Unexpected Lessons Learned From the Wheat Belly Lifestyle
In the seven years since the original Wheat Belly book hit bookstores and turned the nutritional world topsy-turvy and millions of people have engaged in a grain-free lifestyle, many unique lessons have been learned. Even though I had engaged the practices of this lifestyle for a number of years and in thousands of people before I broadcast these ideas through books, expanding the audience to many more people yielded feedback on an enormous scale, new lessons that even surprised me. Among the new lessons learned along the way: Plantar fasciitis—I did not expect to have so many people report that this painful conditi...
Source: Wheat Belly Blog - October 17, 2018 Category: Cardiology Authors: Dr. Davis Tags: News & Updates bowel flora gluten gluten-free grain-free grains Inflammation Weight Loss Source Type: blogs

Best practices in head CT imaging: How are we doing?
Computed tomography, or CT scanning, is one of the most powerful diagnostic tools to emerge during my medical career. Just look at the detail in the brain images above, taken at 90-degree angles through the brain. And I was there at the beginning. I remember well when I was a medical student taking neurology, and the first CT scanner arrived at the Mayo Clinic. By today’s standards, it was incredibly crude. It displayed a tiny image on a cathode ray tube that was then photographed with a Polaroid camera. Preservative lacquer was then smeared on the photograph and it was pasted into the patient’s chart with glue...
Source: Kevin, M.D. - Medical Weblog - October 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/christopher-johnson" rel="tag" > Christopher Johnson, MD < /a > Tags: Conditions Neurology Pediatrics Radiology Source Type: blogs

Navigating back pain treatments: Can a physiatrist help?
If self-care steps for back pain such as gentle activity, local heat, or massage don’t ease discomfort within a few weeks to a month, or if you struggle with chronic low back pain, a physiatrist can help you navigate the dizzying number of treatment options. These range from conservative therapies (such as medicines, physical therapy, and chiropractic care) to more invasive options (such as spine injections and spinal surgery). What is a physiatrist? Physiatrists are medical doctors who specialize in physical medicine and rehabilitation. We focus on holistic, nonsurgical care aimed at improving function for people wh...
Source: Harvard Health Blog - October 10, 2018 Category: Consumer Health News Authors: Edward N. Wei, MD Tags: Back Pain Bones and joints Health Pain Management Source Type: blogs

Drip bar: Should you get an IV on demand?
For many people receiving care in a hospital or emergency room, one of the most common occurrences (and biggest fears) is getting an IV, the intravenous catheter that allows fluids and medications to flow into a vein in your arm or hand. A trained health professional puts in an IV by sticking a needle that’s inside a thin tube (catheter) through the skin into a vein. Once inside the vein, the needle is removed. The catheter is left in the vein and taped down to keep it from moving or falling out. While IV lines are typically painless, the initial needle stick can be quite painful, especially for those who are a &ldqu...
Source: Harvard Health Blog - September 28, 2018 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Health trends Source Type: blogs

Signposting Teaching Moments: Get Credit for What You Already Do
  Hospitals around the country are struggling to accommodate the increasing number of patients requiring acute inpatient care while physician staffing remains relatively stagnant. Every time the emergency department goes into divert mode, the natural question is: “Why can’t the residents just take more patients? Can resident duty hours and teaching time preservation just be waived for a little while?” For clinical educators, the census and complexity of an inpatient service has a major effect on the time available for teaching. We ultimately want to provide the best learning experience for our studen...
Source: Academic Medicine Blog - September 25, 2018 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective clinical educators rounds teaching strategies Source Type: blogs

Deton is Developing “Aerosol Biopsy” to Detect Lung Diseases
Biopsies and bronchoscopies are the gold standard for diagnosing lung diseases, including pneumonia and cancer. However, these procedures are difficult to provide, requiring general anesthesia and an operating room. Deton hopes to simplify the process. The Pasadena-based company takes advantage of the lung’s natural reaction to bacteria or particles — coughing it out. Rather than invasively sampling lung tissue within the lungs, Deton’s patented technology samples the particles ejected from the lungs. The expelled cough sample is then read by a point-of-care analyzer or sent to a lab. “When a person...
Source: Medgadget - September 7, 2018 Category: Medical Devices Authors: Cici Zhou Tags: Diagnostics Exclusive Medicine Oncology Pathology Thoracic Surgery Source Type: blogs

