January 12th, 2011 by PJSkerrett in Better Health Network, Health Tips
Tags: Archives of Internal Medicine, Benefits Vs. Harms, Cardiology, Cleveland Clinic, Coronary Angiogram, Diagnostic Procedures, Emergency Bypass Surgery, Harvard Health Blog, Harvard Health Publications, Harvard Heart Letter, Harvard Medical School, Harvard University, Heart Attack, Heart Failure, Heart Health, Heart Transplant, PJ Skerrett, Risk Vs. Harm, Unnecessary Medical Tests, Unnecessary Procedures
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Here’s an important equation that all of us — doctors include — should know about healthcare, but don’t:
More ≠ Better
“More does not equal better” applies to diagnostic procedures, screening tests meant to identify problems before they appear, medications, dietary supplements, and just about every aspect of medicine.
That scenario is spelled out in alarming detail in the Archives of Internal Medicine. Clinicians at the Cleveland Clinic describe the case of a 52-year-old woman who went to her community hospital because she had been having chest pain for two days. She wasn’t having symptoms of a heart attack, such as shortness of breath, unexplained nausea, or a cold sweat, and her electrocardiogram and other tests were fine. The woman’s doctors concluded that her chest pain was probably due to a muscle she had pulled or strained during her recently begun exercise program to lose weight.
To “reassure her” that she wasn’t having a heart attack, the emergency department team recommended she have a CT scan of her heart. This noninvasive procedure can spot narrowings in coronary arteries and other problems that can interfere with blood flow to the heart. When it showed a suspicious area in her left anterior descending artery (a key artery nourishing the heart), she underwent a coronary angiogram. This involves inserting a thin wire called a catheter into a blood vessel in the groin and deftly maneuvering it into the heart. Once in place, equipment on the catheter is used to make pictures of blood flow through the coronary arteries. Read more »
*This blog post was originally published at Harvard Health Blog*
January 12th, 2011 by Peggy Polaneczky, M.D. in Better Health Network, News
Tags: Contraception, Dr. Peggy Polaneczky, Implanon, Merck, Nexplanon, OB/GYN, Obstetrics And Gynecology, TBTAM, The Blog That Ate Manhattan, Unexpected Pregnancy, Unintended Pregnancy
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The media has been buzzing over recent reports of pregnancies occurring in women using Implanon, a single rod progestin-only contraceptive inserted under the skin of the upper arm and lasting for up to three years.
The headlines make it sound horrifying: “Hundreds Become Pregnant Despite Contraceptive Implanon” and “British Pregnancy Scare in UK Implicates Implanon.” I love how terminology can make something so common sound so frightening.
Actually, what happened was that 584 pregnancies occurred in Britain among about 1.3 million women using Implanon, for a failure rate of .04 percent. In other words, the method had an efficacy of over 99 percent. That’s a pretty effective contraceptive if you ask me.
But it should have been better than that
As good as it may seem, this failure rate is significantly higher than most of us would have expected based upon data from clinical trails of Implanon.
I recall being told at an Implanon insertion training just prior to its introduction in the U.S. that in fact, not a single pregnancy had been reported at that point among users of the device in clinical trails. This would put the method up there with sterilization and IUD in terms of efficacy.
So what happened?
How did Implanon go from perfect efficacy to something less than perfect? Read more »
*This blog post was originally published at tbtam*
January 11th, 2011 by BobDoherty in Better Health Network, Health Policy
Tags: ACA, ACP Advocate, Affordable Care Act, American College Of Physicians, Bob Doherty, CBO, Congressional Budget Office, Economic Deficit, Federal Budgetary Commitment to Healthcare, Government-Funded Care, Health Insurance, Healthcare Coverage, Healthcare Policy, Healthcare Politics, Healthcare Premiums, Healthcare Reform Bill, Healthcare Reform Repeal, John Boehner, Medicare, National Healthcare Costs, Out-Of-Pocket Healthcare Expenses, U.S. Healthcare System, Uninsured Patients
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[Soon] the new GOP-controlled House of Representatives will be voting on and is expected to pass a bill to repeal the Affordable Care Act (ACA) — lock, stock, and barrel. There is virtually no chance the repeal bill will get through the Senate, though, which maintains a narrow Democratic majority, and President Obama would veto it if it did.
