics, and patient-centered homes.

Hospitalists were seen as people to lead the charge for safety because they were already taking care of patients, already focused on reducing LOS and improving care delivery—and never to be underestimated, they were omnipresent, Dr. Gandhi says of her experience with hospitalists around 2000 at Brigham and Women’s Hospital in Boston. “At least where I was, hospitalists truly were leaders in the quality and safety space, and it was just a really good fit for the kind of mindset and personality of a hospitalist because they’re very much … integrators of care across hospitals,” she says. “They interface with so many different areas of the hospital and then try to make all of that work better.”

“When the IOM report came out, it gave us a focus and a language that we didn’t have before,” says Dr. Wachter, who served as president of SHM’s Board of Directors and to this day lectures at SHM annual meetings. “But I think the general sensibility that hospitalists are about improving quality and safety and patients’ experience and efficiency—I think that was baked in from the start.”

“The role of the hospitalist often is to take recommendations from a lot of different specialties and come up with the best plan for the patient,” says Tejal Gandhi, MD, MPH, CPPS, president and CEO of the National Patient Safety Foundation. “They’re the true patient advocate who is getting the cardiologist’s opinion, the rheumatologist’s opinion, and the surgeon’s opinion, and they come up with the best plan for the patient.”

Dr. Merlino says he’s proud of the specialists who rotated through the hospital rooms of AIDS patients. But so many disparate doctors with no “quarterback” to manage the process holistically meant consistency in treatment was generally lacking

Two major complaints emerged early on, Dr. Gorman says. Number one was the notion that hospitalists were enablers, allowing PCPs to shirk their long-established duty of shepherding their patients’ care through the walls of their local hospital. Number two, ironically, was the opposite: PCPs who didn’t want to cede control of their patients also moonlit taking ED calls that could generate patients for their own practice.

Dr. Wachter and other early leaders also worried that patients, used to continuity of care with their primary-care doctors, would not take well to hospitalists. Would patients revolt against the idea of a new doctor seeing them every day?

Some “specialists worried that if hospitalists were more knowledgeable than once-a-month-a-year attendings, and knew more about what was going on, they would be less likely to consult a specialist,” Dr. Goldman explains, adding he and Dr. Wachter thought that would be an unintended consequence of HM. “If there was a reduction in requested consults, that expertise would somehow be lost.”

Perhaps the biggest concerns to hospital medicine in the beginning came from the residents at UCSF. Initially, residents worried—some aloud—that hospitalists would become too controlling and “take away their delegated and graduated autonomy,” Dr. Goldman recalls

But those efforts were few and far between. And they were nearly all in the community setting. No one had tried to staff inpatient services with committed generalists in an academic setting.

The model Dr. Wachter settled on—internal medicine physicians who practice solely in the hospital—wasn’t entirely novel. He recalled an American College of Physicians (ACP) presentation at 7 a.m. on a Sunday in 1995, the sort of session most conventioneers choose sleep over. Also, some doctors nationwide, in Minnesota and Arizona, for instance, were hospital-based as healthcare maintenance organizations (HMOs) struggled to make care more efficient and less costly to provide.

Others are implementing bedside ultra-sonography for procedures and diagnosis, pioneering methods of making rounds more patient- and family-centric, implementing unit-based leadership teams, or applying process-improvement ap-proaches such as the Toyota Pro-duction System to inpatient care.

Many are developing early-warning pro-tocols in which electronic health record data are used to identify patients who are at risk for prob-lems such as sepsis or falls.

mentation of quality- and systems-related initiatives. Hospitalists have been slow to pursue sub-stantial inquiry into discovery re-lated to the common inpatient diseases they see or to lead multi-center trials of new diagnostic or therapeutic approaches. This defi-ciency limits hospitalists’ credibil-ity in academia and the advance-ment of the field.

Many hospitalists have added value as local leaders in quality improvement, safety, and innova-tion, but some have functioned more as shift workers. For exam-ple, many community hospital-ists have a 7-days-on, 7-days-off schedule that focuses mainly on high-volume clinical work and sends an unspoken but clear mes-sage that, at the end of an inten-sive clinical “on” stint, one is “off ” and uninvolved. Our impression is that hospitalist programs pro-vide more value when hospital-ists’ inpatient assignments (clini-cal “systole”) are complemented by a systems-oriented “diastole,” dur-ing which clinical activity is limit-ed but they contribute to key in-stitutional programs. Productive diastole is more likely when hos-pitalists have strong leadership, a robust professional-development curriculum, and a mutual hospi-tal–hospitalist commitment to adding value during specified and structured nonclinical time.

The field’s rapid growth has both ref lected and contributed to the evolution of clinical practice over the past two decades.

Conversely, some traditional programs may develophospitalist tracks that emphasize acquisition of theskills most relevant to inpatient practice. If suchtracks are developed, it will be important not to re-duce training in ambulatory care too aggressively,since the competent hospitalist will need a full un-derstanding of what can — and cannot — be donein the outpatient setting

As a result, we anticipate the rapid growth of anew breed of physicians we call “hospitalists” — spe-cialists in inpatient medicine — who will be respon-sible for managing the care of hospitalized patientsin the same way that primary care physicians are re-sponsible for managing the care of outpatients.

