CMS Issues Final Rule on CY 2017 Physician Fee Schedule
Conclusion
The CY 2017 PFS final rule is the latest showing of the Administration-wide strategy to create a health care system that results in better care, smarter spending, and a healthier population.
Related StoriesOpen Payments Having an Adverse Effect on Physician-Rep RelationshipsCMS Bundled Payments for Care Improvement Evaluation ReleasedCMS Releases MA and Part D Landscape Information for 2017 (Source: Policy and Medicine)
Source: Policy and Medicine - November 2, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Research and Reviews in the Fastlane 153
Welcome to the 153rd edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check o...
Source: Life in the Fast Lane - September 29, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Clinical Research Education Emergency Medicine R&R in the FASTLANE Renal Resuscitation critical care Intensive Care research and reviews Trauma Source Type: blogs
Statin Wars: Less-is-More versus Unlimited Medicine
By SARAH JHA, MD
It is the beauty of evidence-based medicine (EBM) that a scientist can at once be a Pope and a Galileo. His transmutation is as effortless as it is discretionary. If you think you’ve met Galileo – a rebel, a free thinker, a rocker of the establishment – the following week he is a Pope, castigating detractors, censoring critics, and celebrating uniformity. He changes by a roll of the dice. His change is decided by a quirk in hypothesis-testing known as statistical significance. If the p value is 0.051 he is Galileo, if the p value is 0.049 he becomes the cardinal. He is one day a raging skepti...
Source: The Health Care Blog - September 20, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Device closure of patent ductus arteriosus (PDA)
PDA angio prior to device closure
Though small PDAs can be closed by coils, large PDAs require a device to close them. Initially an angiogram (descending aortogram) is taken to confirm the size of the PDA to choose the size of the device. The angiogram above shows pigtail catheter in the descending aorta and the contrast passing from the descending aorta to pulmonary artery through the PDA. The PDA is superimposed on the tracheal air column in this view.
PDA device in position
A guide wire is introduced into the femoral vein and guide through inferior vena cava into right atrium. From right atrium it is passed into the pu...
Source: Cardiophile MD - September 19, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions Source Type: blogs
Balloon aortic valvotomy (BAV)
Balloon aortic valvotomy is usually done as a palliative procedure for those at high risk for open aortic valvotomy or aortic valve replacement. A guide wire is introduced through the femoral artery into the aorta. The stenotic aortic valve is crossed, often requiring multiple attempts and a long time. A long sheath is introduced over the guidewire and through the sheath a Mansfield balloon is introduced and positioned across the aortic valve. The balloon is manually inflated using a large syringe filled with dilute contrast. Care is taken to avoid melon seeding of the balloon into the aorta during inflation. If there is ...
Source: Cardiophile MD - September 19, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions Balloon aortic valvotomy BAV guide wire Mansfield balloon melon seeding melon seeding of the balloon risk of development of aortic regurgitation trans valvar gradient Source Type: blogs
Device closure of atrial septal defect (ASD)
Device closure of ASD
Device closure of ASD is suitable for secundum ASD with a good rim all around for holding the two discs together. Trans esophageal echo (TEE) is done to assess the superior, aortic and mitral rims as well as the total septal length. It is ideal to have TEE guidance during the procedure as well. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium across the ASD. The tip of the wire is placed in the pulmonary vein and a long venous sheath is introduced. Once the sheath is in position, the device attached to the delivery cable is introduce...
Source: Cardiophile MD - September 17, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions Source Type: blogs
The Politics of Hillary ’s Pneumonia
By SAURABH JHA, MD
It is selfish of a leader of a nation to drop dead during office. Jawaharlal Nehru, India’s first prime minister, died suddenly at 74, apparently from a ruptured aneurysm. His aneurysm, allegedly, had something to do with Edwina Mountbatten – the wife of Lord Mountbatten, the last Viceroy of India. Shortly after Nehru’s death, Pakistan attacked India. Nehru’s replacement, Lal Bahadur Shastri, died mysteriously in Tashkent two years after Nehru’s death, and was succeeded by Indira, Nehru’s daughter. India’s future was forever changed by a burst aneurysm or, if rumors are to be believed, by ...
