FDA Study Provides Some Reassurance About Boehringer Ingelheim’s Pradaxa
In the latest development in its ongoing review of the new oral anticoagulant dabigatran (Pradaxa, Boehringer Ingelheim), the FDA today offered largely reassuring news about the sometimes controversial drug. The FDA study of 134,000 Medicare patients found that dabigatran was associated with a reduced risk for ischemic stroke, bleeding in the brain, and death, compared to warfarin. But the study also found that, dabigatran was associated with an increased risk for major gastrointestinal bleeding. There was no difference between the drugs in the risk of MI. … Click here to read the full post on Forbes. (Source: CardioBrief)
Source: CardioBrief - May 13, 2014 Category: Cardiology Authors: Larry Husten Tags: Heart Rhythms Policy & Ethics Prevention, Epidemiology & Outcomes anticoagulants Boehringer dabigatran Pradaxa Source Type: blogs
Battle of the Bulge: Olecranon Bursitis
Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.
Normal bursae are usually small, but they can grow to be quite large, swollen, and occasionally even infected when they become irritated or inflamed. The swelling is obvious because the space in this area is lim...
Source: The Procedural Pause - May 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Battle of the Bulge: Olecranon Bursitis
Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.
Normal bursae are usually small, but they can grow to be quite large, swollen, and occasionally even infected when they become irritated or inflamed. The swelling is obvious because the space in this area is l...
Source: The Procedural Pause - May 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Hospitalist H&P: The Funny Abbreviated Version!
Here is an example of a hospitalist H&P in abbreviated template form. If you understand this history and physical format, you have definitely been in nursing or medicine for a very long time. Or you've got Savant syndrome. Probably both though. If any important details have been left out, leave your abbreviations in the comments below and they'll get added to the story. The goal here is to make this the most abbreviated hospitalist H&P in history.HPI: RUQ 12/10 ABD x 2 HRS. 4/10 W/ 2 MG MSO4ALL: NKDARX: ASA, FeSO4, HCTZ, MOM, NTG, TMP/SMX, MTX, MVI, ...
Source: The Happy Hospitalist - April 22, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Stuck
Unless things really improve with my mag levels in the next 2 weeks, I'm going to have to get a port.(in my upper arm or chest) All my arm/hand veins are completely shot. Ports scare the bejabbers out of me,& I refuse to have one done. But magnesium has to get in somehow. I'm trying to supplement with fast-acting magnesium liquid,& I 'm going to talk to my doc about Epsom Salt soaks(that is a very iffy method of upping levels though and my doc said he once knew someone who did it so much she put herself in a high magnesium coma that led to death). My mag levels are being drawn weekly.(and they are staying stable-low end wi...
Source: The D-Log Cabin - April 10, 2014 Category: Diabetes Authors: HVS Source Type: blogs
New post up on Medscape/Cardiology: Ablation versus medicine as an intitial strategy for treating AF
Earlier this month I promised to put together teaching points from the Rich Peverley story. His was an interesting case of sudden collapse that likely occurred as a result of atrial fibrillation therapy rather than atrial fibrillation itself.
This was my original report: Important lessons from the collapse of NHL player Rich Peverley (BTW: It set a blog record for pageviews on a single day.)
This was the follow-up post in which I discuss the fact that atrial fibrillation featured prominently in the mishap: Atrial fibrillation features prominently in Rich Peverley collapse
Mr Peverley and his doctors announced a great dea...
Source: Dr John M - March 25, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Failure To Communicate: The Dangers Of Inadequate Hospital Handoffs And What To Do About It
One of my biggest pet peeves is taking over the care of a floor-full of complicated patients without any explanation of their current conditions or plan of care from the physician who most recently treated them. Absent or inadequate verbal and written “handoffs” of patient care are alarmingly common in my experience. I work primarily as a locum tenens physician, traveling across the country to “cover” for my peers on vacation or when hospitals are having a hard time recruiting a full-time MD. This type of work is particularly vulnerable to gaps in continuity of care, and has heightened my awareness ...
Source: Better Health - March 24, 2014 Category: Health Medicine and Bioethics Commentators Authors: Dr. Val Jones Tags: Health Policy Health Tips Opinion Change Of Shift Communication Failure To Communicate hand off History And Physical Exam Hospital Sign-Outs Hospitalists Locum Tenens Medical Errors Nursing Progress Note Sign out Talk Source Type: blogs
Clinical Trial Prestidigitation - Making Old Data Look Worse So New Data Looks Better
Prestidigitation, also known as sleight of hand or legerdemain, is a form of stage magic which uses dextrous manipulation and misdirection to distract the viewer from seeing it. The example, reported by Bloomberg on 26 February, 2014, is discussed late because the nature of the trick meant it took me a while before I understood how it was done.BackgroundPradaxa, a new anticoagulant, was approved by the US Food and Drug Administration (FDA) in 2010 for use by patients with atrial fibrillation to prevent strokes. We discussed previously the release of documents during litigation that showed how marketers from its manuf...
