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	<title>db&#039;s Medical Rants</title>
	<link>http://www.medrants.com</link>
	<description>Contemplating medicine and the health care system</description>
	<lastBuildDate>Tue, 16 Mar 2010 12:46:12 +0000</lastBuildDate>
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		<title>Parathyroidectomy &#8211; a set piece</title>
		<description><![CDATA[This post is by request from a comment.
I have a very short set piece concerning the indications for parathyroidectomy.&#160; There are 2 indications in Primary Hyperthyroidism &#8211; symptoms related to the hypercalcemia &#8211; &#34;stones, groans, moans and broken bones&#34; or significantly decreased bone density.
I leave secondary hyperparathyroidism decisions to the nephrologists &#8211; perhaps a nephrology [...]


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<li><a href='http://www.medrants.com/archives/5294' rel='bookmark' title='Permanent Link: Set pieces on rounds 1'>Set pieces on rounds 1</a></li>
<li><a href='http://www.medrants.com/archives/4132' rel='bookmark' title='Permanent Link: Stage III CKD &#8211; when to refer'>Stage III CKD &#8211; when to refer</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5368</link>
			</item>
	<item>
		<title>Rate control in a fib &#8211; not too tight</title>
		<description><![CDATA[Many articles in the NEJM seem arcane and eclectic to this blogger.&#160; However, the best articles in this esteemed journal are really great.&#160; So it is today with the early release of this article &#8211; &#34;Lenient&#34; as good as &#34;strict&#34; ventricular rate control in permanent AF: RACE-2 trial&#160;

When pursuing a rate-control strategy in patients with [...]


Related posts:<ol><li><a href='http://www.medrants.com/archives/3616' rel='bookmark' title='Permanent Link: Atrial fibrillation &#8211; stick with rate control'>Atrial fibrillation &#8211; stick with rate control</a></li>
<li><a href='http://www.medrants.com/archives/765' rel='bookmark' title='Permanent Link: Rate control'>Rate control</a></li>
<li><a href='http://www.medrants.com/archives/2148' rel='bookmark' title='Permanent Link: Chronic atrial fibrillation &#8211; rate control is more cost-effective'>Chronic atrial fibrillation &#8211; rate control is more cost-effective</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5366</link>
			</item>
	<item>
		<title>Safety and patient care</title>
		<description><![CDATA[Today I hope to make you think.&#160; Today I will rant against rampant subspecialization.&#160; Today I will make some readers mad.
Pauline Chen has a wonderful article in the NY Times &#8211; Learning to Keep Patients Safe in a Culture of Fear.
In this article she writes about the problems we have in improving patient safety in [...]


Related posts:<ol><li><a href='http://www.medrants.com/archives/5127' rel='bookmark' title='Permanent Link: More on safety and root cause analysis'>More on safety and root cause analysis</a></li>
<li><a href='http://www.medrants.com/archives/5117' rel='bookmark' title='Permanent Link: Hospital safety and root cause analysis'>Hospital safety and root cause analysis</a></li>
<li><a href='http://www.medrants.com/archives/4900' rel='bookmark' title='Permanent Link: Reform residency but intelligently'>Reform residency but intelligently</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5364</link>
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		<title>My thoughts on March 8 acid-base</title>
		<description><![CDATA[First, thanks to the great discussion.&#160; Readers will learn as much from the discussion as they will from me.&#160; To repeat the presentation:
The patient is an 81 year old man found with altered mental status.&#160; He has known diabetes mellitus, hypertension, COPD and CHF, but has not taken any medications for the past year.



Electrolyte panel


Na
142
Cl
96
BUN
99


K
5.5
HCO3
21
creat
2.3


Blood [...]


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<li><a href='http://www.medrants.com/archives/5026' rel='bookmark' title='Permanent Link: 17 days at the VA &#8211; day 12'>17 days at the VA &#8211; day 12</a></li>
<li><a href='http://www.medrants.com/archives/4454' rel='bookmark' title='Permanent Link: AMS &#8211; an acid-base problem solution'>AMS &#8211; an acid-base problem solution</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5358</link>
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	<item>
		<title>Yesterday&#8217;s acid-base challenge</title>
		<description><![CDATA[We have a brilliant debate ongoing in the comment section of yesterday&#39;s problem.&#160; I will refrain from commenting for 24 hours.&#160; Please join the debate &#8211; then I will weigh in some time tomorrow.
I cannot answer every question about this patient, but I can answer some key questions.


Related posts:Duty hours &#8211; no easy answers (h/t [...]


