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Medical Island’s Top 10 Medical Blogs

Top 10 Medical Blogs

 Blogging has of late become a regular past-time among various professionals and the medical profession is no exception. Medical Blogging requires serious consideration of the audience and the topics to be covered. Medical Professionals across the globe keep themselves updated through various electronic media and the internet has become the ultimate source of medical information for most of them.

Medical blogs make up a major chunk of the information available on the internet. They cover a range of topics from providing regular medical updates to the peculiar blog that talks about mundane medical terms and nuances. Medical Blogs are either started by individuals, run by some companies and organisations or an amalgamation of both. The vast number of medical blogs made the task of finding the “BEST” a serious business.

It is only true that no single blog could be the same for the entire audience, hence the ranking provided here is arbitrary based on my personal preferences. Without much ado, here is my list of the “TOP 10 MEDICAL BLOGS”

1. KevinMD Blog

2. Science Roll

3. GeriPal

4. Practical Bioethics

5. The Health Care Blog

6. Life in the Fast Lane

7. Creativity in Healthcare

8. Doc Gurley

9. Academic Life in Emergency Medicine

10. CasesBlog – Medical and Health Blog

I enjoyed reading many other medical blogs, but the ones mentioned here really caught my attention. I hope you too enjoy reading and following these blogs.

You will have suggestions to make about the selection or your own collection of favourite medical blogs. If so, post them in the comments section so that I can create another list of “The Best 100 Medical Blogs”.

[box type=”note”]If you want to setup your own medical blog for free or read stories from numerous practitioners and patients check out CausePages.[/box]

Funny Medical Abbreviations

Funny Medical Abbreviations

Hospital lingo can be dead serious, very serious, serious, not serious, jolly, light hearted, funny, hilarious or absolutely insane. Abbreviations and acronyms make it to the top of the list when it comes to medical humour and sarcasm. I can never get enough of it and I scourged the net to find some interesting ones to add to my kitty of funny medical abbreviations. You can find them in the nurse’s note, the doctor’s scribble, and even the technician’s records, not to forget the graffiti in the rest room of the hospital. Humour finds a special place in the hospital and its daily humdrum. Here is my list of Funny Medical Abbreviations and Acronyms. Enjoy.

ABITHAD – Another Blithering Idiot – Thinks He’s A Doctor.

ADR – Ain’t Doin’ Right.

AGMI – Ain’t Gonna Make It

ART – Assuming Room Temperature (recently deceased).

ATS – Acute Thespian Syndrome (the patient is faking illness)

ATSWWT – Always Thinks Something’s Wrong With Them.

CNS-QNS – Central Nervous System – Quantity Not Sufficient.

CTD – “Circling The Drain”. May also mean “Certain To Die”

DAAD – Dead As A Doornail.

DBI – Dirt Bag Index – multiply the number of tattoos by the number of missing teeth to give an estimate of the number of days since the patient last bathed.

DIC – Death Is Coming, Death In Cage – used by veterinarians describing the complications of Disseminated intravascular coagulation

DRT – Dead Right There.

EFT – Eleventh Floor Transfer (in a 10 floor hospital; refers to patient who is very close to death)

FDGB – Fall Down Go Boom.

FFFFF – Fat, Female, Fertile, Forty and Flatulent

FF or FFY – Frequent Flyer – A patient who returns to a medical provider for everything.

FLD – Funny Looking Dad.

FLK – Funny Looking Kid – used to indicate a child (usually a newborn) whose habitus or overall appearance, while normal in gross anatomy, suggests a need further medical investigation for congenital and genetic anomalies.“Funny”, in this sense, means strange or unusual, not laughable.

FOS – Full Of Shit, a diagnosis given to a patient that is likely not telling the truth or, alternatively to a patient with a bowel obstruction.

FTD – Fixing To Die.

FTF – Failure To Fly.

FLGD – Familial lack of Genetic Diversity.

FTW – Friggin Train Wreck (patient with multiple problems).

GOK – God Only Knows.

GFPO – Good For Parts Only.

GGTG – Gomers Go To Ground (they fall out of bed or gurneys).