But let’s say that the seemingly impossible happened, and the ACA was repealed. What would the impact be on healthcare coverage, costs, and the federal deficit?
In a letter to Speaker John Boehner (R-OH), the Congressional Budget Office (CBO) released its preliminary estimates of the impact of repeal on the deficit, uninsured, and costs of care, and found that it would make the deficit worse, result in more uninsured persons, and higher premiums for many:
— Deficit: repeal of the ACA would increase the deficit by $145 billion from 2012-2019, by another $80 to $90 billion over the 2020-21 period, and by an amount “that is in the broad range of one-half percent of the GDP” in the decade after 2019* — or about a trillion dollars. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
January 11th, 2011 by Toni Brayer, M.D. in Better Health Network, Health Tips
Tags: American Diet, Caloric Intake, Calorie Content of Foods, Cancer, Chain Restaurants, Chain Vending Machine Operators, Counting Calories, Diet and Nutrition, Dr. Toni Brayer, Everything Health, Fast Food, FDA, Food and Drug Administration, Food and Nutrition, Healthcare reform, Healthy Diet, Heart Disease, New Healthcare Legislation, Nutrition and Health, Nutrition Labeling Guidelines, Nutrition Labeling On Menus, Nutrition Labels, Nutritional Facts, Nutritional Information, Obesity, Overweight, Patient Protection and Affordable Care Act, PPACA, Prepared Foods, Restaurant Menu Labeling, Stroke, Total Calories, Type 2 Diabetes
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As part of the new healthcare legislation (Affordable Care Act), the FDA has now published its guidelines for restaurants to inform consumers of the calorie counts of food. It establishes requirements for nutrition labeling of standard menu items for chain restaurants and chain vending machine operators.
This is important because Americans now consume an estimated one-third of their total calories from foods prepared outside the home. Consumers are generally unaware of the number of calories they consume from these foods, and being overweight or obese increases the risk of a number of diseases including heart disease, type 2 diabetes, stroke, and cancer.
Here’s what the guidelines say:
— Restaurants with 20 or more locations must disclose the number of calories in each standard menu item on menus and menu boards (have 19 chain locations? You get a pass. Daily specials also get a pass.)
— Additional written nutrition information must be available to consumers upon request (total fat, saturated fat, cholesterol, sodium sugars, carbs, fiber, protein, etc.)
— The menu must say that the additional nutritional information is available. Read more »
*This blog post was originally published at EverythingHealth*
January 11th, 2011 by Linda Burke-Galloway, M.D. in Better Health Network, Health Tips
Tags: Birth-Related Complications, C-Section, Cesarean Section, Complications After Surgery, Dr. Atul Gawande, Dr. Linda Burke-Galloway, Dr. Patrick Duff, Healthy Baby, Labor And Delivery, OB/GYN, Obstetrics And Gynecology, Smart Mother, Surgical Complications, University of Florida
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Although I’ve been a proponent for the prevention of medical errors for years and wrote a book to address those issues, I think my obstetrician-gynecologist (OB/GYN) colleagues are finally catching on.
Dr. Patrick Duff of the University of Florida’s OB/GYN department wrote an article in the December issue of the journal Obstetrics & Gynecology that caught my attention. In his article, “A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery,” Duff outlines steps that OB/GYNs should take in order to reduce complications during and after a cesarean section. Duff patterns his list after Dr. Atul Gawande’s book, “The Checklist Manifesto: How to Get it Right,” which has set the standard regarding reducing complications after surgery. According to Duff, the following steps should be taken in order to reduce complications after a cesarean section:
1. Clip hair at the surgical site just before making the incision to reduce wound infections. Duff states that there is a greater chance of promoting infections when the hair is shaved the night before the procedure. He also recommends clipping hair as opposed to shaving which reduces the rate of would infections.
2. Cleanse skin with chlorhexidine solution rather than iodine because medical studies have demonstrated a reduction in infections using chlorhexidine solution.
3. Give broad spectrum antibiotics before the surgical incision as opposed to after the newborn’s umbilical cord is clamped. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