Source: Health Care Renewal - March 18, 2014 Category: Health Medicine and Bioethics Commentators Tags: Boehringer Ingelheim deception FDA manipulating clinical research Pradaxa Source Type: blogs
Acute warfarin overdose
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - March 17, 2014 Category: Internists and Doctors of Medicine Tags: toxicology Source Type: blogs
We need to talk about TTM…. Again
This study has brought about widespread (although not universal) practice change in Australia.Whilst the conclusions of the trial were well received, there have been concerns from those involved in the trial that the study has been misinterpreted as evidence against actively cooling patients following out of hospital cardiac arrest. It is worth noting that many international bodies that set guidelines for the management of cardiac arrest have not endorsed the recommendations of the TTM trial. Currently this includes the Australian Resuscitation Council (ARC).
As has been well documented, social media played a large role in...
Source: Life in the Fast Lane - March 8, 2014 Category: Emergency Medicine Doctors Authors: David Denman Tags: Emergency Medicine Evidence Based Medicine Featured Intensive Care Resuscitation post-cardiac arrest care Targeted Temperature Management Therapeutic Hypothermia TTM trial Source Type: blogs
My Social Media Talk at the 2014 Western AF (atrial fibrillation) symposium
How can social media improve AF patient and provider interaction?
It was an honor to speak at the seventh annual Western AF symposium this past weekend in Park City Utah. Once in the shadow of the Boston AF symposium, Dr. Nassir Marrouche (@nmarrouche) and his colleagues at the University of Utah have elevated Western AF to elite status. It’s a special meeting because it brings the world’s leading experts in atrial fibrillation to a cozy and welcoming place. The “vibe” if you will is informal and warm–serious, yes, but conducive to interaction. Perfect, if you ask me.
My task was to explain...
Source: Dr John M - March 5, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Warfarin Benefits Extended To Patients with Chronic Kidney Disease
Anticoagulation is a cornerstone of therapy for atrial fibrillation because it lowers the heightened risk for stroke in this population. People with chronic kidney disease are also at increased risk for stroke, but the benefits of anticoagulation are less clear in this group, and anticoagulation is used less often in AF patients who have CKD. Now, a large observational study offers some reassurance that anticoagulation in AF patients with CKD may be beneficial. Researchers in Sweden analyzed data from more than 24,000 survivors of acute myocardial infarction who had AF…. … Click here to read More… (Source: CardioBrief)
Source: CardioBrief - March 4, 2014 Category: Cardiology Authors: Larry Husten Tags: Heart Rhythms Prevention, Epidemiology & Outcomes AF anticoagulation atrial fibrillation chronic kidney disease stroke prevention warfarin Source Type: blogs
Boehringer Kept Pradaxa Analysis From FDA, Records Show
Boehringer Ingelheim GmbH didn’t disclose a data analysis to U.S. regulators that indicated the blood-thinner Pradaxa may have caused more fatal bleeding after it was cleared for sale than the drug did in a study used to win approval, unsealed court filings show.Boehringer gave U.S. regulators one analysis of data gathered after the drug’s October 2010 approval that showed the number of people who died from bleeding was less than expected, according to internal documents made public in lawsuits over the product. The company didn’t share a second analysis showing a higher death rate, the documents show.The F...
Source: PharmaGossip - February 26, 2014 Category: Pharma Commentators Authors: insider Source Type: blogs
Blaming Obamacare is the wrong diagnosis
The Wall Street Journal began the week by publishing a provocative essay in which a young man suggested Obamacare kept his mother from getting appropriate medicine for her cancer. The writer crafted a poignant story about his mother, who sounds like a good person with a bad disease.
Mainstream media buzzes with these types of stories. The Obamacare-is-the-problem narrative fits quite well on conservative news outlets.
The problem, as it so often is, is in the details.
The story here begins with a familiar first chapter: the writer’s mother had good insurance coverage but then it was cancelled. Next came her struggle...
Source: Dr John M - February 25, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
"Can't This be Avoided?" - How Corporate Marketers Manipulated a Clinical Research Report to Avoid "Undermining" Marketing Messages
ConclusionsThis case study, only made possible by the public release of internal corporate documents in the course of litigation, suggests that in retrospect the dissemination of the results of one particular clinical trial were manipulated in a somewhat subtle way so that the data would not contradict a marketing message that now appears rather fictional.In the absence of litigation, and of a judge willing to make public documents that one party to the litigation doubtless wanted to hide, the manipulation of this particular study might never have been apparent. Most clinical research is now sponsored by health care ...
Source: Health Care Renewal - February 13, 2014 Category: Health Medicine and Bioethics Commentators Tags: Boehringer Ingelheim deception manipulating clinical research Pradaxa secrecy Source Type: blogs
