December 3rd, 2011 by Elaine Schattner, M.D. in Opinion, Research
Tags: Annals Of Internal Medicine, Cancer Diagnosis, Cancer Screening, Cervical Cancer, Cytology, DNA Testing, Gynecology, HPV, Human Papillomavirus, Pap Smear, Pap Test, Pathology, Under-The-Radar, USPSTF, Women's Health
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The latest issue of the Annals of Internal Medicine contains 2 noteworthy papers on cervical cancer screening. The first, a systematic review of studies commissioned by the USPSTF, looked at 3 methods for evaluating abnormalities in women over 30 years:
high-grade cervical cell dysplasia (Dr. E. Uthman, Wikimedia Commons)
1. Conventional cytology (as in a Pap smear; the cervix is scraped and cells splayed onto a microscope slide for examination);
2. Liquid-based cytology (for LBC, the NHS explains: the sample is taken as for a Pap test, but the tip of the collection spatula is inserted into fluid rather than applied to slides. The fluid is sent to the path lab for analysis);
3. Testing for high-risk HPV (human papillomavirus). Currently 3 tests have been approved by the FDA in women with atypical cervical cells or for cervical cancer risk assessment in women over the age of 30: Digene Hybrid Capture 2 (manufactured by Quiagen), Cobas 4800 HPV (Roche) and Cervista HR HPV (Hologic); another Roche Diagnostics assay, Amplicor HPV, awaits approval.
These HPV assays use distinct methods to assess DNA of various HPV strains.
There’s a lot of jargon here, and I have to admit some of this was new to me despite my nearly-due diligence as a patient at the gynecologist’s office and my familiarity as an oncologist with the staging, clinical manifestations and treatment of cervical cancer. Who knew so many decisions were made during a routine pelvic exam about which manner of screening? Read more »
*This blog post was originally published at Medical Lessons*
December 2nd, 2011 by Nicholas Genes, M.D., Ph.D. in Opinion
Tags: Baseball, Busy, Emergency Medicine, Fast pace, Hectic, High Functioning, Nomar Garciaparra, schedule, Slow, Slow days, Speed, Workflow, Workload
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I had a couple of slow shifts in the emergency department recently, around Thanksgiving. And it made me think of Nomar Garciaparra, the old Red Sox shortstop.
Nomar always had to throw off-balance, while running and jumping. You can see his style on display when throwing the ceremonial first pitch at Fenway last year.
In an interview (can’t find the reference, sorry) he said he always had to throw this frenzied manner, even for an easy grounder where he’d normally have time to collect himself. If he paused too long to think about it, the throw would come off badly, he said.
I always thought this was a psychological issue — dubbed Read more »
*This blog post was originally published at Blogborygmi*
December 2nd, 2011 by Jessie Gruman, Ph.D. in Health Policy, Opinion
Tags: Annals of Family Medicine, Care Coordination, Electronic Medical Records, Health Information Technology, Jessie Gruman, Patient Portal, Patient-Centered Care, Patient-Centered Medical Home, PCMH, Primary Care, Shared Decision-Making, Transformed
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Here’s the bad news: We will not benefit from the health care services, drugs, tests and procedures available to us unless we pay attention, learn about our choices, interact with our clinicians and follow through on the plans we make together. And that “following through”part? We have to work at doing that every day, whether we feel sick or well, energetic or tired out. And if we can’t do it, we’d best find a spouse or parent or friend or social service agency who can step in to do the things we can’t manage.
OK. For some people, this is not bad news. This is how we think it should be: “Nothing about me without me.” For others, our personal encounters with tests and treatments and illness have taught us that this is just the way it is.
But for many of us, this news – should we have reason to attend to it – is inconsistent with our idealized vision of health care that, tattered as its image might be, will step in, take over and fix what ails us. Most of us, after all, are mostly well most of the time and our exposure to health care is minimal.
Efforts to improve the effectiveness of health care and contain its cost have produced Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
December 1st, 2011 by MuinKhouryMDPhD in Opinion, Research
Tags: BRCA Testing, Breast Cancer, CDC, Centers For Disease Control and Prevention, Education, Family History, Future, gene, Genetic Alliance, Genetics, Genomics, Public Health, Tests, University of Michigan
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In June 2011, the CDC Office of Public Health Genomics launched a community wide consultation process to develop priorities for the field of public health genomics in the next 5 years. This process was initiated as part of strategic visioning for integrating the emerging tools of genomics into practice and assuring the success of these new tools in improving population health. The process was conducted at a time of a widening gap between the rapid scientific advances in genomics and their impact on improving population health. The University of Michigan Center for Public Health and Community Genomics and Genetic Alliance spearheaded an effort to seek, collate and synthesize advice and recommendations from numerous stakeholders and constituents. The effort culminated in a workshop conducted on September 14, 2011 in Bethesda, Maryland. The results of the consultation, discussions and deliberations are summarized in a report published by the University of Michigan. Highlights of the recommendations are summarized here but readers should consult the full report. Some of the recommendations include:
To improve public health genomics education: Read more »
*This blog post was originally published at Genomics and Health Impact Blog*
December 1st, 2011 by ErikDavis in Opinion, Research
Tags: Antioxidants, Beneficial, Detrimental, Diet and Nutrition, Effectiveness, Exercise, Folic Acid, Health, Multivitamins, Review, Skeptic, Supplements, Vitamins
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I have skeptical confession to make. I was once a panacea-seeking antioxidant-taker. As background, I’m a marathon runner and occasional triathlete. Several years ago, I was training for an Ironman triathlon, and banking 20+ hours of intense exercise per week. That may sound absurd to many (it does to me, now that I have kids) but that kind of training is necessary for the long races. So what did this pharmacist-wannabe-triathlete with access to discount vitamins do? He stocked up on the fancy bottles of multivitamins, the “endurance” version, of course — with extra antioxidants. Why did I supplement? I wanted to maximize my workouts, speed recovery, and minimize downtime and the risk of injury. Oxidation sounds bad — like a rusting car. Anti-oxidants sounded like the ultimate in preventative medicine. My workouts may have been more extreme, but the practice of supplementing if you exercise is common among athletes.
As it turns out, not only were the antioxidants likely ineffective, they may have compromised some of the gains I was seeking with all that training. That I didn’t evaluate the evidence at the time was my critical-thinking blind spot. Over the the past several years, more data on antioxidants and exercise have emerged. A recent review article, Read more »
*This blog post was originally published at Skeptic North*