Related posts:<ol><li><a href='http://www.medrants.com/archives/5323' rel='bookmark' title='Permanent Link: Duty hours &#8211; no easy answers (h/t @FutureDocs)'>Duty hours &#8211; no easy answers (h/t @FutureDocs)</a></li>
<li><a href='http://www.medrants.com/archives/5108' rel='bookmark' title='Permanent Link: 15 days at the VA – day 2'>15 days at the VA – day 2</a></li>
<li><a href='http://www.medrants.com/archives/5353' rel='bookmark' title='Permanent Link: March 8, 2010 &#8211; an acid base challenge'>March 8, 2010 &#8211; an acid base challenge</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5356</link>
			</item>
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		<title>March 8, 2010 &#8211; an acid base challenge</title>
		<description><![CDATA[The patient is an 81 year old man found with altered mental status.&#160; He has known diabetes mellitus, hypertension, COPD and CHF, but has not taken any medications for the past year.



Electrolyte panel


Na
142
Cl
96
BUN
99


K
5.5
HCO3
21
creat
2.3


Blood Sugar
568



Alb 3.1
ABG on 4 liters nasal oxygen



ABG


pH
7.38


pCO2
29


pO2
133


HCO3
18



So please address these questions: 1. What is the acid-base disorder? 2.Provide a differential for the [...]


Related posts:<ol><li><a href='http://www.medrants.com/archives/5358' rel='bookmark' title='Permanent Link: My thoughts on March 8 acid-base'>My thoughts on March 8 acid-base</a></li>
<li><a href='http://www.medrants.com/archives/4433' rel='bookmark' title='Permanent Link: AMS an acid-base problem &#8211; part 1'>AMS an acid-base problem &#8211; part 1</a></li>
<li><a href='http://www.medrants.com/archives/5298' rel='bookmark' title='Permanent Link: A new acid-base problem'>A new acid-base problem</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5353</link>
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		<title>What I said about pain control</title>
		<description><![CDATA[If you reread my post, I was talking clearly about patients in the hospital with a clear cause of pain.&#160; For example, a patient with pancreatitis from gallstones or a patient with a hip fracture or a patient with painful osteomyelitis.&#160; I was making a point about inpatient pain control.
I appreciate the difficulties related to [...]


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<li><a href='http://www.medrants.com/archives/4666' rel='bookmark' title='Permanent Link: Thoughts on accountability and quality'>Thoughts on accountability and quality</a></li>
<li><a href='http://www.medrants.com/archives/4850' rel='bookmark' title='Permanent Link: Does IM training lead to decrease primary care selection?'>Does IM training lead to decrease primary care selection?</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5351</link>
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		<title>Pain control</title>
		<description><![CDATA[Over the past several weeks I have emphasized in-hospital pain control.&#160; Regularly I find patients with &#34;legitimate&#34; pain who complain about their pain control.&#160; The resident&#39;s default order for many years is (pick your opioid) q 3 or 4 hours p.r.n.
My palliative care colleagues have stressed that we should schedule pain control rather than provide [...]


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<li><a href='http://www.medrants.com/archives/4717' rel='bookmark' title='Permanent Link: Much ado about something important'>Much ado about something important</a></li>
<li><a href='http://www.medrants.com/archives/5333' rel='bookmark' title='Permanent Link: Odynophagia'>Odynophagia</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5347</link>
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		<title>Primary care &#8211; money is the answer</title>
		<description><![CDATA[Primary care doctors need financial independence
Nice article but it does miss one important point.&#160; I believe the way we pay for primary care causes the problems.&#160; Paying for a visit with a fixed price has so many unintended consequences that I do not believe the model can work.&#160; Our payment system encourages shorter visits.&#160; Our [...]


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<li><a href='http://www.medrants.com/archives/4285' rel='bookmark' title='Permanent Link: Dazed and Confused &#8211; Levels of primary care?'>Dazed and Confused &#8211; Levels of primary care?</a></li>
<li><a href='http://www.medrants.com/archives/4220' rel='bookmark' title='Permanent Link: Finding enough primary care'>Finding enough primary care</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5345</link>
			</item>
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		<title>The road to expertise</title>
		<description><![CDATA[Had a great conversation with an outstanding intern yesterday.&#160; He is bright, thoughtful and has a great bedside manner.&#160; He also is self aware and understands that he still has much to learn about being a great physician.&#160; He will get there because he cares, he reads and he learns from his attendings everyday.&#160; He [...]


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<li><a href='http://www.medrants.com/archives/4935' rel='bookmark' title='Permanent Link: How should we balance learning with work hours?'>How should we balance learning with work hours?</a></li>
<li><a href='http://www.medrants.com/archives/4840' rel='bookmark' title='Permanent Link: Graduate medical education and the Long Tail'>Graduate medical education and the Long Tail</a></li>
</ol>]]></description>
		<link>http://www.medrants.com/archives/5343</link>
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