GLM – Good Looking Mum.

GOMER – “get out of my emergency room” – a patient, usually poor or elderly, in the emergency room with a chronic, non-emergency condition. The name was popularized by Samuel Shem in his novel The House of God.

GPO – “Good for Parts Only”

GTO – Gomer Tip Over.

HP – Hispanic Panic, used to describe a Hispanic patient who believes their condition is worse than it actually is. This is generally a result of the perceived over-dramatic and theatrical nature of many Hispanic cultures.

LOBNH – Lights On But Nobody Home

LOLINAD – Little Old Lady In No Acute Distress.

LOLTWO – Little Old Lady Totally Whacked Out.

MFC – Measure For Coffin.

M & Ms – mortality and morbidity conferences where doctors and other health-care professionals discuss mistakes and patient deaths

NAD – Not Actually Done

NFS – Normal For Swindon.

O2T – Oxygen Thief.

ODD&DDR – Out ‘De Door and Down ‘De Road.

PAFO or PFO – Pissed And Fell Over

PBBB – Pine Box By Bedside.

PGT – Pissed and Got Thumped

PIP – Pyjama Induced Paralysis.

PITA – Pain In The A**.

PJAR – Person Just Ain’t Right.

PPP – Piss Poor Protoplasm – a patient endowed with inferior/defective genetic material

SALT – Same As Last Time.

SNEFS – Sub-Normal Even For Suffolk.

SWAG – Scientific, wild-A** Guess.

TBW – Tossed By Wave.

TEETH – Tried Everything Else; Try Homeopathy.

TEON – Two Eyes One Nose.

TMB – Too Many Birthdays.

TOBAS – Take Out Back And Shoot.

TTGA – Told To Go Away.

TTR – Tea Time Review

TUBE – Totally Unnecessary Breast Examination, often used to refer to an EKG done with the sole purpose of looking at a female patients breasts

UBI – “Unexplained Beer Injury”

UDI – “Unexplainable Drinking Injury”

WDWNF – Well Developed Well Nourished Female.

WNL – Used for recording vital signs. It can mean “within normal limits” or “we never looked”.

WTDB (Pronounced “whiskey tango DB”) – White Trash Douchebag

6PFP – 6-pack and a fishing pole, as in “this patient doesn’t need chemo, he needs 6PFP.” – Usually referring to an end-stage patient who should go die somewhere else.

funny medical abbreviations

I loved compiling these from various sources. It will be cool if you can send in your suggestions. Feel free to add your own through the comments. I will append the list above to make it more comprehensive.

Hospital Acquired Pneumonia

Hospital-Acquired Pneumonia (HAP): A Growing Concern

Pneumonia is an important cause of morbidity and mortality in adults with about 5 million cases reported annually in the United States itself. Hospital-acquired pneumonia (HAP) occurs in 0.5-5% of hospitalized patients, with a higher incidence in certain groups like postoperative patients and patients in ICU. It is also called “Nosocomial Pneumonia” or “Health care-associated pneumonia”. It is defined as pneumonia developing more than 48 hours after admission to a health care facility.

The diagnosis of Hospital-acquired pneumonia may be difficult as the clinical features of pneumonia are non-specific and many non-infectious conditions like atelectasis, pulmonary embolus, aspiration, heart failure and cancer, can cause infiltrates on a CXR mimicking a consolidation. This is made more tricky by the difficulty in identifying the organism responsible for the pneumonia due to the high incidence of oropharyngeal colonisation by Gram-negative bacteria. Only 6% of cases of nosocomial pneumonia exhibit a positive blood culture. Ventilator-associated pneumonia (VAP) is a type of nosocomial pneumonia arising >48-72 hours after intubation. It is associated with a higher incidence of multidrug-resistant organisms.

Pathogenesis

Nosocomial pneumonia most likely occurs due to microaspiration of bacteria colonising the upper respiratory tract. Other routes of infection include microaspiration of gastric contents, inhaled aerosols, haematogenous spread, spread from pleural space and direct inoculation from Hospital/ICU personnel.

