July 2022: Locked
"Can you order this guy some pain medicine?" the nurse asked me. “He looks like he's in agony."He had tipped over while standing on top of a step stool. Now he couldn't straighten his knee. It was unyieldingly bent at 90 degrees, and any attempts to extend it met with resistance.The presentation seemed classic. I had seen this once before; it had to be a bucket handle meniscus tear. We would get a precautionary x-ray, but I was already explaining how a bucket handle tear was analogous to a rug being stuck under a door. I asked him to imagine how hard that makes it to move the door. The same thing was ha...
Source: Lions and Tigers and Bears - July 1, 2022 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
What Would Newt Do? Making Value-Based Care Victorious
By MICHAEL MILLENSON
Health care’s much-trumpeted transition “from volume to value” care remains more tepid than transformational, according to a new study. Looking at 22 health systems nationwide, RAND researchers found that compensation continues to be “dominated by volume-based incentives designed to maximize health systems revenue.”
Although confusing payment schemes bear part of the blame, there are deeper problems that appeared in sharp relief when I chanced upon a long-ago PowerPoint from a prominent political strategist and early advocate of “data-driven reimbursement.”
I refer, of cour...
Source: The Health Care Blog - February 21, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Public Health HITCH act Michael Millenson Newt Gingrich Source Type: blogs
Why I don ’ t trust my clinical reasoning: and why this matters
“See someone experienced” I hear people with pain say. “They’ll know what’s wrong with you.”
Well, based on the research I’ve read, I wouldn’t be so sure. In fact, I’m certain my own clinical reasoning is biased, prone to errors that I don’t notice, and influenced by factors that most clinicians would be horrified to think they, too, were influenced by.
Let me give you a few to ponder:
I’m interested in women and pain – and there’s a lot of evidence showing that women’s pain doesn’t get the same kind of diagnostic and managem...
Source: HealthSkills Weblog - July 11, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Science in practice Chronic pain Clinical reasoning healthcare Source Type: blogs
Alternate Realities Help Medical Education And Training During COVID-19
With the need to limit physical contact amidst the pandemic, the whole world turned to virtual solutions to reprise their daily activities. Zoom and Slack became the new workplace; and even medical consultations were increasingly conducted online.
However, by turning indoors, aspiring healthcare professionals were negatively impacted since hands-on practices and training were limited, if not impossible. In Scotland, dental students had to repeat a whole year due to insufficient clinical exposure. In particular, they could not practise aerosol-generating procedures (AGPs) enough. The latter were limited due to their pote...
Source: The Medical Futurist - March 9, 2021 Category: Information Technology Authors: Pranavsingh Dhunnoo Tags: Covid-19 Artificial Intelligence in Medicine Augmented Reality Biotechnology E-Patients Future of Medicine Future of Pharma Healthcare Design Medical Education Virtual Reality Surgery VitraMed DentSim Simulator orthopedics stud Source Type: blogs
Knee arthroscopy: Should this common knee surgery be performed less often?
Imagine you’re walking along and suddenly experience excruciating knee pain. Though it initially seems stuck in one position, after a minute or two you can limp along home, but just barely. At your doctor’s visit, an x-ray is normal but symptoms continue for weeks. An MRI is performed and now you have an explanation: a torn meniscus. (Two menisci — rubbery cartilage pads that act as shock absorbers — separate the bottom of your knee bone from the top of your shin bone.) A month later, you’re no better despite rest, pain medicines, and physical therapy. It’s time for surgery to fix it, right? Maybe not.
Knee art...
Source: Harvard Health Blog - April 20, 2020 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Injuries Osteoarthritis Pain Management Surgery Source Type: blogs
Trammpolin, A Meniscus Prosthesis to Improve Knee Surgeries: Interview with CEO Jan Hunik
Meniscus tears are a fairly common knee injury. Treatment typically involves complete or partial removal of the damaged meniscus. Without shock-absorbing role of the meniscus, however, patients are at risk for accelerated wear of the knee joint and osteoarthritis. Currently, patients have to wait for many years until they are eligible for a total knee replacement (TKR). Orthopedic surgeons lack options during this period, what they call the “treatment gap.”
ATRO Medical is working on another option for patients: a meniscus prosthesis. The Netherlands-based company was founded in 2016 and has been developing the Tram...
Source: Medgadget - February 28, 2020 Category: Medical Devices Authors: Cici Zhou Tags: Exclusive Orthopedic Surgery Source Type: blogs
Optical Coherence Tomography Finally Used to Measure Cartilage Health
Optical coherence tomography (OCT) is an imaging modality that provides a micron-level look at the tissues being examined. It is used in ophthalmology to assess the eyes and for imaging the interior of arteries to help with atherectomies. Although OCT has significant potential to help clinicians evaluate the health of tissues, it has proven difficult to use deep within the body.
Now, researchers at Duke University have managed to equip a rigid borescope, the kind used to look inside joints during arthroscopies, with OCT imaging capability. The borescope, with a diameter of only 4 mm, was used to assess the state of cart...
