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Practical barriers for comparative effectiveness studies

David Williams

Health Policy

July 10, 2010

Writing in the New England Journal of Medicine three authors share their experience in running a head-to-head trial of Avastin (bevacizumab) versus Lucentis (ranibizumab) for wet age-related macular degeneration (AMD).

They describe the barriers they faced and suggest that the barriers will need to be removed for comparative effectiveness research to succeed. They make good points and may well be correct in their policy recommendations.

However the case of Avastin and Lucentis …

How to treat slouching in children

Roy Benaroch, MD

Conditions and Diseases

July 9, 2010

“I’m worried about my daughter’s posture. What can I do about it other than constantly nagging her to stand up straight?”

You’re probably talking about “kyphosis,” which is the rounded-shoulders, hunched forward kind of posture common in children and many adults. It’s often called “postural kyphosis” because it can be corrected if the child tries to stand straight up. Rarely, there’s a genuine spinal deformity, called Scheuermann’s Kyphosis or Scheuermann’s Disease, …

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How to treat slouching in children

How to implement CPOE successfully at your hospital

John Halamka, MD

Health Technology

July 9, 2010

One in every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes. This has created a new urgency for all hospitals in the state to install computerized physician order entry (CPOE).

At BIDMC, we implemented CPOE in 2001 and have not had a handwritten order in most areas, except for the 2 days of our network outage in 2002. Implementing CPOE is challenging and requires …

Short stature increases heart disease risk

MedPage Today

Conditions and Diseases

July 9, 2010

by Todd Neale

People of short stature appear to have a heightened risk of adverse cardiovascular outcomes compared with their taller counterparts, according to a new meta-analysis.

Among 22 studies analyzed, the shortest people had a 1.46-fold greater risk of coronary heart disease or death, Tuula Paajanen, MD, of the University of Tampere in Finland, and colleagues reported online in the European Heart Journal.

A critical height cutoff point for increased risk could …

World Cup soccer lessons that doctors can use

Philippa Kennealy, MD, MPH

Physician

July 9, 2010

Not being much of a soccer aficionado, I have nevertheless been captivated by some of the games in the 2010 World Cup Soccer. Probably has something to do with my being South African!

While I hear many Americans bemoan the slow pace of the televised game (“boring!”), the low scores (“where’s the action?”) and the vuvuzelas (“irritating!”), I have been struck by lessons these matches have offered up for entrepreneurial physician …

Mark Midei and the failure of peer review

Robert Wachter, MD

Conditions and Diseases

July 8, 2010

A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb.

A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t need them, justifying the procedures by purposely misreading cath films. In several of the cases, Midei allegedly read a 90 percent coronary stenosis when the actual …

Ambulatory surgical centers may have higher infection rates

MedPage Today

Conditions and Diseases

July 8, 2010

by Todd Neale

Failure to follow recommendations to control nosocomial infections appears to be common in ambulatory surgical centers — even during formal inspections, researchers found.

Of 68 centers in three states participating in a pilot inspection program, about two-thirds (67.6%) had a lapse in at least one of five infection control categories, according to Melissa Schaefer, MD, of the CDC’s Division of Healthcare Quality Promotion in Atlanta, and colleagues.

The most common …

The grief men face when their wives undergo mastectomies

Anesthesioboist T., MD

Conditions and Diseases

July 8, 2010

I have given anesthesia for a lot of breast surgery. I don’t think I’ll ever get used to the fog of pain and sorrow surrounding a double mastectomy.

All surgery is invasive in some way. Amputations, in particular, have a horror all their own; the idea that destroying someone – cutting off a body part, violating a coherent whole – should be necessary in order to save a life is almost …

Emergency room waits grow as more people become insured

Kevin Pho, MD

Health Policy

July 8, 2010

Remember when I wrote, way back when, that expanding health coverage without a concurrent increase in primary care access will only worsen emergency room waits?