What can physicians do to combat confirmation bias?
The day begins at 6 a.m. I am rounding on my nine patients, quickly examining them and providing a brief update about the plan. Like the other harried residents, I am speeding from one room to the next, trying to get everything done on time. And then, inevitably my beeper goes off — “Patient in emergency room being admitted, please call for signout.” I stop in my tracks. I can literally feel the time ticking away, and there is so much to do. But as I clear my mind to hear about the new admission, I have to remind myself of a lesson I learned as a medical student — the importance of slowing down. Ms....
Source: Kevin, M.D. - Medical Weblog - September 6, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/komal-kothari" rel="tag" > Komal Kothari, MD < /a > Tags: Physician Hospital-Based Medicine Neurology Source Type: blogs

New Study Suggest Rampant Healthcare Fraud Regarding Shared Decision Making & Patient Decision Aids
When Medicare agreed to cover Screening for Lung Cancer with Low Dose Computed Tomography (LDCT), it required that the clinician and patent first have a "shared decision making, including the use of one or more decision aids." But in a new study, rese... (Source: blog.bioethics.net)
Source: blog.bioethics.net - September 3, 2018 Category: Medical Ethics Authors: Thaddeus Mason Pope, JD, PhD Tags: Health Care syndicated Source Type: blogs

A day in the beautiful life of this doctor
Recently, a patient came in around 11 p.m., just as the chaos of the day had settled, and I was thinking of rest after 16 hours of work. He was an older gentleman with vague and concerning complaints that would demand a thorough workup. I suspended my thoughts of self-preservation and stepped in to evaluate him. After an hour and a half, I had found a source of infection that explained most of what was going on. But on a CT scan looking for blood clots, there was an advanced cancer that had grown silently and painlessly and was not at all in my differential diagnosis. Suddenly — my closure talk would go from “l...
Source: Kevin, M.D. - Medical Weblog - September 1, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/james-nichols" rel="tag" > James Nichols, MD < /a > Tags: Physician Oncology/Hematology Source Type: blogs

Rwanda and the Dreamers of Digital Health in Africa: Wakanda Is Real
Rwandans in remote villages are using an artificial intelligence-based algorithm on their mobile phones to get a diagnosis for their health problems, doctors in Kigali consult their colleagues in the Western Province about radiology cases through telemedicine, blood is delivered by Zipline’s medical drones, and a central electronic health records system ensures data is collected about health activities. Rwanda is a pioneer in digital health in Africa – a real Afrofuturistic embodiment of Black Panther‘s Wakanda. Let’s see how and why that happened. Wakanda gets real in Rwanda Black Panther&rsq...
Source: The Medical Futurist - August 29, 2018 Category: Information Technology Authors: nora Tags: Future of Medicine Healthcare Policy Africa AI artificial intelligence chatbot development digital health drones government medical drone mobile app mobile health regulation rwanda smartphone telemedicine Source Type: blogs

Rwanda and the Dreamers of Digital Health in Africa: Wakanda Is Real
Rwandans in remote villages are using an artificial intelligence-based algorithm on their mobile phones to get a diagnosis for their health problems, doctors in Kigali consult their colleagues in the Western Province about radiology cases through telemedicine, blood is delivered by Zipline’s medical drones, and a central electronic health records system ensures data is collected about health activities. Rwanda is a pioneer in digital health in Africa – a real Afrofuturistic embodiment of Black Panther‘s Wakanda. Let’s see how and why that happened. Wakanda gets real in Rwanda Black Panther&rsq...
Source: The Medical Futurist - August 29, 2018 Category: Information Technology Authors: nora Tags: Future of Medicine Healthcare Policy Africa AI artificial intelligence chatbot development digital health drones government medical drone mobile app mobile health regulation rwanda smartphone telemedicine Source Type: blogs

New Artificial Intelligence Software Spots Lung Nodules on CT Scans
Detecting lung nodules on CT scans is central to diagnosing cancer and the earlier that can be accomplished the better the outcome. Currently, only about two thirds of detectable nodules are actually spotted by trained professionals. Researchers at University of Central Florida have been working on an artificial intelligence program that can review CT scans and spot nodules with near perfect accuracy. Their software, called S4ND, relies on deep learning techniques, coupled with more than 1,000 previously captured lung CT scans, to point out suspect lesions. The Central Florida team built a 3D convolutional neural network t...
Source: Medgadget - August 27, 2018 Category: Medical Devices Authors: Editors Tags: Informatics Radiology Thoracic Surgery Source Type: blogs

