Phorest & Trees 09-2021

 

PHOREST & TREES

Like the new look? always available here.

AANEM & NEUROMUSCULAR STUFF

• I may already have expressed my profound admiration for Ileana Howard MD in this space, but here it is again. “The Advocacy Award honors members or nonmembers who have made extraordinary contributions in advocating to government entities or insurance companies in regard to the diagnosis/treatment of NM or EDX medicine.” You go Supergirl!
• Here is a nice review of head drop differential. I’ve already had about 5 patients with this over the years (thanks to Ileana for the link).
• These authors propose that injected steroids (triamcinolone) in carpal tunnel work by an antifibrotic effect, suppressing collagen expression in subsynovial connective tissue fibroblasts. None of the proinflammatory IL-6, COX-2, and NF-B generes were significantly downregulated by it. Clinical eval revealed increased grip strength, EDx revealed improved SNAPs, and MRI did not reveal an antiedematous effect on synovial tissue. I thought this was a really good study.
• Very very rare GBS after vaccine and Turns out sural sparing is still a good indicator of GBS
• Don’t take too much laughing gas or you’ll get a neuropathy
• Great Job Opp

 

MUSCULOSKELETAL / PAIN / RHEUM

• “Doc, seeing what you see on my MRI, do I have to worry about future back pain?” Attached is the first large population-based study investigating longitudinal relationships between lumbar MRI findings and LBP, where analyses were conducted for the whole cohort and separately for those with and without baseline pain. Residents are encouraged to read the intro and discussion.
• How long should a sling be worn after proximal humeral fracture? Not long.
• I’m no tailbone doctor but this seems like something to consider at the tail end of treatment (heh).
• Yet another meta-analysis of injectates into knees. I just wish PRP formulations were standardized for comparison. “further investigations minimizing PRP formulation heterogeneity by standardizing PRP preparation and classification are warranted to better understand the true efficacy of PRP on clinical outcomes.”
• Treatment of RA has resulted in decreased TKA/THA
• Metformin is associated with reduced risk of needing a joint replacement in diabetes.
• I didn't know what TOLF was. It's thoracic ossification of ligamentum flavum. It can cause myelopathy but it's rare.
• Multi-day hospitalizations for E-Scooter orthopedic trauma
• Radiofrequency Echographic Multi-Spectrometry technology by analysis of native raw unfiltered ultrasound signals appears to be able to recognise and overcome the most common artifacts, such as osteoarthritis, which may underestimate BMD by DEXA
• A prospective RCT revealed oral perioperative acetaminophen reduced opioid use and showed better pain control  in patients undergoing rotator cuff repair.

TREES

• My reply when a friend sent this image to me: Conceptually not surprising but astonishingly dramatic when visually represented this way.  Many would argue this to be a major contributing cause to the frustrating impediments to progress and even daily operations. The response was “Amen! 2019 before Covid we spent $3.7 trillion for health care, total fed budget was $4 trillion, and 25% for "administrative costs" which was more than any other country paid per capita for their health care except France and they are rated #1 by the WHO, not 37th like us.”

• Just disgusting
• How much of published scientific data is fraudulent?
• This article on how to discourage doctors is probably a sham but so well-written.
• A discussion with Dan Pierce about the “many issues with the way the scientific process has evolved when using statistics... there is a real danger with p-hacking when there is such a strong bias to publish positive results. One way to combat this is to publish the protocol prior to performing the actual experiment. I remember talking about this salmon experiment in my statistics class – a humorous example of misapplying the p-value.”  Attached is the very funny article he’s referring to.
• A trauma surgeon talks about night call. “I had some subconscious awareness that I wasn't using my cortical functions until I knew the relief of staying at home or the acceptance of going in. In fact, the longer the conversation would go on without knowing whether I had to go in, the tenser I got, because of the uncertainty. “Although we can all relate to this, I wonder if this is also how our patients feel when they hear a lab result or diagnosis.
• Interesting thoughts on speaking your mind which I can understand. I wonder if this person knew how to speak his mind. The comments sections are fascinating as well.
• 41% of americans lost confidence in their doctors during covid because of less communication. Those who had more faith attributed it to virtual care.
• Unbelievable the administrative burdens that continue to be poured on physicians when it's the insurance companies that are the ones setting the billing rates Doc Groups Hail Decision to Delay 'Advanced EOB' Rule
• CMS proposed changes for payment, here's AANEM's summary.
• An interesting proposal to pay primary care
• Using AI to prevent variation in care.
• How medical notes will change if patients get to see them (kevinmd.com)
• Trans women are dying faster
• Old folks prefer texting too!

BRAIN STUFF (“abstracts only” for me)

• Geeks only. This is MEG visualization of arithmetic and simple sentence cortical processing .
• Yet another reason to exercise.
• The search for biomarkers continues with amyloid precursor protein in alzheimer’s and Neurofilament light chain in ALS.
• Vagus stim for Stroke Rehab FDA approved.
• 6-9 for bedtime. (get your mind out of the gutter!)
• The nose knows.