#PWChat – Diabetes Management in the Cardiovascular Outcome Trial Era

#PWChat – Diabetes Management in the Cardiovascular Outcome Trial Era

Join us Monday, November 27 at 3:00pm ET / Noon PT for a live, interactive tweetchat with former AACE president, Yehuda Handelsman, MD, FACP, FACE, FNLA. Topics to be discussed include: How heart disease presents in people with type 2 diabetes. What contributes to the development of heart and vascular disease in diabetes. Current treatment recommendations to reduce cardiovascular disease in people with diabetes. What makes comprehensive management of patients with diabetes and heart disease particularly challenging. How these obstacles can be overcome, including what works and how medication adherence can be improved. Controversial topics surrounding glucose, lipid, and cardiovascular risk management in patients with diabetes and heart disease. The current status of the safety of medications for hyperglycemia and whether or not clinicians should stop prescribing them. Key outcome trials that may impact guidelines and clinical practice in diabetes and cardiovascular disease management. How should diabetes be managed in this Cardiovascular Outcome Trial (CVOT) era? How clinicians can learn more about outcomes of cardiovascular trials and their impact on managing diabetes in patients with heart disease. Whit it’s important to have a special conference dedicated to diabetes, obesity, insulin resistance & cardiovascular disease. How to Join the Chat Log into your Twitter account. Don’t have an account? Where have you been?! Just kidding, we don’t judge, but you should get one! It’s easy to create, and free. You’ll be glad you did. A couple minutes before 3:00pm ET on November 27, Search Twitter (top right of every Twitter page) for #PWChat. On the search results page, click LATEST at the top left. This will show you all the...
Statin Continuation Following an Adverse Event

Statin Continuation Following an Adverse Event

Statins are among the most widely studied, successful medications in the treatment and prevention of cardiovascular disease including stroke, myocardial infarction, and peripheral vascular disease. Sadly, due to some bad press, there continues to be much misinformation and misunderstanding regarding the risks and benefits of statin use. Many patients and clinicians believe that statins harm the liver, cause diabetes and cognitive decline, and lead to muscle aches and pains. In fact, of the 56 million Americans who are candidates, only about 50% are actually on statin therapy. Additionally, among those who are prescribed statins, 75% abandon their prescription within 2 years. Given the litany of presumed adverse effects, it’s no wonder that many see a greater risk than benefit in statin use.   Examining the Relationship Because of the misinformed presumptions described above, Huabing Zhang, MD, and colleagues conducted a study to examine the relationship between continuation of statin therapy following an adverse reaction and clinical outcomes. Published in Annals of Internal Medicine, the study was a retrospective cohort drawn from Brigham and Women’s Hospital and Massachusetts General Hospital. All information, adverse reactions, continuation or discontinuation of statins, and outcomes were retrospectively obtained from reviewing electronic medical records (EMRs). The cohort was 81.1% Caucasian and male, and most were aged 50-70 years. Data, analyzed from January 2000 to December 2011, revealed that 22% of patients identified adverse reactions. Of the patients who reported reactions, 62% were analyzed, and of those, 70% were continued on some form of statin therapy. Patients who continued to receive statin prescriptions were more likely to be older and have a higher income, government insurance,...
3D Printing a Q Fever-Infected Aortic Aneurysm

3D Printing a Q Fever-Infected Aortic Aneurysm

Aortic infection is a rare, but severe condition. Primary infection with Coxiella burnetii bacteria in patients with chronic Q fever is notorious in the southern part of The Netherlands. Leaving the infected aorta untreated can lead to death in up to 80% of cases. The spiral vein reconstruction, advocated by Drs. Patrick Vriens and Jan Heyligers is a successful method for treating these patients (www.spiralvein.org). This 3D-printed model was used to explain to patients and students about the rare but interesting medical case. It took us 2.5 days to print the model with the Ultimaker 3 (Ultimaker BV, Geldermalsen, the Netherlands). The costs for the print are approximately 10-15 euro. We initially printed it upside down to reduce the amount of polyvinyl alcohol, or PVA (support), that was needed to print the model. Because of the dual extruder, we were able to print very small medical details. This model shows the relation between the abdominal aortic aneurysm very clearly. Furthermore, the small lumbar arteries to the vertebral bodies, at the level of L1-L4, are seen very...
#PWChat – Why Doctors Are Losing the Public’s Trust

