Adherence to Treatment Guidelines Varies Widely in Colon Cancer
Posted by: admin on: August 1, 2011
- Young, healthy patients with early-stage colon cancer are more likely to be overtreated, whereas older, uninsured patients with higher-risk disease tend to be undertreated, according to an analysis of 236,964 cases.
- Treatment guideline adherence has been proposed as a potential measure of the quality of cancer care. Colon cancer guideline adherence is a potentially attractive quality measure since consensus on treatment standards exists among several agencies including the National Comprehensive Cancer Network (NCCN), the American Society for Clinical Oncology, and the National Quality Forum, he said. However, nationwide assessment of current stage-specific colon cancer treatment practices is lacking.
- Using the National Cancer Data Base, Dr Chagpar and his colleagues in the department of surgical oncology at MD Anderson Cancer Center in Houston, identified all patients diagnosed with colon cancer from 2003 to 2007. The database captures about 70% of all annual cancer diagnoses within the United States from more than 1,430 hospitals, and is a joint program of the American College of Surgeons Commission on Cancer and the American Cancer Society. Read the rest of this entry »
Evaluating dizziness in the cardiologist’s office
Posted by: admin on: July 29, 2011
- I see a lot of patients who are sent to me for evaluation of dizziness. On the surface you wouldn’t think a cardiologist would have much to do with a symptom that relates more to the head than the heart, but there is some logic to it—poor blood flow to the brain could lead to dizziness and, since blood flow starts in the heart that could be the place to look. While it is true that diminished (or occasional absence of) blood flow from the heart can render a person devoid of the faculties that allow for stable upright posture, true dizziness is rarely the result of impairment of the cardiovascular system. Read the rest of this entry »
Insulin Therapy for Hospitalized Patients Should Not Be Abandoned
Posted by: admin on: July 29, 2011
The American Association of Clinical Endocrinologists and the American Diabetes Association Joint Statement in Response to American College of Physicians (ACP) Clinical Guidelines for Inpatient Glucose Control
- The publication of the systematic review of intensive insulin therapy in hospitalized patients and the American College of Physicians (ACP) clinical guidelines for inpatient glucose control in the February 15th issue of Annals of Internal Medicine has again raised the issue of optimal management of hyperglycemia in the hospital. Read the rest of this entry »
Treating patients with pre-diabetes: Weight loss and carbohydrate restriction
Posted by: admin on: July 29, 2011
What physician has not stifled a groan when a patient presents with a chief complaint of “I just don’t feel right, Doc.” About this time last year, I had that “not quite right” feeling and vague, seemingly unrelated symptoms … sweating, mid-morning headaches, and frequent feelings of hunger, which I was accustomed to satisfying with a muffin. I began to diagnose myself. No chest pain — hence, no myocardial infarction. No asthma. No history of hypertension or coronary artery disease.
Rather than calling my primary care physician as I should have, I ordered a few standard lab tests. To my utter astonishment, my fasting blood sugar was just over 100.
I made an appointment with my PCP. After a thorough workup, he informed me that I have what we now call pre-diabetes.
Palliative care needs a simple and consistent message-
Posted by: admin on: July 28, 2011
Alex Smith, Assistant Professor of Medicine, Department of Medicine, and Division of Geriatrics at the University of California
- I was consulted recently about an elderly woman who refused surgery for a large bowel obstruction from a colonic mass, likely cancer. The inpatient team asked me to help with the transition to hospice and to help make her comfortable. When I went to see her, she had a nasogastric tube sucking up brown material from her stomach. Her abdomen was swollen and uncomfortable. Her primary goal was to return to walking about with her walker. I persuaded her that surgery would meet her goals better than no surgery.
- After considerable discussion, she agreed. What a shock to the primary team! They called a palliative care consult to assist with the transition to hospice, and here I’d gone and persuaded the patient to have surgery.
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