April 4th, 2011 by M. Brian Fennerty, M.D. in Health Tips, Opinion
Tags: Acid Reflux, Antibiotic Resistance, Bacteria, Clarithromycin, GERD, H. Pylori, Heartburn, Reflux, Resistance
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H. pylori dominated the GI news in the 1990s, and despite it disappearing from the front pages, it remains a common and important clinical problem. The dominant recommended initial treatment strategy has been a clarithromycin-based PPI triple therapy, with either amoxicillin or metronidazole as the third drug. This approach was based on clinical studies, ease of use, and tolerability factors. Bismuth-based quadruple therapy (a bismuth agent, metronidazole, tetracycline, and a PPI), despite demonstrating excellent activity, was usually relegated to second-line therapy because of the complexity of the dosing as well as compliance and tolerability issues.
However, duringthe last decade, the widespread use of macrolides in the general population has led to rising resistance to clarithromycin (by 30% or more of H. pylori strains in some areas), and when clarithromycin resistance is present, the efficacy of clarithromycin-containing triple therapy falls from about 80% to 50% or even lower. However, clarithromycin resistance does not affect the efficacy of bismuth-based quadruple therapy, and that efficacy of those regimens remains at about 90% when patients are compliant with the treatment.
So the questions for you to consider are:
1) Do you know what the clarithromycin resistance rate in H. pylori is in your community?
2) What first-line H. pylori treatment regimen do you use?
3) Are you planning to change your H. pylori treatment strategy now that clarithromycin resistance rates are rising?
Let us know what you think.
*This blog post was originally published at Gut Check on Gastroenterology*
April 4th, 2011 by Michael Sevilla, M.D. in Medblogger Shout Outs, Opinion
Tags: Creation, Curation, Facebook, Medical Blogging, Social Media, Twitter
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Shout out to @DanaMLewis for pointing out this post from Mashable entitled, “Why Curation Is Just As Important As Creation.” When people are starting out in social media creation, whether it be blogging, or podcasting, or whatever – the phrase always comes up – “Content Is King.” But is content really king anymore?
Now, I certainly wasn’t the first physician blogger, but I would probably consider myself “in those early days.” I mean, starting in 2006 was a few years ago. Back then, writing every single day was imperative. And, the way that you were judged were the amount of comments that you received. I mean, this was in the days before facebook and twitter, when the comment section of the blog was the only way to give feedback publically.
Back then, the way to make a name for yourself was to have the home base of the blog, and that’s how people knew you. Now, with so much content out there, people are overwhelmed and just cannot read everything that they want to read. I definitely can relate to this.
Now, many people are becoming “internet famous” by just sharing through their twitter or facebook stream – the items which they think are important. Maybe, sometimes, not even creating a bit of content on their own. Does this make them a second class citizen in the social media world – not anymore.
I agree with the assertion that being the “information maven” – meaning evaluating social media information – meaning being a curator – instead of a social media creator – this will be very important in the days ahead. Am I wrong, let me know in the comments below – or on twitter, or on facebook, or other social media way…
*This blog post was originally published at Family Medicine Rocks Blog - Mike Sevilla, MD*
April 3rd, 2011 by Bryan Vartabedian, M.D. in Opinion
Tags: Doctors, Drug Reps, Interaction, Pediatrics, Pharma, Pharmaceutical Representatives, Physicians
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Patient care is increasingly under third party control. And as a consequence I make fewer decisions regarding the brand of medication used in my patients.
So the role of a pharmaceutical rep comes into question. If I don’t choose which medication my patients will use, why would a representative call on me? And as American medicine becomes more centralized and standardized, I wonder how and why industry will connect with treating physicians. Pharma it seems is asking the same question: Of the core medications I prescribe, I see far fewer reps these days and our relationships are markedly different from a decade ago.
I don’t miss the pitch. But I find the element of human support to be important. For example, recently the FDA issued a black box warning for the concomitant use of Remicade and 6-MP. My representative visited to be sure that I was aware of the changes in the product insert. Sure the information was in my mailbox – along with 6 inches of pulp spam. It’s basic attenionomics: I’m more likely to hear a person than a letter. Read more »
*This blog post was originally published at 33 Charts*
April 3rd, 2011 by DavidHarlow in Health Policy, Opinion
Tags: HIPAA, Hospital, Law, Legal, Rules, Social Media, Social Media Strategy
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Health care social media continues to be a hot-button issue for hospitals and other provider types around the country. Health care provider organizations considering taking a first step into social media often articulate concerns about regulatory and legal barriers to the use of social media in health care. As regular readers of HealthBlawg know, I believe that an ounce of prevention is worth a pound of cure — in the health care social media arena as elsewhere. Careful planning up front will help you avoid the potential liabilities and pitfalls you may otherwise face in implementing a health care social media program. I invite you to take a look at this quick compendium of rules to live by, which I compiled with Dan Hinmon of Hive Strategies, and follow the link on the last page of the embedded presentation to download an expanded version. Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
April 2nd, 2011 by DrWes in Health Policy, Opinion
Tags: Cardiology, Costs, Health Care Reform, Law, Medical Malpractice, Pressure, Professional Liability, Reduce Testing
1 Comment »
Cardiologists in Connecticut are standing up to the lack of liability protection in the state’s new low-income health plan called SustiNet:
The SustiNet program would create large pools of people, including those who can’t currently afford health insurance, that would theoretically drive down premium costs by competing with the plans of private insurers. Among other cost savings, it would designate a single doctor or practice for each patient, to reduce emergency care use, and create new “best-use” procedures for a variety of ailments to reduce the number of tests doctors order.
But a key provision of the plan was that doctors, in return for following the new procedures and ordering fewer tests, would be protected from malpractice suits if the outcome of a case was not favorable for the patient. However, with backing from the Connecticut Trial Lawyers Association, that provision was removed from the SustiNet bill two weeks ago.
Cardiologists are considered a particularly important group for the new best-use procedures because they tend to order a battery of expensive tests when patients show signs of heart trouble. If specialists like them failed to participate in the SustiNet program, cutting medical costs could be more difficult.
On Tuesday, the Connecticut chapter of the American College of Cardiology withdrew its support for the bill and said that it would circulate an open letter to House Speaker Christopher G. Donovan and Gov. Dannel P. Malloy saying that it could not support the bill without the malpractice protection.
As screws continue to get tightened on doctors’ ability to order tests thanks to third-party oversight bodies, look for more physicians to play hardball about liability limits at both the state AND national levels.
Doctors are being forced to do do their part to control health care costs as a result of our increasingly government-controlled health care initiatives. It’s high time for the trial lawyers’ to do the same. And there’s already precedent to doing so: just look to the legal protections military doctors enjoy when caring for their members. While legal recourse still exists in the military, the challenge of suing the government on behalf of their employees thwarts frivolous claims.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
