December 26th, 2011 by PeterWehrwein in Research
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We are fast entering the era of the electronic health record, when it will be possible to call up our medical records on our computers and mobile devices. Medication lists, lab results, appointment schedules—they’ll all be available with clicks of your mouse or taps on the screen of your smartphone or tablet.
But one question that’s far from settled is whether the electronic health record should include the notes that doctors make about them. A doctor’s notes can be straightforward, such as a reminder that an additional test might be needed. But they can also include somewhat speculative observations and hunches about a patient and his or her medical conditions. The Open Notes project is a research program designed to test the consequences of giving patients access to doctors’ notes. Harvard-affiliated Beth Israel Deaconess Medical Center is one of the test sites.
The Open Notes project is far from finished. But results of a survey of the expectations that doctors and patients have for note sharing are being reported in today’s Annals of Internal Medicine.
I don’t think there are any great surprises here. More than half of the primary care physicians Read more »
*This blog post was originally published at Harvard Health Blog*
December 3rd, 2011 by Elaine Schattner, M.D. in Opinion, Research
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The latest issue of the Annals of Internal Medicine contains 2 noteworthy papers on cervical cancer screening. The first, a systematic review of studies commissioned by the USPSTF, looked at 3 methods for evaluating abnormalities in women over 30 years:
high-grade cervical cell dysplasia (Dr. E. Uthman, Wikimedia Commons)
1. Conventional cytology (as in a Pap smear; the cervix is scraped and cells splayed onto a microscope slide for examination);
2. Liquid-based cytology (for LBC, the NHS explains: the sample is taken as for a Pap test, but the tip of the collection spatula is inserted into fluid rather than applied to slides. The fluid is sent to the path lab for analysis);
3. Testing for high-risk HPV (human papillomavirus). Currently 3 tests have been approved by the FDA in women with atypical cervical cells or for cervical cancer risk assessment in women over the age of 30: Digene Hybrid Capture 2 (manufactured by Quiagen), Cobas 4800 HPV (Roche) and Cervista HR HPV (Hologic); another Roche Diagnostics assay, Amplicor HPV, awaits approval.
These HPV assays use distinct methods to assess DNA of various HPV strains.
There’s a lot of jargon here, and I have to admit some of this was new to me despite my nearly-due diligence as a patient at the gynecologist’s office and my familiarity as an oncologist with the staging, clinical manifestations and treatment of cervical cancer. Who knew so many decisions were made during a routine pelvic exam about which manner of screening? Read more »
*This blog post was originally published at Medical Lessons*
November 27th, 2011 by Howard LeWine, M.D. in Health Tips, Research
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Good vibrations may work for dancing on the beach or for romance, but they don’t seem to do much to strengthen bones.
Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.
The results are a disappointment for older women and men looking to strengthen their bones without exercising, not to mention to the companies that have sprung up to sell whole-body vibration platforms as an easy way to halt osteoporosis, the age-related loss of bone.
The idea behind whole-body vibration makes sense. Like walking, running, and other weight-bearing physical activities, whole-body vibration Read more »
*This blog post was originally published at Harvard Health Blog*
November 19th, 2011 by Toni Brayer, M.D. in Research
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Low back pain is one of the most common conditions to affect humans. More than 80% of Americans experience low back pain at some time in their lives and “chronic” pain is on the rise as people live longer and get heavier. Numerous studies have shown that doctors and patients underutilized exercise as a treatment for chronic back and neck pain even though it has been shown to be effective. A new study was published in the Annals of Internal Medicine that showed yoga to be an effective treatment for chronic low back pain.
The study authors took two groups of patients and compared yoga to usual care for chronic or recurrent low back pain. All patients received a back pain education booklet, but the study group also received Read more »
*This blog post was originally published at EverythingHealth*
September 21st, 2011 by Michael Kirsch, M.D. in Opinion
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All of us have been to fast food establishments. We go there because we are in a hurry and it’s cheap. We love the convenience. We expect that the quality of the cuisine will be several rungs lower than fine dining.
We now have a fast medicine option available to us. Across the country, there are over 1000 ‘minute-clinics’ that are being set up in pharmacies, supermarkets and other retail store chains. These clinics are staffed by nurse practitioners who have prescribing authority, under the loose oversight of a physician who is likely off sight. These nurses will see patients with simple medical issues and will adhere to strict guidelines so they will not treat beyond their medical knowledge. For example, if a man comes in clutching his chest and gasping, the nurse will know not to just give him some Rolaids and wish him well. At least, that’s the plan.
Primary care physicians are concerned over the metastases of ‘minute-clinics’ nationwide. Of course, they argue from a patient safety standpoint, but there are powerful parochial issues worrying physicians. They are losing business. They have a point that Read more »
*This blog post was originally published at MD Whistleblower*
