Sunday, August 30, 2015

Blood, Urine & Other Lab Tests Education | Lab Tests Online

Lab Tests Online is an award-winning health information web resource designed to help patients and caregivers understand the many lab tests that are vital part of medical care. Laboratory professionals, who are experts in the field, develop and review all content, including articles on lab tests, conditions/diseases, screening,clinical laboratory topics, and lab test news. The site is produced by AACC, a global scientific and medical professional organization dedicated to clinical laboratory science and its application to healthcare.

20 Doctors You Should Be Following on Twitter | HealthWorks Collective

Twitter can be the ideal platform for a physician to offer meaningful, relevant information to patients and colleagues. Getting started is the hardest part, but looking to others who have succeeded on Twitter can be a good way to draw inspiration. These 20 doctors are burning up their Twitter feeds and attracting massive followings—each in their unique way.

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Saturday, August 29, 2015

NYTimes: New Alternatives to Statins Add to a Quandary on Cholesterol

Doctors have long faced a conundrum in prescribing statins to lower cholesterol and heart attack risk: The drugs are cheap and effective for most people, and large, rigorous clinical trials have found minimal side effects. But as many as 25 percent of those who try them complain of muscle pain. Others stop taking the drugs because, they say, they cause a hazy memory or sleep problems, among other side effects not documented in studies.

Now, with the approval on Thursday of the second in a powerful — and very expensive — new class of cholesterol-lowering drugs, the dilemma confronting doctors just got trickier. Should the people who need to lower their cholesterol, but say they cannot tolerate statins, be prescribed new drugs that cost more than $14,000 a year, potentially adding billions of dollars to the nation's medical bill?

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Pregnancy Apps Do Everything but Ease Labor Pains - The New York Times

Three months ago, my wife, Chrysta, and I were driving along Melrose Avenue in Los Angeles when she let out a harrowing cry.

I knew exactly what to do: I reached for my iPhone and pressed the bright green "Start" button on the screen and continued to drive as I waited for her to stop wailing.

The app I was using is called Full Term, which kept track of the length and intervals of her contractions. The app was, as my wife and I learned while rushing to the hospital for the birth of our first child, more useful than we could have ever imagined.

I should preface this by saying that before we downloaded the app (a last-minute recommendation from a friend when I texted: "OMG! We're in labor!"), I had scoffed at all these baby and pregnancy tools. After all, people have been having babies without apps since the dawn of humanity. Why do we need them now?

Turns out, I was wrong.

When my wife went into labor, for example, we could have tracked it the old-fashioned way: get a stopwatch, a pen and piece of paper, then jot down the duration of each contraction, and the time in between, and then somehow convey that information to our doctor while my wife endures the most intense pain of her life.

Or, we could open Full Term (a free app, though $1 donations are welcome) and press a green button to start, and a red one to stop. It gives you a detailed graph of the overall length and how far apart the labor pains are, which I could then text to our doctor. (We later discovered that we showed up at the hospital a tad early, by about 10 hours.)

In addition to the "go bag" that you pack for the hospital, you need a "go folder" of smartphone apps.

Pregnancy-related apps are not a niche category. According to a 2013 report by Citrix, a software company that tracks app usage, pregnancy-related apps were more popular than fitness apps. And at the Apple iTunes store, four of the top 10 paid medical apps are currently baby-related, including My Baby's Beat, Baby Connect and Baby Heartbeats.

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Let Fear Guide Early Stage Breast-Cancer Decisions - The New York Times

Two patients, I'll call them Sara and Janine, both learned that they had ductal carcinoma in situ (D.C.I.S.), often referred to as Stage 0 breast cancer. Both underwent lumpectomies in their early 50s. Told that worrisome cells were found, both had another surgery. Then a third surgery was recommended.

Sara decided she would rather live with the risk. Janine had the opposite response. "Let's get this all out," she said.

Each is certain she made the best decision, but can both of them be right?

Each year about 60,000 American women are told that they have D.C.I.S., a cluster of cancer cells currently limited to the milk duct, but which may eventually spread. It used to be rare, but widespread mammographyhas led to the discovery of more of these cancers. The logic of "catching it early" now has a twist: Despite the removal of thousands of D.C.I.S. lesions each year, there hasn't been a drop in the incidence of invasive breast cancers. Some argue D.C.I.S. should not even be called cancer.

Now there's a sense that some women with D.C.I.S. probably derive little benefit from treatment. But while treatment may not be helpful for some, we still don't know enough to confidently say to any individual woman, "Your D.C.I.S. will never progress." We are thus left treating virtually everyone.

Last week a study added to the confusion. The authors used a cancer incidence database to look at the chances of dying or having a recurrence among more than 100,000 women given a diagnosis of and treated for D.C.I.S. The primary finding, and one that can't be overemphasized, is that the chances of dying from D.C.I.S. are quite low, about 3.3 percent at 20 years. Nevertheless, for some groups the risk was more than twice as high.

The most misleading suggestion from the media coverage would be that the study establishes the safety of not getting treatment. It does not.

