Check out . . .

. . . Carotids.com - "an irreverent look at the latest medical news. We as health professionals enjoy learning, discussing, and laughing at the latest news and research. Get your real research from your journals. Come here to laugh and chat about our wonderful professions."

Some good stuff on this website and more than a few laughs. I've added it to my Blogroll.

Galen has bluntly chimed in on the study comparing exercise stress testing and calcium scores from electron beam computed tomography (EBCT) that the lay press has been reporting.

As we brace ourselves for patients demanding EBCT, let's consider the data and recommendations. Again, UptoDate comes in handy:

Coronary calcification detected by EBCT is found in individuals who have significant angiographic CHD, with a sensitivity ranging from ...

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Sound familiar?

Poor reimbursement rates for dealing with the indigent population, leading to a shortage of those who represent them. Another story on our broken health care system? No - apparently, the same thing is happening to lawyers.

Lawyers, welcome to our world.

The lay press is all over this study, blaring out this headline: Stress Test May Miss Early Heart Disease. Here were the participants in the study:

Most were men over 45 or women over 55, smokers, people with high cholesterol or high blood pressure, diabetes or a close relative with early heart disease, they reported in this week's issue of the Journal of the American College of Cardiology.


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A website . . .

. . . allowing those to comparison shop for prescription medication is proving to be quite popular in New York state.

Morning news rounds

I have an extra half-hour this morning before I see patients, so here are some interesting stories to start your day.

Despite tort reform, some physicians are leaving high-risk practice.

An article on people who steal physician identities.

I do some work at the VA, so I see first-hand many of the primary care physician shortages (6+ month wait in some cases). With a ...

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Today's Annals of Internal Medicine reports a study suggesting that colonoscopies may be overdone. This story was picked up by the lay press.

With regards to hyperplastic polyps, the guidelines are unclear. Here is what UptoDate says:

At the present time, there is no clear consensus regarding what recommendations should be given to asymptomatic patients at average risk for CRC who are found to ...

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A story . . .

. . . from the BMJ where it was assumed that test results would be conveyed expediently to a patient. Unfortunately, it wasn't - leading to days of anxiety.

. . . to life on the general medicine service (via Medrants).

Doctors and white coats

Interesting study - most patients seem to want their physicians to wear white coats:

In contrast to doctors, who view white coats as an infection risk, most patients, and especially those older than 70 years, feel that doctors should wear them for easy identification. Further studies are needed to assess whether this affects patients' perceived quality of care and whether patient education will alter this view.

I find wearing ...

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Smoke free or die

In my home state, where motercyclists can ride without helmets, New Hampshire is becoming one of the last states to ban smoking in restaurants. Tough to be a public health officer here when you do not have the support of the state. As one such officer puts it: "New Hampshire is becoming the ashtray of New England".

The New England Journal published a sounding board piece on the future of primary care in the United States. The authors suggest that one paradoxical reason is the increased exposure to primary care in residency training:

But an additional possibility, albeit an apparently paradoxical one, is that the decline is due in part to the successful efforts by medical schools to increase students' exposure to primary care practice. ...

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New pain guidelines

While I was on vacation, the DEA released guidelines "designed to help doctors prescribe narcotics like Oxycontin and morphine without fear of arrest".

A recent study suggests that a single IM dose of steroid is equivalent as an 8-day tapering course of oral steroid in the setting of relapse rates from acute asthma attacks:

Objective: To compare the efficacy of long-acting IM methylprednisolone to tapering oral methylprednisolone in adult asthmatic patients discharged from the emergency department (ED).

Methods: Randomized, double-blind, placebo-controlled trial of a single IM dose of 160 mg depot ...

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I’m back . . .

. . . from a wonderful vacation and ready to work. Forums will be open later today, and I'll slowly answer my email.

I went to lovely St. Martin, the culinary capital of the Caribbean. The small fishing village of Grand Case hosts an unbelievable array of fantastic dining - and it surely did not disappoint. Highly recommended to any gourmet ...

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. . . while I'm gone:

The dangers of medical advisory board scams.

A poignant story, entitled "It's not just what we say."

Another story on the rewards of medicine.

A new addition to the Scutmonkey Comics.

Overlawyered links to some comments on my "Screen me or I'll sue" story.

Medrants discusses the levels of thinking ...

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. . . and without internet access. Apologies in advance if I don't respond to emails. Regular blogging will continue when I return and my forums will reopen on August 14th.

The RALES study, published in 1999, concluded that spironolactone reduce mortality in those with severe heart failure (i.e. Class IV failure). Today's NEJM comes out with a study showing that due to the RALES study, rates of hyperkalemia and mortality from this complication increased. Taking this into account, there were no significant decreases in death from all causes.

The reason for this is that most ...

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Waits for mammograms

A few weeks ago, one of my colleague's sister from Ireland came over for a visit. The wait for a screening mammogram there was 6 months. She decided to pay out of pocket to have one here. It was booked for her the next day. However, in some parts of the country, the wait times are growing.

. . . that triptans do not increase the rate of heart attack and stroke. Reassuring for migraine sufferers.

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