For instance, consider this, from CNN.com:

What good is having health insurance if you can’t find a doctor to see you? …

… The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to …

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Emergency room waits grow as more people become insured

Combo pills do not save patients money

Leslie Ramirez, MD

Medications

July 7, 2010

Many prescription medicines are actually two or more medicines combined into one pill or package. True, this packaging is convenient– but you can often save money by buying your medicine as its separate components. Let’s look at some examples:

Lotrel blood pressure pills. This is actually a combination of two blood pressure medicines: amlodipine and benazapril. Lotrel, the combo pill, is available in a generic form, as are it’s two individual …

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Combo pills do not save patients money

MKSAP: 68-year-old woman with difficulty seeing out of her left eye

mksap

Conditions and Diseases

July 7, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old woman is evaluated in the emergency department for difficulty seeing out of her left eye.

The symptoms were first present upon awakening 45 minutes earlier. She describes her vision as “looking through a dark veil.” Her right eye is unaffected. There is …

Treatment decisions under migraine headache influence

Diana E. Lee

Patient

July 7, 2010

by Diana E. Lee

At an appointment with my local neurologist I showed up feeling bone tired and mentally drained.

Next thing I knew I was going back on a medication I had deliberately chosen to stop taking just because a doctor told me I should be taking something.

When the doctor finally came into my exam room he looked over the list of medications I was taking and declared that Lyrica alone …

Best free Android medical apps

Kevin

Health Technology

July 7, 2010

by Brett Einerson and Iltifat Husain

Health care professionals and students using Android are probably wondering what free Android apps may be helpful in the health care setting.

Android developers continue to add more apps to the Market that relate to health and medical practice. While the field of apps relevant to health care professionals on Android lags far behind the iPhone OS platform, there are several apps worth noting.

Here, we …

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Best free Android medical apps

Tomorrow’s surgeons are today’s video gamers

Dr. Martin Young

Physician

July 7, 2010

As a young medical student I remember the arrival of the first video arcade games very clearly: Asteroids, Space Invaders and Pacman.

I spent whatever spare cash I had on them, never playing long enough to be any good, or rich enough to get any better. When I bought my first computer in my late-twenties, I relived my excitement with the newest computer games, spending a disproportionate amount of time long …

How to choose an EHR after a demo

Rosemarie Nelson

Health Technology

July 7, 2010

Selecting an EHR is not just about the demo. But those EHR vendors sure do put a lot of focus on that demo! You need to get beyond the smoke and mirrors and consider how to use that focus to evaluate the solution as it meets your needs and requirements.

Before you even schedule any vendor demonstrations, write down your “must haves.” Can you identify your top 10 requirements?

For example, in …

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How to choose an EHR after a demo

Patients can ask for discounts if the doctor is running late

Kevin Pho, MD

Patient

July 7, 2010

Should doctors face consequences if they run late?

From the New York Times’ health blog, Well, comes a story where a medical group promises, “same-day appointments and longer, more personalized visits that start on time.”

Sounds good, right?

But it comes with a caveat, namely, a $199 annual membership fee. A tremendous amount of primary care can be bought with that amount of money, and if patients were willing to pay that, …

Op-ed: Empowered e-patients are failed by our health system

Kevin Pho, MD

Physician

July 6, 2010

The following op-ed was published on June 7th, 2010 in CNN.com.

“I read all about my condition on the Internet,” a recent patient proudly told me. Like other doctors, I’m seeing more patients research their symptoms thoroughly before setting foot in the exam room.

Patients are using the Web in unprecedented ways for their own health empowerment. According to the Pew Internet & American Life Project, 61 percent of American adults …

Physical features of autism spectrum disorder (ASD)

William R. Yates, MD

Conditions and Diseases

July 6, 2010

Social and language issues dominate most of the discussion about the features of autism spectrum disorder (ASD).

A neglected area of study are the physical feature characteristics that have been known to be associated with ASD. Unlike some of the diagnostic physical changes in disorders such as Down Syndrome, physical features found in ASD are often subtle and missed by most clinicians.

Ozgen and colleagues from the Netherlands, UCLA and the UK …

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