The Cost of Public Reporting

ANISH KOKA MD In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe. Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear.  He loved guitar playing,  and camp horror movies.  Those who knew him well said he had a kind heart, a quick wit and loved cats. I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon.  I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack.  Not able to make sense of the story on the phone, I was in to try to sort it out.  Joe was gruff, short with his answers – but clearly something just wasn’t right.   He was only 54 but had more problems than the average 50 year old.   Progressive calcification of his aortic valve  some years ago  had caused intolerable shortness of breath resulting in  replacement with an artificial valve. Longstanding diabetes had resulted in kidney failure and dialysis,  and most recently abnormal liver tests had  revealed the presence of the early stages of cirrhosis from hepatitis C.  Yet Joe continued to live an active life – with only a tight circle of family and friends aware of the illnesses beneath the surface. But on this particular day it was readily apparent Joe was not well. &nb...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: blogs

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Congenital thumb hypoplasia is a rare deformity of the upper extremity. The classification of thumb hypoplasia was created by Blauth in 1967 (types I to V). The base of the first metacarpal bone is absent for hypoplasia types IIIb to V, therefore, toe-to-hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for a successful toe-to-hand transplantation. The aim of this study is to describe a new technique for thumb reconstruction with the second toe transfer and metatarsophalangeal joint (MTPJ) arthrodesis, which can provide a five-digit hand and restore thumb f...
Source: Techniques in Hand and Upper Extremity Surgery - Category: Surgery Tags: Technique Source Type: research
We present a case report of an adult woman with AKL-positive ALCL, diagnosed by endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA).A 59-year-old women with no history of breast implants, was admitted for a four-month low back pain. Initially, the patient was treated for a spondyloarthropathy, but due to persistence of the symptoms, a lumbosacral MRI was performed, showing changes in morphology and signal intensity in the vertebral body of L3, along with edema and a paravertebral collection that affected the left psoas muscle, suggesting granulomatous spondylodiscitis. Chest CT-scan showed mild left ...
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
A 58-year-old female presents with a 1-year history of hematochezia, 20-pound weight loss, and increased straining with bowel movements. She denies increased bowel frequency or change in stool caliber. Her medical history is notable for irritable bowel syndrome, but otherwise unremarkable. She has no family history of malignancy and does not take any prescribed medications or supplements. She denies abdominal pain, bone pain, or any symptoms concerning for metastatic disease. Her initial physical examination was notable for an Eastern Cooperative Oncology Group performance status of 0, and presence on digital rectal examin...
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Gray Zone Source Type: research
Summary: The incidence and prevalence of diabetes continues to increase, and proper understanding of the adverse effects on bone metabolism is important. This review attempts to discuss the pathophysiology of the effects of diabetes and diabetic medications on bone metabolism and bone health. In addition, this review will address the mechanisms resulting in increased fracture risk and delayed bone healing to better treat and manage diabetic patients in the orthopedic clinical setting.
Source: Journal of Orthopaedic Trauma - Category: Orthopaedics Tags: State-of-the-Art Source Type: research
Conclusions: This is the first case that reports stabilization of a descemetocele with a PROSE device. For patients at high risk for postsurgical complications, PROSE treatment could be considered as an alternative to corneal transplantation and as an adjunct to other ocular therapies in patients with descemetocele formation.
Source: Eye and Contact Lens: Science and Clinical Practice - Category: Opthalmology Tags: Case Report Source Type: research
Objective: To determine effects of wearing soft toric silicone hydrogel, rigid gas-permeable (RGP), and mini-scleral lenses on corneal microstructure using confocal microscopy. Method: A prospective cohort study was conducted on 33 neophyte patients fitted with contact lenses (avg. age: 26±7 years) in the tertiary eye center. Patients were instructed to wear soft toric silicone hydrogel, RGP, or mini-scleral lenses based on clinical diagnoses. Inclusion criteria were age greater than 18 years and best-corrected visual acuity ≥3/10. Patients with a history of eye-involving systemic diseases were excluded. Bas...
Source: Eye and Contact Lens: Science and Clinical Practice - Category: Opthalmology Tags: Article Source Type: research
Conclusion: Capillary nonperfusion area in the posterior retina increases with increasing DR severity as measured by swept-source OCTA. Quantitative analysis of retinal nonperfusion on wide-field OCTA may be useful for early detection and monitoring of disease in patients with diabetes and DR.
Source: RETINA - Category: Opthalmology Tags: Original Study Source Type: research
Conclusion: Changes in the choroid may occur before the development of diabetic retinopathy and seem to progress with increasing diabetes mellitus duration despite the absence of diabetic retinopathy and without associated retina thickening. Choroidal thickness could be valuable for screening in diabetic children.
Source: RETINA - Category: Opthalmology Tags: Original Study Source Type: research
Conclusion: Autologous RPE–choroid patch achieved long-lasting BCVA improvement and central fixation, in eyes with choroidal neovascular membrane and intact external limiting membrane. Atrophic maculopathies only obtained temporary visual benefit.
Source: RETINA - Category: Opthalmology Tags: Original Study Source Type: research
Purpose: To compare intraocular pressure, anterior segment optical coherence tomography, and ultrasound biomicroscopy parameters over 3 months after panretinal photocoagulation (PRP) for proliferative diabetic retinopathy after 1 of 2 sittings by conventional laser (half PRP) and a single sitting of Pattern Scan Laser (PASCAL) PRP. Methods: This was a prospective, randomized, interventional study. All tests were performed at baseline, and at 1, 6, and 24 hours, and 1, 4, 8, and 12 weeks after PRP. Results: The intraocular pressure at 1 hour and 6 hours after PRP was significantly raised in both groups. Mean intraoc...
Source: RETINA - Category: Opthalmology Tags: Original Study Source Type: research
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