Clinical Diagnosis

The diagnosis of Nosocomial pneumonia is based on the time of onset i.e. it develops more than 48 hours after admission to a health care facility, CXR changes, clinical features and simple laboratory investigations or the result of quantitative microbiology.

Clinically, HAP is diagnosed by the finding of a new infiltrate or a change in an infiltrate on CXR and growth of pathogenic organisms from sputum plus one of the following:

  • WBC count: > 12 x 105/Litre
  • Core body temperature: ≥ 38.3°C
  • Sputum Gram stain Scores: more than 2 on a scale of 4 of polymorphonuclear leukocytes and bacteria.

Investigations

A parallelism exists in the investigations required for the diagnosis of HAP and CAP.

  • CXR: Most definitions of nosocomial pneumonia require the presence of new persistent infiltrates on a CXR.
  • Respiratory secretions: Certain organisms are always pathogenic and are indicative of an infection when found in tracheal aspirates.
  • Blood cultures: This helps in identifying the aetiological agent in 8-20% of patients. Bacteraemia is associated with a worse prognosis. In 50% of patients with severe hospital-acquired pneumonia and positive blood cultures, there is another source of sepsis.

Management

The initial selection of antibiotics is made on the basis of epidemiological clues until quantitative microbiology results are obtained. It is important that antibiotics should be instituted within 1 hour of diagnosis. The microbiological investigations are used to narrow down the microbial cover based on sensitivity. Treatment should be reassessed after 2-3 days or sooner if the patient deteriorates.

Recommended Initial Empiric Treatment for Nosocomial Pneumonia

  • No risk factors for multidrug-resistant pathogens : Cefotaxime or Levofloxacin, Moxifloxacin or Ciprofloxacin or Ampicillin/Sulbactam or Ertapenem
  • Antimicrobial therapy in previous 90 days or Current hospitalisation for ≥ 5 days or High frequency of antibiotic resistance in the specific hospital unit or Hospitalisation for 2 days or more in previous 90 days or Residence in nursing home or extended-care facility or Home infusion therapy (including antibiotics) or Chronic dialysis within 30 days or Home wound care or Family member with multidrug-resistant pathogen or Immunosuppression or Bronchiectasis : One of: Antipseudomonal cephalosporin (Cefepime or Ceftazidime) or Antipseudomonal Carbapenem (Meropenem or Imipenem-Cilastatin) or β-lactam/β-lactamase inhibitor (Piperacillin-Tazobactam or Cefoperazone-Sulbactam) plus one of: Aminoglycoside or Antipseudomonal quinolone (Levofloxacin or Ciprofloxacin) plus one of the following for patients at high risk of methicillin-resistant Staphylococcus aureus (MRSA) infection: Linezolid or Vancomycin or Teicoplanin

Duration of Therapy

Current ATS guidelines recommend 7 days’ treatment provided the aetiological agent is not P. aeruginosa and the patient has a good clinical response with resolution of clinical features of infection. There is no significant difference in the clinical outcome of those who receive treatment for 8 days or 14 days for ventilator-associated pneumonia.

Response to Therapy

At least 48-72 hours of therapy should have elapsed to notice any clinical improvement. Interestingly, the CXR is of limited value for assessing response as there is an initial deterioration and improvement in CXR often lags behind clinical response. However, a rapidly deteriorating CXR pattern with a > 50% increase in size of infiltrate in 48 hours, new cavitation or a significant new pleural effusion should raise concern.

If the patient fails to respond reconsider the diagnosis, host factors and therapeutic factors. Review the antibiotics and repeat cultures. It may be useful to broaden the antibiotic coverage while waiting for the results of the investigations. Consider invasive sampling of respiratory secretions, CT or ultrasonography of the chest to look for an empyema or abscess, another source of infection, open-lung biopsy to establish diagnosis and aetiology, or administration of steroids.

Prevention

Measures recommended by the Centers for Disease Control (CDC) include:

  • hand-washing, nursing patients in a 30° head-up position
  • subglottic aspiration of secretions
  • orotracheal rather than nasotracheal intubation
  • changing the breathing circuit only when visibly soiled or mechanically malfunctioning
  • preferential use of non-invasive ventilation.