Source: The Health Care Blog - September 14, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Deep vein thrombois of upper limbs – Cardiology MCQ
Wrong statement about deep vein thrombosis of upper limbs compared to lower limbs:
a) Lower chance of pulmonary embolism
b) Higher recurrence at one year
c) Lower incidence of post thrombotic syndrome
d) None of the above
Correct answer: b) Higher recurrence at one year
The chance of pulmonary embolism is 6% for upper extremities, while it ranges from 15 – 30% with lower limbs. Recurrence at one year is 2-5% for upper extremities while it is 10% for lower extremities. The incidence of post thrombotic syndrome is much higher for lower extremities than upper extremities. (Source: Cardiophile MD)
Source: Cardiophile MD - September 5, 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
Unfractionated heparin for PE – Cardiology MCQ
Unfractionated heparin is preferred over low molecular weight heparin in the treatment of acute pulmonary embolism in all except:
a) Creatinine clearance less than 30 mL/min
b) Patients at low risk of bleeding
c) High risk, hypotensive patients
d) Extremely overweight patients
Correct answer: b) Patients at low risk of bleeding
In all other situations, low molecular weight heparin or fondaprinux given subcutaneously, with dosage adjusted for the weight are considered better. Anti factor Xa agents rivaroxaban and apixaban have been approved as oral only treatment in stable patients. These agents have been shown to have lowe...
Source: Cardiophile MD - September 4, 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
Risk of intracraial bleed for tenecteplase – Cardiology MCQ
Risk of intracraial bleed for tenecteplase in acute pulmonary embolism:
a) 2%
b) 5%
c) 10%
d) 15%
Correct answer: a) 2%
The incidence hemorrhagic stroke after thrombolysis of acute pulmonary embolism with tenecteplase was 2% while it was only 0.2% in those given heparin alone. But there was a significant reduction in all cause mortality / hemodynamic collapse in the tenecteplase treated group. Hence tenecteplase can be considered in all with hypotension and as rescue treatment in those with evidence of right ventricular dysfunction and myocardial injury. (Source: Cardiophile MD)
Source: Cardiophile MD - September 3, 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
Surgical embolectomy in pulmonary embolism – Cardiology MCQ
Surgical embolectomy in pulmonary embolism is indicated in:
a) Impending paradoxical systemic embolism
b) Hypotension with contraindication for thrombolysis
c) Failed thrombolysis
d) All of the above
Correct answer: d) All of the above
By impending paradoxical systemic embolism, it is meant that a thrombus in transit has been caught in the patent foramen ovale and is extending to both atria.
Reference
1. Myers PO, Bounameaux H, Panos A, Lerch R, Kalangos A. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest 2010; 137 (1): 164-70. (Source: Cardiophile MD)
Source: Cardiophile MD - September 2, 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
IVC filter for pulmonary embolism – Cardiology MCQ
True regarding inferior vena caval (IVC) filter for prevention of pulmonary embolism:
a) Indicated when anticoagulation is contra indicated
b) Recurrence in spite of anticoagulation
c) Increases risk of leg vein thrombosis
d) All of the above
Correct answer: d) All of the above
In addition to these, a retrievable filter should be used whenever there is only a transient risk factor. Retrieval should be attempted after reversal of the predisposing risk factor. (Source: Cardiophile MD)
Source: Cardiophile MD - September 1, 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
Drugs approved for treatment of normotensive patients with pulmonary embolism
Heparin
Fondaparinux
Rivaroxaban
Apixaban
Dabigatran
Edoxaban
Thrombolytic therapy is reserved for rescue in case of decompensation due to right ventricular failure or recurrence of pulmonary embolism in these stable patients. (Source: Cardiophile MD)
Source: Cardiophile MD - August 31, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
Syncope, Hypotension, and a Large Right Ventricle -- What is the ECG Diagnosis?
CaseA 60-something woman had syncope and was unconscious for a few minutes. It was not a seizure. EMS found her lethargic and short of breath but without chest pain. Pulse was 103, BP 100/60, and O2 saturation on room air 98%.She was brought to the ED, where her SpO2 was 93%, BP 88/48, pulse 100.On arrival in the ED, she underwent an immediate bedside cardiac ultrasound:What do you see?There is a very large RV and very poor LV filling; the LV ejection fraction is nearly 100%. It is easy to jump to the conclusion that this patient has a pulmonary embolism (hypotension, tachycardia, low O2 saturations, sy...
Source: Dr. Smith's ECG Blog - August 31, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 149
Welcome to the 149th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check o...
Source: Life in the Fast Lane - August 31, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Emergency Medicine Infectious Disease Intensive Care Neurology Palliative care Pre-hospital / Retrieval R&R in the FASTLANE Radiology Respiratory critical care recommendations research and reviews Resuscitation Source Type: blogs
