Archive for November, 2009

New USPTF Guidelines – I finally know enough to write something.

The new USPTF guidelines for breast cancer screening have been a super hot topic for the last week.  We started out with outrage, moved to outrage at the outrage, and are finally settling into a state of reasonable interpretation.   The growing consensus (that I’ve seen) is that the USPTF guidelines are not so far off, but their wording could have been much better.   It is true that mammograms before the age of 50 have a low positive predictive value, and thusly a high false positive rate.  It is also true, based on the USPTF data, that for every 1000 women screened annually between 40 and 50 years of age, over 50% of them will need additional imaging at one point, 20% will get a breast biopsy, and only 1-2 breast cancer deaths will be prevented.  Based on this, it is clearly worth discussing whether patients 40-50 should be getting mammograms.

But the world, at first, didn’t want to discuss it.   We immediately attacked the USPTF, even accusing them of somehow being in league with new health care reform policies meant to reduce costs, at the known expense of women’s lives.  Even Sanjay Gupta went attack dog against one of the USPTF members live on CNN.  That was the most surprising thing to me.

But now people are starting to come around, and they are coming around pretty much to where I started.

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Categories: Gynecology, Imaging

Any questions for upcoming podcast interviews?

November 25, 2009 1 comment

Hey everyone!   I have a number of great interviews with folks in the near future and want to open up the interviews a bit.   If you have any questions you would like me to ask in the upcoming interviews, post them here and I’ll definitely get them in there for you.   They can be about the guests are of expertise, or about something else in general that you think they might have insight on.

Here is what is coming up –

11/27/09 –  Dr Paul Ridker – Massively published cardiologist from Brigham and Women’s, lead author for the 24 country JUPITER trial, examining the effects of crp on heart disease and efficacy of statins in non-hyperlipemic but crp high patients.  Will be talking about crp and heart diease in women, as well as the modern model for heart disease prevention and detection.  It ain’t all about lipids anymore folks!  This is just 2 days away so get me the questions quick!

TBA – Dr John Schnorr – Reproductive Endocrinologist from Southeastern Fertility – Specific topics to be finalized.  Dr Schnorr pioneered cryopreservation and restoration of ovarian tissue around the time of chemotherapy.

TBA – Dr Jennifer Gunter (@drjengunter) – Generalist OB/GYN and Reproductive Infectious Disease and vulvar disease specialist, also boarded in pain management (quad boarded!)  Will be talking about vulvar disease and her new book!

TBA – Dr Chukwuma Onyeije(@chukwumaonyeije) – MFM and Web 2.o afficionado in Atlanta, GA.  We’re going to talk about the new USPTF mammography guidelines, and the role of traditional and web media in the publics perceptions of these issues.  We’d love to have a third or fourth guest for a roundtable on this one (@drjengunter, @macobgyn, @somebodyelse?)

If you have any questions for these folks, leave them in the comments.  If you have ideas for people you would like to see in a podcast, or you want to be on the podcast yourself, let me know that too!  I’d love to have guests to talk about their research and work, or to just help me do one of the regular journal club review episodes!

Academic OB/GYN Podcast Episode 12 – Evidence Based Postpartum and Postoperative Instructions

Dr Lucas Minig and I discuss his recent paper on the evidence behind postpartum and postoperative instructions.  We also talk about socialized health care in the countries where he has lived, and current reforms in the United States.

Academic OB/GYN Episode 12 – Evidence Based Postpartum and Postoperative Instructions

What is it with anonymous medbloggers?

November 23, 2009 16 comments

Something has got my hackles lately….anonymous medbloggers.

I just don’t get it.  If a physician is going to take the time to create a blog to spread his or her opinions and expertise, why wouldn’t they do it under their own name?  In a way it really bothers me.   There is so much information on the web, and a great deal of it is poorly sourced and unreliable.  I would like to think that physicians will publish medical information that is accurate, at least as well as we know, and that the MD or PhD credential will lend credibility to their writings.   But to me it just destroys that credibility when the doc chooses to blog under a psuedonym.