Talking it Like it is: Advice from a HPM Fellow to all the New Interns
by Christine BridgesThe hallways are full again after a short June reprieve. Starched white coats, cleaner than it ever seemed possible bustle through the hallways, making up in speed what they lack in direction. They fill each space with eager anticipation. It is almost palpable. It is the scent of July. Each furtive glance at the clipboard in the elevator fills me with longing to tell them the advice I wish had been passed out with my first pager.The biggest challenge ahead of you will be communication. Over the next 3-7 years more often than relieving tension pneumothoraxes, performing thoracenteses, or placing art line...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 22, 2018 Category: Palliative Care Tags: bridges communication intern residency The profession Source Type: blogs

Do uninsured patients receive more unnecessary care?
American physicians dole out lots of unnecessary medical care to their patients. They prescribe things like antibiotics for people with viral infections, order expensive CT scans for patients with transitory back pain, and obtain screening EKGs for people with no signs or symptoms of heart disease. Some critics even accuse physicians of ordering such services to bolster their revenue. So what happens when uninsured patients make it to the doctor’s office with coughs, low back pain, or other problems? Do physicians stop ordering all these unnecessary tests and services, out of recognition that most of these patients w...
Source: Kevin, M.D. - Medical Weblog - August 17, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/peter-ubel" rel="tag" > Peter Ubel, MD < /a > Tags: Policy Medicare Public Health & Source Type: blogs

Fight Aging! Newsletter, August 6th 2018
In this study, we analyzed FGF21 levels and alterations in the expression of genes encoding components of the FGF21-responsive molecular machinery in adipose tissue from aged individuals so as to ascertain whether altered FGF21 responsiveness that develops with aging jeopardizes human health and/or accelerates metabolic disturbances associated with aging. We studied a cohort of 28 healthy elderly individuals (≥70 years) with no overt signs of metabolic or other pathologies and compared them with a cohort of 35 young healthy controls (≤40 years). Serum FGF21 levels were significantly increased in elderly indiv...
Source: Fight Aging! - August 5, 2018 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

3D-Printed Ceramic Implants Help Regrow Bone
Researchers at NYU have developed 3D-printed ceramic implants that dissolves slowly, allowing bone to grow in their place. The implants can be tailored to mimic the shape of the missing bone, and are chemically-coated to stimulate bone growth. The research team hopes that the technology will be useful for patients with non-healing bone defects. At present, large non-healing bone defects are difficult to treat. One option is bone grafting, but this involves damaging bone elsewhere, and isn’t always suitable. To address this issue, researchers are developing a variety of implants in the lab that can help to stimulate b...
Source: Medgadget - August 2, 2018 Category: Medical Devices Authors: Conn Hastings Tags: Materials Orthopedic Surgery Source Type: blogs

Undoing Aging: Doug Ethell's Presentation on the Leucadia Therapeutics Approach to Treating Alzheimer's Disease
Doug Ethell has a clear and comparatively easily tested hypothesis on an important cause of Alzheimer's disease: that it results from the progressive failure of drainage of cerebrospinal fluid through one particularly crucial pathway in the skull. This traps ever greater levels of metabolic waste in the brain, such as amyloid-β, tau, and α-synuclein, and leads to the spectrum of well-known neurodegenerative diseases characterized by protein aggregates and resultant dysfunction and death of neurons. Dave Gobel of the Methuselah Foundation backed the first work on this hypothesis a few years back, and the r...
Source: Fight Aging! - August 1, 2018 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

See Me Now
​A young woman with known psychiatric illness and a tendency toward self-injury was sent to the emergency department for medical clearance. She had presented in the past after ingesting objects, so an upright chest and KUB radiograph were obtained.​Nothing unusual popped out at first glance, but it was an entirely different story when magnified in a dark room. The sharp square edge extending beyond the vertebral body was impossible to miss. The four holes confirmed she had almost certainly swallowed a razor blade. Inversion made it even easier to see.​Identifying the object is only half the battle. What is the next s...
Source: Lions and Tigers and Bears - August 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

