Prognostication: A fading Hippocratic art?

Over the past 75 years modern medicine has advanced in its ability to diagnose and treat many diseases. However, the medical profession's ability to prognosticate the course and outcome of an illness has not satisfied the needs of many patients. Physicians must not lose the ability, or desire, to consider the whole person in relation to a patient's disease. We need to ask ourselves what person has the disease, not what disease the person has. Here I endeavor to demonstrate why Hippocrates valued prognostication highly, how its importance may have faded from the consciousness of current medical practice, and how modern technology is attempting to reinvent or revise it.

Hippocrates, the first aphorism, and decorum: A personal view of caution and guidance regarding Generation Z students.

Generation Z students can be challenging. The Internet, the Covid-19 epidemic, its political aftermath, and the substantial online educational content they have been required to endure, has left them with a perspective towards a work-life balance to which we older, more experienced faculty are not accustomed. Here, I give caution and guidance to my colleagues regarding their interactions with this cohort through my reading of the Hippocratic corpus.

Presumed antiphospholipid syndrome and thrombotic thrombocytopenic purpura: An infrequent association.

Antiphospholipid syndrome (APS) is an autoimmune disease that demonstrates antiphospholipid antibodies that cause hypercoagulability and leads to venous and arterial thrombosis. Autoantibodies to a disintegrin-like and metalloprotease with thrombospondin type I motif, member 13 (ADAMTS 13) play a role in the microthrombosis of thrombotic thrombocytopenic purpura in APS patients.

Eluding meaninglessness: a note to self in regard to Camus, critical care, and the absurd.

Here I present a medical narrative, as a catharsis, regarding Albert Camus's The Myth of Sisyphus in an attempt to elude meaninglessness in my difficult everyday practice of critical care medicine. It is well documented that physicians who practice critical care medicine are subject to burnout. The sense of despair that occasionally overwhelms me prompted my rereading of Camus's classic text and caused me to recount his arguments that life is meaningless unless one is willing to take a leap of faith to the divine or, alternately, to commit suicide. This set up the examination of his third alternative, acceptance of a life without prima facie evidence of purpose and meaning, a view that may truly have some bearing on my professional life in the intensive care unit.

Association between in-hospital acute hypertensive episodes and outcomes in older trauma patients.

Although chronic hypertension is associated with long-term complications, few studies directly examine the effects of in-hospital acute hypertensive episodes in trauma patients. The aim was to determine whether there is an association between in-hospital acute hypertension and morbidity. We included trauma patients between 45 and 89 years who presented to a level I trauma center between January and September 2008. Patients were classified as either experiencing or not experiencing acute hypertensive episode(s) as defined by systolic blood pressure ≥180, or diastolic blood pressure ≥110 mmHg, or at least two readings of systolic blood pressure ≥160 or diastolic blood pressure ≥100 mmHg. The primary outcome was a composite endpoint of myocardial infarction, stroke, venous thromboembolism, new-onset atrial fibrillation, or acute kidney injury. At least one acute hypertensive episode occurred in 42.6% (69/162) of patients. A total of 10.5% patients developed the composite endpoint, 17.4% in the acute hypertensive episode group compared to 5.4% in the non-hypertensive group, p = 0.012. Patients in the acute hypertensive group were more likely to require an intensive care unit admission compared to the non-hypertensive group (33.3 versus 14.0%, p = 0.004). Of the 17 patients who developed an acute hypertensive episode and met the primary endpoint, 10 were on home antihypertensive medications. Of those, four were restarted on all medications initially, three on some, two were started on new medications, and one was not resumed on home medications. Development of acute hypertensive episode(s) in older trauma patients was associated with an increase in the composite endpoint. Prospective studies are needed.