Archive for the ‘Best of TPR’ Category

The science of alpha-PVP (“gravel”), a second-generation bath salt

March 14, 2014, 7:24 pm


Pharmacology of novel synthetic stimulants structurally related to the “bath salts” constituent 3,4-methylenedioxypyrovalerone (MDPV). Marusich JA at al. Neuropharmacology 2014 Mar2 [Epub ahead of print]


Earlier this month TPR noted that a relatively new second-generation bath salt call “gravel” was reported to have surfaced in various parts of the United States, including Tennessee. As background, while first-generation bath salts …

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Into the Wild: did a neurotoxin kill Chris McCandless?

January 6, 2014, 5:01 pm

In April 1992, Chris McCandless, aka “Alexander Supertramp,” hiked into the Alaskan wilderness with no map, no compass, and no means of communicating with the outside world. A 24-year-old from Fairfax, Virginia, he had graduated with honors with a double major (history, anthropology) from Emory University in Atlanta. However, as chronicled in Jon Krakauer’s book Into the Wild, he …

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Deaths in an Australian nursing home: murder by insulin?

November 2, 2013, 12:10 pm


The Australian Broadcasting Corporation reported this week that that two residents of the Summitcare Wallsend nursing home in Newcastle — an 83-year-old woman and an 80-year-old man — died of hypoglycemia under suspicious circumstances. An additional resident of that same home was sent to hospital with dangerously low blood glucose levels, but survived. Police have called in homicide experts from …

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Must-read: Anti-NMDA Receptor Encephalitis

August 28, 2013, 1:35 pm


Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: an etiology worth considering in the differential of delirium. Punja M et al. Clin Toxicol 2013 Aug 20 [Epub ahead of print]


This important paper is a must-read, especially for toxicologists who have not heard of this under-appreciated neurological disorder. (I was not aware of it until several days ago, when I found out that …

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Official report about overdose patient who awoke in OR just before surgeons harvested her organs

July 11, 2013, 12:18 am

Several days ago TPR posted  about a distressing case from Syracuse (NY), in which an overdose patient woke up in the operating room just as surgeons were about to harvest her organs. There were some details in the Syracuse Post-Standard story. An astute reader sent a comment pointing out that the report investigating this case — produced by the …

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Hospital fined after overdose patient awakes just before surgeons harvest her organs

July 8, 2013, 4:39 pm

The Syracuse (NY) Post-Standard reports that St. Joseph’s Hospital Health Center has been fined $22,000 for a 2009 incident in which a patient declared brain dead and cleared for organ donation woke up in the operating room just before the harvesting procedure was to begin.

According to the report, the 41-year-old patient was brought to the emergency department comatose. Although …

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Are vasopressors effective therapy in calcium channel blocker overdose?

May 17, 2013, 9:43 pm


Critical Care Management of Verapamil and Diltiazem Overdose with a Focus on Vasopressors: A 25-Year Experience at a Single Center. Levine M et al. Ann Emerg Med 2013 May 1 {Epub ahead of print]


This uncommonly interesting and thought-provoking study comes from the Department of Medical Toxicology at Banner Good Samaritan Medical Center in Phoenix. The authors note that …

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Absolute must-read: Why Rating Your Doctor Is Bad For Your Health

January 5, 2013, 4:42 pm

Forbes has posted a detailed and well-researched article (set to appear in the magazine’s January 21, 2013 issue) reviewing the amazing history of Press Ganey Associates, and pointing out statistical problems — not to mention potential dangers — inherent in patient satisfaction surveys.

As reporter Kai Falkenberg notes, the Press Ganey company was started in 1985 by 2 academics …

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The money and influence behind “Pain as the Fifth Vital Sign”

December 16, 2012, 11:46 pm


A must-read article in the Wall Street Journal this weekend focuses on Dr. Russell Portenoy, a New York City pain specialist who two decades ago was instrumental in the drive to expand use of opioid analgesics to treat chronic pain. (Unfortunately, the article is behind the WSJ firewall and requires subscription.)

The Journal notes that today, prescription opioids …

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