Docnotes

Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis

When Bill Ventres and his colleagues published their paper last year on this topic - I was impressed, but for some reason I didn't write about it here or forward a link to all of my colleages as I should have done. Bill presented the paper at this year's STFM - and of course he uploaded his powerpoint to FMDRL. Required reading.

Role of Family Medicine in Care of Children

An interesting review of some thorny issues ..

Speaker Outlines Role of Family Medicine in Care of Children -- AAFP News Now -- American Academy of Family Physicians

Nasendusche = "Nose Shower"

Docnotes readers (and my patients) know I'm a fan of the Nose Shower.

There was a great story on NPR a few weeks ago about nasal irrigation. Listen to it - to hear a great explanation of the differences between nasal irrigaion and nasal moisturizing. This is a key difference that many people don't quite understand.

Seems like the Germans do. A patientsent me the link to this German website promoting the Nasendusche. (Translation coutresy of google - don't laugh too hard!) It seems more efficient than a Neti Pot. I'll try to buy a few to have on hand for demonstration. US distributorship anyone?

What's interesting to me is that nasal irrigation with Dead Sea Salt has been found to have efficacy for allergic rhinitis as well as chronic sinusitis. There is research documenting increased CBF with hypertonic saline (no clarity on whether this has any clinical implication, of course), the AAP guidelines for the management of chronic sinusitis in children reccomend saline irrigation, and while there remains controversy - it seems that studies with negative outcomes use less agressive irrigation ( should we call this nasal moisturization?) than those with more compelling outcomes.

What's clear to me is that sinusitis is an obstructive problem - and that the obstruction is the primary problem - not the infection.