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Academic OB/GYN Answers – RealHand Instruments

November 22, 2009 2 comments

One of the viewers from Switzerland wanted to see a video of the RealHand laparoscopic instruments from Novare Surgical.  Here it is!

A post by Seth Godin that has a lot of relevance to social media medicine…

November 21, 2009 1 comment

I love Seth Godin’s writing.  He writes a great deal about how to market things on the internet, and what separates online success from online obscurity.  He writes a great article here on the phenomenae of the internet-based expert, something I’ve thought of for a while as well, but have never put into such eloquent words.  Though he doesn’t speak directly to medicine here, the relevance is clear.

Somehow the world has gotten the idea that just because there is a lot of information available on the internet they now can become experts overnight.  The problem is that all the information in the world does not give someone the clinical judgement of a physician or other experienced practitioner, just as reading a manual on carpentry does not make you an experienced contractor.   Reading Harrison‘s does not make you an internist.  Reading Gabbe does not make you an obstetrician.  It takes years of experience.

The reading is necessary but not sufficient.   It takes years of experience and training to get the clinical judgement necessary to use all the facts learned in those books effectively.  That is why we supervise residents for 3-8 years before we let them out on the world. Presumably they have already read the books before they start, but clearly they need those years before they really have the skills they need.

So check out Godin’s post, and some comments by 33 charts as well.  They’re worth the read.

Categories: Social Media

Academic OB/GYN Podcast Episode 11 – Grey Journal Oct-Nov 2009

Host Dr Nicholas Fogelson discusses articles from the October and November 2009 issues of the Grey Journal.  On tap are discussions of the effects of second stage length and pushing times on outcomes, ST segment automated analysis of fetal heart rate tracings, a listener question on CA125 screening, and a few other short reviews.

Academic OB/GYN Episode 11 – Grey Journal October-November 2009

Tranexamic Acid Approved by FDA – A new tool for treatment of mennorhagia

November 15, 2009 4 comments

Tranexamic acid was recently approved by the FDA for treatment of fibroid related mennoraghia, under the trade name Lysteda.  Being ignorant of this drug, I wanted to do a  little research.  Being a blogger, I want to share this research.

Apparently, this drug has been available in Europe for quite a long time, and there is substantial evidence of its efficacy and safety for treatment of a wide variety of bleeding issues, both gynecologic and otherwise.  Tranexamic acid (Wiki, WA) is in class of drugs called antifibrinolytics.   It is related to the drug Amicar (ε-aminocaproic acid) which is used in the US most notably after dental procedures as a mouthwash in patients with bleeding disorders.  These drugs function by blockade of lysine binding sites on plasminogen, thus blocking degradation of plasminogen into plasmin (sort of an anti-tPA).  Through this mechanism it stabilizes clots and prevents clot breakdown, thus augmenting the clotting system and decreasing bleeding.

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Protracted thoughts on protracted labor…

November 8, 2009 108 comments

When I was an intern in Charleston, SC, I quickly learned the importance of the labor curve.  When checking out with my chief, I was often asked the question “Is she on the curve?”  Quickly I learned the idea that women that “fall off the curve” were in a dysfunctional labor pattern, and were more likely to require a cesarean delivery.  I dutifully listened to all this, and did many a cesarean for active phase arrest.  As a junior level I did the cesareans, and as chief I called them.  But at the same time, I had doubts about all of this.
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Academic OB/GYN Answers – CA125 screening for a child with a family history of ovarian cancer?

November 2, 2009 3 comments

Our first reader question –

“A patient of mine had ovarian cancer, she’s brought her 13 year old in for a consultation regarding various issues of irregular menses. ….how soon we should start getting CA125s…. Have an answer/opinion for exactly how young to start?”

That’s a great question!

First, there is probably not a definitive answer.  Screening for ovarian cancer is clearly an area where we do not have good answers.  I think a clear part of this question is actually whether or not the patient should be screened at all.  Patients think that there should be a good screening for ovarian cancer, but based on current literature and practice, I don’t think there is any method for screening this patient that is effective.

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