Another Example of Defensive Medicine
The ultrasound images above show a circular clot in the superficial femoral vein. The image on the left is without compression and the image on the right is with compression. Normally blood vessels flatten out when compressed. Since the vessel did not flatten with compression it confirmed the presence of a blood clot.
While discussing a case with one of the nurses with whom I work, I saw how once again defensive medicine had affected my medical practice.
I gave a few examples of defensive medicine in a post several years ago and I also mentioned how sometimes doctors have to prove a negative when dealing with patients. Bot...
Source: WhiteCoat's Call Room - September 18, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Defensive Medicine Patient Encounters Source Type: blogs
Is this the most important cardiology study of the last decade?
In recent years, progress in the field of cardiology has been painfully incremental. We have enjoyed small gains–a better ablation catheter and mapping system, a couple of new anti-platelet drugs, maybe better stents, and even the highly touted anticoagulant drugs are within 99% in efficacy and safety of warfarin. Major breakthroughs, though, are non-existent. (And please don’t tell me squishing valves in the frail elderly is a major advance.)
This absence of game-changing type progress has an explanation. Perhaps the answer will be obvious after I tell you about the most important cardiology medical study of t...
Source: Dr John M - August 27, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Getting the dabigatran (Pradaxa) story right… Correcting four common mistakes.
This purpose of this post is to clarify misstatements made in a recent New York Times article about the anticoagulant drug dabigatran (Pradaxa). The piece had three major inaccuracies, plus one thought-error from a cardiology leader. I write these words because the most valuable tool in the treatment of AF is knowledge. Getting it right is critical. (For readers that persist, I offer a bonus at the end.)
The thrust of the Times’ story concerned editorials in the British Medical Journal that questioned the safety of dabigatran. The first non-warfarin anticoagulant has had plenty of controversy, the most recent of whic...
Source: Dr John M - August 21, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Top stories in health and medicine, August 7, 2014
From MedPage Today:
Return to Warfarin Okay After TBI? Restarting warfarin (Coumadin) after a traumatic brain injury (TBI) improved overall outcomes despite the bleeding risk.
Dietitians Take Aim at Food Industry Sponsorships. Andy Bellatti has been troubled by some of the continuing education programs he’s seen at the Academy of Nutrition and Dietetics (AND) annual meeting.
Immune-Boosting Nutrients No Help in ICU Patients. In critically ill patients, high-protein enteral nutrition supplemented with immune-modulating agents had no benefit and a suggestion of harm.
Benefits Add Up for Regular Aspirin Use. Average-r...
Source: Kevin, M.D. - Medical Weblog - August 7, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Heart Neurology Source Type: blogs
Finger Fascination
It’s summertime, and people are spending a lot of time outside in their yards, at the pool, traveling, hiking, and getting their fingers caught in things. That makes it the perfect time for a tribute to finger lacerations, specifically those with nail bed disruption and avulsion.
You will need to do a bit of handy work yourself if you work in an urgent care center that does not have a hand specialist on call 24/7. Finger lacerations can be complicated, but you simply need to keep in mind the basic principles about repair of soft tissue injuries. It is also important to identify tuft fractures and tendon disruption.
...
Source: The Procedural Pause - August 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Finger Fascination
It’s summertime, and people are spending a lot of time outside in their yards, at the pool, traveling, hiking, and getting their fingers caught in things. That makes it the perfect time for a tribute to finger lacerations, specifically those with nail bed disruption and avulsion.
You will need to do a bit of handy work yourself if you work in an urgent care center that does not have a hand specialist on call 24/7. Finger lacerations can be complicated, but you simply need to keep in mind the basic principles about repair of soft tissue injuries. It is also important to identify tuft fractures and tendon disruption.
...
Source: The Procedural Pause - August 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Two AF cases — and my changing view of AF
I receive many emails about AF. I don’t often answer them because it is bad practice to doctor without seeing the person. Recently, however, I received a note with more general questions. The sender suggested I could use the response as a blog post. The reason I am posting these two cases along with my response is that my views on AF are changing. I am in the process of putting these global thoughts on AF together as a more general update, but these cases are a start.
Here is the email from a reader: (a doctor).
Dear John,
What would you recommend?
My med school roommate and I are 69 years old and in good health, nor...
Source: Dr John M - August 4, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Research and Reviews in the Fastlane 040
In this study the role of a “1/2 dose” thrombolysis was evaluated for the reduction of pulmonary artery pressure in moderate PE. A total of 121 patients with moderate PE received either tissue plasminogen activator plus anticoagulation or anticoagulation alone with the primary end points of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. The results suggested that the ½ dose or “safe dose” thrombolysis was safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was ma...
