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Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?
Conclusions: Head CT is common in NT-OHCA.  Cerebral edema is more common in patients presenting with an initial rhythm of PEA/asystole than in VT/VF and is associated with higher mortality.  Management is rarely affected by routine use of early head CT. In those who required urgent PCI, CT was associated with a (non-statistically significant) 21 minute longer mean DBT. Kurkciyan et al., abstracthttp://www.sciencedirect.com/science/article/pii/S0300957201003811Objective: Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest is poorly evaluated. We analyse disease-specific and emergency...
Source: Dr. Smith's ECG Blog - October 20, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs

Health lessons from Reverend Al Sharpton…
However you see the Reverend Al Sharpton, one thing is certain: you see less of him now. His Twitter pic tells you he is proud of his 167-pound weight loss. Good for him, he should be. If you care about health, the disappearance of the Sharpton-of-old is worth mention. His story teaches us a lot, and, if one dares to look a little deeper, bigger lessons bulge out. Surely this is more than just a weight loss story. The obvious question: How did he lose the weight? Yes, of course, we all want to know about the process of shedding 160+ pounds. But I ask you to call time-out and first look carefully at the pronoun in the six-w...
Source: Dr John M - October 11, 2013 Category: Cardiology Authors: Dr John Source Type: blogs

What Board Recertification Is Failing to Teach Doctors
I continue to study for my third ABIM re-certifications in both cardiovascular disease and cardiac electrophysiology. In preparation for the examinations, I purchased the review materials offered by the American College of Cardiology called ACCSAP-8 and took the surprisingly expensive Cardiac Electrophysiology Board Review course held in Chicago recently. I find I have little time to study all
Source: Dr. Wes - October 8, 2013 Category: Cardiology Authors: Westby G. Fisher, MD Tags: Maintenance of Certification board certification American Board of Internal Medicine Source Type: blogs

Successful US healthcare reform must consider human nature
Reform of healthcare in the United States is infinitely complex. Millions of words have been written. The noise drowns out the signal. It’s rare therefore that one paragraph could sum up the problem so concisely. It came from Edward Davies, an editor at the British Medical Journal. He was quoting journalist Owen Dwyer who was writing on the challenge of doing less. “How many of us would voluntarily take steps that slash our income, and that of our employees, while simultaneously alienating our customers? That is what US physicians are being asked to do. Only a physician of rare moral courage could push back alone ...
Source: Dr John M - October 6, 2013 Category: Cardiology Authors: Dr John Source Type: blogs

Eyes Wide Shut – Managing Multi-EMR Meaningful Use Stage 2 Is Hard
Most discussions on Meaningful Use (MU) seem to focus on a single healthcare provider organization (acute or ambulatory), with a single EMR, and a single Medical Record Number (MRN) pool generating unique patient identifiers. Even in that context, the complaints of the difficulties of successfully implementing the technology and obtaining the objectives are deafening. How daunting might those challenges seem, multiplied across a large integrated delivery network (IDN), attempting to make enterprise-wide technology and operational process decisions, in alignment with MU incentive objectives? Imagine you are an IDN with 9 ho...
Source: EMR and HIPAA - October 2, 2013 Category: Technology Consultants Authors: Mandi Bishop Tags: Certified EHR Direct Project EHR Stimulus Electronic Health Record Electronic Medical Record EMR EMR Implementation EMR Technology Healthcare Interoperability HealthCare IT HIE HITECH Meaningful Use Patient Portal Active Direct Source Type: blogs

ObamaCare will not make us sick…
On day 1 of ObamaCare, the headline in our paper said “SHUTDOWN.” It’s here; it’s really here. You might be wondering what’s been going on in the hospital or office–the contact points where healthcare actually happens. The funny thing is: nothing seems any different. And…this is the problem with ObamaCare. It hasn’t, won’t, or perhaps couldn’t, change the fundamental problem with US healthcare. Namely, that it is too big, too disruptive, and too devoid of nuance. In this way, healthcare mirrors modern American culture. We put in too little, expect too much and can’t seem to get by with less. I...
Source: Dr John M - October 1, 2013 Category: Cardiology Authors: Dr John Source Type: blogs