#PWChat – Why Doctors Are Losing the Public’s Trust

Join us Thursday, November 30 at 3:00pm ET for a live, interactive tweetchat with Linda Girgis, MD, based on her blog post on why doctors are losing the public’s trust. Topics to be discussed are subject to change but will likely include: What makes trust between patients and physicians so important that Dr. Girgis would say there is no relationship where the bond of trust should be so strong, outside of matrimony. How third parties have contributed to the erosion in the patient-physician relationship in recent years. How outlier doctors who game the system have contributed to doctors no longer being held is such high esteem as they were decades ago. How mandates, such as meaningful use and MACRA, have led to patients feeling their doctors are no longer listening to them. How HMO cuts in reimbursements to doctors have contributed to patients feeling doctors are pushing them through for profit and don’t care about them. How the media’s portrayal of doctors has contributed to the erosion of the patient-physician relationship. How Dr. Girgis would responds to the following comments on her original blog post: “The main reason the public has lost trust in doctors is how they ignore serious symptoms and tell people it’s in their head and nothing is wrong with them” Pill pushers are what most of you are and I sincerely hope that your days are numbered!” What physicians can do, both on an individual basis and on a community- or even nation-wide basis, to help re-establish trust in the public. More… How to Join the Chat Log into your Twitter account. Don’t have an...
Bringing 3D-Printed Prosthetic Hands to Third-World Countries

Bringing 3D-Printed Prosthetic Hands to Third-World Countries

3D printing is commonly used in first-world countries. However, 3D printing can be of added value in third-world countries as well. Prosthesis for children are normally handmade and expensive. e-NABLE is a is an amazing group of individuals from all over the world who are using their 3D printers to create free 3D-printed hands and arms for those in need of an upper limb assistive device, including this 3D-printed hand. 2nd version #3Dprinted prosthetic hand. #SierraLeone #highschoolproject #youtharethefuture @ETZnl @makerbot @Til_Surg @Enablethefuture pic.twitter.com/tghvNC9WqO — Lars Brouwers (@Brouwers_3D) October 31, 2017 We are exploring this field of 3D printing now as well. My friend and I are going to Sierra Leone overland by car (Netherlands – Belgium – France – Spain – Morocco – Mauritania – Senegal – Guinea – Sierra Leone). He will work as a tropical doctor and I will give him a “ride” in our Saab 9.5. I was looking for an opportunity to expand our 3D-printing knowledge to third-world countries. I found a project in Freetown (capital city), which I would like to support with a 3D printer, material, and knowledge (www.gmin.org). Therefore, I’m printing several prototypes of existing prosthetic hands (www.thingiverse.com) to see which will perform best in Sierra Leone. A first version of a 3D-printed prosthetic hand was a very low-budget option. Taking a closer look at the second version, you will notice that the extension of the fingers is performed by elastic bands, which is quite fragile. The thumb is also not placed in the ideal position to grab things. At the moment, we are printing the third version; the elastic bands are...
2017 Diabetes Facts & Statistics

2017 Diabetes Facts & Statistics

Diabetes costs the U.S. economy over $245 billion per year, making it the country’s most expensive disease. But the damage obviously extends well beyond dollars and cents. It’s the 3rd most deadly disease in the U.S., claiming over 80,000 lives per year and becoming a daily concern for millions more. Yet the roughly 9 in 10 Americans who don’t have diabetes probably don’t understand the full extent of the struggle, either. The same can also be said of the nearly 1 in 4 people with diabetes who don’t know they have it. So to help spread awareness, WalletHub assembled an interesting infographic exploring the impact of the disease as well as what folks are doing to fight back. We also surveyed a panel of diabetes experts about issues ranging from personal finance to policy. You can find everything below. Source:...
Addressing Sugar Intake to Achieve Weight Loss

