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Sunday, January 31, 2010

medical student loans and forgiveness (part 2)

One option for those who would want to take advantage of the new 10 year loan forgiveness plan, but who are in a situation where they are not going to be working for the government or a non-profit hospital might be to actually start their own non-profit foundation.

It's possible that your clinical practice could be in a non-profit, private foundation and you receive your salary from the organization.

There are definitely tax implications. There's a lot of information at http://www.irs.gov/charities/foundations/index.html

Saturday, January 30, 2010

Direct admissions

I wonder if anyone has thoughts on what kind of patient should be a direct admission and what kind needs to go to the ER?

It just seems like it's always when I'm seeing acutes in clinic when I'm busy and I have the least amount of time to think about it and it's such an ordeal.

It seems to depend on the consultant precepting (if they're bossy) and the consultant on the service (if they know the scoop).

It seems kind of crappy to send someone to the ER if it's not an emergency (but maybe it is a Friday or Saturday or something)

I definitely realize the service census is important.

It's totally clear who absolutely needs to go to the ER (super sick, unstable, etc)

I think it'd be nice if there was an algorithm or something to avoid the unnecessary hassle.

If the census is more than 7: to the ER. (If 5 or more admissions already: to the ER?)

If no relevant labs/workup available (or can't get relevant workup): to the ER

What else? It just seems like there should be a protocol in place to take away hassle, drama, extra time (when you don't have it in clinic/in the hospital).

If anybody's reading this, I'd love to hear thoughts. Where I'm going next year, everyone just goes to the ER. Here, I think consultants take it as a matter of pride that we have a service to admit to.

Wednesday, January 27, 2010

American Family Physician Call for Papers

Date: January 24, 2010

A new call for papers with request for topics to be chosen over the next 2-4 weeks.

Below is a list of topics for which we are seeking experienced authors. Please have any interested author contact our D.C. editorial office at afpjournal@georgetown.edu.

We will be making assignments over the next 2-4 weeks. We prefer that experienced clinicians skilled in critically evaluating the evidence and experienced with the medical publishing process serve as first and corresponding author, to help ensure the quality of the content that goes out to our nearly 190,000 readers. Also, there should be no potential conflicts of interest with the subject matter of the article.

AFP Call for Papers—Available Topics, January 2010:

Acne: evaluation and treatment: requires high quality photos
Asthma--acute asthma attack management
Brain injury—mild/moderate traumatic brain injury: evaluating and managing long term effects
Breast—evaluation and management of common problems (mass, pain, discharge)
Burns—outpatient management of 1st degree/2nd degree burns. High quality photos desired.
Caregiver care—evaluating caregiver stress, assisting with support.
Carpal tunnel syndrome: evaluation and treatment options
Depression: diagnosis, initial evaluation, including suicide evaluation (not treatment).
Diagnostic imaging radiation—risks, principles of judicious imaging.
Dysphagia—evaluation, differential diagnosis (not treatment)
Dysuria—evaluation, differential diagnosis (not treatment).
Foot pain--OTC remedies for common foot disorders (toe pads, inserts, orthotics, with photos). Gastroenteritis in children (outpatient focus: vomiting & diarrhea, dehydration, oral rehydration).
Genital ulcers: evaluation, differential diagnosis, treatment. High quality photos desired.
Headache--tension-type headache: diagnosis and treatment
Hearing loss: evaluation, differential diagnosis, treatment principles
Heart failure: evaluation and treatment
Heart murmurs in children (newborns and older children): evaluation, when to refer.
HIV: anti-retroviral medication adverse effects: recognition and management
House calls/home visits: how to maximize their effectiveness
Joint pain—polyarticular joint pain-- evaluation, differential diagnosis (not treatment).
Knee pain-- evaluation, differential diagnosis (not treatment).
Lymphadenopathy-- evaluation, differential diagnosis (not treatment).
Mononucleosis /EBV infection: diagnosis and treatment
Newborn exam: basic elements, common problems to look for. Good for videos of techniques.
Obesity: surgery for morbid obesity: options, relative merits.
Osteoarthritis: evaluation and treatment
Pregnancy: OTC meds in pregnancy: what’s safe to use for common problems?
Prostate cancer: evaluation and treatment options (not screening)
Pruritus-- evaluation, differential diagnosis (not treatment).
Skin/shave biopsy—how to, procedure article; requires high quality photos of techniques
Spiritual assessment—how to incorporate spiritual issues into patient care
Tinnitus: evaluation, differential diagnosis (not treatment)
Tremor: evaluation, differential diagnosis (not treatment).
Urticaria and angioedema – evaluation, differential diagnosis, treatment; requires photos.
Vaginitis: evaluation, differential diagnosis, treatment
Weight loss--unintended weight loss: evaluation, differential diagnosis (not treatment).

New guidelines:
1. A checklist of key sources of high quality evidence. Previously, we recommended that authors consult several preferred sources of high quality evidence when preparing their paper:
http://www.aafp.org/online/en/home/publications/journals/afp/afpauthors.html#Parsys89685

We will now ask that authors report which sources they used for a new section on Literature Review & Data Sources. This process mirrors that of the Family Physicians Inquiries Network, which asks authors to indicate which approved sources they used when writing an FPIN Clinical Inquiry. We feel that this step helps ensure that the highest quality evidence is used when providing clinical recommendations on diagnosis and treatment.