Last Words

Hospital-Acquired or Nosocomial Pneumonia has been of primary importance in most tertiary health-care facilities due to the rampant use of high-end antibiotics which could otherwise have been avoided. The rampant use of antibiotics has resulted in “superbugs” that are resistant to all existent antibiotics and this has created a growing awareness among health care professionals. We ought to be judicious in our use of antibiotics and should follow recommended guidelines to avoid any more damage that might result out of our complacency.

Total Parenteral Nutrition

Role of Total Parenteral Nutrition in Hospitalized Patients

Enteral feeding is the preferred means of nutritional support. Without any specific surgical contraindication, all patients should  receive enteral feeding  as soon as possible, preferably within 24 hours of admission. Enteral feeding provides nutrition and helps to maintain gastrointestinal tract integrity and function. However, not all patients can receive enteral nutritional support due to some contraindications. This requires the assistance of some extraneous source of energy and nutrients to support the body during times of stress.

Total parenteral nutrition (TPN) support is an important component  of supportive therapy in hospitalized patients, particularly ICU patients. It is generally not necessary if the patient is likely to be able to recommence enteral feeding within a few days, unless the patient is already severely wasted or malnourished.

Typical Composition of  Standard Total Parenteral Nutrition

Volume – 2.5 Litres

Nitrogen Source (9-14 g nitrogen) – L-amino acid solution

Energy Source (1500-2000 kcal) – Glucose and Lipid emulsion

Additives – Electrolytes, Trace Elements, Vitamins

Other Additives – Insulin and H2 blockers may be added if required

Practical Aspects of Parenteral Nutrition

TPN should be customized to a person’s requirements. Advice should be sought from dietitians or a parenteral nutrition team for specialized scenarios but a standard feed will suffice for most. Standard adult feeds are typically 2.5 litres a day, but smaller  volume feeds are available for fluid-restricted patients.

Parenteral feeds are hypertonic and cause thrombophlebitis. Hence, they are preferentially given via central venous lines. However, high volume lower-osmolality feeds are now developed that can be given via peripherally inserted feeding lines called “Peripheral TPN”. It is a good practice to keep one lumen clean and dedicated for TPN.

Parenteral nutrition mixtures make good culture mediums for bacteria, so make sure not to break the line to give anything else. TPN is given by constant infusion over 24 hours and delivered by volumetric infusion pumps.

Monitoring Total Parenteral Nutrition

Advice should be sought from the nutrition team and dietitian. The following should be assessed on a daily basis to provide a well-tailored TPN to the patient.

  • Fluid balance
  • Urea, Electrolytes, Phosphate
  • Glucose: An insulin infusion might need to be instituted to maintain blood sugar levels to an acceptable level. Close control of blood sugar levels have recently been shown to improve the outcome of critically ill patients.
  • Adequate energy requirements: Clinical acumen is required to assess adequate energy requirements by degree of catabolism.
  • Liver function (albumin, transferrin and enzymes) indicate adequate protein synthesis and give an early indication of TPN-related complications.

Complications of Total Parenteral Nutrition

  • All complications of central venous access are an accompaniment of TPN.
  • Metabolic derangement, particularly hyper- or hypoglycaemia, hypophosphataemia and hypercalcaemia, are quite common and require adequate adjustment of the feed.
  • Hepatobiliary dysfunction, including elevation of liver enzymes, jaundice and fatty infiltration of the liver may occur. This is usually a consequence of the patient’s underlying disease processes and overfeeding. Reduce the volume of TPN and/or energy content in the feed to correct the same. If the serum becomes very lipaemic it may be necessary to reduce the fat content.
Abdominal Compartment Syndrome

Abdominal Compartment Syndrome – A Silent but Lurking Danger!

