December 20th, 2010 by RyanDuBosar in Better Health Network, News, Research
No Comments »
Emergency patients with acute abdominal pain feel more confident about medical diagnoses when a doctor has ordered a computed tomography (CT) scan, and nearly three-quarters of patients underestimate the radiation risk posed by this test, reports the Annals of Emergency Medicine.
“Patients with abdominal pain are four times more confident in an exam that includes imaging than in an exam that has no testing,” said the paper’s lead author. “Most of the patients in our study had little understanding of the amount of radiation delivered by one CT scan, never mind several over the course of a lifetime. Many of the patients did not recall earlier CT scans, even though they were listed in electronic medical records.”
Researchers surveyed 1,168 patients with non-traumatic abdominal pain. Confidence in medical evaluations with increasing levels of laboratory testing and imaging was rated on a 100-point scale. Then, to assess cancer risk knowledge, participants rated their agreement with these factual statements: “Approximately two to three abdominal CTs give the same radiation exposure as experienced by Hiroshima survivors,” and “Two to three abdominal CTs over a person’s lifetime can increase cancer risk.” Read more »
*This blog post was originally published at ACP Internist*
December 10th, 2010 by RamonaBatesMD in Better Health Network, Research
No Comments »
Most medical centers routinely perform or require that breast tissue be sent to pathology for histologic examination. The authors of the article (referenced below) question whether this is useful when the breast tissue excised comes from an adolescent male with gynecomastia considering the benign nature of the condition.
Furthermore, the authors point out male breast cancer is rare and when it does occur it is most often in older males, not adolescent males:
In 2009, there were an estimated 1,910 new cases and 440 deaths related to male breast cancer, accounting for just 0.25% and 0.15% of all new cases of cancer and cancer deaths for males in the entire United States, respectively, with historical cohorts demonstrating that the peak incidence of male breast cancer occurs at approximately 71 years of age. More significantly, breast cancer becomes increasingly uncommon among younger age groups.
To look at the issue, the authors did a retrospective chart review of their patients younger than 21 years of age who had undergone subcutaneous mastectomy for gynecomastia between 1999 and 2010. A review of the literature was done, as was an informal survey of major children’s hospitals regarding their practice of histologic examination for adolescent gynecomastia. Read more »
*This blog post was originally published at Suture for a Living*
November 15th, 2010 by GarySchwitzer in Better Health Network, Health Policy, News, Opinion
No Comments »
Last week, after the National Lung Screening Trial results were released, David Sampson, American Cancer Society director of medical and scientific communications, wrote that “our greatest fear was that forces with an economic interest in the test would sidestep the scientific process and use the release of the data to start promoting CT scans. Frankly, even we are surprised how quickly that has happened.”
And, yes, the marketing has even hit fly-over country in the Twin Cities, with this ad appearing in the Sunday Minneapolis Star Tribune in the “A” section:
Of course, no where in the ad will you read about the potential harms of such scans, the false positive rate, what happens when you get a false positive (unnecessary followup testing and perhaps unnecessary treatment), and more costs. And nowhere in the ad will you read that 300 heavy smokers had to be scanned in order for just one to get a benefit of extending his life. But six clinics in this chain are standing by to take your money and do your scan.
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
October 9th, 2010 by GarySchwitzer in Better Health Network, Health Policy, News, Opinion, Quackery Exposed
1 Comment »
The Chicago Tribune reports on mammogram marketing tactics being used across the U.S. — some of it apparently to “woo women back to the imaging room” after confusion over conflicting advice about breast cancer screening.
Yes, the tactics include “mammogram parties” offering chocolate fondue, massages, beauty consultations, wine, cheese, roses, and weekend-getaway spa packages. But there’s another side to this, the Tribune reports:
Simply inviting women to “mammogram parties,” could send the wrong message, said Lynne Hildreth, department administrator of women’s oncology at Moffitt Cancer Center in Tampa. …”Mammograms are a medical test, and to treat it like a haircut overlooks that there are very real risks,” said Hildreth. “It’s not the same risk as getting hit by a car, but there’s a real risk of getting a false positive, which means a biopsy work-up, time off work, sleepless nights waiting for test results and a nagging in the back of the mind that never goes away. If we put a woman through that with no medical basis, it’s irresponsible.
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
July 5th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, Research
No Comments »
Emergency physicians are in a dilemma. Risk missing a diagnosis and be sued, or be criticized for overtesting.
Regular readers of this blog, along with many other physicians’ blogs, are familiar with the difficult choices facing doctors in the emergency department.
The Associated Press, continuing its excellent series on overtesting, discusses how lawsuit fears is a leading driver of unnecessary tests. Consider chest pain, one of the most common presenting symptoms in the ER:
Patients with suspected heart attacks often get the range of what the ER offers, from multiple blood tests that can quickly add up in cost, to X-rays and EKGs, to costly CT scans, which are becoming routine in some hospital ERs for diagnosing heart attacks …
… and the battery of testing may be paying off: A few decades ago insurance statistics showed that about 5 percent of heart attacks were missed in the emergency room. Now it’s well under 1 percent, said Dr. Robert Bitterman, head of the American College of Emergency Physicians’ medical-legal committee.
“But you still get sued if you miss them,” Bitterman added.
The American Medical Association’s idea of providing malpractice protection if doctors follow standardized, evidence-based guidelines makes sense in these cases. Furthermore, it can also help reduce the significant practice variation that health reformers continually focus on. Read more »
*This blog post was originally published at KevinMD.com*
