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JAMA Performance Improvement: Do No Harm — Performing the Wrong Procedure

What to do when the wrong procedure is performed? In this first installment of JAMA Performance Improvement: Do No Harm we explore the options for dealing with this very difficult problem with Tami Minnier, RN, MSN, Paul Phrampus, MD, Linda Waddell, RN, MSN, and David Baker, MD, MPH, FACP. Air traffic audio courtesy of LiveATC.net, used with permission.

 




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Fluid Resuscitation for Patients in Septic Shock

When managing septic shock, passive leg raising is the best test to determine if a patient is likely to respond to a fluid bolus, better than CVP lines or even bedside ultrasound. Dr Najib Ayas, Associate professor of Critical Care Medicine at the University of British Columbia, discusses shock management from the context of his Rational Clinical examination article in the September 27, 2016 issue of JAMA, entitled “Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?




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Treatments for Hyperemesis and Nausea and Vomiting in Pregnancy

Nearly all women experience some element of nausea and vomiting during their pregnancies. In this podcast we review the entire spectrum of disease all the way up to hyperemesis gravidarum and how to provide care for women experiencing these problems.

Article discussed in this episode:

Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy

 




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Professional Boundaries: What to Do When Clinicians Ask Other Clinicians to Prescribe Medications for Them

In this episode of JAMA Professionalism: Best Practice, Edward H. Livingston, MD looks at the case of a physician requesting prescription medication from a colleague to examine professional boundaries between physicians and options for managing those boundaries. Shiphra Ginsburg, MD and Wendy Levinson, MD, authors of the related article, join Dr Livingston to discuss the best options for handling this challenging situation. Arthur S. Hengerer, MD, chair of the Federation of State Medical Boards discusses the legal and licensure ramifications of physicians prescribing for other clinicians and Kate E. Engelhardt, MD, and D. Brock Hewitt, MD, MPH, practicing physicians, relate their experience with other clinicians asking them to prescribe medications.










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Updated Guidelines for Sepsis Management

In 2017 the Society for Critical Care Medicine updated its guidelines for sepsis management. These new guidelines differ significantly from ones in the past in that they no longer recommend protocolized resuscitation and emphasize early and aggressive fluid resuscitation when patients present with septic shock. This is the first podcast in the Surviving Sepsis guideline series. The next episode discusses why the new sepsis guideline changed.

Article discussed in this episode: Management of Sepsis and Septic Shock

Speakers:

Laura Evans, MD, MSc, of Bellevue Hospital and NYU Medical Center

Andrew Rhodes, MBBS, MD, of St George’s University Hospitals NHS Trust and co-chair of the Surviving Sepsis guideline panel

Mitchell M. Levy, MD, of the Alpert Medical School of Brown University and Rhode Island Hospital