Addressing Sugar Intake to Achieve Weight Loss

For over 20 years, efforts to stop or reverse soaring rates of obesity in the United States have failed. In fact, the obesity epidemic is now a global issue. My colleagues and I hypothesized that the increasing prevalence of fructose in our collective diets is not only a major contributor to the obesity epidemic but also responsible for the dysmetabolic effects that result in metabolic syndrome and chronic diseases.   The Dangers of Fructose We conducted a review, published in The Journal of the American Osteopathic Association, to better understand the role of fructose in these conditions. Along with co-investigators from the University of California, San Francisco, we identified fructose—especially high-fructose corn syrup (HFCS)—as the most damaging type of sugar. Compared with glucose, which metabolizes 20% in the liver and 80% throughout the rest of the body, fructose metabolizes 90% in the liver and converts to fat up to 18.9 times faster than glucose. We learned that HFCS is found in 75% of packaged foods and drinks, mainly because it is cheaper and 20% sweeter than raw sugar. It is particularly harmful because it depletes energy in order to be metabolized, without contributing any nutrients. Because fructose in its processed form has no nutritional value and isn’t metabolized in the brain, the body and mind don’t register that food has been taken in. Thus, one can consume as much fructose as they want but will always want more.   A Look at Fructose Restriction Included in our review was a study that sought to determine the metabolic impact of fructose restriction irrespective of weight change. Participants were children with...
Beyond Late Night Calls: What Keeps Physicians Up at Night?

Beyond Late Night Calls: What Keeps Physicians Up at Night?

In television and movie medical dramas, there’s always that one scene in which a physician receives a call in the middle of the night—the one where the physician needs to dispense advice or rush back to the office or hospital. While that still happens (though not always as dramatically as in the Hollywood versions), there are countless other issues that keep physicians from getting a full night’s sleep. Patient Issues It’s no surprise that many factors occupying physicians’ minds throughout the night are related to their patients. Some patients may be suffering from unexpected complications from surgery and require additional treatment. Others may be experiencing adverse effects from prescribed treatment or aren’t responding to their treatments and require additional research into the underlying causes. Especially disconcerting for physicians are patients with terminal outcomes or unclear diagnoses. And some patients are so ill that they require more than the usual attention from medical staff. Physicians also must manage problematic patients. These patients fall into several categories: difficult, unhappy, non-compliant, and malingering. Each patient type requires a different approach by the physician, especially if there is interference from the patient’s family. One of the newer challenges for physicians is the current opioid crisis. Physicians are tasked with determining strategies for patient pain management and how to handle patient requests for additional narcotics.   Administration Concerns Whether physicians own or work in a private practice or in a hospital setting, they are faced with a variety of administration problems that contribute to sleepless nights. For some it may be increasing practice costs and decreasing reimbursements. Others struggle with scrutiny, pressure, and emotional...
#PWChat – Exercise as Medicine: PART II

#PWChat – Exercise as Medicine: PART II

Join us Wednesday, November 1 at 3:00pm ET for a live, interactive tweetchat with Greg Wells, PhD, on how to help patients make sense of all the exercise-related information found online and elsewhere. Topics to be discussed are subject to change but will likely include The pros and cons of flexibility training. Whether the recent explosion in the popularity of yoga, including hot yoga, is good, bad, or neither. How clinicians can help patients cut through all the noise on the internet about the latest exercise and fitness fads. Why it is important to help patients “get back to basics” on exercise. The types of exercise clinicians should be recommending to their patients. Where clinicians should direct their patients online for reliable exercise information. More… How to Join the Chat Log into your Twitter account. Don’t have an account? Where have you been?! Just kidding, we don’t judge, but you should get one! It’s easy to create, and free. You’ll be glad you did. A couple minutes before 3:00pm ET on November 1, Search Twitter (top right of every Twitter page) for #PWChat. On the search results page, click Latest at the top left. This will show you all the latest tweets using the #PWChat hashtag. The page will automatically update every couple minutes, letting you know how many new tweets there are using the #PWChat hashtag. Answer questions, reply to other’s comments, or make a comment of your own as much and as often as you like. Just make sure to leave room to include #PWChat to make sure what your tweet is included in the chat. Otherwise,...
3D Printing Shows Talocalcaneal Joint Very Well!

3D Printing Shows Talocalcaneal Joint Very Well!

