June 23rd, 2011 by PJSkerrett in Health Tips, Opinion
Tags: Better Medical Care, Cancer, Clinical Trials, ClinicalTrials.gov, Diabetes, Important Medical Questions, Medical Research, New Drugs, Placebo, Salsalate, TINSAL-T2D, Type 2 Diabetes
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For several years I’ve been preaching in the pages of the Harvard Heart Letter about the importance of taking part in clinical trials. Why? Because I believe they improve medical care, telling us what works and what doesn’t. Figuring it was time to put up or shut up, I volunteered for a clinical trial. I’m glad I did—I learned a lot, received excellent care, and saw first-hand the effort it takes.
The trial was called Targeting Inflammation Using Salsalate in Type 2 Diabetes, or TINSAL-T2D for short. It was being conducted at 16 centers, including the Joslin Diabetes Center in Boston, a short walk from my office. Its aim was to see if an old drug called salsalate (a cousin of aspirin) could arrest low-grade inflammation that may—emphasis on may—make muscles resistant to the effects of insulin and eventually tip the body into type 2 diabetes.
I responded to an ad for TINSAL-T2D and, after undergoing a few preliminary tests, was accepted to take part in it. I was given a bottle of blue pills and asked to take several of them every day. No one—not lead investigator Dr. Allison Goldfine, not study nurse Kathleen Foster, and certainly not me—knew if the pills were the real thing or a placebo. I was also asked to check my blood sugar every morning, and to show up monthly for blood tests and questions galore.
I just finished my year-long stint, still not knowing whether I was taking salsalate or a placebo. I really don’t care, though I’m keen to know if salsalate worked as hoped, something I’ll learn when the results are published.
Why bother?
Read more »
*This blog post was originally published at Harvard Health Blog*
June 23rd, 2011 by John Di Saia, M.D. in Opinion
Tags: Bad Results, Embarrassed, Good Results, Labiaplasty, Nerve Damage, Plastic Surgery, Reduction Labiaplasty, Safe, Sensation, Sensitivity
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Reader Question:
I want to get the [labiaplasty] surgery because I’m really embarrassed about the way I look… but I’ve read online that some experienced really bad results and ended up having pain for the rest of their lives… due to nerves getting trapped and stuff… how common is this? Do you make sure that no nerves get trapped? Because I believe that sensitivity is more important than the look… and how much do you usually remove? the bare minimum or…? I’m afraid of being embarrassed that I got this operation if I go through with it.
Labiaplasty is a serious consideration. The online reflections of all patients who have had surgery however encompass a multitude of different operations.
It is my belief that Read more »
*This blog post was originally published at Truth in Cosmetic Surgery*
June 23rd, 2011 by Glenn Laffel, M.D., Ph.D. in Opinion
Tags: Attrition, Cancer, Cause-And-Effect, Chronic Diseases, Delay, Diabetes, Healthy Choices, Healthy Decision, Heart Attack, Kaiser Permanente, Long Interval, mobile behavioral intervention, My Path to Healthy Life, Russell Glasgow, Unhealthy Behavior, Web-based Behavioral Intervention
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We have all seen people exhibit flagrantly unhealthy behavior. Some of us–though we’d never admit it–derive a certain, smug satisfaction by observing them. At least I don’t do that!
Somewhere in the course of our daily lives though, most of us do exhibit behavior that suggests at least some disregard for our health. We don’t change our diet, though we know we should. We don’t floss, take medications as prescribed, or get the screening tests we’re supposed to.
Multiple intertwining causes underlie all unhealthy behavior, of course. I had always figured that one pervasive cause was the lack of a simple, observable connection between health-related behaviors and health outcomes. There is a long delay for example, between establishing unhealthy dietary preferences and the sequellae of that behavior (a heart attack, diabetes or whatever). The longer the delay between cause and effect, the more likely someone will be to exhibit unhealthy behavior.
On the other hand, if there’s a short interval between cause and effect—it only takes minutes for susceptible people to develop a severe allergic reaction after eating peanuts, for example—well, that’s where I’d expect high adherence to the required healthy behavior.
If I’m right, then we have a problem. For many chronic diseases (diabetes, heart disease, some cancers) Read more »
*This blog post was originally published at Pizaazz*
June 22nd, 2011 by Happy Hospitalist in Health Policy, Opinion
Tags: ACLU, AMA, Bail, Government, Guards, Hospital Expenses, Incarceration, Labor Costs, medicaid, Prisoners, VA
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Are government entities required to pay the hospital bills of incarcerated prisoners? This is a scenario that happens quite often. Jailed patients are admitted onto the hospitalist service through the ER for anything from patients faking seizures in the ER to chest pain to drug overdoses. When patients are under the custody of the city, state or federal system, those entities are required to pay for necessary acute health care services. I don’t know, maybe it has something to do with a prisoner’s constitutional right. You lose your right to vote, but not to get a liver transplant.
So what happens? Jailed patients get admitted and guards, sometimes, one, two or three at a time, are required to be at the patient’s bedside 24 hours a day. If the patient needs to transport to the radiology department, sometimes this must be arranged with the guards ahead of time to allow extra staffing for the transport.
As you can tell, having a jailed patient is expensive, not only for the cost of the incurred hospital expenses but also the extra labor costs of having additional guards in the patient’s room 24 hours a day. So what’s a city to do? Read more »
*This blog post was originally published at The Happy Hospitalist*
June 22nd, 2011 by M. Brian Fennerty, M.D. in Opinion
Tags: Airway Compromise, Anesthesia, Endoscopy, Gastroenterology, Gastrointestinal Wall Injury, GI foreign-body retrieval, Overtube, Removal of foreign body, Sedation, Stomach
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I have observed extreme variation in how my colleagues manage GI foreign-body retrieval from the stomach. Some always use general anesthesia and endotracheal intubation; others (myself included) use conscious sedation. Some use an overtube to withdraw the object into if possible; others simply pull it up to the endoscope and use the endoscope to guide it through the esophagogastric junction and upper esophageal sphincter. The reasons for this variation are clearly related to the perceived risk of airway compromise or gastrointestinal wall injury during withdrawal of the object from the stomach.
So my questions to you are:
1) When do you ask for endotracheal intubation during foreign-body retrieval?
2) Do you use an overtube when removing foreign bodies from the stomach, and, if so, always or in what situations?
3) If you don’t use an overtube, what technique do you use during withdrawal of the object?
4) What is your favorite “tool” or endoscopic accessory to grab objects from the stomach?
I look forward to hearing your thoughts on this issue.
*This blog post was originally published at Gut Check on Gastroenterology*
