July 24th, 2011 by John Mandrola, M.D. in Opinion, Research
Tags: Apixaban, Atrial Fibrillation, Blood Thinners, Cardiology, Cardioversion, Compliance, Dabigatran, Doctor Responsibility, Dr. Melissa Walton-Shirley, Non-Warfarin Blood Thinners, Patient Responsinility, Pradaxa, Rivaroxaban, Stroke, Stroke Prevention, Warfarin
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I recently came across a very important blog post on the use of the novel new blood-thinner, dabigatran (Pradaxa).
Fellow Kentucky cardiologist, and frequent TheHeart.org contributor, Dr. Melissa Walton-Shirley wrote this very detailed case presentation involving a cantankerous non-compliant rural patient with AF (atrial fibrillation) that sustained a stroke while “taking” dabigatran.
Dr. Walton-Shirley details the very commonly done procedure of cardioversion (shock) for AF. As she clearly points out, the most important safety feature of shocking AF back to regular rhythm entails adequate blood thinning before and after the procedure. Thin blood prevents the possibility of clots dislodging after restoring normal contraction to the top chambers of the heart (atria).
Herein lies the rub with dabigatran, and the two soon-to-be-approved non-warfarin blood-thinning agents, apixaban and rivaroxaban. In the past, Read more »
*This blog post was originally published at Dr John M*
July 24th, 2011 by Harriet Hall, M.D. in Opinion, Research
Tags: Antidepressants, Clinical Trial, Depression, Efficacy, Efficiency, Erick Turner, FDA, Food and Drug Administration, Oregon Health and Science University, Over-prescribed, Over-used, Pharmaceuticals, Placebo, Portland Veterans Affairs Medical Center, Psychiastrist, Psychology, Psychotherapy, Risk Benefit Ratio
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Antidepressant drugs have been getting a bad rap in the media. I’ll just give 3 examples:
- On the Today show, prominent medical expert
Tom Cruise told us Brooke Shields shouldn’t have taken these drugs for her postpartum depression.
- In Natural News, “Health Ranger” Mike Adams accused pharmaceutical companies and the FDA of covering up negative information about antidepressants, saying it would be considered criminal activity in any other industry.
- And an article in Newsweek said “Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.”
Yet psychiatrists are convinced that antidepressants work and are still routinely prescribing them for their patients. Is it all a Big Pharma plot? Who ya gonna believe? Inquiring minds want to know:
- Are antidepressants more effective than placebo?
- Has the efficacy of antidepressants been exaggerated?
- Is psychotherapy a better treatment choice?
The science-based answers to the first two questions are Read more »
*This blog post was originally published at Science-Based Medicine*
July 23rd, 2011 by Dr. Val Jones in Health Tips, Opinion
Tags: Advice, Caregivers, CFAH, ePatients, Healthcare System, Hospitals, Louise H. Batz Patient Safety Foundation, MedHelp, Medical Errors, PHR, Survival
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Alright, I admit that the title of this post is a little dramatic. But it really does seem that most people I know socially have had a bad experience with the healthcare system lately. Take for example my friend whose 3- year-old went to the hospital for a common pediatric procedure – the little girl was overdosed on a medicine, aspirated, got pneumonia, went into respiratory distress (noticed first by her mom) and remained in the pediatric ICU for several days. The hospital staff swept the overdose under the rug, and outright denied it happened when faced with direct questioning. As outrageous as that all is, my friend chose not to pursue action against the hospital and staff for their error and behavior. She just “let it go” because no permanent harm had occurred.
Another dear friend was recently misdiagnosed with having a pulmonary condition when he was in heart failure from an arrhythmia… and almost had a stroke during a contraindicated pulmonary stress test. His simple conclusion: “doctors suck.” Was anyone held accountable for this? No. Again because no permanent harm had occurred.
Just the other night I was having dinner with some visitors from out of town. They both told me Read more »
July 23rd, 2011 by Dinah Miller, M.D. in Book Reviews, Opinion
Tags: Book Review, Crazy, Crazy: Tales on and off the couch, Graduate School, Ph.D., Psychiatry, Psychology, Rob Dobrenski, Sex Education, ShrinkTalk.net, Talk Therapy, Therapy
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Rob Dobrenski, PhD. is a psychologist who blogs over on ShrinkTalk.net. He’s written a book about what it’s like to be a psychology graduate student, a psychotherapy patient, and a psychologist. Oh, we like the folks who go from Shrink blog to Shrink book — it somehow feels familiar — and so I agreed to read his book: Crazy: Tales on and Off the Couch.
So bear with me while I tell you that the book rubbed me wrong at the outset. Dr. Dobrenski begins by saying something to the effect that he describes things that all shrinks feel, and if they say they don’t, they aren’t being honest. I really hate it when people tell me what I feel. It’s like saying that Prozac made your depression better and if it didn’t, then you just didn’t recognize it. And then the book gets off on a provocative start — Rob discovers that many people in his life, from a patient, to a colleague, to himself — are “f***ing crazy.” The asterisks are mine. Dr. Dobrenski had no trouble using the word — I counted 19 times in the 39 pages, including in direct quotes of discussions he has with both a patient and one of his supervisors. Not in a million years. I wasn’t sure what the point was. To let people know he knows obscene words? To be Read more »
*This blog post was originally published at Shrink Rap*
July 23rd, 2011 by Peggy Polaneczky, M.D. in Opinion
Tags: Doctor-Patient Communication, Electronic Medical Records, Email, EMRs, EPIC, Gynecology, Inbox, Macros, Obstetrics And Gynecology, Online Results, Quick Actions, Results Notes, Standardized Letter
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My practice has been using the EPIC electronic medical record for 5 years now, and it’s taken about that long for me to figure out how to tweak the system to make myself more efficient, and for the system to evolve to a place where I could tweak it myself.
Case in point – Quick Actions.
EPIC’s most recent upgrade includes little self-made macros called “quick actions” that turn repetitive tasks into a mouse click. I’m using quick actions to manage my results in basket in much the same way you may be using Rules in Outlook to manage your email.
Some of my macros are actually little work-arounds for a system that is not yet entirely integrated and a patient population that has not yet embraced online results communication. About half of my patients sign up for online results – I’m working hard on the rest…
Like many of you, I like a clean inbox, but need a place to park messages that are awaiting some future task for completion. I’ve decided to use the “results notes” inbasket for this purpose, so you’ll see some of my macros moving messages there.
I now have the following Quick Action options whenever I view a lab report – Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