Eyes Wide Shut – Is This Meaningful Use?
Again and again, I find myself expounding upon the need to differentiate between the “letter of the law” and the “spirit of the law” of Meaningful Use Stage 2. I believe whole-heartedly in the transformative power of health IT, and support the future vision of the Meaningful Use objectives of patient empowerment and nationwide standards for records transmission and interoperability. The spirit of the “law” is a revolutionary movement towards a technology-enabled, patient-centric healthcare system, where clinical data can be shared and consumed instantly, whenever patient desires or requires it. The letter of th...
Source: EMR and HIPAA - September 25, 2013 Category: Technology Consultants Authors: Mandi Bishop Tags: Certified EHR Direct Project EHR Benefits EHR Stimulus Electronic Health Record Electronic Medical Record EMR EMR Implementation EMR Technology Healthcare HealthCare IT Hospital EHR Meaningful Use Patient Portal Patients Dire Source Type: blogs

Healthy Privilege, Social Fabric, Education — Perspective means a lot.
Perhaps writing about health matters from the perspective of a cardiologist/bike racer is a little like parenting: At times the message seems less than compassionate, even though it’s born out of concern for others, knowledge and a tincture of middle-age experience. The many excellent comments on my recent telomere/heart-health post stirred me to write a little more–about perspective and mindfulness. Let’s just get to the comments and I’ll expand. The first one comes from Carolyn Thomas of the HeartSisters blog. My hunch is that you are speaking from the perspective of a competitive cyclist, meaning that yo...
Source: Dr John M - September 23, 2013 Category: Cardiology Authors: Dr John Source Type: blogs

Physician Payment Sunshine Act: Doctors Bracing for Increased Public Scrutiny
The Wall Street Journal recently reported on the Physician Payment Sunshine Act. The Journal noted that doctors are "bracing" for increased "public scrutiny of the payments and gifts they receive from pharmaceutical and medical-device companies as a result of the new health law." As we have reported numerous times, the Journal broadly summarizes the Sunshine Act: "Starting this month, companies must record nearly every transaction with doctors—from sales reps bearing pizza to compensation for expert advice on research—to comply with the so-called Sunshine Act provision of the U.S. health-care overhaul. The compa...
Source: Policy and Medicine - August 30, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs

Getting sleep versus staying engaged with the patient
Lisa Rosenbaum has posted a thoughtful piece over at The New Yorker entitled "Why Doesn't Medical Care Get Better When Doctors Rest More?"  After introducing a story about a patient, she says,A few days later, the resident caring for the patient neared the teaching hospital’s witching hour: whether or not his work was done, he had to leave at 6 P.M. That’s because, a decade ago, largely in response to widespread concerns that tired residents were making too many errors, the Accreditation Council for Graduate Medical Education enacted nationwide rules that limited the number of consecutive hours residents can work....
Source: Running a hospital - August 26, 2013 Category: Health Managers Source Type: blogs

The George W Bush stent case: An incredible teaching opportunity on the basics of heart disease
The wrist artery hardly had time to seal. (Surely it was a radial.) The controversy came that fast. The drumbeat of naysayers seemed to start only minutes after a prideful press release announced that George W Bush had undergone successful cardiac stent placement. The ever-quotable cardiologist from Cleveland Clinic, Dr. Steven Nissen, said, “This is really American medicine at its worst.” Dr. David L Brown, from Stony Brook University, and author of an important 2012 study on stents, added that GWB was “now the poster child for the inappropriate use of stenting.” How could this be? It must be a good thing to uncov...
Source: Dr John M - August 11, 2013 Category: Cardiology Authors: Dr John Source Type: blogs