Source: Medgadget - November 18, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Diagnostics Orthopedic Surgery Pathology Radiology Source Type: blogs
Life – Over The Past Month
I was out of work for 31 days, from August 16 until September 17. The reason is because I had surgery on my left knee, an arthroscopy of the medial meniscus. It got damaged somehow; the cause is unknown to me. It started becoming problematic sometime around Christmas 2018, but I didn’t really pay much attention to it. I figured it had to be something fairly minor which would resolve itself. However, it didn’t. And ultimately it led to my being evaluated by an orthopedic surgeon, having to get X-Rays and Magnetic Resonance Imaging on my knee, and finally having the surgical procedure performed to fix the problem...
Source: Qui Interrogat - September 21, 2019 Category: Nursing Authors: Walt Trachim Tags: Uncategorized Source Type: blogs
Custom 3D Printed Robotic Surgical Instruments for Every Patient
Today’s arthroscopic instruments that are used to perform minimally invasive procedures on hips, knees, and other parts of the body, are rigid devices. They also tend to be one-size-fits-all solutions that surgeons have to use on patients with varied anatomies.
Now, a team at the Australian Centre for Robotic Vision are working on being able to make custom robotic instruments that align with a given patient’s anatomy. The idea is that a knee, for example, would be imaged using an MRI machine and the resulting scan used to define where the robot can and cannot go. Targets are set and a path is defined for the...
Source: Medgadget - July 12, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Orthopedic Surgery Source Type: blogs
The Brain Stage: The Power & Promise of The Cephalic Phase for Health
Listen to the Podcast or Read the Transcript
[00:00:03] Hi I’m Dr. Alan Greene pediatrician and I’d like to talk with you tonight about The Brain Stage.
[00:00:10] I remember vividly when I was a pediatric resident in training go to a Grand Rounds about a surprising topic.
[00:00:18] The function of the brain and the function of the skin and one of the things that dermatologists talked about was a common procedure freezing warts. Freezing warts was then, and is still, one of the most common ways to get rid of warts. What she talked about was how wildly different the results were in different studies. Peo...
Source: Conversations with Dr Greene - May 23, 2019 Category: Child Development Authors: Alan Greene MD Tags: Dr. Greene's Blog Uncategorized Cephalic Phase Placebo The Brain Stage Source Type: blogs
The Brain Stage: The Power & Promise of The Cephalic Phase for Health
Listen to the Podcast or Read the Transcript
[00:00:03] Hi I’m Dr. Alan Greene pediatrician and I’d like to talk with you tonight about The Brain Stage.
[00:00:10] I remember vividly when I was a pediatric resident in training go to a Grand Rounds about a surprising topic.
[00:00:18] The function of the brain and the function of the skin and one of the things that dermatologists talked about was a common procedure freezing warts. Freezing warts was then, and is still, one of the most common ways to get rid of warts. What she talked about was how wildly different the results were in different studies. People use...
Source: Conversations with Dr Greene - May 23, 2019 Category: Child Development Authors: Dr. Alan Greene Tags: Dr. Greene's Blog Uncategorized Cephalic Phase Placebo The Brain Stage Source Type: blogs
AF, Ablation, Stents and Five Nuances
Joan has left an excellent comment on my recent 2019 AF ablation update.
She brings up many important issues. Let’s dissect it.
Q: Joan asks if it is common to see patients who think they are cured after AF ablation but are still in AF?
A: The scenario I described in my previous post is not common, but it is not rare. Since AF ablation entails much instrumentation and many burns, it can affect how the heart feels things. The heart has its own nervous system; yes, the heart feels. Also, the bigger the procedure, the bigger the placebo effect.
Q: If ablation doesn’t work, then I sure know a lot of peo...
Source: Dr John M - February 9, 2019 Category: Cardiology Authors: Dr John Source Type: blogs
Managing pain after surgery
Surgery and pain pills used to go hand in hand. After all, you need a strong prescription pain medication to ensure you aren’t in pain after a procedure, right?
Turns out not only is prescription pain medication not always needed, but often not advisable after surgery, because it can raise the risk of opioid addiction. As a result, surgeons today are rethinking post-surgical pain management strategies. And if you’re going under the knife, you should too.
In the 1990s, the number of opioid prescriptions written for people undergoing surgery or experiencing pain conditions grew — and so did related problems. As a resul...
Source: Harvard Health Blog - February 7, 2019 Category: Consumer Health News Authors: Kelly Bilodeau Tags: Health Pain Management Surgery Source Type: blogs
Surgeons are doing fewer knee surgeries
When knee arthroscopy became widely available in the 1980s, it represented a major advance. Today orthopedists evaluating and treating common knee problems often recommend arthroscopy, during which they insert an instrument into the joint and, with a light and camera on its tip, directly inspect the knee from the inside. While there, he or she can diagnose and treat common painful knee problems, such as arthritis or torn cartilage. The risks are much lower and recovery times much shorter than standard “open” knee operations.
As with any technology or other advance in medicine, years of research were required to underst...
Source: Harvard Health Blog - December 27, 2018 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Arthritis Bones and joints Health Source Type: blogs
The challenge of no to arthroscopic surgery
Nearly half of Canadians aged 65 and over experience osteoarthritis in their knees. Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage on the ends of bones wears down over time leading to pain, stiffness and decreased mobility. It frequently occurs in the hips and k nees— and can be quite […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - December 6, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/eric-bohm-and-ivan-wong" rel="tag" > Eric Bohm, MD and Ivan Wong, MD < /a > Tags: Conditions Orthopedics Surgery Source Type: blogs