How urgent care rejuvenates this primary care doctor
I volunteered to work Saturdays. And to do walk-ins. And to take all comers, not just our patients. It has been an interesting journey. Some clinics put their newest, least experienced clinicians on the very front line of doing urgent care. Here, it’s the opposite. I’ve got 39 years under my belt, and I see everything from sore throats to people who left the emergency room in the middle of a workup because their anxiety kept them from waiting for their CT scan to rule out a blood clot in their lungs. The waiting room fills up, and it’s just me and a medical assistant. Continue reading ... Your patients a...
Source: Kevin, M.D. - Medical Weblog - July 25, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Primary Care Source Type: blogs

Why medical errors can never be completely eliminated
This article originally appeared in Physician’s Weekly. Image credit: Shutterstock.com Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - July 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/skeptical-scalpel" rel="tag" > Skeptical Scalpel, MD < /a > Tags: Physician Gastroenterology Surgery Source Type: blogs

Could you have prevented this young man's cardiac arrest?
Written by Pendell MeyersWe received a call from an outside hospital asking to transfer a " traumatic post arrest " patient. We were told that a young patient was brought in with altered mental status but complaining of right hip and/or leg pain after being found by his mother at the bottom of the stairs into the basement. His history was significant only for IV heroin abuse, but he denied any recent use. Apparently he had been confused about why he was at the bottom of the stairs, unsure if he had fallen, unsure whether there was any specific traumatic mechanism.The practitioner on the phone stated that he sudde...
Source: Dr. Smith's ECG Blog - July 24, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Name Your Price MRI Startup Coming to an Imaging Center Near You
Medmo, a unique name-your-price imaging service, is helping patients access affordable MRIs and other imaging services by matching them to imaging centers within their budget.  The New York-based startup’s platform is designed to help patients with high deductibles or no insurance find low-cost scans and imaging centers fill up empty slots in their schedule.Medmo could be paving the way for a whole new pricing concept in the healthcare industry. Since the platform works by connecting patients with imaging centers that might have last minute openings, users can pay discounted rates as low as $225 for an MRI and $...
Source: radRounds - July 19, 2018 Category: Radiology Authors: Julie Morse Source Type: blogs

Medmo Offers New “Name-Your-Price” Platform for Medical Imaging
New medical technology solution lets patients set their own price for radiology imaging tests, like MRIs and CAT scans Medmo (https://www.medmo.com) is a new, rapidly-growing healthcare start-up that enables patients to obtain medical imaging tests – such as MRIs, CT scans (CAT scans), PET scans, and more  – at the exact price they can afford, with no surprise fees or bills. Patients simply indicate the type of scan they need, and Medmo connects them with a nearby, accredited imaging center that can work with their budget. “The ‘name your price’ concept has worked well in the travel indus...
Source: Medgadget - July 12, 2018 Category: Medical Devices Authors: Medmo Tags: Releases - Featured Sponsored Content Source Type: blogs

The fecalization of America
I’ve been lately discussing the issue of small intestinal bacterial overgrowth, or SIBO, a situation in which bowel microorganisms (especially of the undesirable Enterobacteriaceae variety such as E. coli and Shigella) ascend up from the colon and colonize the ileum, jejunum, duodenum, and stomach. This has numerous health implications that are only beginning to be appreciated: irritable bowel syndrome (IBS), fibromyalgia, psoriasis and other skin rashes, restless leg syndrome, diverticular disease, heightened body-wide inflammation, increased risk for colon cancer—SIBO is either synonymous with these condition...
Source: Wheat Belly Blog - July 9, 2018 Category: Cardiology Authors: Dr. Davis Tags: News & Updates bowel flora dysbiosis Inflammation microbiota prebiotic probiotic sibo small intestinal bacterial overgrowth undoctored wheat belly Source Type: blogs

What Should You Do When Your Hospital Bills You Nearly $4,000 for a CT Scan?
A middle-aged Mississippi man has fallen victim to the trappings of the U.S. ’s overly-complex medical billing system. Jimmie Taggart, a financial consultant, was billed $3,878.25 for a CT scan earlier this year and is now refusing to pay.Taggart ’s doctor at the North Mississippi Medical Center recommended he undergo a CT scan after a urine test indicated he had kidney stones. Before agreeing to the scan, Taggart was assured by the medical center that his insurance would cover the procedure.Later on, a bill came in the mail stating that the scan cost $5,171 but his provider, Aetna, indicated that its in-networ...
Source: radRounds - July 7, 2018 Category: Radiology Authors: Julie Morse Source Type: blogs

