August 12th, 2011 by M. Brian Fennerty, M.D. in Opinion
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The first cases of Barrett esophagus (BE) ablation in the late 1980s used YAG and Argon laser. Since then, a myriad of ablation techniques have been described, including multipolar electrocautery (MPEC), argon plasma coagulation (APC), cryotherapy, radiofrequency ablation (RFA), and endoscopic mucosal resection (EMR). Each technique has had its advocates, and some of the techniques appear to have certain advantages in certain types of BE: e.g., long segment, nodular, etc.
Most cases of BE are short segment, and most neoplastic cases do not have nodules or erosions. So the question I would like to see discussed is: In a patient with 1–2 cm of otherwise featureless flat but neoplastic BE:
What ablation technique would you use, and what do you feel makes this technique advantageous? Read more »
*This blog post was originally published at Gut Check on Gastroenterology*
August 11th, 2011 by Bryan Vartabedian, M.D. in Opinion
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I never thought I’d change the way I practice medicine. But I recently enrolled as a provider in the Improved Care Now (ICN) collaborative network and I’m already working differently.
ICN is an alliance of gastroenterologists and patients working in a new model of pediatric inflammatory bowel disease care based on the analysis of thousands of doctor–patient visits as well as the latest studies and treatments. Doctors and patients apply this information, experiences are tracked in an open registry, the results are then shared and refined to improve care. I can see what I’m doing well and where I’m falling short relative to other clinics and pediatric gastroenterologists.
ICN is under the direction of Dr. Richard Colletti of the University of Vermont. ICN is supported by the Chronic Collaborative Care Network (C3N), the brainchild of Cincinnati Children’s qualitymeisters, Peter Margolis and Michael Seid. I flew to Cincinnati earlier this week to catch up on C3N and what appears to be a first step into medicine’s future. More on the specifics later. But suffice it to say that I’m stoked about where this is all headed.
A couple of thoughts after enrolling my first few patients: Read more »
*This blog post was originally published at 33 Charts*
August 3rd, 2011 by Michael Kirsch, M.D. in Opinion, Research
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Most of us born several decades ago, recall the futuristic book Fantastic Voyage by Isaac Asimov, where a miniaturized crew traveled through a human body to cure a scientist who has a blot clot lodged in his brain. Ironically, miniaturized medical care is now upon us while books are at risk of becoming obsolete.
I hope that gastroenterologists won’t become obsolete, at least until my last kid graduates from college.
I perform an amazing diagnostic procedure called wireless capsule endoscopy (WCE), when patients swallow a camera. Once swallowed, this miniaturized camera takes its own fantastic voyage through the alimentary canal. The test is used primarily to identify sources of internal bleeding within the 20 feet of small intestine, which are beyond the reach of gastroenterologists’ conventional scopes. I have performed over 200 of these examinations, and I am still awestruck when I watch a ‘movie’ of someone’s guts. While most examinations do not reveal significant findings, I have seen dramatic lesions that were bleeding before my eyes. WCE can crack a cold medical case wide open.
Here’s a typical view of the small bowel as seen by the cruising camera: Read more »
*This blog post was originally published at MD Whistleblower*
July 30th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
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As a gastroenterologist, I treat hundreds of patients with heartburn. You already know the names of the medicines I prescribe, since they are advertised day and night on television and appear regularly in print newspapers. Pharmaceutical representatives for each one of these drugs come to our office each claiming some unique clinical advantage of their products over the competitors. They have a tough job since the medicines are all excellent, are priced similarly and are safe. On some days we will have 2 or 3 reps visiting us, each one proffering a medical study or two that supports their product. They show us graphs where their drug is superior to the others regarding an event of questionable clinical import. Their goal is to show that the graph line of their drug is going up, while those of their competitors are going down.
Physicians, like me, who do give these folks some time, have mastered the art of the slow head nod as the drug’s virtues are being related. In the past, the relationships they cultivated with us translated directly into prescriptions being written. Not so today, when our prescribing pens are controlled by insurance company formulary requirements. Those drugs that are not on the coveted list not just swimming upstream, they’re trying to scale a waterfall.
Drug companies know a lot more about us than we know about them. They have Read more »
*This blog post was originally published at MD Whistleblower*
July 5th, 2011 by admin in News
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A strong abdominal exam is a must-have clinical skill for an aspiring healthcare professional. Diagnoses spanning cirrhosis, appendicitis, hernias, peritonitis, aortic aneurysms, and cholecystitis, for example, can be suspected and even made via abdominal exam.
Unfortunately, secondary to factors which include an increasing dependence on imaging and other diagnostics, time constraints in the practice of medicine, and fewer chances for bedside instruction in medical education with work-hour regulations, physicians rely increasingly less on their physical exam skills today than has been the case in the past.
In that manner, here we review the Answers in Abdominal Examination App, released in May 2011 by Answers in Medicine. Answers in Medicine, which specializes in presenting medical content via short modules in audio or video format for healthcare professionals, has developed a number of medical apps, including Answers in Alcoholic Liver Disease, Answers in Ulcerative Colitis, Answers in Crohn’s Disease, Answers in Irritable Bowel Syndrome, and Answers in Dyspepsia, to name several. Read more »
*This blog post was originally published at iMedicalApps*