Unfortunately, this approach collides with the re-alities of managed care and its emphasis on efficien-cy.

It’s estimated that unneeded or unproven medical procedures cost us billions each year.

Significant procedures are sometimes not nearly as effective as you might think. “In 2002, the New England Journal of Medicine published a landmark study where they found that this very common knee operation worked no better than a sham procedure in which a surgeon merely pretended to operate,” Patashnik says.

So many medical publications appear worldwide every day that it is no longer possible for an individual medical professional to keep up with the latest state of knowledge. In order to offer support and to encourage new medical research, EBM provides a toolbox of different methods. These tools can be divided into three categories:The first category includes methods that serve to create reliable new knowledge: Someone who would like to compare the advantages and disadvantages of different drugs, for example, will find suitable types of studies here.The second category involves methods that help to summarize the existing knowledge on a subject: They serve to find and select the previously published studies that are best able to answer a particular question. There are now networks of researchers that specialize in looking for the latest research findings and summarizing them to provide easily accessible information.The third category covers methods for presenting information to medical professionals and laypeople in a way that helps them to find, understand and make use of it.The main aim is always to find out what kind of care is most suitable for a particular patient – and how to incorporate their individual preferences and circumstances into the treatment decision.

An evidence-based approach also includes informing patients about the pros and cons of medical options so that they can actively be part of the decision.So making a treatment decision in accordance with EBM means basing it on the best available knowledge from clinical research and medical practice. A number of factors play an important role in the decision. As well as the type and severity of the health problem, these include the person's general life situation, personal values and opinions.

This is the purpose of evidence-based medicine (EBM): to provide healthcare professionals, patients and those close to them with up-to-date and scientifically proven information on the various medical options that are available to them. It can help to find out what sorts of advantages or disadvantages a treatment or test has, when people might benefit from it and whether it might also be harmful.EBM uses special methods that it has developed to find the highest quality evidence for the benefits of a specific medical intervention. This evidence can be found in conclusive scientific studies. EBM also plays a part in making sure that the research that is done can help patients to answer the most important questions. This means that studies look into both the benefits of a treatment as well as how it affects quality of life, for example.

“It’s about embracing the inscrutable nature of human interactions,” says Chang. Evidence-based medicine was a massive improvement over intuition-based medicine, he says, but it only covers traditionally quantifiable data, or those things that are easy to measure. But we’re now quantifying information that was considered qualitative a generation ago.

The concept of patient-centered care extends to the treatments and therapies clinicians provide. Not only are care plans customized, but medications are often customized as well. A patient’s individual genetics, metabolism, biomarkers, immune system, and other “signatures” can now be harnessed in many disease states — especially cancer — to create personalized medications and therapies, as well as companion diagnostics that help clinicians better predict the best drug for each patient.

Strict visiting hours and visitor restrictions are a thing of the past in a patient-centered care model. Patients are given the authority to identify who can visit and when. Family members (as defined by the patient and not limited to blood relations) are invited to visit during rounding and shift changes so they can be part of the care team, participating in discussions and care decisions. When not in the room with the patient, they are kept informed of their loved one’s progress through direct and timely updates. A patient-centered care hospital’s infrastructure encourages family collaboration through a home-like environment that not only meets the needs of the patient, but also meets the needs of family members. For example, maternity wards are being redesigned with family-friendly postpartum rooms that can accommodate the mom, new baby, and family members, who are encouraged to spend up to 24 hours a day together in the room to foster family bonding.

Poor health literacy is a silent and ubiquitous health care issue, and the field of neurosurgery is particularly prone to the consequent adverse effects. Failure to address low health literacy has several detrimental health and economic consequences, and numerous policies have been initiated to address these. Better facilitating patient understanding of neurosurgical disease, treatment options, and care surrounding the operative period may have a positive impact on the health care economy and ultimately achieve improved outcomes for patients.

agencies involved in the sustenance of vital bodily functions areprogressively delegated from ‘the patient’ as an autonomously embodied entity, to anintricately interconnected sociomaterial assemblage, and then back again.

medical

epilepsy

yellow deaths

emetic

medicine

melancholy

balm

Foe to the bowels

rhubarb

Denum Dei

antidotes

antidoes

poisonous drugs

antidote

Mithridatium

It is really of use against fish-poison

remarkable qualities against poisonous bites

purgative

beans

vermifuge

melasses

vermifuge

ipecacuan

dysenteric complaints

emetic

physician

pulmonic disorders

health

physician

Durante

dropsy

Obia

Obia-men

negroe-conjurers, or Obia-men

They likewise feel imaginary woes; Woes no less deadly

The mineral product of the Cornish mine

worm-grass

cow—itch

dropsy

Ague

Mania

Worms

ingraft (Thus, the small-pox are happily convey’d;/) This ailment early to thy Negroe-train?

successive crops Of defedations oft will spot the skin: These thou, with turpentine and guaiac pods, Reduc’d by coction to a wholesome draught, Total remove, and give the blood its balm

Then let the learned leach [275] Give, in due dose, live-silver from the mine; Till copious spitting the whole taint exhaust.