A patient is left with a choice: financial devastation or blindness
That statement from a recent patient was a summary to me of what is bad in our health care “system.”  It’s a terrible summary of what is seen all over this country with people who must make the choice between financial solvency and health. Here’s what happened:  It was a new patient I saw, who is a veteran who owns two businesses.  He went out on his own when he “kept getting laid off.”  He has largely been successful in what he’s doing, but as is the case with many these days, he couldn’t afford health insurance.  This was especially bad because he h...
Source: Kevin, M.D. - Medical Weblog - June 29, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/rob-lamberts" rel="tag" > Rob Lamberts, MD < /a > Tags: Physician Primary Care Public Health & Policy Source Type: blogs

3D Joint Space Mapping Helps Assess Arthritis Patients
At the University of Cambridge, scientists have developed a method of monitoring small changes in joints of patients living with osteoarthritis. The capability should give clinical researchers and physicians treating patients a new tool to better understand and deal with the disease. The technique relies on CT scans of patient joints, and it measures the slight changes in the distance between the two bones in a given joint. As such, the semi-automated method is called joint space mapping (JSM), and it seems to be better than traditional two-dimensional X-ray imaging, though it has only been tried on donated cadavers. &ldqu...
Source: Medgadget - June 21, 2018 Category: Medical Devices Authors: Editors Tags: Medicine Orthopedic Surgery Radiology Source Type: blogs

Photoacoustic Computed Tomography May Replace Mammographies for Breast Cancer Screening
Though mammography helps to provide early detection of breast cancer, it is a modality that suffers from limitations, particularly in dense breasts. A new technology, developed at Caltech, may have the potential to eclipse mammographies for spotting cancerous lesions. The photoacoustic system sends near-infrared laser light into breast tissue and detectors are used to spot ultrasonic waves that return. Because the light is absorbed disproportionately by hemoglobin molecules, their signal is stronger, and they end up more visible to the detector. Since most of the hemoglobin is present within blood vessels, the scan effecti...
Source: Medgadget - June 20, 2018 Category: Medical Devices Authors: Editors Tags: Diagnostics Ob/Gyn Radiology Surgery Source Type: blogs

Summer Jobs
So this fella has a job! Like, a real, 8 hours a day, 40 hours a week j-o-b...and for all summer long. He is loving it so far! In his third week already, he is at a totally different location than he was his first two weeks. And he has received his first paycheck!We He loves that part!!He applied with many other students his age and was the chosen one! Actually, this year, they approved two more to join the intern team and as for this one here, he is hoping to get hired on right out of high school. But hold on here, he is about to start his Senior year so let's not jump ahead too fast!The first two weeks he worked on heavy...
Source: Cochlear Kids - June 19, 2018 Category: Audiology Authors: Val Blakely Source Type: blogs

Simulation Software Helps to Repair Diseased Heart Valves
At this week’s Computer Assisted Radiology and Surgery conference (CARS 2018) in Berlin, scientists from the Fraunhofer Institute for Medical Image Computing in Germany will be showing off their unique software that helps to fix cardiac valves. Designed for minimally invasive procedures, which involve placing special rings that correct native valve anatomy, the software helps to identify the desired approach and predicts the chances of positive outcomes. Using imaging data gathered from MRI, CT scans, or ultrasound, a virtual heart is created in-silico that can be examined in detail, particularly the valve in qu...
Source: Medgadget - June 18, 2018 Category: Medical Devices Authors: Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs

Hospitals Cry Foul Over Anthem's Radiology Reimbursement Policy
In a previous post, I noted that health insurance company Anthem was refusing to pay the hospital rate for outpatient MRIs and CT scans, dictating that their insurance holders receive outpatient imaging services from less expensive free-standing radiology centers (see: Anthem Won't Pay for Outpatient MRIs and CT Scans in Hospitals). Hospitals are fighting back and taking Anthem to court over this policy (see:Hospitals cry foul and sue Anthem over new policies). Below is an excerpt from this article:County courtrooms are no strangers to contract disputes between local hospitals and insurers. Lately, though, th...
Source: Lab Soft News - June 15, 2018 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Healthcare Business Healthcare Delivery Healthcare Insurance Hospital Financial Radiology Source Type: blogs