2. New guidelines on authorship. Previously we recommended that authors be experienced clinicians who could demonstrate expertise on their area of interest or article topic. We also required that resident physicians, if involved with the manuscript, work with an experienced attending physician who should generally serve as first and corresponding author.

We will now give preference to first/corresponding authors who are experienced in publishing an article in a peer reviewed journal or clinical textbook, and experienced in an evidence based approach to writing. Authors can meet the former stipulation by having previously served as an author or co-author. The latter stipulation includes such measures as 1) preferentially consulting the primary literature, rather than other review articles or textbooks, when crafting a review; 2) consulting sources of pre-assessed, high-quality evidence, such as those from the AAFP EB CME source list: http://www.aafp.org/online/en/home/cme/cmea/ebcme/ebcmesources.html; 3) weighing the strength of evidence when making clinical recommendations, based on a comprehensive search of the relevant literature, ideally using evidence that has been graded for validity and applicability to family medicine. We feel that these steps help ensure that our readers are presented with authoritative, high-quality reviews, and that authors have an excellent chance of having their article successfully pass the peer review process and ultimately be accepted for publication. We also feel that junior authors will best learn the key steps of writing scholarly reviews if they first gain experience as co-authors.
http://www.aafp.org/afp/2008/0501/p1226.html

Saturday, January 23, 2010

Doctors and politics

I'm reading about 'Doctors' Negligence Makes Health Policy Tragedy:
Amity Shlaes' on Fluent News. Here is the link: http://fluentnews.com/s/22867384


Sent from my iPod

Friday, January 22, 2010

resuscitation

Minnesota has released a standardized Provider Orders for Life-Sustaining Treatment (POLST) form.

Here is the simple 2 page sheet.

We should probably start using it.

Thursday, January 21, 2010

Bisphenol A (BPA)

patients do ask about this because it has been in the news.
http://www.nytimes.com/2010/01/21/opinion/21thur2.html

what exactly is the concern?
where is BPA found?
do you need to get rid of all the plastic items in the house?

from wikipedia it appears that it's mostly the polycarbonate type plastics. Type 7 and type 3 plastics, specifically.

sorry I don't have better sources.

Tuesday, January 19, 2010

FPIN Calls in January...You're Invited!


The “FPIN Celebrity” calls are set up as informal interviews. There is time at the end designated for participant questions; otherwise they are not intended to be interactive. Maybe a good thing to have on speaker phone while you multitask at your desk?

This month's "Coffee with the Editor" call will feature Evidence-Based Practice Editor in Chief, Jon Neher. He will present ideas about what’s to come in the future for EBP, where common stumbling blocks can be avoided, etc.

The “Regular Check Ups” are interactive calls. These are geared towards any faculty aspiring to be leaders/Champions, as well as those who are already successful. The Editor in Chief will field participant questions. This is a great time for faculty to share with and learn from each other. Very informal.

Please use the following call-in information for all calls:
Dial in: 218-936-4700
Access code: 65201

FPIN Celebrity Calls in January:

Engaging Students in HDAs like FSU
Friday, January 8 (45 minutes)
3pm ET (2pm CT, 1pm MT, noon PT)

Friday, January 22 (45 minutes)
3pm ET (2pm CT, 1pm MT, noon PT)

Helping Residents Publish with eMedRef
Friday, January 15 (45 minutes)
3pm ET (2pm CT, 1pm MT, noon PT)

Thursday, January 21 (45 minutes)
2pm ET (1pm CT, noon MT, 11am PT)

Coffee with Jon Neher
Wednesday, January 13 (45 minutes)
3pm ET (2pm CT, 1pm MT, noon PT)

Wednesday, January 20 (45 minutes)
1pm ET (noon CT, 11am MT, 10am PT)

Regular Check Up Calls in January:

Clinical Inquiries with Jim Stevermer

Wednesday, January 13 (30 minutes)
5pm ET (4pm CT, 3pm MT, 2pm PT)

Friday, January 22 (30 minutes)
3pm ET (2pm CT, 1pm MT, noon PT)
Please note: access code for this call is 633895

Saturday, January 16, 2010

Family Medicine Journal Club January 2010

JANUARY JOURNAL CLUB DETAILS:
Date:  Tuesday, January 19th
Time:  6:00 PM
Location:  Victoria's Restaurant private room
RSVP to Tammy for attendance.
Topic to be discussed:  Two journal articles are attached. 
Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes:  http://care.diabetesjournals.org/content/26/12/3215.full
Use of Herbs Among Adults Based on Evidence-Based Indications: Findings From the National Health Interview Survey:  http://www.mayoclinicproceedings.com/content/82/5/561.full
Presenter:  Dr. JM Robertson and staff facilitator will be Jane Myers
Residents, remember there will be a financial talk following journal club that should be beneficial.

Friday, January 15, 2010

Thursday, January 7, 2010

Cochrane Journal Club

It's still new, but this could be a great resource if they end up tackling a lot of primary care issues.