WIth heartning food, with turtle, and which conchs; The flowers of sulphur, and hard niccars burnt

yaw

Fell, winged insects, which the visual ray Scarcely discerns, their sable feet and hands Oft penetrate; and, in the flesh nest, Myriads of young produce; which soon destroy [260] The parts they breed in; if assiduous care, With art, extract not the prolific foe.

Yet, if due skill, And proper circumspection are employed, [250] It may be won its volumes to wind round A leaden cylinder: But, O, beware, No rashness practise; else ‘twill surely snap, And suddenly, retreating, dire produce An annual lameness to the tortured Moor.

worm

Study their humours

dropsy

The loathsome leporsy

turtle

No rheums, no dysenteric ails torment: The thirsty hydrops flies

draw From each some blood, as age and sex require; And well with vervain, well with sempre-vive; Unload their bowels.

the white eagle; deadly foe to worms

prone to bloat

WORMS

cholera morbus

medicated

hermit’s spleen

hot well

astringent

small-pox

and like most alternative medicines there is zero evidence that it works

The domain of personalised medicine, in particular, is overflowing with possibilities for innovation [3].

By him the elements of medical science may be taught, with a history & explanations of all it’s successive theories from Hippocrates to the present day: and anatomy may be fully treated.

Donohue syndrome and Rabson-Mendenhall syndrome usually have homozygous or compound heterozygous mutations in the IR gene, and patients with these diseases have severe insulin resistance together with various symptoms, such as growth retardation, occasional hypoglycemia from infancy, intrauterine growth retardation, and low birth weight [3–6]

SoifIhadtochoosebetweenlibtheo,oranyology,Iwouldgowithscienceaslongasservicetothepoorwentalongwithit.ButIdon’thavetomakethatchoice,doI?”

discovery that could potentially revolutionize how and where we harvest, preserve, and use stem cells

The Administration could also exercise its regulatory authority—most potently, to direct the Centers for Medicare and Medicaid Services (CMS) to allow reimbursement for molecular profiling of cancers

As Martha Stoddard Holmes suggests, nineteenth-century thinkers were among the first to see disability as a cause of individual suffering, which has the problematic consequence of minimizing “the importance of the material circumstances that surround all disabilities” while maximizing “the importance of personal agency while minimizing the need for social change” (Fictions of Affliction 28-9).

Small, portable medical devices can offer patient's newfound mobility. Engineers at the University of Pittsburgh developed an artificial lung that can be carried in a patient’s backpack. Trials have so far shown that the device works on sheep and could offer relief and mobility for people who suffer from lung failure.

In patients receiving diuretic therapy symptomatichypotension may occur following the initial dose of proposed FDC, particularly due to volume/salt depletion with diuretic therapy

A UConn engineering professor has uncovered new information about how particles behave in our bloodstream, an important advancement that could help pharmaceutical scientists develop more effective cancer drugs.

Goel’s specialty is “nanobiophysics” — she studies how physics and nanotechnology can effect biology and medicine.

And, like most foreign-born physicians, Tauseef came on a J1 visa. That meant after training he had two options: return to Pakistan or work for three years in an area the U.S. government has identified as having a provider shortage.

These are called “vestigial” characteristics.

Pathology

“What is disease?” is a contentious question among philosophers of medicine.  These philosophers distinguish among four different notions of disease.

First of all, people aren’t uniformly good at splitting pills. Dose deviation is common among pill-splitters and that’s an issue for drugs that need to be maintained in a narrow range. Worse, many pills are in extended release formulations that break down when split. Splitting a time-released pill in half can cause an overdose. The list goes on: cutting all your pills in half before you need them could cause them to become ineffective, people often forget to cut them and take a double dose, etc.

The idea was to pinpoint the doctors prescribing the most pain medication and target them for the company’s marketing onslaught. That the databases couldn’t distinguish between doctors who were prescribing more pain meds because they were seeing more patients with chronic pain or were simply looser with their signatures didn’t matter to Purdue.

chamberlye

For as the medicines which men apply to the bodies of their fellow-men are of no avail except God gives them virtue (who can heal without their aid, though they cannot without His), and yet they are applied; and if it be done from a sense of duty, it is esteemed a work of mercy or benevolence; so the aids of teaching, applied through the instrumentality of man, are of advantage to the soul only when God works to make them of advantage, who could give the gospel to man even without the help or agency of men

it is not the function of medicine simply to make a man quite healthy, but to put him as far as may be on the road to health; it is possible to give excellent treatment even to those who can never enjoy sound health

Its possible abuse is no argument against its proper use on the side of truth and justice.