Abdominal Compartment Syndrome and Intra-abdominal Hypertension are two sides of the same coin. While Intra-abdominal Hypertension exists when intra-abdominal pressure exceeds the normal level which is set between 20 to 25 mmHg, Abdominal compartment syndrome is said to exist when intra-abdominal hypertension is accompanied by manifestations of organ dysfunction, which dramatically reduces upon abdominal decompression. The organ systems commonly involved include the pulmonary, cardiovascular, renal, splanchnic, musculoskeletal/integumentary (abdominal wall), and the central nervous system.

Certain population groups at particular risk for Abdominal Compartment Syndrome are:

  • Severe blunt and penetrating abdominal trauma
  • Ruptured abdominal aortic aneurysms
  • Retroperitoneal haemorrhage
  • Pneumoperitoneum
  • Neoplasm
  • Pancreatitis
  • Massive ascites
  • Liver transplantation
  • Massive fluid resuscitation
  • Accumulation of blood and clot
  • Bowel oedema
  • Forced closure of a noncompliant abdominal wall
  • Circumferential abdominal burn eschars

Epidemiology

  • Incidence among those with identifiable risk is 14%, while the incidence following primary closure after repair of ruptured abdominal aortic aneurysm was found to be 4%.
  • In the trauma population, those patients undergoing abbreviated or “Damage Control” laparotomy, particularly those  with intra-abdominal packing are at an increased risk. Interestingly, an open abdomen does not necessarily mean total absence of the risk of this syndrome.

Signs and Symptoms

  • Respiratory Failure that is characterized by impaired pulmonary compliance resulting in elevated airway pressures with progressive hypoxia and hypercapnia. High airway pressures may be needed in this scenario to overcome the high extrathoracic pressure exerted through the diaphragm and not to overcome an intrinsic lung problem. The earliest manifestations of this syndrome may be a subtle pulmonary dysfunction or an elevated peak airway pressure. Elevated hemidiaphragms with a loss of lung volume may be the only sign in an otherwise innocuous patient.
  • Haemodynamic Indicators: Elevated heart rate, hypotension, elevated pulmonary artery wedge pressure and central venous pressure, reduced cardiac output, and elevated systemic and pulmonary vascular resistance. A decreased venous return is central to the pathophysiology of abdominal compartment syndrome.
  • Renal function impairment is manifested as oliguria progressing to anuria with resultant azotemia. It is only partly reversible by fluid resuscitation.
  • Raised intracranial pressure is also another clinical manifestation.

How to Clinically Confirm a Diagnosis of Abdominal Compartment Syndrome

Intra-abdominal Hypertension is present when intra-abdominal pressure exceeds 20 mmHg

  • Direct measurement of intra-abdominal pressure by means of an intraperitoneal catheter
  • Bedside measurement can be achieved by transduction of pressures from indwelling femoral vein, rectal, gastric, and urinary bladder catheters. Of these, measurement of urinary bladder pressure and gastric pressures are the most common and easily accessible.
  • Intragastric pressure measurements are taken from an indwelling nasogastric tube. This varies within 2.5 cm H2O or 1.84 mmHg (conversion factor 1 cm H2O = 0.736 mmHg) of urinary bladder pressures.

In 1984, Kron et al. described  a method to measure intra-abdominal pressure at the bedside with the use of an indwelling Foley Catheter as follows:

  • Sterile water (50 to 100 ml) is injected into the empty bladder through the indwelling Foley catheter.
  • The sterile tubing of the urinary drainage bag is clamped just distal to the culture aspiration port.
  • The end of the drainage bag tubing is connected to the Foley catheter.
  • The clamp is released just enough to allow the tubing proximal to the clamp to drain fluid from the bladder, then reapplied.
  • A 16-gauge needle is then used to Y-connect a manometer or pressure transducer through the culture aspiration port of the tubing of the drainage bag.
  • Finally, the top of the symphysis pubic bone is used as the zero point with the patient supine.

A Viable Conclusion

Abdominal Compartment Syndrome is best prevented and any existing predisposing factor is looked into and prevented if possible. It is an important component in the critically ill patients and those with blunt abdominal trauma. One must remember that renal failure due to abdominal compartment syndrome does not respond to fluid resuscitation and should trigger us to consider it in the differential diagnosis. It is imperative that the clinician remains alert to this silent but lurking danger that is Abdominal Compartment Syndrome.

