The successes make the challenging cases more bearable
I first met her in the urgent care at the cancer center when I was on call one night. She was beautiful: 53 years old, four adult sons, and in incredible pain. She had stage 4 breast cancer, and unbeknownst to her, she had a metastatic lesion in her femoral neck, which she had fractured about four weeks ago. But she’d just had a spine operation for mets in her lumbar vertebral bodies a month before that, so she thought it was a complication of surgery. Like the pulmonary embolism she’d had.
She squirmed and winced on the bed, clearly uncomfortable, but she had it; as an intern, my chief resident called it spark...
Source: Kevin, M.D. - Medical Weblog - January 17, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/brooke-crawford" rel="tag" > Brooke Crawford, MD < /a > Tags: Physician Cancer Source Type: blogs
Disadvantages of perioperative heparin bridging – Cardiology MCQ
Disadvantages of perioperative heparin bridging:
a) Risk of thromboembolism due to subtherapeutic dose
b) More prolonged total hospital stay
c) Cost and inconvenience of heparin therapy
d) All of the above
Correct answer: d) All of the above
In addition to this, there can be excessive bleeding during re-initiation of warfarin with heparin overlap. Hence continuing warfarin through the procedure is becoming standard of care in certain special instances. This is more applicable to procedures with relatively bleeding risk in those with high risk of thromboembolism. Cataract surgery under topical anaesthesia in one such potent...
Source: Cardiophile MD - December 24, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Funtabulously Frivolous Friday Five 170 Christmas Edition
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 170 Christmas Edition
Question 1
Why is Christmas disease so named?
+ Reveal the Funtabulous Answer
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Haemophilia B was first recognized as a different kind of haemophilia in 1952, named after Stephen Christmas, the first patient described with this disease.
If that was not festive enough for you then the first re...
Source: Life in the Fast Lane - December 23, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five bowel perforation brussel sprouts Christmas accidents christmas cake decoration Christmas disease Christmas pudding Haemophilia B stephen christmas vitamin k warfarin Source Type: blogs
Blood-Monitoring Disposable Smart Patch Delivers Blood Thinners On-Demand
Thrombosis, the occlusion of vasculature by blood clots, is a precursor to debilitating conditions including stroke, pulmonary embolism, and heart attack. Blood thinners such as heparin or Coumadin are used to treat thrombosis, but necessitate ongoing blood tests for precise drug dosing. Researchers from the University of North Carolina at Chapel Hill and North Carolina State University have developed and tested a self-regulating drug eluting patch that monitors the level of thrombin (a clot initiating enzyme) in the blood, and releases appropriate amounts of heparin in response.
The microneedle patch is meant to stick to ...
Source: Medgadget - November 30, 2016 Category: Medical Equipment Authors: Iris Kulbatski Tags: Medicine Nanomedicine Source Type: blogs
Say No to Watchman
Cardiology is on the brink of making a big mistake. We have embraced a new procedure called left atrial appendage isolation.
You may be seeing the ads for a device called Watchman. Like this one>
The appendage-closure idea was a good one: during atrial fibrillation (AF), blood can pool in the left atrial appendage, and this promotes clot formation. (The LA appendage has many nooks and crannies.) So… if we could put a device in there, see image, this would block clots from getting out and causing stroke. Also, once the device has been in for months, the body walls it off and the patient can stop the anticoagulan...
Source: Dr John M - November 10, 2016 Category: Cardiology Authors: Dr John Source Type: blogs
Xprecia Stride Handheld Coagulation Analyzer Cleared for Sale in U.S.
Siemens won FDA clearance for its Xprecia Stride handheld coagulation analyzer, a device designed to speed up testing of patients on warfarin, an anti-coagulant, and make the procedure a bit safer.
It provides Prothrombin Time International Normalized Ratio (PT/INR) results with lab-level accuracy at the point of care. It’s held with one hand and controlled via a touchscreen with the other. The barrel end can be brought right to the spot where the skin is lanced and sampled while the device is held at any angle. Once results are in, a button is used to spit out the test strip into the refuse without having to touc...
