{"id":452,"date":"2011-05-19T17:12:28","date_gmt":"2011-05-19T21:12:28","guid":{"rendered":"http:\/\/blogstemp2.wpengine.com\/?p=452"},"modified":"2011-05-19T17:12:28","modified_gmt":"2011-05-19T21:12:28","slug":"practice-changing-articles-v","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/","title":{"rendered":"Practice-Changing Articles V"},"content":{"rendered":"<p>Recent advances and discussions in medicine are the cornerstone of <em>Journal Watch<\/em>.\u00a0Here\u2019s the fifth installment of the articles that\u00a0made the biggest impression on me in the\u00a0past 2 weeks.\u00a0I hope you enjoy the articles I selected.<\/p>\n<p>Please feel free to leave a comment on the articles \u2014 Do you like them? Dislike them? Agree, disagree, state your opinion, and participate in the discussion. And if you know of another recent interesting article, post a link to it. I would love to read it.<\/p>\n<p>Greg Bratton, MD<\/p>\n<p>Articles of Interest:<\/p>\n<ul>\n<li><strong><a href=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/05\/mom.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-453\" title=\"mom\" src=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/05\/mom.jpg\" alt=\"I love Mom\" width=\"88\" height=\"88\" \/><\/a><a href=\"http:\/\/www.medicalnewstoday.com\/articles\/222035.php\" target=\"_blank\">Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves<\/a> &#8211;\u00a0<\/strong>This\u00a0interesting article\u00a0brings the dreaded question, &#8220;What would <em>you<\/em> do, Doc?&#8221; to the forefront. We have all been asked how we would proceed in a given situation. This article suggests that our answers are not\u00a0always truthful. A group of primary care physicians were presented one of two hypothetical clinical scenarios. One scenario involved choosing between two treatment options for colon cancer, and the other asked about\u00a0two treatment options for avian flu.\u00a0For the two treatment options in each scenario, one had a high rate of side effects but low\u00a0risk for\u00a0death, and the other had a low rate of side effects but a higher risk for death. In analyzing the data, in both scenarios, a large percentage of physicians chose treatments with\u00a0higher risk for death for themselves, but only offered them to their patients between 25% and 50% of the time. Which begs the question, &#8220;Are we, in fact, treating our patients like we would our mother??&#8221;<\/li>\n<li><strong><a href=\"http:\/\/cardiology.jwatch.org\/cgi\/content\/full\/2011\/413\/1\" target=\"_blank\">Cardiac Troponin: Lowering the Threshold, Improving the Outcome <\/a>&#8211;\u00a0<\/strong>In an attempt to make sense of mildly elevated troponins in the ER, researchers examined plasma troponin concentrations (&lt;0.05 ng\/mL, 0.05\u20130.19 ng\/mL, and 0.20 ng\/mL) and the clinical outcomes of those with suspected acute coronary syndrome. When the diagnostic threshold for troponin was lowered to 0.05 ng\/mL from 0.20ng\/mL, the rate of death or MI decreased. Ultimately, I believe if ERs adopt a lower troponin threshold for ACS criteria, we might improve morbidity and mortality, but at a cost of more interventions and\u00a0hospital admissions and greater patient risk.<\/li>\n<li><strong><a href=\"http:\/\/emergency-medicine.jwatch.org\/cgi\/content\/full\/2011\/422\/4\" target=\"_blank\">Treating Sepsis in the Emergency Department Is Cost-Effective <\/a>&#8211;\u00a0<\/strong>This study hits home for me, as our ICU attendings at JPS Hospital currently are\u00a0investigating sepsis and early goal-directed therapy (EGDT). Seeing that\u00a0EGDT<em> <\/em>was associated with a gain of 1.3 quality-adjusted life-years (QALY)\u00a0per patient at a cost of about $5400 per QALY suggests that EGDT was cost-effective\u00a0(probability, &gt;98%). And, with sepsis being one of the most serious and fatal diagnoses among patients admitted to hospitals, having a protocol to identify and treat it expediently will revolutionize emergency medicine centers.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Recent advances and discussions in medicine are the cornerstone of Journal Watch.\u00a0Here\u2019s the fifth installment of the articles that\u00a0made the biggest impression on me in the\u00a0past 2 weeks.\u00a0I hope you enjoy the articles I selected. Please feel free to leave a comment on the articles \u2014 Do you like them? Dislike them? Agree, disagree, state [&hellip;]<\/p>\n","protected":false},"author":18,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5],"tags":[26,31],"class_list":["post-452","post","type-post","status-publish","format-standard","hentry","category-clinical-implications-of-research","category-journal-club","tag-evidence-based-medicine","tag-patient-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v17.1.2 (Yoast SEO v20.8) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Practice-Changing Articles V - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Practice-Changing Articles V\" \/>\n<meta property=\"og:description\" content=\"Recent advances and discussions in medicine are the cornerstone of Journal Watch.