Exodus of Indian Doctors

Will the Exodus of Indian Doctors Continue?

Despite numerous policies in place to achieve self-sufficiency in the health sector, the number of Indian doctors serving the disparate rural population is drastically declining. Many efforts to drive the tech-savvy, white-collared and highly ambitious doctors to the unkempt peripheries of the country has been an utter failure. India still suffers an acute shortage of about 6,00,000 doctors, one million nurses, 200,000 dental surgeons and large numbers of paramedical staff. So, this issue is not just about Indian Doctors. Is it? Well, no, but I focus here mainly on the doctors’ dilemma.

Are the Doctors to be blamed?

Sadly, the doctors are only to be pitied. I say this because of the indifferent attitude of healthcare policy makers who ignore the changing needs of the evolving doctor community. It is no more the age of the general practitioner, and a simple medical degree is merely looked down as “dismal”. It is a general trend that specialists are sought after, and an MS/MD is the bare minimum for a doctor to practice satisfactorily. It is also true that despite the numerous medical colleges being set up, only a few are sanctioned or equipped to run post-graduate degrees. Hence, there is a huge disparity between the number of medical graduates and the number of post-graduate seats being offered in the country. This signals the clogging of an already overburdened health care system. Newly graduated doctors can only practice as residents in teaching institutes or as petty medical officers with a meagre paycheck that drives most of them crazy. The unfathomable amount of investment of time and money during their medical education only drives these hapless newbies to the brink of desperation. Only a few manage to land PG seats without paying hefty donations to institutes that exist for themselves. It is a sad situation, but a real and obviously debilitating experience for the many medical graduates that come out each year from various medical colleges across India.

An Obvious Solution

India is the biggest exporter of doctors in the world. With an overseas workforce equal to almost 10 percent of the Physicians in India, it is quite a contributor. The reason is obvious – a huge backlog of medical graduates waiting to get into a post-graduate course! With the increasing public awareness about healthcare issues and the demand for specialists and super-specialists, there is an increasing need for more post-graduate institutes that can cater to the backlog, but changes in India take time. So, another rather easy channel is to move out of the country to acquire specialist training from abroad, while others switch over to other allied healthcare areas like administration. This has in one way eased the burden on the post-graduate institutes in India but caused a dearth of doctors in the rural setup.

Many medical graduates from India seek to pursue education abroad or to set up practice abroad. Favoured locations have been UK, US, Canada, Australia, New Zealand and many other places. They provide excellent post-graduate trainings which is a bonus much beyond the financial implications. The recent decision by MCI to recognize foreign degrees attained abroad has indeed encouraged many who have settled abroad to consider coming back to India.

Some interesting stats about doctors of Indian origin:

One out of every 10 practicing physicians in Canada have Indian origin.

40,000 Indian doctors in the UK treat approximately half of its population.

50,000 physicians and approximately 15,000 residents and students in the US are Indians.

20% of doctors in Australia have Indian roots.

Isn’t that significant? Yes, it does. This makes India a formidable medical giant in terms of the sheer number of medical graduates it exports to other countries year after year.

Is there still an Exodus?

The number of Indian doctors abroad keeps increasing every single year despite numerous incidences of racial overtones and injustices toward Indian doctors. Reasons behind this exodus still being a comparatively better financial deal and most often a chance to explore possibilities of higher education. There is still a tendency among young or fresh doctors to consider opportunities abroad. Indian authorities need to sincerely consider a drastic change in health policies to improve the living standard, the emoluments, and an improved system to accommodate doctors serving the rural population. This could possibly improve the outlook among the growing number of junior doctors in India and give them a reasonably satisfying career in India itself.

Will the Exodus continue?

We will have to wait and see. If there are changes in the healthcare system in India with adequate facilities for fresh medical graduates, I should say there might be a change. With India becoming a major player in the medical tourism industry, the trend might change. [box type=”spacer”]We hope to see many more Indian doctors abroad come back to serve India with more vigour and valour.[/box]Indian Doctors' Woes

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