Day in and day out - life goes on
Have I become numb to living with diabetes? And is that just ok? Sometimes I wonder! My sister was here yesterday and our truck was done at the shop. He comes out and asks me if I want to take him to get it. I said, "when we're done with our visit." I thought my tone was pleasant - I was enjoying my sister's company. He immediately turned snarky and said, "you don't have to if you don't want to." and walked out the door to the mail box.I looked at my sister with nothing but sorry in my eyes. Sorrow that she had to see him get in a snit because I didn't jump at his...
Source: Wife of a Diabetic - June 9, 2018 Category: Endocrinology Tags: camping diabetes gastroparentesis lipohypertrophy sugar low Source Type: blogs

Exclusive Tour of Materialise, a Leader in 3D Printing of Patient Specific Parts
3D printing technology was originally touted to provide consumers the ability to print customized mugs, plates, and other household items. The reality turned out to be a lot more exciting, at least for us in the medical space, since 3D printing is already being used daily by thousands of doctors to help perform procedures that would otherwise be too risky or simply impossible. For a great example, you can read our recent piece on how cardiologists at the Henry Ford Hospital in Detroit are able to implant transcatheter mitral valves. While on that visit, we learned that Materialise, a Belgian company with North American hea...
Source: Medgadget - June 8, 2018 Category: Medical Devices Authors: Editors Tags: Cardiac Surgery Cardiology Exclusive Orthopedic Surgery Source Type: blogs

Increasing Pancreatic Cancer Detection Rates with Machine Learning
Most patients with pancreatic cancer receive their diagnosis when it ’s too late, as it’s often difficultto identify the tumor during its early stages. A team of researchers at Johns Hopkins University (JHU) are trying to rectify the disease ’s low detection rate by developing a deep learning algorithm that can recognize pancreatic cancer when it can still be easily removed.Karen Horton, MD, director of JHU ’s department of radiology and radiological science, and Elliot K. Fishman, MD professor and director of Diagnostic Imaging and Body CT at the university’s hospital, are spearheading &...
Source: radRounds - June 8, 2018 Category: Radiology Authors: Julie Morse Source Type: blogs

Lung ventilation-perfusion scintigraphy – Cardiology MCQ – Answer
Lung ventilation-perfusion scintigraphy has a negative predictive value of nearly — percent for excluding thromboembolic pulmonary hypertension: Correct answer: a) 100% Because of the nearly 100% negative predictive value,  a normal lung ventilation-perfusion scintigraphy (V/Q scan) virtually excludes the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). V/Q scanning has a high sensitivity of 96 – 97.4% for detecting perfusion abnormalities. But V/Q scan being not very specific, its diagnostic utility is low. It can only be used as an initial screening test. Any abnormal test requires add...
Source: Cardiophile MD - May 28, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

A physician ’s personal crisis with pain
Six months ago, I had severe right flank pain. In the ER, I had an ultrasound showing a possible kidney stone. I deferred a CT scan and went home with medication. I fit the textbook picture: I had abnormal imaging, and I was given a treatment and discharged. I was advised to return if the pain worsened or failed to resolve. I briefly improved, but then the pain returned much worse. Ten days later, I returned to the ER. I was given ketorolac and had a CT, which showed no stone. The ER attending advised me to go home and take ibuprofen. At that point, my pain was 8/10, and I was having significant trouble moving despite the ...
Source: Kevin, M.D. - Medical Weblog - May 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/heather-finlay-morreale" rel="tag" > Heather Finlay-Morreale, MD < /a > Tags: Physician Emergency Medicine Nephrology Pain Management Source Type: blogs

Cushioning the fall of bad news
Angela Harris has been here in the hospital for six hours, awaiting the results of her CT scan. I won’t take responsibility for all of that wait time: complicated CT scans and labs do take a significant amount of time to perform. But she didn’t need to wait the last hour. She was waiting on me — her emergency physician — because I needed to confirm her cancer diagnosis with radiology, arrange some oncology follow-up … and find the most appropriate phraseology for: “You have stage IV cancer, but you don’t meet admission criteria.” I’ve delivered this diagnosis five time...
Source: Kevin, M.D. - Medical Weblog - May 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/meghan-gaffney-liroff" rel="tag" > Meghan Gaffney Liroff, MD < /a > Tags: Physician Hospital-Based Medicine Oncology/Hematology Source Type: blogs

