MKSAP: 52-year-old man with rheumatoid arthritis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing stairs due to persistent pain and swelling in the right knee. Medications are methotrexate, 25 mg weekly; prednisone, 10 mg/d; naproxen; and folic acid.
...
Source: Kevin, M.D. - Medical Weblog - May 14, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
Designing Successful Bundled Payment Initiatives
Bundled payment initiatives are a growing form of value-based payment. The use of bundled payments can align reimbursement with the health care triple aim of improving experience of care, improving population health, and reducing total costs of care. Successful bundled payment initiatives have demonstrated an ability to both lower costs and improve health care quality.
However, bundled payments also change financial incentives because the model shifts risk from payers to providers. This may result in unintended consequences, including underutilization of needed but costly services or avoiding caring for the sickest patient...
Source: Health Affairs Blog - April 20, 2016 Category: Health Management Authors: Michael Ciarametaro and Robert Dubois Tags: Costs and Spending Featured Insurance and Coverage Medicare Payment Policy Population Health Quality Bundled Payments chronic disease High-Cost Patients triple aim Source Type: blogs
Lynn’s facial redness gone in 3 days on the Wheat Belly Detox!
Lynn shared her “before” and “during” photos, just 3 days into her Wheat Belly 10-Day Detox experience.
“This is how much my skin redness has calmed since starting my Wheat Belly Detox 3 days ago. I was always getting asked if my blood pressure was up. I have always had great blood pressure, so that was never the issue. However, I never understood why my face would get red like this. Then I noticed it was especially after I ate.
“The ‘before’ pic was taken during Christmas time, therefore the redness isn’t from sun but from the wheat and grains. Also both pics are witho...
Source: Wheat Belly Blog - April 8, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle facial change gluten grains Inflammation redness skin Source Type: blogs
Stephen’s return from the medical quagmire
Stephen shared his 60-day Wheat Belly experience:
“Started Wheat Belly 60 days ago after a major health crisis. I found out I had type 2 diabetes 2 and very bad cholesterol. My numbers 60 days ago were: cholesterol 189, triglycerides 475, LDL could not be measured as it was so bad, HDL was 32. Two weeks ago: 20 pound weight loss, wearing a 15.5-inch neck size shirt compared to an 18. Triglycerides 79, LDL 25, HDL 40, cholesterol 81.
“I was first told on January 24, 2016 that my glucose level was 157. Forty five days later, my average glucose was 107 when measured by my diabetes counselor by downloading the data...
Source: Wheat Belly Blog - April 7, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories cholesterol diabetes gluten grains HDL statins triglycerides Weight Loss Source Type: blogs
Society must decide what it wants from health insurance
Jeffrey Lurie is the owner of my beloved Philadelphia Eagles. He pays the players. He picks the coaches. But I think we would agree that his checkbook should not allow him to be the one who calls the offensive plays. The coach should do that.
So why is it different in health care?
I have a patient who was diagnosed with polymyositis. Polymyositis is an autoimmune disease that causes inflammation of muscles and generalized weakness. It is treated with high-dose steroids to reduce inflammation and with medications, such as Imuran, methotrexate and IV immunoglobulins (IVIG) to suppress the immune system. My ...
Source: Kevin, M.D. - Medical Weblog - March 7, 2016 Category: Journals (General) Authors: Mark Lopatin, MD Tags: Physician Rheumatology Source Type: blogs
A low-grade fever that humbled this physician
The clues are usually there, even in the hardest of cases. They just aren’t presented to you on a silver platter.
Gwen Stephenson had an ill-defined polyarthritis and had been on methotrexate for some time. Her rheumatologist, Norm Fahler, had tapered her off the medication while keeping an eye on her inflammatory markers and they had leveled off at just above the normal range.
Seven or eight years ago, Gwen had suffered a bad bout of sciatica, and a few weeks ago, she had told me her sciatica was bothering her a little again. “Not enough to have those injections yet, mind you,” she had said with a grimace and a gest...
Source: Kevin, M.D. - Medical Weblog - December 16, 2015 Category: Journals (General) Authors: A Country Doctor, MD Tags: Conditions Infectious disease Source Type: blogs
Biologics for Takayasu Arteritis
Journal Review
A multicentric retrospective analysis of 49 patients with Takayasu arteritis refractory to steroids or disease modifying drugs (mostly methotrexate and azathioprine) treated with biologics {tumor necrosis factor (TNF) alpha antagonists or tocilizumab} has been reported in Circulation [1]. Tocilizumab is a monoclonal antibody directed against interleukin 6 (IL-6). Overall response to biologics for Takayasu arteritis was 83% at one year (either partial or complete remission). The responders had a lower initial C-reactive protein levels and lower requirement for steroids. Both C-reactive protein levels and s...
