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In other words, I think that you are saying:

"I don't think that means what you think it means"

R

For a more complete review of these "inconceivable" words that "dont mean
what they think it means" see

https://www.youtube.com/watch?v=1-b7RmmMJeo

On Fri, Oct 31, 2014 at 1:09 PM, Eugene Izsak <[log in to unmask]> wrote:

> I agree with Marty and here is my rationale:
>
> 1 The Guideline was based on a "Retrospectve, observational cohort
> population, over 130,000 HOSPITALIZED patients"
>
> 2 No clear guidance on how to diagnose PURE Bronchiolitis and be able to
> separate out those with atopy or underlying asthma.
>         see: Lehtinen, P., Ruohola, A., Vanto, T. et al. Prednisolone
> reduces recurrent wheezing after a first wheezing episode associated with
> rhinovirus infection or eczema. J Allergy Clin Immunol. 2007; 119: 570–575
>
> 3 The practice of Evidence Based medicine is the *confluence* of 3 realms
>     a. Clinical Expertise : our own experience
>     b. The Evidence : The literature (of which practice guidelines are
> hardly at the pinnacle)
>     c.  The patient's (or parent's) perspective
>
>         Without expertise, evidence can tyrannize practice (read COOKBOOK
> medicine)
>   Without evidence, expertise can become outdated  (read DOGMA)
>
> My own experience is that Albuterol benefits 1/3 to 1/2 of patients under 2
> years with first time wheezing in this season.
>         "Tis the Season to be Wheezin' ".
>
>
> Just my 2 cents.
>
>
> On Thu, Oct 30, 2014 at 8:30 PM, Marty Herman <[log in to unmask]>
> wrote:
>
> > I do not plan to use the AAP guidelines. It has been my experience that
> > some kids do benefit from albuterol with bronchiolitis,I also have seen
> > nice improvement with racemic epi, and epi nebs, Recently I have added
> > hypertonic saline to my armamentarium and think it helps..
> >
> >
> > Marty
> > Martin Herman, M.D.
> >
> > Pediatric Emergency Medicine
> > Sacred Heart Children's Hospital
> >
> > Email: [log in to unmask]
> >
> > CONFIDENTIALITY NOTICE:
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> other
> > applicable privilege.
> >
> >
> >
> >
> >
> >
> > > Date: Thu, 30 Oct 2014 15:17:57 -0700
> > > From: [log in to unmask]
> > > Subject: My name is Dr. Indigo Montoya, You Killed Albuterol..
> > > To: [log in to unmask]
> > >
> > > ... prepare to die.
> > >
> > > In face of the recent AAP Guideline on the management of
> bronchiolitis, I
> > > am recruiting other Peds ED centers who will be endorsing this set of
> > > practices to serve as the treatment group in my non-randomized
> > > observational study. Our center will serve as the 'out-of-control'
> group
> > > and we will be initiating a new clinical pathway entitled... 'Empiric
> > > therapy for the treatment of undifferentiated respiratory distress in
> > > infants.'
> > >
> > > It is my hypothesis that our group's admission and bounce-back rates
> will
> > > be the same as last year.
> > >
> > > I anxiously await the data from the centers who adopt the AAP approach!
> > >
> > >
> > > Jay Fisher MD
> > > Medical Director, Peds EM, Children's Hospital of NV
> > > Physician Consultant, Dread Pirate Roberts
> > >
> > > For more information, send mail to [log in to unmask] with
> the
> > message: info PED-EM-L
> > > The URL for the PED-EM-L Web Page is:
> > >                  http://listserv.brown.edu/ped-em-l.html
> >
> > For more information, send mail to [log in to unmask] with the
> > message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >                  http://listserv.brown.edu/ped-em-l.html
> >
>
>
>
> --
> *"I would rather be the kind of person who makes molehills out of
> mountains, then mountains out of molehills." *
> *"I dream of a better world, where chickens can cross the road and not have
> their motives questioned." Anon.*
> *"The art of medicine consists in amusing the patient while nature cures
> the disease." Voltaire*
> *"I may not have gone where I intended to go, but I think I have ended up
> where I needed to be."  Douglas Adams*
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html
>

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html