Patient – prosthesis mismatch
Patient – prosthesis mismatch Patient – prosthesis mismatch is often noted in aortic position, that too after surgery for aortic stenosis. In aortic stenosis the aortic root is not dilated and the left ventricle is hypertrophied. Hence often a lower size of prosthetic valve has to be chosen, which can lead to patient – prosthesis mismatch. In aortic regurgitation, a dilated aortic root often allows a good sized prosthesis to be chosen. To put it simply, a prosthetic valve too small for the patient’s body surface area produces patient-prosthesis mismatch. It produces an increase in transvalvar gradie...
Source: Cardiophile MD - May 24, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Source Type: blogs

Multi detector CT for differentiation of prosthetic valve thrombus from pannus
Differentiation of prosthetic valve thrombus from pannus is often difficult by echocardiography. Both can cause abnormal masses and both can cause increase in the transvalvar gradients and leaftlet thickness. Multi detector computed tomograms are useful for differentiation of prosthetic valve thrombus from pannus. Attenuation of signals as measured in Hounsfield units is lower for the thrombus compared to pannus. Pannus has attenuation values similar to the adjacent interventricular septum. ECG (electrocardiogram) gated computed tomography (CT) also helps in the assessment of the dynamic function of the prosthetic va...
Source: Cardiophile MD - May 24, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Can We Treat Obesity with Regulated Hunger Signaling?
Recent research suggests that obesity can be controlled by regulating the satiety cascade, including influencing the nerves carrying hunger signals. Global obesity levels have almost doubled in the last 30 years. This is a worrying fact, especially when considering that obesity represents one of the major risk factors for many chronic diseases, cardiovascular and metabolic diseases in particular. Thus, it is not surprising that conditions like insulin resistance, pre-diabetes, and diabetes are becoming increasingly common worldwide. Although it is clear that obesity develops when caloric energy intake exceeds energy expen...
Source: World of Psychology - May 23, 2018 Category: Psychiatry & Psychology Authors: Psych Central Staff Tags: Brain Blogger Health-related Publishers Research gut-brain axis hunger signaling Obesity Weight Loss Source Type: blogs

AI Detects and Measures Small Vessel Disease in Brain CT Scans
Clinicial researchers at Imperial College London and the University of Edinburgh have developed an artificial intelligence software for identifying and quantifying small vessel disease, a frequent cause of dementia and stroke in older people, from CT scans. The investigators have already tested the software at Imperial’s Charing Cross Hospital, demonstrating that the technology rivals that of MRI scans coupled with specialized clinicians in spotting and measuring small vessel disease. Because CT scans are used, which are considerably faster to perform than MRI scans, and that the assessment may not need any human in...
Source: Medgadget - May 22, 2018 Category: Medical Devices Authors: Editors Tags: Informatics Neurology Neurosurgery Radiology Source Type: blogs

The Ethics of Keeping Alfie Alive
By SAURABH JHA Of my time arguing with doctors, 30 % is spent convincing British doctors that their American counterparts aren’t idiots, 30 % convincing American doctors that British doctors aren’t idiots, and 40 % convincing both that I’m not an idiot. A British doctor once earnestly asked whether American physicians carry credit card reading machines inside their white coats. Myths about the NHS can be equally comical. British doctors don’t prostate every morning in deference to the NHS, like the citizens of Oceania sang to Big Brother in Orwell’s dystopia. Nor, in their daily rounds, do the...
Source: The Health Care Blog - May 21, 2018 Category: Consumer Health News Authors: at RogueRad Tags: OP-ED Uncategorized AlfieEvans Source Type: blogs

How mindfulness helped this physician ’s primary care journey
“Paying attention in a particular way: on purpose, in the present moment and nonjudgmentally.” That’s how Jon Kabat-Zinn, PhD, describes mindfulness. In the book Zen Mind, Beginner’s Mind, another thought leader in mindfulness, Shunryu Suzuki, says that, “In the beginner’s mind there are many possibilities, but in the expert’s there are few.” In my experience, I’ve found that cultivating a beginner’s mind opens doors and improves clinical diagnosis. Medical training has phases, and clinicians in different phases think differently. In medical school, students learn...
Source: Kevin, M.D. - Medical Weblog - May 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/heather-finlay-morreale" rel="tag" > Heather Finlay-Morreale, MD < /a > Tags: Physician Primary Care Source Type: blogs

