As we walk around in many hospitals, one notices a loss of " the physical exam". Should we as physicians say good bye to the stethoscope. Some argue that the "ritual" of the exam should not be lost and should be passed down and be a core part of being a physician. Some feel that in the current age of technology, one doesn't need it. In other words, the exam was used to get information but if you can get information more accurately by innovation in technology, do you need the exam?
If you can get an ultrasound of the heart in 30 minutes with good accuracy, why bother doing a detailed heart exam?
Hmm... this is a debate that has sparked some concern in the medical community.
What should we be teaching our medical students and residents in the current world of iPhones and iPads? The debate of the real vs ipatient is now coming to be questioned?
Recent publications in Annals and other journals have highlighted this very issue
The Stanford medical residency mandates certain skills to be learned prior to graduation. They are listed below on their website. They are called The Stanford 25.
See if you agree with them!
Friday, February 10, 2012
Thursday, February 9, 2012
CLINICAL CASE 51, Answers and Summary
TRUE OR FALSE: RENAL ARTERY STENOSIS ON THE AFFECTED SIDE PROTECTS ON DEVELOPMENT OF GLOMERULAR DISEASE ON THAT SIDE.
16 (39%)
|
13 (31%)
|
12 (29%
|
Based on some of the review of the literature and recent nephrol
group comments, renal artery stenosis protects against glomerulonephritis.
In experimental models of serum sickness where immune complexes
are formed, the side that had stenosis or obstruction was spared of the immune
complex deposots. Hence, decreased
perfusion/filtration decreased chances of immune complex depositon. Multiple
case series have supported this hypothesis.
A case report in 1997 also showed that FSGS was spared in the kidney
that was having stenosis. The first case of such a protection was described as early as 1960s. Look below for full references. To my knowledge, I couldn't find any specific glomerular disease that made a different observation than most stated below. Although, the side that has stenosis might see ischemic nephropathy, but there is sparing of the glomerular disease process. This might be also true for diabetic nephropathy cases.
Ref:
Tuesday, February 7, 2012
Concept Map: Hyponatremia( etiology and pathogenesis)
Here is a concept map of hyponatremia created by Dr. Helbert Rondon from
Division of Nephrology, University of New Mexico School of Medicine. For good size view, download the image and view it.
Division of Nephrology, University of New Mexico School of Medicine. For good size view, download the image and view it.
Sunday, February 5, 2012
Cost and more costs- The burden of CKD
As the baby boomers age, there is going to be a significant rise in CKD and ultimately ESRD population. Care by a nephrologist usually is seen late due to late referrals and sometimes leading to "crash" dialysis.
As a result, sometimes options of peritoneal dialysis or transplantation are not available to these patients.
Multidisciplinary or rather multi professional team care during CKD care has shown in small studies to decrease mortality and decrease cost considerably. Delay in getting to ESRD will benefit greatly in cost savings.
What do you think is the average cost per patient per year for Hemodialysis? Peritoneal Dialysis? and Transplantation? Match below to HD, PD and transplant ( in US dollars)
A. around 75,000
B. around 57,000
C. around 25,000
As a result, sometimes options of peritoneal dialysis or transplantation are not available to these patients.
Multidisciplinary or rather multi professional team care during CKD care has shown in small studies to decrease mortality and decrease cost considerably. Delay in getting to ESRD will benefit greatly in cost savings.
What do you think is the average cost per patient per year for Hemodialysis? Peritoneal Dialysis? and Transplantation? Match below to HD, PD and transplant ( in US dollars)
A. around 75,000
B. around 57,000
C. around 25,000
Saturday, February 4, 2012
eAJKD: Interviews
eAJKD has some recent author interviews on multiple topics
1. Dosing of dialysis in AKI
2. Heparin or Citrate for CVVHD
3. Hyponatremia in cancer patients
4. Cardiac surgery and the kidney
5. Newer Anemia therapies
1. Dosing of dialysis in AKI
2. Heparin or Citrate for CVVHD
3. Hyponatremia in cancer patients
4. Cardiac surgery and the kidney
5. Newer Anemia therapies
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