April 1st, 2011 by John Mandrola, M.D. in Health Tips, True Stories
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My neighbor Ed was a thin man all his life. He maintained an ideal body weight by combining regular physical activity with a modest intake of calories. He was a “young” seventy year-old who looked the picture of heart health.
Ed regularly read the newspaper while walking on his treadmill, he hit a golf ball straighter and longer than his peers, and he wore the same size jeans now than he did in college 50 years ago. What’s more, he bragged about his low blood pressure, normal cholesterol level and perfect blood chemistries. He took no pills. I think he went to his primary care doctor each year just to show off his health.
The morning he woke with crushing chest pressure and shortness of air stunned him. “This couldn’t be a heart attack?” he thought. An hour later, minutes after his urgent heart catheterization showed severe blockages in all three of the main coronary arteries, a sternal saw provided a heart surgeon access to his dying heart.
Ed did well. The story had a happy ending. He still looks the picture of health, but now there’s a scar on his chest and a few pill bottles in his medicine cabinet.
How can a human who exudes heart health go to bed well and wake up with severe heart disease? What’s missing? What could Ed have done differently? Could his doctors have measured anything—over and above the traditional risk measures—that might have suggested his obviously higher cardiac risk? Read more »
*This blog post was originally published at Dr John M*
April 1st, 2011 by Glenn Laffel, M.D., Ph.D. in News, Research
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Millions of people watch YouTube videos depicting teens injuring and cutting themselves, according to a new study. The authors conclude that the videos may serve to legitimize the behaviors as acceptable, even normal.
To assess the scope and accessibility of self-injury videos on the Internet, Stephen Lewis of the University of Guelph, and colleagues searched YouTube for keywords like “self-harm,” and “self-injury.”
They found that the top 100 most frequently viewed videos were watched more than 2.3 million times. Ninety-five percent of the viewers were female. Their average age was 25, although Lewis’ group suspects their actual average age was lower, since some YouTube viewers provide restricted content only to older viewers. Read more »
*This blog post was originally published at Pizaazz*
April 1st, 2011 by admin in Book Reviews
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Hall WA, Nimsky C, Truwit CL. Intraoperative MRI-Guided Neurosurgery. Thieme 2010, 272 pages, $159.95.
This book is a multiauthored text edited by three senior authors who have a tremendous experience in the use of intraoperative MRI technology. The book is divided into five sections that describe the various iterations of iMRIs that are available, its application for minor procedures, the resection of neoplastic lesions, and its role in the management of nonneoplastic disorders. The last section focuses on the future improvements in design that are likely to improve surgical access and utility of this burgeoning technology.
The first section describes the characteristics of iMRI machines that are available in the low, medium and high field strength. The reader gets a very good idea about the relative benefits and limitations of each of these machines. Hospitals that may be in the process of deciding which technology to go in for may use this information as a good guide. This section also highlights the optimal pulse sequences that may help differentiate tumor-brain interface, perform intraoperative fMRI and DTI tracking and detect complications related to brain ischemia and hematoma formation. The chapters in this section are well illustrated and show both the technology and the images obtained with various units. The chapter on optimal pulse sequences is very well written and discusses the specific pulse sequences that can help obtain the maximum intraoperative information with the least amount of time. These sequences can be tailored to provide not only anatomical details but also to help obtain both DTI and functional activation data for intraoperative neuronavigation, thereby accounting for brain shifts and movement of eloquent tracts during surgery. The authors describe the challenges of this methodology. Specific anesthetic challenges that restrict the use of standard monitoring equipment have been outlined. These include patient access, length of operative procedure, influence of magnetic field and RF currents on the functioning of the equipments and the images obtained, and risk of migration of ferromagnetic instruments, among others. This has led to the development of MR compatible anesthesia and monitoring equipment. Safety issues and steps needed to ensure reliability of equipment have been described. Read more »
*This blog post was originally published at AJNR Blog*
April 1st, 2011 by Debra Gordon in Health Policy, Opinion
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Who would have thought when we first looked upon you a year ago, barely formed, still somewhat embryonic, that you would have grown so much in just a year, and created so much, well, trouble? Yes, I’m talking about you, health reform. After all, aren’t you the reason for the sea change in Washington? Aren’t you behind several pending appeals that will get to the Supreme Court? Aren’t you the reason that the country is going to hell in a handbasket?
But wait. Let’s look at some other major milestones of the past year.
— You sent $250 checks to Medicare beneficiaries to help cover the “donut hole” in their drug coverage.
— You created special insurance pools designed to provide health care NOW to people with preexisting conditions who can’t get coverage.
— You allowed parents to keep their kids on their health insurance until the children turn 26, providing a major safety net.
— You did away with lifetime caps, enabling those with some serious medical conditions to continue receiving health insurance.
And that’s just in a year. Imagine what the next year and the year after that will bring. So I’ll say it again, Happy Birthday, Healthcare Reform. May you live to a ripe old age and only get better.
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
April 1st, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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The larger the bureaucracy the more inefficient a system becomes. Several things can happen in the decision making process.
1. The decision making process can become opaque rather than transparent.
2. Decisions are made by a committee by consensus.
3. Consensus committee decisions might not sharply define the original goals.
4. Blame for errors gets dissipated.
5. Decisions are only as good as the information that is gathered.
6. Changing a wrong decision can be difficult and costly.
President Obama’s healthcare reform law is creating 256 new agencies to gather information and recommend decisions for other agencies to write regulations.
The following decision is being made by an agency in Washington state. It is not only the wrong decision, but is a decision that will set back the care of Type 2 Diabetes Mellitus 15 or 20 years. It is a decision being made using the wrong information. Read more »
*This blog post was originally published at Repairing the Healthcare System*