Source: Cardiophile MD - November 4, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
What medications have you been able to stop on the Wheat Belly lifestyle?
I posed this question on the Wheat Belly Facebook page recently and received an overwhelming response. Here, I share a partial list of the responses: medications people have been able to stop by following the Wheat Belly lifestyle.
Just take a look at this incredible list: these represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat the inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, and other abnormal effects all caused by wheat and grains.
The list includes anti-inf...
Source: Wheat Belly Blog - October 6, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle asthma cholesterol diabetes drugs gluten grains hypertension prescription medication reflux Source Type: blogs
LITFL Review 190
Welcome to the 190th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Ken and Chris over at The SGEM are trialling a new project: ‘Hot or Not’ They want to know what you think of five recently published articles. Looks like it could be an interesting addition to cutting down the Knowledge Translation window f...
Source: Life in the Fast Lane - July 26, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Top stories in health and medicine, April 9, 2015
From MedPage Today:
Methotrexate Helps Save Large Joints in RA. Patients with rheumatoid arthritis (RA) who received concomitant methotrexate with their tumor necrosis factor (TNF) inhibitor were less likely to need a large joint replacement than if they were on anti-TNF treatment alone.
More U.S. Teens Opt for Birth Control With IUDs, Implants. The use of long-acting reversible contraception (LARC) by teens increased from 2005 to 2013 but still remained relatively low.
Blues’ Quality Contract Raising Hackles in Massachusetts. Major fads usually start on the West Coast and travel East. But when it comes to major he...
Source: Kevin, M.D. - Medical Weblog - April 9, 2015 Category: Journals (General) Authors: MedPage Today Tags: News OB/GYN Obesity Rheumatology Source Type: blogs
Are Shortages Going Down Or Not? Interpreting Data From The FDA And The University Of Utah Drug Information Service
Drug shortages are a significant public health issue that have affected many critically important drugs including chemotherapy treatments, nutritional support preparations, and antibiotics. Drug shortages can result in delaying or denying needed care to patients and may cause practitioners to prescribe an alternative therapy that poses greater risk or that may be less effective for the patient. Drug shortages have interfered with clinical trials, in some cases delaying research on important new therapies.
The year 2011 was a critical one in this public health crisis. After several years of steady increases in new shortage ...
Source: Health Affairs Blog - April 8, 2015 Category: Health Management Authors: Marta Wosinska, Erin Fox, and Valerie Jensen Tags: Access All Categories Consumers Health Care Delivery Health Law Pharma Policy Public Health Research Source Type: blogs
MKSAP: 23-year-old woman with stiffness and achiness of the hands
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 23-year-old woman is evaluated for a 1-year history of morning stiffness and achiness of the hands as well as Raynaud phenomenon. Two months ago, she experienced a sun-induced rash on the chest and back and patches of discoloration on the hands.
On physical examination, temperature is 36.4 °C (97.5 °F), blood pressure is 106/66 mm Hg, pulse rate is 60/min, and respiration rate is 16/min. The lungs are clear. Erythematous, violaceous, clumped papules over the extensor surfaces of the elbows, metacarpophalange...
Source: Kevin, M.D. - Medical Weblog - February 28, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
Methotrexate overdose
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - February 1, 2015 Category: Internists and Doctors of Medicine Tags: toxicology Source Type: blogs
Top stories in health and medicine, January 5, 2015
From MedPage Today:
For Better Medication Outcomes, Help Patients Do the Math? One-third of patients in private rheumatology practices can’t follow dosing instructions for ibuprofen correctly, and one-fifth can’t follow instructions for methotrexate.
Metformin: A Great Lakes Disaster? There is more than one way to measure prescription drug use in modern society.
Flu Deaths Hit Epidemic Threshold. The CDC is reporting that the flu season is well and truly underway, with the proportion of deaths attributed to pneumonia and influenza reaching the epidemic level.
Meniscus Lesions Tied to Neuropathic Pain in Knee ...
Source: Kevin, M.D. - Medical Weblog - January 5, 2015 Category: Journals (General) Authors: MedPage Today Tags: News Source Type: blogs
Is Malaysia ready for separation of dispensing?
Discussion on Separation of Dispensing in the DOBBS Doctors forum
Please note that Dobbs forums discussions are available only to logged in Dobbs members. Membership is FREE for all Malaysian doctors and done in two easy steps
1) Register at http://dobbs.my/daftar
– automatic signup and activation link will be sent via email
2) After activating, do LOGIN and VERIFY as a doctor here:
http://dobbs.my/verify (Source: Malaysian Medical Resources)
Source: Malaysian Medical Resources - December 22, 2014 Category: Global & Universal Authors: palmdoc Tags: - Nation Dispensing Drugs Pharmacists Pharmacy Source Type: blogs
