Two most common pediatric migraine medications no more effective than placebo

Neither of the two drugs used most frequently to prevent migraines in children–amitriptyline and topiramate–is more effective than a placebo, according to results of the Childhood and Adolescent Migraine Prevention (CHAMP) trial published this week in The New England Journal of Medicine. The investigators found no significant differences in reduction in headache frequency or headache-related disability in childhood and adolescent migraineContinue reading “Two most common pediatric migraine medications no more effective than placebo”

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A Medical Degree in Paperwork

A recent study in Annals of Internal Medicine found that physicians in four office-based specialties spent the majority of their time on documentation and paperwork: Overall, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on documentation (paper and electronic). While in the examination roomContinue reading “A Medical Degree in Paperwork”

On Informing Families a Child has Died

I am sharing a moving piece by Naomi Rosenberg, an emergency room doctor at Temple University Hospital in Philadelphia, about telling a mother her child has died. It is hauntingly familiar; over the past 20 years as a pediatric emergency medicine physician, I have followed a sequence similar to the steps she describes in her piece. ItContinue reading “On Informing Families a Child has Died”

Should Doctors Undergo Opioid Prescribing Risk Training?

Earlier this week, an advisory panel recommended that the Food and Drug Administration require doctors who prescribe painkillers s to undergo training aimed at reducing misuse and abuse of the medications. The New York Times notes: It is the second time since 2010 that an F.D.A. panel has recommended expanding safety measures for painkillers. But the trainingContinue reading “Should Doctors Undergo Opioid Prescribing Risk Training?”

Emergency Department Return Visits as a Quality Metric

A recent JAMA publication lead-authored by Dr. Amber Sabbatini examined the scientific soundness of emergency department (ED) return visits as a measure of the ED’s quality of care. Emergency department return visits have been considered for wider adoption as a quality metric, especially for those patients who are hospitalized during the return ED visit. The “quality”Continue reading “Emergency Department Return Visits as a Quality Metric”

Robots vs. doctors?

Although I agree with the basic premise of this week’s Washington Post article “The Robot Doctor Will See You Now“–namely, that computers can augment medical care–the article misses the art-science balance so central to physician’s practice.  He states: If you’ve ever gone to a doctor with an odd set of symptoms and realized that your doctor has no clue what theyContinue reading “Robots vs. doctors?”

Guns, Drugs and Cars

This week’s JAMA released a comparison of major causes of injury death and how they contribute to the gap in life expectancy between the US and other high-income countries. Here are their findings: Men in the comparison countries had a life expectancy advantage of 2.2 years over US men (78.6 years vs 76.4 years), asContinue reading “Guns, Drugs and Cars”

The stethoscope is dead?!

A Washington Post piece this week features a prominent cardiologist’s contention that stethoscopes must be–and are being–replaced with echocardiography. “The stethoscope is dead,” he states.  The article presents as counterpoint a pediatric cardiologist who states that cardiac auscultation won’t be replaced with costly imaging.  The article notes that the easier availability of echocardiography and otherContinue reading “The stethoscope is dead?!”

Will prevention ever be sexy?

As a pediatric emergency medicine provider, many of the reasons patients show up in the Emergency Department are related to symptoms–a fever, cough, rash, ache, nausea, runny nose, diarrhea, etc.  What is this causing it? What will make it go away as soon as possible? A commentary on NPR’s Shots series notes that, often, despiteContinue reading “Will prevention ever be sexy?”

Optimizing CPR

An article in today’s New York Times reminds us that the quality of cardiopulmonary resuscitation varies widely region-to-region in the US. As a result, survival rates after cardiac arrest also vary widely. Although advances in CPR research are ongoing, their adoption by citizens and providers vary by location. The best evidence is synthesized every 5 years by the American Heart Association (AHA),Continue reading “Optimizing CPR”