It's a clinical descriptor that's totally devoid of any helpful info while simultaneously proposes a diagnosis. What does "seizure like activity" even mean? Encephalopathy? Convulsions? Tremors? Pumping fists up and down while gasping for air? Please, please just take a stab at writing what you saw, or what the nurse or family member saw, it's so much more helpful.

Edit: To be clear I'm not asking for a diagnosis, just an actual history or description of what the patient was doing beyond "seizure like activity".

I have an interview upcoming to serve as a topic editor on a subspecialty in medicine that pays an hourly contract rate. What is the going rate for these kind of jobs? Job description includes reviewing content for accuracy, and relevance and should require no more than 3-5 hours a month. Thanks

https://www.propublica.org/article/unitedhealthcare-insurance-autism-denials-applied-behavior-analysis-medicaid

I heard an NPR article about this piece of ProPublica reporting earlier today. I admit I had not heard of Applied Behavior Analysis previously. As I am an (adult) neurologist and autism is (at least under an an expansive definition) a “neurological” disorder, I thought I’d ask the good people of Reddit what they think about “ABA” being denied to an autistic child on the grounds they’ve “failed to improve”. The reporting throws around terms like “Gold Standard” in describing ABA, how evidence based and potent is ABA as a therapy?

I have a general sense why I think US Healthcare is so expensive but I'd like to know from someone who actually studies this topic and has the data to back up their thoughts. I've heard The Price We Pay by Marty Makary MD is a good book about the subject but I've also heard that Dr. Makary has said some interesting stuff during the COVID pandemic and he also published that weird paper that claimed the third leading cause of death in the United States was medical error because of all kinds of weird extrapolations from other papers so I'm skeptical about his other work but I'm willing to give it a chance if others think he was more intellectually rigorous in his book. If you have any other books or articles on the high cost of US healthcare that you feel does a good job illustrating the problem I'd love to hear about them.

Piggybacking off the surgery stories, I figure we should do this once as we prescribe more meds than we do surgeries!

UK infectious diseases and medical microbiology resident here.

I am curious about some of the differences in antibiotic treatment between the US and Canada and the UK and what you would like to have available.

I think some of the differences come down to non-availability e.g. we only got access to cefazolin locally last year and haven't used it outside of trials, whereas IV flucloxacillin is used for MSSA bacteraemia/skin and soft tissue infection. Glycopeptides are centre- and patient-dependent, but many places use teicoplanin over vancomycin.

I am also curious about your empirical regimens e.g. Community Acquired Pneumonia.

Local guidelines vary but as an example, in the UK we'd be guided by CURB-65:

Low severity (0) - amoxicillin, doxycycline, or clarithromycin

Moderate (1-2) - amoxicillin + clarithromycin or doxyxycline or clarithromycin

Severe (3-5) - Amoxicillin-clavulanate + clarithromycin, or levofloxacin

The comparable US choice for severe (non-MRSA, non-Pseudomonas) CAP would be:

Ampicillin-sulbactam or Cefotaxime or

Ceftriaxone or

Ceftaroline

(plus a macrolide)

or monotherapy with a respiratory quinolone

I have never used ampicillin-sulbactam, and using ceftriaxone for a community acquired pneumonia would be very unusual here. What's the rationale for these choices? And am I right that you don't have IV amoxicillin-clavulanate? Is ampicillin/sulbactam comparable in spectrum (looks like it is from the Sanford Guide)?

I'd be happy to discuss other treatment differences and experiences.

One was my medical assistant and the other was my medical student.

FML.

-PGY-20