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Total 283 results found since Jan 2013.

Critical gaps in STEMI knowledge base : What is the relationship between “ Time window ” and “ Age ” of IRA thrombus ?
Cardiologists are grappling with at least  half a dozen time windows  in the management of STEMI. (It can be combinations of any of the following :Symptom – DAPT Loading – Door – Needle /Balloon-Sheath, wire crossing etc ) Time windows are Important in choosing the right (or no)modality of re-perfusion . Though superiority of  primary PCI  is thought to be established in academic community , it  may not be in real world. Published studies that suggest pPCI is superior to lysis at any time window  still lack good evidence. Why is this long drawn confusion  ?  One of the important determinant of...
Source: Dr.S.Venkatesan MD - February 9, 2019 Category: Cardiology Authors: dr s venkatesan Tags: cath lab tips and tricks PCI PTCA Hardware Primary -PCI STEMI STEMI -Managment STEMI-Primary PCI Thrombolysis how to estimate the age of thrombus in stemi acs soft vs hard thrombus in stemi thrombus hardening time thrombus organising t Source Type: blogs

Watching the Detectives: Logical Fallacies and Unsubstantiated Claims to Denigrate Investigations of Leaders ' Conflicts of Interest and Alleged Corruption
DiscussionSo here is one example, one anecdote, showing, in my humble opinion, an extreme case of illogical, unsupported argumentation in defense of our current president against multiple credible allegations of conflicts of interest and corruption.  These allegations should concern anyone who cares about conflicts of interest and corruption in health care, because the presidency sets the tone for the whole country, and up to now, the executive branch of the US government provided the most and best resources for preventing and challenging conflicts of interest in health care.  Obviously, these allegations should ...
Source: Health Care Renewal - January 30, 2019 Category: Health Management Tags: conflicts of interest disinformation Donald Trump health care corruption logical fallacies propaganda Source Type: blogs

Evidence less cardiology : Is “ No-flow ” better than “ No-reflow ” in STEMI ?
Cath labs are propably the best place to practice preventive cardiology . . . Practice of medicine is primarily guided by Infinite Information , plenty of Intuition, little bit of Intelligence and unquantifiable amount of Ignorance.The science of coronary reperfusion is standing example for variable mix of the above.The term no reflow is a jargan used liberally in cath labs right from first year fellow to super consultant without knowing what exactly they mean by it. What really is No-reflow then ? The academic definition :According to Kloner no-reflow is defined as suboptimal myocardial reperfusion through a part of coron...
Source: Dr.S.Venkatesan MD - January 26, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Fight Aging! Newsletter, January 14th 2019
In conclusion, reduction of LDL-C to less than 50 mg/dl seems safe and provides greater CV benefits compared with higher levels. Data for achieved LDL-C lower than 20-25 mg/dl is limited, although findings from the above mentioned studies are encouraging. However, further evaluation is needed for future studies and post-hoc analyses. Wary of the Beautiful Fairy Tale of Near Term Rejuvenation https://www.fightaging.org/archives/2019/01/wary-of-the-beautiful-fairy-tale-of-near-term-rejuvenation/ One might compare this interview with researcher Leonid Peshkin to last year's discussion with Vadim Gladyshev. ...
Source: Fight Aging! - January 13, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag
By ANISH KOKA MD  The message comes in over the office slack line at 1:05 pm. There are four patients in rooms, one new, 3 patients in the waiting room. Really, not an ideal time to deal with this particular message. “Kathy the home care nurse for Mrs. C called and said her weight yesterday was 185, today it is 194, she has +4 pitting edema, heart rate 120, BP 140/70 standing, 120/64 sitting” I know Mrs. C well. She has severe COPD from smoking for 45 of the last 55 years. Every breath looks like an effort because it is. The worst part of it all is that Mrs. C just returned home from the hospital just days ago. The yo...
Source: The Health Care Blog - January 10, 2019 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Hospitals Medicare Anish Koka hospital readmissions HRRP MedPAC Source Type: blogs

Statistical Certainty: Less is More
By ANISH KOKA MD  The day after NBC releases a story on a ‘ground-breaking’ observational study demonstrating caramel macchiatas reduce the risk of death, everyone expects physicians to be experts on the subject. The truth is that most of us hope John Mandrola has written a smart blog on the topic so we know intelligent things to tell patients and family members. A minority of physicians actually read the original study, and of those who read the study, even fewer have any real idea of the statistical ingredients used to make the study. Imagine not knowing whether the sausage you just ate contained rat droppings. At...
Source: The Health Care Blog - December 26, 2018 Category: Consumer Health News Authors: matthew holt Tags: Data Health Policy Anish Koka Brian Nosek data analysis HRRP randomized controlled trials statistics Source Type: blogs

Philips HealthWorks Supports Startups Using AI for Radiology, Ultrasound, and Oncology: Interview
In Philips innovation hubs located in Cambridge, Massachusetts, Eindhover, Netherlands, Bangalore, India, and Shanghai, China, 19 startups out of 750 applicants are taking part in an intensive, 12-week Philips HealthWorks program to accelerate their ...
Source: Medgadget - December 19, 2018 Category: Medical Devices Authors: Michael Batista Tags: Exclusive Informatics Medicine Net News Oncology Radiology Society Source Type: blogs

