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(No Ratings Yet)Controlling asthma by the use of proton pump inhibitors apparently doesn’t work any better in children than it does in adults. Yet the practice is widely used.
A study in JAMA and an accompanying fiery editorial seem to put the notion to rest. Listen in.
As always, suggestions are welcomed. You can reach me directly at 617-440-4374 — don’t be shy!
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(2 votes, average: 3.00 out of 5)The American College of Physicians wants to encourage high-value, cost-conscious care. And so they convened a consensus panel of physicians to list tests that they considered overused or inappropriately used in certain circumstances. One example would be the use of MRI for breast screening in normal-risk patients; another is the use of imaging studies in the diagnosis of nonspecific low-back pain.
The panel came up with about 40 such examples, and the ACP is inviting your reactions (and suggestions for further examples) on a survey available on its website, a link to which is in the list below.
Meanwhile, listen in on a 15-minute conversation with Dr. Amir Qaseem, the first author of the panel’s report, just published in the Annals of Internal Medicine. An editorial on the report cites a Congressional Budget Office study estimating that 5% of the nation’s GDP is misspent on medical tests and procedures that don’t help the patient. That’s fully 25% of all health expenditures! Houston, we have a problem….
Links:
Physician’s First Watch coverage (free)
Annals of Internal Medicine article (free abstract)
ACP survey form (free access)
(1 votes, average: 4.00 out of 5)
Yes, it apparently does.
An international study in the New England Journal of Medicine monitored subclinical atrial fibrillation among some 2600 patients who’d just received an implanted pacemaker or cardioverter-defibrillator.
After 3 months of monitoring, about 10% of the group showed subclinical episodes of afib lasting at least 6 minutes.
Over an additional 2.5 years of follow-up the patients initially showing subclinical afib were found to have at least twice the risk for stroke or systemic thromboembolism compared with the rest of the group.
What does it all mean to clinicians? Should anticoagulation measures be taken in patients showing subclinical afib?
Dr. Stuart J. Connolly, one of the study’s principal authors, chatted with Clinical Conversations, offering some clinical guidance on what to do while the apparent magnitude of the effect is investigated further.
Links:
Physician’s First Watch coverage (free)
New England Journal of Medicine abstract (free)
(4 votes, average: 4.00 out of 5)The new edition of the American College of Physicians Ethics Manual has just been released, and at 30 pages, it’s well worth the reading time.
It’s available free online as a supplement to the Annals of Internal Medicine. New or updated topics include social media and online professionalism, interrogation of prisoners, and allocation of medical resources.
In discussing the relation of the physician to the government, the manual states unequivocally: “Under no circumstances is it ethical for a physician to be used as an instrument of government to weaken the physical or mental resistance of a human being….”
Listen in to our chat with two of the people on the committee that put the new edition of the manual together
Links:
(2 votes, average: 3.00 out of 5)A double-blind crossover study in the New England Journal of Medicine shows that 3 months of continuous positive airway pressure (CPAP) in patients with moderate to severe obstructive sleep apnea ameliorates some components of the metabolic syndrome, which is present in about three quarters of such patients.
The authors acknowledge the difficulty of motivating patients to use CPAP consistenly, which could limit its use in routine practice, and they stress the need for counseling to accompany any CPAP prescription.
Links:
Physician’s First Watch coverage (free)
New England Journal of Medicine article (free)
(6 votes, average: 2.83 out of 5)When kids go for ambulatory care, they get an antibiotic prescribed about 20% of the time. Half of those antibiotics are of the broad-spectrum variety.
What are the factors leading up to this, and what are some resources to turn to for better information on this dangerous situation?
Listen in to this 27-minute podcast with the first author of a Pediatrics study examining the issue.
Links:
Physician’s First Watch coverage of the Pediatrics paper (free)
Get Smart: Know When Antibiotics Work (free CDC site mentioned by Dr. Hersh)
Get Smart for Healthcare (free CDC site)
Rising Plague by Brad Spellberg (book mentioned by Hersh)
ASM statement on the GAIN Act (legislation mentioned by Hersh)
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