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The Macro View – Health, Economics, and Politics and the Big Picture. What I Am Watching Here And Abroad.
October 27, 2022 Edition-----In the UK we have a political farce running with only a day or so to run when you read this, with a new PM (Rishi Sunak) in place..In the US the mid-term elections are coming in a week or so, thus some concern as to where the US is going!In China Xi has his third 5 year term so we all wonder how that will turn out!In OZ we have has a Budget with floods, inflation, data leaks, the threat of recession, Medicare concerns and other issues just rolling on! At least the Budget does not seem to have broken anything!Overall an ‘omnishambles’ as they say!-----Major Issues.-----https://www.afr.com/wo...
Source: Australian Health Information Technology - October 27, 2022 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs

Weekly Overseas Health IT Links – 23rd July2022.
In this study, researchers sought to determine whether differences in occult hypoxemia treatment existed between people of different races.Occult hypoxemia was defined as arterial blood oxygen saturation of less than 88 percent despite a pulse oximetry reading of 92 percent or more.-----https://healthitsecurity.com/news/security-awareness-and-training-crucial-to-preventing-healthcare-phishing-attacksSecurity Awareness and Training Crucial to Preventing Healthcare Phishing AttacksSecurity awareness and training greatly decreased the likelihood of an employee falling for a healthcare phishing attack, KnowBe4 researchers foun...
Source: Australian Health Information Technology - July 23, 2022 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs

An Adolescent with dizziness and near syncope
Submitted by Maura Corbett, PA-C, written by Alex Bracey, with some comments by Smith and MeyersA teenage male presented to the emergency department with the complaint of dizziness with near-syncope. He was stable and able to provide a history and mentioned that he was asymptomatic while seated but dizzy and weak when attempting to stand. An ECG was recorded:What do you think? There iscomplete (third degree) heart block with wide complex bradycardicescape.  The morphology is that of LBBB and so the escape is originating from the right bundle.The possible etiologies of this ECG are:- Structural/congenital heart di...
Source: Dr. Smith's ECG Blog - August 7, 2021 Category: Cardiology Authors: Bracey Source Type: blogs

Rheumatic fever : Dr Jones would smile if we get rid of the “ supportive criteria ”
Dr. Duckett Jones, the famed American physician, from Good Samaritan hospital, Boston would be a proud man in heaven, to find his criteria still being celebrated all over the globe. He will also be pleased to know his home country USA  is painted green on the world RHD map due to his untiring efforts that began in 1944. Of course, what the rest of the world has done in the last century has left us wanting (including the WHO).   Global RHD map. Note the red and brown shading in south Asia and Africa. It is obvious, RHD is more about economics, equality, and poverty, rather than aggression from an otherwise innocuous...
Source: Dr.S.Venkatesan MD - March 28, 2021 Category: Cardiology Authors: dr s venkatesan Tags: rheumatic heart disease acute rheumatic fever aso titer chronic rheumatic fever dr duckket jones jones criteria primary vs secondory prevention rtpcr for rheumatic fever supportive criteria for acute rheumatic fever essential Source Type: blogs

Role of RT-PCR in the diagnosis of Rheumatic fever/RHD
RT-PCR: Real-time polymerase chain reaction, a sophisticated gene sequence-based biochemical test. Thanks to corona, this complex medical investigation has become a household name. Jones proposed his criteria to diagnose acute rheumatic fever  in 1944, we still use it to diagnose with many modifications . Currently, AHA position statement – 2015 by Gewitz et all is  being followed. (Circulation 2015) From Braunwald textbook of cardiology. Apart from this, there is one catch . Even if the child fulfills Jone criteria, there needs to be evidence for preceding streptococcal sore throat, either by culture or antibody. ...
Source: Dr.S.Venkatesan MD - October 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acute rheumatic fever aha rhd 2015 rhuematic fever anti dnase streptococcus group a beta hemolytic streptococci rtpcr mirna rtpcr rhd qpcr in rheumatic fever revised jonec criteria 2015 RHD jones criteria role of rtpcr fro Source Type: blogs

Because there is nothing else to do
If you ever hear your doctor say we are going to do something because there is nothing else to do, be afraid. Be very afraid. First of all, it should be self-evident that if caring and empathy and relief of suffering count as doing something, there is always something to do for patients. A growing problem in medicine, especially in death-denying specialities like cardiology and oncology, is that having nothing else to do translates to not having a cure, or a promise of immortality. In times past, such misthink wasn’t so hazardous. Now, however, the inability to see failing organs as the natural order has never been ...
Source: Dr John M - November 8, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