A surgical resident used the above 3D-printed calcaneal fracture to gain more insight in the fracture pattern during preoperative evaluation. Using this 3D printed model, the surgical resident was able to determine which part of the fracture had to be fixed first, second, and so on. During the surgical procedure, the resident used the model to remember which steps had to be taken to perform the best fracture reduction. The patient is already discharged from the hospital and is doing...
#PWChat – Ketamine for Depression: Exciting but Controversial

#PWChat – Ketamine for Depression: Exciting but Controversial

Join us Thursday, November 16 at 9:00pm ET for a live, interactive tweetchat with Steven P. Levine, MD, on the use of ketamine to treat depression. Topics to be discussed are subject to change but will likely include: Why there is a need for alternatives to antidepressants, like ketamine, for treating depression. How ketamine, a psychedelic club drug, ever became even a possibility for the treatment of depression. What makes ketamine a promising alternative to antidepressants and other standard depression care. What quality research there is to support the use of ketamine for depression. Whether patients and providers should be wary of using ketamine for depression, since the FDA has not approved ketamine for this use. Whether patients and providers should be concerned that the side effects of taking repeated small doses of ketamine are unknown. How patients with depression can afford ketamine, which runs from $400 to $800 per infusion and is rarely covered by insurance. How Dr. Levine responds to the American Psychiatric Association’s conclusion that ketamine isn’t ready for widespread use for treatment-resistant depression. Why some scientists are skeptical that ketamine is a good long-term solution to depression and how Dr. Levine responds to them. Whether or not esketamine and rapastinel look to be promising developments in this field. More… How to Join the Chat Log into your Twitter account. Don’t have an account? Where have you been?! Just kidding, we don’t judge, but you should get one! It’s easy to create, and free. You’ll be glad you did. A couple minutes before 9:00pm ET on November 16, Search Twitter (top right of every Twitter page)...
Calling on the Surgeon General: What Americans Need Most

Calling on the Surgeon General: What Americans Need Most

By Linda Girgis, MD, FAAFP In the first week of August 2017, Dr. Jerome Adams was confirmed as Surgeon General as nominated by President Donald Trump. By training, Dr. Adams is an anesthesiologist who also served as the Indiana state health commissioner. He pledged to tackle the US’s opioid epidemic stating, “The addictive properties of prescription opioids is a scourge in America and it must be stopped.” Physicians have strong opinions about what issues the “The doctor of the US”—as the office has been dubbed for decades—should tackle. In a recent poll conducted by Platform Q Health, approximately 45% of healthcare providers felt that the Surgeon General’s top priority should be resourcing addiction recovery and mental health. Click above to view full size. Source: Adapted from material available from Platform Q Resourcing Addiction Recovery and Mental Health In the US currently, more than 6 out of 10 drug overdose deaths involve an opioid. In fact, 91 Americans die every day as a result of opioids (including both prescription medication and heroin). The CDC concluded that the increased number of opioid-related deaths over the past 15 years is driven by prescriptions for opioid medications. In a New York Times data analysis, drug overdose deaths rose 19% from 2015 through 2016. Preliminary analysis shows that rate is expected to jump even higher in 2017. Previous Surgeon General Dr. Vivek Murthy issued a landmark study addressing drug and alcohol addiction—the first time in US history. In his 400-page report, he concluded that 20.8 million Americans suffer a substance use disorder. However, only 10% of these people receive any treatment. “Substance use disorders represent...
Why Actionable Data Is Crucial in the Operating Room