Source: Medgadget - October 5, 2016 Category: Medical Equipment Authors: Editors Tags: Cardiology Medicine Source Type: blogs
More Blasts Of Concern Over ROCKET-AF
The controversy over the big Xarelto trial does not appear to be going away. A new investigation published in the BMJ raises more troubling questions about the ROCKET-AF trial, which compared the novel oral anticoagulant rivaroxaban (Xarelto, Johnson & Johnson) to warfarin in patients with atrial fibrillation. The controversy about the trial first unfolded last...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - September 28, 2016 Category: Cardiology Authors: Larry Husten Tags: People, Places & Events Policy & Ethics Alere BMJ INR rivaroxaban ROCKET-AF Xarelto Source Type: blogs
Here Is A Call For Progress In A Domain The ADHA Should Put At The Top Of Their List.
This appeared during the last week:RACGP calls time on faxes and letters22 September 2016 THE RACGP is calling time on the era of the fax machine and the letter, officially telling the government and other health services to catch up and integrate with the electronic communication systems of general practices.The shift should happen within three years, the college says in a new position statement, citing cases where a lack of timely communication between general practice and other health services have put patient safety at risk.In one well-known case, a South Australian coroner found that a specialist's "archaic" practice ...
Source: Australian Health Information Technology - September 26, 2016 Category: Information Technology Authors: Dr David More MB PhD FACHI Source Type: blogs
A Hole in the Heart, Part II
This study looked at patients between 18 and 60 years of age who had a prior stroke or a transient ischemic attack within the prior 6 months. This was a resoundingly negative study. At two years, the 12/447 patients in the closure group suffered a recurrent stroke, while 13/462 patients in the medical therapy suffered a recurrent stroke. The trial, however, reveals one of the important chinks in the armor of the randomized control trial (RCT). Randomized control trials are only as good as the patients they enroll. Enroll the wrong patients, and the results don’t tell you much. CLOSURE-1 didn’t provide closure...
Source: The Health Care Blog - September 11, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
MKSAP: 74-year-old woman with peripheral arterial disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. Medications are amlodipine, lisinopril, and aspirin.
On physical examination, she is afebrile, blood pressure is 136/78 mm Hg, pulse rate is 68/min, and respiration rate is 15/min. BMI is 32. The lungs are clear to auscultation, and no murmurs are noted. A bruit is heard over the left femoral artery.
The right ankle-brachial index is 1.2 and...
Source: Kevin, M.D. - Medical Weblog - September 3, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
How much thought do you give to health literacy?
It’s Friday afternoon at 4 p.m., and Mr. Anderson walks into my endoscopy suite as the last patient of the day. He’s a 65-year-old publicly-insured male who presents for a screening colonoscopy. He’s 20 minutes late, because he went to registration in the surgery department. He is convinced “looking for cancer” requires surgery.
In triage, the nurses learn that he has held his Coumadin for five days as personally instructed by his cardiologist, but that he did not follow instructions for adequate bowel preparation and hence is still passing light brown stool. Upon further questioning, the nurses also learn that h...
Source: Kevin, M.D. - Medical Weblog - August 21, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/darrell-m-gray-ii" rel="tag" > Darrell M. Gray, II, MD, MPH < /a > Tags: Physician GI Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 5
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Source: Cardiophile MD - August 6, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Why Bad News Is Not Always Bad
Last month, the cover of BusinessWeek featured an article, How Big Pharma Uses Charity Programs to Cover for Drug Price Hikes, focused on co-pay charities for Medicare patients. I of course had heard about such co-pay charities before, and even had the opportunity to meet with a representative of one a few years ago, but frankly I had no idea what they did. So when the article came out, outlining the "evils" of this practice, it caught my attention. By catching my attention, it actually saved my elderly parents significant amounts of money.
My father and mother are both retired, living on a small pension and Social Secur...
Source: Policy and Medicine - August 4, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Anorectal Procedures: Thrombosed Hemorrhoids
We are going to get up close and personal this month to talk about hemorrhoids. You should be familiar with these painful offenders because half to two-thirds of people between 45 and 65 will suffer from their cruelty. (Am Surg 2009;75[8]:635.) Patients may seek emergency department care if they experience bleeding or severe pain from hemorrhoids.Hemorrhoids are highly vascular structures that are round or oval in shape. They arise from the rectal and anal canal, and sometimes appear around the anus itself. It is important to note that hemorrhoids do not have arteries and veins but special blood vessels called sinusoid...
Source: The Procedural Pause - August 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