Mrs. Verma Goes to Washington
By ANISH KOKA MD  Seema Verma, the Trump appointee who runs Medicare, has had an active week. The problem facing much-beloved Medicare is one that faces every other government-funded healthcare extravaganza: it’s always projected to be running out of money. Medicare makes up 15% of the total federal budget. That’s almost $600 billion dollars out of a total federal outlay of $4 Trillion dollars. The only problem here is that revenues are around $3.6 trillion. We are spending money we don’t have, and thus there there is constant pressure to reduce federal outlays. This is a feat that appears to be legislatively im...
Source: The Health Care Blog - November 15, 2018 Category: Consumer Health News Authors: anish_koka Tags: Health Policy Hospitals Medicare Physicians Anish Koka Government Health care spending Source Type: blogs

My life time clinical coronary skill went in vain . . . when this patient entered my clinic with chest pain !
Evening cardiac clinic is generally a relaxing place until an occasional patient  with vague chest discomfort present with this sort of an ECG . He was a 68 y old hypertensive and was on Tablet Amlodipine .After a cursory look at his ECG , eyes wandered to look for some specifics. Suddenly ,my  ECG reading skill was stretched . Is it really LVH ? or Ischemia ? I asked for any old ECG which he couldn’t provide. I had to blink  more than a moment , before asking him to describe his chest pain in detail one more time . I got almost convinced it was not ACS  since he was having only localized pain over left side of...
Source: Dr.S.Venkatesan MD - November 10, 2018 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome acute coronary syndrome Clinical cardiology lvh vs ischemia primary vs secondary st t changes triaging chest pain Source Type: blogs

Managing Digital Health Regulatory Uncertainty
Uncertainty abounds when managing digital health regulatory uncertainty regarding the FDA and other international regulatory bodies. For this discussion we'll divide uncertainty into two categories, uncertainty due to a lack of knowledge about the potential regulations on the part of manufacturers and uncertainty about just what various regulatory agencies are doing - or going to do - about new and innovative products that meet the definition of a medical device. What is a Medical Device? Let's start with the first category; there is an astounding amount of misinformation and just plain wrong-headedness on the part of many...
Source: Medical Connectivity Consulting - October 24, 2018 Category: Information Technology Authors: Tim Gee Tags: Regulatory Bibliography Standards & Regulatory Source Type: blogs

Anterior STEMI and multiform PVCs with Narrow Coupling Interval. When to give beta blockers in acute MI?
Conclusion of first report:In patients with anterior Killip class II or less ST-segment –elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.Conclusion of 2nd report: In patients with anterior Killip class  ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer h...
Source: Dr. Smith's ECG Blog - October 19, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Expensive Hospitals: The Enemy Within
By ANISH KOKA MD Everyone agrees that health care is bankrupting the nation. The prevailing winds have carried the argument that a system that pays per unit of health care delivered and thus favors volume over value is responsible. The problem, you see, was the doctors. They were just incentivized to do too much. This incontrovertible fact was the basis for changes in the healthcare system that favored hospital employment and have made the salaried physician the new normal. Yet, health care costs remain ascendant. Why? It turns out overutilization in the US healthcare system isn’t what its cracked up to be. Figure 1...
Source: The Health Care Blog - October 1, 2018 Category: Consumer Health News Authors: anish_koka Tags: Finance Patients Physicians Anish Koka expensive health care finances health care finances Incentives Source Type: blogs

A 60 year old patient with large T-wave inversions
Written by Andrus Alian and Pendell Meyers, with edits by Steve SmithA female in her 60s with history of stage IV lung cancer presented to the ED with 3/10 chest pain and dyspnea waxing and waning for the last 24 hours. She had no personal or family history of coronary artery disease, drug use, HTN, or dyslipidemia. She did have a history of smoking. She recently had a 2 hour flight. She denied diaphoresis, nausea, or back pain. Vital signs were stable and she was afebrile.Here is her initial ECG (during persistent 3/10 active chest pain):Large T-wave inversions. What is their distribution? What is distinctive about them? ...
Source: Dr. Smith's ECG Blog - October 1, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Thoughts on the Apple Watch
Apple products are cool. I love them. But (even) Apple will struggle delivering health. Making healthy people healthier is fraught with problems. At the core of this issue are the many snags of screening people for disease. Here are 600 words I wrote for Medium: I’m a Heart Doctor. Here’s Why I’m Wary of the New Apple Watch Here are my thoughts in the Wall Street Journal:  https://www.wsj.com/articles/apple-adds-heart-monitoring-fall-detection-features-to-its-watch-1536792518 And the Washington Post:  https://www.washingtonpost.com/technology/2018/09/14/what-cardiologists-think-about-apple-watchs-heart-tracking-fe...
Source: Dr John M - September 18, 2018 Category: Cardiology Authors: Dr John Source Type: blogs