\u00a0Here\u2019s the fifth installment of the articles that\u00a0made the biggest impression on me in the\u00a0past 2 weeks.\u00a0I hope you enjoy the articles I selected. Please feel free to leave a comment on the articles \u2014 Do you like them? Dislike them? Agree, disagree, state [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2011-05-19T21:12:28+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/05\/mom.jpg\" \/>\n<meta name=\"author\" content=\"Greg Bratton, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Greg Bratton, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/\",\"name\":\"Practice-Changing Articles V - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2011-05-19T21:12:28+00:00\",\"dateModified\":\"2011-05-19T21:12:28+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/aa7ea23414872f1f891225542cb80120\"},\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Practice-Changing Articles&nbsp;V\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/aa7ea23414872f1f891225542cb80120\",\"name\":\"Greg Bratton, MD\",\"description\":\"Born and raised in Dallas, Texas, Dr. Bratton received his Bachelor of Science in Kinesiology-Movement Science at Texas Christian University in Fort Worth, Texas. While at TCU, Dr. Bratton was a 4-year letter winner on the TCU Horned Frog Division I baseball team. He received his medical degree from the University of Texas Health Science Center in San Antonio. Dr. Bratton completed his Family Medicine residency and served as Chief Resident at John Peter Smith Hospital in Fort Worth, Texas. He currently is a Fellow in Sports Medicine at JPS.\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/author\/gbratton\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Practice-Changing Articles V - Insights on Residency Training","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/","og_locale":"en_US","og_type":"article","og_title":"Practice-Changing Articles V","og_description":"Recent advances and discussions in medicine are the cornerstone of Journal Watch.\u00a0Here\u2019s the fifth installment of the articles that\u00a0made the biggest impression on me in the\u00a0past 2 weeks.\u00a0I hope you enjoy the articles I selected. Please feel free to leave a comment on the articles \u2014 Do you like them? Dislike them? Agree, disagree, state [&hellip;]","og_url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/","og_site_name":"Insights on Residency Training","article_published_time":"2011-05-19T21:12:28+00:00","og_image":[{"url":"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/05\/mom.jpg"}],"author":"Greg Bratton, MD","twitter_misc":{"Written by":"Greg Bratton, MD","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/","url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/","name":"Practice-Changing Articles V - Insights on Residency Training","isPartOf":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/#website"},"datePublished":"2011-05-19T21:12:28+00:00","dateModified":"2011-05-19T21:12:28+00:00","author":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/aa7ea23414872f1f891225542cb80120"},"breadcrumb":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/05\/practice-changing-articles-v\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.nejm.org\/general-medicine\/"},{"@type":"ListItem","position":2,"name":"Practice-Changing Articles&nbsp;V"}]},{"@type":"WebSite","@id":"https:\/\/blogs.nejm.org\/general-medicine\/#website","url":"https:\/\/blogs.nejm.org\/general-medicine\/","name":"Insights on Residency Training","description":"Observation of residents across diverse medical specialties","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/aa7ea23414872f1f891225542cb80120","name":"Greg Bratton, MD","description":"Born and raised in Dallas, Texas, Dr. Bratton received his Bachelor of Science in Kinesiology-Movement Science at Texas Christian University in Fort Worth, Texas. While at TCU, Dr. Bratton was a 4-year letter winner on the TCU Horned Frog Division I baseball team. He received his medical degree from the University of Texas Health Science Center in San Antonio. Dr. Bratton completed his Family Medicine residency and served as Chief Resident at John Peter Smith Hospital in Fort Worth, Texas. He currently is a Fellow in Sports Medicine at JPS.","url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/author\/gbratton\/"}]}},"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts\/452","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/users\/18"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/comments?post=452"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts\/452\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/media?parent=452"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/categories?post=452"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/tags?post=452"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}