Why Actionable Data Is Crucial in the Operating Room

Today’s hospitals face relentless pressure to improve quality, especially in the operating room. This challenge requires insights into root causes of problems and unnecessary clinical variations, which are notoriously difficult to diagnose. As a counter measure, hospitals are turning to analytics solutions that are embedded directly within perioperative workflows. Such technology converges IoT tools with healthcare analytics to produce actionable data—that is, data which is near real time and relevant to the patient, and can be acted on during the episode of care. This includes during critical care transitions, such as between prep and surgery, and from surgery to recovery. Moreover, actionable data’s value can be extended to identify effective training protocols and to standardize best practices. Three developing scenarios, in particular, are calling for an intensive effort to leverage actionable data in the operating room—and they are only increasing in urgency.   MACRA MIPS The Medicare Access and CHIP Reauthorization Act (MACRA) replaces Medicare’s sustainable growth rate formula for reimbursement with an emphasis on quality and improvements. One of the two main programs in this model is the Merit-based Incentive Payment System (MIPS). While MIPS payment bonuses – or penalties – will begin in 2019, these will be based on data from 2017. Of most importance to hospital clinicians is the 60 percent weight assigned to quality and 15 percent weight assigned to clinical practice improvements, all the way through 2021. After that timeframe, quality will account for 30 percent of MIPS scoring – still a significant percentage. As such, the operating room will benefit from actionable data to improve adherence to best practices during procedures, and also...
Conference Highlights: IDWeek 2017

Conference Highlights: IDWeek 2017

Comorbidities Screening in HIV Patients For a study, researchers analyzed medical records of HIV patients to determine screening frequencies for potential comorbid conditions and clinical factors associated with screening the previous 12 months. Only 18% of patients were screened for hepatitis B, 26% for hepatitis C, 37% for diabetes, 38% for gonorrhea, 41% for chlamydia, 42% for tuberculosis, and 46% for syphilis. Patients with three or more medical visits with CD4 count or viral load tests during the previous year were significantly more likely to be screened for sexually transmitted infections (STIs) and hepatitis C. When compared with African-American patients, Hispanic patients were more likely to be screened for hepatitis C, and Caucasian patients were less likely to be screened for diabetes. Self-reported sexual risk behaviors and injection drug use were not associated with screening for STIs or hepatitis C, respectively. —————————————————————- Continuous Virologic Suppression & Non-AIDS Diagnoses The distribution of non-AIDS diagnoses (NAD) among early diagnosed and treatment patients with HIV who had equal access to care was examined for a study that sought to evaluate the effect of continuous virologic suppression (CS) on NAD. Among the 15.2% of patients with NAD, the most common were cardiovascular disease (4.4%) and acute renal failure (2.8%), followed by chronic kidney disease (2.0%), anal cancer (1.0%), cirrhosis (0.8%), and prostate cancer (0.6%). Older age at antiretroviral therapy initiation and female gender were associated with NAD, whereas higher CD4 cell count was protective. Although not statistically significant, hazard ratios for NAD trended toward demonstrating a benefit for CS. —————————————————————-   Herpes Zoster Incidence in Patients With HIV Current herpes zoster incidence data...
Skin-Prick Testing for Allergic Rhinitis

Skin-Prick Testing for Allergic Rhinitis

According to published data, allergic rhinitis is the most common form of allergy worldwide, affecting 10% to 30% of adults and as many as 40% of children. The effectiveness of interventions to treat allergic rhinitis, such as immunotherapy, avoidance, and pharmacotherapy, are largely dependent on ascertaining an accurate diagnosis. Through properly assigned treatment, a correct diagnosis helps alleviate financial burden and loss of quality of life for millions of patients affected by this condition. Skin-prick tests—followed by intradermal testing to confirm negative test results—are recommended by professional medical societies and associations for diagnosing allergic rhinitis due to ease of administration and low level of invasiveness. However, researchers have yet to come to a consensus on the accuracy of skin testing for allergies, particularly when seeking to detect allergic rhinitis.   Reviewing the Literature Due to concern that skin-prick testing was being overused and inflicting significant costs into the Canadian healthcare system, the Ontario Ministry of Health and Long-Term Care recently asked Health Quality Ontario to evaluate published evidence on the utility of the test in the diagnosis of allergic rhinitis. “We conducted a systematic review and meta-analysis of published studies on the diagnostic accuracy of skin-prick testing in children or adults with suspected symptoms of allergic rhinitis, using nasal provocation as the reference standard,” says Dr. Nevis. “We also evaluated the diagnostic accuracy of intradermal testing for the same patient group as a secondary objective.” For the analysis, the authors screened more than 2,000 citations and 56 full-text articles reporting on both sensitivity and specificity of skin-prick testing in at least 10 subjects, published between 1964 and March 2015....
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