The study does not compare treatment to no treatment because everyone was treated, as surgery is part of the standard of care. The opposite interpretation would be equally valid: Low mortality rates might instead show that treatment has been working.

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Doubt Is Raised Over Value of Surgery for Breast Lesion at Earliest Stage - The New York Times

As many as 60,000 American women each year are told they have a very early stage of breast cancer — Stage 0, as it is commonly known — a possible precursor to what could be a deadly tumor. And almost every one of the women has either a lumpectomy or a mastectomy, and often a double mastectomy, removing a healthy breast as well.

Yet it now appears that treatment may make no difference in their outcomes. Patients with this condition had close to the same likelihood of dying of breast cancer as women in the general population, and the few who died did so despite treatment, not for lack of it, researchers reported Thursday in JAMA Oncology.

Their conclusions were based on the most extensive collection of data ever analyzed on the condition, known as ductal carcinoma in situ, or D.C.I.S.: 100,000 women followed for 20 years. The findings are likely to fan debate about whether tens of thousands of patients are undergoing unnecessary and sometimes disfiguring treatments for premalignant conditions that are unlikely to develop into life-threatening cancers.

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Wednesday, July 29, 2015

Advance Care Planning (ACP) Decisions | Patient Education Videos

We are a non-profit foundation consisting of a group of clinicians who want to empower patients and families with video support tools. Our video support tools are carefully crafted after undergoing rigorous review by leading experts in medicine, geriatrics, oncology, cardiology, ethics, and decision-making. We are thankful to the patients and families who have agreed to be filmed for the purposes of educating and improving decision-making for all patients. Today, multiple healthcare systems use our video support tools to empower patients and families.

Building a Khan Academy for Health Care - The New York Times

Doctors don't like to talk about death, and they often avoid doing so. Most physicians — including me — never studied palliative care in medical school and were rarely trained in how to communicate with patients. By the time I finished residency in 2002, I had to show competency in running Code Blues, inserting arterial lines and performing lumbar punctures, but not a single senior physician had to certify that I could actually talk with patients.

The recent expansion of the field of palliative medicine, with doctors who are experts on having these discussions, is a giant step in the right direction. But the growth of this specialty has not kept up with the need: There are 4,400 such doctors in the United States today, but the need is estimated to be as high as 18,000 physicians. Incentives such as student loan forgiveness, higher baseline salaries and more robust insurance reimbursements would encourage more students to consider the specialty as a profession. But it would take time for society to reap the benefits.

Recently Medicare announced plans to reimburse doctors for having advance care planning conversations with patients. This is an important start. But it's not enough to simply reimburse for these discussions, which are not one-time exchanges but rather a process over time. Neither is it realistic to expect most doctors who have never been trained to have these dialogues to all of a sudden be experts, which studies have suggested is difficult. We need to make sure that these exchanges are high-quality, informed, shared decision-making encounters where patients understand each of their options along with the risks and benefits.

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Thursday, July 23, 2015

To Create Better Doctors, Cultivate Their Creative Side - Pacific Standard

Want to train a better generation of physicians? See to it that they develop the sensibility of artists.

That's the argument Dr. Caroline Wellbery and Dr. Rebecca McAteer of the Georgetown University School of Medicine make in an essay just published in the journal Academic Medicine. Utilizing insights from research (as well as their own experience), they propose a curriculum for an eight-week "arts observation seminar" that could provide invaluable new perspectives to aspiring doctors.

They argue that such a program, which would encompass poetry, photography, and descriptive writing, could aid young physicians in three crucial ways: Encouraging them to "see with an open mind," rather than reflexively linking a set of symptoms with a textbook diagnosis; honing their ability to describe their observations with nuance and precision; and teaching them how to effectively articulate their ideas to patients and colleagues.

"The literary and visual arts," they write, "have long-standing and venerable roles in fortifying the lessons of clinical empathy, communication skills, critical thinking, and attention"—crucial qualities that can easily get overlooked in an era of assembly line office visits, where a doctor's attention is often more focused on lab-test data than actual communion with the patient.

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Easy DNA Editing Will Remake the World. Buckle Up. | WIRED

SPINY GRASS AND SCRAGGLY PINES creep amid the arts-and-crafts buildings of the Asilomar Conference Grounds, 100 acres of dune where California's Monterey Peninsula hammerheads into the Pacific. It's a rugged landscape, designed to inspire people to contemplate their evolving place on Earth. So it was natural that 140 scientists gathered here in 1975 for an unprecedented conference.

They were worried about what people called "recombinant DNA," the manipulation of the source code of life. It had been just 22 years since James Watson, Francis Crick, and Rosalind Franklin described what DNA was—deoxyribonucleic acid, four different structures called bases stuck to a backbone of sugar and phosphate, in sequences thousands of bases long. DNA is what genes are made of, and genes are the basis of heredity.

Preeminent genetic researchers like David Baltimore, then at MIT, went to Asilomar to grapple with the implications of being able to decrypt and reorder genes. It was a God-like power—to plug genes from one living thing into another. Used wisely, it had the potential to save millions of lives. But the scientists also knew their creations might slip out of their control. They wanted to consider what ought to be off-limits.

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