May 31st, 2011 by RyanDuBosar in News, Research
No Comments »
Despite poor awareness and a lack of training on handling peripheral artery disease, internists can and should be able to recognize the symptoms and manage 95% of such cases. Experts advise using the ankle-brachial index as a quick and effective diagnostic method.
But internists often don’t. As was reported in ACP Internist‘s previous cover story on the subject, the ankle-brachial index can be a major part of preventing peripheral artery disease, itself a major predictor of strokes and heart attacks, over and above the Framingham risk score.
The ankle-brachial index is the ratio of the ankle to the arm systolic pressure. A ratio of 0.90 or less indicates peripheral artery disease. Its sensitivity is 79% to 95%, and its specificity is 95% to 100%. It takes less than five minutes to perform in the office.
Yet, among the 85 respondents, 36 (42.35%) said “It’s a quick and easy test.” Another 27 (31.76%) thought, “It’s difficult to fit into the standard visit.” The final 22 (25.88%) said, “I don’t use the ABI to screen patients for PAD.” Read more »
*This blog post was originally published at ACP Internist*
May 30th, 2011 by Dr. Val Jones in Announcements
No Comments »
Better Health salutes the U.S. military for their service to our country. Blog posts will resume tomorrow.
May 30th, 2011 by Mark Crislip, M.D. in Health Tips
No Comments »
It is hard to get infected. The immune system is robust and has a multitude of interlinking defenses that are extremely efficient in beating off most pathogens. Most of the time.
Fortunately, it is a minority of microbes that have evolved to be virulent in humans. Bacteremia is common with our own microbiome. When you brush or floss, bacteria leak into the blood stream:
We identified oral bacterial species in blood cultures following single-tooth extraction and tooth brushing. Sequence analysis of 16S rRNA genes identified 98 different bacterial species recovered from 151 bacteremic subjects. Of interest, 48 of the isolates represented 19 novel species of Prevotella, Fusobacterium, Streptococcus, Actinomyces, Capnocytophaga, Selenomonas, and Veillonella.
but with a good immune system, low virulence bacteria and no place to go, unfortunately the bacteria rarely cause infections.
Even heroin users rarely get infection. Heroin is a rich melange of bacteria and, on occasion, yeasts (I hate to say contaminated, since avoiding microbes is hardly a worry of heroin manufacturers), and the water used for injection is rarely sterile, yet infections are relatively rare despite the filth in which many heroin users exist.
I used to be somewhat fatalistic about hospital acquired infections. However, as the institutions in which I have worked have proven, almost all infections in the hospital are preventable if the institutions aggressively pursue high standards of care.
There are many systems in place in society to prevent infections: flush toilets, good nutrition, public health, vaccines, antibiotics, good hygiene, and an understanding of disease epidemiology, and I suspect people forget there are bugs out there that are pathogenic, just waiting to sicken and kill us. At least a couple of times a year I see patients come into the hospital, previously healthy, who rapidly die of acute infections. But for most people, most of the time, it takes a lot of effort to get an infection.
From my perspective we are Charlie Chaplain on skates , mostly unaware of the infections that awaits us if we do something silly, Read more »
*This blog post was originally published at Science-Based Medicine*
May 30th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
1 Comment »
The development and use of an electronic medical record is extremely important for communication, rapid diagnosis and clinical decision making, increasing efficiency in working up patients, decreasing the cost of duplication of testing and time delays in medical care and treatment.
There are many other advantages of using a functional electronic medical records. A person could be anywhere in the world and have his medical information immediately available. The results of all testing should immediately be communicated to the treating physician. All imaging studies should be digital.
Patients’ physicians could immediately read and use them for their clinical decision making.
These are only a few of the advantages of the electronic medical record. Read more »
*This blog post was originally published at Repairing the Healthcare System*
May 29th, 2011 by John Mandrola, M.D. in Opinion
1 Comment »
I have been in Hamburg, Germany for the past five days. I enjoyed an amazing opportunity to visit one of the world’s most respected heart rhythm labs. Among other things, the main purpose was to learn a new way to ablate atrial fibrillation.
It was an incredible learning experience, one for which I owe an enormous debt of gratitude to the kind and generous people of Dr Karl-Heinz Kuck’s EP lab. Though these people are famous, they treated me as a respected colleague.
Details of all that I learned regarding this newly-approved ablation technique is a matter for future posts. Suffice it to say, I already feel like a better AF doctor.
For now, may I highlight a few of the more striking differences between Europe and the States, as noted by a Kentuckian on his first trip across the Atlantic? Read more »
*This blog post was originally published at Dr John M*
But internists often don’t. As was reported in ACP Internist‘s previous cover story on the subject, the ankle-brachial index can be a major part of preventing peripheral artery disease, itself a major predictor of strokes and heart attacks, over and above the Framingham risk score.
