When I was a resident (over ten years ago!) we were taught that there was no evidence that breast self-examination saved lives. A new review puts another nail in the coffin of breast self-examination. This week the Cochrane Review published a re-analysis of a review of the scientific studies on breast examination. The conclusion: women who perform breast self-examination undergo more breast biopsies but die of breast cancer at the same rate as women who do not examine themselves. The same ap...
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Antipsychotic Medication Overused in Dementia Patients
Dementia is not a single disease. Dementia is a family of diseases that cause progressive memory loss, usually in older patients. The most common cause of dementia is Alzheimer's disease. Dementia is progressive, and while some treatments exist, their efficacy is only modest. In addition to memory loss, patients frequently suffer personality and behavior changes.
Dementia is common, affecting 3.4 million Americans as of 2002, and this number is sure to increase as our population ages.
The ...
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Only 4% of American Physicians Have Electronic Health Records
This week, a large national survey of physicians' use of electronic health records (EHRs) was published in the New England Journal of Medicine. The results generated a lot of attention in the general media.
The good news is that physicians with EHRs are largely very satisfied with them and believe that EHRs improve patient care. The bad news is that nationally only 4% of doctors use EHRs. The largest barrier cited as preventing physicians from adopting EHRs is the expense.
In any o...
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What We Don’t Know About Diabetes – Part 2
In February I wrote about the results of the ACCORD trial, a study designed to test whether strict glucose control in patients with diabetes helps prevent strokes and heart attacks and prolongs life. The startling results were that the patients with diabetes who were randomized to have their glucose lowered to normal levels died sooner than those with more lax sugar control.
This week the New England Journal of Medicine published the results of another study, the ADVANCE trial, which ...
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Flip-Flop Hubbub
As summer approaches, researchers at Auburn University have performed a study demonstrating the dangers of that ubiquitous summer accessory, the flip-flop. They recruited volunteers and recorded their gait in both sneakers and flip-flops. In flip-flops the subjects took shorter steps and didn't raise their toes as far as they did in sneakers.
This makes sense, if you think about it. When we wear flip-flops we curl our toes down to keep the sandals from flying off our feet. This keeps us fro...
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Patients Want Education, Not Just Medication
I've written before on the increasing danger of bacteria that are resistant to multiple antibiotics. This resistance is a side effect of the use, and frequent misuse, of the many antibiotics physicians have at our disposal. I've also written about the pressure that physicians sometimes face from patients to prescribe unnecessary antibiotics.
Last week Slate published an article by Dr. Zachary Meisel, an emergency department physician who recounts facing a very common dilemma. He took care of...
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Smoking and Quitting Are Social Behaviors
"But he can't be a man 'cause he doesn't smoke The same cigarettes as me." -- Rolling Stones, (I Can't Get No) Satisfaction
An article in this week's New England Journal of Medicine illuminates the social dynamics of smoking and quitting, and generated a lot of attention in the media. The study followed twelve thousand people, many of whom were initially smokers, from 1971 until 2003. The large group was all connected in one large social network, meaning ...Osteoporosis Screening: Not Just for Women Anymore
Osteoporosis, which means very low bone density, is a major risk factor for fractures. Fractures can be catastrophic for older people, and effective medicines exist to treat osteoporosis and prevent fractures, so detecting osteoporosis before a fracture happens is very important in older patients. Since osteoporosis is very common in postmenopausal women, screening them for osteoporosis is a well-established part of preventive care.
Though men are less likely then women to have osteoporosis, ...
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When Less Care is More
Doctors are trained to try to figure out what's wrong and fix it. We're trained to make a plan and execute it, to do something. But that impulse to order the next test, prescribe the next therapy or do the next procedure can harm our patients if it's done without consideration of the patient's goals. That's particularly true with older frail patients whose quality of life is decreasing. In our reflexive rush from symptom to test result to treatment, we may never stop to thin...
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Home Defibrillators Less Helpful than Hoped
Automatic external defibrillators (AEDs) are machines that are designed to be used by non-medical personnel in the event of a witnessed sudden collapse. The AED is connected to the chest of the patient and automatically detects the patient's heart rhythm. If the AED detects a rhythm that requires an electric shock, the AED delivers the shock and monitors the rhythm until paramedics arrive. The time between collapse and delivery of the first shock is critical to survival. So it was hoped that...
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