Source: Life in the Fast Lane - July 21, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Gastroenterology Haematology Health Infectious Disease Intensive Care Neurology Pre-hospital / Retrieval Respiratory critical care literature R&R in the FASTLANE Source Type: blogs
The Cost-Response Curve
By LEONARD KISH and KEVIN O’BRIEN, MD “Drugs don’t work in people who don’t take them.” C. Everett Koop, former US Surgeon General Cost-based non-adherence, like any lack of medication adherence, leads to further complications and hospitalizations that could have been prevented. CMS appears to have recognized this when they announced that a new ACO measures on whether […] (Source: The Health Care Blog)
Source: The Health Care Blog - July 11, 2014 Category: Consumer Health News Tags: THCB ACOs CMS Cost Cost-Response Curve Coumadin does-response Efficacy Non-adherence RxREVU Source Type: blogs
ROCKET AF sub study on rivaroxaban in elderly
Atrial fibrillation – representative image
Rivaroxaban is an oral factor Xa inhibitor. It has been shown to be non inferior to warfarin in the ROCKET AF trial. A sub study evaluated how it fared in the elderly [Halperin JL et al. Efficacy and Safety of Rivaroxaban Compared With Warfarin Among Elderly Patients With Nonvalvular Atrial Fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 2014; 130: 138-146]. Over six thousand and two hundred patients with atrial fibrill...
Source: Cardiophile MD - July 9, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
PREVAIL Trial result – free access at JACC website
The PREVAIL Trial [Prospective Randomized Evaluation of the Watchman Left Atrial Appendage Closure Device in Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy] has been published online at the Journal of American College of Cardiology (JACC) website home page. At present the full text pdf is available free online [Holmes DR et al. (J Am Coll Cardiol 2014;64:1–12) http://dx.doi.org/10.1016/j.jacc.2014.04.029]. The trial has concluded that left atrial appendage (LAA) occlusion is non inferior to warfarin for prevention of ischemic stroke or systemic embolism beyond one week post procedure. (Source: Cardiophile MD)
Source: Cardiophile MD - July 1, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Top stories in health and medicine, June 18, 2014
From MedPage Today:
Is There an Rx for High Drug Prices? In the U.S., rising prescription drug prices are the law — at least that’s the way it looks to Leonard Saltz, MD, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center in New York City.
Targets Tightened for Kids’ Type 1 Diabetes. Tiered treatment targets in pediatric type 1 diabetes have been eliminated by the American Diabetes Association in favor of a single, lower goal.
MERS: Serious But Not an Emergency. The Middle East coronavirus (MERS) remains a serious concern but is still not a global public health emergency, a Wor...
Source: Kevin, M.D. - Medical Weblog - June 18, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Diabetes Infectious disease Source Type: blogs
Pharmacists and GPs complement each other – Keith Ridge
Dr Keith Ridge CBE, the Chief Pharmaceutical Officer for NHS England, gives his views on best practice in action:
One of the privileges of my job is being able to get out and about to see great clinical practice up close.
Last week was one of those opportunities arose when, together with the Chief Executive of the Royal Pharmaceutical Society, Helen Gordon, I spent an enthralling few hours at the Old School Surgery in Fishponds, Bristol.
It’s a modern GP practice with a growing list of 15,000 situated in the heart of the local community.
Two things make the practice a bit different from the norm. Firstly, an independen...
Source: Fade Library - June 10, 2014 Category: Databases & Libraries Authors: NHS England Tags: Chief Pharmaceutical Officer gp Guest blogs Home keith ridge News Pharmacists Source Type: blogs
Top stories in health and medicine, June 10, 2014
From MedPage Today:
AMA Mulls Gun Violence CME. As the AMA’s House of Delegates was meeting in a downtown hotel here, 29 local residents were shot and four killed within a 10-mile radius.
Most Breast Ca Patients Fall Short on Exercise. Two-thirds of breast cancer patients reported lower levels of physical activity than currently recommended.
Promising Target ID’d for Obesity, Diabetes Tx. Researchers have identified an immune pathway that appears to play an important roles in activating the fat-burning brown and beige fats which are promising targets for treating obesity and diabetes.
Cardio Notes: Xarelto fo...
Source: Kevin, M.D. - Medical Weblog - June 10, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Cancer Heart Source Type: blogs
Guessing games with prosthetic valve gradients !
A 40 year old women came with acute dyspnea who had a prosthetic mitral valve implanted 2 years ago for RHD .
An emergency echo showed a peak gradient of 35mmhg across the valve .She was on warfarin regularly and her last INR was 2.2.Heart rate was 138/minute, lungs showed congestion .LA,LV were dilated. LV function appeared mildly compromised but could not be accurately quantified as the patient was in distress.
The fellow on duty had no hesitation in diagnosing prosthetic valve thrombus .He Initiated Inj streptokinse bolus followed by infusion along with diuretics . After few hours the...
Source: Dr.S.Venkatesan MD - June 2, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Hemodynamics Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions prosthetic valve dysfunction prosthetic valves false gradients across prosthetic valve pesduo prosthetic obstruction prosthe Source Type: blogs