Parasternal long axis (PLAX) view – echocardiogram – split screen images
Parasternal long axis (PLAX) view – echocardiogram – split screen images Split screen display with side by side display of 2-D (2 dimensional) and Colour Doppler imaging in echocardiography from parasternal long axis view. Left panel shows the 2-D image with mitral valve open. Structure nearest to the transducer in the PLAX view is the right ventricular free wall (RVFW). There may be a thin echo free space anterior to it due to pericardial pad of fat. Beneath that the outflow region of the right ventricle is partially seen, but not the pulmonary valve or sub pulmonary region. Next comes the interventricular se...
Source: Cardiophile MD - May 16, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Echocardiography Source Type: blogs

A surgeon channels his mentor
“A teacher affects eternity; he can never tell where his influence stops.” – Henry Adams Mrs. Jones (identifying information changed) is a vibrant woman in her eighties who has been admitted to the hospital with swallowing problems and a fever. The CT scans show some swelling next to one of the major blood vessels and our team has been asked to see her and decide if she would benefit from surgery. She winces as I touch her swollen, tender neck. “The scan shows that there is an infection deep in the tissues,” I tell her. “It will clear up more quickly if we take you to the operating room,...
Source: Kevin, M.D. - Medical Weblog - May 7, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/bruce-campbell" rel="tag" > Bruce Campbell, MD < /a > Tags: Physician Surgery Source Type: blogs

Insurance denials: the law of the land
It all started out with Malaysian methimazole, and didn’t end until two highly trained medical professionals sat on opposite ends of a telephone call, scratching their heads and wondering how two digits being transposed could lead to so many problems. Those two transposed digits caused a thyroid uptake scan to become a bone marrow scan (whatever that is). But look at all it took to get there. Mystery illness, mystery medicine It started when a new patient came to see one of my colleagues with a mystery illness, and a medication in a pill bottle with a label in another language. After figuring out what this medicine w...
Source: Kevin, M.D. - Medical Weblog - May 7, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/fred-n-pelzman" rel="tag" > Fred N. Pelzman, MD < /a > Tags: Physician Primary Care Source Type: blogs

Imaging Innovations Predict Fractures Among Aging Patients
Bone fractures are  increasingly commonamong aging populations. Not only is rehabilitation and healing a strenuous and long process, but pain management can result in its own complications and stress. Fortunately, a new study from the University of Wisconsin suggests routine CT scans might be able to determine if a patient is at risk for an osteopathic fracture. This discovery could prompt aging patients to take conscientious measures for preventing falls.  " CT scans are commonly performed in older adults for a wide variety of reasons. The rich bone data embedded in these scans is often ignored, but can and...
Source: radRounds - May 5, 2018 Category: Radiology Authors: Julie Morse Source Type: blogs

When a physician gets yelled at
It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children, and grandchildren. It was a good relationship — until Harvey got sick, that is. Originally, there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle-aged man. A few CT scans later, and he was in the oncologist’s office discussing chemotherapy. A regimen was decided on, and therapy began the next day. Therapy was hard. Naus...
Source: Kevin, M.D. - Medical Weblog - May 4, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jordan-grumet" rel="tag" > Jordan Grumet, MD < /a > Tags: Physician Primary Care Source Type: blogs

Radiology and Errors
Conclusion should use diagnostic terms /  reflect  one opinion about disease and not  an echogenic  …. Etc . one can take the help of , could rep …. in view of …… etcComparison with old  images should follow , expressing various components  including the effect of therapy/ progression of the disease  findings etcAlways proof read your report with the help of your data entry operators( who would even confirm that you have reported the correct patient , i.e. images and report belong to the same individual/ investigation done is  what the clini...
Source: Sumer's Radiology Site - April 24, 2018 Category: Radiology Authors: Sumer Sethi Source Type: blogs

Bedside ultrasound is not yet the standard of care. But it will be.
I just read a Clinical Problem Solving case from the New England Journal of Medicine (NEJM). It was entitled “Stream of Consciousness“and it told the story of a 65-year-old man who was a patient at the Brigham and Women’s Hospital of Harvard Medical School, arguably one of the finest medical institutions in the world. These cases are presented in single paragraphs to a clinical expert physician who then comments about his or her thought processes and discusses how he or she would have handled the situation. In this narrative, the patient presented to a different hospital in New England with kidney failure...
Source: Kevin, M.D. - Medical Weblog - April 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/janice-boughton" rel="tag" > Janice Boughton, MD < /a > Tags: Conditions Hospital-Based Medicine Neurology Source Type: blogs