10/14/2010

NAIL IN COFFIN FOR TRANSMYOCARDIAL LASER SURGERY

I remember few months back there was a great "ho ha" about a certain tertiary teaching hospital buying "state of the art" transmyocardial laser surgery.

A lot of my patients were asking me whether he / she should be referred for it. Below is an article from medscape. It is really a nail in coffin for this therapy.. Furthermore, what a waste of public funding..

Lasers Vaporised from NICE Guideline Recommendations for Refractory Angina

Christine Wright

Posted: 10/04/2010; Br J Cardiol. 2010;17(4):159-160

Introduction

As from May 2009 the National Institute for Health and Clinical Excellence (NICE) have removed transmyocardial laser revascularisation (TMLR) from the list of treatments for refractory angina.^[1] From their analysis of efficacy they found no evidence of improved myocardial perfusion, ejection fraction or prognosis. There was also no evidence for improvement in exercise tolerance or Canadian Cardiovascular Society (CCS) class when compared with other treatments. Furthermore, looking at the data on safety, randomised controlled trials showed evidence of increased myocardial infarction in the TMLR-treated patient group, as well as evidence of left ventricular perforation.

There have been reservations regarding this technique for many years and it would seem to be a valid decision on behalf of the specialist advisers. It seems appropriate, therefore, to look at how to best treat this complex group of patients.

8/28/2010

FROM HEARTWIRE : "MACSTATIN"

The "MacStatin": Fast food with some ketchup, salt, and a statin to go

AUGUST 13, 2010 | Michael O'Riordan

London, UK (updated) - Pushing the envelope of primary prevention to a point few doctors are likely to be comfortable with, a group of British cardiologists are proposing a rather radical strategy to neutralize the risk of cardiovascular disease caused by unhealthy eating habits.

They suggest that fast-food restaurants, such as McDonald's, offer customers a statin to go with their meal, one that could be found alongside the salt, sugar, ketchup, and mayonnaise. The statin, they say, could be sprinkled atop customers' Quarter Pounders, into their milkshakes, or onto their supersized French fries to offset the mounds of fat found in these unhealthy meals [1].

Consider the irony that you can have harmful condiments provided free of charge, in unlimited quantities, and yet people think this one simple, potentially protective additive would be crazy to add.

The "mischievous" strategy, outlined in the August 15, 2010 issue of the American Journal of Cardiology, is not intended to encourage individuals to think they can eat unhealthily because the statin, which the authors dubbed the MacStatin—slogan: "I'm neutralizing it!"—is a panacea for all risks. Instead, they stress that medical direction should continue to place drug therapy behind lifestyle interventions, such as healthy eating, smoking cessation, and regular exercise.

"I am not crazy, and I do not tell my patients that they can eat unhealthily and get away with it," Dr Darrel Francis (Imperial College London, UK), senior author of the report, told heartwire. "We're simply providing a calculation for the medical community to think about the size of the effect of a statin tablet vs an unhealthy meal and to also consider the irony that you can have harmful condiments provided free of charge, in unlimited quantities, and yet people think this one simple, potentially protective additive would be crazy to add. And I don't know why they would think that."

FROM HEARTWIRE: Who's the boss? White House recommends physicians join hospitals, large groups

Who's the boss? White House recommends physicians join hospitals, large groups

AUGUST 27, 2010 | Robert Lowes

Adapted from Medscape Medical News—a professional news service of WebMD

Washington, DC - The White House is advising physicians to accept a life in Big Medicine—as a hospital employee or member of a large group practice—in the wake of healthcare reform [1].

Some leaders of organized medicine, however, are objecting to the government message.

"We're not ready to write off the small practices," Dr J Fred Ralston, president of the American College of Physicians (ACP), said in an interview. "We think there needs to be more than one delivery model."

"America is not a one-size-fits-all country," added Dr M Todd Williamson (North Georgia Neurological Clinic, Lawrenceville), a spokesperson for the Coalition of State Medical and National Specialty Societies, which campaigned against the new healthcare-reform law, now called the Affordable Care Act.

America is not a one-size-fits-all country.

Ralston and Williamson were responding to an article by two White House officials and one ex-official about the implications of healthcare reform for medicine that was published August 23, 2010 in the Annals of Internal Medicine. The authors are Nancy-Ann DeParle, director of the Office of Health Reform; Dr Ezekiel Emanuel, special advisor for health policy with the Office of Management and Budget; and Dr Robert Kocher, who stepped down in July from the National Economic Council.

The economic forces put in motion by the [Affordable Care Act] are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups," they write. Physicians who embrace the changes and opportunities created by the law "are likely to deliver the greatest benefits to their patients, the health system, and themselves" and "will be rewarded in the future payment system."

8/26/2010

it started with a dream..

went searching high and low for ideal house..

we found a place..

missed by many people scouting for house..

in the middle of ipoh town..

it took so long to get it going.. because it is a deceased tittle..

after almost a year.. we finally got it..

got contractor to demolish the house..

next step

get architect to design house plan..

MID RAMADHAN

WE HAVE PASSED THE HALF WAY MARK OF RAMADHAN. IT IS THE TIME TO INTENSIFY OUR PRAYERS. IT IS TME TO REFLECT ON OURSELVES.

MAY BE IS THE TIME TO COOL DOWN.. TO PONDER.. TO BE GRATEFUL..

INSYAALLAH

MAY THIS RAMADHAN BE FRUITFUL TO ALL OF US..

8/01/2010

Taking patients directly to existing PCI centers is more cost-effective than expanding PCI capacity

FROM HEARTWIRE..

ACUTE CORONARY SYNDROMES

Taking patients directly to existing PCI centers is more cost-effective than expanding PCI capacity

JULY 28, 2010 | Reed Miller

Boston, MA - Improving the ability of emergency medical services (EMS) to move ST-segment-elevation-MI (STEMI) patients directly to existing PCI facilities is a more cost-effective regional strategy than building and staffing more PCI labs, a new computer simulation study shows [1].

In a study published online July 27, 2010 in Circulation: Cardiovascular Quality and Outcomes, Dr Thomas Concannon (Tufts University, Boston, MA) and colleagues estimated incremental treatment costs and quality-adjusted life expectancies of 2000 patients with STEMI who received PCI or fibrinolytic therapy in simulations of emergency care in a regional hospital system in Dallas County, TX.

PCI is generally more effective than fibrinolytic therapy for the treatment of STEMI, but most US hospitals are not equipped for PCI. Because the cost/benefit ratio of delaying any treatment in order to reach a PCI lab is different for each patient, depending on where they are and their specific condition, Concannon et al's model examined each case, Concannon told heartwire. "And in a county of pretty significant size, we were able to show that EMS detection and diversion would work better than hospital construction."

The researchers compared a base case strategy of no new construction or staffing with several different hospital-based strategies that entailed building new PCI laboratories or extending the hours of existing laboratories and then compared all of those strategies with a system in which EMS transported all STEMI patients to the existing PCI-capable hospitals.