Research and Reviews in the Fastlane 052
This study looked at compliance with discharge instructions. Surprisingly (or maybe not so), 39% of pediatric patients returned to play (RTP) on the day of the injury. RTP is widely recognized as a risk for recurrent and more severe concussions as well as significant morbidity. It is the duty of the Emergency Physician to stress the importance of discharge instructions as well as the importance of appropriate follow up. Recommended by: Anand Swaminathan PediatricsSingleton T et al. Emergency department care for patients with hemophilia and von Willebrand disease. J Emerg Med. 2010; 39(2): 158-65. PMID: 18757163 Bleeding...
Source: Life in the Fast Lane - October 9, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Anaesthetics Cardiology Clinical Research Education Emergency Medicine Haematology Infectious Disease Intensive Care International Emergency Medicine Microbiology Neurosurgery Obstetrics / Gynecology Ophthalmology Source Type: blogs

What Ails Mt. Sinai Hospital Ails The Entire US Healthcare System
A Bloomberg News article raises extremely troubling questions about policies and procedures that have made the Mt. Sinai hospital catheterization laboratory the busiest and most lucrative in New York City. It is unclear whether the specific allegations in the article will stand up to rigorous scrutiny but, say some experts, the ills identified in the article go far beyond Mt. Sinai and New York City and are actually endemic throughout the entire US healthcare system. The most explosive charge in the story by David Armstrong, Peter Waldman and Gary Putka is that hospital physicians scheduled emergency room appointments for More…
Source: CardioBrief - March 7, 2014 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics Bloomberg News Mt. Sinai Samin Sharma Source Type: blogs

The problem with testing students and doctors is what gets truncated
For me, maybe you too, the best part about science is how it disrupts the status quo. A belief, a way of doing something, a paradigm if you will, becomes entrenched. Humans love patterns. We get attached. I call this the way-it’s-always-been-done philosophy. It’s endemic in medicine, and, from what I can see, in education as well. Take the notion that SAT and ACT scores are all that. Maybe they are…and maybe they are not. Surely the 2 billion dollar testing industry says their tests are important. Testers even say their tests open doors for the under-privileged. The idea appeals to our intuition. The meri...
Source: Dr John M - February 20, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

With vaccines…Is there no middle ground, no room for questions?
“We should be as demanding of ourselves as we are of those who challenge us.” Dr. Jerome Groopman, writing in the New Rupublic Writing about the medical decision-making surrounding vaccines proved to be sketchy. Yesterday’s post brought stinging criticism from both sides of the debate. A pediatrician felt the structure of the post was patronizing. Just an hour later, a skeptic sent me the same message–patronizing. This was educational. Criticism is taken seriously here, especially when it comes from both sides of an argument. The reflex: Perhaps its useful to write more on the matter? (It’s f...
Source: Dr John M - December 6, 2013 Category: Cardiology Authors: Dr John Source Type: blogs

Tough calls in cardiology :Dengue fever in a patient with prosthetic valve and warfarin !
Oral anticoagulant usage has been steadily increasing for variety of  indications.Dengue fever is also  appearing in different avatars with  low platelet counts  and bleeding being a primary risk. I was recently contacted by a physician , regarding a therapeutic dilemma .A young lady with mitral prosthetic valve and a febrile illness diagnosed as dengue . She has a platelet  count of 100,000 .She is on regular warfarin and aspirin .The physician  wanted to know , should he stop the OAC and aspirin ? What are the options ? Confirm if it is really dengue. Look for clinical bleeding.INR, platelet function tests are not...
Source: Dr.S.Venkatesan MD - December 5, 2013 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -guidelines Cardiology -Mechnisms of disease Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Cardiology-Statistics dengue and coronary stent des and dengue falling platlets and coroanry Source Type: blogs

Iron Deficiency in the Elderly, the Silent Killer
    Once more our laxidasical healthcare system has struck my family. My favorite aunt, well into her 80's but living independently with her husband and enjoying life, suddenly goes into congestive heart failure. With encouragement from me, she agrees to go to the emergency, gets the urgent intervention to reverse the failure, and is referred to a cardiologist. Keep in mind she had just been to a cardiologist six weeks before and was told everything was fine----but that is another story.     During her stay in the emergency it was found that her blood was down several pints and she was gi...
Source: What's Wrong with Healthcare? - February 25, 2013 Category: Family Physicians Source Type: blogs